Parents of Schizophrenia Patients Found More Likely to Seek Psychiatric Care

The demands of providing long-term care to a family member with severe, chronic illness have been shown to have a negative effect on the health of caregivers. A study published Monday in Schizophrenia Bulletin now suggests that parents of patients with schizophrenia are more likely to seek care for mental illness than parents of patients with other chronic diseases and healthy controls.

Ellenor Mittendorfer-Rutz, Ph.D., of Karolinska Institutet and colleagues analyzed data derived from Swedish nationwide registers to compare health care resource use, adverse health status, and more of 18,215 parents of patients with schizophrenia, 11,292 parents of patients with multiple sclerosis, 15,516 parents of patients with rheumatoid arthritis, 34,715 parents of patients with epilepsy, and 18,408 parents of healthy controls without a chronic illness. (Previous studies show multiple sclerosis, rheumatoid arthritis, and epilepsy place a high burden on caregivers.) The investigators assessed trends for each of the designated outcomes from four years before the child was diagnosed with the chronic illness to seven years after this diagnosis was made.

“Use of specialized health care due to psychiatric or somatic diagnoses showed an increasing trend for all parents throughout the observation period,” Mittendorfer-Rutz and colleagues wrote. Parents of patients with schizophrenia had a higher risk of psychiatric health care use compared with the other parental groups during follow-up, they reported.

The most frequent diagnostic groups of psychiatric diagnoses among the parents were affective and anxiety disorders as well as schizophrenia, they noted. Parents of children with moderately severe schizophrenia had a slightly higher risk of use of psychiatric services compared with parents of children with less severe schizophrenia.

“Different psychosocial interventions aim[ed] at parents of patients with schizophrenia have been reported to be helpful to reduce stress, which may also play a role in stabilizing mental health of such parents,” the researchers wrote. “Unfortunately, no data were available for this study regarding the proportion of parents attending such intervention.”

For related information, see the Psychiatric Services article “Psychological Distress Among Caregivers of Individuals With a Diagnosis of Schizophrenia or Schizoaffective Disorder.”

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Young People With Psychotic Disorder at Highest Risk of Death in Year Following Diagnosis

Young patients newly diagnosed with a psychotic disorder are at higher risk for mortality, mostly due to injuries and poisoning, particularly for the first year or two after diagnosis, according to a study published Wednesday in JAMA Psychiatry.

In fact, the adolescents and young adults studied were more than eight times more likely to die within the first year of being treated for an initial psychotic disorder diagnosis than were patients who received other outpatient services, according to the report by Gregory E. Simon, M.D., M.P.H., of Kaiser Permanente Washington Health Research Institute and colleagues. After initial diagnosis of unipolar depression, patients were three times more likely to die than general outpatients.

For this cohort study, researchers examined eight years of records from several health systems that serve more than 8 million members. They examined records for 11,713 patients aged 16 through 30 who were first diagnosed with a psychotic disorder along with two comparison groups: 35,576 patients who received outpatient services and 23,415 patients with a first diagnosis of unipolar depression.

The researchers found that for every 10,000 patients, 55 of those with a first diagnosis of psychotic disorder died within the first 12 months, compared with 21 deaths of those with first diagnosis of unipolar depression and 7 of those seen by general outpatient services. Of the 64 patients who died within a year of a psychotic disorder diagnosis, more than half were from injuries or poisoning (34% self-inflicted, 17% unintentional). For patients with an initial diagnosis of unipolar depression, more than half of the 48 deaths (54%) were self-inflicted.

Overall mortality and mortality due to injuries and poisonings decreased gradually during the three years after initial diagnosis with psychosis. However, such mortality remained elevated in comparison with patients who received general outpatient health services and those who were newly diagnosed with unipolar depression.

“Our findings support the importance of systematic early intervention for young people experiencing the first onset of psychosis. Strong evidence supports the effectiveness of coordinated specialty care programs for improving clinical outcomes,” the researchers noted. They added that few such patients receive this type of care. Some studies have suggested that continuous treatment with antipsychotic medication may also reduce mortality in this group.

For related information, see the AJP in Advance article “Care Pathways Before First Diagnosis of a Psychotic Disorder in Adolescents and Young Adults” and the Psychiatric News article “Gralnick Award Lecturer Emphasizes Importance of First-Episode Treatment.”

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