Cited by 870Schizophrenia research and treatmentMental Health Treatment and AccessPsychiatric care and mental health services

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Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

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DE HERT, MARC, COHEN, DAN, BOBES, JULIO, CETKOVICH‐BAKMAS, MARCELO, LEUCHT, STEFAN, NDETEI, DAVID M., NEWCOMER, JOHN W., UWAKWE, RICHARD, ASAI, ITSUO, MÖLLER, HANS‐JURGEN, GAUTAM, SHIV, DETRAUX, JOHAN, CORRELL, CHRISTOPH U.·2011·World Psychiatry

DOI 10.1002/j.2051-5545.2011.tb00036.xPMC PMC3104888

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Abstract

Physical disorders are, compared to the general population, more prevalent in people with severe mental illness (SMI). Although this excess morbidity and mortality is largely due to modifiable lifestyle risk factors, the screening and assessment of physical health aspects remains poor, even in developed countries. Moreover, specific patient, provider, treatment and system factors act as barriers to the recognition and to the management of physical diseases in people with SMI. Psychiatrists can play a pivotal role in the improvement of the physical health of these patients by expanding their task from clinical psychiatric care to the monitoring and treatment of crucial physical parameters. At a system level, actions are not easy to realize, especially for developing countries. However, at an individual level, even simple and very basic monitoring and treatment actions, undertaken by the treating clinician, can already improve the problem of suboptimal medical care in this population. Adhering to monitoring and treatment guidelines will result in a substantial enhancement of physical health outcomes. Furthermore, psychiatrists can help educate and motivate people with SMI to address their suboptimal lifestyle, including smoking, unhealthy diet and lack of exercise. The adoption of the recommendations presented in this paper across health care systems throughout the world will contribute to a significant improvement in the medical and related psychiatric health outcomes of patients with SMI.

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Sharma, A., Blakemore, A., Byrne, M., Nazary, M., Siroya, K., Husain, N., & Neupane, S. P. (2024) · Global Public Health · doi:10.1080/17441692.2024.2408597 · Cited by 7
“People with SMI may require an educational intervention tailored to their specific needs (De Hert et al., 2011; Michie et al., 2011).”
Exploring the stigma against people with mental illness in Bangladesh
Roy, P., & Chowdhury, K. U. A. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.107 · Cited by 7
“Professional stigma affects the patients ’ well-being and treatment process (De Hert et al., 2011).”
Bipolar and Substance Use Disorder Comorbidity: Diagnostic and Treatment Considerations
Ostacher, M. J. (2011) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.9.4.foc428 · Cited by 7
Disparities in Reperfusion Therapy and Time Delays Among Patients With Ischemic Stroke and a History of Mental Illness
Mackenhauer, J., Christensen, E. F., Andersen, G., Mainz, J., & Johnsen, S. P. (2022) · Stroke · doi:10.1161/strokeaha.122.038591 · Cited by 7
INSIG2Polymorphism and Weight Gain, Dyslipidemia and Serum Adiponectin in Finnish Patients with Schizophrenia Treated with Clozapine
Koskinen, S., Kampman, O., Solismaa, A., Lyytikäinen, L., Seppälä, N., Viikki, M., Hämäläinen, M., Moilanen, E., Mononen, N., Lehtimäki, T. J., et al. (2016) · Pharmacogenomics · doi:10.2217/pgs-2016-0117 · Cited by 7
The Role of Social Workers in Improving the Physical Health of People Who Use Mental Health Services
Maylea, C., Roberts, R. J., & Craik, C. (2019) · Australian Social Work · doi:10.1080/0312407x.2019.1638430 · Cited by 7
Examining the feasibility, acceptability, validity and reliability of physical activity, sedentary behaviour and sleep measures in people with schizophrenia
Berry, A., Drake, R., Butcher, I., & Yung, A. R. (2021) · Mental health and physical activity · doi:10.1016/j.mhpa.2021.100415 · Cited by 9
COVID-19 vaccination rates in hospitalized mentally ill patients compared to the general population in Germany: Results from the COVID Ψ Vac study
Wiegand, H. F., Maicher, B., Rueb, M., Wessels, P., Besteher, B., Hellwig, S., Pfennig, A., Rohner, H., Unterecker, S., Hölzel, L. P., et al. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.33 · Cited by 7
“By these risk factors in combination with pandemic-associated reduced health-care services [5, 6] the COVID-19 pandemic has the potential to further broaden the appallingly large mortality gap for severe mental disorders [7, 8].”
Background
Anticoagulation therapy and outcomes in patients with atrial fibrillation and serious mental illness: A systematic review and meta-analysis
Farran, D., Feely, O., Ashworth, M. J., & Gaughran, F. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.11.002 · Cited by 7
Appraisal of primary health care services in federal capital territory, Abuja, Nigeria: how committed are the health workers?
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“The documentation of associations between severe mental illnesses and physical disorders or increased odds of reporting difficulties in accessing care [24] makes neglect of mental disorders particularly worrisome.”
Background
The role of community mental health services in supporting oral health outcomes among consumers
Meldrum, R., Ho, H., & Satur, J. G. (2018) · Australian Journal of Primary Health · doi:10.1071/py17132 · Cited by 7
Exploring Perceptions of Continuity of Care Among People With Long-Term Mental Disorders in Denmark
Folker, A. P., Kristensen, M. M., Kusier, A. O., Nielsen, M. B. D., Lauridsen, S., & Sølvhøj, I. N. (2019) · Qualitative Health Research · doi:10.1177/1049732319840286 · Cited by 7
“Moreover, it has been documented that most of this excess mortality stems from the neglect of physical symptoms and physical diseases which are underdiagnosed and undertreated (De Hert et al., 2011; Lawrence, Hancock, & Kisely, 2013).”
Background
Physical Comorbidities are Independently Associated with Higher Rates of Psychiatric Readmission in a Chinese Han Population
Yang, C., Zhong, X., Zhou, H., Wu, Z., Zhang, M., & Ning, Y. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s261223 · Cited by 7
Strengthening the delivery of integrated care for individuals experiencing serious mental illness within mental health settings: a qualitative description of health provider perspectives
Ambreen, M., Canning, C., Lo, B., Agarwal, S. M., Burhan, A. M., Castle, D. J., Giudice, M. E. D., Thege, B. K., Liu, L., Melamed, O. C., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06572-2 · Cited by 20
Barriers and facilitators to accessing sexual and reproductive health services for people with severe mental illness: a systematic review
Brown, M., Tassie, E., Carlisle, S., Covshoff, E., Ronaldson, A., Williams, J., Smith, S. M., Trevillion, K., Hughes, E. A., & Heslin, M. (2025) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-025-02844-0 · Cited by 7
GLP-1R Agonists for Weight Loss in Psychiatric Disorders: A Systematic Review and Meta-analysis
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Underweight and hypoalbuminemia as risk indicators for mortality among psychiatric patients with medical comorbidities
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“Therefore, a physical illness causing weight loss may be easily overlooked among inpatients at psychiatric hospitals.(16) Monitoring patients’ weight and the early detection of underweight may help to avoid the oversight of medical comorbidities.”
Background
Prevalence, risk factors and clinical correlates of glucose disturbances in a large sample of Han Chinese patients with first-episode drug-naïve major depressive disorder
Chen, S. W., Wu, Y., Li, S., Li, J., Lang, X. E., & Zhang, X. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01581-2 · Cited by 6
Gender differences in prevalence and clinical risk factors of suicide attempts in young adults with first-episode drug-naive major depressive disorder
Zhu, Q., Lang, X., & Zhang, X. (2024) · BJPsych Open · doi:10.1192/bjo.2023.635 · Cited by 7
High persistence and low treatment rates of metabolic syndrome in patients with mood and anxiety disorders: A naturalistic follow-up study
Brouwer, J., Wardenaar, K. J., Liemburg, E. J., Doornbos, B., Mulder, H., & Cath, D. C. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.042 · Cited by 6
Delineating the Psychic Structure of Substance Use and Addictions, from Neurobiology to Clinical Implications: Ten Years Later
Pani, P., Maremmani, A. G. I., Pacini, M., Trogu, E., Gessa, G. L., Ruiz, P., & Maremmani, I. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9061913 · Cited by 6
Psychiatric Medication Changes Associated With Increased Rate of Medical Readmissions in Patients With Serious Mental Illness
Germack, H. D., Weissinger, G., Bizhanova, Z., & Martsolf, G. R. (2020) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001282 · Cited by 6
“Given their chronic physical health conditions, peoplewith SMI are often on complex medication regimens prescribed by different providers to manage both their physical comorbidities and their psychiatric symptoms (De Hert et al., 2011a, 2011b).”
Background
Schizophrene Psychosen
Falkai, P., Schennach, R., Lincoln, T. M., Schaub, A., & Hasan, A. (2016) · Springer eBooks · doi:10.1007/978-3-642-45028-0_64-1 · Cited by 9
Physical Healthcare for People with a Severe Mental Illness in Belgium by Long-Term Community Mental Health Outreach Teams: A Qualitative Descriptive Study on Physicians’, Community Mental Health Workers’ and Patients’ Perspectives
Martens, N., Haeck, E. D., Vondel, E. V. D., Destoop, M., Catthoor, K., Dom, G., & den Broeck, K. V. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010811 · Cited by 6
“In addition, both stigmatization and self-stigmatization increase the barriers to proper physical healthcare [13,16,17].”
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COVID-19-associated mortality in individuals with serious mental disorders in Sweden during the first two years of the pandemic– a population-based register study
Gibbs, A., Maripuu, M., Öhlund, L., Widerström, M., Nilsson, N., & Werneke, U. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05629-y · Cited by 6
“Differences in immunological profile [51], barriers to somatic care [52], socioeconomic [53], social and environmental factors may all play a role.”
Background
Evaluation of health promotion programmes in severe mental illness: theory and practice
van Hasselt, F. M., Krabbe, P. F. M., Postma, M. J., & LOONEN, A. J. M. (2014) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1456 · Cited by 8
Low Rate of Obesity among Psychiatric Inpatients in Indonesia
Marthoenis, M., Aichberger, M. C., Puteh, I., & Schouler‐Ocak, M. (2014) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.48.3.c · Cited by 6
“During acute and maintenance treatment of Schizophrenia, weight gain side effect of antipsychotics were reported to affect between 15% to 72% of the patients [24].”
Preparing family physicians for the care of patients with severe and persistent mental illness
Romain, A., Muench, J., & Phillips, J. P. (2015) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217415592353 · Cited by 6
“Unfortunately, combinations of these problems often create additional barriers to care for patients with more severe mental illness.(7) Traditionally, psychiatrists have only minimal training in primary care,(8) and physical health services are often not reimbursable in mental health settings.”
Health Care and Mortality among Persons with Severe Mental Illness
Gal, G., Munitz, H., & Levav, I. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716666997 · Cited by 6
Inhibited autonomy for promoting physical health: qualitative analysis of narratives from persons living with severe mental illness
Nakanishi, M., Tanaka, S., Kurokawa, G., Ando, S., Yamasaki, S., Fukuda, M., Takahashi, K., Kojima, T., & Nishida, A. (2019) · BJPsych Open · doi:10.1192/bjo.2018.77 · Cited by 6
Risk factors for metabolic and cardiovascular disease in inpatients with severe mental illness
Lavagnino, L., Gurguis, C. I., & Lane, S. D. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.114148 · Cited by 7
Mortality Rates and Trends Among Bologna Community Mental Health Service Users
Berardi, D., Pavarin, R. M., Chierzi, F., Terzi, L., Manzo, V., Piazza, A., Menchetti, M., & Fioritti, A. (2018) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000906 · Cited by 7
Maintenance treatment for patients with a first psychotic episode
Sommer, I. E., Oomen, P. P., & Hasan, A. (2019) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000494 · Cited by 7
An audit of general practitioner involvement in public community mental health care
Jang, J. S., Futeran, S., Large, M. M. B., & Curtis, J. (2015) · Australasian Psychiatry · doi:10.1177/1039856215592479 · Cited by 6
Medical Co-morbidities Among Patients with Severe Mental Illnesses in a Community Health Facility in Nigeria
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Multi-agent norm perception and induction in distributed healthcare
Li, C., Petruchik, O., Grishanina, E., & Kovalchuk, S. V. (2025) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2025.104835 · Cited by 7
Women and psychosis: a guide to evidence-based, hormone-informed care
Brand, B. A., Behrman, S., Marwick, K. F. M., Reilly, T. J., Sommer, I. E., Talaulikar, V. S., & McCutcheon, R. A. (2026) · The Lancet Psychiatry · doi:10.1016/s2215-0366(26)00016-7 · Cited by 5
The development of type 2 diabetes management in people with severe mental illness in the Capital Region of Denmark from 2001 to 2015
Bakkedal, C., Persson, F., Christensen, M., Kriegbaum, M., Mohr, G. H., Andersen, J. S., Lind, B., Lykkegaard, C., Siersma, V., & Rozing, M. P. (2024) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13650 · Cited by 5
Depression symptoms and suicidal ideation among HIV infected Rwandans: the mediating and moderating effects of complicated grief and substance abuse
Uwiringiyimana, A., Niyonsenga, J., Kéthina, L. G., Bugenimana, A., Mutabaruka, J., & Nshimiyimana, A. (2024) · AIDS Research and Therapy · doi:10.1186/s12981-024-00628-1 · Cited by 6
Plasma glucose monitoring in psychiatric inpatients with primary affective disorder
Kelbrick, M., & Picchioni, M. (2013) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.263 · Cited by 5
Recent Trends of Antipsychotics Polypharmacy in Schizophrenia
Chang, J. G., Roh, D. D., & Kim, C. H. (2013) · 대한정신약물학회지 · Cited by 5
The Dual Burden of HIV Infection and First-Episode Psychosis in Africa
Chhagan, U., Ntlantsana, V., Tomita, A. M., Chiliza, B., & Paruk, S. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001366 · Cited by 5
“…the studies from Africa reported a much higher rate of HIV prevalence (23%–32%), with a pooled prevalence of 26%, than the international literature on HIV prevalence in FEP samples (De Ronchi et al., 2006; Hughes et al., 2016) and those with severe mental illness (1% to 24%; De Hert et al., 2011).”
Background

Authors: DE HERT, M., COHEN, D., BOBES, J., CETKOVICH‐BAKMAS, M., LEUCHT, S., NDETEI, D. M., NEWCOMER, J. W., UWAKWE, R., ASAI, I., MÖLLER, H., GAUTAM, S., DETRAUX, J., & CORRELL, C. U.
Affiliations: University of Groningen (NL)
Universidad de Oviedo (ES)
Technical University of Munich (DE)
University of Nairobi (KE)
Washington University in St. Louis (US)
Nnamdi Azikiwe University (NG)
SMS Medical College (IN)
KU Leuven (BE)
Albert Einstein College of Medicine (US)
ORCID: COHEN, DAN
BOBES, JULIO
LEUCHT, STEFAN
NDETEI, DAVID M.
NEWCOMER, JOHN W.
UWAKWE, RICHARD
DETRAUX, JOHAN
CORRELL, CHRISTOPH U.
Venue: World Psychiatry
Publisher: Wiley
Published: 2011-06
Volume: 10
Issue: 2
Pages: 138-151
ISSN: 1723-8617 (ISSN-L)
2051-5545
DOI: 10.1002/j.2051-5545.2011.tb00036.x
PMC: PMC3104888
OpenAlex: W1828019950
Cited by: 870
References: 150
Citations by year: 2026: 39 · 2025: 50 · 2024: 50 · 2023: 57 · 2022: 68 · 2021: 54 · 2020: 72 · 2019: 76 · 2018: 68 · 2017: 56 · 2016: 79 · 2015: 57 · 2014: 37 · 2013: 57 · 2012: 39
FWCI: 31.70
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 650 d)
Locations: World Psychiatry (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Lirias (submittedVersion)
mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders: Bristol-Myers Squibb
Pfizer
Società Italiana di Psichiatria Biologica
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords: physical illness, severe mental illness, barriers to care, physical health screening, treatment guidelines, lifestyle risk factors, smoking, diet, physical activity, developing countries

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Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

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