Early Intervention for physical comorbidity in patients with mental illness reduces premature mortality

Early intervention on various physical health parameters is important to lessen morbidity and premature mortality in severe mental illness patients as per a study published in the journal "The Lancet Psychiatry, 2022." 

Past Literature shows that individuals with severe mental illness, have an increased prevalence of chronic physical health problems. The temporal relationship between physical disease acquisition and diagnosis of a severe mental illness is not clear despite the increased rates of physical health problems in people with schizophrenia, bipolar disorder, and other psychotic illnesses. So, researchers from the U.K. conducted a study to determine the cumulative prevalence of 24 chronic physical conditions in people with severe mental illness from 5 years before to 5 years after their diagnosis. 

Using the UK Clinical Practice Research Datalink (CPRD), a cohort study was performed on patients aged 18–100 years who were diagnosed with severe mental illness between Jan 1, 2000, and Dec 31, 2018. Patients with severe mental illness were matched with up to four individuals without severe mental illness from the CPRD by sex, 5-year age band, primary care practice, and year of primary care practice registration. Individuals in the matched cohort were assigned an index date equal to the date of severe mental illness diagnosis in patients with severe mental illness to whom they were matched. The cumulative prevalence of 24 physical health conditions, based on the Charlson and Elixhauser comorbidity indices, at 5 years, 3 years, and 1 year before and after severe mental illness diagnosis and at the time of diagnosis was the primary outcome. After adjusting for key variables such as age, sex, and ethnicity, logistic regression was used to compare people with severe mental illness with the matched cohort. 

Results: 

• 68,789 patients diagnosed with a severe mental illness were matched to 2,74,827 patients without a severe mental illness diagnosis.
• The median age in both cohorts was 40·90 years.
• 1,75,138 (50·97%) people were male, and 1,68,478 (49·03%) were female.
• The majority of patients were of White ethnicity. 
• The most prevalent conditions at the time of diagnosis in people with severe mental illness were asthma, hypertension, diabetes, neurological disease, and hypothyroidism.
• At diagnosis, people with schizophrenia had increased odds of five of 24 chronic physical conditions compared with matched controls, and nine of 24 conditions were diagnosed less frequently than in matched controls.
• Individuals with bipolar disorder and other psychoses had increased odds of 15 conditions at diagnosis.
• At 5 years after severe mental illness diagnosis, these numbers had increased to 13 conditions for schizophrenia, 19 for bipolar disorder, and 16 for other psychoses. 

Thus, the researchers finally concluded that due to the increased odds of multiple conditions at the time of severe mental illness diagnosis, early intervention in physical health is necessary to reduce morbidity and premature mortality. They also mentioned that relative to patients with other severe mental illness subtypes some physical conditions might be under-recorded in patients with schizophrenia. 

To read the full article, click here: https://doi.org/10.1016/S2215-0366(22)00225-5 

Launders N, Kirsh L, Osborn DPJ, Hayes JF. The temporal relationship between severe mental illness diagnosis and chronic physical comorbidity: a UK primary care cohort study of disease burden over 10 years. The Lancet Psychiatry. Published online July 2022.