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Psychosocial and Demographic Factors Associated with Physical Multimorbidity in Severe Mental Illness: A Systematic
Erin G Lawrence1, Uzma Zahid2, Abigail C Thomson1
1Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom, E1 2AB.
Background And Hypothesis:
People with severe mental illness (SMI), such as schizophrenia and bipolar disorder have a reduced life expectancy. This is largely due to physical multimorbidity (MM), defined as the coexistence of two or more physical health conditions. This systematic review identifies which psychosocial and demographic factors are associated with MM in SMI.
Study Design:
Embase, PubMed, and PsychINFO were searched with no limits on publication date or study design. Studies were eligible for inclusion if they assessed the impact of psychosocial and/or demographic factors on MM outcomes among people with SMI.
Study Results:
Thirty studies met the inclusion criteria for this review. The strongest predictors of MM were childhood maltreatment (odds ratios [OR] up to 8.70 [95% CI 2.49-30.33]), female gender (OR up to 2.47 [95% CI 1.35-4.50]), older age (OR up to 1.60 [95% CI 1.31-1.96]), and ethnicity (e.g. OR up to 2.09 [95% CI 1.81-2.42] for Black Caribbean groups relative to White British groups). Predictors with mixed evidence included educational attainment, employment status, socioeconomic status, marital status, urbanicity, deprivation, country of origin, healthcare access, and global functioning.
Conclusions:
The findings highlight psychosocial factors (e.g. childhood maltreatment) and demographic factors (e.g. older age) that may contribute to MM, which has strong clinical implications. Some factors are modifiable (e.g. education) and can inform risk prevention strategies for MM in SMI, mitigating risks of premature mortality. Future research should use consistent definitions of MM for cross-study comparisons and assess additional risk factors, their interactions, and underlying mechanisms.
Insights
Childhood maltreatment, female gender, older age, and ethnicity are key factors linked to physical multimorbidity in severe mental illness (SMI). Addressing these can help reduce premature mortality risks.
Area of Science:
- Psychiatry
- Public Health
- Epidemiology
Background:
- Severe mental illness (SMI) is associated with reduced life expectancy.
- Physical multimorbidity (MM), the presence of multiple physical health conditions, significantly contributes to this disparity.
- Understanding factors associated with MM in SMI is crucial for improving health outcomes.
Purpose of the Study:
- To systematically review and identify psychosocial and demographic factors associated with physical multimorbidity (MM) in individuals with severe mental illness (SMI).
Main Methods:
- A systematic literature search was conducted across Embase, PubMed, and PsychINFO.
- Studies assessing the impact of psychosocial and/or demographic factors on MM outcomes in people with SMI were included.
- No limits were placed on publication date or study design.
Main Results:
- Thirty studies met the inclusion criteria.
- Strongest predictors of MM included childhood maltreatment (OR up to 8.70), female gender (OR up to 2.47), older age (OR up to 1.60), and ethnicity.
- Factors with mixed evidence included education, employment, socioeconomic status, and healthcare access.
Conclusions:
- Psychosocial factors like childhood maltreatment and demographic factors such as older age are significant contributors to MM in SMI.
- Modifiable factors, such as education, can inform risk prevention strategies to mitigate premature mortality.
- Standardized MM definitions and further research into risk factor interactions are recommended.
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