Mental illness a barrier to cardiac care

In a first-ever study of the role mental illness plays in cardiovascular care, a team of Yale psychiatric and public health experts found that mentally ill patients receive significantly fewer cardiovascular procedures following a heart attack than other patients. Previous studies have shown that race and gender are important factors in the treatment of cardiovascular patients, but this is the first study to show that mental health also plays an important role in cardiovascular care unrelated to the patient’s other health and social issues.

The study’s findings, which appeared in the January 26 issue of the Journal of the American Medical Association, showed that a mental disorder reduces a patient’s chances of receiving otherwise standard cardiovascular procedures, including angioplasty, coronary-bypass surgery, and cardiac catheterization, by up to 32 percent. According to the director of the study, Benjamin G. Druss, M.D., M.P.H. ’95, assistant professor of psychiatry and of public health, “It’s analogous to findings in the race and gender literature about differences in practices. This difference in care was not based on the severity of cardiac illness, or socioeconomic, hospital or regional differences between groups.” The study looked at a range of serious mental disorders, including schizophrenia, anxiety, depression and substance abuse. “We saw a similar pattern across the spectrum,” said Druss.

The causes for the differences in care are not entirely clear. “It’s complicated,” said Druss. “Our best guess is that it’s something going on at the level of the patient-provider interaction. There’s obviously something going on that merits a closer look, and efforts should be made to raise patients’ and physicians’ consciousness about the issue.”

Druss is now leading follow-up studies looking into longer-term outcomes and quality of care for patients with mental illness and ways of overcoming barriers to their care.