Skip to main content

Advertisement

SpringerLink
Log in

The prevalence of physical multimorbidity among people with non-affective psychotic disorders 10 years after first diagnosis: a matched retrospective cohort study

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Aims

The higher prevalence of chronic physical health conditions among people with psychotic disorders may result in a reduced life expectancy as compared to the general population. More research is needed on the risk of multiple co-occurring chronic health conditions, known as multimorbidity, for people with psychotic disorders.

Methods

We conducted a matched retrospective cohort study to quantify the prevalence of multimorbidity and associated factors among people with psychotic disorders over the 10-year period following first diagnosis, relative to those without psychosis. Data from an early psychosis intervention program in London, Canada were linked to population-based health administrative data to identify patients with first-episode psychosis (n = 439), and a comparison group from the general population (n = 1759) matched on age, sex, and postal code. We followed the cohort for 10 years to ascertain the prevalence of multimorbidity. We compared people with and without psychosis using modified Poisson regression models, and explored risk factors for multimorbidity among those with psychotic disorders.

Results

People with psychotic disorders may have a 26% higher prevalence of multimorbidity 10 years following first diagnosis, although our findings include the possibility of a null effect (PR = 1.26, 95% CI 0.96–1.66). People with psychosis living in areas with the highest levels of material deprivation had a threefold higher prevalence of multimorbidity as compared to those in the lowest areas of material deprivation (PR = 3.09, 95% CI 1.21–7.90).

Conclusion

Multimorbidity is prevalent among those with psychosis, and assessment for chronic health conditions should be integrated into clinical care for younger populations with psychotic illness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Foley DL (2018) Multiple indicators of ill health are evident in people with psychosis. Evid Based Ment Heal 21:e1 LP-e2. https://doi.org/10.1192/bjp.bp.112.123943

  2. Lee EE, Liu J, Tu X et al (2018) A widening longevity gap between people with schizophrenia and general population: a literature review and call for action. Schizophr Res 196:9–13

    Article  PubMed  Google Scholar 

  3. De Hert M, Correll CU, Bobes J et al (2011) Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10:52–77

    Article  Google Scholar 

  4. Meyer JM, Davis VG, Goff DC et al (2008) Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: prospective data from phase 1. Schizophr Res 101:273–286

    Article  PubMed  PubMed Central  Google Scholar 

  5. Smith M, Hopkins D, Peveler RC et al (2008) First-v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 192:406–411

    Article  CAS  PubMed  Google Scholar 

  6. Kalman D, Morissette SB, George TP (2005) Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict 14:106–123

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stubbs B, Williams J, Gaughran F, Craig T (2016) How sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr Res 171:103–109

    Article  PubMed  Google Scholar 

  8. Foley DL, Morley KI (2011) Systematic review of early cardiometabolic outcomes of the first treated episode of psychosis. Arch Gen Psychiatry 68:609–616

    Article  PubMed  Google Scholar 

  9. Mitchell AJ, Vancampfort D, De Herdt A et al (2013) Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophr Bull 39:295–305. https://doi.org/10.1093/schbul/sbs082

    Article  PubMed  Google Scholar 

  10. Filipcic IS, Ivezic E, Jaksic N et al (2019) Gender differences in early onset of chronic physical multimorbidities in schizophrenia spectrum disorder: Do women suffer more? Early Interv Psychiatry. https://doi.org/10.1111/eip.12867

    Article  PubMed  Google Scholar 

  11. Smith DJ, Langan J, McLean G et al (2013) Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ Open 3:e002808

    Article  PubMed  PubMed Central  Google Scholar 

  12. Salisbury C, Johnson L, Purdy S, Valderas JM (2011) Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 61:e12–e21. https://doi.org/10.3399/bjgp11X548929

    Article  PubMed  Google Scholar 

  13. Agborsangaya CB, Lau D, Lahtinen M et al (2012) Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health 12:201

    Article  PubMed  PubMed Central  Google Scholar 

  14. Moreno C, Nuevo R, Chatterji S et al (2013) Psychotic symptoms are associated with physical health problems independently of a mental disorder diagnosis: results from the WHO World Health Survey. World Psychiatry 12:251–257. https://doi.org/10.1002/wps.20070

    Article  PubMed  PubMed Central  Google Scholar 

  15. Strassnig M, Harvey P, Holden J, et al (2019) O6.6. Real world sedentary behavior and activity levels in schizophrenia patients and healthy controls derived from ecological momentary assessment. In: Schizophrenia Bulletin, 2019/04/09. Oxford University Press, pp S178–S178

  16. Owen N, Sparling PB, Healy GN et al (2010) Sedentary behavior: emerging evidence for a new health risk. Mayo Clin Proc 85:1138–1141. https://doi.org/10.4065/mcp.2010.0444

    Article  PubMed  PubMed Central  Google Scholar 

  17. Multimorbidity Technical Working Group (2012) Summary Report: Technical Meeting: Measurement of Multimorbidity for Chronic Disease Surveillance in Canada

  18. Lehnert T, Heider D, Leicht H et al (2011) Health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev 68:387–420

    Article  PubMed  Google Scholar 

  19. Sinnott C, Mc Hugh S, Browne J, Bradley C (2013) GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open 3:e003610

    Article  PubMed  PubMed Central  Google Scholar 

  20. Makovski TT, Schmitz S, Zeegers MP et al (2019) Multimorbidity and quality of life: systematic literature review and meta-analysis. Ageing Res Rev. https://doi.org/10.1016/j.arr.2019.04.005

    Article  PubMed  Google Scholar 

  21. Rodrigues M, Wiener JC, Stranges S, et al (2020) The risk of physical multimorbidity in people with psychotic disorders: A systematic review and meta-analysis. J Psychosom Res 110315

  22. Fortin M, Almirall J, Nicholson K (2017) Development of a research tool to document self-reported chronic conditions in primary care. JOC. https://doi.org/10.15256/joc.2017.7.122.285

  23. Ryan BL, Jenkyn KB, Shariff SZ et al (2018) Beyond the grey tsunami: a cross-sectional population-based study of multimorbidity in Ontario. Can J Public Heal 109:845–854

    Article  Google Scholar 

  24. Benchimol EI, Smeeth L, Guttmann A et al (2015) The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 12:e1001885. https://doi.org/10.1371/journal.pmed.1001885

    Article  PubMed  PubMed Central  Google Scholar 

  25. ICES (2020) About ICES. https://www.ices.on.ca/About-ICES. Accessed 14 Apr 2020

  26. Norman RMG, Manchanda R (2016) Prevention and early intervention program for psychoses (PEPP). Heal Q 18:37–41

    Article  Google Scholar 

  27. ElTayebani M, ElGamal M, Roshdy R, Al-Khadary S (2014) Gender difference in affective and nonaffective psychosis. Egypt J Psychiatry 35:45

    Article  Google Scholar 

  28. Chen Y, Farooq S, Edwards J et al (2019) Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records. BMC Med 17:227. https://doi.org/10.1186/s12916-019-1462-y

    Article  PubMed  PubMed Central  Google Scholar 

  29. George M, Maheshwari S, Chandran S et al (2017) Understanding the schizophrenia prodrome. Indian J Psychiatry 59:505–509. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_464_17

    Article  PubMed  PubMed Central  Google Scholar 

  30. Feely A, Lix LM, Reimer K (2017) Estimating multimorbidity prevalence with the Canadian chronic disease surveillance system. Heal Promot Chronic Dis Prev Canada Res policy Pract 37:215

    Google Scholar 

  31. Roberts KC, Rao DP, Bennett TL et al (2015) Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada. Heal Promot Chronic Dis Prev Canada Res policy Pract 35:87–94

    CAS  Google Scholar 

  32. Matheson FI, van Ingen T (2018) 2016 Ontario marginalization index: user guide. St. Michael’s Hospital. Joint publication with Public Health Ontario, Toronto

    Google Scholar 

  33. Moin JS, Moineddin R, Upshur REG (2018) Measuring the association between marginalization and multimorbidity in Ontario, Canada: A cross-sectional study. J Comorbidity 8:2235042X18814939. https://doi.org/10.1177/2235042X18814939

  34. Köhler O, Horsdal HT, Baandrup L et al (2016) Association between Global Assessment of Functioning scores and indicators of functioning, severity, and prognosis in first-time schizophrenia. Clin Epidemiol 8:323–332. https://doi.org/10.2147/CLEP.S109036

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ministry of Community and Social Services (2016) Monthly reports: OW and ODSP

  36. Rosenheck RA, Estroff SE, Sint K et al (2017) Incomes and outcomes: social security disability benefits in first-episode psychosis. Am J Psychiatry 174:886–894. https://doi.org/10.1176/appi.ajp.2017.16111273

    Article  PubMed  Google Scholar 

  37. Stata (2021) Stata version 17.0 [computer program]. Coll. Station. Tex Stata Corp

  38. Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702–706. https://doi.org/10.1093/aje/kwh090

    Article  PubMed  Google Scholar 

  39. Hardt J, Herke M, Leonhart R (2012) Auxiliary variables in multiple imputation in regression with missing X: a warning against including too many in small sample research. BMC Med Res Methodol 12:184. https://doi.org/10.1186/1471-2288-12-184

    Article  PubMed  PubMed Central  Google Scholar 

  40. Fortin M, Bravo G, Hudon C et al (2005) Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 3:223–228. https://doi.org/10.1370/afm.272

    Article  PubMed  PubMed Central  Google Scholar 

  41. Stubbs B, De Hert M, Sepehry AA et al (2014) A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia. Acta Psychiatr Scand 130:470–486. https://doi.org/10.1111/acps.12313

    Article  CAS  PubMed  Google Scholar 

  42. Carney CP, Jones L, Woolson RF (2006) Medical comorbidity in women and men with schizophrenia. J Gen Intern Med 21:1133–1137

    Article  PubMed  PubMed Central  Google Scholar 

  43. Varghese D, Scott J, Welham J et al (2011) Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophr Bull 37:389–393. https://doi.org/10.1093/schbul/sbp083

    Article  PubMed  Google Scholar 

  44. Gontijo Guerra S, Berbiche D, Vasiliadis H-M (2019) Measuring multimorbidity in older adults: comparing different data sources. BMC Geriatr 19:166. https://doi.org/10.1186/s12877-019-1173-4

    Article  PubMed  PubMed Central  Google Scholar 

  45. Viron MJ, Stern TA (2010) The impact of serious mental illness on health and healthcare. Psychosomatics 51:458–465. https://doi.org/10.1016/S0033-3182(10)70737-4

    Article  PubMed  Google Scholar 

  46. Stubbs B, Ku P-W, Chung M-S, Chen L-J (2017) Relationship between objectively measured sedentary behavior and cognitive performance in patients with schizophrenia vs controls. Schizophr Bull 43:566–574. https://doi.org/10.1093/schbul/sbw126

    Article  PubMed  Google Scholar 

  47. Fortin M, Stewart M, Poitras M-E et al (2012) A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 10:142–151

    Article  PubMed  PubMed Central  Google Scholar 

  48. Quiñones AR, Botoseneanu A, Markwardt S et al (2019) Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS ONE 14:e0218462

    Article  PubMed  PubMed Central  Google Scholar 

  49. Penttilä M, Jääskeläinen E, Hirvonen N et al (2014) Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 205:88–94. https://doi.org/10.1192/bjp.bp.113.127753

    Article  PubMed  Google Scholar 

  50. Tonelli M, Wiebe N, Fortin M et al (2015) Methods for identifying 30 chronic conditions: application to administrative data. BMC Med Inform Decis Mak 15:31. https://doi.org/10.1186/s12911-015-0155-5

    Article  PubMed  PubMed Central  Google Scholar 

  51. Huntley AL, Johnson R, Purdy S et al (2012) Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med 10:134–141. https://doi.org/10.1370/afm.1363

    Article  PubMed  PubMed Central  Google Scholar 

  52. Lambert L, Blais C, Hamel D et al (2012) Evaluation of care and surveillance of cardiovascular disease: can we trust medico-administrative hospital data? Can J Cardiol 28:162–168. https://doi.org/10.1016/j.cjca.2011.10.005

    Article  PubMed  Google Scholar 

  53. Perry MJ (1996) The relationship between social class and mental disorder. J Prim Prev 17:17–30

    Article  CAS  PubMed  Google Scholar 

  54. Anderson KK, Norman R, MacDougall AG et al (2018) Disparities in access to early psychosis intervention services: comparison of service users and nonusers in health administrative data. Can J Psychiatry 63:395–403

    Article  PubMed  PubMed Central  Google Scholar 

  55. Langan J, Mercer SW, Smith DJ (2013) Multimorbidity and mental health: can psychiatry rise to the challenge? Br J Psychiatry 202:391–393. https://doi.org/10.1192/bjp.bp.112.123943

    Article  PubMed  Google Scholar 

  56. Knaak S, Mantler E, Szeto A (2017) Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum. SAGE Publications Sage CA, Los Angeles, pp 111–116

    Google Scholar 

Download references

Acknowledgements

This work was supported by a grant from the Canadian Institutes for Health Research (#153022), an Early Researcher Award from the Ontario Ministry of Research, Innovation, and Science (KKA), and the Dr. Carol Buck Graduate Scholarship in Epidemiology from the Department of Epidemiology and Biostatistics at Western University (MR).

Funding

Role of the funding source: none.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada

    Myanca Rodrigues, Saverio Stranges, Bridget L. Ryan & Kelly K. Anderson

  2. Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada

    Saverio Stranges & Bridget L. Ryan

  3. Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg

    Saverio Stranges

  4. Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Canada

    Kelly K. Anderson

Authors
  1. Myanca Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Saverio Stranges
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bridget L. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kelly K. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kelly K. Anderson.

Ethics declarations

Conflict of interest

Declaration of interest: none.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOC 193 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rodrigues, M., Stranges, S., Ryan, B.L. et al. The prevalence of physical multimorbidity among people with non-affective psychotic disorders 10 years after first diagnosis: a matched retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 57, 495–503 (2022). https://doi.org/10.1007/s00127-021-02157-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-021-02157-y

Keywords

Search

Navigation