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        No mental health without physical health – a call to arms
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        No mental health without physical health – a call to arms
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        No mental health without physical health – a call to arms
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This volume includes two invited editorials on the important topic of comorbid physical health in those with serious mental illness (Docherty et al. in press; Suetani et al. in press). This field of research has matured substantially over the last two decades, thanks to the hard work of many researchers, who have compiled a solid and consistent body of observational epidemiology. Patients with serious mental disorders (such as schizophrenia) have a shorter life expectancy (Saha et al. 2007; Walker et al. 2015). Those with serious mental disorders such as schizophrenia are more likely to die from suicide, but are also more likely to die from respiratory and cardiometabolic related conditions (Olfson et al. 2015). The medications we use to treat mental disorder are associated with increased mortality estimates (Correll et al. 2015). When our patients develop comorbid physical disorders, they are less likely to receive optimal health care (Lawrence et al. 2013).

In addition to the substantial body of research based on primary data, regular editorials have been appearing on this topic (Mitchell & De Hert, 2015; Stewart, 2015; Suetani et al. 2015). This volume of Epidemiology and Psychiatric Sciences contributes to the rise in this metric. What does it say about a field when the ratio of editorials to primary papers increases? It suggests that a particular topic is important. It might also suggest that some type of response from the field is required. The message from the two linked editorials is clear. We need to shift focus into developing better interventions to reduce the burden of physical disorder comorbidity, and we need to invest in health services research and implementation science. We need to ensure that effective treatments are used routinely and become engrained into everyday practice.

There is a danger that sincere and diligent researchers will invest time and research dollars in telling us results that we already know. This is a well-recognized issue for the field of epidemiology – it is called ‘circular epidemiology’ (Kuller, 1999). Kuller describes how a field of research can ‘freeze’ and fail to evolve into applied clinical and service-level interventions. Normally, this type of scientific ‘arrested development’ is not associated with particularly adverse outcomes. However, when the focus of the circular epidemiology is mortality, then the matter becomes more pressing.

Both editorials outline what type of interventions work, and what type of research is needed now. The authors have hard-won experience in this tough area of research. It involves patient-related factors, clinical services and policy factors, and whole-of-society issues. Mindful of how hard it is to shift behaviour in the general population (e.g. smoking, exercise, diet), we need to have a realistic appreciate of what is feasible in the short term. Because it would not be ethical to withhold proven and safe interventions from those with serious mental illnesses, interventions related to reducing adverse physical health outcomes may be better suited to comparative effectiveness studies (e.g. Is proven treatment X cheaper/quicker/more acceptable than proven treatment Y?). And because we know how hard it is roll out these treatments in under-funded services, perhaps we need more investment in interventions that target implementation and service-level reform (e.g. the Recovery After Initial Schizophrenia Episode [RAISE] study, which examined patient and service-level outcomes in cluster-randomised, non-University clinical settings (Correll et al. 2014; Kane et al. 2015b ; Kane et al. 2015a )).

If we do nothing, then we can predict that we will see a further widening of the life expectancy gap between the general population (who are benefitting from public health interventions and better clinical care) v. that of people with severe mental disorder. The widely used mantra of ‘no health without mental health’ needs to be complemented with a commitment to ‘no mental health without physical health’ (Editorial, 2011).


J. M. received a John Cade Fellowship APP1056929 from the National Health and Medical Research Council.

Financial support

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Conflict of Interest



Correll, CU, Robinson, DG, Schooler, NR, Brunette, MF, Mueser, KT, Rosenheck, RA, Marcy, P, Addington, J, Estroff, SE, Robinson, J, Penn, DL, Azrin, S, Goldstein, A, Severe, J, Heinssen, R, Kane, JM (2014). Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study. JAMA Psychiatry 71, 13501363.
Correll, CU, Detraux, J, De Lepeleire, J, De Hert, M (2015). Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 14, 119136.
Docherty, M, Stubbs, B, Gaughran, F (in press). Strategies to deal with comorbid physical illness in psychosis. Epidemiology and Psychiatric Sciences. doi: 10.1017/S2045796016000056.
Editorial (2011). No mental health without physical health. The Lancet 9766.
Kane, JM, Schooler, NR, Marcy, P, Correll, CU, Brunette, MF, Mueser, KT, Rosenheck, RA, Addington, J, Estroff, SE, Robinson, J, Penn, DL, Robinson, DG (2015 a). The RAISE early treatment program for first-episode psychosis: background, rationale, and study design. Journal of Clinical Psychiatry 76, 240246.
Kane, JM, Robinson, DG, Schooler, NR, Mueser, KT, Penn, DL, Rosenheck, RA, Addington, J, Brunette, MF, Correll, CU, Estroff, SE, Marcy, P, Robinson, J, Meyer-Kalos, PS, Gottlieb, JD, Glynn, SM, Lynde, DW, Pipes, R, Kurian, BT, Miller, AL, Azrin, ST, Goldstein, AB, Severe, JB, Lin, H, Sint, KJ, John, M, Heinssen, RK (2015 b). Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. American Journal of Psychiatry. appiajp201515050632.
Kuller, LH (1999). Circular epidemiology. American Journal of Epidemiology 150, 897903.
Lawrence, D, Hancock, KJ, Kisely, S (2013). The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 346, f2539.
Mitchell, AJ, De Hert, M (2015). Promotion of physical health in persons with schizophrenia: can we prevent cardiometabolic problems before they begin? Acta Psychiatrica Scandinavica 132, 8385.
Olfson, M, Gerhard, T, Huang, C, Crystal, S, Stroup, TS (2015). Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 110.
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 11231131.
Stewart, R (2015). Mental disorders and mortality: so many publications, so little change. Acta Psychiatrica Scandinavica 132, 410411.
Suetani, S, Whiteford, HA, McGrath, JJ (2015). An urgent call to address the deadly consequences of serious mental disorders. JAMA Psychiatry 12.
Suetani, S, Rosenbaum, S, Scott, J, Curtis, J, Ward, PB (in press). Bridging the gap: what have we done, and what more can we do to reduce the burden of avoidable death in people with psychotic illness? Epidemiology and Psychiatric Sciences. doi: 10.1017/S2045796015001043.
Walker, ER, McGee, RE, Druss, BG (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 72, 334341.