Association of severe mental illness with stroke outcomes and process-of-care indicators: nationwide cohort study

Kelly Fleetwood, Sarah H Wild, Daniel J Smith, Stewart W Mercer, Kirsty Licence, Cathie L M Sudlow, Caroline A Jackson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Severe mental illness (SMI) is associated increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care.
Aims
To determine the association between SMI and stroke outcomes and receipt of processes of acute stroke care.
Method
We conducted a cohort study using routinely collected linked datasets, including adults with a first hospitalised stroke in Scotland during 1991-2014, with processes of care data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, one-year and five-year mortality and receipt of processes of care by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction).
Results
Among 228 699 stroke patients, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared to adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) 1.33, 95%CI 1.16–1.52), bipolar disorder (aOR 1.37, 95%CI 1.18–1.60) and major depression (aOR 1.11, 95%CI 1.05–1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of processes of care.
Conclusions
Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.
Original languageEnglish
JournalThe British Journal of Psychiatry
DOIs
Publication statusPublished - 19 Aug 2021

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