Somatic health perception among in-patients with severe mental illness: a comparison of self-rated and clinically assessed health

Abstract

Purpose: To investigate somatic health burden and self-rated health (SRH) among forensic psychiatric (FP) patients and the concordance between these two health measurements. Additionally, the study evaluates how different binary groupings of SRH responses impact concordance.

Methods: In a cross-sectional study, 67 inpatients from two Danish forensic psychiatric hospitals were assessed. SRH was measured using a single-item question from the validated and widely used SF-12 scale, and clinical evaluation was performed by a general physician using the Clinical Frailty Scale (CFS). SRH responses were dichotomised in two different ways to test concordance with clinical assessment, and detailed somatic health data were collected from consultations with health care professionals and patient records.

Results: Seventy-nine percent of FP patients assessed their own health as "good" or better despite the presence of risk factors such as history of smoking (median pack years = 20) and 25% having hypertension, 84% being overweight, and 55% having metabolic syndrome when assessed by a physician. We found a total of 195 somatic diagnoses with no clear trend in either diagnosis or organ system. Regardless of grouping, concordance between self-reported health and clinician-rated CFS remained low, ranging from 58 to 61%.

Conclusion: This study reveals discrepancies between forensic psychiatric patients' subjective and clinically assessed health. The findings underscore the need to interpret SRH with caution in populations with severe mental illness, where discrepancies between SRH, physician-rated health and diagnoses burden are pronounced. Clinicians and researchers should approach SRH critically to avoid underestimating patients' health risks.

Keywords: Severe mental illness; clinical frailty score; forensic psychiatry; self-rated health; test validity.