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People with severe mental illness die up to 20 years earlier than others – a gap, according to researchers, only worsens
A new global report led by Australian researchers revealed how the many physical health problems faced by people with mental illness contributed to years of life lost.
Although it has been recognized for some time that people with severe mental disorders are more likely to die sooner, the researchers found that people with mental illness were also more likely to live with the disease. obesity, diabetes and cardiovascular disease.
"We are seeing high rates of cardiovascular and metabolic disease in people with depression, anxiety, schizophrenia and even alcohol-related disorders," said Joseph Firth, lead author and lead researcher at Western Sydney University.
"Basically, all types of … mental disorders are badociated with a double or triple risk of these diseases."
This was linked to a host of lifestyle-related risk factors, such as sedentary behavior, adverse effects of psychiatric medications, and lack of adequate health care, the researchers said.
"This is not just a difference in life expectancy – it's also a huge gap in terms of quality of life," said Dr. Firth.
The report, The Lancet Psychiatry Commission: A Physical Health Protection Project for People with Mental Illness, recommends changing health policy to better integrate physical and mental health care.
"It's really a very serious problem," said Dr. Firth.
"The gap in life expectancy between people with mental illness and the general population is increasing over time.
"Protecting the physical health of people with mental illness should be considered an international priority."
Lifestyle factors and substandard care
The report summarized the findings of nearly 100 systematic reviews and meta-badyzes of the prevalence of physical health problems among people with mental illness.
The study found that people with mental illness were at risk of developing obesity, diabetes, and cardiovascular disease 1.4 to 2 times higher than that of the general population.
"For patients with depression, the risk of developing heart disease, hypertension, stroke, diabetes, metabolic syndrome or obesity is about 40% higher than that of the general population" , wrote the authors.
Research has shown that all mental health diagnoses are badociated with lifestyle-related risk factors, including high alcohol consumption, smoking, sedentary behavior, poor diet, and lack of sleep.
However, it was unlikely that lifestyle factors were the only explanation for the poor physical health outcomes of people with mental illness.
The report also found that differences in the availability and quality of health care were implicated, with some research suggesting that people with mental illnesses were less likely to have a physical examination in primary care and less likely to have interventions. medical or surgical.
"The problem here is about equality," said co-author Simon Rosenbaum, research fellow at the University of New South Wales.
Dr. Rosenbaum also said that lifestyle interventions, such as encouraging people to be more active or eating healthier, were known to help reduce chronic disease in the general population and needed to become a critical component. mental health care.
"We need to take what works and find innovative and cost-effective ways to make these interventions a standard part of care for people treated for mental illness."
But there were challenges to this approach.
"The general population is struggling to adopt a healthy lifestyle and there are many obstacles," said Dr. Rosenbaum.
"When you add to that a mental illness and the problems badociated with it … it's actually very hard for people to adopt this type of behavior." They need adequate support, they need some time. "
For example, lifestyle interventions would not always allow people taking psychiatric medications to induce sedentary behavior, to feel lethargic or to increase their craving for food, Dr. Rosenbaum explained.
"If we really want to change people's way of life, we have to take these things into account."
The report revealed that some psychiatric medications may also play a direct role in the disease.
"Antipsychotics and some antidepressants can have quite serious metabolic side effects that, if left untreated, lead to cardiovascular disease, cardio-metabolic disease, and early death," said Dr. Rosenbaum.
"It is therefore very important to improve the prescription of psychiatric drugs based on evidence."
Integrate physical and mental health care
An independent expert, Max Abbott, professor of psychology and public health at the Auckland University of Technology, said the findings of the report were not a surprise.
"These high rates of physical morbidity and this dramatic reduction in life expectancy are totally unacceptable," he said.
In addition to lifestyle factors and the side effects of drugs, he said that stigma, discrimination, poverty, unemployment, housing problems and social isolation were "also, without a doubt, important. "
"Hopefully the Lancet report will help mobilize global efforts to solve this long neglected problem," he said.
The report's authors recommended that physical and mental health care be better integrated.
They also recommended a multidisciplinary approach to mental health treatment integrating health professionals who specialize in nutrition, physical activity and behavioral changes.
"The evidence shows very clearly that the use of non-traditional services – exercise physiology, dietetics, paramedical services – should be an integral part of mental health treatment," said Dr. Rosenbaum.
In Australia, there is a system that allows doctors to consult dietitians and exercise physiologists to change their lifestyle.
"What is unfortunate is that it is totally underutilized, partly because of awareness and education, but also because of the lack of knowledge about the location of providers. "
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