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Untreated Medical Comorbidity Is High in Patients with Serious Mental Illness

Three studies document psychiatric patients' higher rate of medical illness and, in 1 healthcare system, their tendency to obtain fewer medical services.

Research results are conflicting about whether medical illness is more prevalent among psychiatric than among nonpsychiatric patients. In 3 studies, researchers investigated this question by analyzing large administrative databases of patients with and without mental disorders.

One team gathered data on 11,185 disabled Massachusetts Medicaid claimants with psychotic disorders (2563 with comorbid substance-use disorders) and on 15,147 claimants with no mental illness (3457 with substance-use disorders). Multivariate analyses indicated that patients with psychotic disorders were significantly more likely than those without mental illness to have heart disease, asthma, gastrointestinal disorders, skin infections, acute respiratory disorders, diabetes, hypertension, or malignant neoplasms. Concomitant substance abuse added to the risks for the first 5 of these 8 conditions. Risks for all of the medical conditions except hypertension were significantly higher among participants with only substance-use disorders than among participants without psychotic or substance-use disorders.

In the second study, researchers used 391,454 Philadelphia Medicaid claims and related welfare data to assess the link between serious mental illness and HIV infection. Compared with claimants without mental illness, those with affective disorders were 3.8 times more likely, and those with schizophrenia 1.5 times more likely, to have HIV infection.

In the third study, researchers assessed use of medical care among 175,633 veterans in southern California and Nevada. Veterans with psychiatric diagnoses (especially schizophrenia and bipolar disorder) made fewer medical-care visits overall than did other veterans. Among veterans with diabetes or hypertension, those who also had schizophrenia, bipolar illness, PTSD, or substance-use disorder made fewer visits than did veterans with the same medical conditions but without psychiatric diagnoses.

Comment: The results of these 3 studies document psychiatric patients' higher rate of medical illness and, in 1 healthcare system, their tendency to obtain fewer medical services. The adverse medical effects of psychiatric medications and the poor health habits (e.g., smoking, obesity) associated with mental illness may underlie these findings, although the effects of psychiatric illness on immune and endocrine systems may also contribute to them. The results argue strongly for less separation between the mental and physical healthcare systems. For example, new healthcare models could bridge these systems and compensate for the lack of training that providers have for conditions treated in the other system.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry August 7, 2002

Citation(s):

Dickey B et al. Medical morbidity, mental illness, and substance use disorders. Psychiatr Serv 2002 Jul; 53:861-7.

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• Medline abstract (Free)

Blank MB et al. Co-occurrence of HIV and serious mental illness among Medicaid recipients. Psychiatr Serv 2002 Jul; 53:868-73.

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• Medline abstract (Free)

Cradock-O'Leary J et al. Use of general medical services by VA patients with psychiatric disorders. Psychiatr Serv 2002 Jul; 53:874-8.

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• Medline abstract (Free)