Prevalence and Associated Factors of Metabolic Syndrome among Patients with Severe Mental Illness Attending a Tertiary Hospital in Southwest Uganda

Abstract

Globally, the prevalence of metabolic syndrome (MetS) and its components which are the major cardiovascular disease (CVD) risk factors, is higher among patients with severe mental illness (SMI) compared to the general population. This is mainly due to the deleterious lifestyles characterized by physical inactivity, excessive alcohol consumption, smoking, and unhealthy diets common among patients with SMI as well as due to cardiometabolic effects of psychotropic medications. Despite these conditions being highly prevalent among patients with SMI, little attention is given to these conditions during routine reviews in the mental health clinics in most low-income countries including Uganda. The main objective of this study was to determine the prevalence and associated factors of MetS among patients with SMI at Mbarara Regional Referral Hospital (MRRH), a tertiary hospital in southwestern Uganda. Through a cross-sectional study at the mental health clinic of the hospital, we recruited 304 patients with SMI and evaluated them for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We defined the prevalence of MetS as the proportion of patients meeting the NCEP ATP III criteria. We used logistic regression to evaluate associations between MetS and independent variables. We included a total of 302 (44.37% male, 55.63% female) patients with a diagnosis of SMI in the analysis. The prevalence of MetS was 23.51% (95% CI 18.84–28.71). At multivariable logistic regression, age >40 years and long duration of mental illness (>10 years) were significantly associated with MetS. The prevalence of MetS is high among patients with psychiatric disorders, and thus metabolic screening, especially among the high-risk groups, is critical.

A 10-Year Risk of Cardiovascular Disease among Patients with Severe Mental Illness at Mbarara Regional Referral Hospital, Southwestern Uganda

“…Our results indicate that patients with SMI at Mbarara Regional Referral Hospital are at an increased 10-year risk of CVD, with 80.84% having intermediate to high risk, the risk being higher in males compared to females. This could be attributed to the high prevalence of metabolic syndrome (MetS) of 23.51% previously found in the same population [22]. MetS has been found to play a key role in developing CVD [26].…”

“…This study was part of a bigger cross-sectional survey that was conducted at the outpatient mental health clinic of MRRH between October 2018 and March 2019 to evaluate metabolic syndrome among patients with SMI [22]. We enrolled participants ≥ 18 years of age, who were in remission phase or who had recovered from an acute episode of mental illness.…”

“…Weight was measured using a calibrated seca weighing scale (seca 762, GmbH & Co. KG, Hamburg, Germany) to the nearest 0.5 kg with the participant not wearing shoes and heavy clothes whereas height was measured using a stadiometer to the nearest 0.5 cm with the participant standing upright with the heel, buttock, and upper back along the same vertical plane. The details of the methodology have been described elsewhere [22].…”

“…Fasting total cholesterol was tested from three mls (3 mls) of venous blood drawn from the cubital fossa after at least 8 hours of fasting using an ELITechGroup PIT-CHSL-4-v21 (09/2016) machine following the enzymatic-colorimetric method. All procedures were done following standard operating procedures as previously described [ 22 ]. Those who had not fasted for 8 hours at the time of recruitment were only included in the study if they were willing to wait till they completed 8 hours of fasting.…”

Cardio-metabolic abnormalities among patients with severe mental illness at a Regional Referral Hospital in southwestern Uganda

“…This study was part of a bigger cross-sectional study that was conducted at the outpatient mental health clinic of MRRH between October 2018 and March 2019 to identify the prevalence and associated factors of metabolic syndrome among patients with SMI [ 15 ]. MRRH is a public health facility in southwestern Uganda that serves about five million people, mainly from 10 catchment districts of southwestern Uganda.…”