Elsevier

General Hospital Psychiatry

Volume 35, Issue 1, January–February 2013, Pages 16-22
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Associations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: a systematic review,☆☆,,★★

https://doi.org/10.1016/j.genhosppsych.2012.08.001Get rights and content

Abstract

Objective

To systematically review the literature to determine if health risk behaviors in patients with schizophrenia or bipolar disorder are associated with subsequent symptom burden or level of functioning.

Method

Using the PRISMA systematic review method we searched PubMed, Cochrane, PsychInfo and EMBASE databases with key words: health risk behaviors, diet, obesity, overweight, BMI, smoking, tobacco use, cigarette use, sedentary lifestyle, sedentary behaviors, physical inactivity, activity level, fitness, sitting AND schizophrenia, bipolar disorder, bipolar illness, schizoaffective disorder, severe and persistent mental illness, and psychotic to identify prospective, controlled studies of greater than 6 months duration. Included studies examined associations between sedentary lifestyle, smoking, obesity, physical inactivity and subsequent symptom severity or functional impairment in patients with schizophrenia or bipolar disorder.

Results

Eight of the 2130 articles identified met inclusion criteria and included 508 patients with a health risk behavior and 825 controls. Six studies examined tobacco use, and two studies examined weight gain/obesity. Seven studies found that patients with schizophrenia or bipolar illness and at least one health risk behavior had more severe subsequent psychiatric symptoms and/or decreased level of functioning.

Conclusion

Tobacco use and weight gain/obesity may be associated with increased severity of symptoms of schizophrenia and bipolar disorder or decreased level of functioning.

Section snippets

Background

Health risk behaviors such as sedentary lifestyle [1], tobacco use [2], poor diet [3] and obesity [4] have been associated with increased risk of developing chronic medical disorders. These health risk behaviors account for approximately 40% of deaths in the United States [5]. Depression is associated with the incidence of health risk behaviors such as obesity, smoking and lack of exercise potentially causing early development of chronic illnesses such as coronary heart disease (CHD) and

Methods

We followed the PRISMA method of conducting a systematic review [32] but did not register the review using a pre-specified protocol. We searched the PubMed, Cochrane, PsychInfo and EMBASE databases [last search run on March 30th, 2012] using the following term combinations: health risk behaviors, diet, obesity, overweight, BMI, smoking, tobacco use, cigarette use, sedentary lifestyle, sedentary behaviors, physical inactivity, activity level, fitness, sitting AND schizophrenia, bipolar disorder,

Study characteristics

The results of our search are shown in Fig. 1. Two thousand one hundred and thirty studies were identified and screened after duplicates were removed. Full articles were pulled and assessed for eligibility for ninety-three of these studies. Eight studies met our inclusion criteria and were included in the review. The eight studies included 508 patients with SPMI and a health risk behavior and 825 control patients with SPMI without a health risk behavior. Study size ranged from 19 to 147

Findings and Implications

This systematic review found 8 studies that have prospectively examined the associations among health risk behaviors and symptoms of SPMI. The only health risk behaviors assessed in these studies were weight gain/obesity and tobacco use. No studies have examined other health risk behaviors such as sedentary lifestyle or physical inactivity. Health risk behaviors were associated with adverse outcomes based on either symptoms of SPMI or level of functioning (or both) in seven out of eight

Limitations

This review has several limitations. Although our search strategy yielded 2130 unique articles, only eight studies fit our inclusion criteria. The small sample size in the majority of studies is a major limitation. Having one adverse health risk behavior is often correlated with a higher likelihood of having multiple health risk behaviors such as sedentary lifestyle, poor diet, use of alcohol and other substances and lack of use of preventive care [55]. However, most studies did not evaluate

Conclusions

We found that seven out of eight published prospective studies found negative associations between health risk behaviors and subsequent severity of symptoms of SPMI or decreased level of functioning. No conclusion on the direct impact of health risk behaviors on symptom severity or level of functioning can be made. Large prospective studies are needed that control for socioeconomic variables and a full range of health risk behaviors and quality of medical care. If negative associations between

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    Sources of financial support: Supported by NRSA grant 5T32MH020021 from the NIMH.

    ☆☆

    Previous presentations of work: No prior presentations.

    Assistance: The authors wish to acknowledge Judy C. Stribling, MLS, MA for her valuable assistance with the literature search.

    ★★

    Disclaimer statements: Dr. Cerimele has no disclosures. Dr. Katon has received speaking fees from Pfizer, Eli Lilly and Forest during the last 12 months.

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