Acta Psychiatr Scand 2015: 131: 240–241 All rights reserved DOI: 10.1111/acps.12346
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA PSYCHIATRICA SCANDINAVICA
Editorial comment
Are there any lessons to be learnt from psychiatric epidemiology? This editorial comment is not dedicated to a strictly clinical topic, but to an analysis from the GAZEL study (1). This prospective cohort study was established in 1989 and followed employees of the French national electricity (EDF) and gas (GDF) companies. Information on health and lifestyle as well as on individual, social and occupational factors was collected on an annual basis. Additional data on, for example, utilisation of the occupational health department or sickness absence were provided by EDF-GDF. The present research focussed on a 10-year period and examined whether non-psychiatric hospitalisation rates were higher in those with a diagnosis of a mental disorder in the past. It distinguished between ‘allcause hospitalisations’ (excluding mental health reasons) as well as hospitalisations due to a myocardial infarction, stroke and any type of cancer. The study found those with a diagnosis of a mental disorder to have overall higher rates of somatic hospitalisations compared with those without mental disorder. Hospitalisations due to a myocardial infarction were also more frequent, but not those for stroke or cancer. ‘So what?’, may one ask. Why does Acta Psychiatrica Scandinavica publish such a paper? What is the wider significance of these results for an average Acta Psychiatrica Scandinavica reader? First of all, we need to take a closer look at the design of this cohort study. The authors point out that the participants have civil servant status and, therefore, benefit from a high level of job security. Additionally, they have access to universal healthcare in France. This means that the results were achieved under ‘quasi-ideal’ conditions regarding healthcare access. Still, people with a mental disorder have overall higher rates of somatic hospitalisations compared with those without such a condition. The present study cannot give reasons for this. Poor lifestyle and consecutive comorbidities are one cause for higher rates of somatic hospitalisations. However, health services which are not suitable for this particular population is another one. One simple example for this is the difficulty for people with mental illness to move between 240
different levels of a national care system, for example, between primary and secondary healthcare providers or between health and social care services (2). This leads to the second point: if health services, whether it is their accessibility, their permeability or their quantity or quality of care, are difficult to handle for people with mental health problems, at least (mental) health professionals must support them. Thus, we always must remember that our patients are at higher risk for somatic disorders. This is by far not new. Several studies already showed that people with mental illness use more often the health system (3). Besides, cultural diversity in physical diseases could be shown amongst people with mental illness (4). However, there are only few evidence-based interventions available for these patients (5). This is all the more surprising when we look at the overall dimension of somatic disorders in people with mental illness. Finally, Azevedo Da Silva et al.’s study (1) is a perfect example how epidemiology can help improve our knowledge about service use aspects. Acta Psychiatrica Scandinavica, in the August 2014 issue, focussed on another, but related aspect of psychiatric epidemiology, that is, the different perspectives of register research (6–8). It is obvious that we need ongoing cohort studies and register research as their results keep us alert, for example, to the overall health aspect of what we are doing in our day-to-day clinical practice. C. Lauber Services psychiatriques Jura bernois – Bienne-Seeland, Bellelay, Switzerland E-mail: [email protected] References 1. Azevedo Da Silva M, Lemogne C, Melchior M et al. Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort. Acta Psychiatr Scand 2015;131:307–317. 2. Adnanes M, Steihaug S. Obstacles to continuity of care in young mental health service users’ pathways - an explorative study. Int J Integr Care 2013;13:e031.
Editorial comment 3. Dezetter A, Briffault X, Bruffaerts R et al. Use of general practitioners versus mental health professionals in six European countries: the decisive role of the organization of mental health-care systems. Soc Psychiatry Psychiatr Epidemiol 2013;48:137–149. 4. Larsen JI, Andersen UA, Becker T et al. Cultural diversity in physical diseases among patients with mental illnesses. Aust N Z J Psychiatry 2013;47:250–258. 5. Park AL, McDaid D, Weiser P et al. Examining the cost effectiveness of interventions to promote the physical health
of people with mental health problems: a systematic review. BMC Public Health 2013;13:787. 6. Amaddeo F. The small scale clinical psychiatric case registers. Acta Psychiatr Scand 2014;130:80–82. 7. Stewart R. The big case register. Acta Psychiatr Scand 2014;130:83–86. 8. Munk-Jørgensen P, Okkels N, Goldberg D, Ruggeri M, Thornicroft G. Fifty years’ development and future perspectives of psychiatric register research. Acta Psychiatr Scand 2014;130:87–98.
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© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA PSYCHIATRICA SCANDINAVICA
Editorial comment
Are there any lessons to be learnt from psychiatric epidemiology? This editorial comment is not dedicated to a strictly clinical topic, but to an analysis from the GAZEL study (1). This prospective cohort study was established in 1989 and followed employees of the French national electricity (EDF) and gas (GDF) companies. Information on health and lifestyle as well as on individual, social and occupational factors was collected on an annual basis. Additional data on, for example, utilisation of the occupational health department or sickness absence were provided by EDF-GDF. The present research focussed on a 10-year period and examined whether non-psychiatric hospitalisation rates were higher in those with a diagnosis of a mental disorder in the past. It distinguished between ‘allcause hospitalisations’ (excluding mental health reasons) as well as hospitalisations due to a myocardial infarction, stroke and any type of cancer. The study found those with a diagnosis of a mental disorder to have overall higher rates of somatic hospitalisations compared with those without mental disorder. Hospitalisations due to a myocardial infarction were also more frequent, but not those for stroke or cancer. ‘So what?’, may one ask. Why does Acta Psychiatrica Scandinavica publish such a paper? What is the wider significance of these results for an average Acta Psychiatrica Scandinavica reader? First of all, we need to take a closer look at the design of this cohort study. The authors point out that the participants have civil servant status and, therefore, benefit from a high level of job security. Additionally, they have access to universal healthcare in France. This means that the results were achieved under ‘quasi-ideal’ conditions regarding healthcare access. Still, people with a mental disorder have overall higher rates of somatic hospitalisations compared with those without such a condition. The present study cannot give reasons for this. Poor lifestyle and consecutive comorbidities are one cause for higher rates of somatic hospitalisations. However, health services which are not suitable for this particular population is another one. One simple example for this is the difficulty for people with mental illness to move between 240
different levels of a national care system, for example, between primary and secondary healthcare providers or between health and social care services (2). This leads to the second point: if health services, whether it is their accessibility, their permeability or their quantity or quality of care, are difficult to handle for people with mental health problems, at least (mental) health professionals must support them. Thus, we always must remember that our patients are at higher risk for somatic disorders. This is by far not new. Several studies already showed that people with mental illness use more often the health system (3). Besides, cultural diversity in physical diseases could be shown amongst people with mental illness (4). However, there are only few evidence-based interventions available for these patients (5). This is all the more surprising when we look at the overall dimension of somatic disorders in people with mental illness. Finally, Azevedo Da Silva et al.’s study (1) is a perfect example how epidemiology can help improve our knowledge about service use aspects. Acta Psychiatrica Scandinavica, in the August 2014 issue, focussed on another, but related aspect of psychiatric epidemiology, that is, the different perspectives of register research (6–8). It is obvious that we need ongoing cohort studies and register research as their results keep us alert, for example, to the overall health aspect of what we are doing in our day-to-day clinical practice. C. Lauber Services psychiatriques Jura bernois – Bienne-Seeland, Bellelay, Switzerland E-mail: [email protected] References 1. Azevedo Da Silva M, Lemogne C, Melchior M et al. Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort. Acta Psychiatr Scand 2015;131:307–317. 2. Adnanes M, Steihaug S. Obstacles to continuity of care in young mental health service users’ pathways - an explorative study. Int J Integr Care 2013;13:e031.
Editorial comment 3. Dezetter A, Briffault X, Bruffaerts R et al. Use of general practitioners versus mental health professionals in six European countries: the decisive role of the organization of mental health-care systems. Soc Psychiatry Psychiatr Epidemiol 2013;48:137–149. 4. Larsen JI, Andersen UA, Becker T et al. Cultural diversity in physical diseases among patients with mental illnesses. Aust N Z J Psychiatry 2013;47:250–258. 5. Park AL, McDaid D, Weiser P et al. Examining the cost effectiveness of interventions to promote the physical health
of people with mental health problems: a systematic review. BMC Public Health 2013;13:787. 6. Amaddeo F. The small scale clinical psychiatric case registers. Acta Psychiatr Scand 2014;130:80–82. 7. Stewart R. The big case register. Acta Psychiatr Scand 2014;130:83–86. 8. Munk-Jørgensen P, Okkels N, Goldberg D, Ruggeri M, Thornicroft G. Fifty years’ development and future perspectives of psychiatric register research. Acta Psychiatr Scand 2014;130:87–98.
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