Physical disease accumulates across body systems years earlier in psychosis and bipolar disorder

Design

Statewide retrospective matched hospital cohort, 2000–2023

Population

30,189 people with schizophrenia-spectrum or bipolar disorder and 148,476 age- and sex-matched controls

Primary outcome

Cumulative number of body systems with chronic physical disease

Effect

sHR 1.85 (1.81–1.88) for ≥1 system, 2.25 (2.19–2.32) for ≥2; +18.4 per 100 with ≥2 systems at 20 years

This statewide hospital cohort in Queensland, Australia, matched 30,189 people with schizophrenia-spectrum or bipolar disorder by age and sex to 148,476 people without, over 2000–2023. Median age at entry was 32. The outcome was the number of body systems affected by chronic physical disease.

The excess grew with each additional system. The subdistribution hazard ratio was 1.85 (95% CI 1.81–1.88) for at least one affected system, 2.25 (2.19–2.32) for two, and 3.16 (3.01–3.30) for five. In absolute terms, at 20 years there were about 18 additional people per 100 with two or more affected systems and about 12 per 100 with five or more. The relative excess was largest in the youngest patients — in women under 25 the hazard ratio for five or more systems was 9.24 (7.30–11.71).

This moves the question of physical health earlier. Metabolic monitoring is often treated as a task for patients who have been on antipsychotics for years; these data say the divergence is under way in people's twenties and thirties. The study used hospital records, so conditions managed only in primary care will have been missed in both groups, and it cannot separate illness, medication and social disadvantage as causes.

• Record weight, waist, blood pressure, glucose or HbA1c and lipids at the first episode, before starting an antipsychotic
• Repeat metabolic checks at 12 weeks and then at least yearly
• Ask about smoking and offer cessation support at every review
• Name a clinician responsible for physical health, so it is not left between psychiatry and primary care
• Prefer lower metabolic-risk antipsychotics in young patients where clinically reasonable

Why it matters

Physical multimorbidity in severe mental illness starts early, so waiting for middle age to screen misses the window.

Don't overread it

This is an observational hospital-record study — it shows who is at risk, not whether antipsychotics or the illness itself is the cause.

The statistics, in plain English

A subdistribution hazard ratio of 2.25 means the rate of developing disease in two or more systems was a little over twice that of matched controls, after accounting for death as a competing event. The absolute figure — about 18 extra people in every 100 at 20 years — is the more useful one for a clinic. The very high ratio in young women partly reflects how rare multimorbidity is in young controls, which inflates a relative measure.

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