Health inequalities in People with seveRe mental Illnesses: Impact of antipsychOtic tReatments and social Inequalities on long Term phYsical health (PRIORITY).

PROJECT STATUS: Ongoing

START DATE AND DURATION: April 2022

Summary

People with severe mental illness, such as schizophrenia and bipolar affective disorder, are at greater risk of developing diabetes, heart disease and strokes. As a result, they, on average, die 10-15 years younger than people who do not have these conditions. They are often prescribed antipsychotic drugs for many years to help manage their condition. These drugs can increase body weight and alter blood pressure and cholesterol levels when taken for long periods. This, in turn, might partly explain why they are at higher risk of diabetes, heart disease and strokes.

Aims & Methods:

We aimed to examine the long-term effect of antipsychotics on physical health in people with SMI and how this might depend on the patient’s age, gender, ethnicity and level of deprivation. Using electronic primary care records from more than 200,000 patients, we analysed long-term changes in antipsychotic prescription patterns (e.g., antipsychotic type and dose variation) during the observation period (2006-2018). Then, we compared their body weight, blood pressure and cholesterol before and after the initiation of antipsychotic treatment to understand the long-term impact on physical health. We also examined how prescription patterns and their impact on physical health may change by sociodemographic characteristics.

Key Findings

Younger men and people from more disadvantaged backgrounds who have severe mental illnesses tended to receive higher doses of antipsychotic medication in the first year of treatment. However, this higher dosage decreased over time during that first year. In the long run, most people end up with moderate exposure to antipsychotics. Also, those from disadvantaged backgrounds and those on higher doses of antipsychotics had a higher risk of developing diabetes. Antipsychotic medication was also linked to weight gain, higher LDL cholesterol levels, and an increased risk of heart problems, especially in men and people with less economic resources. Clinical findings help patients and their doctors understand how antipsychotics can affect physical health in the long term and inform future treatment decisions.

IMPACTS

Thanks to this research, the connection between long-term antipsychotic prescriptions and the physical health of people with SMI and the role inequalities play in this relationship in primary care contexts is now better understood. People with SMI and clinicians will benefit from new relevant information when decisions on second-generation antipsychotic treatment are taken. For example, doctors and patients can better balance the advantages of current mental health and the disadvantages of future physical health when prescribing different doses of antipsychotics in the long term. Moreover, the risk will be tailored to particular characteristics such as age, gender or deprivation group. Thus, the findings will help shape future health interventions designed to reduce health inequalities.

The innovative quantitative methods applied in this research, particularly the complex interrupted time series designs and analyses (e.g., controlled ITS with joint modelling), will benefit health researchers who want to investigate using electronic health records and our approach as an exemplar.

Partners & Collaborators

University College London

Keele University

KTH Royal Institute of Technology

University of Aberdeen

Lead Investigator

Juan Carlos Bazo Alvarez (UCL, Principal Investigator)

Investigating Team

Irene Peterson (UCL)

Kate Walters (UCL)

Kelvin Jordan (Keele)

Claudia Cooper (UCL)

Joseph Hayes (UCL)

Magnus Boman (KTH Royal Institute of Technology)

Matteo Quartagno (UCL)

Craig Ramsay (Aberdeen)