The Progression of Serious Mental Disorders to Mortality in Primary Care

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atmire.migration.oldid4624
dc.contributor.advisorPatten, Scott
dc.contributor.advisorBulloch, Andrew
dc.contributor.authorVallerand, Isabelle
dc.contributor.committeememberDuffy, Anne
dc.contributor.committeememberAddington, Donald
dc.contributor.committeememberMacMaster, Frank
dc.contributor.committeememberLesage, Alain
dc.date.accessioned2016-09-15T16:46:43Z
dc.date.available2016-09-15T16:46:43Z
dc.date.issued2016
dc.date.submitted2016en
dc.description.abstractSerious mental disorders (schizophrenia, bipolar disorder and major depressive disorder (MDD)) have been associated with an excess risk of mortality. However, most datasets used to study these associations have been limited by small sample sizes, use of specialized clinical samples, and few covariates recorded, thereby impeding proper assessments of mortality risks. Electronic medical records databases such as The Health Improvement Network (THIN) directly address these limitations by offering a large primary care population for study, with inclusion of numerous clinically-relevant covariate data over a long follow-up period. To date, THIN has not been used to study mortality in serious mental illness. As such, this thesis had the following objectives: i) estimate annual prevalence of serious mental illness; ii) determine the covariate-adjusted and unadjusted risk of all-cause mortality in serious mental illness and iii) demonstrate the feasibility of using THIN to study the excess mortality associated with serious mental illness. THIN was used to define schizophrenia, bipolar disorder and MDD cohorts between the years of 1986-2012, where annual prevalence estimates in 2012 were 0.23%, 0.26% and 9.49% respectively. Survival analyses adjusted for important covariates revealed that in the schizophrenia cohort (n=6,056), the risk of all-cause mortality was more than double (HR=2.36, 95%CI: 1.83 – 3.04) the risk in the referent cohort (n=6,137,760). Similarly, patients with bipolar disorder (n=9,425) were found to have twice the risk of all-cause mortality (HR=2.00, 95%CI: 1.70-2.34) compared to the referent cohort (n=6,131,373). Patients with MDD (n=405,866) were also found to have a significantly greater risk of all-cause mortality (HR=1.28, 95%CI: 1.21-1.36) compared to the referent cohort (n=5,337,098). Annual prevalence estimates for schizophrenia and MDD were similar to previous reports, but estimates were lower for bipolar disorder, possibly due to issues in correctly identifying these patients in primary care. This study was the first to confirm the excess mortality associated with serious mental disorders using THIN, highlighting that studying mortality among patients with serious mental illness is feasible in THIN. As such, the work presented in this thesis can pave the way for future research using THIN to improve the health of patients with serious mental disorders.en_US
dc.identifier.citationVallerand, I. (2016). The Progression of Serious Mental Disorders to Mortality in Primary Care (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/28283en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/28283
dc.identifier.urihttp://hdl.handle.net/11023/3297
dc.language.isoeng
dc.publisher.facultyGraduate Studies
dc.publisher.institutionUniversity of Calgaryen
dc.publisher.placeCalgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subjectEpidemiology
dc.subjectMental Health
dc.subject.classificationEpidemiologyen_US
dc.subject.classificationMental disordersen_US
dc.subject.classificationprimary careen_US
dc.subject.classificationSurvival Analysisen_US
dc.titleThe Progression of Serious Mental Disorders to Mortality in Primary Care
dc.typedoctoral thesis
thesis.degree.disciplineCommunity Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
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