A new study, published in this month's journal Psychiatric Services, suggests that the risk of developing cancer is 2.6 times higher in those who suffer from a serious mental illness, such as bipolar disorder, debilitating depression or schizophrenia.

The new Johns Hopkins research highlights whether patients with serious mental illnesses are adequately screened for cancer and receive preventive care that is linked to cancer risk factors like smoking.

Leading researcher Gail L. Daumit, M.D., M.H.S., an associate professor of medicine and psychiatry at the Johns Hopkins University School of Medicine declared: "The increased risk is definitely there, but we're not entirely sure why. Are these people getting screened? Are they being treated? Something's going on."

Daumit discovered in a separate study, which was featured in last month's journal Injury Prevention that those suffering from with serious mental illness had a 50% higher risk of ending up in a hospital's emergency room or inpatient department due to injury than the general population and that their mortality risk of dying from their injuries tended to be around 4.5 times higher.

According to Daumit, about 5% of Americans suffer from serious mental illness, and evidence exists that they are two to three times more likely to die from a premature death, compared with those who have no debilitating psychiatric problems. Daumit continues saying that a small percentage of this higher risk could be due to the higher danger of suicide and homicide victimization in these people. However, these factors do not explain most of the disparity. The leading cause of mortality is cancer and cardiovascular disease, which is identical to the leading causes for people with no serious mental illness.

Daumit, a practicing internist, believes people with serious mental illness are "falling through the cracks."

In her first study, Daumit and her team evaluated data from 3,317 Maryland Medicaid beneficiaries with schizophrenia and bipolar disorder to establish which of these people developed cancer and which type between 1994 and 2004. Compared with the general population, they discovered that schizophrenic patients had a 4.5 higher risk of developing lung cancer and a 3.5 times higher risk of developing colorectal cancer, whilst the risk of developing breast cancers was almost three times higher. The risks for all three types of cancer were similar in people who were bipolar. The team discovered no ethnic differences in who developed cancer within this group, who had an average age of 42 to 43 years.

Daumit believes that smoking could be one of the reasons for a higher risk of lung cancer, as more people with serious mental illness tend to smoke. Regarding the higher breast cancer risk in this population, Daumit believes that this may be due to the fact that schizophrenic and bipolar women are less likely to have children, given that it is thought that having children reduces the risk of developing breast cancer. In addition, some psychotropic drugs are known to raise prolactin hormone levels, which is also associated with breast cancer. She continues saying that the colorectal cancer risk could be linked to lifestyle factors, like lack of physical activity, smoking and consuming insufficient fruit and vegetables.

According to Daumit, further research is required to investigate the role, which behavioral and pharmacological factors have in an elevated cancer risk in those with serious mental illness, and to what extent these people are appropriately screened against cancer and treated. She urges mental health providers and primary care physicians to collaborate in promoting screening and to reduce modifiable risk factors like smoking in this population.

In Daumit's second study, the team assessed similar Maryland Medicaid data from 1994 to 2001 to look for other patterns. They discovered that from 6.234 seriously mentally ill people 43% visited a hospital's emergency department or were admitted to hospital with an injury over the 7-year period. Furthermore, of those study participants who sustained an injury, 42% were injured once, whilst 23% were injured twice and 25% were injured 3-5 times. Ten percent of injured seriously mentally ill patients were injured six or more times.

The most frequent injuries amongst study participants were superficial injuries, open wounds and sprains, whilst burns and poisoning were the least frequent injuries.

The findings indicate that those with serious mental illness seem to have a higher risk for both intentional and unintentional injury, and that most injuries seem to be consistent with minor violence and falls.

Seriously mentally ill people also have a higher tendency of suffering from problems related to substance abuse. Being under the influence of drugs or alcohol problems can heighten the risk of injury, as well as being in a location where illegal drugs are sold. However, Daumit says substance abuse rates do not explain the entire higher risk.

She continues saying that another risk factor could be low socioeconomic status, as this is also linked to mental illness and the risk of injury. Daumit's team adds that environmental risk factors linked to poverty that place those with serious mental illness at a higher risk of injury include unsafe housing and poorly kept neighborhoods. For instance, house without appropriate railings to prevent falls and neighborhoods that have no sidewalks.

Daumit says: "Just as this population has other medical risks, injury requiring acute medical attention in the emergency department is common and we should consider this when we are looking at the overall care of the patient."

She concludes that doctors need to be aware of the risk of injury when they counsel seriously mentally ill patients and their carers, recommending that carers raise the issue of wearing bicycle or motorcycle helmets, preventing falls and safe firearm storage. Daumit adds that doctors should also assess and address side effects caused by psychotropic drugs, including dizziness, which could be the cause of unintentional injuries.

Written by Grace Rattue