title: Physical multimorbidity and psychosis: comprehensive cross sectional analysis including 242,952 people across 48 low- and middle-income countries.
abstract: BACKGROUND
  In people with psychosis, physical comorbidities, including cardiovascular and metabolic diseases, are highly prevalent and leading contributors to the premature mortality encountered. However, little is known about physical health multimorbidity in this population or in people with subclinical psychosis and in low- and middle-income countries (LMICs). This study explores physical health multimorbidity patterns among people with psychosis or subclinical psychosis.
  
  
  METHODS
  Overall, data from 242,952 individuals from 48 LMICs, recruited via the World Health Survey, were included in this cross-sectional study. Participants were subdivided into those (1) with a lifetime diagnosis of psychosis ("psychosis"); (2) with more than one psychotic symptom in the past 12 months, but no lifetime diagnosis of psychosis ("subclinical psychosis"); and (3) without psychotic symptoms in the past 12 months or a lifetime diagnosis of psychosis ("controls"). Nine operationalized somatic disorders were examined: arthritis, angina pectoris, asthma, diabetes, chronic back pain, visual impairment, hearing problems, edentulism, and tuberculosis. The association between psychosis and multimorbidity was assessed by multivariable logistic regression analysis.
  
  
  RESULTS
  The prevalence of multimorbidity (i.e., two or more physical health conditions) was: controls = 11.4% (95% CI, 11.0-11.8%); subclinical psychosis = 21.8% (95% CI, 20.6-23.0%), and psychosis = 36.0% (95% CI, 32.1-40.2%) (P < 0.0001). After adjustment for age, sex, education, country-wise wealth, and country, subclinical psychosis and psychosis were associated with 2.20 (95% CI, 2.02-2.39) and 4.05 (95% CI, 3.25-5.04) times higher odds for multimorbidity. Moreover, multimorbidity was increased in subclinical and established psychosis in all age ranges (18-44, 45-64, ≥ 65 years). However, multimorbidity was most evident in younger age groups, with people aged 18-44 years with psychosis at greatest odds of physical health multimorbidity (OR = 4.68; 95% CI, 3.46-6.32).
  
  
  CONCLUSIONS
  This large multinational study demonstrates that physical health multimorbidity is increased across the psychosis-spectrum. Most notably, the association between multimorbidity and psychosis was stronger among younger adults, thus adding further impetus to the calls for the early intervention efforts to prevent the burden of physical health comorbidity at later stages. Urgent public health interventions are necessary not only for those with a psychosis diagnosis, but also for subclinical psychosis to address this considerable public health problem.
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK. brendon.stubbs@kcl.ac.uk.|Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, UK. brendon.stubbs@kcl.ac.uk.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain.|Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid, 28029, Spain.
authors.forename: Ai
authors.initials: A
authors.lastname: Koyanagi
authors.affiliation: Geriatrics Division, Department of Medicine-DIMED, University of Padova, Padova, Italy.|Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.|KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium.
authors.forename: Davy
authors.initials: D
authors.lastname: Vancampfort
authors.affiliation: Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.|Department of Neurosciences, University of Padova, Padova, Italy.|Local Health Unit ULSS 17, Mental Health Department, Monselice, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Gaughran
authors.affiliation: Department of Psychiatry and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK.|Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Lally
authors.affiliation: Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: Kyambogo University, Kampala, Uganda.|Butabika National Referral and Mental Health Hospital, Kampala, Uganda.
authors.forename: James
authors.initials: J
authors.lastname: Mugisha
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.|Hofstra Northwell School of Medicine, Hempstead, New York, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D014943:Global Health / Q000191:economics; D006306:Health Surveys / Q000379:methods; D006801:Humans; D038622:Internationality; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D008875:Middle Aged; D011203:Poverty / Q000191:economics; D015995:Prevalence; D025341:Principal Component Analysis; D011618:Psychotic Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult
keywords: Metabolism; Multimorbidity; Physical health; Psychosis; Psychotic experiences