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Managing co-occurring physical disorders in mental health care 

Managing co-occurring physical disorders in mental health care
Managing co-occurring physical disorders in mental health care
Oxford Textbook of Community Mental Health

Delia Cimpean

and Bob Drake


Individuals with serious mental illness (SMI) have increased rates of medical comorbidity. The most common serious medical conditions in this population include cardiovascular disease, cardiovascular risk conditions (obesity, hyperlipidaemia, type 2 diabetes), and blood-borne viral infections. The cluster of cardiovascular risk factors that includes high body-mass index (BMI), high blood pressure, high blood sugar and cholesterol, sometimes called metabolic syndrome, is found in 35 % to 63 % of people with schizophrenia and is associated with a fivefold increase in risk of diabetes and twofold increased cardiovascular risk.

As consequences of high rates of medical comorbidity, people with SMI have greatly reduced physical functioning, are vulnerable to early institutionalization in nursing homes, experience worse mental health outcomes, and ultimately, high levels of early mortality, especially cardiovascular mortality. Indeed, on average, people with SMI have 30-year shorter lifespans compared to people of the same age without mental illness (Dickey et al., 2002; Miller et al., 2006).

Morbidity, disability, and early mortality observed in people with SMI are outcomes that resemble that of people 20 years older in the general population. In other populations with premature aging or ‘weathering’, chronic pervasive socioeconomic stress was associated with increased allostatic load, measured by several cardiovascular, metabolic, and inflammatory biomarkers (Bird et al., 2010; Geronimus et al., 2006). Similarly, people with SMI are subjected to pervasive stress, such as poverty, unemployment, homelessness, and overt or subtle chronic stigma and discrimination. Over the course of a lifetime, psychological and physiological response to pervasive stress and the high effort required for coping, produce premature aging of people with SMI. This underlines the importance of coupling socioeconomic measures to the health improvement programmes to address the high medical burden and early mortality of people with SMI.

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