Mental Health Problems and Health Related Behaviours
Health problems and health related behaviours
Prevalence estimates suggest that approximately 1 million adults (16-74 years) in London in 2003 had a
common mental health problem (such as anxiety, depression, phobias, obsessive compulsive and
panic disorders) at any one time (approximately 18.2% of the population), and 22,000 (0.4% of
the population) had a possible psychotic disorder within the year
(see Prevalence of Mental Health Problems).
Evidence summarised in the Social Exclusion Unit's report on mental health (1) shows that
mental health and physical health problems are closely linked.
- Having a mental health problem increases the risk of premature death. For example, having a diagnosis of schizophrenia can reduce the average life expectancy by 10 years, largely due to physical health problems (2,3)
- Deaths from infectious diseases, endocrine, circulatory, respiratory, digestive and genito-urinary system disorders are significantly more likely to occur in adults with severe mental health problem (2)
- It is estimated that 70% of all new cases of depression in older adults are caused by poor physical health (4)
- It has been suggested that sustained stress or trauma may damage the immune system and thus increase susceptibility to viral infections and physical illness (5)
People with mental health problems are also more likely to engage in behaviours that increase
the risk of poor health. For example people with severe mental health problems are more likely to
have poor diets, take less exercise, smoke heavily and be dependent on alcohol thus increasing the
risk of illness such as cardiovascular disease (6,7,8). However, it has been suggested that those
with mental health problems are less likely to be offered or receive regular health review and
reviews of their medication (9). Therefore mental health problems are a prominent factor in health
inequalities (also see Basket of Indicators) and the health of the capital see Health in London.
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Smoking
Smoking causes premature death and poor health, with at least half of all regular smokers dying as
a result of tobacco. Over 10,500 deaths of people aged 35 and over were due to smoking in London in 2001
(more than one in six of all deaths in London). About 31% of males and 26% of females in London smoked
in 2001 (10). In the general population, increased prevalence of smoking has been associated with
deprivation and manual workers (see Compendium of Clinical Indicators and the Smoking section).
People with mental health problems are more likely to smoke than those without. The ONS survey of psychiatric
morbidity amongst adults found that 44% people with common mental health problems were smokers, compared with 27%
of people without these problems. Further, people with common mental health problems were twice as likely to be
heavy smokers (20 cigarettes or more per day) than people without (16% compared with 7%). Rates of heavy and
moderate smoking increased if a person had more than one common mental health problem (11)
For people with psychotic disorders, 64% were smokers and 9% were ex-smokers, compared with 29% and 23% of those
with no evidence of psychosis. In addition, people with psychotic disorders were over three times more likely to be
heavy smokers (20 cigarettes or more per day) compared with those without psychosis (35% compared with 9%) (12).
Deaths from smoking related diseases are twice as high amongst people with schizophrenia (13)
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Substance use and misuse
Alcohol
In 2001 it is estimated that 31% of males and 17% of females in London drank over the recommended limit in the
last week, compared with 27% of males and 15% of females in England as a whole. Excessive use of alcohol has been linked to
a range of health consequences including mental health problems (see section on Alcohol Use); a review of alcohol
and mental health by the Institute of Alcohol Studies reported that "people with mental health problems are at raised
risk of alcohol problems and vice versa" (7).
The ONS psychiatric survey of adults found that people with a common mental health problem were twice as likely
to have a dependency to alcohol (from mild to sever dependency) than those without a mental health problem
(13% compared with 6%). Further, moderate or severe alcohol dependency was associated with a mental health problem
(2% of people with a common mental health problem had a moderate or severe dependency to alcohol compared with 0%
of those without a common mental health problem) (11,12).
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Illicit drug use
A research study on the prevalence of co-morbidity of mental health and drug misuse problems found that 31% of
adults receiving mental health services reported problem drug use in the past year, with a London sample having
significantly higher rates than two non-London samples. Around 75% and 86% of adults receiving drug service and
alcohol service treatments, respectively, were found to have at least one mental health problem (14).
The ONS survey results for illicit drug use amongst people with mental health problems are provided in Data
sources (15). Also prevalence rates of drug misuse and admission rates for drug misuse and drug poisoning can be
found in the Drug Misuse section.
Mental Health Problems - Datasets & Resources
- Office of the Deputy Prime Minister (2004) Mental Health and Social Exclusion: Social Exclusion Unit Report ODPM: London.
- Harris, EC and Barraclough B. (1998) 'Excess Mortality of mental disorders', British Journal of Psychiatry, 173 (1998) 11-53, in (1)
- Allebeck P (1989) 'Schizophrenia: A life-shortening disease', Psychiatric Bulletin, 15(1): 81-89, in Mentality (2003) 'Promoting Healthy living for People with mental health problems' in (1)
- Evans O, Singleton N, Meltzer H, Stewart R, and Prince M (2003) 'The mental health of older people' in (1)
- Mentality (2001) 'An executive briefing on mental health promotion: implementing Standard One of the national Service Framework' in (1)
- Phelan M, Stradins L and Morrison S (2001) 'Physical health of people with severe mental illness', British Medical Journal, 322: 443-444 in (1)
- Institute of Alcohol Studies (2002) Factsheet: Alcohol and Mental Health St Ives, Cambridgeshire.
- McCreadie R and Kelly C (2002) 'Patients with schizophrenia who smoke: private disaster, public resource', Editorial, British Journal of Psychiatry, 176: 109 in (1)
- Mentality (2003) 'Promoting Healthy living for People with mental health problems' in (1)
- Callum C, & White P (2004) Tobacco in London: The preventable burden A joint report by SmokeFree London and the London Health Observatory.
- Coulthard M, Farrell M, Singleton N, Meltzer H (2002) Tobacco, alcohol and drug use and mental health TSO: London.
- O'Brien M, Singleton N, Sparks J, Meltzer H, Brugha T (2002) Adults with a psychotic disorder living in private households, 2000 TSO: London.
- McNeil A (2001) Smoking and mental health - a review of the literature Smoke Free London Programme: London.
- Weaver T, Charles V, Madden P, Renton A (2002) A study of the prevalence and management of co-morbidity amongst adult substance misuse and mental health treatment populations. Research report submitted to the Department of Health. Department of Social Science & Medicine/Centre for Research on Drugs and Health Behaviour. Imperial College of Science, Technology & Medicine.
- Singleton N, Bumpstead R, O'Brien M, Lee A, Meltzer H (2001) Psychiatric morbidity among adults living in private households, 2000. Her Majesty's Stationery Office (HMSO): London.
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