Journal Article Annotations
2016, 1st Quarter
Annotations by Lydia Chwastiak, MD, MPH, FAPM and Oliver Freudenreich, MD, FAPM
The finding: This very large population-based study was conducted in 17 countries, and examined the association between mental illness and the increased risk of a broad range of chronic physical conditions. All mental disorder classes (mood, anxiety, impulse control, and substance use) were associated with increased odds of developing between 7-10 of the physical conditions evaluated, and an increasing number of mental disorders was associated with increased odds of diagnosis of the physical disorders.
Strength and weaknesses: The study included a large, representative sample: almost 50,000 people from 17 countries. It used a structured diagnostic interview (CIDI) to identify mental disorders.
Weaknesses: This cross-sectional study is limited by retrospective recall of age of onset of mental disorder, which is subject to bias. The assessment of physical disorders was less rigorous than the assessment of mental disorders. This observational study cannot determine causality.
Relevance: The findings have significant public health implications, as they suggest that all patients with mental disorders (not just those with serious mental illness) are at increased risk of developing physical illness. This argues for more comprehensive treatment of mental illness in order to address this risk.
The finding: This rigorous meta-analysis of 13 studies involving almost 200,000 youth exposed to antipsychotic medications indicates that the unadjusted cumulative risk of T2DM was 2.6 fold higher than healthy controls and 2.1 fold higher than psychiatric controls (and incidence of T2DM was 3.0-fold and 1.8-fold higher). The attenuated difference compared to psychiatric controls suggests that unhealthy lifestyle and other medications also contribute to diabetes risk.
Strength and weaknesses: This was a very large sample, and rigorous methods for meta-analysis were utilized. But 13 is relatively few studies, and follow-up times of these studies were short. There was also substantial heterogeneity across studies with respect to design, sample characteristics, outcomes, matching of control groups and duration of follow-up. Data in all but three of the studies were collected retrospectively.
Relevance: This meta-analysis of studies involving almost 200,000 youth exposed to antipsychotics provides the strongest evidence to date about the risk of diabetes, and the strongest recommendations for limiting use (judiciously and for the shortest necessary duration). Caution should be especially high in patients with non-psychotic disorders.
The finding: The study systematically documents dropout rates and predictors in physical activity interventions in people with schizophrenia, and found that 26.7% of participants drop out of such studies (higher even than in other vulnerable populations).
Strength and weaknesses: Rigorous methods and inclusion of a large number of studies. Weaknesses were that meta-analysis included only RCTs of individuals with schizophrenia. There are limitations in evaluating individual participants’ reasons for drop-out in clinical trials. Some potential moderators were only included in a small number of trials, limiting analyses.
Relevance: This meta-analysis provides specific practical recommendations for increasing the effectiveness of physical activity interventions among patients with schizophrenia. Additional resources may be required to deal with high drop-out rates, including delivery and/ or supervision by a qualified physical activity professional.