People with mental illness are prescribed fewer drugs for physical disorders than the rest of the population

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A year ago this week I blogged about a study in the British Journal of Psychiatry that showed the dramatically reduced life expectancy of people with severe mental illness, who on average live 15-20 years less than the rest of the population. Twelve months on and a new study published in the same journal paints an equally depressing picture about the treatment people with mental health issues receive for comorbid physical illnesses such as cardiovascular disease, cancer, diabetes, arthritis, osteoporosis and HIV.

The systematic review and random effects meta-analysis carried out by researchers from the University of Leicester, brings together the results of 61 comparative analyses (from 23 publications), which investigate the prescription rates of 12 different classes of medication in a total of nearly 2 million people.

The search strategy for the review focused on non-organic mental health disorders, so studies looking at delirium or dementia were excluded. The authors divided the subgroups of patients by severe mental illness, affective disorders and other miscellaneous conditions.

Here’s what they found:

  • In severe mental illness:
    • The pooled odds ratio for equitable prescribing was 0.74 (95% CI 0.63-0.86) favouring non-mental ill health
    • For schizophrenia alone the pooled odds ratio across all medication was 0.69 (95% CI 0.57-0.83, P<0.0001)
  • In affective disorders:
    • The combined meta-analysis showed a trend towards low receipt with a pooled odds ratio of 0.75 (95% CI 0.55-1.02, P=0.07), which was significant in fixed-effect but not random-effects analysis
  • In other miscellaneous mental health conditions:
    • The combined pooled odds ratio was 0.95 (95% CI 0.92-0.98)

The researchers concluded:

Individuals with severe mental illness (including schizophrenia) appear to be prescribed significantly lower quantities of several common medications for medical disorders, largely for cardiovascular indications, although further work is required to clarify to what extent this is because of prescriber intent.

As always with this kind of meta-analysis, it’s important to consider whether or not it’s sensible to pool the various studies.  The review authors state that heterogeneity was found in 5 out of 11 main analyses and this meant that the odds ratios observed for affective disorders were non-significant.

The researchers also highlight the possibility that patients with mental illness in the included studies had more severe physical illness than the comparison group, which should of course lead to higher prescribing rates, not the lower rates that were generally found.

Lead author Dr Alex Mitchell said:

People with severe mental illness appear to be receiving significantly less medication for medical disorders, particularly for cardiovascular problems.

Mental health professionals may not feel confident in prescribing medication to treat physical problems, and hospital specialists may be worried about interactions of mental health medication.

However we cannot rule out the possibility that medical conditions are being undertreated where they co-exist with mental health problems.

Link

Mitchell AJ, Lord O, Malone D. Differences in the prescribing of medication for physical disorders in individuals with v. without mental illness: meta-analysis. Br J Psychiatry. 2012 Dec;201:435-43. doi: 10.1192/bjp.bp.111.094532. [PubMed abstract]

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