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Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda

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Abstract

While psychiatric and physical comorbidities in severe mental illness (SMI) have been associated with increased mortality and poor clinical outcomes, problem has received little attention in low- and middle-income countries (LMICs). This study established the prevalence of psychiatric (schizophrenia, bipolar affective disorder, and recurrent major depressive disorder) and physical (HIV/AIDS, syphilis, hypertension and obesity) comorbidities and associated factors among 1201 out-patients with SMI (schizophrenia, depression and bipolar affective disorder) attending care at two hospitals in Uganda. Participants completed an assessment battery including structured, standardised and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidities and potential risk factors. Bipolar affective disorder was the most prevalent (66.4%) psychiatric diagnoses followed by schizophrenia (26.6%) and recurrent major depressive disorder (7.0%). Prevalence of psychiatric comorbidity was 9.1%, while physical disorder comorbidity was 42.6%. Specific comorbid physical disorders were hypertension (27.1%), obesity (13.8%), HIV/AIDS (8.2%) and syphilis (4.8%). Potentially modifiable factors independently significantly associated with psychiatric and physical comorbidities were: use of alcohol for both syphilis and hypertension comorbidities; and use of a mood stabilisers and khat in comorbidity with obesity. Only psychiatric comorbidity was positively associated with the negative outcomes of suicidality and risky sexual behaviour. The healthcare models for psychiatric care in LMICs such as Uganda should be optimised to address the high burden of psychiatric and physical comorbidities.

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Acknowledgements

The authors wish to thank the managers of the two study sites (Butabika National Psychiatric Referral Hospital and Masaka Regional Referral Hospital) for permitting the study to be conducted at their out-patient departments. The authors extend appreciation to the Medical Research Council, Uganda (MRC, Uganda) for funding and facilitating the study. Special gratitude is extended to the staff working at the two out-patient departments where the study was conducted. Appreciation is extended to the diligent work of research assistants. Gratitude is extended to the participants for their time and trust.

Funding

This study was funded by Medical Research Council (MRC core funding to the Mental Health project of Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Unit under the headship of Professor Eugene Kinyanda to undertake the ‘HIV clinical trials preparedness studies among patients with Severe Mental ILlnEss in HIV endemic Uganda (SMILE Study)’.

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Authors and Affiliations

  1. MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda

    Richard Stephen Mpango, Wilber Ssembajjwe, Allan Kalungi, Moffat Nyirenda & Eugene Kinyanda

  2. Senior Wellcome Trust Fellowship, Entebbe, Uganda

    Richard Stephen Mpango, Wilber Ssembajjwe, Allan Kalungi, Moffat Nyirenda & Eugene Kinyanda

  3. Brown School, Washington University, in St. Louis, St. Louis, MO, 63130, USA

    Richard Stephen Mpango

  4. Statistical Section, MRC/UVRI and LSHTM Uganda Research Unit, P. O. Box 49, Entebbe, Uganda

    Wilber Ssembajjwe

  5. Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda

    Godfrey Zari Rukundo

  6. Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA

    Kenneth D. Gadow

  7. Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA

    Vikram Patel

  8. Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda

    Carol Birungi & Eugene Kinyanda

  9. Global Non-Communicable Diseases (NCD) Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda

    Moffat Nyirenda

  10. Department of Mental Health, Soroti School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda

    Richard Stephen Mpango

  11. Butabika National Psychiatric Hospital, Kampala, Uganda

    Richard Stephen Mpango

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  1. Richard Stephen Mpango
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  9. Eugene Kinyanda
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Contributions

Dr. Richard Stephen Mpango (RSM), Mr. Wilber Ssembajjwe (WS), Dr. Godfrey Zari Rukundo (GZR), Dr. Carol Birungi (CB), Professor Kenneth D. Gadow (KDG), Dr. Allan Kalungi (AK), Professor Vikram Patel (VP), Professor Moffat Nyirenda (MN) and Professor Eugene Kinyanda (EK) have made substantial contributions to conception, design, acquisition of data, drafting the manuscript, revising it critically and gave the final approval of this version to be published. WS did the analysis and interpretation of data. Each author participated sufficiently in this work and takes public responsibility for appropriate portions of the content.

Corresponding author

Correspondence to Richard Stephen Mpango.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval and consent to participate

The study obtained ethical approvals from the Uganda Virus Research Institute’s Research and Ethics Committee (GC/127/19/10/612) and the Uganda National Council of Science and Technology (HS 2337). Participants were given information about the study by trained study Psychiatric Nurses/Psychiatric Clinical Officers and informed consent and assent sought before enrolment into the study. Participants found to have a SMI were provided healthcare and supported at the out-patient departments (OPDs) of their respective hospitals. Informed consent and assent were obtained from all the individual participants included in the study.

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Not applicable.

Supplementary Information

Below is the link to the electronic supplementary material.

406_2022_1478_MOESM1_ESM.docx

Table S4 Psychosocial and psychiatric illness factors associated with comorbid psychiatric and physical disorders at bivariate analysis (DOCX 15 KB)

406_2022_1478_MOESM2_ESM.docx

Table S5: Final multivariate model of socio-demographic, psychosocial and psychiatric illness factors associated with psychiatric and physical comorbidity (DOCX 17 KB)

Table S7: Measures and variables for the study (DOCX 65 KB)

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Mpango, R.S., Ssembajjwe, W., Rukundo, G.Z. et al. Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda. Eur Arch Psychiatry Clin Neurosci 273, 613–625 (2023). https://doi.org/10.1007/s00406-022-01478-6

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