African Americans' lived experiences with serious mental illness and cardiovascular disease: a syndemic perspective

African Americans with serious mental illness (SMI) face a disproportionate burden of cardiovascular disease (CVD), reflecting the intersection of biological vulnerability and structural inequities. Yet little is known about how individuals living with both conditions understand and navigate these interconnections in their daily lives.

Guided by grounded theory and syndemic theory, we conducted semi-structured interviews with 23 African American adults diagnosed with SMI and self-reporting CVD. Participants were recruited from the Genomic Psychiatry Cohort (GPC) and its African American sub-cohort (AAGPC). Interviews explored perceptions of illness interaction, self-management, and contextual barriers. Data were analyzed using constant comparative methods to identify patterns and develop a theoretical model of syndemic interdependency.

Analysis generated the core concept of syndemic interdependency-a dynamic process through which psychiatric and cardiovascular conditions interact and mutually reinforce one another within contexts of structural deprivation, Environmental and neighborhood influences, and Healthcare distrust. Participants described how psychiatric symptoms disrupted adherence to CVD management, while cardiovascular complications heightened psychiatric distress, creating self-perpetuating cycles of illness. Structural constraints such as reliance on public assistance and food insecurity provided minimal stability but reinforced dependency. Environmental influences, including unsafe housing and neighborhood violence, further undermined health behaviors. Distrust in healthcare providers-particularly in psychiatric care-emerged as a cross-cutting mechanism that deepened disengagement and exacerbated comorbid illness trajectories.

This study extends syndemic theory by illustrating how individuals themselves conceptualize the reciprocal entanglement of SMI and CVD within structural and environmental constraints. Findings underscore the need for integrated, equity-focused care models that address psychiatric and cardiovascular health simultaneously while embedding trust-building, housing stability, and food security interventions. Disrupting SMI-CVD interdependency ultimately requires addressing the structural and institutional forces that sustain these overlapping health disparities.