TY - JOUR
T1 - Physical multimorbidity and psychosis: Comprehensive cross sectional analysis including 242,952 people across 48 low- and middle-income countries
AU - Veronese, Nicola
AU - Vancampfort, Davy
AU - Veronese, Nicola
AU - Mugisha, James
AU - Lally, John
AU - Carvalho, André F.
AU - Koyanagi, Ai
AU - Stubbs, Brendon
AU - Solmi, Marco
AU - Gaughran, Fiona
AU - Correll, Christoph U.
AU - Mitchell, Alex J.
PY - 2016
Y1 - 2016
N2 - Background: In people with psychosis, physical comorbidities, including cardiovascular and metabolic diseases, are highly prevalent and leading contributors to the premature mortality encountered. However, little is known about physical health multimorbidity in this population or in people with subclinical psychosis and in low- and middle-income countries (LMICs). This study explores physical health multimorbidity patterns among people with psychosis or subclinical psychosis. Methods: Overall, data from 242,952 individuals from 48 LMICs, recruited via the World Health Survey, were included in this cross-sectional study. Participants were subdivided into those (1) with a lifetime diagnosis of psychosis ("psychosis"); (2) with more than one psychotic symptom in the past 12months, but no lifetime diagnosis of psychosis ("subclinical psychosis"); and (3) without psychotic symptoms in the past 12months or a lifetime diagnosis of psychosis ("controls"). Nine operationalized somatic disorders were examined: arthritis, angina pectoris, asthma, diabetes, chronic back pain, visual impairment, hearing problems, edentulism, and tuberculosis. The association between psychosis and multimorbidity was assessed by multivariable logistic regression analysis. Results: The prevalence of multimorbidity (i.e., two or more physical health conditions) was: controls=11.4% (95% CI, 11.0-11.8%); subclinical psychosis=21.8% (95% CI, 20.6-23.0%), and psychosis=36.0% (95% CI, 32.1-40.2%) (P<0.0001). After adjustment for age, sex, education, country-wise wealth, and country, subclinical psychosis and psychosis were associated with 2.20 (95% CI, 2.02-2.39) and 4.05 (95% CI, 3.25-5.04) times higher odds for multimorbidity. Moreover, multimorbidity was increased in subclinical and established psychosis in all age ranges (18-44, 45-64, ≥ 65years). However, multimorbidity was most evident in younger age groups, with people aged 18-44 years with psychosis at greatest odds of physical health multimorbidity (OR=4.68; 95% CI, 3.46-6.32). Conclusions: This large multinational study demonstrates that physical health multimorbidity is increased across the psychosis-spectrum. Most notably, the association between multimorbidity and psychosis was stronger among younger adults, thus adding further impetus to the calls for the early intervention efforts to prevent the burden of physical health comorbidity at later stages. Urgent public health interventions are necessary not only for those with a psychosis diagnosis, but also for subclinical psychosis to address this considerable public health problem. © 2016 The Author(s).
AB - Background: In people with psychosis, physical comorbidities, including cardiovascular and metabolic diseases, are highly prevalent and leading contributors to the premature mortality encountered. However, little is known about physical health multimorbidity in this population or in people with subclinical psychosis and in low- and middle-income countries (LMICs). This study explores physical health multimorbidity patterns among people with psychosis or subclinical psychosis. Methods: Overall, data from 242,952 individuals from 48 LMICs, recruited via the World Health Survey, were included in this cross-sectional study. Participants were subdivided into those (1) with a lifetime diagnosis of psychosis ("psychosis"); (2) with more than one psychotic symptom in the past 12months, but no lifetime diagnosis of psychosis ("subclinical psychosis"); and (3) without psychotic symptoms in the past 12months or a lifetime diagnosis of psychosis ("controls"). Nine operationalized somatic disorders were examined: arthritis, angina pectoris, asthma, diabetes, chronic back pain, visual impairment, hearing problems, edentulism, and tuberculosis. The association between psychosis and multimorbidity was assessed by multivariable logistic regression analysis. Results: The prevalence of multimorbidity (i.e., two or more physical health conditions) was: controls=11.4% (95% CI, 11.0-11.8%); subclinical psychosis=21.8% (95% CI, 20.6-23.0%), and psychosis=36.0% (95% CI, 32.1-40.2%) (P<0.0001). After adjustment for age, sex, education, country-wise wealth, and country, subclinical psychosis and psychosis were associated with 2.20 (95% CI, 2.02-2.39) and 4.05 (95% CI, 3.25-5.04) times higher odds for multimorbidity. Moreover, multimorbidity was increased in subclinical and established psychosis in all age ranges (18-44, 45-64, ≥ 65years). However, multimorbidity was most evident in younger age groups, with people aged 18-44 years with psychosis at greatest odds of physical health multimorbidity (OR=4.68; 95% CI, 3.46-6.32). Conclusions: This large multinational study demonstrates that physical health multimorbidity is increased across the psychosis-spectrum. Most notably, the association between multimorbidity and psychosis was stronger among younger adults, thus adding further impetus to the calls for the early intervention efforts to prevent the burden of physical health comorbidity at later stages. Urgent public health interventions are necessary not only for those with a psychosis diagnosis, but also for subclinical psychosis to address this considerable public health problem. © 2016 The Author(s).
UR - http://hdl.handle.net/10447/455327
UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84997514469&doi=10.1186/s12916-016-0734-z&partnerID=40&md5=8ce84669a19fafc1e9bfa22dad66db04
M3 - Article
VL - 14
JO - BMC Medicine
JF - BMC Medicine
SN - 1741-7015
ER -