Physical multimorbidity arrives years early in psychosis and bipolar disorder — start monitoring at the first episode

Design

Statewide retrospective matched cohort, hospital registries

Population

30,189 people with schizophrenia-spectrum or bipolar disorder vs 148,476 matched comparators

Primary outcome

Number of body systems affected by chronic physical disease

Effect

≥3 systems: sHR 2.65 (2.56 to 2.74); +18.6 cases per 100 at 20 years

This Queensland statewide cohort, published 1 September in Lancet Psychiatry, matched 30,189 people with schizophrenia-spectrum or bipolar disorder (median age 32) with 148,476 age- and sex-matched hospital comparators, following them from 2000 to 2023 for chronic disease across body systems.

The hazard of accumulating disease rose with every additional system: 1.85 for at least one, 2.65 for at least three and 3.16 for at least five. Over 20 years, that meant about 18 extra people per 100 with disease in two or three systems. Relative hazards were highest in the youngest groups; women under 25 had a ninefold hazard of five-system multimorbidity (HR 9.24, 95% CI 7.30 to 11.71).

Physical health checks in severe mental illness are often deferred until middle age or until antipsychotic side effects appear. This study says the divergence starts early and compounds. The first episode is the moment to begin metabolic, cardiovascular and respiratory surveillance, to choose antipsychotics with metabolic risk in mind, and to link the patient to a physician.

• Start baseline and annual physical health checks from the first psychotic or manic episode, whatever the age.
• Weigh metabolic risk when choosing an antipsychotic, especially in young women.
• Screen for smoking and offer cessation support at every review.
• Make sure every patient with severe mental illness has a named physician or GP for physical care.

Why it matters

Challenges the assumption that physical health in severe mental illness is a problem of later life.

Don't overread it

Comparators were hospital patients and the data were from hospital records, so milder community-managed conditions are missed.

The statistics, in plain English

A subdistribution hazard ratio of 2.65 means people with these disorders developed disease in three or more systems at about two and a half times the rate of comparators. The 20-year absolute difference — about 18 extra cases per 100 — is what that means in real patients.

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