Mental health and physical illness

Patients with psychiatric illness are also prone to poor physical health. Without good primary care some of these patients may need hospital admission. The University of Western Australia has therefore investigated how many of these hospital admissions are preventable.

Using several databases, the researchers found a cohort of 139,208 people with mental health problems. These patients were matched with 294,180 people of the same sex and similar age.

Hospital admissions were considered to be potentially preventable if they involved illnesses such as asthma, nutritional deficiencies, vaccine-preventable diseases and adverse drug events. Discharge records showed that more than 10% of admissions were potentially preventable.

Patients with mental health problems had more than twice the rate of preventable admissions seen in the control group. The biggest differences between the groups were for seizures and nutritional deficiencies.

The researchers suggest that poor quality primary care may be a contributor to the increased morbidity in the mentally ill. If this imbalance can be redressed, almost 50,000 admissions could be prevented.

Comment
Physical illness can affect people’s mental health, for example the depression associated with chronic illness. Conversely, a mental illness can lead to physical problems.

Nutritional problems may be expected in patients with depression, schizophrenia and alcohol dependency. The metabolic effect of some psychotropic drugs can add to the problems of poor nutrition.

Many patients’ problems are associated with disadvantage. GPs have little influence over issues such as income and area of residence.

A limitation of this study is that it did not have data from general practice.
Dr John Dowden

Mai Q, Holman CD, Sanfilippo FM, Emery JD. The impact of mental illness on potentially preventable hospitalisations. BMC Psychiatry;11:163