Samenvatting

Abstract:
People with a severe mental illness
People with a ‘severe mental illness’ (SMI) are those who suffer from a psychiatric illness for a prolonged period of time that seriously affects their social functioning, professional functioning and functioning in the community,
and who are in need of professional care or treatment (1). SMI is not limited to specific diagnoses, though some are more prevalent within the population. The most common diagnosis of people with SMI is psychotic disorders, with 67%
diagnosed with a psychotic disorder such as schizophrenia (1). The remaining one-third mainly have such diagnoses as mood disorders, personality disorders and addiction disorders (1). Co-morbidities, both somatic and psychiatric, are
very common in this patient group.

Burden of disease and contributors to disease In the Netherlands, approximately 281,000 people (1.7% of the total population) have SMI, of which 160,000 (57%) are aged between 18 and 65 years (1). Though
the overall prevalence of SMI is low, for schizophrenia alone the burden of disease is substantial with 13.4 (95% uncertainty intervals: 9.9–16.7) million years lived with disability (2). People with SMI have an increased risk of premature death than the general population with a reduced life expectancy of up to 20 years (3).

The primary cause of premature death in this population is physical disease, with cardiometabolic diseases being the highest contributors. Evidence shows that for people with mental health disorders the risk of a cardiometabolic disease is increased by 1.4 to 2.0 times relative to the general population. For example, people with depression have a 40% higher risk of developing cardiac disease, hypertension, stroke, and metabolic syndrome than the general population (4). Besides cardiometabolic disorders, almost all chronic physical diseases are significantly more prevalent in patients with SMI (4).