Association of Psychiatric Illness and Obesity, Physical Inactivity, and Smoking among a National Sample of Veterans

Background: Increased cardiovascular morbidity and mortality have been reported across a number of chronic psychiatric illnesses. Interventions to decrease cardiovascular risk have focused on single health behaviors. Objective: To evaluate the co-occurrence of multiple poor health behaviors that increase cardiovascular risk among veterans with psychiatric diagnoses. Methods: Using data from the 1999 Large Health Survey of Veterans (n = 501,161), multivariate logistic regression was used to evaluate the associations between current smoking, no regular exercise, and obesity with each of six Axis I diagnoses. Results: There were statistically increased odds of co-occurrence of obesity, current tobacco use, and no regular exercise among veterans with each of the psychiatric diagnoses, with the exception of drug use disorders (which was not significantly different from 1). The highest odds were among veterans with schizophrenia, PTSD, and bipolar disorder [OR (95% CI) of 1.37 (1.29, 1.45); 1.26 (1.20, 1.32); and 1.19 (1.11, 1.25), respectively]. The OR for depression was not significant after adjustment for medical comorbidity. Conclusions: Veterans with psychiatric illnesses, and particularly those with schizophrenia, PTSD, and bipolar disorder, are much more likely to have multiple poor health behaviors that increase their cardiovascular risk. Interventions to decrease cardiovascular risk among veterans with serious mental illness need to target multiple health behaviors. (Psychosomatics 2011; 52:230-236)