Physical Health Problems Among People With Severe Mental Illnesses: Race, Gender, and Implications for Practice

Abstract

BACKGROUND Individuals with severe mental illnesses experience high rates of chronic health conditions; however, the extent to which risk of chronic physical health problems varies by race and gender among these individuals is understudied. AIMS This study examines variations in health problems by race and gender among individuals with severe mental illnesses. METHOD Administrative data, which included blood pressure, body mass index (BMI), and glycated hemoglobin (HbA1c) values, were obtained from 603 individuals with serious mental illnesses who received integrated health and behavioral health services from a large mental health agency in the Midwest. Bivariate and multivariate statistical models were used to examine variation in physical health problems by race and gender. RESULTS Compared with men, women with severe mental illnesses were more likely to have BMI levels indicating obesity or morbid obesity ( p < .001). Compared with White participants, Black participants were less likely to have high HbA1c levels ( p < .001) but were more likely to have high blood pressure ( p < .001). Among race and gender groups, Black women were more likely to have high BMI ( p < .05), Black men were more likely to have high blood pressure ( p < .001), and White men were more likely to have high HbA1c levels ( p < .01) when holding constant all other variables. CONCLUSIONS There is evidence that types and severity of physical health problems among individuals with severe mental illnesses varies by race and gender. Replication of these results and more research is needed to ensure that health-related education and integrated health and behavioral health interventions meet the needs of individuals with serious mental illnesses.

Treatment pearls

“…23 People with SMI have more than two times higher cardiovascular mortality than the general population and an increased prevalence of all cardiovascular disease risk factors, including sedentary behavior, diabetes, tobacco smoking, obesity, dyslipidemia, elevated hemoglobin A1C levels, and hypertension. 11,[23][24][25] Treatment recommendations • Start with a broad physical activity prescription (for example, sitting less, standing, and walking during TV commercials) throughout the day. 24 • Individualize recommendations to encourage a slight but regular increase from the patients' current activity level.…”

“…Metabolic syndrome comprises weight gain (particularly abdominal obesity), increased blood glucose, dyslipidemia, and high BP 13. Persons with SMI are three times more likely to have metabolic syndrome than the general population, with obesity rates of 70% compared with 42% in the general population 11,14. Women with SMI are more likely than men to have obesity, with higher body mass index (BMI) seen in Black women than White women 11…”

“…Diabetes prevalence is twice as high among patients with SMI, but metabolic screening remains low 15. Because patients with SMI have difficulty engaging in care, they struggle with adhering to national recommendations for treating diabetes or metabolic issues 11. In 2004, the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity came together as a panel to develop metabolic screening guidelines for patients taking second-generation antipsychotics (SGAs) 16.…”

“…6,7,12 Similar to the general population, racial and gender health disparities exist among people with SMI with higher prevalence in females and Black individuals. 11 Lower access and healthcare service utilization in racial and ethnic minorities are compounded in the SMI population, who generally struggle socioeconomically. The objective of this article is to discuss some of the foremost medical issues in patients with SMI and provide strategies for NPs to monitor and treat.…”

“…Most persons with SMI report at least one chronic health condition (such as, diabetes, hypertension, and pulmonary disease) 10. The types and severity of physical health problems among this population vary by race and gender, with higher rates of cardiovascular disease, diabetes, and obesity than the general population 11. Individuals with SMI are less likely to access and utilize physical healthcare 6,7,12.…”