Background: People diagnosed with severe mental illness (SMI) have poorer
physical health and higher mortality than those without SMI. In this thesis I
investigate the physical health and planned and emergency physical health
hospital use of people with SMI compared to people without SMI.
Methods: I conducted a meta-analysis to quantify excess hospital use for non mental health causes in people with SMI and five physical long-term conditions
(LTCs). I used primary care records to investigate the prevalence of 24 LTCs in
those with and without SMI, to identify patterns of multimorbidity, and to
investigate cancer incidence and mortality. I then linked primary and secondary
care records to investigate planned and emergency physical health hospital
admissions in people with SMI.
Results: Patients with SMI had higher prevalence of 19 of 24 physical LTCs, and
of multimorbidity (odds ratio:1.84, 95%CI:1.80-1.88) than those without SMI, with
13 LTCs elevated at or before SMI diagnosis. However, clusters of LTCs were
similar between those with and without SMI. Patients with schizophrenia had a
lower risk of cancer diagnosis (hazard ratio[HR]:0.83, 95%CI:0.78-0.89) but were
at greater risk of cancer mortality (HR:1.93, 95%CI:1.54-2.41) and had fewer
planned physical health admissions (incidence rate ratio [IRR]:0.80, 95%CI:0.72-
0.90) than those without SMI. Patients with SMI had more emergency physical
health admissions, particularly avoidable admissions (IRR:2.88, 95%CI:2.60-
3.19).
Conclusions: Interventions to improve physical health should focus on similar
groups of conditions as for the general population, but at a younger age, and
early in the course of SMI. The low incidence of cancer and of planned physical
health admissions in people with schizophrenia suggest a need for interventions
to improve access to preventative and planned services. The high rate of
avoidable admissions in those with SMI suggests interventions are required to
improve the management of existing physical LTCs.