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Mental health and chronic medical conditions: schizophrenia, its treatment, risk of metabolic complications, and health care utilization Open Access


Other title
atypical antipsychotic agents
type 2 diabetes
cardiovascular disease
health care utilization
Type of item
Degree grantor
University of Alberta
Author or creator
Bresee, Lauren
Supervisor and department
Johnson, Jeffrey A (School of Public Health)
Examining committee member and department
Patten, Scott B (Psychiatry; Community Health Sciences)
Tibbo, Philip (Psychiatry)
Voaklander, Donald C (School of Public Health)
Majumdar, Sumit R (Medicine; School of Public Health)
School of Public Health

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Objective - To assess the relationship between schizophrenia and cardiovascular disease by evaluating metabolic risk associated with treatment for schizophrenia, prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D), and health care utilization in people with schizophrenia compared to the non-schizophrenic population. Methods – Four studies were completed to evaluate the dissertation objectives. A systematic review was completed to quantify the change in metabolic parameters associated with use of atypical antipsychotic agents. The second study utilized a period prevalence design to compare prevalence of CV-RF (diabetes, hypertension, dyslipidemia) and CV-D in people with and without schizophrenia using the administrative databases of Alberta Health and Wellness. General and cardiac specialist health care utilization was evaluated in people with schizophrenia using data from Alberta Health and Wellness. Lastly, results from the Canadian Community Health Survey were used to evaluate prevalence of CV-RF and CV-D while controlling for important lifestyle and demographic variables unavailable in the databases of Alberta Health and Wellness. Results – Use of atypical agents, particularly clozapine, resulted in statistically significant weight gain and increases in total cholesterol and blood glucose compared to typical agents. Having schizophrenia was associated with a significantly higher prevalence of diabetes, obesity, smoking, and CV-D compared to people without schizophrenia. Individuals with schizophrenia visited a general practitioner and the emergency department more often, and were more likely to be hospitalized than those without schizophrenia. Despite having a higher prevalence of coronary artery disease, individuals with schizophrenia were significantly less likely to visit a cardiologist or undergo revascularization compared to people with coronary artery disease who did not have schizophrenia. Conclusion – Individuals with schizophrenia have a considerable burden of cardiovascular disease compared to people without schizophrenia. This is likely a result of a number of factors, including medications used to treat schizophrenia, the increased prevalence of smoking and other unhealthy lifestyle factors, and the increased prevalence of cardiovascular risk factors in people with schizophrenia. Individuals with schizophrenia utilize the general health care system more frequently than their non-schizophrenic counterparts, therefore the opportunity exists for monitoring for and management of modifiable cardiovascular risk factors in this vulnerable population.
License granted by Lauren Bresee ( on 2010-09-23T14:26:40Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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