Epidemiology & Impact of Psychosis

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Compared to their peers, people with schizophrenia are at substantially increased risk of unemployment, incarceration, homelessness, social isolation, and premature mortality. Research conducted by SPIRIT faculty has investigated the epidemiology and impact of psychosis and factors that drive quality of care and outcomes and has identified critical health and healthcare disparities.

Prevalence of Psychosis

National Study of Mental Health (NSMH). This Substance Abuse and Mental Health Services (SAMHSA)-funded National Study of Mental Health (NSMH) will provide precise national estimates of mental health disorders among U.S adults ages 18 to 65. Led by investigators at the Research Triangle Institute (RTI), this $30 million study is designed to address two important gaps in previous epidemiologic studies: 1) accurate estimates of the most seriously impairing disorders, such as schizophrenia; and 2) the exclusion of the incarcerated, homeless, and institutionalized populations from national estimates. SPIRIT investigators are partners on this large nationwide study which will involve clinical interviews of national samples of households and incarcerated individuals in federal/state prisons; and local samples of individuals in homeless shelters, jails and state psychiatric hospitals in New York City, NY; Seattle, WA and Durham, NC. Funding Source SAMHSA 1H79FG000030 (PI: Ringeisen, Edlund). Study Impact

Impact of Psychosis

Veterans with schizophrenia have increased risk of mortality compared to veterans who do not have a mental disorder.

In a study of a national sample of more than 500,000 veterans, having a diagnosis of schizophrenia was associated with 1.5 times the risk of all-cause mortality over a 9-year period. This increased risk was independent of medical illness, obesity, exercise frequency and current smoking, alcohol or drug use.

People with schizophrenia have a higher risk of dementia.

In a population-based study of more than 2.8 million persons aged 50 years or older from 6 nationwide registers in Denmark followed for 18 years, individuals with schizophrenia–especially those younger than 65 years–had a markedly increased relative risk of dementia that could not be explained by established dementia risk factors.

Tobacco use is associated with poor outcomes in First Episode Psychosis treatment.

In another study that used data from the RAISE clinical trial, we found that 50% of the 400 youth and young adults who participated in this research study reported recent tobacco use–and that tobacco smokers had significantly more severe psychiatric symptoms and lower quality of life during treatment relative to non-smokers. This highlights a need for First Episode programs to systematically identify and address smoking.

Quality of Care

Racial Disparities in First Episode Psychosis Treatment.

SPIRIT investigators collaborated with colleagues from the Behavioral Health Innovations team at Washington State University to analyze data from the National Institute of Mental Health (NIMH)-funded RAISE study. RAISE was a large national research study that involved more than 400 youth and young adults in 34 sites around the US and demonstrated that coordinated specialty care was more effective in treating a first episode of psychosis than usual treatment. In additional analyses of RAISE study data, SPIRIT investigators demonstrated that Black patients were less likely to receive important services (compared with non-Hispanic white patients), both among those receiving either usual community care or the NAVIGATE treatment of coordinated specialty care.

Having schizophrenia increases the risk of medical re-hospitalization among people with diabetes.

In a study of more than 80,000 adults in Washington state who had a medical hospitalization for diabetes between 2010-2011, those who also had schizophrenia were 24% more likely to be re-hospitalized within 30 days.

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