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Study shows poorer health care for Ontarians living with schizophrenia and diabetes

CAMH Discovers: News from CAMH Research and the Campbell Family Mental Health Research Institute
Research Roundup​​​​​​​​​​​​​​​

​Study shows poorer health care for Ontarians living with schizophrenia and diabetes​


A study by researchers at the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES) highlights the urgent need for individuals with severe mental illness to receive better, integrated health care for their co-existing diabetes condition.

Dr. Paul KurdyakPublished in General Hospital Psychiatry, the study was based on records of more than one million Ontarians with diabetes, of whom 2.3 per cent had schizophrenia. These latter individuals faced poorer quality of care compared to other people with diabetes. On average, the lives of these individuals are 15 to 20 years shorter than individuals without a serious mental illness, and this reduced life span has been attributed to cardiovascular illnesses, with diabetes being a major risk factor.

“There is no question that we simply have to do better to integrate mental and physical health care for these individuals,” says Dr. Paul Kurdyak, lead​ author of the study and Clinician Scientist with the Institute for Mental Health Policy Research and Medical Director of Performance Improvement at CAMH. Dr. Kurdyak is also Director of Health Outcomes with the Medical Psychiatry Alliance, and Lead of the Mental Health and Addictions Research Program at ICES.

Worse outcomes, more hospitalizations

Researchers in this study identified all Ontario residents with diabetes as of April 1, 2011, with and without a diagnosis of schizophrenia. The study looked at the quality of diabetes care provided to both groups and diabetes-related Emergency Department visits and hospitalizations over a two-year period.

Researchers found that individuals with schizophrenia received poorer quality of care for their diabetes, and had worse diabetes-related outcomes. Three out of four did not receive guideline-level diabetes care, versus two out of three individuals without schizophrenia, despite having more access to primary care physicians than those without schizophrenia. They were also 34 per cent more likely to have diabetes-related hospitalizations after researchers adjusted for age, sex, rurality, material deprivation, comorbidities and duration of diabetes.

Need for evidence

“We know that providing high-quality medical and psychiatric care to individuals with both a physical illness and severe mental illness is challenging. We do not have much evidence on how to address these deficits in quality of care or poor outcomes in this population,” says Dr. Kurdyak. “We really need to develop more innovative and integrated ways to address both mental and physical illness in a large population that is burdened by both types of conditions.”

The study, which used population-based data to understand the burden of illness for individuals with a serious mental illness and diabetes, serves as a baseline effort to improve the quality of care for these individuals.

The Medical Psychiatry Alliance – a collaborative health partnership of CAMH, The Hospital for Sick Children, Trillium Health Partners, the University of Toronto, the Ministry of Health and Long-Term Care, and an anonymous donor – is developing interventions to improve the quality of care and quality of life for individuals with mental and physical illnesses. 

The study was supported by the Medical Psychiatry Alliance, ICES and grants from the Ministry of Health and Long-Term Care.​​​​​

​​Preventing diabetes in schizophrenia

CAMH's Dr. Margaret Hahn is conducting research to prevent diabetes and other factors contributing to a higher risk of heart disease among people with schizophrenia. Find out more about Dr. Hahn's research.​​​

Dr. Margaret Hahn

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