Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia: Multi-country cross-sectional survey

Gerardo A. Zavala*, Asiful Haidar-Chowdhury, Krishna Prasad-Muliyala, Kavindu Appuhamy, Faiza Aslam, Rumana Huque, Humaira Khalid, Pratima Murthy, Asad T. Nizami, Sukanya Rajan, David Shiers, Najma Siddiqi, Kamran Siddiqi, Jan R. Boehnke

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background People with severe mental illness (SMI) die earlier than the general population, primarily because of physical disorders. Aims We estimated the prevalence of physical health conditions, health risk behaviours, access to healthcare and health risk modification advice in people with SMI in Bangladesh, India and Pakistan, and compared results with the general population. Method We conducted a cross-sectional survey in adults with SMI attending mental hospitals in Bangladesh, India and Pakistan. Data were collected on non-communicable diseases, their risk factors, health risk behaviours, treatments, health risk modification advice, common mental disorders, health-related quality of life and infectious diseases. We performed a descriptive analysis and compared our findings with the general population in the World Health Organization (WHO) 'STEPwise Approach to Surveillance of NCDs' reports. Results We recruited 3989 participants with SMI, of which 11% had diabetes, 23.3% had hypertension or high blood pressure and 46.3% had overweight or obesity. We found that 70.8% of participants with diabetes, high blood pressure and hypercholesterolemia were previously undiagnosed; of those diagnosed, only around half were receiving treatment. A total of 47% of men and 14% of women used tobacco; 45.6% and 89.1% of participants did not meet WHO recommendations for physical activity and fruit and vegetable intake, respectively. Compared with the general population, people with SMI were more likely to have diabetes, hypercholesterolemia and overweight or obesity, and less likely to receive tobacco cessation and weight management advice. Conclusions We found significant gaps in detection, prevention and treatment of non-communicable diseases and their risk factors in people with SMI.

Original languageEnglish
Article numbere43
Number of pages13
JournalBJPsych Open
Issue number2
Publication statusPublished - 23 Mar 2023

Bibliographical note

© The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Funding Information:
This research was funded by the National Institute for Health Research (NIHR) (grant number GHRG 17/63/130; awarded to N.S.), using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.


  • comorbidity
  • health risk behaviour
  • multimorbidity
  • Physical health conditions
  • severe mental illness

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