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Disease Burden Among Individuals with Severe Mental Illness in a Community Setting

Community Mental Health Journal volume 52, pages 424–432 (2016)Cite this article

Abstract

This study examines the prevalence of comorbid physical health conditions within a community sample of individuals with severe mental illness (SMI), compares them to a matched national sample without SMI, and identifies which comorbidities create the greatest disease burden for those with SMI. Self-reported health status, co-morbid medical conditions and perceived disease burden were collected from 203 adults with SMI. Prevalence of chronic health conditions was compared to a propensity-matched sample without SMI from the National Comorbidity Survey-Replication (NCS-R). Compared to NCS-R sample without SMI, our sample with SMI had a higher prevalence of seven out of nine categories of chronic health conditions. Chronic pain and headaches, as well as the number of chronic conditions, were associated with increased disease burden for individuals with SMI. Further investigation of possible interventions, including effective pain management, is needed to improve the health status of this population.

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Notes

  1. Random selection was employed to ensure that potential participants would not be included in or excluded from participating in this study on the basis of psychological functioning, service utilization history, standing at the CMHC (beyond being an active client) or any other demographic factor. The methodological benefit of drawing the sample directly from the mental health services board, as opposed to drawing it directly from the CMHC, is that CMHC administrators and staff were not involved in the selection of potential study participants.

References

  • Birgenheir, D. G., Ilgen, M. A., Bohnert, A. S. B., Abraham, K. M., Bowersox, N. W., Austin, K., & Kilbourne, A. M. (2013). Pain conditions among veterans with schizophrenia or bipolar disorder. General Hospital Psychiatry, 35, 480–484.

    Article  PubMed  Google Scholar 

  • Bradford, D. W., Cunningham, N. T., Slubicki, M. N., McDuffie, J. R., Kilbourne, A. M., Nagi, A., & Williams, J. W, Jr. (2013). An evidence synthesis of care models to improve general medical outcomes for individuals with serious mental illness: a systematic review. Journal of Clinical Psychiatry, 74(8), e754–e764. doi:10.4088/JCP.12r07666.

    Article  PubMed  Google Scholar 

  • Bradford, D. W., Kim, M. M., Braxton, L. E., Marx, C. E., Butterfield, M., & Elbogen, E. B. (2008). Access to medical care among persons with psychotic and major affective disorders. Psychiatric Services, 59(8), 847–852.

    Article  PubMed  Google Scholar 

  • Carliner, H., Collins, P. Y., Cabassa, L. J., McNallen, A., Joestl, S. S., & Lewis-Fernández, R. (2014). Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: A critical review. Comparative Psychiatry, 55(2), 233–247.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2000). Measuring healthy days. Atlanta, GA: CDC. http://www.cdc.gov/hrqol/pdfs/mhd.pdf.

  • Centers for Disease Control and Prevention. (2013). Behavioral risk factor surveillance: Prevalence and trends data. Accessed on September 10, 2013 at: http://apps.nccd.cdc.gov/brfss/.

  • Elman, I., Zubieta, J. K., & Borsook, D. (2011). The missing p in psychiatric training: Why it is important to teach pain to psychiatrists. Archives of General Psychiatry, 68(1), 12–20.

    Article  PubMed  PubMed Central  Google Scholar 

  • Engels, G., Francke, A. L., van Meijel, B., Douma, J. G., de Kam, H., Wesselink, W., et al. (2014). Clinical pain in schizophrenia: A systematic review. Journal of Pain, 15(5), 457–467.

    Article  PubMed  Google Scholar 

  • Fraeman, K. H. (2010). An introduction to implementing propensity score matching with SAS. NorthEast SAS® Users Group. Accessed on September 9, 2013 at: http://www.nesug.org/Proceedings/nesug10/ad/ad05.pdf.

  • Gadermann, A. M., Alonso, J., Vilagut, G., Zaslavsky, A. M., & Kessler, R. C. (2012). Comorbidity and disease burden in the National Comorbidity Survey Replication (NCS-R). Depression and Anxiety, 29, 797–806.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hawkins, K., Musich, S., Bottone, F. G., Ozminkowski, R. J., Cheng, Y., Rush, S., et al. (2013). The impact of pain on physical and mental quality of life in adults 65 and older. Journal of Gerontological Nursing, 39(6), 32–44.

    Article  PubMed  Google Scholar 

  • Hughes, M. E., & Waite, L. J. (2002). Health in household context: Living arrangements and health in late middle age. Journal of Health and Social Behavior, 43(1), 1–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jones, S., Howard, L., & Thornicroft, G. (2008). ‘Diagnostic overshadowing’: Worse physical health care for people with mental illness. Acta Psychiatrica Scandinavica, 118, 169–171.

    Article  PubMed  Google Scholar 

  • Jones, D. R., Macias, C., Barreira, P. J., Fisher, W. H., Hargreaves, W. A., & Harding, C. M. (2004). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services, 55, 1250–1257.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kessler, R. C., & Merikangas, K. R. (2004). The National Comorbidity Survey Replication (NCS-R): background and aims. International Journal of Methods in Psychiatric Research, 13(2), 60–68.

    Article  PubMed  Google Scholar 

  • Lawrence, D. & Kisely, S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology, 24(11) Supplement 4, 61–68.

  • Levinson, D., Karger, C. J., & Haklai, Z. (2008). Chronic physical conditions and the use of health services among persons with mental disorders—results from the Israel National Health Survey. General Hospital Psychiatry, 30, 226–232.

    Article  PubMed  Google Scholar 

  • Lorig, K., Ritter, P. L., Pifer, C., & Werner, P. (2014). Effectiveness of the chronic disease self-management program for persons with serious mental illness: A translation study. Community Mental Health Journal, 50, 96–103. doi:10.1007/s10597-013-9615-5.

    Article  PubMed  Google Scholar 

  • Mitchell, A. J., Malone, D., & Doebbeling, C. (2009). Quality of medical care for people with and without comorbid mental illness and substance misuse: Systematic review of comparative studies. The British Journal of Psychiatry, 194, 491–499.

    Article  PubMed  Google Scholar 

  • National Heart, Lung and Blood Institute. (2008). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. (NIH publication no. 98-4083). Bethesda, MD.

  • Parks, J., Svendsen, D., Singer, P., & Foti M. E. (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health program Directors. Medical Directors Council, 2006. http://www.nasmhpd.org/docs/publications/MDCdocs/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf.

  • Piatt, E. E., Munetz, M. R., & Ritter, C. (2010). An examination of premature mortality among decedents with serious mental illness and those in the general population. Psychiatric Services, 62, 663–668.

    Article  Google Scholar 

  • Pirraglia, P. A., Rowland, E., Wu, W., Taveira, T. H., Cohen, L. B., Friedmann, P. D., & O’Toole, T.P. (2012). Benefits of a primary care clinic co-located and integrated in a mental health setting for veterans with serious mental illness. Preventing Chronic Disease, 9, E51. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340211/]

  • Snyder, K., Dobscha, S. K., Ganzini, L., Hoffman, W. F., & Delorit, M. A. (2008). Clinical outcomes of integrated psychiatric and general medical care. Community Mental Health Journal, 44, 147–154. doi:10.1007/s10597-007-9117-4.

    Article  PubMed  Google Scholar 

  • Stahl, E., Lindberg, A., Jansson, S. A., Ronmark, E., Svensson, K., Andersson, F., et al. (2005). Health-related quality of life is related to COPD disease severity. Health and Quality of Life Outcomes, 3, 56. doi:10.1186/1477-7525-3-56.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sterling, E. W., von Esenwein, S. A., Tucker, S., Fricks, L., & Druss, B. G. (2010). Integrating wellness, recovery, and self-management for mental health consumers. Community Mental Health Journal, 46, 130–138. doi:10.1007/s10597-009-9276-6.

    Article  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). Health related quality-of-life 14-item healthy days measure. http://www.cdc.gov/hrqol/hrqol14_measure.htm.

  • Walker, E. R., McGee, R. E. & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry, published online February 11, 2015.

  • Weber, N. S., Cowan, D. N., Millikan, A. M., & Niebuhr, D. W. (2009). Psychiatric and general medical conditions comorbid with schizophrenia in the National Hospital Discharge Survey. Psychiatric Services, 60(8), 1059–1067.

    Article  PubMed  Google Scholar 

  • Weber, N. S., Fisher, J. A., Cowan, D. N., & Niebuhr, D. W. (2011). Psychiatric and general medical conditions comorbid with bipolar disorder in the National Hospital Discharge Survey. Psychiatric Services, 62(10), 1152–1158.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by the Northeast Ohio Medical University Office of Research and Sponsored Programs (Christian Ritter, PI) to establish the Research Focus Area in Community-based Mental Health Research. The authors would like to acknowledge Mark Munetz, MD, for his consultation and advice throughout this project and preparation of the manuscript. We also would like to thank Zhenyu Jia, PhD, and James Meeker, MA, for their assistance with data analysis.

Author information

Affiliations

  1. Department of Family and Community Medicine, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA

    Kristin R. Baughman

  2. Department of Psychiatry, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA

    Natalie Bonfine & Christian Ritter

  3. Pharmacy Practice Department, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA

    Sara E. Dugan

  4. Department of Sociology, Kent State University, 215 Merrill Hall, PO Box 5190, Kent, OH, 44242, USA

    Richard Adams

  5. Department of Sociology, Kent State University at Stark, 6000 Frank Ave NW, North Canton, OH, 44720, USA

    Mary Gallagher

  6. Department of Family and Community Medicine, University of New Mexico, 1 University of New Mexico Bldg 177, Albuquerque, NM, 87131, USA

    R. Scott Olds

  7. Department of Sociology, Hiram College, 6832 Hinsdale St, Hiram, OH, 44234, USA

    Elizabeth Piatt

Authors
  1. Kristin R. Baughman
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  2. Natalie Bonfine
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  3. Sara E. Dugan
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  4. Richard Adams
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  5. Mary Gallagher
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  6. R. Scott Olds
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  7. Elizabeth Piatt
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  8. Christian Ritter
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Corresponding author

Correspondence to Kristin R. Baughman.

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Conflict of Interest

The authors declare that they have not conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Baughman, K.R., Bonfine, N., Dugan, S.E. et al. Disease Burden Among Individuals with Severe Mental Illness in a Community Setting. Community Ment Health J 52, 424–432 (2016). https://doi.org/10.1007/s10597-015-9973-2

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  • DOI: https://doi.org/10.1007/s10597-015-9973-2

Keywords

  • Co-morbid illness
  • Severe mental illness
  • Chronic pain
  • Health status