The overall health of people with serious mental illness is well below the
suboptimal level found in the general population.
A comparison of patients with either schizophrenia or major mood disorder
with a sample matched for age, gender, and race in the general population
found that only 1 percent of those with serious mental illness met the
criteria for five selected health indicators. The study appeared in the July
Those indicators included smoking status, exercise, good dentition, absence
of obesity, and absence of serious medical co-occurring illness. A sixth item,
absence of injury requiring medical treatment in the previous 90 days, was
also compared but was not included in the composite, according to researchers
at Sheppard Pratt Health System, the University of Maryland School of
Medicine, and Johns Hopkins University School of Medicine.
At the same time, only 10 percent of those in the general population met
criteria for all five health indictors.
"The general population in the U.S. is hampered by health problems,
but our patients are even more so," co-author Faith Dickerson, Ph.D.,
M.P.H., told Psychiatric News. "We found that a very small
percentage of our patient group actually met the healthy criteria for each of
She is director of psychology at Sheppard Pratt Health System in Baltimore.
The study was funded by the National Alliance for Research on Schizophrenia
and Depression, and the principal investigator was Lisa Dixon, M.D., of the
University of Maryland.
In the study, a sample of 100 adults with schizophrenia and 100 with major
mood disorder were recruited from randomly selected outpatients receiving
community-based psychiatric treatment. Participants were surveyed about health
indicators using items from the National Health and Nutrition Examination
Study III (NHANES III) and the National Health Interview Survey (NHIS). Their
responses were compared with those of matched samples from the general
The researchers focused on survey items consistent with the leading health
indicators for the U.S. population as identified by the Healthy People 2010
program of the Centers for Disease Control and Prevention. Specifically, they
included being a nonsmoker (not smoking a cigarette in the previous 30 days);
engaging in exercise meeting recommended standards (defined as at least 20
times a month); not being obese (a body mass index with a score of less than
30); being free of a co-occurring lifetime serious medical illness defined as
arthritis, asthma, chronic bronchitis, emphysema, diabetes, congestive heart
failure, hypertension, stroke, and cancer; having teeth in good, very good, or
excellent condition; and not requiring medical treatment for an injury in the
previous 90 days.
Items 1 to 5 were from the NHANES III, and item 6 from the NHIS. The
differences between the two groups were statistically significant (with the
mentally ill group reporting worse health) on all indicators except for
exercise meeting recommended standards. On that score, 39 percent of both
groups reported exercise that met recommended standards (see chart on page
The researchers found that within the mentally ill group, educational
level, but not diagnosis, was independently associated with a composite
measure of health behaviors. There was a significant association between
nonsmoking status and good dentition; between absence of obesity and absence
of a co-occurring serious medical illness; and between good dentition and
absence of a co-occurring medical illness. None of the other associations
between individual health items was significant, nor was the association
between the health behaviors and the health outcomes composites.
These findings indicate that individuals' health status on different
indicators is relatively independent, Dickerson explained. The findings also
argue, she said, for examining multiple health indicators to assess overall
health status in persons with serious mental illness, as has been studied in
the general population.
She said the study did not address whether the use of the composite
indicators would be practical in everyday clinical practice, but noted that
monitoring of general medical conditions in patients with serious psychiatric
illness is fast becoming a major issue.
Wayne Fenton, M.D., director of adult translational research and treatment
development at the National Institute of Mental Health (NIMH), has called the
phenomenon of metabolic syndrome among patients with schizophrenia "an
epidemic" and called for psychiatrists to be more actively involved in
monitoring patients' weight and other health indicators (Psychiatric
News, April 26, 2006).
Dickerson said that Sheppard Pratt Health System is looking at a more
standardized way to collect health behavior and basic medical information,
such as smoking, obesity, and lipid levels.
"There are increasing efforts to integrate routine health status
checks into psychiatric care," Dickerson said. "The interest in
medical illness and health behaviors among people with primary psychiatric
problems is fairly recent. There is a small but growing literature on the
subject. With increasing interest in smoking and obesity among the general
population, there has been a growing awareness that patients with serious
mental illness are even more prone to these risk factors."
An abstract of "Health Status of Individuals With Serious
Mental Illness" is posted at<http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/32/3/584>.▪