Adults with severe psychiatric conditions are significantly more likely to die from coronary heart disease and stroke than healthy peers but not from cancer, according to an article in the February issue of the Archives of General Psychiatry.
The authors of the large British study noted that physical health is a concern among patients with severe mental illnesses. Adverse effects of antipsychotic medication, along with smoking, lifestyle factors and poverty, may contribute to physical illness in this population. However, estimates for rates of cancer and heart disease among the mentally ill in the past have disagreed with each other.

David P.J. Osborn, PhD, and colleagues at the Royal Free and University College Medical School, London, selected 46,136 individuals with severe illness including schizophrenia, schizoaffective disorder, bipolar disorder and delusional disorder and 300,426 adults without mental illness from a nationally representative database in the United Kingdom.

The researchers compared the two group's death rates from coronary heart disease, stroke and the seven most common types of cancer in the United Kingdom: respiratory, colorectal, breast, prostate, stomach, esophageal and pancreatic cancer.

They wrote, "We chose to study death rates rather than incidence rates, because mortality is the most robust outcome since it includes diagnoses made post-mortem."

Over a follow-up period of at least six months, individuals of all ages were significantly more likely to die from coronary heart disease and stroke if they had a severe mental illness. Those with severe mental illness age 18 to 49 years were 3.22 times as likely to die from heart disease and 2.53 times as likely to die from stroke; adults age 50 to 75 years were 1.86 times more likely to die from heart disease and 1.89 times more likely to die from stroke, and those older than 75 were 1.05 times as likely to die from heart disease and 1.34 times as likely to die from stroke.

The rates did not change significantly after the researchers adjusted for smoking rates and social deprivation, both of which contribute to risk for heart disease. The use of antipsychotic medication did have an effect.

"People with severe mental illness who were not prescribed any antipsychotics were at increased risk of coronary heart disease and stroke than controls, whereas those prescribed such agents were at even greater risk," the authors wrote. "Those receiving the higher doses were at greatest risk for death from both coronary heart disease and stroke."

Additional research is needed to help prevent cardiovascular disease and death among those with severe mental illness, the authors concluded. "Clinically, a holistic approach to the care of people with severe mental illness is still frequently overlooked," they wrote. "Such an approach requires monitoring for somatic conditions and demands effective communication between primary and secondary care to provide coherent physical health care."