Background

Metabolic Syndrome (Mets) is a worldwide health problem that can be defined as a constellation of risk factors including glucose intolerance, raised blood pressure, obesity, and dyslipidemia, which increases cardiovascular morbidity and mortality rate [1]. During the last two decades, the frequency of obesity and diabetes mellitus has increased in the United States, which is directly associated with cardiovascular disease (CVD) [2] When compared to people without MetS, the chance of heart attack or stroke is three times more and the chance of death because of cardiovascular complication is twice higher in MetS patients [3].

In contrast to the general population, patients with schizophrenia have a higher rate of Mets [4]. As a result of this, these patients are at increased risk of premature CVD and subsequent shorter life expectancy [5–7]. A previous study showed that 31–34% of the population with severe and persistent psychiatric disorders complicated by Metsdied from CVD, which indicates how much Mets directly increases the risk of developing CVD [8].

Abnormally large waist circumference (WC) has been debated in the literature as a controversial measurement parameter for the assessment of metabolic Mets. It was not consistently considered as a diagnostic criterion for determining Mets [9]. However, increased WC is the main feature of Mets, and it is associated with high fasting blood glucose (FBG) and hypertension as well as lipid dysregulation. Other metabolic risk factors include central obesity and insulin resistance [10,11]. The waist height ratio (WhtR) has been recommended as a simple cost, and noninvasive screening tool for psychiatric patients receiving antipsychotic medications to assist in identifying metabolic screening [12]. Although Mets in psychiatric patients is a burning issue causing CVD, the screening guidelines are still not widely applied, even in developed countries [13,14]. Besides, the studies conducted regarding Mets risk show inconsistent results. Therefore, the present study was aimed to determine the risk of Mets and its associated factors among psychiatric patients in the study setting, since limited data is available in the current study area regarding metabolic risk and associated factors.

Methods

Result

A total of 300 patients were interviewed, of which 168 (56%) were females, and most of them 145 (48.3%) were in the age group 18–30 years (Mean age 31.97). Half (151,50.3%) of the participants had low literacy levels and were self-employed (156, 52%). Nearly half of them live in rural areas 167(55.7%) and more than two-third of participants are from ≤ 40km distance (220, 73.3%).

The present study showed that schizophrenia (147, 49%) was the most commonly diagnosed psychiatric disorder in the study setting. Major depression (100, 33.3%) was the second leading case diagnosed in this setting. On the other hand, brief psychosis and generalized anxiety disorders were the least common psychiatric disorders in our setting. The majority of the study participants (138, 46%) had ≤ five years of duration of illness, and 95% of the patients had been treated with pharmacotherapy for a period of fewer or equal to ten years. Besides, haloperidol was the most commonly prescribed antipsychotic in the study setting (Table 1). As per waist to a height ratio scale, 58% (174) of the patients had a risk of metabolic syndrome.

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Table 1. Socio-demographic characteristics and clinical features of participants.

https://doi.org/10.1371/journal.pone.0256195.t001

In the binary logistic regression analysis, the study indicated that male patients had an 88% decreased risk of Metsas compared to female patients (AOR = 0.191, 95% CI = 0.093–0.391, p- <0.0001). Besides, participants who were government workers (AOR = 1.009, 95% CI = 0.168–6.052, p = 0.032) and self-employed (AOR = 0.339, 95% CI = 0.143–0.802, p = 0.032) were 1.009 and 0.339 times less likely to develop risk of Metsas compared to unemployed patients, respectively. The current study also showed that being single had a 73% decreased risk of acquiring Metsin contrast to married patients (AOR = 0.270, 95% CI = 0.107–0.684, p = 0.006). On the other hand, patients who were living closer to the hospital had a higher chance of getting Mets. However, the other parameters did not show a statistically significant association with the Mets risk (Table 2).

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Table 2. Univariable and multivariable binary logistic regression analysis of predictors of metabolic syndrome risk.

https://doi.org/10.1371/journal.pone.0256195.t002

Discussion

Based on WhtR value over 0.50 as a parameter that reveals confirmation of abdominal obesity, 58% of participants had abdominal obesity, which directly indicates Metsrisk. One factor that could lead to such increased metabolic risk is the duration of the illness, with more than half (54%) of the patients having a duration of illness greater than 5 years. There is some eviedence for a dose-responce association with the severity and duration of symptoms and for a bidirectional longitudinal impact between psychatric disorders and Mets. Associations generally seem stronger with abdominal obesity and dyslipidemia dysregulation than with hypertension. Contributing mechanisms are an unhealthy life style and a poor adherence to medical regimen which are prevalent among psychiatric patients. Specific psychiatric medications have also shown a profound impact in increasing Mets dysregulations. Finally, pleiotropy in genetic vulnerablity and pathophysiological mechanisms, such as those leading to the increased central and peripherial activation of immunometabolic or endocrine symptoms, plays in both Mets and psychiatric disorder development [17].

Previous studies showed that the risk of Mets was prevalent among patients on second-generation antipsychotics [18,19]. However, in our setting due to the limited availability of second-generation antipsychotics, first-generation antipsychotics such as haloperidol was frequently prescribed. Hence, the lack of a significant association between Mets risk and the prescribed medications in our setting could be probably due to the prevalent use of first-generation antipsychotics which has a lower risk of Mets. Related to the specific case, it has been reported that the prevalence of Mets in patients with major depression ranges from 36–50% [16]. Nevertheless, there was no significant association identified between Mets and the types of psychiatric disorders in our setting. The finding of the study indicated that females had an increased risk than males which is in line with a study conducted in South Africa [20] and Brazil [21]. the study done in jimma University Specialized Hospital, Southeast Ethiopia also showed a significant association of Mets with being female [22]. Another study also showed that the prevalence rate of Metswas 51.6–54.2% in women and 36–36.6% in male [23]. This increased risk in women might be because of difference in body composition, with women having more fat mass. Different conditions such as pregnancy, oral contraceptive therapy, and menopause could also contribute to Mets [24].

Significant association between employment status and Metsrisk was shown in our study. A previous study showed that there is a relationship between employment status and physical inactivity, which was explained mainly by health-related and socioeconomic factors [25]. Another study also revealed that there was an association between physical inactivity and Mets [26]. A significant association in the current study could also be because of the higher unemployment, which leads to stress imposes peoples to be stressed and stress is thought to influence eating behavior. Stress is more likely to increase food intake, along with high consumption of palatable food, rich in saturated fat and sugar [27].

Our study also revealed that those who were single have an increased risk for Mets than married/ever married. Similarly, a study conducted in this area showed that marital status to be of important factor. Here, living single was to be associated with a poorer lifestyle and higher CVD risk, at least in males [28]. Another study also reported marital quality as one of the important factors that mediate the association between marital status and Mets [29].

Furthermore, participants who were relatively near to the hospital were at risk of Mets than those far away. The possible reason could be as the hospital is in an urban area, the majority of the study population (73.3%) are living near the hospital, having a sedentary life and eating an unhealthy diet. However, an insignificant association was found between living in the urban area (44.3% of the patients) and Mets. This could be because even though the patients are residing in the rural areas, the distance from their home to the hospital might be lesser than 40 km as is evident by the result which shows that 73.3% of the participants are living near the hospital at a distance of less than 40 km.

Psychiatric patients are at increased risk of Mets and this risk is present for a range of psychiatric conditions, including major depressive disorder, bipolar disorder, schizophrenia, anxiety disorder, attention-deficit/hyperactivity disorder, and posttraumatic stress disorder [17]. In the current study, no correlation was found between the type of psychiatric disorder and the risk of Mets. One possible reason might be the prolonged duration of the mental disorder that is observed in the majority of the study participants (54%), increasing the chance of metabolic disorder irrespective of the type of the type of psychiatric disorder.

Limitation of the study

Identifying patients with Mets and other comorbid conditions with the help of laboratory parameters in the psychiatric care unit was not carried out in our setting. For that reason, the study was unable to differentiate patients who already have Mets. In addition to this, as it is a cross-sectional study, confounding variables cannot be controlled to identify definitive exposing factors for Mets at risk. The lack of information regarding patients’ awareness of suffering from clinical conditions associated with metabolic syndrome could also be considered as a possible limitation since adequate awareness of individual cardiovascular risk profile is a key element for improving adherence to life-style rules and adoption of preventive treatment strategies [30].

Conclusion

The present study showed that long-term psychiatric patients are at increased risk of Mets. Sex, marital status, employment status, and distance to the hospital were statistically associated with Mets. Therefore, routine physical and laboratory investigations to detect Mets are indispensable to prevent cardiovascular complications.

Supporting information