Santiago Madero, Gerard Anmella, Michele De Prisco, Vincenzo Oliva, Clàudia Valenzuela-Pascual, Ariadna Mas, Giovanna Fico, Andrea Murru, Marc Valentí, Jordi Blanch, Clemente Garcia-Rizo, Vicent Llorca-Bofí, Silvia Amoretti, Norma Verdolini, Miquel Bioque, Eduard Parellada, Eduard Vieta, Diego Hidalgo-Mazzei
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Diagnostic categories included schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder, other non-organic psychoses, unipolar psychotic depression, and other mental health diagnoses. Cox proportional hazards models assessed mortality risk, adjusting for sociodemographic factors and comorbidities.</p><p><strong>Results: </strong>About one-third of the sample received their first psychotic disorder diagnosis in specialized care. All psychotic disorders showed elevated mortality risk vs other mental health conditions. Schizophrenia had the highest risk (HR, 2.63; 95%CI, 2.46-2.81, p<0.001 followed by schizoaffective (HR, 1.99; 95%CI, 1.77-2.24, p<0.001) and delusional disorders (HR, 1.92; 95%CI, 1.66-2.21, p<0.001). Low socioeconomic status (HR, 3.69; 95%CI, 3.48-3.92, p<0.001) and comorbidities (HR, 1.82 per comorbidity; 95%CI, 1.81-1.83, p<0.001) were significant predictors of mortality across diagnoses. Gradient boosting machine modeling identified comorbidities (56.07%) and diagnostic category (24.51%) as top predictors of mortality risk.</p><p><strong>Conclusions: </strong>This study demonstrates significantly elevated mortality risk across the spectrum of psychotic disorders in a Southern European context, with socioeconomic factors and medical comorbidities emerging as critical determinants. These findings underscore the need for integrated care approaches addressing both mental and physical health needs in psychotic disorders.</p>","PeriodicalId":101179,"journal":{"name":"Spanish Journal of Psychiatry and Mental Health","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic pathways and mortality across psychotic disorders: Evidence from Catalonia integrated health records.\",\"authors\":\"Santiago Madero, Gerard Anmella, Michele De Prisco, Vincenzo Oliva, Clàudia Valenzuela-Pascual, Ariadna Mas, Giovanna Fico, Andrea Murru, Marc Valentí, Jordi Blanch, Clemente Garcia-Rizo, Vicent Llorca-Bofí, Silvia Amoretti, Norma Verdolini, Miquel Bioque, Eduard Parellada, Eduard Vieta, Diego Hidalgo-Mazzei\",\"doi\":\"10.1016/j.sjpmh.2025.02.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Although psychotic disorders are associated with significant morbidity and mortality, the diagnostic trajectories and mortality risks across the spectrum of these disorders remain poorly understood. This study aimed to characterize diagnostic pathways and compare mortality outcomes across psychotic disorders in Catalonia.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using electronic health records of 357,007 adults accessing mental health services in Catalonia from 2015 through 2019. Diagnostic categories included schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder, other non-organic psychoses, unipolar psychotic depression, and other mental health diagnoses. Cox proportional hazards models assessed mortality risk, adjusting for sociodemographic factors and comorbidities.</p><p><strong>Results: </strong>About one-third of the sample received their first psychotic disorder diagnosis in specialized care. All psychotic disorders showed elevated mortality risk vs other mental health conditions. Schizophrenia had the highest risk (HR, 2.63; 95%CI, 2.46-2.81, p<0.001 followed by schizoaffective (HR, 1.99; 95%CI, 1.77-2.24, p<0.001) and delusional disorders (HR, 1.92; 95%CI, 1.66-2.21, p<0.001). Low socioeconomic status (HR, 3.69; 95%CI, 3.48-3.92, p<0.001) and comorbidities (HR, 1.82 per comorbidity; 95%CI, 1.81-1.83, p<0.001) were significant predictors of mortality across diagnoses. Gradient boosting machine modeling identified comorbidities (56.07%) and diagnostic category (24.51%) as top predictors of mortality risk.</p><p><strong>Conclusions: </strong>This study demonstrates significantly elevated mortality risk across the spectrum of psychotic disorders in a Southern European context, with socioeconomic factors and medical comorbidities emerging as critical determinants. 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引用次数: 0
摘要
虽然精神障碍与显著的发病率和死亡率相关，但这些疾病的诊断轨迹和死亡率风险仍然知之甚少。这项研究的目的是表征诊断途径，并比较在加泰罗尼亚精神病的死亡率结果。方法：我们使用2015年至2019年在加泰罗尼亚获得心理健康服务的357,007名成年人的电子健康记录进行了一项回顾性队列研究。诊断类别包括精神分裂症、双相情感障碍、分裂情感障碍、妄想障碍、其他非器质性精神病、单极精神病性抑郁症和其他精神健康诊断。Cox比例风险模型评估了死亡风险，调整了社会人口因素和合并症。结果：大约三分之一的样本在专门护理中接受了他们的第一次精神障碍诊断。与其他精神健康状况相比，所有精神障碍均显示出较高的死亡风险。精神分裂症的风险最高(HR, 2.63；95%CI, 2.46-2.81, p < 0.001，其次是分裂情感性(HR, 1.99；95%CI, 1.77 ~ 2.24, p < 0.001)和妄想障碍(HR, 1.92；95%CI, 1.66 ~ 2.21, p < 0.001)。社会经济地位低(HR, 3.69；95%CI, 3.48-3.92, p < 0.001)和合并症(HR， 1.82 /合并症；95%CI （1.81-1.83, p < 0.001）是诊断中死亡率的显著预测因子。梯度增强机器模型确定合并症（56.07%）和诊断类别（24.51%）是死亡风险的主要预测因素。结论：这项研究表明，在南欧的背景下，整个精神病谱系的死亡风险显著升高，社会经济因素和医学合并症成为关键决定因素。这些发现强调需要综合护理方法解决精神障碍的精神和身体健康需求。
Diagnostic pathways and mortality across psychotic disorders: Evidence from Catalonia integrated health records.
Introduction: Although psychotic disorders are associated with significant morbidity and mortality, the diagnostic trajectories and mortality risks across the spectrum of these disorders remain poorly understood. This study aimed to characterize diagnostic pathways and compare mortality outcomes across psychotic disorders in Catalonia.
Methods: We conducted a retrospective cohort study using electronic health records of 357,007 adults accessing mental health services in Catalonia from 2015 through 2019. Diagnostic categories included schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder, other non-organic psychoses, unipolar psychotic depression, and other mental health diagnoses. Cox proportional hazards models assessed mortality risk, adjusting for sociodemographic factors and comorbidities.
Results: About one-third of the sample received their first psychotic disorder diagnosis in specialized care. All psychotic disorders showed elevated mortality risk vs other mental health conditions. Schizophrenia had the highest risk (HR, 2.63; 95%CI, 2.46-2.81, p<0.001 followed by schizoaffective (HR, 1.99; 95%CI, 1.77-2.24, p<0.001) and delusional disorders (HR, 1.92; 95%CI, 1.66-2.21, p<0.001). Low socioeconomic status (HR, 3.69; 95%CI, 3.48-3.92, p<0.001) and comorbidities (HR, 1.82 per comorbidity; 95%CI, 1.81-1.83, p<0.001) were significant predictors of mortality across diagnoses. Gradient boosting machine modeling identified comorbidities (56.07%) and diagnostic category (24.51%) as top predictors of mortality risk.
Conclusions: This study demonstrates significantly elevated mortality risk across the spectrum of psychotic disorders in a Southern European context, with socioeconomic factors and medical comorbidities emerging as critical determinants. These findings underscore the need for integrated care approaches addressing both mental and physical health needs in psychotic disorders.
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