People With Serious Mental Illness Have A Higher Risk Of Cancer And Injuries
New research from Johns Hopkins University suggests that cancer and injuries are 2.6 times more common in people with serious mental illness, such as bipolar disorder, schizophrenia, and disabling depression than the general population.
The findings, published in the journal Psychiatric Services, raises concerns about whether preventative measures and cancer screenings are administered to those diagnosed with serious mental illness. There are associated cancer risk factors for smokers who have a mental illness, for example, which is more common among this demographic.
"The increased risk is definitely there, but we're not entirely sure why," said study leader Gail L. Daumit, MD, an associate professor of medicine and psychiatry at the Johns Hopkins University School of Medicine. "Are these people getting screened? Are they being treated? Something's going on."
In another study, Daumit looked at injury prevention, noting that those with serious mental illness are close to twice as likely to be hospitalized for an injury, and 4.5 times more likely to die from the injury than the general population. And those with mental illness are two to three times more likely to die prematurely than those without mental illness. While suicide contributes to this number, the leading causes of death are cardiovascular disease and cancer, which is the same as the general population.
Daumit's speculation is that those with mental illness are "falling through the cracks."
In the first study, Daumit and her team use data from 3,317 Maryland Medicaid beneficiaries with bipolar disorder and schizophrenia. They determined what type of cancer each patient had, and if they developed it between 1994 and 2004. Schizophrenia patients were 4.5 times more likely to develop lung cancer, 3.5 times more likely to have colorectal cancer, and close to three times more likely to develop breast cancer.
The increased likelihood for lung cancer is probably due to smoking, which Daumit says is more common among those with mental illness. And the breast cancer risk, she believes, may be from the increased hormone prolactin due to the use of psychotropic medications, or because women with schizophrenia and bipolar disorder are less likely to have children. (Child bearing is speculated to reduce the risk of breast cancer.) She said the colorectal cancer risk may be due to lifestyle choices, such as lack of physical activity, poor food choices, and smoking.
More studies are needed to look at whether or not those with mental illness receive the necessary cancer screenings and treatments.
In the second study, which looked at mental illness and injury, researchers used data from Maryland Medicaid from between 1994 to 2001. In seven years, 43 percent of the 6,234 patients with serious mental illness were seen in an emergency room or admitted to a hospital for an injury. Among those injured, 42 percent were injured once, 23 percent were injured twice, 25 percent between three and five times, and 10 percent were injured six or more times.
Injuries were mostly due to falls and minor violence, which could be related to the fact that those with serious mental illness are often more likely to have a substance abuse problem. Socioeconomic status and living in poverty could also play a role, by way of living in unsafe housing or poorly maintained neighborhoods.
"Just as this population has other medical risks, injury requiring acute medical attention in the emergency department is common and we should consider this when we are looking at the overall care of the patient," Daumit said.
She recommends doctors and caregivers speak to those with serious mental illness about safety habits such as using bicycle helmets, fall prevention, or safe firearm storage. Doctors should also evaluate medications to see if side effects, such as dizziness, could lead to unintentional injury in patients.