Screening, treatment for CVD lower in people with mental disorders
The databases of PubMed and PsycInfo were searched through 31 July 2020 for relevant studies. A random-effect meta-analysis was also performed on observational studies comparing CVD screening and treatment in individuals with and without mental disorders.
In addition, the investigators conducted sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, controlling for confounding by indication, as well as meta-regressions. They also assessed publication bias and quality.
Forty-seven studies (n=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were included in the meta-analysis.
The rates of screening or treatment in patients with mental disorders were lower for any CVD (k=47; odds ratio [OR], 0.773, 95 percent confidence interval [CI], 0.742–0.804), coronary artery disease (k=34; OR, 0.734, 95 percent CI, 0.690–0.781), cerebrovascular disease (k=8; OR, 0.810, 95 percent CI, 0.779–0.842), and other mixed CVDs (k=11; OR, 0.839, 95 percent CI, 0.761–0.924).
Significant disparities were also noted for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across mental disorders, except for CVD medications in mood disorders. Disparities were largest for schizophrenia, which also differed across countries.
Median study quality was high (Newcastle-Ottawa Scale score, 8). Higher-quality studies reported larger disparities. Of note, publication bias did not affect the results.
“It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders,” the investigators said.