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Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta‐analysis
Open accessAbstract
Metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. The primary aim of this systematic review and meta‐analysis was to assess the prevalence of MetS and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder, comparing subjects with different disorders and taking into account demographic variables and psychotropic medication use. The secondary aim was to compare the MetS prevalence in persons with any of the selected disorders versus matched general population controls. The pooled MetS prevalence in people with severe mental illness was 32.6% (95% CI: 30.8%‐34.4%; N = 198; n = 52,678). Relative risk meta‐analyses established that there was no significant difference in MetS prevalence in studies directly comparing schizophrenia versus bipolar disorder, and in those directly comparing bipolar disorder versus major depressive disorder. Only two studies directly compared people with schizophrenia and major depressive disorder, precluding meta‐analytic calculations. Older age and a higher body mass index were significant moderators in the final demographic regression model (z = −3.6, p = 0.0003, r 2 = 0.19). People treated with all individual antipsychotic medications had a significantly (p<0.001) higher MetS risk compared to antipsychotic‐naïve participants. MetS risk was significantly higher with clozapine and olanzapine (except vs. clozapine) than other antipsychotics, and significantly lower with aripiprazole than other antipsychotics (except vs. amisulpride). Compared with matched general population controls, people with severe mental illness had a significantly increased risk for MetS (RR = 1.58; 95% CI: 1.35‐1.86; p<0.001) and all its components, except for hypertension (p = 0.07). These data suggest that the risk for MetS is similarly elevated in the diagnostic subgroups of severe mental illness. Routine screening and multidisciplinary management of medical and behavioral conditions is needed in these patients. Risks of individual antipsychotics should be considered when making treatment choices.
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TL;DR
This systematic review and meta-analysis found that metabolic syndrome (MetS) affects about one third of people with severe mental illness and is elevated versus matched general population controls. Risk was similar across schizophrenia, bipolar disorder, and major depressive disorder, but differed by age, body mass index, and individual antipsychotic medication.
Key findings
- Pooled MetS prevalence in people with severe mental illness was 32.6% (95% CI: 30.8%–34.4%; N=198; n=52,678), and compared with matched general population controls the relative risk was 1.58 (95% CI: 1.35–1.86; p<0.001).
- MetS prevalence did not differ significantly in direct comparisons of schizophrenia versus bipolar disorder (RR=0.92, 95% CI: 0.79–1.06; p=0.24) or bipolar disorder versus major depressive disorder (RR=0.87, 95% CI: 0.48–1.55; p=0.64); only two studies directly compared schizophrenia and major depressive disorder, precluding meta-analysis.
- Older age and higher body mass index were significant moderators in the final demographic regression model (z=23.6, p=0.0003, r²=0.19).
- Among antipsychotics, MetS prevalence was lowest for aripiprazole (19.4%, 95% CI: 8.0%–34.2%) and highest for clozapine (47.2%, 95% CI: 42.0%–52.6%); antipsychotic-naïve participants had 10.2% (95% CI: 6.8%–14.3%). Compared with controls, risk was increased for all MetS components except hypertension, which showed a statistical trend (RR=1.12, 95% CI: 0.99–1.28; p=0.07).
Methods
- Systematic review and meta-analysis conducted according to MOOSE and PRISMA, searching MEDLINE, PsycARTICLES, EMBASE, and CINAHL from database inception to January 1, 2015.
- Included observational studies in adults with DSM-IV/ICD-10 diagnoses of schizophrenia or related psychotic disorders, bipolar disorder, or major depressive disorder, and MetS defined by non-modified ATP-III, ATP-III-A, IDF, or WHO criteria; 198 studies with 52,678 unique persons with severe mental illness were included.
- Pooled prevalence used the DerSimonian-Laird random-effects proportion method; relative risks were calculated for MetS and its components within and across diagnostic subgroups and versus matched general population controls, with meta-regression for moderators.
Limitations
- The paper states considerable methodological heterogeneity across studies; cross-sectional data meant directionality of medication–metabolic associations could not be deduced with certainty; clinical subtypes and concomitant or previous antidepressant/mood stabilizer use were often insufficiently reported or controlled; publication bias and heterogeneity were encountered, though main findings were robust after trim-and-fill adjustment; and inadequate data on ethnicity and lifestyle behaviors precluded meta-analytic assessment of these factors.
- Evident from the text: there were no data in first-episode bipolar disorder or major depressive disorder patients, precluding comparison with multi-episode patients, and only two studies directly compared schizophrenia and major depressive disorder.
- Evident from the text: illness duration was a significant predictor in separate meta-regression but not in the final model, which the authors note may be due to limited data available for illness duration compared with age.
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65 Own result · 14 Not checked yet · 9 Own method · 5 Own interpretation · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“MetS risk was significantly higher with clozapine and olanzapine (except vs. clozapine) than other antipsychotics, and”
- Also stated in: § Medication use · plain
“Those treated with olanzapine had significantly higher MetS prevalence than those treated with amisulpride (p<0.05),aripiprazole (p<0.001),risperidone (p<0.01) and typical antipsychotic medications (p<0.05).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Medication use · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“hyperglycaemia (N 5 20; RR 5 1.51, 95% CI: 1.24-1.84,p<0.001;Q 5 94.4,p<0.001)”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Risk of metabolic syndrome and its components in persons with various disorders compared with general population controls
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Compared with matched general population controls, people with severe mental illness had a significantly increased risk for MetS (RR 5 1.58; 95% CI: 1.35-1.86;p<0.001) and all its components, except for hypertension (p 5 0.07).”
- Also stated in: § Risk of metabolic syndrome and its components in persons with various disorders compared with general population controls · plain
“In a pooled relative risk metaanalysis, persons with SMIs (n 5 6,610; 29.2%, 95% CI: 25.9%-32.6%;Q 5 230, p<0.001), compared with general population controls (n 5 101,223; 18.1%, 95% CI: 15.8%-20.5%,Q 5 230, p<0.001), had significantly increased risk of MetS (RR 5 1.58, 95% CI: 1.35-1.86,p<0.001;Q 5 62, p 5 0.003).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Risk of metabolic syndrome and its components in persons with various disorders compared with general population controls · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“low HDL cholesterol (N 5 19; RR 5 1.33, 95% CI: 1.15-1.54,p<0.001;Q 5 114.7, p<0.001)”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Risk of metabolic syndrome and its components in persons with various disorders compared with general population controls
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“People with severe mental illness had significantly increased risk for abdominal obesity (N 5 18; RR 5 1.43, 95% CI: 1.23-1.66,p<0.001;Q 5 198.8, p<0.001)”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Risk of metabolic syndrome and its components in persons with various disorders compared with general population controls
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Relative risk meta-analyses established that there was no significant difference in MetS prevalence in studies directly comparing schizophrenia versus bipolar disorder, and in those directly comparing bipolar disorder versus major depressive disorder.”
- Also stated in: § Diagnostic subgroups · boosted
“Relative risk meta-analyses established that there was no significant difference in MetS in studies directly comparing schizophrenia (39.2%, 95% CI: 30.5%-48.3%;n 5 2,338) versus bipolar disorder (35.5%, 95% CI: 27.0-44.3%;n 5 2,077) (N 5 10, RR 5 0.92, 95% CI: 0.79%-1.06%;v 2 5 1.33, p 5 0.24; Q 5 21.3, p<0.011).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
boosted- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Diagnostic subgroups · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“People treated with all individual antipsychotic medications had a significantly (p<0.001) higher MetS risk compared to antipsychotic-na€ ıve participants.”
- Also stated in: § Medication use · plain
“Patients treated with all individual antipsychotic medications had significantly (p<0.001) higher MetS risk compared to antipsychotic-na€ ıve participants.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Medication use · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“hypertriglyceridemia (N 5 19; RR 5 1.49, 95% CI: 1.28-1.73,p<0.001;Q 5 91.2, p< 0.001)”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Risk of metabolic syndrome and its components in persons with various disorders compared with general population controls
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Older age and a higher body mass index were significant moderators in the final demographic regression model (z 5 23.6, p 5 0.0003, r 2 5 0.19).”
- Also stated in: § Demographic variables · plain
“Overall, the final model was a significant predictor of the variance in MetS (z 5 23.6, p 5 0.0003; r 2 5 0.19).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Demographic variables · plain
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In the paper
“with a statistical trend for hypertension (N 5 12; RR 5 1.12, 95% CI: 0.99-1.28,p 5 0.07; Q 5 127.1, p<0.001).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Risk of metabolic syndrome and its components in persons with various disorders compared with general population controls
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 13
- The quote only partly states this claim. 2
- Probably not a substantial claim. 13
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In the paper
“Only two studies directly compared people with schizophrenia and major depressive disorder, precluding meta-analytic calculations.”
- Also stated in: § Diagnostic subgroups · plain
“Only two studies directly compared MetS in people with schizophrenia and major depressive disorder, precluding meta-analytic calculations.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
plainn = 2- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Diagnostic subgroups · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The trim-andfill method demonstrated that adjusting for publication bias had little effect on the pooled MetS estimate, which was virtually identical (32.5%, 95% CI: 30.8%-34.2%,Q 5 2991, p<0.01, n 5 52,678).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Prevalence of metabolic syndrome and its components
boosted- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
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In the paper
“There were no data in first-episode bipolar disorder or major depressive disorder patients, precluding a comparison with multi-episode patients.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Diagnostic subgroups
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“South-America | 10 | 25.8% (95% CI: 20.7%-31.3%)”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“This finding may, however, be somewhat affected by different MetS criteria, with IDF criteria, which are often used in Australian studies, being associated with the highest MetS prevalences.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Australia and New Zealand* | 6 | 50.2% (95% CI: 35.3%-65.0%)”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“This mortality gap translates into a 10-20 year shortened life expectancy (3,4) and appears to be widening (5).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
What the sources say
- Not checked yetcites [5] source
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“People with severe mental illness (SMI), including schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder (MDD), experience a twothree times higher mortality rate than the general population (1,2).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“This mortality gap translates into a 10-20 year shortened life expectancy (3,4) and appears to be widening (5).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Methodological appraisal was performed according to PRISMA standards (28), including evaluation of bias (confounding, overlapping data, publication bias).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Search criteria, study selection and critical appraisal
What the sources say
- Not checked yetcites [28] source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“A brief meta-analytic report comparing MetS frequencies in patients with schizophrenia and bipolar disorder found that these populations are at similar risk (25).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
What the sources say
- Not checked yetcites [25] source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“In order to increase homogeneity of compared samples and eliminate smaller studies with less precise point estimates, we also conducted sensitivity analyses, restricting the sample to large, population-based studies.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Statistical analyses
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Two independent authors (DV, BS) searched MEDLINE, PsycARTICLES, EMBASE and CINAHL from database inception to January 1, 2015.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Search criteria, study selection and critical appraisal
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“This systematic review was conducted in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines (27) and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard (28).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Inclusion and exclusion criteria
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In the general population, these clustered risk factors have been associated with the development of CVD and excess mortality (13)(14)(15).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
What the sources say
- Not checked yetcites (13)(14)(15)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Publication bias was tested using the Egger's regression method (29) and Begg-Mazumdar test (30), with a p value <0.05 suggesting the presence of bias.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Search criteria, study selection and critical appraisal
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The trimand-fill approach (32) was used to adjust the overall estimate for funnel plot asymmetry.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Statistical analyses
What the sources say
- Not checked yetcites [32]
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Factors predisposing people with SMI to CVD include antipsychotic medication and unhealthy lifestyles (7) as well as their reduced likelihood to receive standard levels of medical care (8)(9)(10)(11)(12).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
What the sources say
- Not checked yetcites [7] source
- Not checked yetcites (8)(9)(10)(11)(12)
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“However, these findings should be interpreted with caution, since comparisons were performed at study level and not limited to studies directly comparing the two populations, and patient samples were not matched for age and illness duration (26).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Abstract
What the sources say
- Not checked yetcites [26] source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Fourth, a threat to the validity of any meta-analysis is publication bias and heterogeneity, which we encountered in several of our analyses.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To our knowledge, this is the first meta-analysis of MetS and its components including and comparing data from the main SMIs: schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
In the paper
“antipsychotics with lower cardiometabolic risk profiles in short-term studies are often prescribed for higher risk patients in clinical care, which may lead to a not reduced or even increased cardiometabolic risk in naturalistic settings (42).”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
What the sources say
- Not checked yetcites [42] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, although the main findings were heterogeneous, they were also highly robust and not influenced by publica-tion bias, being virtually unaltered after applying the trimand-fill method.”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Since age is a relevant risk factor for MetS in the general population too, the relative MetS risk *Two-sided p<0.05, two-sided p<0.01, ***two-sided p<0.001”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > DISCUSSION
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“chronic conditions such as coronary artery disease, fibromyalgia, rheumatoid arthritis, and mood disorders such as Major Depressive Disorder (MDD) and Post Traumatic Stress Disorder (PTSD) have also been associated with abnormally high CORT levels and metabolic disruptions ( 5-13 ).”
From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [13]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“many of these conditions are accompanied by a disruption of normal glucose metabolism while preserving some degree of CORT rhythmicity.”
From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [13]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“People with severe mental illness (schizophrenia, bipolar disorder or major depressive disorder) have higher levels of somatic comorbidities and premature mortality than the general population 1-3 .”
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“in hypercortisolism, it is not only that CORT levels are higher than normal, but in some cases, they also display abnormal rhythmicity. This varies depending on whether the underlying condition is associated with Cushing's syndrome, depression, PTSD, acute inflammation following major surgery, or chronic inflammatory diseases (e.g., rheumatoid arthritis) ( 2, 5-13, 57-60 ).”
From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [13]
Experimental — accuracy not yet measuredIn the citing paper
“There is evidence for the use of pyridostigmine 96 , non-steroidal anti-inflammatories 97 , caffeine 98 and erythropoietin 99 as adjunctive agents in patients who remain symptomatic with the above regime.”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [97]
In the citing paper
“The current meta-analysis adds to the evidence that a first-episode diagnosis is a unique predictor of lower T2DM prevalence independent of mean age, a finding that was also apparent in a recent analysis of metabolic syndrome prevalences across patients with the same three main SMIs 33 .”
From Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis (2016) · cites this paper as [33]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Diagnostic subgroups
“The pooled MetS prevalence was 33.4% (95% CI: 30.8%-36.0%,Q 5 1955.0,p<0.001) in people with schizophrenia (N 5 93, n 5 29,596)”
§ Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis > Diagnostic subgroups
“multi-episode schizophrenia (34.2%, 95% CI: 30.8%-36.0%,Q 5 1,955, p<0.001;N 5 105, n 5 29,596)”
Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00135 · Cited by 37,554
Toprak, Ö., Kurt, H., Sarı, Y., Şarkış, C., Us, H., & Kırık, A. (2017) · Kidney & Blood Pressure Research · doi:10.1159/000468530 · Cited by 29,772
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944
Expert Panel on Detection, E. (2001) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.285.19.2486 · Cited by 26,011
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,586
Meta-analysis of Observational Studies in Epidemiology<SUBTITLE>A Proposal for Reporting</SUBTITLE>
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623
Research works printed but not linked: 2
- World Health Organization, 1999, Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus
- Duvall S, 2000, A non‐parametric ‘trim and fill’ method for assessing publication bias in meta‐analysis, J Am Stat Assoc, 95, 89
Cited by
Sorted by citations
Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., et al. (2017) · World Psychiatry · doi:10.1002/wps.20420 · Cited by 1,729
Self-citationFirth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allan, S., Caneo, C., Carney, R., Carvalho, A. F., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30132-4 · Cited by 1,531
Self-citationPillinger, T., McCutcheon, R. A., Vano, L., Mizuno, Y., Arumuham, A., Hindley, G., Beck, K., Natesan, S., Efthimiou, O., Cipriani, A., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30416-x · Cited by 1,090
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31544-0 · Cited by 1,047
Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., Probst, M., Ward, P. B., Gaughran, F., De Hert, M., et al. (2017) · World Psychiatry · doi:10.1002/wps.20458 · Cited by 957
Self-citation
Metadata
- Authors
- Vancampfort, D., Stubbs, B., Mitchell, A. J., De Hert, M., Wampers, M., Ward, P. B., Rosenbaum, S., & Correll, C. U.
- Affiliations
- KU Leuven (BE)
- University of Greenwich (GB)
- University of Leicester (GB)
- UPC KU Leuven, Campus Kortenberg, Department of Neurosciences, KU Leuven ‐ University of Leuven Kortenberg Belgium
- UNSW Sydney (AU)
- Hofstra University (US)
- ORCID
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2015-09-25
- Volume
- 14
- Issue
- 3
- Pages
- 339-347
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC4592657
- OpenAlex
- W2150458484
- Cited by
- 1,271
- References
- 65
- Citations by year
- 2026: 120 · 2025: 142 · 2024: 122 · 2023: 101 · 2022: 117 · 2021: 138 · 2020: 132 · 2019: 101 · 2018: 131 · 2017: 96 · 2016: 65 · 2015: 4
- FWCI
- 13.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Lirias (KU Leuven) (submittedVersion)
- Funders
- Yale University
- University of Pittsburgh
- University of Rochester
- Postgraduate Institute of Medical Education and Research, Chandigarh
- Newcastle University
- Rijksuniversiteit Groningen
- Universiteit Utrecht
- Vrije Universiteit Amsterdam
- University of Toronto
- Kuopion Yliopistollinen Sairaala
- Taipei Medical University
- University of California, San Diego
- Medical Center, University of Rochester
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- metabolic syndrome, schizophrenia, bipolar disorder, major depressive disorder, psychosis, severe mental illness, antipsychotic drugs, clozapine, olanzapine, aripiprazole, body mass index, cardiovascular risk, hypertension, metabolic syndrome prevalence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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