Severe mental illness patients give physical health low priority
MedWire News: Patients with severe mental illness (SMI) are less likely than other psychiatric patients to see physical health as a priority, say UK researchers who call for greater emphasis on health promotion and awareness of modifiable risk factors among such patients.
Compared with the general population, patients with SMI, such as schizophrenia-spectrum disorders and bipolar disorder, have markedly increased rates of morbidity and mortality particularly from coronary heart disease and stroke. While lifestyle habits and access to medical care play a role, they do not fully explain the increased risk.
To examine how SMI patients perceive their global physical health and and their motivation to change high-risk behaviors, Kurt Buhagiar and colleagues from University College London Medical School studied 52 SMI patients and 94 patients with non-psychotic mental illness.
The participants completed a general physical health questionnaire, a health and lifestyle questionnaire, items from the Camberwell Assessment of Need questionnaire, and the Multidimensional Health Locus of Control questionnaire. Data on age, gender, self-reported smoking status, and socioeconomic and demographic variables were also gathered.
Of the SMI patients, 65.4% had schizophrenia, 7.7% had schizoaffective disorder, and 26.9% had bipolar affective disorder. In the non-psychotic mental illness group, 69.1% had unipolar depression, 14.9% had anxiety disorder, and 16.0% had personality disorder.
There were no significant differences between the two groups in the proportion who described their overall physical health as "excellent," "very good," or good." They had similar responses on their perceived likelihood of a myocardial infarction in the next 10 years.
SMI patients were significantly more likely than non-psychotic mental illness patients to smoke, and significantly less likely to have attempted to increase their level of exercise, at odds ratios of 4.0 and 0.2, respectively. Almost all participants from both groups reported not getting enough exercise, and having a poor diet.
The team reports in the journal BMC Psychiatry that SMI patients were significantly less likely to rank physical health, accommodation, and friends and family as one of their top four priorities than other patients, at odds ratios of 0.5, 0.4, and 0.2, respectively. These differences did not remain significant after taking into account confounding variables.
Nevertheless, SMI patients were more likely to regard their mental health as a main priority than non-psychotic mental illness patients, at an odds ratio of 2.2. SMI patients were also significantly more likely to place the locus of control on others and chance.
"This finding could provide an important focus of clinical intervention, as it places healthcare professionals in a very favourable position to exert their influence by means of health promotion and active therapeutic interventions that reduce modifiable risk factors for physical disease and improve outcomes," the researchers conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Liam Davenport