Compared to the general population, people with severe mental illness (SMI) experience poorer physical health and they often die 15-20 years earlier, usually from physical conditions that can be prevented such as heart and lung disease. Studies on personality disorders (PD) are limited, and at times the conditions are misunderstood and underdiagnosed.
People with SMI and PD often require long-term management of their conditions. The current GP practice register for people with SMI in England provides an inadequate understanding of characteristics for people SMI as it does not provide breakdowns by demographic and socio-economic factors. This can result in improper planning of services. With PD there is no such national register to start with. The only data available is through surveys or research studies. These often cover a small proportion of people with PD, are often based on self-reported symptoms, and do not provide the demographic and socio-economic breakdowns.
This study will focus on people with SMI and PD in England. Using a large sample of GP data and a definition of these conditions reviewed by experts, it will aim to estimate the numbers and proportion of people with SMI and PD at national and where possible at local levels
This work will provide information to better understand and monitor the number of people with SMI and PD, both nationally and locally. This will then help support the design, planning and commissioning of preventive initiatives and services for these people which in turn will lead to improved health outcomes.
People with severe mental illness (SMI) have reduced life expectancy and are at increased risk of physical health comorbidities compared to the general population. Recorded prevalence of SMI, as seen on GP registers is reported to be 0.93%. However, the register does not provide prevalence breakdowns by demographic and socio-economic which are proven to affect prevalence of SMI. There is no national register for people with personality disorders (PD). As reported in the 2014 Annual Psychiatry Morbidity Survey, the prevalence of people positively screened for Borderline Personality Disorder was 2.4% and for Antisocial Personality Disorder 3.3% .
Evidence suggest that the local recorded prevalence of SMI is an underestimate, and for PD local estimates are not available.
Factors such as age, gender, ethnicity and deprivation are suggested to affect prevalence of SMI. With PD, there is some evidence suggesting that age, gender and ethnicity affect its prevalence.
The purpose of this study is to explore the use of national prevalence of SMI and PD to calculate local prevalence estimates in England. This will primarily be an exploratory study, underpinned by both descriptive and methodological approach. It will calculate point prevalence at England level for people with SMI and PD overall, and by conditions sub-groups and the above variables.
We will run a multivariate logistic regression model to confirm which variables in our model significantly affect the prevalence of these conditions. Finally, we will use a synthetic estimate approach to derive local prevalence estimates. This approach will use the calculated national prevalence by variables and apply it to the local population to calculate estimated prevalence counts and proportions. This study will provide improved local prevalence estimates of SMI and new estimates of PD to support needs based planning and commissioning of services for people with SMI and PD.
The study will calculate the prevalence for -
• Patients with SMI (with or without PD)
• Patients with PD (with or without SMI)
Primary outcomes: Point prevalence of SMI and PD (overall and sub-conditions) in England; point prevalence of SMI and PD by age, gender, ethnicity and deprivation in England; estimated local prevalence of SMI and PD for Clinical Commissioning Groups (CCGs) and Upper Tier Local Authority (UTLAs).
Secondary outcomes: Point prevalence of SMI and PD in England by combination of deprivation quintiles, age groups, gender and ethnicity groups for local estimates purpose
Gabriele Price - Chief Investigator - Office for Health Improvement and Disparities
Gabriele Price - Corresponding Applicant - Office for Health Improvement and Disparities
Alex Stirzaker - Collaborator - NHS England
Cam Lugton - Collaborator - Office for Health Improvement and Disparities
David Osborn - Collaborator - University College London ( UCL )
Hannah Walke - Collaborator - Office for Health Improvement and Disparities
Hiral Mehta - Collaborator - Office for Health Improvement and Disparities
James Kirkbride - Collaborator - University College London ( UCL )
Jianhe Peng - Collaborator - Office for Health Improvement and Disparities
Joseph Hayes - Collaborator - University College London ( UCL )
Lanre Segilola - Collaborator - Office for Health Improvement and Disparities
Louis Thackray - Collaborator - Office for Health Improvement and Disparities
Matthew Wickenden - Collaborator - NHS England
Thomas Bardsley - Collaborator - NHS England
Danny Yip - Collaborator - Office for Health Improvement and Disparities
Hannah Walke - Collaborator - Public Health England
Louis Thackray - Collaborator - Office for Health Improvement and Disparities
Thomas Bardsley - Collaborator - NHS England
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record