The Poor General Health of the Severely Mentally Ill: Impact of Schizophrenic Diagnosis
10.1007/s10597-005-2651-z Cite this article as: Chafetz, R.N.L., White, R.N.M.C., Collins-Bride, R.N.G. et al. Community Ment Health J (2005) 41: 169. doi:10.1007/s10597-005-2651-z Abstract
This study focused on poor health among the severely mentally ill and additional risks associated with schizophrenia. Records of 781 clients in short-term residential treatment programs provided data. The schizophrenic subgroup was compared to others in bivariate analyses, with significant findings included in logistic regression. Those with schizophrenia were more likely to be male, unemployed, and insured by MediCal/Medicare. Most health problems occurred at similar rates across diagnoses, reflecting common environmental risk factors. Those with schizophrenia had less substance abuse and fewer liver conditions, but more diabetes and chronic respiratory problems. Implications for providers and for research are discussed.
Keywords schizophrenia severe mental illness medical co-morbidity diabetes respiratory risk factors
This work was partially supported by grants from the Bureau of Health Professions (Chafetz and Collins-Bride, Adult Nurse Practitioners for Severely Mentally Ill Adults, D24 NU 00777, 1997–2001); and the National Institute for Nursing Research (Chafetz and White, Clinical Trial of Wellness Training for the Mentally Ill, RO1-NRO5350, 2000–2005).
References Blank, M. B., Mandell, D. S., Aiken, L., Hadley, T. R. 2002 Co-occurrence of HIV and serious mental illness among Medicaid recipients Psychiatric Services 53 868 873 CrossRef PubMed Brown, S., Inskip, H., Barraclough, B. 2000 Causes of the excess mortality of schizophrenia British Journal of Psychiatry 177 212 217 CrossRef PubMed Cradock-O’Leary, J., Young, A. S., Yano, E. M., Wang, M., Lee, M. L. 2002 Use of general medical services by VA patients with psychiatric disorders Psychiatric Services 53 874 878 CrossRef PubMed Dickerson, F. B., Ringel, N., Parente, F. 1999 Predictors of residential independence among outpatients with schizophrenia Psychiatric Services 50 515 519 PubMed Dickey, B., Normand, S. L., Weiss, R. D., Drake, R. E., Azeni, H. 2002 Medical morbidity, mental illness, and substance use disorders Psychiatric Services 53 861 867 CrossRef PubMed Dixon, L., Postrado, L., Delahanty, J., Fischer, P. J., Lehman, A. 1999 The association of medical co-morbidity in schizophrenia with poor physical and mental health Journal of Nervous and Mental Disease 187 496 502 CrossRef PubMed Dixon, L., Weiden, P., Delahanty, J., Goldberg, R., Postrado, L., Lucksted, A., Lehman, A. 2000 Prevalence and correlates of diabetes in national schizophrenia samples Schizophrenia Bulletin 26 903 912 PubMed Druss, B. G., Bradford, W. D., Rosenheck, R. A., Radford, M. J., Krumholz, H. M. 2000 Mental disorders and use of cardiovascular procedures after myocardial infarction The Journal of the American Medical Association 283 506 511 CrossRef Druss, B. G., Bradford, W. D., Rosenheck, R. A., Radford, M. J., Krumholz, H. M. 2001 Quality of medical care and excess mortality in older patients with mental disorders Archives of General Psychiatry 58 565 572 CrossRef PubMed Fields, S. L., et al. 1995 Progress Foundation, San Francisco Warner, R. eds. Alternatives to the hospital for acute psychiatric treatment. American Psychiatric Press Washington DC 57 73 Folsom, D. P., McCahill, M., Bartels, S. J., Lindamer, L. A., Ganiats, T. G., Jeste, D. V. 2002 Medical comorbidity and receipt of medical care by older homeless people with schizophrenia or depression Psychiatric Services 53 1456 1460 CrossRef PubMed Gelberg, L., Doblin, B. H., Leake, B. D. 1996 Ambulatory health services provided to low-income and homeless adult patients in a major community health center Journal of General Internal Medicine 11 156 162 PubMed Hampton, M. D., Chafetz, L. 2002 Factors associated with residential placement in an assertive community treatment program Issues in Mental Health Nursing 23 677 689 CrossRef PubMed Hannerz, H., Borga, P. 2000 Mortality among persons with a history as psychiatric inpatients with functional psychosis Social Psychiatry and Psychiatric Epidemiology 35 380 387 CrossRef PubMed Hansen, V., Jacobsen, B. K., Arnesen, E. 2001 Cause-specific mortality in psychiatric patients after deinstitutionalisation British Journal of Psychiatry 199 438 443 CrossRef Harris, E. C., Barraclough, B. 1998 Excess mortality of mental disorder British Journal of Psychiatry 17 11 53 CrossRef Havassy, B. E., Arns, P. G. 1998 Relationship of cocaine and other substance dependence to well-being of high-risk psychiatric patients Psychiatric Services 49 935 940 PubMed Hoyer, E. H., Mortensen, P. B., Olesen, A. V. 2000 Mortality and causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993 British Journal of Psychiatry 176 76 82 CrossRef PubMed Joukamaa, M., Heliovaara, M., Knekt, P., Aromaa, A., Raitasalo, R., Lehtinen, V. 2001 Mental disorders and cause-specific mortality British Journal of Psychiatry 179 498 502 CrossRef PubMed Kane, J. M. 2003 Oral ziprasidone in the treatment of schizophrenia: a review of short-term trials Journal of Clinical Psychiatry 64 19 25 PubMed Kessler, R. C., Crum, R. M., Warner, L. A., Nelson, C. B., Schulenberg, J., Anthony, J. C. 1997 Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey Archives of General Psychiatry 54 313 321 PubMed Lawrence, D. M., Holman, C. D., Jablensky, A. V., Hobbs, M. S. 2003 Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998 British Journal of Psychiatry 182 31 36 CrossRef PubMed Lawrence, D., Jablensky, A. V., Holman, C. D. J., Pinder, T. J. 2000 Mortality in Western Australian psychiatric patients Social Psychiatry Psychiatric Epidemiology 35 341 347 CrossRef Lyon, E. 1999 A review of the effects of nicotine on schizophrenia and anti-psychotic medications Psychiatric Services 50 1346 1350 PubMed Melkersson, K., Dahl, M. L. 2004 Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications Drugs 64 701 723 PubMed Osby, U., Brandt, L., Correia, N., Ekbom, A., Sparen, P. 2001 Excess mortality in bipolar and unipolar disorder in Sweden Archives of General Psychiatry 58 844 850 CrossRef PubMed Osby, U., Correia, N., Brandt, L., Ekbom, A., Sparen, P. 2000 Mortality and causes of death in schizophrenia in Stockholm county, Sweden Schizophrenia Research 45 21 28 CrossRef PubMed Osher, F. C., Goldberg, R. W., McNary, S. W., Swartz, M. S., Essock, S. M., Butterfield, M. I., et al. 2003 Five-Site Health and Risk Study Research Committee. Substance abuse and the transmission of hepatitis C among persons with severe mental illness Psychiatric Services 54 842 847 CrossRef PubMed Pandiani, J. A., Banks, S. M., Bramley, J., Moore, R. 2002 Mortality of mental health service recipients in Vermont and Oklahoma Psychiatric Services 53 1025 1027 CrossRef PubMed Potkin, S. G., Saha, A. R., Kujawa, M. J., Carson, W. H., Ali, M., Stock, E., Stringfellow, J., Ingenito, G., Marder, S. R. 2003 Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs. placebo in patients with schizophrenia and schizoaffective disorder Archives of General Pshychiatry 60 681 690 CrossRef
Progress Foundation (1997–1998). Unpublished data. San Francisco, California.
Ryan, M. C., Collins, P., Thakore, J. H. 2003 Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia The American Journal of Psychiatry 160 284 289 CrossRef PubMed Ryan, M. C., Thakore, J. H. 2002 Physical consequences of schizophrenia and its treatment: the metabolic syndrome Life Sciences 71 239 257 CrossRef PubMed Segal, S. P., Vandervoort, D. J., Liese, L. H. 1993 Residential status and the physical health of a mentally ill population Health Social Work 18 208 214 PubMed Sernyak, M. J., Leslie, D. L., Alarcon, R. D., Losonczy, M. F., Rosenheck, R. 2002 Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia American Journal of Psychiatry 159 561 566 CrossRef PubMed White, M. C., Tulsky, J. P., Dawson, C., Zolopa, A. R., Moss, A. R. 1997 Association between time homeless and perceived health status among the homeless in San Francisco Journal of Community Health 22 271 282 CrossRef PubMed Wirshing, D. A., Pierre, J. M., Erhart, S. M., Boyd, J. A. 2003 Understanding the new and evolving profile of adverse drug effects in schizophrenia The Psychiatric Clinics of North America 26 165 190 CrossRef PubMed