Posts tagged mortality
Articles and news from the latest research reports.
Study shows increasing rates of premature death and violent crime in people with schizophrenia since 1970s
New research, published in The Lancet Psychiatry journal, shows that rates of adverse outcomes, including premature death and violent crime, in people with schizophrenia are increasing, compared to the general population.
The results come from a unique study, led by Dr Seena Fazel, at Oxford University, UK, which analyses long-term adverse outcomes – including conviction for a violent crime (such as homicide or bodily harm) premature death (before the age of 56), and death by suicide – between 1972 and 2009 in nearly 25,000 people in Sweden diagnosed with schizophrenia or related disorders.
For the first time, the researchers compared adverse outcomes in people with a diagnosis of schizophrenia to both the general population and to unaffected siblings, allowing them to account for risk factors within families (such as parental criminality or violence) which might be expected to affect the risk of suicide or violent behaviour in siblings.
Overall, the results show that within five years of diagnosis, around 1 in 50 men and women with schizophrenia (2.3% of men and 1.7% of women) died by suicide; around one in 10 (10.7%) of men and around one in 37 (2.7%) of women with schizophrenia were convicted of a violent offence within five years of diagnosis. Overall, men and women with schizophrenia were eight times more likely to die prematurely than the general population.
Analysing the changing rate of adverse outcomes across the study period (1972 – 2009), the researchers found that the risk of premature death, suicide, and conviction for a violent offence has increased for men and women with schizophrenia in the last 38 years, compared with both the general population, and their unaffected siblings.
By tracking the number of nights spent in hospital by people with schizophrenia during the study period, the study shows that these increased rates of adverse outcomes appear to be associated with decreasing levels of inpatient care for these patients, although the study does not provide any evidence for a causal connection between decreasing inpatient care and adverse outcomes.
The researchers also analysed risk factors for adverse outcomes in both people with schizophrenia, the general population, and unaffected siblings. Across all three groups, the risk factors for violence and premature death were broadly similar, and included drug use disorders, criminality, and self-harm, all before diagnosis – suggesting that improved strategies to address these risk factors have the potential to reduce violence and premature deaths across the population, and not just in those with schizophrenia.
According to Dr Fazel, “In recent years, there has been a lot of focus on primary prevention of schizophrenia – preventing people from getting ill. While primary prevention is clearly essential and may be some decades away, our study highlights the crucial importance of secondary prevention – treating and managing the risks of adverse outcomes, such as self-harm or violent behaviour, in patients. Risks of these adverse outcomes relative to others in society appear to be increasing in recent decades, suggesting that there is still much work to be done in developing new treatments and mitigating risks of adverse outcomes in people with schizophrenia.”*
Dr Eric Elbogen and Sally Johnson, at the University of North Carolina-Chapel Hill School of Medicine, USA, write in a linked Comment that, “One of the unique aspects of this study—that violence and suicide were analysed simultaneously—has an important implication for how we as a society perceive people with mental illness. News coverage of schizophrenia and other psychiatric disorders often focuses on violence and crime. Much less attention is paid to suicide and self-harm in people with severe mental illnesses.”
However, they add that, “Importantly, we should remember that, when reporting about the intricate links between schizophrenia and these adverse outcomes, most people with schizophrenia and related disorders are neither violent nor suicidal. Despite the need to ensure people with schizophrenia are provided help to reduce their risks of suicide, violence, or premature death, researchers reporting findings also bear the burden of ensuring that most people with schizophrenia and related disorders, who are not violent, are not left to contend with stigma and discrimination. Policy makers, researchers, and clinicians need to remember the importance of appropriately weighing up the issue of schizophrenia relative to the myriad of other factors that contribute to increased risk of violence and suicide.”
(Source: alphagalileo.org)
How Subtle Movements and Facial Features Could Predict Your Demise
Princeton study shows that health assessments made by medically untrained interviewers can predict mortality of individuals better than those made by physicians or the individuals themselves
Features like the wrinkles on your forehead and the way you move may reflect your overall health and risk of dying, according to recent health research. But do physicians consider such details when assessing patients’ overall health and functioning?
In a survey of approximately 1,200 Taiwanese participants, Princeton University researchers found that interviewers — who were not health professionals but were trained to administer the survey — provided health assessments that were related to a survey participant’s risk of dying, in part because they were attuned to facial expressions, responsiveness and overall agility.
The researchers report in the journal Epidemiology that these assessments were even more accurate predictors of dying than assessments made by physicians or even the individuals themselves. The findings show that survey interviewers, who typically spend a fair amount of time observing participants, can glean important information regarding participants’ health through thorough observations.
"Your face and body reveal a lot about your life. We speculate that a lot of information about a person’s health is reflected in their face, movements, speech and functioning, as well as in the information explicitly collected during interviews," said Noreen Goldman, Hughes-Rogers Professor of Demography and Public Affairs in the Woodrow Wilson School.
Together with lead author of the paper and Princeton Ph.D. candidate Megan Todd, Goldman analyzed data collected by the Social Environment and Biomarkers of Aging Study (SEBAS). This study was designed by Goldman and co-investigator Maxine Weinstein at Georgetown University to evaluate the linkages among the social environment, stress and health. Beginning in 2000, SEBAS conducted extensive home interviews, collected biological specimens and administered medical examinations with middle-aged and older adults in Taiwan. Goldman and Todd used the 2006 wave of this study, which included both interviewer and physician assessments, for their analysis. They also included death registration data through 2011 to ascertain the survival status of those interviewed.
The survey used in the study included detailed questions regarding participants’ health conditions and social environment. Participants’ physical functioning was evaluated through tasks that determined, for example, their walking speed and grip strength. Health assessments were elicited from participants, interviewers and physicians on identical five-point scales by asking “Regarding your/the respondent’s current state of health, do you feel it is excellent (5), good (4), average (3), not so good (2) or poor (1)?”
Participants answered this question near the beginning of the interview, before other health questions were asked. Interviewers assessed the participants’ health at the end of the survey, after administering the questionnaire and evaluating participants’ performance on a set of tasks, such as walking a short distance and getting up and down from a chair. And physicians — who were hired by the study and were not the participants’ primary care physicians — provided their assessments after physical exams and reviews of the participants’ medical histories. (Study investigators did not provide special guidance about how to rate overall health to any group.)
In order to understand the many variables that go into predicting mortality, Goldman and Todd factored into their statistical models such socio-demographic variables as sex, place of residence, education, marital status, and participation in social activities. They also considered chronic conditions, psychological wellbeing (such as depressive symptoms) and physical functioning to account for a fuller picture of health.
"Mortality is easy to measure because we have death records indicating when a person has died," Goldman said. "Overall health, on the other hand, is very complicated to measure but obviously very important for addressing health policy issues."
Two unexpected results emerged from Goldman and Todd’s analysis. The first: physicians’ ratings proved to be weak predictors of survival. “The physicians performed a medical exam equivalent to an annual physical exam, plus an abdominal ultrasound; they have specialized knowledge regarding health conditions,” Goldman explained. “Given access to such information, we anticipated stronger, more accurate predictions of death,” she said. “These results call into question previous studies’ assumptions that physicians’ ‘objective health’ ratings are superior to ‘subjective’ ratings provided by the survey participants themselves.”
In a second surprising finding, the team found that interviewers’ ratings were considerably more powerful for predicting mortality than self-ratings. This is likely, Goldman said, because interviewers considered respondents’ movements, appearance and responsiveness in addition to the detailed health information gathered during the interviews. Also, Goldman posits, interviewer ratings are probably less affected by bias than self-reports.
"The ‘self-rated health’ question is religiously used by health researchers and social scientists, and, although it has been shown to predict mortality, it suffers from many biases. People use it because it’s easy and simple,” Goldman continued. "But the problem with self-rated health is that we have no idea what reference group the respondent is using when evaluating his or her own health. Different ethnic and racial groups respond differently as do varying socioeconomic groups. We need other simple ways to rate individual health instead of relying so heavily on self-rated health."
One way, Goldman suggests, is by including interviewer ratings in surveys along with self-ratings: “This is a straightforward and cost-free addition to a questionnaire that is likely to improve our measurement of health in any population,” Goldman said.
(Source: wws.princeton.edu)
Are Thoughts of Death Conducive to Humor?
A New Study Shows an Increase in Humorous Creativity when Individuals are Primed with Thoughts of Death.
Humor is an intrinsic part of human experience. It plays a role in every aspect of human existence, from day-to-day conversation to television shows. Yet little research has been conducted to date on the psychological function of humor. In human psychology, awareness of the impermanence of life is just as prevalent as humor. According to the Terror Management Theory, knowledge of one’s own impermanence creates potentially disruptive existential anxiety, which the individual brings under control with two coping mechanisms, or anxiety buffers: rigid adherence to dominant cultural values, and self-esteem bolstering.
A new article by Christopher R. Long of Ouachita Baptist University and Dara Greenwood of Vassar College is titled Joking in the Face of Death: A Terror Management Approach to Humor Production. Appearing in the journal HUMOR, it documents research on whether the activation of thoughts concerning death influences one’s ability to creatively generate humor. As humor is useful on a fundamental level for a variety of purposes, including psychological defense against anxiety, the authors hypothesized that the activation of thoughts concerning death could facilitate the production of humor.
For their study, Long and Greenwood subdivided 117 students into four experimental groups. These groups were confronted with the topics of pain and death while completing various tasks. Two of the test groups were exposed unconsciously to words flashed for 33 milliseconds on a computer while they completed tasks – the first to the word “pain,” the second to the word “death.” The remaining two groups were prompted in a writing task to express emotions concerning either their own death or a painful visit to the dentist. Afterward, all four groups were instructed to supply a caption to a cartoon from The New Yorker.
These cartoon captions were presented to an independent jury who knew nothing about the experiment. The captions written by individuals who were subconsciously primed with the word death were clearly voted as funnier by the jury. By contrast, the exact opposite result was obtained for the students who consciously wrote about death: their captions were seen as less humorous.
Based on this experiment, the researchers conclude that humor helps the individual to tolerate latent anxiety that may otherwise be destabilizing. In this connection, they point to previous studies indicating that humor is an integral component of resilience.
In light of the finding that the activation of conscious thoughts concerning death impaired the creative generation of humor, Long and Greenwood highlight the need for additional research, not only to explore the effectiveness of humor as a coping mechanism under various circumstances, but also to identify its emotional, cognitive, and/or social benefits under conditions of adversity.
New findings on mortality of individuals with schizophrenia
A new study from Lund University in Sweden shows that the average life expectancy of men and women with schizophrenia is 15 years and 12 years shorter respectively than for those who do not suffer from the disease. The study has been carried out in collaboration with Stanford University in the US.
The reasons why people with schizophrenia have a shorter life expectancy have previously been unknown, but have been much discussed in recent years. The research report that has now been published shows that individuals with schizophrenia are more likely to die of two major diseases.
The study followed over six million individuals from 2003 to 2009, of whom 8,277 had schizophrenia, by analysing the Swedish population and health registers.
The results show that people with schizophrenia had contact with the health service over twice as often as people without the condition, but they were no more likely to be diagnosed with cardiovascular disease or cancer.
“Yet we saw an opposing pattern of death from these diseases. It is clear that the health service is failing to diagnose cardiovascular disease and cancer in these patients”, says Jan Sundquist, general practitioner and professor at the Centre for Primary Health Care Research at Lund University.
Women with schizophrenia were 3.3 times more likely to die of cardiovascular disease and men 2.2 times more likely. Women with schizophrenia were 1.7 times more likely to die of cancer while men were 1.4 times more likely, compared with those without schizophrenia. Only 26.3% of the men with schizophrenia who died of cardiovascular disease had been diagnosed before their deaths, compared with 43.7% of the men who did not have schizophrenia.
“It is unacceptable that such a vulnerable group of people, who also have extensive documented contact with the health service, should die prematurely of conditions such as cardiovascular disease and cancer – diseases that should be preventable”, says Professor Sundquist. “A much greater degree of diagnostic and preventive measures could be put in place for this vulnerable group in our society.”
Death: A special report on the inevitable
The only certain thing in life is that it will one day end. That knowledge is perhaps the defining feature of the human condition. And, as far as we know, we alone are capable of contemplating the prospect of our demise. In these articles we explore the implications: the shifting definition of death, how knowing that we will die gave birth to civilisation, the grim reality of decomposition and whether it makes sense to fear death. But first, when did we become aware of our own mortality?
Shortened telomere length tied to dementia, mortality risk
July 25, 2012
(HealthDay) — Shortened telomere length (TL) is associated with risks for dementia and mortality in a population of older adults, according to a study published online July 23 in the Archives of Neurology.
Lawrence S. Honig, M.D., Ph.D., from the Columbia University College of Physicians and Surgeons in New York City, and colleagues used real-time polymerase chain reaction analysis to determine TL in stored leukocyte DNA from 1,983 participants in a community-based study of aging. Participants were 65 years or older and blood was drawn at a mean age of 78.3 years. Participants were followed for a median of 9.3 years for mortality, and 9.6 percent developed incident dementia.
The researchers found that TL correlated inversely with age and was shorter in men than women. TL was significantly shorter in persons dying during follow-up compared with survivors, even after adjusting for age, sex, education, and apolipoprotein E genotype. TL was significantly shorter in the participants with incident and prevalent dementia, compared with those who remained dementia-free. Shorter TL correlated with earlier onset of dementia but this association was significant in women only.
"Our results show an association between shortened TL and mortality, and more specifically an association of shortened TL with Alzheimer’s disease, and are consistent with but not indicative of the possibility that TL may be a factor indicative of biological age," the authors conclude.
Source: medicalxpress.com