Physical Health Problems of Persons with Severe Mental Illness: Variations By Race and Gender

Background: There is a wealth of information that persons with severe mental illness have higher rates of chronic physical health problems and have significantly shorter life spans compared to the general population. To exacerbate matters, there are a number of individual, provider and system-level barriers that make it difficult for persons with mental illness to access routine prevention and care for their chronic health conditions. Efforts to integrate health and behavioral health care through co-located or reverse co-located integrated care models are increasingly common; however, research has yet to determine the extent to which disparities exist in the distribution of chronic health conditions among people with severe mental illness. To address this knowledge gap, this study examines how health problems vary by race and gender among persons with mental illness.

Methods: Subjects were participants in a reverse co-located integrated health and behavioral health intervention at a large mental health agency in the Midwest. The intervention included routine physical health care and monitoring, wellness counseling, and educational groups. Mental health functioning and physical health indicators were collected at baseline for a total of 470 participants: 131 (29%) were white men; 124 (26%) were African American men; 114 (24%) were African American women; and 101 (21%) were white women. The mean age of the participants was 39.64 (SD= 9.30), 50% (n=235) had a diagnosis of schizophrenia and 71% (n=334) had co-occurring substance use disorders. Also, 73% (n=343) were single and 35% (n=165) had a high school degree or equivalent. Chi-square tests were used to compare physical health functioning of persons with severe mental illness across race and gender groups.

Results: Compared to males, females were more likely to be overweight (X²(1)=5.13, p<.05) and more likely to report poor overall health (X²(1)=5.45, p<.05). Also, compared to males, females were more likely to report that their mental health symptoms were a problem (X²(1)=4.96, p<.05). Compared to white subjects, African American subjects were more likely to have high blood pressure (X²(1)=5.22, p<.05); however, white subjects were more likely to report that their mental health symptoms were a problem (X²(1)=6.82, p<.01) and have elevated glucose levels (X²(1)=5.43, p<.05). When examining the interaction of race and gender, findings suggest that white females were more likely to report that their mental health symptoms were a problem (X²(3)=15.99, p<.01), compared to other race/gender groups, and were more likely to report poor overall health (X²(3)=8.63, p<.05). However, African American females were more likely to be overweight compared to the other three groups (X²(3)=8.25, p<.05).

Discussion: These results suggest that gender and race can moderate the health challenges faced by persons with mental illness. Efforts to integrate health and behavioral health care of persons with mental illness should be targeted to accommodate the unique issues among persons of color with severe mental illness and how chronic physical health conditions vary by gender. More research is needed to establish evidence-based integrated care practices that meet the unique health care needs of persons with severe mental illness that vary by race and gender.