The Physical Health of People With Severe Mental Illness in South Asia: A Cross-Sectional Multi-Country Survey

Abstract

Background: People with severe mental illness (SMI) die earlier than the general population, primarily due to physical disorders. There is little information on the prevalence of physical illnesses and health-risk behaviours in people with SMI in low and middle-income countries.Methods: We recruited adults with SMI attending specialist mental health service in Bangladesh, India, and Pakistan to a cross-sectional survey. Data were collected on non-communicable diseases (NCDs), risk factors and health-risk behaviours using the WHO STEPwise approach to Surveillance of NCDs. We also investigated chronic infections, health-related quality of life and healthcare utilisation.Findings: Before halting recruitment due to the COVID-19 pandemic, we assessed 3,229 patients for eligibility, we recruited 2,506 participants with bipolar disorder (36·7%), non-affective psychosis (42·2%), and depression with psychotic symptoms (21·1%). Nine percent had diabetes, 3·8% cardiovascular diseases, 3% tuberculosis and 2·4% chronic hepatitis. Forty-four percent were overweight/obese, 24·3% had hypertension, 48·9% hypercholesterolemia, and 38·0% anaemia. An important incidental finding of this research is that most participants with diabetes, hypertension and hypercholesterolemia were previously undiagnosed. Fifty-two percent of men and 16·4% of women used tobacco; 53·0% engaged in recommended levels of physical activity and 12·5% consumed recommended portions of fruit and vegetables. Only 45·0% with NCDs, 42·4% with hypertension and 26·6% of tobacco users received any treatment or health advice.Interpretation: A third of people with SMI reported physical disorders. We found significant gaps reported in screening, prevention and treatment, physical health in people with SMI may be grossly neglected in South Asia.Trial Registration: ISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933.Funding Statement: This research was funded by the National Institute for Health Research (NIHR) (Grant: GHRG 17/63/130:) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.Declaration of Interests: The authors declare that they have no conflicts of interest.Ethics Approval Statement: The study was approved by the ethics committees of the Department of Health Sciences, University of York, UK; Centre for Injury Prevention and Research, Bangladesh; NIMHANS and Health Ministry Screening Committee, India; and the National Bioethics Committee, Pakistan. All study procedures complied with legislation and guidance for good practice governing the participation in research of people who may lack capacity (Mental Capacity Act (UK) 2005).