Managing the Physical Health Risks That Come With Severe Mental Disorders

Research has found that people with severe mental disorders (SMD) have an average life expectancy that is 10 to 20 years lower than the general population. This may seem unsurprising when considering the heightened risk of suicide among people with conditions such as major depressive disorder, schizophrenia and bipolar disorder. However, research has found that physical health risks are a major factor in the shortened life span of people with SMD. More importantly, many of these risks, such as diabetes and cardiovascular disease, are preventable, prompting the medical community to take action and push for more interdisciplinary care.

Chart comparing mortality rates among people with severe mental health disorders.
The years lost among people with severe mental disorders varied based on gender and diagnosis. In all cases of a diagnosis, the diagnosed population had higher mortality risks than the general population did. Go to a tabular version of data at the bottom of the page to learn about mortality rates among people with severe mental disorders.

What Are the Physical Health Risks for People With Severe Mental Disorders?

According to “Guidelines for the Management of Physical Health Conditions in Adults With Severe Mental Disorders,” released by the World Health Organization (WHO), individuals living with SMD are at a much higher risk for developing a number of physical health complications. These health risks include both non-communicable and communicable diseases.

  • People with SMD have an approximately one to three times higher risk of cardiovascular morbidity and mortality compared to the general population.
  • People with schizophrenia and bipolar disorder have double the risk for diabetes compared to the general population while people with depression have 1.5 times the risk.
  • Infectious diseases, including tuberculosis and hepatitis, appear to contribute to an increased risk of death in people with SMD, with a risk that is four to eight times greater than that of the general population.
  • Among people with SMD, the median prevalence of HIV in the United States is 1.8 percent with a higher rate of 3.8 percent among inpatient populations. The overall United States adult population estimated prevalence of HIV is 0.5 percent. 
Chart comparing adults living with severe mental disorders, in the United States, by demographic.
Across age groups, serious mental disorders are most prevalent among people ages 18–25, and in that age group, nearly twice as many women are affected as men (9.7% compared to 5.3%). People of two or more races are more affected (13.1%) than other races. Go to a tabular version of data at the bottom of the page to learn about adults living with severe mental disorders in the United States.

Why Are People With SMD at Higher Risk for Physical Health Complications?

There are many potential causes for the increased mortality of people with severe mental disorders. While individuals diagnosed with SMD do have higher rates of death due to unnatural causes, including accidents, homicide and suicide, the majority of deaths among this population can be attributed to chronic physical health conditions and diseases.

One of the most prominent links between mental and physical health is a person with SMD’s increased exposure to behavior-based risk factors. This can include smoking, substance abuse, lack of physical activity, unhealthy diets and engaging in risky behavior. The CDC reported in 2016 that 32 percent of adults in the United States with a mental illness reported current use of tobacco, compared to just 23 percent of adults in the United States with no mental illness.

Chart comparing tobacco and alcohol use among adults living with severe mental health disorders in the United States.
According to the 2017 National Survey on Drug Use and Health, created by the Substance Abuse and Mental Health Services Administration, the instances of tobacco and alcohol consumption in individuals experiencing mental health issues is sometimes twice as high as those who do not have a severe mental disorder. Go to a tabular version of data at the bottom of the page to learn about tobacco and alcohol use among adults with severe mental health disorders in the United States.

People with SMD are also often prescribed psychiatric drugs, such as antidepressant or antipsychotic medications, which can have health-altering side effects like weight gain. This, in turn, can lead to a number of comorbidities, including obesity, insulin resistance, diabetes and cardiovascular issues.

There’s also the issue of accessibility. Many people with SMD do not have access to quality care for mental health issues, let alone interdisciplinary care that addresses comorbidities in a way that is holistic and effective. A report released in 2017 by the National Alliance on Mental Illness cited denial of care by insurers, high out-of-pocket costs, difficulties accessing psychiatric medications and problems finding providers in insurance networks as the most common barriers for people seeking mental health care. Because of these barriers, nearly half of all people with mental health conditions in the United States go without any treatment (PDF, 754 KB).

How Can Individuals With SMD Work With Their Provider To Address Physical Health Risks?

In light of this global health issue, WHO recently released its “Guidelines for the Management of Physical Health Conditions in Adults With Severe Mental Disorders” (PDF 2.3 MB). The report serves as a means for providers to enact systemic change but can also be a tool of empowerment for individuals with SMD and their caregivers to advocate for themselves.

“The main message for clinicians in WHO’s new guidelines on management of physical health conditions in adults with severe mental disorders is that it is important to pay as much attention to the physical health of people with severe mental disorders as to their mental health,” said Neerja Chowdhary, MD, from the department of mental health and substance abuse at WHO, in an interview with Healio Psychiatry.

Understanding the WHO Guidelines

WHO’s recommendations for the treatment of tobacco cessation, weight management, substance use disorders, cardiovascular disease, diabetes, HIV/AIDS and other infectious diseases examine decision making over the following:

Interactions Between Drugs to Treat Physical Health Issues and Mental Illness

Combining medications to address both physical and mental health can sometimes cause negative interactions. For example, pharmacological treatments for tobacco cessation can interact with antipsychotics or antidepressants to cause adverse side effects like nausea.

Independent Side Effects of Medications

Drugs used to treat SMDs can cause a number of side effects that affect an individual’s health. Weight gain is a common result, which can lead to other comorbidities such as cardiovascular disease. These medications can also affect current medical conditions such as diabetes — certain drugs have a higher propensity for directly affecting blood sugar.

When to Utilize Behavioral Interventions

When individuals with SMD are at risk for multi-drug interaction or adverse side effects caused by medication, they may instead choose to implement a care plan to change their behavior to address a physical health risk. For example, if a psychiatric medication is highly effective for a patient but they are experiencing weight gain, they may opt to address the health risk through exercise and nutrition with the help of a provider.

How People With SMD Can Improve Their Physical Health

With the guidelines set forth by WHO in mind, individuals with SMD and their caretakers can also advocate for themselves when working with a provider.

Ask for early and regular screenings for physical health risks.
For example, the American Heart Association recommends getting checked for blood pressure, cholesterol, weight and blood glucose.

Discuss drug options.
If you are concerned about side effects that you may experience due to a medication, you can talk with a provider about changing your medications.

Discuss behavioral interventions for physical health risks.
In cases where ceasing to take a medication is simply not an option, you may consider a plan to make behavioral changes. The United States Preventive Services Task Force provides recommendations on behavioral interventions for weight loss to prevent obesity-related problems in adults.

Resources for Further Reading

The following section contains tabular data from the graphics in this post.

Mortality Rates Among People With Severe Mental Disorders

DiagnosisYears Lost (Men)Years Lost (Women)
Personality disorders
Alcohol use
Substance use disorders
Depressive episode/recurrent depressive disorder
Bipolar disorder
Opioid use
Schizoaffective disorder

Back to graphic

Percentage of Adults Living With Serious Mental Illness in the United States

GenderPercentage of Adults
Hispanic Origin and RacePercentage of Adults
Two or More Races
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Not Hispanic or Latino
Black or African-American
Hispanic or Latino

Back to graphic

Tobacco and Alcohol Use Among Adults With Serious Mental Illness in the United States

Substance Use in the Past YearPercentage of Adults With Severe Mental IllnessPercentage of Adults With No Mental Illness
Tobacco Products
Substance Use in the Past MonthPercentage of Adults With Severe Mental IllnessPercentage of Adults With No Mental Illness
Tobacco Products
Daily Cigarette Use
Heavy Alcohol Use

Back to graphic

Citation for this content: Nursing@USC, the online FNP program from the University of Southern California.