It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness.

To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness.

Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders.

People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors.

A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.

The mental health of sexual minority (SM) individuals remains overlooked and understudied in Czechia. We aimed to estimate (1) the prevalence rate and (2) the relative risk of common mental disorders and (3) the mental distress severity among the Czech SM people compared with the heterosexual population. In addition, we aimed to investigate help-seeking for mental disorders in SM people.

We used data from a cross-sectional, nationally representative survey of Czech community-dwelling adults, consisting of 3063 respondents (response rate = 58.62%). We used the Mini-International Neuropsychiatric Interview to assess the presence of mental disorders. In individuals scoring positively, we established help-seeking in the past 12 months. We assessed symptom severity using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. We computed the prevalence of mental disorders and the treatment gap with 95% confidence intervals. To assess the risk of having a mental disorder, we used binary logistic regression.

We demonstrated that the prevalence of current mental disorders was 18.85% (17.43–20.28), 52.27% (36.91–67.63), 33.33% (19.5–47.17) and 25.93% (13.85–38) in heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. Suicidal thoughts and behaviours were present in 5.73% (4.88–6.57), 25.00% (11.68–38.32), 22.92% (10.58–35.25) and 11.11% (2.45–19.77) of heterosexual, gay or lesbian, bisexual and more sexually diverse individuals, respectively. After confounder adjustment, gay or lesbian individuals were more likely to have at least one current mental disorder compared with heterosexual counterparts (odds ratio = 3.51; 1.83–6.76). For bisexual and sexually more diverse individuals, the results were consistent with a null effect (1.85; 0.96–3.45 and 0.89; 0.42–1.73). The mean depression symptom severity was 2.96 (2.81–3.11) in heterosexual people and 4.68 (2.95–6.42), 7.12 (5.07–9.18) and 5.17 (3.38–6.95) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. The mean anxiety symptom severity was 1.97 (1.85–2.08) in heterosexual people and 3.5 (1.98–5.02), 4.63 (3.05–6.2) and 3.7 (2.29–5.11) in gay or lesbian, bisexual and more sexually diverse individuals, respectively. We demonstrated broadly consistent levels of treatment gap in heterosexual and SM individuals scoring positively for at least one current mental disorder (82.91%; 79.5–85.96 vs. 81.13%; 68.03–90.56).

We provide evidence that SM people in Czechia have substantially worse mental health outcomes than their heterosexual counterparts. Systemic changes are imperative to provide not only better and more sensitive care to SM individuals but also to address structural stigma contributing to these health disparities.

To investigate the associations of physical-activity trajectories with the level of cognitive performance (CP) and its decline in adults 50 years of age or older.

We studied 38 729 individuals (63 ± 9 years; 57% women) enrolled in the Survey of Health, Ageing and Retirement in Europe (SHARE). Physical activity was self-reported and CP was assessed based on immediate recall, verbal fluency and delayed recall. Physical-activity trajectories were estimated using growth mixture modelling and linear mixed-effects models were used to investigate the associations between the trajectories and CP.

The models identified two trajectories of physical activity: constantly high physical activity (N = 27 634: 71%) and decreasing physical activity (N = 11 095; 29%). Results showed that participants in the decreasing physical-activity group exhibited a lower level of CP compared to the high physical-activity group (immediate recall: ß = 0.94; 95% confidence interval [CI] = 0.92–0.95; verbal fluency: ß = 0.98; 95% CI = 0.97–0.98; delayed recall: ß = 0.95; 95% CI = 0.94–0.97). Moreover, compared with participants in the constantly high physical-activity group, participants in the decreasing physical-activity group showed a steeper decline in all cognitive measures (immediate recall: ß = −0.04; 95% CI = −0.05 to −0.04; verbal fluency: ß = −0.22; 95% CI = −0.24 to −0.21; delayed recall: ß = −0.04; 95% CI = −0.05 to −0.04).

Physical-activity trajectories are associated with the level and evolution of CP in adults over 50 years. Specifically, our findings suggest that a decline in physical activity over multiple years is associated with a lower level and a steeper decline in CP.

We aimed to assess the changes in public stigma towards people with mental health problems in Czechia; and to investigate the association between these and the exposure to the ongoing mental health care reform and one of its implementation projects focused on reducing stigma.

We analyzed data from three cross-sectional surveys representative of the Czech adult population. We used linear regression models to compare population attitudes and desire for future contact with people with mental health problems between the 2013/2014 baseline and the 2019 follow-up. In our 2019 sample, we employed linear regression models to assess the relationship between exposure to mental health care reform and nation-wide anti-stigma campaign, and population stigmatizing attitudes and intended behavior. We utilized a propensity score matching procedure to mitigate potential bias.

The 2013, 2014, and 2019 datasets consisted of 1797, 1810, and 1077 participants, respectively. Population attitudes improved significantly between 2014 and 2019 (B = 0.99, 95% CI = 0.06; 1.93), but we did not detect a change in population desire for future contact with people with mental health problems. Exposure to the nationwide anti-stigma campaign or mental health care reform was associated with more favorable attitudes (B = 4.25, 95% CI = 2.07; 6.42 and B = 7.66, 95% CI = 3.91; 11.42), but not with higher desire for future contact with people with mental health problems.

Mental health care reform and its nation-wide anti-stigma project seems to have a positive impact on population attitudes, but not on desire for future contact with people with mental health problems.

To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care.

Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied.

The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02–1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97–5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12–3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03–1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist.

The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.

A large variation in cognitive performance exists between European regions. However, it is unclear how older Europeans differ in the rate of cognitive decline.

We analysed data from 22 181 individuals (54% women; median age 71) who participated in the Survey on Health, Ageing and Retirement in Europe. Cognition was measured using tests on verbal fluency, immediate and delayed recall. We used linear regression and linear mixed effects regression to examine regional differences in the level of cognitive performance and the rate of cognitive decline.

Scandinavians had the highest baseline cognitive scores (mean standardized overall cognitive score 0.3), followed by Western Europeans (mean 0.2), Central and Eastern Europeans (mean 0.1) and individuals from Mediterranean countries (mean -0.4). These differences persisted even after adjustment for sociodemographic and clinical characteristics. The annual cognitive decline in Scandinavia (0.59%) was approximately two times greater than in Western Europe (0.28%), Central and Eastern Europe (0.25%) and Mediterranean countries (0.23%).

There are substantial differences in cognitive performance as well as rates of cognitive decline among the elderly throughout European regions. This might be explained by differing levels of cognitive reserve.