Background: Severe Mental Illness (SMI) describes a group of illnesses such as schizophrenia and bipolar disorder characterized by psychosis (disturbed thoughts with hallucinations or delusions). People with SMI have poorer physical health and a shorter life expectancy than the general population, and are more likely to develop diabetes and associated complications.
Aims: To find out why patients with SMI are more likely to develop diabetes and have more complications from their diabetes, and how the provision of healthcare may contribute to this, so that we can identify ways to improve diabetes care for people with SMI.
Design: We will use anonymised routinely collected information from health records to find out which patients with SMI are at greatest risk of developing diabetes and its complications, and how a diagnosis of diabetes impacts on mental and physical health. We will examine how diabetes is screened for, monitored and managed, to understand what helps to improve diabetes outcomes and how much improving care costs the NHS.
Dissemination: We will ensure our findings are made available to people with SMI, NHS staff and people who make decisions about priorities in the NHS.
Background: People with severe mental illness (SMI) have poorer physical health and lower life expectancy than the general population. A 2-3 fold increased risk of diabetes and its associated complications contribute to this health inequality.
Aim: Our aim is to improve understanding of the increased risks of diabetes and poorer diabetes outcomes for people with SMI.
Methods: We will interrogate linked primary care and hospital records for a large representative sample of adults with SMI, SMI and diabetes, and a matched control group with diabetes but no SMI. We will quantify risk factors implicated in development of diabetes in people with SMI, and variation in health outcomes in people with comorbid SMI and diabetes. We will explore variations in diabetes screening and management, estimate costs for these, and determine the role of healthcare interventions in contributing to health outcomes. Analysis will use a range of statistical models, which take account of the structure of the data for each research objective (e.g. multilevel modelling to explore the impact of key variables, and matching methods to compare disparities in healthcare).
Impact: This knowledge will help healthcare commissioners, providers and researchers to develop targeted effective interventions for this population and improve existing services.
Diabetes status and onset; Diabetic and cardiovascular control (measured by recorded HbA1c, blood pressure, cholesterol levels); Diabetic complications: acute hyperglycemic events, hypoglycemia, micro-vascular complications [retinopathy, neuropathy, nephropathy], macro-vascular complications [coronary artery disease, cerebrovascular disease, peripheral arterial disease]; Hospital admissions for the above conditions; Mental health outcomes (including SMI relapses and markers of depression or anxiety); Mortality; Healthcare utilisation (including the number and type of primary care consultations) and costs; Healthcare interventions (e.g. medication, care pathways and referrals).
Najma Siddiqi - Chief Investigator - University of York
Najma Siddiqi - Corresponding Applicant - University of York
Catherine Hewitt - Collaborator - University of York
Claire Eccles - Collaborator - University of York
David Shiers - Collaborator - University of York
Johanna Taylor - Collaborator - University of York
Kate Bosanquet - Collaborator - University of York
Lu Han - Collaborator - University of York
Lu Han - Collaborator - University of York
Maria Ana Matias - Collaborator - University of York
Panagiotis Kasteridis - Collaborator - University of York
Richard IG Holt - Collaborator - University of Southampton
Rita Santos - Collaborator - University of York
Rowena Jacobs - Collaborator - University of York
Sarah Anderson - Collaborator - University of Leeds
Shehzad Ali - Collaborator - University of York
Simon Gilbody - Collaborator - University of York
Stephanie Prady - Collaborator - University of York
Tim Doran - Collaborator - University of York
HES Admitted Patient Care;HES Admitted Patient Care;HES Admitted Patient Care;HES Outpatient;Mental Health Services Data Set (MHSDS);ONS Death Registration Data;ONS Death Registration Data;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Patient Level Index of Multiple Deprivation;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation