People with severe mental illness, such as schizophrenia-spectrum disorder and bipolar disorder, face poorer health outcomes from multiple chronic illnesses. Physical multimorbidity, the coexistence of two or more chronic physical conditions, and psychiatric multimorbidity, the coexistence of three or more psychiatric disorders, are both emerging concepts useful in conceptualising disease burden. However, the prevalence of physical and psychiatric multimorbidity in this cohort is unknown. This study aimed to estimate the absolute prevalence of both physical and psychiatric multimorbidity in people with severe mental illness, and also compare the odds of physical multimorbidity prevalence against people without severe mental illness. We searched CINAHL, EMBASE, PubMed, and PsycINFO from inception until Feb 15, 2024, for observational studies that measured multimorbidity prevalence. To be included, studies had to have an observational study design, be conducted in an adult population (mean age ≥18 years) diagnosed with either schizophrenia-spectrum disorder or bipolar disorder, and include a measurement of occurrence of either physical multimorbidity (≥2 physical health conditions) or psychiatric multimorbidity (≥3 psychiatric conditions total, including the severe mental illness). From control studies, a random-effects meta-analysis compared odds of physical multimorbidity between people with and without severe mental illness. Absolute prevalence of physical and psychiatric multimorbidity in people with severe mental illness was also calculated. Sensitivity and meta-regression analyses tested an array of demographic, diagnostic, and methodological variables. From 11 144 citations we included 82 observational studies featuring 1 623 773 individuals with severe mental illness (specifically schizophrenia-spectrum disorder or bipolar disorder), of which 21 studies featured 13 235 882 control individuals without severe mental illness (descriptive data for the entire pooled cohorts were not available for numbers of males and females, age, and ethnicity). This study did not feature involvement of people with lived experience. The odds ratio (OR) of physical multimorbidity between people with and without severe mental illness was 2·40 (95% CI 1·57–3·65, k=11, p=0·0009). This ratio was higher in younger severe mental illness populations (mean age ≤40 years, OR 3·99, 95% CI 1·43–11·10) compared with older populations (mean age >40 years, OR 1·55, 95% CI 0·96–2·51; subgroup differences p=0·0013). For absolute prevalence, 25% of those with severe mental illness have physical multimorbidity (95% CI 0·19–0·32, k=29) and 14% have psychiatric multimorbidity (95% CI 0·08–0·23, k=21). This is the first meta-analysis to estimate physical alongside psychiatric multimorbidity prevalence, showing that these are common in people with schizophrenia-spectrum disorder and bipolar disorder. The greater burden of physical multimorbidity in people with severe mental illness compared with those without is higher for younger cohorts, reflecting a need for earlier intervention. Our findings speak to the utility of multimorbidity for characterising the disease burden associated with severe mental illness, and the importance of facilitating integrated physical and mental health care. None.

中文翻译：

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患有和不患有严重精神疾病的人中多种疾病的患病率：系统评价和荟萃分析


患有严重精神疾病（例如精神分裂症谱系障碍和双相情感障碍）的人因多种慢性疾病而面临着较差的健康结果。身体多重病态（两种或多种慢性身体状况的共存）和精神多重病态（三种或多种精神疾病的共存）都是有助于概念化疾病负担的新兴概念。然而，该队列中身体和精神多重疾病的患病率尚不清楚。本研究旨在估计患有严重精神疾病的人身体和精神多重病的绝对患病率，并比较身体多重病患病率与没有严重精神疾病的人的几率。我们检索了 CINAHL、EMBASE、PubMed 和 PsycINFO 从建库到 2024 年 2 月 15 日的数据，以查找测量多种疾病患病率的观察性研究。要纳入研究，必须采用观察性研究设计，在诊断患有精神分裂症谱系障碍或双相情感障碍的成年人群（平均年龄≥18岁）中进行，并包括对任一身体多重病态（≥2身体健康状况）或精神多重病（总共≥3种精神状况，包括严重精神疾病）。根据对照研究，随机效应荟萃分析比较了患有和不患有严重精神疾病的人之间身体多重疾病的几率。还计算了严重精神疾病患者身体和精神多重疾病的绝对患病率。敏感性和荟萃回归分析测试了一系列人口统计、诊断和方法学变量。 从 11 144 条引用中，我们纳入了 82 项观察性研究，涉及 1 623 773 名患有严重精神疾病（特别是精神分裂症谱系障碍或双向情感障碍）的个体，其中 21 项研究涉及 13 235 882 名没有严重精神疾病的对照个体（整个汇总的描述性数据）队列中没有男性和女性的数量、年龄和种族）。这项研究没有邀请有生活经验的人参与。患有和不患有严重精神疾病的人之间身体多重疾病的比值比 (OR) 为 2·40 (95% CI 1·57–3·65, k=11, p=0·0009)。与老年人群（平均年龄 > 40 岁，OR 1·55, 95）相比，年轻严重精神疾病人群（平均年龄 ≤ 40 岁，OR 3·99，95% CI 1·43–11·10）的这一比例更高。 % CI 0·96–2·51；亚组差异 p=0·0013）。就绝对患病率而言，25% 的严重精神疾病患者患有躯体多重疾病 (95% CI 0·19–0·32, k=29)，14% 患有精神多重疾病 (95% CI 0·08–0·23, k =21）。这是第一个估计身体和精神多种疾病患病率的荟萃分析，表明这些疾病在精神分裂症谱系障碍和双相情感障碍患者中很常见。与没有严重精神疾病的人相比，年轻群体的身体多重病负担更大，这反映出早期干预的必要性。我们的研究结果说明了多发病对于描述与严重精神疾病相关的疾病负担的效用，以及促进综合身心保健的重要性。没有任何。