Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 5;27(1):e301021.
doi: 10.1136/bmjment-2024-301021.

Comorbid physical health burden of serious mental health disorders in 32 European countries

Dennis Wienand  1 , Lena I Wijnen  2   3 , Daniel Heilig  2 , Christoph Wippel  2 , Celso Arango  4 , Gitte M Knudsen  5   6 , Guy M Goodwin  7 , Judit Simon  2   7
Affiliations

Comorbid physical health burden of serious mental health disorders in 32 European countries

Dennis Wienand et al. BMJ Ment Health. .

Abstract

Background: Mental health disorders (MHDs) are associated with physical health disparities, but underlying excess risk and health burden have not yet been comprehensively assessed.

Objective: To assess the burden of comorbid physical health conditions (PHCs) across serious MHDs in Europe.

Methods: We estimated the relative prevalence risk of PHCs associated with alcohol use disorders (AUD), bipolar disorder (BD), depressive disorders (DD) and schizophrenia (SZ) across working-age populations of 32 European countries in 2019 based on a targeted literature review. Excess physical health burden was modelled using population-attributable fractions and country-level prevalence data.

Findings: We screened 10 960 studies, of which 41 were deemed eligible, with a total sample size of over 18 million persons. Relative prevalence of PHCs was reported in 54%, 20%, 15%, 5% and 7% of studies, respectively, for SZ, DD, BD, AUD or mixed. Significant relative risk estimates ranged from 1.44 to 3.66 for BD, from 1.43 to 2.21 for DD, from 0.81 to 1.97 for SZ and 3.31 for AUD. Excess physical health burden ranged between 27% and 67% of the total, corresponding to 84 million (AUD), 67 million (BD), 66 million (DD) and 5 million (SZ) PHC diagnoses in Europe. A 1% reduction in excess risk assuming causal inference could result in two million fewer PHCs across investigated MHDs.

Conclusions: This is the first comprehensive study of the physical health burden of serious MHDs in Europe. The methods allow for updates, refinement and extension to other MHDs or geographical areas.

Clinical implications: The results indicate potential population health benefits achievable through more integrated mental and physical healthcare and prevention approaches.

Keywords: Adult psychiatry; Data Interpretation, Statistical; Depression & mood disorders; Schizophrenia & psychotic disorders; Substance misuse.

PubMed Disclaimer

Conflict of interest statement

Competing interests: CA has been a consultant to or has received honoraria or grants from Acadia, Angelini, Biogen, Boehringer, Gedeon Richter, Janssen Cilag, Lundbeck, Medscape, Menarini, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering-Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda. GMK has received honoraria as a speaker or consultant for Angelini, Gilgamesh, H Lundbeck, Onsero, Pangea, Sage and Sanos. GMG is Chief Medical Officer at Compass Pathways, holds shares and share options at Compass Pathways, and has served as consultant, advisor or CME speaker in the last 3 years for Beckley Psytech, Boehringer Ingelheim, Clerkenwell Health, Compass Pathways, Evapharma, Janssen, Lundbeck, Medscape, Novartis, Ocean Neuroscience, P1Vital, Servier and Takeda. JS has received honoraria as academic advisor from the European Brain Council.

Figures

Figure 1
Figure 1
Inter-relation between main study characteristics. AUD: alcohol use disorders; BD: bipolar disorder; DD: depressive disorders; SZ: schizophrenia.
Figure 2
Figure 2
Levels of excess physical health condition risks by ICD-10 chapters. I: certain infectious and parasitic diseases; II: neoplasms; III: diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; IV: endocrine, nutritional and metabolic diseases; VI: diseases of the nervous system; VII: diseases of the eye and adnexa; VIII: diseases of the ear and mastoid process; IX: diseases of the circulatory system; X: diseases of the respiratory system; XI: diseases of the digestive system; XII: diseases of the skin and subcutaneous tissue; XIII: diseases of the musculoskeletal system and connective tissue; XIV: diseases of the genitourinary system; XV: pregnancy, childbirth and the puerperium; XVII: congenital malformations, deformations and chromosomal abnormalities; XVIII: symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified; XIX: injury, poisoning and certain other consequences of external causes; XX: external causes of morbidity and mortality; XXI: factors influencing health status and contact with health services.
Figure 3
Figure 3
Population health impact of potential reductions in excess physical comorbidity risks by ICD-10 chapters. I: certain infectious and parasitic diseases; II: neoplasms; III: diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; IV: endocrine, nutritional and metabolic diseases; VI: diseases of the nervous system; VII: diseases of the eye and adnexa; VIII: diseases of the ear and mastoid process; IX: diseases of the circulatory system; X: diseases of the respiratory system; XI: diseases of the digestive system; XII: diseases of the skin and subcutaneous tissue; XIII: diseases of the musculoskeletal system and connective tissue; XIV: diseases of the genitourinary system; XV: pregnancy, childbirth and the puerperium; XVII: congenital malformations, deformations and chromosomal abnormalities; XVIII: symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified; XIX: injury, poisoning and certain other consequences of external causes; XX: external causes of morbidity and mortality; XXI: factors influencing health status and contact with health services.
See this image and copyright information in PMC

References

    1. Vos T, Lim SS, Abbafati C, et al. . Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 2020;396:1204–22. 10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. Arias D, Saxena S, Verguet S. Quantifying the global burden of mental disorders and their economic value. EClinicalMedicine 2022;54:101675. 10.1016/j.eclinm.2022.101675 - DOI - PMC - PubMed
    1. Scott KM, Lim C, Al-Hamzawi A, et al. . Association of mental disorders with subsequent chronic physical conditions: world mental health surveys from 17 countries. JAMA Psychiatry 2016;73:150–8. 10.1001/jamapsychiatry.2015.2688 - DOI - PMC - PubMed
    1. Correll CU, Solmi M, Veronese N, et al. . Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a Large‐Scale Meta‐Analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 2017;16:163–80. 10.1002/wps.20420 - DOI - PMC - PubMed
    1. DE Hert M, Correll CU, Bobes J, et al. . Physical illness in patients with severe mental disorders. I. prevalence, impact of medications and disparities in health care. World Psychiatry 2011;10:52–77. 10.1002/j.2051-5545.2011.tb00014.x - DOI - PMC - PubMed