Comorbidities and other factors are associated with a higher burden

Individuals living with schizophrenia tend to have high rates of medical comorbidities and mortality. Multiple behavioural and treatment-related factors contribute to medical comorbidities including overeating, sedentary lifestyle, high smoking rates, inadequate medical care, and medication side effects (such as cardiovascular risk associated with antipsychotics).¹ Comorbidities commonly identified include alcohol and substance abuse, diabetes, chronic obstructive pulmonary disease, cardiovascular disease (hypertension, congestive heart failure), hyperlipidaemia, obesity, HIV, and hepatitis C.¹ In a US cohort of 57,506 patients with schizophrenia, 66.1% had ≥1 cardiometabolic comorbidity; over one-third had ≥2.⁴ Another US-based study (1997–2003) of 2,327 patients with schizophrenia found that 39.4% of people were depressed at enrolment, with poor mental and physical health.⁷

Comorbid substance abuse is associated with increased treatment for asthma, GI diseases, skin infections, and acute respiratory disease; and increased risk of hospitalization for diabetes, GI disorders, skin infections, and injury/poisoning,² which may further contribute to the overall economic burden of schizophrenia.

Abbreviations: GI=gastrointestinal; HIV=human immunodeficiency virus; US=United States

References:

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2.Dickey B, Azeni H, Weiss R, Sederer L. Schizophrenia, substance use disorders and medical co-morbidity. J Ment Health Policy Econ 2000; 3: 27–33.

3.Wienand D, Goodwin GM, Simon J. Non-mental health hospital costs associated with selected serious mental health conditions in Europe. Eur J Public Health 2025; 35(Suppl 4): ckaf161.1936.

4.Correll CU, Ng-Mak DS, Stafkey-Mailey D, et al. Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis. Ann Gen Psychiatry 2017; 16: 9.

5.Kessler T & Lev-Ran S. The association between comorbid psychiatric diagnoses and hospitalization-related factors among individuals with schizophrenia. Compr Psychiatry 2019; 89: 7–15.

6.Stewart AJ, Patten SB, Fiest KM, et al. Factors associated with high health care spending among patients with schizophrenia. Health Promot Chronic Dis Prev Can 2022; 4210: 431–439.

7.Conley RR, Ascher-Svanum H, Zhu B, et al. The burden of depressive symptoms in the long-term treatment of patients with schizophrenia. Schizophr Res 2007; 90: 186–97.