Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study
Objectives The impact of non-participation due to psychiatric illness on study outcomes in general population studies is insufficiently investigated. Here, we investigate the mental health bias in a population study and the potential impact on estimates of cardiovascular morbidity and overall surviv...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-07-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/1/e000289.full |
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| author | Christian Torp-Pedersen Mads Rasmussen Christina Ellervik Anders Jorgensen Henrik E Poulsen Zerlina Rygner |
| author_facet | Christian Torp-Pedersen Mads Rasmussen Christina Ellervik Anders Jorgensen Henrik E Poulsen Zerlina Rygner |
| author_sort | Christian Torp-Pedersen |
| collection | DOAJ |
| description | Objectives The impact of non-participation due to psychiatric illness on study outcomes in general population studies is insufficiently investigated. Here, we investigate the mental health bias in a population study and the potential impact on estimates of cardiovascular morbidity and overall survival.Design Data were retrieved from nationwide registries.Setting The Danish General Suburban Population Study (GESUS), a cross-sectional community study conducted in Naestved Municipality, Denmark, from 2010 to 2013.Participants 49 707 subjects invited to participate in GESUS.Main outcome measures Factors related to non-participation were examined using multivariable logistic regression and time-to-event data using Cox proportional hazards models.Results Of 21 203 (43%) participants, 823 (3.9%) had a psychiatric diagnosis. Of 28 504 non-participants, 2453 (8.6%) had a psychiatric diagnosis (OR for non-participation 1.84 (95% CI 1.69 to 2.00)). The most under-represented psychiatric disorders in participants were organic mental disorders (5.76 (3.90 to 8.48)), substance abuse (3.12 (2.14 to 4.54)) and schizophrenia (3.12 (2.33 to 4.18)). Overall, more non-participants used psychotropic drugs than participants (1.26 (1.21 to 1.31)), and psychiatric non-participants had higher psychiatric hospital service utilisation than psychiatric participants. Compared with non-psychiatric participants in a 5-year follow-up, psychiatric non-participants had higher rates of cardiovascular events (HR 2.30 (2.07 to 2.56)) and all-cause mortality (3.37 (3.01 to 3.78)) than non-psychiatric non-participants (1.65 (1.48 to 1.83) and 2.26 (2.02 to 2.54), respectively) and psychiatric participants (1.39 (1.21 to 1.59) and 1.23 (1.05 to 1.44), respectively), pinteraction<0.0001 for both outcomes.Conclusions This study demonstrates a considerable non-participation bias due to psychiatric illness in a general population health study, potentially leading to distorted estimates of somatic morbidity and mortality. Strategies for better-representing individuals with psychiatric illnesses in population health studies are needed. |
| format | Article |
| id | doaj-art-816406ebe69440f9bebf40004de844e2 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-816406ebe69440f9bebf40004de844e22025-01-28T16:05:11ZengBMJ Publishing GroupBMJ Public Health2753-42942024-07-012110.1136/bmjph-2023-000289Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population studyChristian Torp-Pedersen0Mads Rasmussen1Christina Ellervik2Anders Jorgensen3Henrik E Poulsen4Zerlina Rygner5Public Health, University of Copenhagen, Copenhagen, DenmarkEmergency Department, Nykobing Falster Sygehus, Nykobing, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCopenhagen Psychiatric Center, Frederiksberg, Hovedstaden, DenmarkDepartment of Endocrinology, Bispebjerg Hospital, Kobenhavn, DenmarkDepartment of Endocrinology, Bispebjerg Hospital, Kobenhavn, DenmarkObjectives The impact of non-participation due to psychiatric illness on study outcomes in general population studies is insufficiently investigated. Here, we investigate the mental health bias in a population study and the potential impact on estimates of cardiovascular morbidity and overall survival.Design Data were retrieved from nationwide registries.Setting The Danish General Suburban Population Study (GESUS), a cross-sectional community study conducted in Naestved Municipality, Denmark, from 2010 to 2013.Participants 49 707 subjects invited to participate in GESUS.Main outcome measures Factors related to non-participation were examined using multivariable logistic regression and time-to-event data using Cox proportional hazards models.Results Of 21 203 (43%) participants, 823 (3.9%) had a psychiatric diagnosis. Of 28 504 non-participants, 2453 (8.6%) had a psychiatric diagnosis (OR for non-participation 1.84 (95% CI 1.69 to 2.00)). The most under-represented psychiatric disorders in participants were organic mental disorders (5.76 (3.90 to 8.48)), substance abuse (3.12 (2.14 to 4.54)) and schizophrenia (3.12 (2.33 to 4.18)). Overall, more non-participants used psychotropic drugs than participants (1.26 (1.21 to 1.31)), and psychiatric non-participants had higher psychiatric hospital service utilisation than psychiatric participants. Compared with non-psychiatric participants in a 5-year follow-up, psychiatric non-participants had higher rates of cardiovascular events (HR 2.30 (2.07 to 2.56)) and all-cause mortality (3.37 (3.01 to 3.78)) than non-psychiatric non-participants (1.65 (1.48 to 1.83) and 2.26 (2.02 to 2.54), respectively) and psychiatric participants (1.39 (1.21 to 1.59) and 1.23 (1.05 to 1.44), respectively), pinteraction<0.0001 for both outcomes.Conclusions This study demonstrates a considerable non-participation bias due to psychiatric illness in a general population health study, potentially leading to distorted estimates of somatic morbidity and mortality. Strategies for better-representing individuals with psychiatric illnesses in population health studies are needed.https://bmjpublichealth.bmj.com/content/2/1/e000289.full |
| spellingShingle | Christian Torp-Pedersen Mads Rasmussen Christina Ellervik Anders Jorgensen Henrik E Poulsen Zerlina Rygner Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study BMJ Public Health |
| title | Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study |
| title_full | Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study |
| title_fullStr | Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study |
| title_full_unstemmed | Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study |
| title_short | Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study |
| title_sort | impact of non participation bias due to psychiatric illness on mortality and cardiovascular event estimates a danish longitudinal population study |
| url | https://bmjpublichealth.bmj.com/content/2/1/e000289.full |
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