Physical morbidity and mental health: why we need to act now

By Carol Brayne, Lee Smith, and Ben Underwood

December 2023

The burden of mental disorders is increasing globally. Worldwide, mental health disorders are now known to be within the top ten leading causes of health burdens — a situation, evidence suggests, that has been worsening for more than three decades.

Yet while many people may be aware that mental health issues are linked with social problems, such as intergenerational adversity, reduced productivity and isolation, these disorders are also linked with physical illness. These include HIV, diabetes mellitus, and gastrointestinal, cardiovascular, and respiratory diseases. There is not, however, sufficient awareness about physical health and specific disorders in people suffering from mental health issues. What’s more, to combat this public health threat, we need to band together, as researchers and clinicians, to help those in need — and aim to prevent the cascade of physical diagnoses we are likely to see develop in the coming years.

For a start, our recent review and recent meta-analysis published in the BMJ Mental Health, which brought together nineteen studies comprising data from nearly 200,000 patients internationally, suggests that the risk of multiple physical issues is nearly twice as high among people with severe mental health problems compared with the general population.

Specifically, we found that, compared to people without mental health disorders, those with severe mental health problems have an 84% increased chance of having a concurrent physical morbidity. These included serious and often life-changing diagnoses such as diabetes, obesity, hypertension, respiratory, vascular, kidney and gastrointestinal diseases, and cancer.

Our confidence, statistically speaking, in this figure ranged from a 33% increase to a 154% increase — suggesting that at the very best, we’re facing a serious problem, and at worst, an alarming one.

To put this issue in perspective: evidence from 2019 suggests that one billion people worldwide are living with a mental health disorder. Other evidence suggests that people with severe mental health issues have up to a 20-year shorter life expectancy than does the general population, largely owing to physical diseases that clinicians might help to prevent. According to our meta-analysis, we are likely to see millions of potentially preventable, and treatable, physical disorders in the coming years, all relating to mental health problems that we collectively fail to treat.

This research is part of a larger collaboration between Cambridgeshire and Peterborough NHS Foundation Trust, the University of Cambridge, and Anglia Ruskin University (ARU), which has also shown that eating disorders are associated with physical morbidities, which include obesity and alcohol dependence. Further research papers are in press.

We believe that, to solve this already-exploding public health bomb, multidisciplinary solutions — approaches that include the input of public health specialists, psychologists, psychiatrists, sociologists, and general practitioners, as well as people experiencing mental health conditions and their families — are essential. No single field has the specialist knowledge necessary for addressing this enormous problem, though by designing panels that tailor interventions to time, place, and culture, we have a chance at alleviating the mental health burdens likely to translate to a wave of physical problems.

Specifically, we need to develop models of care that allow for an integrated approach to diagnosing, monitoring, and treating physical morbidities in patients with mental illness, particularly people living in socially and economically deprived areas. Through local models that take a multidisciplinary perspective, we may achieve more effective healthcare delivery along a continuum of preventive services and treatment, according to patient needs, welcomed by the most affected communities, over time, and across different levels of a given health system. For example, as medication concordance is often a problem among people with mental health issues, we must collectively make more efforts to prevent, rather than to treat, potential physical diseases, circumnavigating the issue of concordance altogether. An integrated care approach such as this would be cost-effective, patient-centred, and equitable — and may help to break an emerging cycle that is likely to have negative public health consequences for generations.

To further this goal, the University of Cambridge and ARU hosted a collaboration day on the 13^th of December.Together, we may be able to help prevent many of these morbidities before they emerge. We invite researchers in the Cambridge area and beyond to help us design the models we need to solve this urgent and growing problem.