Psychiatric readmissions and their association with physical comorbidity variables: A systematic literature review. Lilijana Šprah, Mojca Zvezdana Dernovšek, Research Centre of the Slovenian Academy of Sciences and Arts, Ljubljana

1. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Psychiatric readmissions and their
association with physical comorbidity
variables: A systematic literature review
Lilijana Šprah & Mojca Zvezdana Dernovšek
Research Centre of the Slovenian Academy of Sciences and Arts,
Sociomedical Institute, Ljubljana, Slovenia

2. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
People with enduring mental health problems are
more likely to develop physical health problems
than the general population
- Have two to threefold increased risk of death compared to persons of
the same age and gender in the general population
- Die on average 20 years younger than the general population, with
cardiovascular disease being the leading cause
- Are more likely to develop a range of chronic respiratory conditions
(chronic obstructive pulmonary disease, chronic bronchitis, asthma)
- Have a higher risk of developing some cancers, heart disease, diabetes
Background

3. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Which comes first?
The pathways leading to comorbidity of
mental and physical disorders are
complex and often bidirectional.
The course of comorbid mental and
physical conditions could be
influenced by each other and
worsening the mental and/or physical
condition, consequently leading to
hospital readmission.
Also conversely: poor physical health can have a
negative effect on mental health

4. People with medical conditions
58% of adult population
People with mental disorders
25% of adult population
68% of adults with mental disorders
have medical conditions
29% of adults with medical
conditions have mental disorders
Adapted from the National Comorbidity Survey Replication, 2001–2003
Comorbidity between mental and medical conditions
is the rule rather than the exception

5. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Objective
The main objective of study was to review
and describe the effect of physical
comorbidity variables on readmission after
discharge from psychiatric or general health
in-patient care with a psychiatric diagnosis.

6. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Results
Studies included in qualitative synthesis
(n = 34)
Main psychiatric discharge
diagnoses + physical comorbidity
(n=23)
Main medical discharge diagnoses
+ psychiatric comorbidity
(n=11)
ADMISSION/DISCHARGE READMISSION
PSYCHIATRIC CONDITION
MEDICAL CONDITION

7. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Results
General characteristics of the reviewed studies:
- 26 studies published after year 2000 (oldest: 1991; most recent: 2014)
- Most of studies included both genders (2 restricted to female, 1
included only male study population)
- Follow-up period varied from 1 month (n=1) to more than 10 years
(n=6); most frequently reported 12 months (n=8)
- Physical comorbidity was not analysed in all studies from the
perspective of psychiatric readmission
- Physical comorbidity considered as a confounding variable!
- A broad spectre of co-occurring physical and mental conditions were
studied

8. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Study population

9. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Comorbid physical variables

10. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Results
Main outcomes
Irrespective of diverse study protocols in reviewed studies some
common trends in comorbid psychiatric and medical conditions were
observed:
- Patients with mental disorders had more physical comorbidities
- The main body of studies supported the hypothesis that patients with
mental disorders are at increased risk of readmission if they had co-
occurring medical condition
- Physical comorbid conditions were more common among readmitted
patients than single admission patients
- Co-occurring physical and mental disorders can worsen patient's course
of illness, leading to hospital readmission due to non-psychiatric reasons

11. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Results
Some medical conditions may increase the probability
of psychiatric readmission
- All psychiatric diagnosis: cellulitis, chronic obstructive pulmonary disease,
liver disease, diabetes, hypertension, circulatory heart conditions,
epilepsy, hypothyroidism
- Substance use disorders diagnosis: chronic lung conditions, hepatitis C
virus infection, hypertension
- Serious mental illness diagnosis: higher Charlson Comorbidity Index,
physical health problems
- Affective disorders diagnosis: depresive disorder - somatic complaints,
more medical diagnosis

12. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Results
BUT not all studies in our review revealed a similar
trend!
Comorbidity with medical condition may also reduce
the readmission risk of psychiatric patients (the
protective effect of the medical comorbidity).
And vice versa, the burden of certain mental disorders
not necessarily increases the medical readmission.

13. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
It is difficult to draw a solid conclusion about actual
impact of physical comorbidity on readmission in
psychiatric population
- The association between physical comorbidity and psychiatric
readmission is still poorly understood phenomenon
- The pathways leading to comorbidity of mental and physical disorders
are in several aspects interrelated
- The scarcity of eligible studies on psychiatric readmission and physical
comorbidities
- Research outcomes varied considerably, possible because of differences
in applied methods, data collection and definitions of comorbidity
CONCLUSIONS

14. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
Approaches to study the impact of comorbidity
become challenging also due to the lack of consensus
about how to define and measure the comorbidity
- Different constructs and measures are associated with the core
concept of comorbidity- coexistence of two or more conditions
in a patient
- Outcomes depend on applied concept of comorbidity (disease in
relation to an index disease; presence of multiple diseases; overall
impact of the different diseases in an individual taking into account
their severity and other health-related attributes)
CONCLUSIONS

15. This project has received funding from the European Union’s Seventh Framework Programme for research,
technological development and demonstration under grant agreement no 603264
A growing interest among practitioners and researchers
occurred in the impact of comorbidity on a range of
outcomes, such as mortality, health-related quality
of life, patient's functioning, health care utilization
and spending.
More high quality research is needed in the future to
understand the associations between physical
comorbidities and psychiatric readmissions.
CONCLUSIONS

16. Thank you for your attention!