Lancet - Prevalence and risk factors for HIV, hepatitis B, and hepatitis C in people with severe mental illness: a total population study of Sweden

The Lancet Psychiatry
Prevalence and risk factors for HIV, hepatitis B, and hepatitis C in people with severe mental illness: a total population study of Sweden
Clarissa Bauer-Staeb, MSc, Lena Jörgensen, PhL, Prof Glyn Lewis, PhD, Prof Christina Dalman, PhD, Prof David P J Osborn, PhD, Dr Joseph F Hayes, MB ChB

Published: 04 July 2017

Introduction

Severe mental illness is commonly defined as a mental disorder that is persistent and disabling in nature, such as schizophrenia, schizoaffective disorder, bipolar disorder, and other psychoses.¹ Increased mortality rates of 2–3 times the general population are well documented among people with severe mental illness, and translate into a reduction in life expectancy of up to 20 years.² Approximately 60% of this excess in mortality has been attributed to poor physical health.² Although much attention has been focused on addressing cardiovascular, respiratory, and cancer health inequalities, infectious diseases have been largely neglected in mental health research and policy.³ This situation is problematic as meta-analytic evidence suggests blood-borne virus (BBV) prevalence is elevated amongst individuals with severe mental illness.³ In North America, the pooled prevalence of BBVs in populations with severe mental illness is estimated to be as high as 6% for HIV, 2·2% for hepatitis B virus (HBV), and 17·4% for hepatitis C virus (HCV).³ Therefore, HIV and HCV are ten times, and HBV around five times, more common in people with severe mental illness than in the general population.⁴ Although lower, similar patterns are evident in people with severe mental illness in European countries (Germany, Belgium, Spain, Greece, Italy), with combined prevalence estimates of 1·9% for HIV, 2·7% for HBV, and 4·9% for HCV.³ However, the true scale of the problem is unclear, because previous studies have used small, unrepresentative convenience samples recruited from treatment settings.³ As far as we are aware, no population-based studies have been done of BBV prevalence in severe mental illness, and no studies have examined prevalence in northern European countries.³ Additionally, literature on risk factors for BBV in individuals with severe mental illness is limited, but high prevalence of substance misuse has been identified as a particular concern in this group.⁵

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