People with severe mental illness (SMI)—including schizophrenia, bipolar disorder, and other psychotic disorders—have a significantly greater risk of developing multiple physical illnesses in the first few years after their SMI diagnoses compared with people without SMI, according to a report published in Lancet Psychiatry.
“If we are to positively affect the incidence and disability burden of chronic physical health problems in people with severe mental illness, interventions need to start early,” wrote Naomi Launders, M.Sc., David P. J. Osborn, Ph.D., and colleagues at the University College London.
Launders, Osborn, and colleagues used electronic health records from the UK Clinical Practice Research Datalink (a database containing records of patients seen in U.K. primary care practices) to identify patients aged 18 to 100 years who were diagnosed with an SMI between 2000 and 2018. The study included 68,789 patients with SMI who were matched with 274,827 patients without SMI. The authors examined if participants in the SMI group were diagnosed with up to 24 chronic physical health conditions five, three, and one years before and after they were diagnosed with SMI, as well as at the time of their SMI diagnoses; physical conditions in the matched group were tracked over the same period. The physical conditions include cancer, diabetes, asthma, hypertension, and HIV/AIDS.
At the time of their first SMI diagnoses, 43% of patients with SMI had at least one chronic physical health problem, compared with 38% of the matched group. The most prevalent conditions among SMI patients were asthma, hypertension, diabetes, neurological disease, and hypothyroidism. Five years later, 57% of patients with SMI had one or more physical health condition, compared with 47% of patients without SMI.
Patients with schizophrenia were at higher risk of five of the physical health conditions compared with the matched group at the time of diagnosis. Five years later, these patients had a greater risk of 13 of the physical health conditions, including nearly three times the risk of neurological disease and twice the risk of diabetes. Patients with bipolar disorder or other psychotic disorders had a higher risk of 15 of the physical health conditions compared with the matched group at the time of diagnosis. Five years later, patients with bipolar had a higher risk of 19 conditions, including nearly three times the risk of hypothyroidism and neurological disease, and patients with other psychotic disorders had a higher risk of 16 physical conditions, including nearly four times the risk of neurological disease.
“Chronic physical health problems should not be viewed as the inevitable result of psychotropic medication’s adverse effects and long-term health risk factors such as poor diet, smoking, or drug or alcohol misuse, because many of these conditions are present at the point of severe mental illness diagnosis first being recorded,” the authors concluded. “Potentially, interventions targeted at improving the physical health of people with severe mental illness have been initiated too late relative to disease progression, and we need to consider early intervention for physical health as well as mental health in this population.”
For related information, see the Psychiatric Services article “Improving Physical Health Among People With Serious Mental Illness: The Role of the Specialty Mental Health Sector.”
(Image: iStock/Charday Penn)
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