Study findings highlight a critical opportunity for GPs to bridge the gap between mental illness and chronic disease outcomes in vulnerable populations.
People with a mental health care plan are less likely to be obese or smoke than those without a care plan, according to a study from Western Sydney University.
For any included mental illness, care plans were associated with 83% lower odds of obesity and 30% lower odds of tobacco smoking. There were negligible differences for high blood pressure and elevated cholesterol for those on a care plan.
Data from nearly 30,000 adults in Western Sydney health district who had an active diagnosis of ADHD, anxiety, bipolar, depression or schizophrenia were included. Half had a mental health care plan put in place between 2016 and 2023.
The study noted that patients with schizophrenia had a higher prevalence of obesity than the reference group of more than 960,000 people without mental illness (45% to 31%), but also a higher prevalence of obesity than other mental illnesses.
However, their analysis suggested that mental health care plans may offset this, showing that the increased risk was roughly equal to the risk reduction associated with care plans.
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“Using care plans, GPs can act as an interface between a complex health system and a wary patient who may feel neglected or misunderstood. This is especially true for a patient population with potentially limited insight into mental health and ensuing metabolic mental health outcomes,” the authors wrote.
“Focus should continue on patients with psychotic disorders (schizophrenia and bipolar disorder) and obesity, mainly due to the medication they take and the relatively increased social disadvantage they face due to the illness and otherwise.”
Fewer than one in ten of the reference cohort smoked but all mental illness types had a higher prevalence of daily smoking. One in four patients with schizophrenia and bipolar disorder smoked daily, and prevalence for those with anxiety, depression and ADHD were between 12%-16%.
While care plans reduced the odds of tobacco use by 30% for any mental illness, this was most pronounced for the ADHD cohort (OR = 0.3) and those with bipolar (OR=0.5).
The proportion of patients with care plans was lowest among those with schizophrenia (33%) and ADHD (35%) and highest among those with anxiety (51%) and depression (49%).
“Psychotic disorders, due to the treatment and negative symptoms, require extended and focused care planning in a multi-disciplinary team setting due to increased metabolic risk (including from treatment) and the challenging nature of their circumstances, mental illness and compounded social disadvantage,” researchers concluded.
Australian and New Zealand Journal of Psychiatry, 13 May 2025
