Hospitalisation time is associated with weight gain in forensic mental health patients with schizophrenia or bipolar disorder

Abstract

Introduction

People with mental disorders have higher mortality from lifestyle diseases than the general population. Forensic mental health patients (FMHPs) are often hospitalised for longer periods of time than non-FMHPs. Thus, hospitalisation may have a greater effect on the risk of lifestyle diseases in FMHPs.

Objective

Investigate associations between proportional hospitalisation time (PHT) and change in body weight or other cardiometabolic risk factors among FMHPs.

Methods

Retrospective cohort study including all FMHPs with schizophrenia or bipolar disorder, prescribed antipsychotics, and treated between 01 January 2016 and 06 April 2020 in the Region of Southern Denmark either in forensic units or as outpatients. Associations between PHT and, respectively, primary and secondary outcomes were analysed using linear regression. PHT was determined between each measurement of the outcomes as the number of days hospitalised divided by the total number of days within the time-period. The primary outcome was weight change and secondary outcomes were change in waist circumference (WC), blood pressure, estimated average glucose (eAG), HDL, LDL, total cholesterol, and triglycerides. Analyses were adjusted for gender, age, smoking, and antipsychotics.

Results

The cohort included 490 FMHPs, of which 440 were diagnosed with schizophrenia. PHT had a significant positive dose-response association with weight change, with an estimated difference of +4.0 kg/year for FMHPs who were hospitalised 100% of the time, compared to FMHPs who were exclusively treated as outpatients. The association interacted with baseline BMI. From the secondary outcomes, the association with PHT was only statistically significant for WC.

Conclusions

PHT was positively associated with weight gain.

Keywords:

• Forensic psychiatry
• body weight
• blood pressure
• blood lipids
• hospitalisation

Acknowledgements

OPEN Odense patient data explorative network put the REDCap electronic data capture tool at our disposal and supervised the project. Statistician Pia Veldt Larsen provided valuable statistical supervision, and a comprehensive work was done by a research assistant and medical secretaries in the collection of data from medical records.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

This work was supported by The Psychiatry Research Fund in the Region of Southern Denmark [project number 180811031] and University of Southern Denmark [Syddansk Universitet].

Notes on contributors

Anne Louise Winkler Pedersen

Anne Louise Winkler Pedersen holds a master’s degree in Human Nutrition and is currently PhD student at Forensic mental health research unit, psychiatric department Middelfart. Her previous work has concerned prevention of lifestyle diseases in forensic mental health patients and in women with gestational diabetes, respectively.

Frederik Alkier Gildberg

Frederik Alkier Gildberg is Professor in Forensic Mental Health and a registered Nurse in Denmark. He holds a diploma in social science in medicine and has published extensively in international journals, books, book chapters, posters and conference papers on subjects such as staff-patient relationships, mental health care and restrictive practices.

Peter Hjorth

Peter Hjorth, RN, MPH and Ph.D. 2013. Associate professor in prevention and treatment of physical illnesses in psychiatry, University of Southern Denmark and Psychiatric Hospital, Vejle, Denmark.

Mikkel Højlund

Mikkel Højlund, MD is a pharmacoepidemiologist with special interest in the efficacy and safety of antipsychotic drugs. He works at the Department of Clinical Pharmacology, Pharmacy, and Environmental Medicine at the University of Southern Denmark and at the Department of Psychiatry Aabenraa.

Kjeld Andersen

Kjeld Andersen is professor in psychiatry and senior consultant in geriatric psychiatry. Main publications have been on psychiatric problems related to older adults; dementia, psychosis, and alcohol abuse. But also, more generally, on drug treatment, including side effects. Kjeld Andersen has also done research on coercion in psychiatry.