Physical health among persons with untreated psychotic disorder in diverse settings of the Global South.

Abstract

Background: There is limited information on the prevalence and profile of comorbid physical health conditions in persons with untreated psychotic disorder in countries of the Global South.

Aim: To investigate the frequency of occurence and association of physical health indicators with untreated psychotic disorder in three diverse settings in the Global South.

Methods: Data were collected as part of the International Research Programme on Psychoses in Diverse Settings (INTREPID II), a population-based incidence and case-control study conducted in selected catchment areas in India, Nigeria, and Trinidad. Cases were aged 18-64 years with an untreated psychotic disorder diagnosed according to ICD 10 criteria. Control participants were matched for age, sex, and neighbourhood. Physical health measurements were acquired using the WHO STEPwise approach to non-communicable disease risk factors surveillance instrument (WHO STEPS). We estimated adjusted odds ratios (aOR) using unconditional logistic regression.

Results: We included 225, 209, and 212 case-control pairs, respectively in Kancheepuram (India), Ibadan (Nigeria), and Northern Trinidad. Among cases, we found marked variations in health behaviours and physical health indicators across settings. In case-control comparisons within settings, cases were more likely to report poor diet (aORs of 1.31 [Trinidad] to 3.70 [Ibadan]), current smoking (aORs of 2.21 [Kancheepuram] to 3.35 [Trinidad]), and physical inactivity (aORs of 0.23 [Ibadan] to 0.62 [Kancheepuram]). However, we found no strong evidence that indicators of cardiometabolic comorbidity were consistently more common among cases compared with controls (i.e.,cases across sites were less likely than controls to have high blood pressure (aORs of 0.65 [Ibadan] to 0.76 [Trinidad]) and to be overweight (aORs of 0.70 [Kancheepuram] and 0.85 [Trinidad]), but were more likely than controls to have diabetes (aOR 1.94) and raised C-reactive protein levels (aOR 2.31) in Ibadan. By contrast, cases were more likely than controls to be underweight in all sites (aORs of 1.76 [Trinidad] to 3.67 [Ibadan]). In Kencheepuram (aOR 1.60) and Ibadan (aOR 2.66), cases were more likely to have a positive blood test for infection. These findings were broadly similar after accounting for health behaviours.

Conclusion: In three settings in the Global South, persons with untreated psychotic disorder were more likely to report poorer health behaviours, to be underweight, and experience more infections, possibly reflecting severe economic and social disadvantage in the settings of this study.