ORIGINAL RESEARCH article

Front. Psychiatry

Sec. Schizophrenia

Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1590037

HOW PHYSICAL MULTIMORBIDITY AFFECTED THE MENTAL HEALTH AND HEALTHCARE UTILIZATION OF PATIENTS WITH SEVERE MENTAL ILLNESS DURING THE COVID-19 PANDEMIC AND EARTHQUAKES

Provisionally accepted
  • 1Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
  • 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Osijek, Croatia
  • 3Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands, Netherlands
  • 4Emergency Medicine Department, Krapina-Zagorje County, Croatia
  • 5University Hospital Centre Zagreb, Zagreb, Croatia
  • 6School of Medicine, University of Zagreb, Zagreb, Croatia

The final, formatted version of the article will be published soon.

Background: People with severe mental illness (SMI) commonly have chronic physical illnesses (CPI) and multimorbidity (CPM). The study aimed to investigate the association between mental health, healthcare utilization, and physical comorbidities in SMI patients affected by the double disasters in Croatia (two earthquakes and the COVID-19 pandemic), and identify predictors of CPI and CPM in this population.Method: A prospective study was conducted among 90 SMI patients at two-time points: May/June 2020 (first COVID-19 wave and earthquake) and December 2020/January 2021 (second COVID-19 wave and earthquake). Results: At the first study point, the CPM group showed significantly higher severity of insomnia (p=.003; mean ISI scores (SD): 5.60(4.360), 9.47(6.802), and 10.83(8.026) for no-comorbidity group, CPI and CPM respectively), while CPI group showed higher perceived stress levels (p=.026; mean PSS scores (SD): 18.21(6.882), 22.32(4.619) and 21.67(3.343) for no-comorbidity group, CPI and CPM respectively) compared to the no-comorbidity group. CPI (5/18) and CPM (10/23) groups visited other specialised non-mental health care services significantly more frequently than those without comorbidity (7/46) (χ2 = 6.557, p=.038). A lower score of perceived social support by friends predicted CPI (OR=0.549; 95% CI:0.349-0.864; p=.010, corrected p=.04), but a higher score on alexithymia subscale "difficulty identifying feelings" predicted CPM (OR=1.235; 95% CI:1.071-1.424; p=.002, corrected p=.004). Conclusion: People with SMI and CPI are especially vulnerable during the COVID-19 pandemic and disasters, as it affects their mental and physical health, leading to increased healthcare utilization. An integrated approach to treating SMI and CPI is necessary for the emergency health response.

Keywords: Comorbidity, multimorbidity, severe mental illness, COVID-19 pandemics, earthquake, double disaster, Health Services

Received: 08 Mar 2025; Accepted: 02 Jun 2025.

Copyright: © 2025 Levaj, Šimunović Filipčić, Medved, Shields-Zeeman, Bolinski, Mikulić and Rojnić Kuzman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ivona Šimunović Filipčić, Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.