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Cited by 1,531Mental Health Treatment and AccessPsychiatric care and mental health servicesSchizophrenia research and treatment

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Open access
Firth, Joseph, Siddiqi, Najma, Koyanagi, Ai, Siskind, Dan, Rosenbaum, Simon, Galletly, Cherrie, Allan, Stephanie, Caneo, Constanza +34 more·2019·The Lancet Psychiatry
DOI 10.1016/s2215-0366(19)30132-4
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Abstract

The poor physical health of people with mental illness is a multifaceted, transdiagnostic, and global problem. People with mental illness have an increased risk of physical disease, as well as reduced access to adequate health care. As a result, physical health disparities are observed across the entire spectrum of mental illnesses in low-income, middle-income, and high-income countries. The high rate of physical comorbidity, which often has poor clinical management, drastically reduces life expectancy for people with mental illness, and also increases the personal, social, and economic burden of mental illness across the lifespan. This Commission summarises advances in understanding on the topic of physical health in people with mental illness, and presents clear directions for health promotion, clinical care, and future research. The wide range and multifactorial nature of physical health disparities across the range of mental health diagnoses generate a vast number of potential considerations. Therefore, rather than attempting to discuss all possible combinations of physical and mental comorbidities individually, the aims of this Commission are to: (1) establish highly pertinent aspects of physical health-related morbidity and mortality that have transdiagnostic applications; (2) highlight the common modifiable factors that drive disparities in physical health; (3) present actions and initiatives for health policy and clinical services to address these issues; and (4) identify promising areas for future research that could identify novel solutions. These aims are addressed across the five parts of the Commission: in Parts 1 and 2 we describe the scope, priorities, and key targets for physical health improvement across multiple mental illnesses; in Parts 3, 4, and 5, we highlight emerging strategies and present recommendations for improving physical health outcomes in people with mental illness.

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Written from the paper’s full text.

TL;DR

This Lancet Psychiatry Commission synthesizes evidence that people with mental illness across diagnoses and income settings have substantially worse physical health, especially cardiometabolic disease, and recommends integrated prevention, lifestyle intervention, medication monitoring, and policy action. It argues these disparities arise from modifiable risk behaviours, psychotropic adverse effects, and inequitable healthcare access.

Key findings

  • A meta-review identified almost 100 systematic reviews/meta-analyses, with 99 meeting inclusion criteria; cardiometabolic risk was generally 1.4- to 2-fold higher in mental illness, and depression was associated with roughly 40% higher risk for cardiac disease, hypertension, stroke, diabetes, metabolic syndrome, and obesity.
  • In severe mental illness, pooled infectious disease prevalence was 15.63% for hepatitis B, 7.21% for hepatitis C, and 7.59% for HIV; syphilis ranged from 1.1% to 7.6%. In the US, hepatitis B and C prevalence in SMI was around 20% each, and median HIV prevalence was 1.8%, nearly four times the general population; in Ethiopia, people with SMI died 30 years prematurely, with half of deaths due to infections.
  • Modifiable risks—smoking, alcohol use, sleep disturbance, inactivity, and poor diet—were elevated transdiagnostically. In LMIC depression samples, odds ratios were 1.41 for smoking, 1.42 for not meeting physical activity guidelines, and 1.94 for ≥8 hours/day sedentary behaviour; among adolescents with psychiatric diagnoses, lifetime STI prevalence was 15%, 40% engaged in risky sexual behaviour, and alcohol use raised unprotected sex odds (OR 1.66).
  • Antipsychotics reduce mortality versus no treatment but carry major adverse effects; clozapine was linked to neutropenia (0.9%), death from neutropenia (0.013%), myocarditis (0.03–1%), and cardiomyopathy (0.06–0.12%). Lithium was associated with mean 4 kg weight gain over 2 years and goitre in up to 50%, while valproate produced mean 6.4 kg gain and weight gain in at least half within three months. The Diabetes Prevention Program reduced type 2 diabetes by 58% over three years (4.8 vs 11.0 cases per 100 person-years).

Methods

  • International Commission with researchers, clinicians, and stakeholders, organized into five parts covering scope, modifiable factors, psychiatric medications, multidisciplinary lifestyle approaches, and integrated physical-mental healthcare.
  • Part 1 used a systematic search of Embase and other sources for systematic reviews/meta-analyses published 2000–2018; 3,796 records were screened, 288 full texts assessed, and 99 reviews included (48 common mental disorders, 30 severe mental illness, 6 alcohol/substance use, 8 other, 7 mixed). Part 2 used a hierarchical evidence synthesis prioritizing meta-analyses, then systematic reviews, then population-scale studies.
  • The Commission synthesized evidence narratively and produced recommendations; it did not conduct a new primary trial or a single formal meta-analysis across all parts.

Limitations

  • The paper states major evidence gaps: LMIC underrepresentation; most meta-research focused on cardiometabolic disease in high-income countries; little evidence on infectious diseases outside SMI, physical multimorbidity, COPD, younger people, and several diagnoses; few effectiveness/implementation studies; DPP trials excluded people with major psychiatric disorders; collaborative care evidence in SMI was equivocal; and mHealth evidence was preliminary.
  • Evident from the text: the Commission combines heterogeneous evidence types and expert consensus, so recommendations are not uniformly derived from high-certainty trial data; several intervention findings come from small or non-generalizable studies (for example, an mHealth pilot with n=25).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/s2215-0366(19)30132-4

Cites

132 of 132 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 345 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Having both medical and psychiatric conditions is linked to higher hospital costs and more readmissions.

    “Such studies have convincingly demonstrated that medical and psychiatric comorbidity is associated with higher hospital costs and increased readmission rates.[76][77][78]”
    Quote in the paperSubstantial claim
  • Findingcitation

    People with severe mental illness, common mental disorders, and substance use disorders are at greatly increased risk of physical multimorbidity from illness onset.

    “Nonetheless, some recent large scale multi-national studies have demonstrated that people with SMI 41,48 , CMDs 49,50 and SUDs 18,51 are at greatly increased risk of physical multimorbidity, right from illness onset. 52”
    Quote in the paperSubstantial claim
  • Findingnone given

    Obesity incidence is significantly elevated across most classes of mental disorders, even compared to the general population.

    “Relatedly, the incidence of obesity is significantly elevated across most classes of mental disorders (appendix pg.6-14), even when compared to the alarmingly high rates of obesity in the general population.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Most meta-research on physical health in mental disorders has focused on cardiovascular or metabolic diseases in high-income countries.

    “To date, the majority of metaresearch on physical health in mental disorders has focused on cardiovascular or metabolic diseases in high-income countries.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    The only inverse relationship between cardiometabolic health and mental disorders is the reduced diabetes incidence in anorexia nervosa (OR=0.71).

    “In fact, the only inverse relationship between cardiometabolic health and mental disorders is the reduced incidence of diabetes in anorexia nervosa (OR=0.71).34”
    Quote in the paperNot a substantial claim
  • May combine two claims. 149
  • Classified as probably not a substantial claim. 58
  • The quote only partly states this claim. 5

  • May combine two claims.

    Findingcitation

    The relationship between mental disorders and cancer risk is equivocal; some reviews find a small increase, others no relationship or decreased risk.

    “The relationships between mental disorders and cancer risk is more equivocal.While some reviews have found that mental illnesses are associated with a small increase in risk of cancer overall, 36 others have found no relationships or even decreased cancer risk.37,38”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In a 10-year follow-up study in Ethiopia, individuals with severe mental illness died 30 years prematurely compared to the general population, with half of deaths due to infectious diseases.

    “For example, in a 10-year follow-up study in Ethiopia, individuals with SMI died 30 years prematurely compared to the general population, with half of all these deaths due to infectious diseases 46 .”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Other behavioural risk factors such as intravenous drug use and risky sexual practices are overrepresented in people with severe mental illness, leading to infectious disease in both low- and middle-income and high-income settings.

    “Whereas Table 2 most considers risk factors for NCDs, other behavioural risk factors such as intravenous drug use and risky sexual practices are also overrepresented in people with severe mental illness, leading to infectious disease in both LMIC and high-income settings (as described in Part 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    There are no meta-analyses on COPD in people with mental disorders, though individual database studies show increased COPD prevalence is an important risk factor for premature mortality.

    “Of note, there was an absence of meta-analyses on Chronic Obstructive Pulmonary Disease (COPD) in people with mental disorders, although individual health database studies have convincingly demonstrated that the increased prevalence of COPD is a important risk factor for the premature mortality observed in people with mental illness.19,41”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    A large proportion of total costs for people with bipolar disorders is attributed to non-mental health treatment, along with double the annual medical treatment costs for metabolic conditions.

    “although there is economic data showing that a large proportion of total costs from people with bipolar disorders are attributed non-mental health treatment, 80 along with double the annual medical treatment costs for metabolic conditions.81”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    A recent meta-analysis of 3,029 adolescents with psychiatric diagnoses reported a 15% lifetime prevalence of sexually transmitted illnesses (95% CI = 3-50%) and 40% engaged in risky behaviour at last encounter (95% CI = 23-78%).

    “For instance, a recent meta-analysis of 3,029 adolescents with a range of psychiatric diagnoses reported a 15% lifetime prevalence of sexually transmitted illnesses (95% CI = 3-50%) and that 40% engaged in risky behaviour at their last encounter (95 CI = 23-78%) 100 .”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    People with anorexia nervosa have a twelve-fold higher incidence of osteoporosis and among the highest premature mortality rates across mental disorders.

    “Due to the physically-damaging behaviours inherent to the condition itself, individuals with this condition face severely elevated risks from other health issues, such as a twelve-fold increase in incidence of osteoporosis, 35 and among the highest rates of premature mortality across all mental disorders.12”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    About 17% of deaths in people with mental illness are attributed to unnatural causes, including suicide.

    “Although suicide contributes to a devastating proportion of these premature deaths (with ~17% of mortality in people with mental illness attributed to unnatural causes) 12,13”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] Chesney, 2014, Risks of all-cause and suicide mortality in mental disorders: a meta-review, World Psychiatry source

      Not checked in the free run.

    • cites [13] Walker, 2015, Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis, JAMA Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    People with depression have a doubled risk of developing Parkinson's disease.

    “Although a recent meta-analysis has shown that people with depression face a doubled risk of developing Parkinson's disease, 40”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites recent meta-analysis

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Physical health disparities occur across all mental illnesses and in low-, middle-, and high-income countries.

    “Physical health disparities are observed across the entire spectrum of mental illnesses, in low, middle-and high-income countries.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The average incidence of hepatitis B, C, and HIV in severe mental illness populations across multiple countries is 15.63%, 7.21%, and 7.59%, respectively, and 1.1% to 7.6% for syphilis.

    “The reviews we identified on infectious diseases in SMI populations found that the average incidence (across multiple countries) for hepatitis B, C and HIV was 15.63%, 7.21% and 7.59% respectively, 42 and 1.1% to 7.6% for syphilis.43”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Multimorbidity occurs from a relatively young age in people with mental illness and greatly increases personal and economic burden while reducing life expectancy.

    “Multimorbidity occurs from a relatively young age in people with mental illness 41,52 , and greatly increases personal and economic burden associated with chronic conditions, while also reducing life expectancy.53,54”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In low- and middle-income countries, individuals with depression were more likely to smoke (OR=1.41), not meet physical activity guidelines (OR=1.42), and engage in over 8 hours per day of sedentary behavior (OR=1.94) than non-depressed counterparts.

    “These include the WHO Study on global AGEing and adult health (SAGE) and WHO World Health Survey (WHS), as data from both shows that individuals with depression in LMICS were more likely to smoke (OR=1.41)94 , not meet physical activity guidelines (OR=1.42)95 , and engage in over 8 hours per day of sedentary behavior (i.e., ≥8 hours/day) (OR=1.94)96 than non-depressed counterparts.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    High rates of physical comorbidities and typically poor clinical management drastically reduce life expectancy and increase personal, social, and economic burden across the lifespan.

    “The high rates of physical comorbidities (and typically-poor clinical management of this) drastically reduces life expectancy, and also increases the personal, social and economic burden of illness across the lifespan.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Bulimia is associated with drastically elevated odds for diabetes (OR=3.45), higher than other psychiatric conditions.

    “Furthermore, other eating disorders, such as bulimia are associated with drastically elevated odds for as diabetes (OR=3.45)34 , which is even higher than other psychiatric conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the United States, hepatitis B and C prevalence in patients with severe mental illness is around 20% for both, compared to 0.3% and >2% in the general U.S. population.

    “For instance, in the United States, the prevalence rates of hepatitis B and hepatitis C in patients with SMI is around 20% (for both), whereas the relative prevalence of these conditions in the general U.S. population is 0.3% and >2% respectively 44,45 .”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Mental disorders are associated with unhealthy lifestyles compared to the general population, with even higher risk in people with schizophrenia for smoking, sedentary behaviour, and diet.

    “However, although mental disorders were associated with unhealthy lifestyles compared to the general population, comparisons between disorders indicate that an even higher risk in people with schizophrenia of smoking, sedentary behaviour and diet.83,[85][86][87]”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The median HIV prevalence among people with severe mental illness in the U.S. is 1.8%, almost four times greater than the general U.S. population.

    “Similarly, the median prevalence of HIV among people with SMI in the U.S. is 1.8%; almost 4 times greater than the general U.S. population 44 .”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Lung cancer risk is increased in both common mental disorders and severe mental illness, while colorectal cancer risk appears similar or lower than the general population.

    “For increased, while there is increased risk of lung cancer in both CMDs and SMI, colorectal cancer risk appears to be similar (or even lower) than the general population.36,37”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Individuals with severe mental illness ate more obesogenic food than the general population, particularly those with schizophrenia, and these differences persisted after adjusting for social deprivation and education.

    “For instance, a recent population-scale study of the U.K. Biobank 83 found that individuals with severe mental illness ate more obesogenic food than the general population, particularly those with schizophrenia (see Figure 2).Importantly, these differences persisted after adjusting for social deprivation and education.83”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The DPP aspects poorly endorsed in the extant literature are use of qualified exercise professionals or dietician staff, sufficient access to supervised exercise services, and familiarisation of existing mental health staff with lifestyle interventions.

    “Specific aspects of the DPP that are poorly endorsed from the extant literature are (i) utilising qualified exercise professionals / dietician staff to deliver lifestyle interventions, (ii) providing sufficient access to supervised exercise services, (iii) ensuring existing mental health staff are appropriately familiarised with the lifestyle interventions.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    These documents present new ideas and best-practice approaches for improving integration of physical and mental healthcare at individual, health service and societal levels.

    “These documents present new ideas and best practice approaches for improving the integration of physical and mental healthcare at the individual, health service and societal levels.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Numerous national and international healthcare and advisory bodies have turned their attention to health inequalities in people with mental illnesses and produced resources on the topic.

    “While the complexity and magnitude of these issues appears daunting, numerous national and international healthcare and advisory bodies have now turned their attention to these issues, and produced an array of resources on the topic of health inequalities in people with mental illnesses (see Table 5 and Supplement 5.1.).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Large disparities in physical health for people with mental illness have persisted over time and might be worsening in some regions.

    “The large disparities in physical health for those with mental illness have persisted over time, and might even be worsening in some regions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Li et al report a small significant decreased overall risk of cancer incidence among patients with schizophrenia, with decreased risks for colorectal and prostate cancer but a higher risk of lung cancer in women (RR=1.2).

    “Li et al 11 report a small significant decreased overall risk of cancer incidence among patients with schizophrenia, with decreased risks for colorectal and prostate cancer but a higher risk of lung cancer in women (RR=1.2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Li et al 11

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The majority of evidence was for cardiovascular (n=30) or metabolic conditions (n=40) in common mental disorder, predominantly depression, or in schizophrenia; for all other categories there were few or no reviews.

    “Focusing on the most recent reviews, as described above, the majority of the evidence was for cardiovascular (n=30) or metabolic conditions (n=40) in common mental disorder (predominantly in depression) or in schizophrenia.For all other categories of mental and physical illness, there were either only a handful or no reviews.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The search identified 3796 unique records; after title and abstract screening, 288 full text articles were retrieved, and 99 met the selection criteria for reviews of prevalence or incidence of physical illness in mental disorder.

    “Our search identified 3796 unique records.Following title and abstract screening, 288 full text articles were retrieved, of which 99 met our selection criteria for reviews of prevalence/incidence of physical illness in mental disorder (see Study flow diagram).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The 99 identified reviews comprised 48 for common mental disorder, 30 for severe mental illness, five for alcohol, one for substance use disorders, and eight for other mental illness; seven reviews included several categories or did not differentiate between types of mental disorder.

    “We identified 99 reviews, 48 for CMD, 30 for SMI, five for alcohol and one for substance use disorders, and eight for other mental illness.Seven reviews included several categories or did not differentiate between types of mental disorder.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The 30 reviews of physical illness in severe mental illness focused predominantly on cardio-metabolic disorders (n=18), with clear evidence of increased risk across all categories of a magnitude of 1.5 to 2.

    “The 30 reviews of physical illness in severe mental illness again focused predominantly on cardio-metabolic disorders (n=18), with clear evidence of an increased risk across all categories of a magnitude of 1.5 to 2.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most studies reported associations or relative risks of developing physical disorders in mental illness, while very few reported physical, emotional, or socio-economic outcomes of mental and physical multimorbidity.

    “Most studies reported associations or relative risks of developing physical disorders in mental illness.Very few reported physical, emotional or socio-economic outcomes of mental and physical multimorbidity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Depression is associated with a small increase in overall cancer risk, with increased risk for lung and liver cancer, but no significant associations for breast, prostate, or colorectal/colon cancer.

    “Depression is associated with a small increase in overall cancer risk, but there are significant differences by cancer type, with increased risk for lung and liver cancer, but no significant associations found for breast, prostate, or colorectal/colon cancer.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Mathers, 2013, Mortality among people who inject drugs: a systematic review and meta-analysis, Bull World Health Organ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    No reviews of infectious diseases in common mental disorders were found.

    “We found no reviews of infectious diseases in common mental disorders.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    For asthma, Jiang et al report a threefold increased prevalence, while incident adult-onset asthma has a relative risk of 1.4.

    “However, for asthma, Jiang et al 3 report a threefold increased prevalence, although incident adult-onset asthma has a more comparable relative risk of 1.4 4 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Jiang et al 3

      Not checked in the free run.

    • cites [4] Hayes, 2015, A systematic review and meta-analysis of premature mortality in bipolar affective disorder, Acta Psychiatr Scand source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    There is most evidence for cardiovascular disorders (13 meta-analyses or systematic reviews), followed by diabetes (seven).

    “There is most evidence for cardiovascular disorders, with 13 meta-analyses or systematic reviews, followed by diabetes, with seven.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Asthma and autoimmune disorders are also increased in severe mental illness, with the risk of osteoporosis being particularly high (OR 2.86).

    “Asthma and autoimmune disorders are also increased, 7,8 with the risk of osteoporosis being particularly high (OR 2.86).9”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [7] Cuijpers, 2014, Is excess mortality higher in depressed men than in depressed women? A meta-analytic comparison, J Affect Disord source

      Not checked in the free run.

    • cites [8] Cuijpers, 2014, Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses, Am J Psychiatry source

      Not checked in the free run.

    • cites [9] Machado, 2018, The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses, BMC Med source

      Not checked in the free run.

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    Findingcitation

    Although collaborative care models are effective for common mental disorders, the evidence for these models in people with long-standing severe mental illness is equivocal, and optimal models of integrated care in this group have yet to be refined.

    “Furthermore, although effective for common mental disorders, the evidence for CC models in people with long-standing SMI is equivocal, and optimal models of integrated care in this group have yet to be refined.[366][367][368]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [366] Erickson, 2016, Behavioral interventions for antipsychotic medication-associated obesity: a randomized, controlled clinical trial, J Clin Psychiatry source

      Not checked in the free run.

    • cites [367] Lally, 2018, The representativeness of participants with severe mental illness in a psychosocial clinical trial, Front Psychiatry source

      Not checked in the free run.

    • cites [368] Czosnek, 2018, Health benefits, safety and cost of physical activity interventions for mental health conditions: a meta-review to inform translation efforts, Ment Health Phys Act

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Bipolar disorder is associated with increased risk of stroke (RR=1.74, 95% CI 1.29-2.35), but no significant increase in risk of myocardial infarction (RR=1.09, 95% CI 0.96-1.24).

    “No evidence for a significant increase in the risk of myocardial infarction, RR=1.09, 95% CI 0.96-1.24,p = 0.20) Risk of stroke increased RR= 1.74 (95% CI, 1.29-2.35,p = 0.0003)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    The evidence for other mental disorders is extremely patchy.

    “The evidence for other mental disorders is extremely patchy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In depression, the prevalence of type 2 diabetes in major depressive disorder is 8.7% (95% CI 7.3-10.2%), and the risk of diabetes is significantly increased (RR=1.49, 95% CI 1.29-1.72).

    “Prevalence of T2DM in MDD = 8.7% (95% CI, 7.3-10.2%)Significantly increased risk of diabetes in MDD RR = 1.49(95% CI, 1.29-1.72;P < .001)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In bulimia, there is a marked increase in risk of diabetes (OR 3.45), and in anorexia, the risk is significantly decreased (OR 0.71).

    “In bulimia, there is a marked increase in risk of diabetes (OR 3.45) and in anorexia, the risk is significantly decreased (OR 0.71).19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Reilly, 2015, Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK, BMJ Open source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    In anorexia nervosa, risk of osteoporosis is increased (OR=12.59, 95% CI 3.30-47.9, p<0.001) and risk of fractures is increased (OR=1.84, 95% CI 1.17-2.89).

    “In anorexia nervosa increased risk of osteoporosis, OR = 12.59 (95% CI, 3.30-47.9,p < 0.001) N= 4. Increased risk of fractures, OR =1.84, 95% CI, 1.17-2.89)N=6.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Ayano et al reported prevalence of hepatitis B, C, and HIV to be 15.63%, 7.21%, and 7.59% respectively.

    “Ayano et al reported prevalence of hepatitis B, C and HIV to be 15.63%, 7.21% and 7.59% respectively.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Chesney, 2014, Risks of all-cause and suicide mortality in mental disorders: a meta-review, World Psychiatry source

      Not checked in the free run.

  • The quote only partly states this claim.

    Findingnone given

    Anxiety is associated with increased risk of obesity (pooled adjusted OR=1.31, 95% CI 1.25-1.38).

    “Increased risk of obesity, pooled adjusted OR=1.31 (95% CI,1.25 -1.38)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The review included 99 articles: 48 on common mental disorders, 30 on severe mental illness, 6 on alcohol and substance use disorders, 8 on other mental disorders, and 7 on mixed mental illness populations.

    “Articles meeting criteria for the review n = 99”
    • Also stated in: § Additional information · plain
      “(n=48) common mental disorders (n=30) severe mental illness (n=6) alcohol and substance use disorders (n=8) other mental disorders (n=7) mixed mental illness populations”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingcitation

    In UK Biobank, people with major depressive disorder, bipolar disorder, and schizophrenia had higher age- and gender-adjusted mean daily macronutrient intake than healthy controls.

    “Bar heights represent amounts by which macronutrient intake (grams) among people with major depressive disorders (MDD; n=14,619), bipolar disorders (BPD; n=952) and schizophrenia (SZ; n=262) exceeds average daily intake among healthy controls (n=54,010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Vancampfort, 2016, Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis, World Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The intervention and data collection method were considered acceptable in this high-risk population.

    “The intervention and data collection method were deemed acceptable in this high risk population and no adverse events were encountered.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [107] Stubbs, 2014, A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia, Acta Psychiatr Scand source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Schizophrenia is associated with increased incidence of cardiovascular disease (pooled RR=1.53, 95% CI 1.27-1.86), but not coronary heart disease (RR=1.20, 95% CI 0.93-1.53), and increased risk of stroke (RR=1.71, 95% CI 1.19-2.46).

    “For incidence of CVD, pooled RR=1.53 (95% CI, 1.27, 1.86)For coronary heart disease RR=1.20 (95% CI, 0.93,1.53)For stroke RR=1.71 (95% CI, 1.19,2.46)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In ADHD, asthma and obesity are increased.

    “In ADHD, asthma and obesity are increased.16,17”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [16] Chang, 2010, All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study, BMC Psychiatry source

      Not checked in the free run.

    • cites [17] Das-Munshi, 2017, Ethnicity and excess mortality in severe mental illness: a cohort study, Lancet Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In ADHD, obesity is increased (OR=1.55, 95% CI 1.32-1.81 in adults; OR=1.20, 95% CI 1.05-1.37 in children).

    “OR=1.55 (95% C, 1.32-1.81) in adults with ADHD OR= 1.20 (95% CI, 1.05-1.37) in children with ADHD”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In mixed severe mental illness, pooled cardiovascular disease prevalence is 9.9% (95% CI 7.4-13.3), adjusted pooled OR for cardiovascular disease is 1.53 (95% CI 1.27-1.83), incidence of a cardiovascular disease event is 3.6% (95% CI 2.7-5.3) during median follow-up of 8.4 years, and increased risk for cardiovascular disease is HR=1.78 (95% CI 1.60-1.98).

    “Pooled CVD prevalence in SMI =9.9% (95% CI, 7.4-13.3)N=38) Adjusted pooled OR for CVD =1.53 (95% CI, 1.27-1.83,p<0.001) N=11 LONGITUDINAL STUDIES Incidence of CVD event in SMI= 3.6% (95% CI, 2.7-5.3%)during median follow-up period of 8.4 years (range 1.8-30.0)N=65 Increased risk for CVD, HR=1.78 (95% CI, 1.60-1.98)N=31”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    In autism, prevalence of asthma is 20.4% in ASD and 15.4% in controls (p<0.001), but pooled OR for asthma prevalence in cross-sectional studies is 1.26 (95% CI 0.98-1.61, p=0.07) and in case-control studies is 0.98 (95% CI 0.68-1.43, p=0.94).

    “Prevalence of asthma in ASD = 20.4%, and in controls =15.4% (p < 0.001).N=10; n=175,406 Pooled OR= 1.26 (95% CI, 0.98-1.61,p = 0.07) for prevalence of asthma in cross-Partal studies.In case-control studies, pooled OR= 0.98 (95% CI, 0.68-1.43,p = 0.94)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Retention was 78% in both the intervention and control groups, with 53 participants in each group.

    “78% retention in both groups (n = 53 in each group).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [107] Stubbs, 2014, A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia, Acta Psychiatr Scand source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    People with schizophrenia have more emergency department visits and experience avoidable admissions to hospital for physical conditions.

    “They also have more emergency department visits, and experience avoidable admissions to hospital for physical conditions 112”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [112] Campos, 2008, HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature, Cad Saude Publica source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The Inverse Care Law applies to physical healthcare for people with mental illness, who are at higher risk, receive physically compromising treatment, and have reduced access to adequate interventions.

    “This applies clearly to physical healthcare for people with mental illness, who are at higher risk at baseline (Parts 1 and 2), receive physically-compromising treatment (Part 3), and then suffer reduced access to adequate lifestyle and medical interventions (Parts 2, 3 and 4).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Premature mortality in people with mental illness has been recognized by the medical community for over 50 years.

    “The premature mortality of people with mental illness has been recognised by the medical community for over half a century.1,2”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Thornicroft, 2013, Premature death among people with mental illness, BMJ source

      Not checked in the free run.

    • cites [2] Ødegard, 1951, Mortality in Norwegian mental hospitals 1926–1941, Acta Genet Stat Med

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The disparities arise from both a higher risk of physical diseases in people with mental illness and their reduced access to adequate healthcare.

    “This stems from both a heightened risk of physical diseases in people with mental illness, along with their reduced access to adequate healthcare.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    A broad range of psychiatric diagnoses are associated with high rates of comorbid physical conditions, particularly cardiometabolic diseases.

    “As discussed in Part 1, a broad range of psychiatric diagnoses are associated with high rates of comorbid physical conditions (particularly cardiometabolic diseases).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Access to health care for people with mental illness may be compromised by financial costs, fragmentation of care and stigma.

    “Finally, access may be compromised by financial costs, fragmentation of care and stigma.124,126,129”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [124] Sullivan, 2005, The prevalence and impact of alcohol problems in major depression: a systematic review, Am J Med source

      Not checked in the free run.

    • cites [126] Vancampfort, 2017, Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis, World Psychiatry source

      Not checked in the free run.

    • cites [129] Baglioni, 2016, Sleep and mental disorders: a meta-analysis of polysomnographic research, Psychol Bull source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physicians may be reluctant to offer some medical procedures because of the ensuing psychological stress, concerns about capacity, informed consent or compliance with postoperative care, or the presence of contra-indications such as substance abuse and smoking.

    “Other factors explaining why physicians may be reluctant to offer some medical procedures because of the ensuing psychological stress, along with concerns about capacity, informed consent or compliance with postoperative care, or the presence of contra-indications such as substance abuse and smoking.126”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [126] Vancampfort, 2017, Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis, World Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Lifestyle risk factors for chronic illness seem to apply transdiagnostically, across the spectrum of mental illnesses.

    “Whereas lifestyle risk factors for chronic illness seem to apply transdiagnostically, across the spectrum of mental illnesses (Part 2),”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In psychiatric patients, cancer incidence is no higher than in the general population, although mortality is higher.

    “In the case of cancer, the incidence of cancer in psychiatric patients is no higher than that of the general population (see Part 1), although mortality is higher.120,121”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [120] Oud, 2009, Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care, BMC Fam Pract source

      Not checked in the free run.

    • cites [121] Liu, 2017, Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas, World Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Antipsychotic medications are the cornerstone of treatment for people with psychotic disorders, leading to reduced acute symptoms, relapses, emergency hospital admissions, rehospitalisation and mortality.

    “Antipsychotic medications are the cornerstone of treatment for people with psychotic disorders, leading to reduced acute symptoms 138 , relapses 139 , emergency hospital admissions 140 , rehospitalisation 141,142 and mortality 22,143 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [138] Teasdale, 2019, Dietary intake of people with severe mental illness: systematic review and meta-analysis, Br J Psychiatry source

      Not checked in the free run.

    • cites [139] Ng, 2015, Sleep-wake disturbance in interepisode bipolar disorder and high-risk individuals: a systematic review and meta-analysis, Sleep Med Rev source

      Not checked in the free run.

    • cites [140] Koskinen, 2009, Prevalence of alcohol use disorders in schizophrenia: a systematic review and meta-analysis, Acta Psychiatr Scand source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight gain is associated with poorer quality of life and barriers to social engagement.

    “and is associated with poorer quality of life [146][147][148] and barriers to social engagement.149”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [146] Janssen, 2015, Review of the evidence: prevalence of medical conditions in the United States population with serious mental illness, Gen Hosp Psychiatry source

      Not checked in the free run.

    • cites [147] Rosenberg, 2001, Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness, Am J Public Health source

      Not checked in the free run.

    • cites [148] Fekadu, 2015, Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia, Br J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Antipsychotic medications are also used in bipolar affective disorder.

    “They are also used in bipolar affective disorder (BPAD) 144 145 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [144] Myles, 2012, Tobacco use before, at, and after first-episode psychosis: a systematic meta-analysis, J Clin Psychiatry source

      Not checked in the free run.

    • cites [145] Debell, 2014, A systematic review of the comorbidity between PTSD and alcohol misuse, Soc Psychiatry Psychiatr Epidemiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The higher cancer mortality in people with mental illness appears driven by disparities at health service level, as they are less likely to be offered cancer screening, have reduced likelihood of surgery for all types of cancer, and wait longer for operations.

    “This again appears to be driven by disparities at health service level, as people with mental illness are less likely to be offered cancer screening, 122 have reduced likelihood of surgery for all types of cancer, 123 and wait longer for their operations.123”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [122] Vigo, 2016, Estimating the true global burden of mental illness, Lancet Psychiatry source

      Not checked in the free run.

    • cites [123]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These factors are associated with compromised adherence with treatment leading to relapse and poor mental health outcomes.

    “These factors are associated with compromised adherence with treatment leading to relapse and poor mental health outcomes.62,63”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [62] Sun, 2015, Depression and the risk of breast cancer: a meta-analysis of cohort studies, Asian Pac J Cancer Prev source

      Not checked in the free run.

    • cites [63] Li, 2018, The incidence rate of cancer in patients with schizophrenia: a meta-analysis of cohort studies, Schizophr Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most antipsychotic medications lead to weight gain, with clozapine and olanzapine having the highest propensity and haloperidol, lurasidone and ziprasidone having the lowest.

    “Most antipsychotic medications lead to weight gain, with clozapine and olanzapine having the highest propensity and haloperidol, lurasidone and ziprasidone having the lowest 150,151 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [150] Stubbs, 2016, Physical multimorbidity and psychosis: comprehensive cross sectional analysis including 242,952 people across 48 low- and middle-income countries, BMC Med source

      Not checked in the free run.

    • cites [151] Stubbs, 2017, Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries, Psychol Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk of akathisia varies dependent on the antipsychotic medication prescribed, but is estimated to occur in 25% of individuals on first-generation antipsychotics.

    “The risk of akathisia varies dependent on the antipsychotic medication prescribed, but is estimated to occur in 25% of individuals on first-generation antipsychotics.207”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [207] Hamer, 2008, Psychiatric hospital admissions, behavioral risk factors, and all-cause mortality: the Scottish health survey, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Acute dystonias are seen in up to 10% of individuals, are more common in antipsychotic-naïve individuals, and can occur rapidly after initiation of antipsychotics.

    “Acute dystonias are seen in up to 10% of individuals, 205 are more common in antipsychotic-naïve individuals, and can occur rapidly after initiation of antipsychotics.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [205] Firth, 2018, The validity and value of self-reported physical activity and accelerometry in people with schizophrenia: a population-scale study of the UK Biobank, Schizophr Bull source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The primary study of the DPP recruited 3,234 nondiabetic adults at elevated risk for developing type-2 diabetes; aiming to achieve a minimum of 7% weight loss/weight maintenance and at least 150 min of physical activity per week.

    “The primary study of the DPP recruited 3,234 nondiabetic adults at elevated risk for developing type-2 diabetes (established via multiple risk factors); aiming to achieve a minimum of 7% weight loss/weight maintenance and at least 150 min of physical activity per week.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [189] De Hert, 2009, Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC), Eur Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The lifestyle intervention in the DPP resulted in a 58% reduction in the development of type-2 diabetes over the three year study, with only 4.8 cases of diabetes per 100 person-years observed in the lifestyle intervention group, compared to 11.0 cases in the control condition.

    “The lifestyle intervention resulted in a 58% reduction in the development of type-2 diabetes over the three year study, with only 4.8 cases of diabetes per 100 person-years observed the lifestyle intervention group, compared to 11.0 cases in the control condition.189,190”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [189] De Hert, 2009, Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC), Eur Psychiatry source

      Not checked in the free run.

    • cites [190] Gates, 2015, Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis, Lancet Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Focusing on cardiometabolic protection in at-risk populations may present the optimal approach for lifestyle interventions.

    “Whereas it may seem counter-intuitive to dedicate intensive resources to individuals with relatively 'intact' metabolic health, focusing on cardiometabolic protection in at-risk populations may present the optimal approach for lifestyle interventions (see also Panel 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Bupropion and Varenicline can increase the likelihood of successful smoking cessation without increasing the risk of neuropsychiatric events in people with SMI.

    “Bupropion and Varenicline can increase the likelihood of successful smoking cessation without increasing the risk of neuropsychiatric events in people with SMI.204”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [204] 2018

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    GLP-1RAs have been shown to reduce the transition to T2D, as well as leading to clinically significant weight loss.

    “GLP-1RAs have also been shown to reduce the transition to T2D, as well as leading to clinically significant weight loss.191”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [191] Carney, 2016, Cardiometabolic risk factors in young people at ultra-high risk for psychosis: a systematic review and meta-analysis, Schizophr Res source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Considering the raised metabolic and lifestyle risk observed across multiple classes of mental disorders, the DPP could be adapted for people with mental illness to be made available through primary care, on a referral basis.

    “Considering the raised metabolic and lifestyle risk observed across multiple classes of mental disorders (Parts 1 and 2), the DPP could be adapted for people with mental illness to be made available through primary care, on a referral basis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Extra-pyramidal side effects are the most common neuro-motor ADR of antipsychotics, can be socially stigmatising and are associated with poor quality of life, treatment dissatisfaction and nonadherence.

    “Extra-pyramidal side effects (EPSE) are the most common neuro-motor ADR of antipsychotics, can be socially stigmatising and are associated with poor quality of life, treatment dissatisfaction and nonadherence 146,147 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [146] Janssen, 2015, Review of the evidence: prevalence of medical conditions in the United States population with serious mental illness, Gen Hosp Psychiatry source

      Not checked in the free run.

    • cites [147] Rosenberg, 2001, Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness, Am J Public Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sodium valproate is associated with metabolic effects, with at least half of individuals experiencing weight gain in the first three months after initiation with a mean weight gain of 6.4kgs.

    “Sodium valproate is also associated with metabolic effects, with at least half of individuals experiencing weight gain in the first three months after initiation 180 with a mean weight gain of 6.4kgs 181 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [180] Ösby, 2016, Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987-2010, Eur J Public Health source

      Not checked in the free run.

    • cites [181] Croudace, 2000, Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis, Psychol Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Treatment with tricyclic antidepressants is frequently associated with anticholinergic effects, including dry mouth, sedation, blurred vision, xerostomia, constipation, urinary retention, as well as increased appetite, weight gain and also hyponatraemia especially in older patients.

    “Treatment with tricyclic antidepressants (TCAs) is frequently associated with anticholinergic effects, including dry mouth, sedation, blurred vision, xerostomia, constipation, urinary retention, as well as increased appetite, weight gain and also hyponatraemia (especially in older patients).186”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [186] Morrens, 2007, Psychomotor and memory effects of haloperidol, olanzapine, and paroxetine in healthy subjects after short-term administration, J Clin Psychopharmacol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The 2018 WHO Guidelines recommend that lifestyle interventions are considered as first line strategies for the management of physical health for adults with SMI.

    “Accordingly, the 2018 WHO Guidelines 233 recommend that lifestyle interventions are considered as first line strategies for the management of physical health (including weight management, cardiovascular disease and cardiovascular risk reduction and diabetes treatment and prevention) for adults with SMI (severe mental illness).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [233] Bobrovitz, 2018, Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments, BMC Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This may present a new, transdiagnostic approach towards the provision of evidence-based and cost-effective lifestyle interventions for protecting the cardiometabolic health of those treated for mental illness through primary care settings.

    “This may present a new, transdiagnostic approach towards the provision evidence-based and cost-effective lifestyle interventions for protecting the cardiometabolic health of those treated for mental illness through primary care settings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Clozapine is associated with severe neutropenia/agranulocytosis (incidence 0.9% 95% CI: 0.7-1.1%) usually in the first month following commencement, rarely leading to death (incidence 0.013% 95% CI: 0.01-0.017%).

    “However, clozapine is associated with severe neutropenia/agranulocytosis (incidence 0.9% 95% CI: 0.7-1.1%)usually in the first month following commencement, rarely leading to death (incidence 0.013% 95% CI: 0.01-0.017%)167 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [167] Šprah, 2017, Psychiatric readmissions and their association with physical comorbidity: a systematic literature review, BMC Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Antipsychotics remain the best evidence based treatments for psychotic disorders, and lead to lower all-cause mortality in schizophrenia than no treatment.

    “Antipsychotics remain the best evidence based treatments for psychotic disorders, and leads to lower all-cause mortality in schizophrenia than no treatment 227 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [227] Kugathasan, 2018, Association of secondary preventive cardiovascular treatment after myocardial infarction with mortality among patients with schizophrenia, JAMA Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cardiac ADRs of clozapine can be life-threatening and include myocarditis (incidence 0.03%-1%, usually within first month) and cardiomyopathy (incidence 0.06-0.12%, usually after the first year).

    “Cardiac ADRs can be life-threatening and include myocarditis (incidence 0.03%-1%, usually within first month) 168,169 and cardiomyopathy (incidence 0.06-0.12%,usually after the first year) 168,170 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [168] Jansen, 2018, Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: a systematic review and meta-analysis, PLoS One source

      Not checked in the free run.

    • cites [169] Greenberg, 2015, The economic burden of adults with major depressive disorder in the United States (2005 and 2010), J Clin Psychiatry source

      Not checked in the free run.

    • cites [170] Bryant-Comstock, 2002, Health care utilization and costs among privately insured patients with bipolar I disorder, Bipolar Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Antipsychotics have been associated with varying degrees of cardiac conduction delays, indicated by prolongation of QTc, which can predispose to torsade de pointes leading to sudden death.

    “Antipsychotics have been associated with varying degrees of cardiac conduction delays, indicated by prolongation of QTc, which can predispose to torsade de pointes leading to sudden death 161”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [161] Wang, 2017, Social isolation in mental health: a conceptual and methodological review, Soc Psychiatry Psychiatr Epidemiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Modifiable lifestyle factors such as physical activity, dietary habits and smoking are increasingly recognised as fundamental to both physical and mental health.

    “Modifiable lifestyle factors such as physical activity, dietary habits and smoking are increasingly recognised as fundamental to both physical and mental health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Lithium is associated with thyroid disease, including development of goitre (occurring in up to 50% of patients), hypothyroidism, as well as hyperthyroidism.

    “Lithium is also associated with thyroid disease 176 , including development of goitre (occurring in up to 50% of patients 177 ), hypothyroidism 178 ), as well as hyperthyroidism.179”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [176] Vallecillo, 2018, Metabolic syndrome among individuals with heroin use disorders on methadone therapy: prevalence, characteristics, and related factors, Subst Abus source

      Not checked in the free run.

    • cites [177] Kahl, 2013, Prevalence of the metabolic syndrome in patients with borderline personality disorder: results from a cross-sectional study, Eur Arch Psychiatry Clin Neurosci source

      Not checked in the free run.

    • cites [178] Mendenhall, 2017, Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the general population, nicotine replacement therapy increases the odds of successful smoking cessation by 1.5-2-fold, with good evidence of efficacy in mental illness.

    “In the general population, nicotine replacement therapy (NRT) increases the odds of successful smoking cessation by 1.5-2-fold, with good evidence of efficacy in mental illness.203”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [203] Cunningham, 2017, Alcohol use and sexual risk behaviors among adolescents with psychiatric disorders: a systematic review and meta-analysis, J Child Adolesc Subst Abuse source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Parkinsonism is seen in approximately 20% of individuals.

    “Parkinsonism is seen in approximately 20% of individuals, 206”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [206] Naslund, 2019, Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders, Evid Based Ment Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Very Brief Advice on Smoking e-learning may be useful for supporting delivery of smoking cessation advice by frontline mental health staff.

    “One such example is the 'Very Brief Advice on Smoking' e-learning from NHS England / Public Health England, 266 which may be useful for supporting the delivery of smoking cessation advice by frontline mental health staff.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [266] Vestergaard, 1988, Prospective studies on a lithium cohort. 3. Tremor, weight gain, diarrhea, psychological complaints, Acta Psychiatr Scand source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    E-cigarettes are already widely used across mental health populations and may present a novel method to reduce smoking-related deaths.

    “E-cigarettes are already widely used across a wide range of mental health populations, 267 may present a novel method to reduce smoking-related deaths.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [267] Fairbrother, 2019, Lithium can cause hyperthyroidism as well as hypothyroidism: a systematic review of an under-recognised association, Aust N Z J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Gym-based resistance exercise may offer a clinical pathway to care for young people with early psychosis or veterans with post-traumatic stress disorder.

    “For example, the provision of gym-based resistance exercise may offer a clinical pathway to care for young people with early psychosis, 244 or veterans with posttraumatic stress disorder 245 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [244] Leucht, 2013, Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis, Lancet source

      Not checked in the free run.

    • cites [245] Roerig, 2011, Atypical antipsychotic-induced weight gain: insights into mechanisms of action, CNS Drugs source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Translating DPP principles into preventative transdiagnostic lifestyle interventions through primary care and intensive interventions for specialist services is likely to bridge the implementation gap and produce new effective programmes for protecting cardiometabolic health in people with mental illness.

    “Thus, efforts to translate these principles into both (i) preventative, transdiagnostic lifestyle interventions available through primary care, and (ii) intensive interventions for specialist services, is likely to bridge the implementation gap and present new, effective programs for protecting the cardiometabolic health of people living with mental illness.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The level of support required by people with severe mental illness is likely to be more intensive than what is required to affect change in the general population.

  • May combine two claims.

    Premisecitation

    The SCIMITAR pilot study was developed with service users and resulted in a three-fold increased quit rate compared with usual care.

    “For instance, the SCIMITAR pilot study was developed with service users, and resulted in a 3-fold increased quit rate compared with usual care.263”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [263] Geddes, 2004, Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials, Am J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Early intervention for smoking is feasible, may improve quit rates, and may improve long-term physical health outcomes.

    “Early intervention for smoking is feasible, 269 may improve quit rates, and long-term physical health outcomes.270”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [269] McKnight, 2012, Lithium toxicity profile: a systematic review and meta-analysis, Lancet source

      Not checked in the free run.

    • cites [270] McDermott, 1986, Lithium-associated thyrotoxicosis, Am J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Participants in the initial FitBit study found the intervention engaging, motivating and empowering.

    “Participants in this initial study found this to be engaging, motivating and empowering, 257”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [257] Land, 2017, The impact of clozapine on hospital use: a systematic review and meta-analysis, Acta Psychiatr Scand source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    People with mental illness are just as motivated to stop smoking as others, but are more nicotine dependent and less likely to seek out and receive appropriate tailored interventions.

    “This may because although people with mental illness are just as motivated to stop smoking, they are more nicotine dependent and less likely to seek out and receive appropriate interventions tailored to their needs 260,261”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [260] Ronaldson, 2015, Clozapine-induced myocarditis, a widely overlooked adverse reaction, Acta Psychiatr Scand source

      Not checked in the free run.

    • cites [261] Alawami, 2014, A systematic review of clozapine induced cardiomyopathy, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dietary risks are collectively a leading risk factor for the global burden of disease, and this risk is exacerbated in people with mental illness by psychotropic medication side-effects, an insensitive reward system, poor cognitive control, food insecurity and financial constraints.

    “Dietary risks are collectively a leading risk factor for the global burden of disease 273 with the risk exacerbated for people with mental illness, 87,274 due to a combination of psychotropic medication side-effects, 275,90,276 insensitive reward system and poor cognitive control 277 and food insecurity and financial constraints.278”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [273] Belcastro, 2013, Metabolic and endocrine effects of valproic acid chronic treatment, Epilepsy Res source

      Not checked in the free run.

    • cites [87] Tang, 2017, Association between anxiety and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies, Psychoneuroendocrinology source

      Not checked in the free run.

    • cites [274] Malhi, 2012, Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder, Bipolar Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Smoking rates have fallen dramatically in the general population but remain high in people with mental illness, including young people.

    “Although smoking rates have dramatically decreased for the general population they have remained high for people with mental illness, 258 even in young people (see Table 2).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [258] Myles, 2018, Meta-analysis examining the epidemiology of clozapine-associated neutropenia, Acta Psychiatr Scand source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The importance of training medical students in lifestyle medicine is increasingly recognised globally.

    “The importance of training medical students in 'lifestyle medicine' is increasingly being recognised globally.249”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [249] De Hert, 2016, Relationship between antipsychotic medication, serum prolactin levels and osteoporosis/osteoporotic fractures in patients with schizophrenia: a critical literature review, Expert Opin Drug Saf source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is a shortage of effectiveness studies and of pragmatic implementation and sustainability research to guide routine implementation of lifestyle interventions in people with mental illness.

    “Currently, there is a shortage of effectiveness studies, and pragmatic implementation and sustainability research guiding the routine implementation of lifestyle interventions in people with mental illness.243”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [243] Mayfield, 2016, Glucagon-like peptide-1 agonists combating clozapine-associated obesity and diabetes, J Psychopharmacol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight loss is often the primary motivation for physical activity, but exercise alone is insufficient to reliably reduce bodyweight, particularly over the short term.

    “Weight loss is often the people's primary motivation factor for physical activity, 271 but exercise alone is insufficient to reliably reduce bodyweight, particularly over the short term.272”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [271] Grootens, 2018, Weight changes associated with antiepileptic mood stabilizers in the treatment of bipolar disorder, Eur J Clin Pharmacol source

      Not checked in the free run.

    • cites [272] Chengappa, 2002, Changes in body weight and body mass index among psychiatric patients receiving lithium, valproate, or topiramate: an open-label, nonrandomized chart review, Clin Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exercise referral has been rolled out through multiple large-scale implementation projects for sedentary adults in primary care in the UK, but has produced only small beneficial effects to date.

    “Exercise referral has already been rolled-out through multiple large-scale implementation projects for sedentary adults in primary care in the UK, although producing only small beneficial effects to date.251,252”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [251] Carbon, 2018, Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis, World Psychiatry source

      Not checked in the free run.

    • cites [252] Strawn, 2007, Neuroleptic malignant syndrome, Am J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Improving diet quality and weight reduction are both associated with decreased mortality rates in the general population.

    “Improving diet quality 284 and weight reduction 285 are both associated with a decreased mortality rates in the general population.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [284] Knowler, 2002, Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin, N Engl J Med source

      Not checked in the free run.

    • cites [285] Vancampfort, 2019, The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials, World Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Initial data suggest that implementing smoking bans and bespoke smoking cessation programmes is well received in inpatient settings and may have broader benefits for service culture.

    “Initial data suggests that implementing smoking bans and bespoke smoking cessation programs are well-received in inpatient settings, and may even have broader benefits for service culture.265”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [265] Correll, 2017, Efficacy of 42 pharmacologic cotreatment strategies added to antipsychotic monotherapy in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence, JAMA Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The recent move to Smokefree environments by NHS England includes banning smoking on mental health wards and hospital premises while promoting cessation at service level throughout community care.

    “For instance, the recent move to 'Smokefree' environments by NHS England includes banning smoking on mental health wards and hospital premises while promoting cessation on a service-level throughout community care.264”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [264] Siskind, 2018, Augmentation strategies for clozapine refractory schizophrenia: a systematic review and meta-analysis, Aust N Z J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Smoking-related deaths disproportionately affect people with mental illness, and smoking is a leading cause of premature mortality in this population.

    “Smoking-related deaths disproportionality affect people with mental illness, and smoking is a leading cause of the premature mortality observed in this population.201,202”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [201] Stuckler, 2012, Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco, PLoS Med source

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    • cites [202] Stuckler, 2012, Big food, food systems, and global health, PLoS Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    This includes government mental health expenditure on specialist mental health services, general health services and social care services.

    “This includes government mental health expenditure on specialist mental health services, general health services and social care services.310”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [310] Solmi, 2018, Treatment of tardive dyskinesia with VMAT-2 inhibitors: a systematic review and meta-analysis of randomized controlled trials, Drug Des Devel Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dietary interventions in people with mental illness are more effective if delivered by specialist clinicians such as dieticians and early in the course of treatment.

    “Dietary interventions in people with mental illness are more effective if delivered: i) by specialist clinicians such as a dieticians, and ii) early in course of treatment 286 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [286] Simon, 2009, Are weight gain and metabolic side effects of atypical antipsychotics dose dependent? A literature review, J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A 2017 Lancet series articulated how syndemic frameworks can be used to conceptualise how health risks and comorbidities interact within the broader environmental context.

    “A 2017 series in The Lancet (focusing on the co-occurrence of chronic health conditions) articulated how 'syndemic frameworks' can be used to conceptualise how health risks and comorbidities interact with one another within the broader environmental context.295”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [295] Schmid, 2004, Cardiac adverse effects associated with psychotropic drugs, Pharmacopsychiatry

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Across the spectrum of mental disorders, alcohol, tobacco and illicit drug use is more prevalent than in the general population and is associated with poorer physical and mental health outcomes.

    “Across the spectrum of mental disorders, alcohol, tobacco and illicit drug use is more prevalent than in the general population and are associated with poorer physical and mental health outcomes [301][302][303] .”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [301] Halstead, 1994, Akathisia: prevalence and associated dysphoria in an in-patient population with chronic schizophrenia, Br J Psychiatry source

      Not checked in the free run.

    • cites [302] Kumar, 2009, Akathisia and second-generation antipsychotic drugs, J Neurol Sci source

      Not checked in the free run.

    • cites [303] Kane, 2009, Akathisia: an updated review focusing on second-generation antipsychotics, J Clin Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Relationships between adversity, physical health and mental health are complex and can operate synergistically to reinforce disadvantage and disability.

    “Relationships between adversity, physical health and mental health are complex, and can operate synergistically to reinforce disadvantage and disability.89”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] Rosenbaum, 2015, The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis, Metabolism source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mental health services are poorly resourced, with 90% of people needing treatment not receiving any care.

    “Hence mental health services are poorly resourced with 90% of people needing treatment not receiving any care.311”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [311] Burger, 2006, Effect of anticholinergics (atropine, glycopyrrolate) and prokinetics (metoclopramide, cisapride) on gastric motility in beagles and labrador retrievers, J Vet Med A Physiol Pathol Clin Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many services have no standardised screening for substance use, and mental health clinicians are often not trained to address substance abuse.

    “Despite this, many services have no standardized screening for substance use, and mental health clinicians are often not trained to address substance abuse.306”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [306] Stryjer, 2004, Mianserin for the rapid improvement of chronic akathisia in a schizophrenia patient, Eur Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Primary care presents an ideal environment for managing multimorbidity, which requires an individualised approach to care provision that addresses both the increased burden of multimorbidity and competing or conflicting treatment needs informed by individuals' preferences and priorities.

    “This presents an ideal environment for managing multimorbidity, which requires an individualised approach towards care provision, not only dealing with the increased burden incurred by multimorbidity, but also managing competing/conflicting treatment needs informed by individuals' preferences and treatment priorities.298”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [298] Stroup, 2018, Management of common adverse effects of antipsychotic medications, World Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several guidelines discuss approaches to preventing chronic physical and mental health conditions.

    “Along with detailing required improvements in healthcare for existing patients, several of these guidelines also discuss approaches to preventing chronic physical and mental health conditions.259,296”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [259] Rohde, 2018, Adverse cardiac events in out-patients initiating clozapine treatment: a nationwide register-based study, Acta Psychiatr Scand source

      Not checked in the free run.

    • cites [296] Ptaszynski, 2013, Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy, Europace source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Effective management of multimorbidity requires integrated care provided holistically so that common risk factors and the bi-directional interaction between physical and mental health and their treatment can be addressed together.

    “Effective management of multimorbidity requires integrated care to be provided in a holistic way; 297 so that common risk factors and the bi-directional interaction between physical and mental health and their treatment can be addressed together.296”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [297] Lally, 2014, Ivabradine, a novel treatment for clozapine-induced sinus tachycardia: a case series, Ther Adv Psychopharmacol source

      Not checked in the free run.

    • cites [296] Ptaszynski, 2013, Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In high-income countries, people with severe mental illness want to quit smoking as much as the general population but are unlikely to be supported to do so.

    “As an example, in high income countries people with SMI want to quit smoking as much as the general population, but are unlikely to be supported to do so.260,261”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [260] Ronaldson, 2015, Clozapine-induced myocarditis, a widely overlooked adverse reaction, Acta Psychiatr Scand source

      Not checked in the free run.

    • cites [261] Alawami, 2014, A systematic review of clozapine induced cardiomyopathy, Int J Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several key health organisation guidelines and academic articles have included real-world examples of how new local and national initiatives can be implemented to improve integration of physical and mental health care.

    “Several key health organisation guidelines 47,259,296 and academic articles 75 have included 'real world' examples of how new local and national initiatives (which take into account the surrounding environmental conditions) can be implemented to improve the integration of physical and mental health care.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [47] Batelaan, 2016, Anxiety and new onset of cardiovascular disease: critical review and meta-analysis, Br J Psychiatry source

      Not checked in the free run.

    • cites [259] Rohde, 2018, Adverse cardiac events in out-patients initiating clozapine treatment: a nationwide register-based study, Acta Psychiatr Scand source

      Not checked in the free run.

    • cites [296] Ptaszynski, 2013, Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mental health services rely predominantly on expensive psychotropic drugs, which are seldom available and are associated with many side-effects requiring close management.

    “Mental health services rely predominantly on expensive psychotropic drugs, which are seldom available, and are associated with a myriad of side-effects which require close management (see Part 3).312”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [312] Every-Palmer, 2017, The porirua protocol in the treatment of clozapine-induced gastrointestinal hypomotility and constipation: a pre-and post-treatment study, CNS Drugs source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Primary care aspires to provide equitable, accessible, safe, effective, comprehensive, person-centred care that meets the needs of individuals, families and communities throughout life.

    “Primary care aspires to provide equitable, accessible, safe, effective, comprehensive, person-centred care, meeting the needs of individuals, families and communities throughout life.300”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [300] Bollini, 1994, Antipsychotic drugs: is more worse? A meta-analysis of the published randomized control trials, Psychol Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Treatments with evidence include motivational interviewing, cognitive-behavioural therapy and family interventions or therapy.

    “Treatments with evidence include motivational interviewing (MI), cognitive-behavioural therapy (CBT) and family interventions/therapy.304”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [304] Miller, 2000, Managing antipsychotic-induced acute and chronic akathisia, Drug Saf source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The syndemic approach sheds new insights into how national and local conditions influence the interface between physical and mental health, and emphasises the importance of accounting for social, political and economic factors when designing public health interventions or implementing health service change.

    “This approach sheds new insights into how national and local conditions influence the interface between physical-mental health, and emphasizes the importance of accounting for social, political and economic factors when designing public health interventions, or implementing health service change.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    People with mental illness are more likely to experience poverty, cardiometabolic and infectious diseases, while chronic physical health conditions and social deprivation are themselves key risk factors for mental illness.

    “For instance, people with mental illness are more likely to experience poverty, cardiometabolic and infectious diseases (see Parts 1 + 2), while chronic physical health conditions and social deprivation are themselves key risk factors for mental illness.89,293,294”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [89] Rosenbaum, 2015, The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis, Metabolism source

      Not checked in the free run.

    • cites [293] Whelton, 2018, J Am Coll Cardiol source

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    • cites [294] 2014

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Royal College of Physicians has recently published reports on harm minimisation to support smokers who are unable or find it difficult to quit.

    “As an example for smoking in particular, the Royal College of Physicians (RCP) has recently published a reports on harm minimisation to support smokers who are unable or find it difficult to quit.309”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [309] Leung, 2011, Tetrabenazine for the treatment of tardive dyskinesia, Ann Pharmacother source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In many countries, most people with mental illness first present to the health system through primary care, and most mental health care is delivered in primary care.

    “In many countries, most people with mental illness first present to the health system through primary care, and most mental health care is delivered in primary care.75”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Yu, 2015, Depression and risk for diabetes: a meta-analysis, Can J Diabetes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is a bidirectional relationship between substance abuse and mental illnesses: substance abuse can cause and exacerbate mental illness, and is often used to reduce symptoms or combat dysphoria.

    “There is a bidirectional relationship between substance abuse and mental illnesses, as substance abuse can cause and exacerbate mental illness, and are often used as a means to reduce symptoms or combat dysphoria.304”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [304] Miller, 2000, Managing antipsychotic-induced acute and chronic akathisia, Drug Saf source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The 2016 King's Fund report puts forth an aspirational approach towards improving integrated care across a broad spectrum of physical and mental health conditions and provides advice for overcoming common barriers to implementation.

    “The 2016 report 296 from The Kings Fund (UK) puts forth an aspirational approach towards improving integrated care across a broad spectrum of physical and mental health conditions, providing advice for overcoming common barriers towards implementation of integrated care (See Table 5, Supplement 5.1.and Naylor et al. 296 ).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [296] Ptaszynski, 2013, Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy, Europace source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Key strategies for effective user engagement include co-designing interventions with consumers, personalising interventions, and just-in-time adaptation.

    “Key strategies for effective user engagement include co-designing interventions with consumers, personalization of interventions, and just-in-time adaptation. 336”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [336] Robson, 2017, Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis, Lancet Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Multiple national and international guidelines now present feasible actions for improving integration of physical and mental health across various health and social care settings.

    “Promisingly, multiple national and international guidelines now present feasible actions for improving the integration of physical and mental health, across various health and social care settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Smartphone apps may promote healthy lifestyle change, but they vary in quality, as does the quality of reported evaluation research.

    “Smartphone apps may promote healthy lifestyle change, although they vary in quality, as does the quality of reported evaluation research.332”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [332] Malpass, 2009, How is cigarette smoking maintained in depression? Experiences of cigarette smoking in people diagnosed with depression, Addict Res Theory source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The WHO estimates that 95% of the world population lives in an area covered by mobile networks, and that there are over 7 billion mobile subscriptions.

    “The WHO estimates that 95% of the world population lives in an area covered by mobile networks, and there are over 7 billion mobile subscriptions -one for almost every person on the planet.327”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [327] Slade, 2017, Implementing shared decision making in routine mental health care, World Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    Opinion is coalescing that good clinical practice in mental healthcare requires attention to the physical health of service users, as demonstrated in this Commission and evidenced in guidelines documents.

    “As demonstrated in this Commission, and evidenced in guidelines documents (appendices pp.35-42), opinion is coalescing that good clinical practice in mental healthcare requires attention to the physical health of service users.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites appendices pp.35-42

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the TEXT ME randomised controlled trial, at six months follow-up, systolic blood pressure and body mass index were reduced in intervention participants.

    “At six months follow up, levels of low-density lipoprotein cholesterol were significantly lower in intervention participants, with concurrent reductions in systolic blood pressure and body mass index, significant increases in physical activity, and a significant reduction in self-reported smoking.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [329] Weinberger, 2018, Nondaily cigarette smoking is increasing among people with common mental health and substance use problems in the United States: data from representative samples of US adults, 2005–2014, J Clin Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In many low- and middle-income countries, the lack of integrated physical-mental health services and poorly developed community-based services result in overreliance on institutional psychiatric care.

    “However, an important challenge in many LMICs is the lack of integrated physical-mental health services, and poorly developed community-based services, resulting in an overreliance on institutional psychiatric care.312”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [312] Every-Palmer, 2017, The porirua protocol in the treatment of clozapine-induced gastrointestinal hypomotility and constipation: a pre-and post-treatment study, CNS Drugs source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A review of integrated care across high-, middle- and lower-income settings presents clear evidence for the rationale and effectiveness of integrated care.

    “A review of integrated care across high, middle, and lower-income settings presents clear evidence for the rationale and effectiveness.75”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Yu, 2015, Depression and risk for diabetes: a meta-analysis, Can J Diabetes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The personal burden of lifelong health disparities affecting people with mental illness is unresolved and worsening.

    “This economic burden must also be considered alongside the so-far unresolved (and in fact worsening [21][22][23][24] ) personal burden of lifelong health disparities which affect people with mental illness.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [21] Tanskanen, 2018, Mortality in schizophrenia: 30-year nationwide follow-up study, Acta Psychiatr Scand source

      Not checked in the free run.

    • cites [22] Laursen, 2018, Cause-specific life years lost among persons diagnosed with schizophrenia: is it getting better or worse?, Schizophr Res

      Not checked in the free run.

    • cites [23] Erlangsen, 2017, Cause-specific life-years lost in people with mental disorders: a nationwide, register-based cohort study, Lancet Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Approximately half of individuals seeking formal health care for mental disorders in low- and middle-income countries choose traditional and religious healers as their first care provider, and this choice is associated with delays in accessing formal mental health services.

    “Approximately half of individuals seeking formal health care for mental disorders in LMICs, choose traditional and religious healers as their first care provider, and this choice is associated with delays in accessing formal mental health services.320”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [320] Markowitz, 2000, Lithium nephrotoxicity: a progressive combined glomerular and tubulointerstitial nephropathy, J Am Soc Nephrol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The review describes a strong theoretical basis, multiple real-world examples and practical steps for implementing integrated care in low- and middle-income country settings, identifying the Practical Approach to Care Kit as a particularly successful example of a best-practice approach to universal integrated primary health care.

    “The review describes a strong theoretical basis along with multiple 'real-world' examples and practical steps towards implementing integrated care in LMIC settings; identifying the 'Practical Approach to Care Kit' (PACK) as a particularly successful example of a best-practice approach towards the provision of universal integrated primary health care.318”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [318] Batlle, 1985, Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Smartphones are more expensive than basic mobiles and require an internet connection, so text messaging may be needed to provide broader population access in some low-income settings.

    “However, smartphones are more expensive than basic mobiles and require an internet connection, so text messaging may be required to provide broader population access in some low-income settings.339”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [339] Curtis, 2018, y-QUIT: smoking prevalence, engagement, and effectiveness of an individualized smoking cessation intervention in youth with severe mental illness, Front Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many people with mental illnesses are affected by co-morbid physical diseases, which are present even from illness onset.

    “As covered in Part 1, many people with mental illnesses are affected by co-morbid physical diseases, which are present even from illness onset.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Part 1

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Specific barriers to integrated mental and physical health policy development and implementation include insufficient coordination across government levels, shortage of human resources and competences, need for buy-in, irrelevance of policies to local actors, governmental bureaucracy, shortage of finances and accountability, and differing funding streams.

    “Specific barriers towards an integrated mental and physical health policy development and implementation include insufficient coordination across different government levels, shortage of human resources and competences at all levels of care, a need for buy-in, irrelevance of policies to local actors, governmental bureaucracy and shortage of finances and accountability, alongside differing streams”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Yu, 2015, Depression and risk for diabetes: a meta-analysis, Can J Diabetes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the TEAMcare trial, more than 50% reductions in depression scores were observed over three times more often in the collaborative care treatment group than in the control condition, alongside improved perceived self-efficacy and greater patient satisfaction with medical care.

    “More than 50% reductions in depression scores were also observed over 3 times more often in the CC treatment group compared to control condition (OR 3.37; 95% CI 1.84 -6.17), alongside improved perceived self-efficacy, and greater patient satisfaction with medical care.[361][362][363]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [361] 2013, The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS, Diabetes Care source

      Not checked in the free run.

    • cites [362] Knowler, 2009, 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study, Lancet source

      Not checked in the free run.

    • cites [363] Ma, 2013, Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial, JAMA Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The PRIMROSE integrated care showed a 12-month mean health care cost difference of -£824 compared to usual care and was cost-effective due to fewer hospital readmissions over 12 months.

    “However, The PRIMROSE integrated care did show a 12 month mean health care cost difference of -£824 (95% CI -£568 to £1079) compare to usual care, and proved to be cost-effective due to fewer of hospital readmissions over a 12-month period; thus indicating the enhanced continuity of care afforded by integrated care approaches can confer important benefits even in the absence of changes in cardiom”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [368] Czosnek, 2018, Health benefits, safety and cost of physical activity interventions for mental health conditions: a meta-review to inform translation efforts, Ment Health Phys Act

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Collaborative care models are emerging as an effective approach that can reduce costs while improving clinical outcomes and treatment adherence in managing both mental illness and chronic physical conditions.

    “Within the broad category of 'integrated care', collaborative care (CC) models are emerging as an effective approach, which can simultaneously reduce costs while improving clinical outcomes and treatment adherence, in the management of both mental illness and chronic physical conditions.[357][358][359][360]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [357] Sotos-Prieto, 2017, Association of changes in diet quality with total and cause-specific mortality, N Engl J Med source

      Not checked in the free run.

    • cites [358] Ma, 2017, Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis, BMJ

      Not checked in the free run.

    • cites [359] Teasdale, 2017, Solving a weighty problem: systematic review and meta-analysis of nutrition interventions in severe mental illness, Br J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Two authors extracted data on type of mental illness, type of physical illness, number of studies and participants, prevalence, incidence, and relative risk or hazard ratios or odds ratios, and outcomes.

    “Two authors extracted data on type of mental illness, type of physical illness, number of studies and participants, prevalence, incidence and relative risk (or hazard ratios, odds ratios) and outcomes as described above.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the TEAMcare trial, compared with usual treatment, the intervention produced significant improvements over 12 months in metabolic health, including between-group differences of -0.56 percentage points for glycated hemoglobin, -9.1 mg/dL for LDL cholesterol, and -3.4 mmHg for systolic blood pressure.

    “Compared to usual treatment, the TEAMcare intervention produced significant improvements over a 12-month period in metabolic health, with a between-group difference of -0.56 percentage points for glycated hemoglobin (95% CI=-0.85 to -0.27), -9.1 mg/dL for LDL cholesterol (95% CI=-17.5 to -0.8) and -3.4 mmHg for systolic blood pressure (95% CI= -6.9 to 0.1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [361] 2013, The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The PRIMROSE study compared integrated primary care to usual care in 327 people with severe mental illness and found no significant benefits for HDL cholesterol over 12 months.

    “One example of this provided by the PRIMROSE study; 368 which compared integrated primary care to usual care in 327 people with SMI, finding no significant benefits for HDL cholesterol over 12 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [368] Czosnek, 2018, Health benefits, safety and cost of physical activity interventions for mental health conditions: a meta-review to inform translation efforts, Ment Health Phys Act

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Three additional key elements of collaborative care models are structured management plans, scheduled patient follow-ups, and enhanced inter-professional communication.

    “Although the specifics vary between models, three additional key elements of CC models are structured management plans, scheduled patient follow-ups, and enhanced inter-professional communication.357”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [357] Sotos-Prieto, 2017, Association of changes in diet quality with total and cause-specific mortality, N Engl J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Where multiple reviews existed on the same comorbidity or multimorbidity, the most comprehensive and recent meta-analyses with within-study control populations were selected.

    “Where there were multiple reviews on the same comorbidity or multimorbidity, we selected the most comprehensive and recent (according to search date) meta-analyses with 'within study' control populations, and reported data from these.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The COINCIDE trial found that an integrated psychological intervention for people with depression comorbid with diabetes or cardiovascular disease produced significant improvements in depression and patient satisfaction, with benefits sustained at 24 months, and was cost-effective.

    “After TEAMcare, the COINCIDE trial 359 tested a psychological intervention for people with depression comorbid with diabetes or cardiovascular disease (CVD), using behavioural activation, healthy lifestyle, exercise and diet.This integrated approach produced significant improvements in depression and in patient satisfaction, with benefits sustained at 24 months follow up, and was cost-effective.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [359] Teasdale, 2017, Solving a weighty problem: systematic review and meta-analysis of nutrition interventions in severe mental illness, Br J Psychiatry source

      Not checked in the free run.

    • cites [364] Rosenbaum, 2014, Physical activity interventions for people with mental illness: a systematic review and meta-analysis, J Clin Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Premisenone given

    There is insufficient trial data for thiazolidinediones in severe mental illness.

    “Insufficient trial data in SMI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Premisenone given

    There is insufficient trial data for insulin in severe mental illness.

    “Insufficient trial data in SMI”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Premisenone given

    There is insufficient trial data for sulphonylureas in severe mental illness.

    “Insufficient trial data in SMI.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Premisenone given

    There is insufficient trial data for SGLT2 inhibitors in severe mental illness.

    “Insufficient trial data in SMI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Experts in the field were consulted to identify additional reviews or large seminal studies, especially where gaps in the literature were found.

    “Experts in the field were consulted to check for any additional reviews or large seminal studies, particularly where gaps in the literature had been identified.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Reviews restricted to studies from a single country were excluded because of limited generalisability.

    “Reviews that were restricted to studies from a single country were excluded because of limited generalisability.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two authors independently screened titles and abstracts, and then full texts, resolving disagreements by consensus.

    “Two authors independently screened titles and abstracts, and subsequently full text articles of potentially relevant articles to identify studies for inclusion, resolving disagreements through consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review used predetermined selection criteria for studies.

    “Predetermined selection criteria for studies included:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Anxiety significantly increases the risk of cardiovascular mortality (RR = 1.41, 95% CI 1.13-1.76), coronary heart disease (RR = 1.41, 95% CI 1.23-1.61), stroke (RR = 1.71, 95% CI 1.18-2.50), and heart failure (RR = 1.35, 95% CI 1.11-1.64).

    “Anxiety significantly increased risk of cardiovascular mortality RR= 1.41 (95% CI,1.13 -1.76); coronary heart disease RR= 1.41 (95% CI, 1.23 -1.61); stroke RR 1.71 (95% CI, 1.18 -2.50); and heart failure RR=1.35 (95% CI, 1.11-1.64).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Jiang, 2014, Comorbidity between depression and asthma via immune-inflammatory pathways: a meta-analysis, J Affect Disord source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of hepatitis C in severe mental disorder is 7.21% (95% CI 4.44-11.50).

    “Prevalence of hepatitis C= 7.21% (95% CI, 4.44-11.50)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Chesney, 2014, Risks of all-cause and suicide mortality in mental disorders: a meta-review, World Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In alcohol use disorders, HCV prevalence ranges from 2.1% to 51%, with an average weighted prevalence of 16.32%.

    “HCV prevalence ranging from 2.1 to 51% and an average weighted prevalence of 16.32%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Gan, 2014, Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies, BMC Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of metabolic syndrome in schizophrenia is 32.5% (95% CI 30.1-35.0).

    “Prevalence of MetS= 32.5% (95% CI, 30.1%-35.0%)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Wulsin, 2003, Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review, Psychosom Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In schizophrenia, the prevalence of type 2 diabetes is 9.5% (95% CI 7.0-12.8) and the pooled RR is 1.82 (95% CI 1.56-2.13).

    “Prevalence of T2DM = 9.5% (95% CI, 7.0 -12.8)N=25; n=145 718 Pooled RR = 1.82 (95% CI, 1.56-2.13)n= 4,489,125.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Rugulies, 2002, Depression as a predictor for coronary heart disease. a review and meta-analysis, Am J Prev Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    When an older meta-analysis or systematic review had been superseded by a newer, larger one on the same topic, the newer study was used.

    “In cases where an older meta-analysis/systematic review had later been covered by a newer, larger metaanalysis/systematic review on the same topic, the more recent study was used instead.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The disparities are due to greater exposure to known risk factors including low socioeconomic status, high rates of smoking, alcohol and other drug use, reduced physical activity and poor nutrition, the side effects of psychotropic medication, and reduced access to physical healthcare.

    “the disparities are due to greater exposure to known risk factors including low socioeconomic status, high rates of smoking, alcohol and other drug use, reduced physical activity and poor nutrition, the side effects of psychotropic medication, and reduced access to physical healthcare”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    In anxiety disorders, the evidence for an obesity association is mostly cross-sectional, with odds ratios of 1.27-1.40.

    “In anxiety disorders, evidence mostly cross-Partal, OR: 1.27-1.40.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Only evidence syntheses published from 2000 onward were used.

    “Only recent evidence syntheses (meta-analyses and systematic reviews published since 2000 onwards) were used.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    The odds ratio for obesity in depression ranges from 1.18 to 3.76, with a stronger association in women.

    “OR for obesity in depression= 1.18-3.76;stronger association observed in women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    People with severe and enduring mental illness are at greater risk of poor physical health and reduced life expectancy compared with the general population.

    “People with severe and enduring mental illness are at greater risk of poor physical health and reduced life expectancy compared to the general population….”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Among psychiatric in-patients in Africa, HIV prevalence ranges from 9% to 23%, with no pooled estimate.

    “Africa Prevalence from 9% to 23%.No pooled estimate.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The prevalence of osteoporosis in schizophrenia is 13.2% (95% CI 7.8-21.6) and the increased risk is OR = 2.86 (95% CI 1.27-6.42, p = 0.01).

    “Prevalence of osteoporosis in schizophrenia= 13.2% (95% CI = 7.8-21.6%)N=19 Increased risk of osteoporosis OR= 2.86 (95% CI, 1.27-6.42,p = 0.01)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Machado, 2018, The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses, BMC Med source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Other contributing factors are relatively high rates of tobacco smoking, an international trend of increased prescribing of psychotropic medications, and difficulties in co-ordinating between primary care and secondary mental health services.

    “Other contributing factors are the relatively high rates of tobacco smoking, an international trend of increased prescribing of psychotropic medications, and difficulties in co-ordinating between primary care and secondary mental health service”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    In people with severe mental illness, hepatitis C virus prevalence ranges from 2.1% to 51%, with a weighted average of 16.32%.

    “HCV prevalence ranging from 2.1 to 51% and an average weighted prevalence of 16.32%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In bipolar disorder, the prevalence of type 2 diabetes is 9.4% (95% CI 6.5-12.7) and the RR is 1.98 (95% CI 1.6-2.4, p < 0.001).

    “Prevalence of T2DM = 9.4% (95% CI, 6.5%-12.7%)n = 18,060 RR= 1.98 (95% CI, 1.6-2.4,P < .001)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Shi, 2016, The relationship between depression and risk of sudden cardiac death and arrhythmias: a meta-analysis, Heart Rhythm

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    People living with serious mental health problems are at greater risk of many chronic health conditions and have a much shorter life expectancy than their general population counterparts.

    “people living with serious mental health problems are at a greater risk of many chronic health conditions and have a much shorter life expectancy than their general population counterparts”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Schizophrenia is associated with increased HIV, cardiovascular disease, obesity, tuberculosis, hepatitis B/C, osteoporosis, poor dental status, diabetes, metabolic syndrome, thyroid dysfunction, impaired lung function, sexual dysfunction, and obstetric complications, and decreased cancer in general, prostate cancer, and rheumatoid arthritis.

    “Increased with good evidence: HIV, CVD, obesity Increased: TB, hepatitis B ⁄ C, osteoporosis, poor dental status, diabetes, MetS, thyroid dysfunction, impaired lung function, sexual dysfunction, obstetric complications Decreased: Cancer in general, prostate cancer, rheumatoid arthritis”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Li, 2015, Impact of depression on incident stroke: a meta-analysis, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The prevalence of metabolic syndrome in bipolar disorder is 37.3% (95% CI 36.1-39.0), with a higher rate than the general population (OR = 1.98, 95% CI 1.74-2.25).

    “Prevalence of MetS= 37.3% (95% CI, 36.1-39.0)Higher rate in bipolar disorder, OR= 1.98 (95% CI, 1.74-2.25)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Meng, 2012, Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies, J Hypertens source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Schizophrenia is associated with decreased incidence risk of colorectal cancer (RR = 0.82, 95% CI 0.69-0.98) and prostate cancer (RR = 0.55, 95% CI 0.42-0.71), and increased lung cancer in female patients (RR = 1.12, 95% CI 1.01-1.25).

    “Significant decreased incidence risk rates of colorectal cancer, RR = 0.82 (95% CI, 0.69-0.98)and prostate cancer RR = 0.55 (95% CI, 0.42-0.71)colorectal cancer in male patients RR = 0.89 (95%, CI 0.81-0.98)lung cancer increased significantly in female patients RR = 1.12 (95% CI, 1.01-1.25)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Roerecke, 2013, Alcohol use disorders and mortality: a systematic review and meta-analysis, Addiction source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    In the STRIDE trial, the intervention group lost 4.4 kg more than the control group at 6 months (95% CI −6.96 to −1.78 kg) and 2.6 kg more at 12 months (95% CI −5.14 to −0.07 kg).

    “The intervention group lost 4.4 kg more than the control group (95% CI= -6.96 kg to -1.78 kg) at 6 months and 2.6 kg more than the control group (95% CI5-5.14 kg to -0.07 kg) at 12 months.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the STRIDE trial, with a two-tailed alpha of 0.05 and a target sample size of 252, the study had 96% power to detect a time-by-group effect on weight at 6 months and 87% power at 12 months.

    “Based on a two-tailed alpha level of 0.05, and a target sample size of 252 participants, study had 96% power to detect a time-by-group effect on weight at 6 months and 87% power at 12 months”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Data on bupropion are lacking in severe mental illness and psychotropic-induced weight gain, although there is some evidence in depression alongside calorie restriction.

    “Data lacking in SMI/ psychotropic-induced weight gain, although some evidence in depression alongside calorie restriction.72”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [72] Renn, 2011, The bidirectional relationship of depression and diabetes: a systematic review, Clin Psychol Rev source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    In the CAPiCOR trial, glucose decreased more in the control group (mean −2.43) than in the intervention group (mean 1.36), with a mean difference of 3.79 (95% CI 0.27-7.30; p=0.035).

    “Glucose also reduced more in the control group (mean = -2.43)compared to intervention (mean = 1.36), (MD = 3.79, 95% CI 0.27 to 7.30, p = 0.035).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the STRIDE trial, intervention participants attended an average of 14.5 sessions (SD 7.2) out of 24 (60.2%).

    “The average number of sessions attended was 14.5 (SD=7.2) out of 24 (60.2%)among intervention participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Topiramate has the second-best evidence for use in psychotropic-induced weight gain after metformin, and also for preventing weight gain.

    “Second-best evidence for use in psychotropic induced weight gain after metformin, also for preventing weight gain.82,83”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [82] Nieto-Martínez, 2017, Are eating disorders risk factors for type 2 diabetes? A systematic review and meta-analysis, Curr Diab Rep source

      Not checked in the free run.

    • cites [83] Vancampfort, 2016, Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis, World Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    In the STRIDE trial, greater engagement as measured by food logs kept and sessions attended was positively correlated with weight change.

    “Greater engagement as measured by food logs kept and sessions attended was positively correlated with weight change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the STRIDE trial, 200 participants were randomised: 104 to STRIDE and 96 to control.

    “200 participants were randomised: 104 STRIDE and 96 controls.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In the CAPiCOR trial, 49% of participants attended at least 60% of sessions, and 6.3% attended no sessions.

    “49% of participants attended at least 60% of the sessions.6.3% did not attend any sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premiseown data

    In the STRIDE trial, there was no significant change in blood pressure or blood lipids.

    “No significant change in blood pressure, blood lipids,”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Raising the head of the bed by 10-20 degrees reduces renal perfusion, activates the renin-angiotensin-aldosterone system, decreases nocturnal diuresis, and thereby increases intravascular volume.

    “Raise head of bed 10-20 degrees: this reduces renal perfusion activating the reninangiotensin-aldosterone system decreasing nocturnal diuresis thereby increasing intravascular volume.85”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85] Vancampfort, 2014, Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables, Psychol Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Midodrine increases arterial resistance, thereby increasing blood pressure.

    “Midodrine increases arterial resistance thereby increasing blood pressure.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [93] Vancampfort, 2013, Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators, Am J Psychiatry source

      Not checked in the free run.

    • cites [94] Czepielewski, 2013, Bipolar disorder and metabolic syndrome: a systematic review, Br J Psychiatry source

      Not checked in the free run.

    • cites [95] Morriss, 2005, Metabolism, lifestyle and bipolar affective disorder, J Psychopharmacol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bupropion has evidence for use in the general population, including combination therapy with naltrexone.

    “Evidence for use in the general population, including combination therapy with naltrexone.71”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Mezuk, 2008, Depression and type 2 diabetes over the lifespan: a meta-analysis, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Midodrine does not cross the blood-brain barrier, so sympathomimetic side effects such as anxiety and tachycardia do not occur.

    “It does not cross the blood brain barrier, which means the sympathomimetic side effects that can accompany the use of adrenergic agents e.g.anxiety and tachycardia, do not occur.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [93] Vancampfort, 2013, Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators, Am J Psychiatry source

      Not checked in the free run.

    • cites [94] Czepielewski, 2013, Bipolar disorder and metabolic syndrome: a systematic review, Br J Psychiatry source

      Not checked in the free run.

    • cites [95] Morriss, 2005, Metabolism, lifestyle and bipolar affective disorder, J Psychopharmacol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the CAPiCOR trial, attendance at centre-based sessions (diet education and group exercise) was 58%, compared with 42.6% for external walking sessions (p=0.006).

    “Attendance at sessions within the centre (diet education and group exercise) was 58%, compared to external walking sessions 42.6% (p = 0.006).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premiseown data

    In the CAPiCOR trial, BMI decreased more in the control group (mean −0.23) than in the intervention group (mean 0.04), with a mean difference of 0.26 (95% CI 0.02-0.51; p=0.038).

    “BMI decreased more in the control group (Mean = -0.23)compared to the intervention group (Mean = 0.04), (MD = 0.26, 95%CI 0.02 to 0.51, p = 0.038).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In the STRIDE trial, follow-up data were available for 91% of participants at 6 months and 85% at 12 months.

    “Follow-up data available for 91% of participants (N=181) at 6 months and for 85% (N=170) at 12 months,”
    Quote in the paperNot a substantial claim
195 of 195

  • The paper relies on this without support.

    Antipsychotics are the best evidence-based treatments for psychotic disorders and reduce mortality compared to no treatment, but harm multiple aspects of physical health.

    “Antipsychotics remain the best evidence-based treatments for psychotic disorders, and reduce mortality rates compared to no treatment, but have adverse impact on multiple aspects of physical health.”

  • The paper relies on this without support.

    Antidepressants are prescribed at much higher rates than antipsychotics, and this is increasing over time.

    “antidepressants are prescribed at much higher rates, which is increasing overtime.”

  • The paper relies on this without support.

    The Diabetes Prevention Program is a gold-standard lifestyle intervention with broadly demonstrated success in the general population.

    “The 'Diabetes Prevention Program' (DPP) is an example of a gold-standard lifestyle intervention, with broadly demonstrated success in the general population.”

  • The paper relies on this without support.

    People with mental illness rarely have access to DPP-based programs through primary or secondary care.

    “However, people with mental illness rarely have access to DPP-based programs through either primary or secondary care services.”

  • The paper relies on this without support.

    General population guidelines for pharmacological management of physical comorbidities are appropriate for people with severe mental illness.

    “For the physical comorbidities associated with serious mental illness (SMI) commonly seen in the general population (e.g.CVD), national and international prescribing guidelines developed for non-SMI populations should be followed.”

  • The paper relies on this without support.

    The level of support required by people with severe mental illness is likely to be more intensive than what is required to affect change in the general population.

    “the level of support required by people with SMI is likely to be more intensive than what is required to affect change in the general population.”

  • The paper relies on this without support.

    There have been a number of null findings in recent years from large-scale clinical trials in people with mental illness.

    “Furthermore, there has been a number of null findings in recent years from large-scale clinical trials in people with mental illness.”

  • The paper relies on this without support.

    The high acceptability of lifestyle interventions offers a novel method to engage typically disengaged service users in more traditional mental health treatment.

    “The high acceptability of lifestyle interventions offers a novel method by which to engage typically disengaged service users in more traditional mental health treatment.”

  • The paper relies on this without support.

    Consideration of potential core health professionals in multidisciplinary mental health teams is rapidly evolving to include allied health professionals with expertise in nutrition, physical activity, behaviour change, and lifestyle psychoeducation and mindfulness training.

    “Consideration of potential core health professionals in multidisciplinary teams in mental health settings is rapidly evolving to include allied health professionals with expertise in nutrition, physical activity, behaviour change, and other aspects such as general lifestyle psychoeducation and mindfulness training.”

  • The paper relies on this without support.

    Providing intensive lifestyle interventions solely through mental health services may cause issues for individuals who attend their mental health centres infrequently, and those who are discharged may struggle to stay engaged with lifestyle changes.

    “Even in high-resource settings, providing intensive lifestyle interventions solely through mental health services may cause issues for individuals who attend their mental health centres infrequently, and those who are discharged may struggle to stay engaged with lifestyle changes.”

  • The paper relies on this without support.

    Community-based interventions may offer a less resource-intensive strategy to optimise maintenance of physical activity behaviour that complements and supports clinician-led strategies.

    “Community based interventions may also offer a less resource intensive strategy to optimise maintenance of physical activity behaviour that compliments and supports clinician led strategies.”

  • The paper relies on this without support.

    Community-based diet programmes such as Weight Watchers provide cost-effective weight-loss interventions when delivered via primary care to obese individuals.

    “Community-based diet programmes, such as 'Weight Watchers' have been found to provide cost effective weight-loss interventions when delivered via primary care to obese individuals.”

  • The paper relies on this without support.

    Mobile health technologies may provide new options for applying adapted versions of programmes such as the DPP in mental illness.

    “Mobile health (or 'mhealth') technologies may also provide new options for applying adapted versions of programs such as the DPP in mental illness.”

  • The paper relies on this without support.

    Mobile health technologies present potential opportunities for delivering novel, scalable and sustainable lifestyle interventions for people with mental illness.

    “Although only explored in small scale pilot studies so far, mHealth technologies present a myriad of potential opportunities for delivering novel, scalable and sustainable lifestyle interventions for people with mental illness.”

  • The paper relies on this without support.

    Adaptations may be required to translate the DPP approach to specific care settings and particular patient needs.

    “However, adaptions may be required to translate such an approach to specific care settings, and for particular patient needs.”

  • The paper relies on this without support.

    General population approaches have not worked for people with mental illness.

    “Issue: General population approaches have not worked for people with mental illness”

  • The paper relies on this without support.

    Smoking cessation training is now freely available for healthcare professionals, which may increase the likelihood of service users receiving access to evidence-based interventions.

    “Smoking cessation training in now freely available for healthcare professionals; which may increase the likelihood of service users receiving access to evidence-based interventions.”

  • The paper relies on this without support.

    The Science and Technology Committee in England has advised mental health trusts to allow e-cigarette use on their premises.

    “Indeed, the Science and Technology Committee in England, have advised mental health trusts to allow e-cigarette use on their premises.”

  • The paper relies on this without support.

    Exercise can attenuate further weight gain, but weight maintenance may not be a strong enough motivator for people with mental illness, particularly if they are overweight beforehand, resulting in disengagement with exercise.

    “Although exercise can attenuate further weight gain, weight maintenance may not be a strong enough motivator for people with mental illness (particularly if they are overweight beforehand) -resulting in disengagement with exercise.”

  • The paper relies on this without support.

    Qualified exercise professionals embedded within mental health services can ensure existing mental health staff are upskilled and equipped to ensure coherent exercise advice regardless of clinical discipline.

    “Qualified exercise professionals embedded within mental health services can ensure existing mental health staff are upskilled and equipped to ensure coherent exercise advice regardless of clinical discipline.”

  • The paper relies on this without support.

    The best dietary regime in people with mental illness is ultimately the one that the person can sustain.

    “As with exercise, the best dietary regime in people with mental illness is ultimately the one that the person can sustain.”

  • The paper relies on this without support.

    Growing understanding of the link between dietary intake, microbiome, inflammation and obesity may signify a viable target to improve physical outcomes in people with mental illness.

    “The growing understanding surrounding the link between dietary intake, microbiome, inflammation and obesity may signify a viable target to improve physical outcomes in people with mental illness.”

  • The paper relies on this without support.

    Even patients requiring specialist mental health services need ongoing engagement with primary care to deliver and coordinate other aspects of their health care, including prevention and management of comorbid physical illness.

    “Even patients requiring specialist mental health services need ongoing engagement with primary care to deliver and coordinate other aspects of their health care, including prevention and management of comorbid physical illness.”

  • The paper relies on this without support.

    Frequent and timely communication between providers is necessary to ensure safety and effectiveness of treatment.

    “At a minimum, frequent and timely communication between providers is necessary to ensure safety and effectiveness of treatment.”

  • The paper relies on this without support.

    Consumers with comorbid drug or alcohol abuse tend to be excluded from either drug treatment programmes or mental health services because of the comorbid condition.

    “Further compounding the problem is a tendency for consumers with comorbid drug or alcohol abuse to be excluded from either drug treatment programs or mental health services due to the presence of the comorbid condition.”

  • The paper relies on this without support.

    Evidence-based interventions can be a challenge to implement in already stretched mental health services.

    “Evidence based interventions can be a challenge to implement in already stretched mental health services.”

  • The paper relies on this without support.

    The advantage of an integrated approach is that the consumer does not need to receive care from two services.

    “The advantage of an integrated approach is that the consumer does not need to receive care from two services.”

  • The paper relies on this without support.

    The disadvantage of an integrated approach is that provision of care requires intensive resources and investment from within the mental health system to upskill mental health clinicians in the treatment of substance use.

    “The disadvantage is that provision of care requires intensive resources and investment from within the mental health system to upskill mental health clinicians in the treatment of substance use.”

  • The paper relies on this without support.

    The advantage of sequential or parallel treatments is that the interventions are delivered within a highly specialised substance use programme.

    “The advantage of sequential or parallel treatments are that the interventions are delivered within a highly specialised substance use program.”

  • The paper relies on this without support.

    The disadvantage of sequential or parallel treatments is that this approach requires seamless coordination and information-sharing between agencies.

    “However the disadvantage is that this approach requires seamless coordination and information-sharing between agencies.”

  • The paper relies on this without support.

    Harm minimisation is achieved by switching to alternative, safer forms of the drug or providing access to safe injecting facilities.

    “This is achieved by switching to alternative, safer forms of the drug (e.g.e-cigarettes, methadone and suboxone) or providing access to safe injecting facilities.”

  • The paper relies on this without support.

    Education about the link between chronic physical and mental health conditions is an important tool to support changes in clinical practice, but it is rarely a one-off solution to altering knowledge and behaviours.

    “Although education about the link between chronic physical and mental health conditions is an important tool to support changes in clinical practice, it is rarely a one-off solution to altering knowledge and behaviours.”

  • The paper relies on this without support.

    Traditional and formal providers currently operate in isolation.

    “Secondly, trust between the two categories of providers needs to be enhanced to improve interaction between the two sectors, which currently operate in isolation.”

  • The paper relies on this without support.

    Public health strategies that are effective in the general population do not always translate effectively for people with mental illness.

    “Primary prevention strategies need to be adapted for people with mental illness, as public health strategies that are effective in the general population do not always translate effectively for those with mental illness.”

  • The paper relies on this without support.

    Digital technology is available at a time and place that suit the client, unlike traditional health services which require attendance at a set time and location.

    “Digital technology is available at a time and place that suit the client, unlike traditional health services which require the person to attend at a set time and location.”

  • The paper relies on this without support.

    Most studies using mhealth to promote healthy behaviours have recruited from the general population.

    “To date, most studies using mhealth to promote healthy behaviours have recruited from the general population.”

  • The paper relies on this without support.

    The consequences of physical diseases in people with mental illness are compounded by personal-, service-, and social-level barriers to healthcare.

    “The risk factors consequences of physical diseases in people with mental illness are further compounded by the personal-, service-and social-level barriers to healthcare faced by this population.”

  • The paper relies on this without support.

    The allocation of research funding is a pathway through which systemic discrimination affects the health and well-being of people with mental illness.

    “Finally, the allocation of research funding presents another pathway through which systemic discrimination impacts on health and well-being of people with mental illness.”
38 of 38

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?

  • Developing MDD can have a pronounced detrimental impact on an individual's health behaviors, including sleep impairment, low motivation for physical activity, over/under-eating, and a propensity to self-medicate with tobacco, alcohol or substance use.

    “On the other hand, developing MDD can have a pronounced detrimental impact on an individual's health behaviors, including sleep impairment, low motivation for physical activity, over/under-eating, and a propensity to self-medicate with tobacco, alcohol or substance use138,139.”

    From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [138]

    The Introduction (page unavailable) identifies smoking, poor diet and inactivity as lifestyle risk factors in people with mental illness. The ‘Managing Substance Comorbidity and Promoting Smoking Cessation’ section (page unavailable) says alcohol, tobacco and illicit drug use are more prevalent across mental disorders and that substances are sometimes used to relieve symptoms. The cited passages do not establish that developing MDD causes the full listed pattern of behaviours, particularly sleep impairment, low motivation for activity and over- or under-eating. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • People with a range of mental illnesses die 15-20 years earlier than the general population, primarily from physical morbidity.

    “People with a range of mental illnesses die 15-20 years earlier than the general population, 213 primarily from physical morbidity”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [213]

    The Introduction says people across the spectrum of mental disorders have substantially reduced life expectancy and that poor physical health is the leading cause of years of life lost. It does not give a 15–20-year figure for that broad group. The Additional information section gives a different range, 10–20 years, specifically for people with severe mental illness. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Mental disorders place individuals at an increased risk of other diseases and injuries or impede their management.

    “Challenges are not limited to mental health systems, as mental disorders also place individuals at an increased risk of other diseases and injuries or impede their management.25”

    From Updated trends in the global prevalence and burden of mental disorders, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023 (2026) · cites this paper as [25]

  • A range of psychiatric conditions (including schizophrenia, bipolar disorder, depression, and anxiety and stress-related disorders) are associated with adverse health behaviors, such as poorer dietary and sleeping patterns, low levels of physical activity, and higher rates of tobacco smoking, compared to healthy controls.

    “For instance, a mass of cross-sectional evidence 9 shows that a range of psychiatric conditions (including schizophrenia, bipolar disorder, depression, and anxiety and stress-related disorders) are associated with adverse health behaviors, such as poorer dietary and sleeping patterns, low levels of physical activity, and higher rates of tobacco smoking, compared to healthy controls.”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [9]

  • For people with comorbid CP and MI, CP is further complicated by mental health problems, which are often accompanied by long-term physical conditions associated with pain symptoms.

    “For people with comorbid CP and MI, this nature of CP is further complicated by MH problems, which are often accompanied by long-term physical conditions 7 that are associated with pain symptoms. 8”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [7]

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.

  • Twofold metabolic-risk claim conflicts with reported estimates

    Minor

    The claim that metabolic syndrome and type 2 diabetes risks are at least doubled across the named disorders conflicts with the appendix's diabetes estimate for major depressive disorder, which is 1.49.

  • Universal SMI cardiovascular-risk claim has an exception

    Minor

    The claim of a 1.4- to 2-fold increase across all examined cardiovascular and metabolic diseases conflicts with the appendix's estimate for myocardial infarction in bipolar disorder, which is 1.09 and not statistically significant.

  • CAPiCOR group sizes do not match enrollment

    Minor

    The reported intervention and control groups contain 332 participants in total, rather than the stated 322.

    Reported 322 · recomputed 332

  • Anorexia diabetes estimate changes measure between sections

    Minor

    The main text labels the 0.71 estimate an odds ratio, while the appendix labels the corresponding cohort-study estimate a relative risk.

4 of 4

Cites

Flagged first, then by citations

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Authors
Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allan, S., Caneo, C., Carney, R., Carvalho, A. F., Chatterton, M. L., Correll, C. U., Curtis, J., Gaughran, F., Heald, A., Hoare, E., Jackson, S. E., Kisely, S., Lovell, K., Maj, M., McGorry, P. D., Mihalopoulos, C., Myles, H., O'Donoghue, B., Pillinger, T., Sarris, J., Schuch, F. B., Shiers, D., Smith, L., Solmi, M., Suetani, S., Taylor, J., Teasdale, S. B., Thornicroft, G., Torous, J., Usherwood, T., Vancampfort, D., Veronese, N., Ward, P. B., Yung, A. R., Killackey, E., & Stubbs, B.
Affiliations
  • The University of Melbourne (AU)
  • Bradford District Care NHS Foundation Trust (GB)
  • Institució Catalana de Recerca i Estudis Avançats (ES)
  • The University of Queensland (AU)
  • UNSW Sydney (AU)
  • Ramsay Health Care (Australia) (AU)
  • University of Glasgow (GB)
  • Pontificia Universidad Católica de Chile (CL)
  • Greater Manchester Mental Health NHS Foundation Trust (GB)
  • Centre for Addiction and Mental Health (CA)
  • Deakin University (AU)
  • Donald & Barbara Zucker School of Medicine at Hofstra/Northwell (US)
  • King's College London (GB)
  • Manchester Academic Health Science Centre (GB)
  • University College London (GB)
  • Dalhousie University (CA)
  • University of Campania "Luigi Vanvitelli" (IT)
  • The University of Adelaide (AU)
  • Universidade Federal de Santa Maria (BR)
  • Anglia Ruskin University (GB)
  • University of Padua (IT)
  • Beth Israel Deaconess Medical Center (US)
  • The University of Sydney (AU)
  • KU Leuven (BE)
  • National Research Council (IT)
Corresponding author
Firth, Joseph
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2019-08
Volume
6
Issue
8
Pages
675-712
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(19)30132-4
OpenAlex
W2958971346
Semantic Scholar
15f9bf118c7b05e5272ebd9641a1446e4873d579
Cited by
1,531
References
132
Citations by year
2026: 215 · 2025: 229 · 2024: 251 · 2023: 216 · 2022: 209 · 2021: 205 · 2020: 168 · 2019: 36
FWCI
24.36
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
  • Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
  • Figshare (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • Griffith Research Online (submittedVersion, cc-by-nc-nd)
  • Padua Research Archive (University of Padova) (submittedVersion, cc-by-nc-nd)
Funders
  • National Institute of Health Research (NIHR) (17/63/130)
  • NHMRC (APP1111136, APP1123336, APP1125000)
  • National Institute of Mental Health (R01MH100470)
  • National Institutes of Health
  • UK Medical Research Council (MR/S001255/1)
  • Clinical Lectureship (ICA-CL-2017-03-001)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
physical health in mental illness, physical health disparities, somatic comorbidity, antipsychotic adverse effects, diabetes prevention, nutrition, health policy, clinical care, life expectancy, modifiable risk factors, prescribing patterns, access to mental health care
MeSH terms
Mental Disorders, Health Status, Humans, Comorbidity, Practice Guidelines as Topic

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