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dc.contributor.advisorHøye, Anne
dc.contributor.authorHeiberg, Ina Heidi
dc.date.accessioned2019-09-27T08:17:43Z
dc.date.available2019-09-27T08:17:43Z
dc.date.embargoEndDate2021-10-04
dc.date.issued2019-10-04
dc.description.abstract<p><i>Background and aims - </i>In the Nordic countries, people with severe mental illness die 15-20 years younger than others. Substance use and higher level of undiagnosed/untreated somatic diseases contribute to this disparity. We aimed to investigate; (i) mortality among people with schizophrenia and/or substance use disorder, with emphasis on the impact of a dual diagnosis; (ii) whether people with schizophrenia or bipolar disorder had higher odds of not being diagnosed with cardiovascular disease prior to cardiovascular death, and; (iii) whether people with schizophrenia or bipolar disorder had equal prevalence of diagnostic testing and treatment of cardiovascular disease prior to cardiovascular death as people without such disorders. <p><i>Methods - </i>We calculated standardized mortality ratios in a 7-year open cohort study including all residents of Norway aged 20-79 with schizophrenia and/or substance use disorders diagnosed in specialized care (i). We used multivariate logistic (ii) and log-binomial regression (iii) to study uptake of CVD-related health care services in residents aged 18 and above. <p><i>Results - </i>We found a four-fold (schizophrenia only) to seven-fold (substance use disorder with or without schizophrenia) increased mortality compared to the general population, implicating that five out of six persons with schizophrenia and/or substance use disorder died prematurely. We also found that people with schizophrenia and women with bipolar disorder were more likely to die from undiagnosed cardiovascular disease. They also had lower prevalence of specialized cardiovascular examinations and invasive cardiovascular treatment prior to cardiovascular death, compared to individuals without schizophrenia or bipolar disorder. We found no difference in uptake of invasive cardiovascular treatment in those diagnosed with cardiovascular disease prior to death. <p><i>Conclusion - </i>The large mortality gap between persons with severe mental illness and the general population highlights the need of securing proper access to specialized somatic care, and a more effective prevention of deaths from unnatural causes in this group.en_US
dc.description.doctoraltypeph.d.en_US
dc.description.popularabstractPeople with severe mental illness in the Nordic countries die 15-20 years younger than others. The current thesis utilized nationwide registers to study mortality among patients with schizophrenia and/or substance use disorders, and uptake of diagnostic tests and treatment among patients with schizophrenia or bipolar disorder. We found a four-fold (schizophrenia only) to seven-fold (substance use disorder with or without schizophrenia) increased mortality compared to the general population, implicating that more than 80% of patients with these disorders died prematurely, both from natural and unnatural causes of death. Patients with schizophrenia or bipolar disorder were more likely to die from undiagnosed and untreated cardiovascular disease. Uptake of invasive cardiovascular treatment did not differ if cardiovascular disease was diagnosed prior to death. Timely access to specialized somatic care, and a more effective prevention of unnatural deaths, is highly needed in this population.en_US
dc.description.sponsorshipForskningsmidler fra Helse Nord (PFP1236-15)en_US
dc.identifier.urihttps://hdl.handle.net/10037/16284
dc.language.isoengen_US
dc.publisherUiT The Arctic University of Norwayen_US
dc.publisherUiT Norges arktiske universiteten_US
dc.relation.haspart<p>Paper I: Heiberg, I.H., Jacobsen, B.K., Nesvåg, R., Bramness, J.G., Reichborn-Kjennerud, T., Næss, Ø., … Høye, A. (2018). Total and cause-specific standardized mortality ratios in patients with schizophrenia and/or substance use disorder. <i>PLoS One, 13</i>(8), e0202028. Also available in Munin at <a href=https://hdl.handle.net/10037/13704>https://hdl.handle.net/10037/13704</a>. <p>Paper II: Heiberg, I.H., Jacobsen, B.K., Balteskard, L., Bramness, J. G., Næss, Ø., Ystrom, E., … Høye, A. (2019). Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness. <i>Acta Psychiatrica Scandinavica, 139</i>(6), 558-571. Also available in Munin at <a href=https://hdl.handle.net/10037/16283>https://hdl.handle.net/10037/16283</a>. <p>Paper III: Heiberg, I.H., Nesvåg, R., Balteskard, L., Bramness, J.G., Hultman, C.M., Næss, Ø., … Høye, A. Diagnostic tests and treatment procedures prior to cardiovascular death in individuals with severe mental illness. (Submitted manuscript). Available in the file thesis_entire.pdf.en_US
dc.rights.accessRightsembargoedAccessen_US
dc.subject.courseIDDOKTOR-003
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Psykiatri, barnepsykiatri: 757en_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Psychiatry, child psychiatry: 757en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Psykiatri, barnepsykiatri: 757en_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Psychiatry, child psychiatry: 757en_US
dc.titleMortality, substance use disorder and cardiovascular health care in persons with severe mental illnessen_US
dc.typeDoctoral thesisen_US
dc.typeDoktorgradsavhandlingen_US


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