Psychiatric–Medical ComorbidityAssociations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: a systematic review☆,☆☆,★,★★
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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Cited by (52)
Association between lower estimated premorbid intelligence quotient and smoking behavior in patients with schizophrenia
2019, Schizophrenia Research: CognitionCitation Excerpt :Health risk behaviors, including cigarette smoking, have been suggested to be associated with symptoms or level of functioning in patients with schizophrenia (Cerimele and Katon, 2013).
The relationship between lifestyle factors and clinical symptoms of bipolar disorder patients in a Chinese population
2018, Psychiatry ResearchCitation Excerpt :Noguchi et al. found that in BD patients, plant-based food and fish product consumption patterns were inversely related to physical and psychiatric symptoms, and in men, this pattern demonstrated an inverse relationship with psychiatric symptoms (Noguchi et al., 2013). Lifestyle factors, such as tobacco use and weight gain/obesity, were associated with an increased severity of BD symptoms (Cerimele and Katon, 2013). Despite these promising data on the importance for lifestyle factors in bipolar disorder, little is known about the influence of lifestyle on the remission of the disease and how lifestyle factors might affect bipolar specific mood symptoms.
Precursors in adolescence of adult-onset bipolar disorder
2017, Journal of Affective DisordersCitation Excerpt :Health conditions present in adolescence were consistently associated with anxiety and depression risk, but less notably with BD. A review found that although some studies linked higher BMI with BD risk, they are inadequate to draw causal inferences due to lack of prospective longitudinal data or ability to tackle potential confounding factors (Cerimele and Katon, 2013; McElroy and Keck, 2012). Our prospectively collected data indicates that there is no evidence of causal influence of BMI on subsequent BD risk.
Methodological quality is underrated in systematic reviews and meta-analyses in health psychology
2017, Journal of Clinical EpidemiologyA feasibility study of a physiotherapy-led motivational programme to increase physical activity and improve cardiometabolic risk in people with major mental illness
2018, General Hospital PsychiatryCitation Excerpt :In addition, MetS is a risk factor for cardiovascular disease [13]. Pro-atherogenic ‘health risk behaviours’ associated with schizophrenia and bipolar disorder, such as smoking, poor nutrition and sedentary lifestyle [14,15] contribute to premature cardiovascular death in this population. Increasing levels of physical activity may mitigate against the development of cardiovascular disease and a host of other chronic diseases among people with MMI [8,16,17].
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Sources of financial support: Supported by NRSA grant 5T32MH020021 from the NIMH.
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Previous presentations of work: No prior presentations.
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Assistance: The authors wish to acknowledge Judy C. Stribling, MLS, MA for her valuable assistance with the literature search.
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Disclaimer statements: Dr. Cerimele has no disclosures. Dr. Katon has received speaking fees from Pfizer, Eli Lilly and Forest during the last 12 months.