The Lancet Regional Health Africa · Nov 2026
Physical comorbidity among adults with schizophrenia, schizoaffective disorder, and bipolar disorder in Sub-Saharan Africa: a cross-sectional study
By Milkias B, Girma E, Arinda A et al.
Background Physical comorbidity is understudied in low- and middle-income countries, where physical conditions may be underdiagnosed and undertreated. We explored associations between psychotic disorders and reported physical comorbidities in four African countries. Methods We analyzed data from the Neuropsychiatric Genetics of African Populations-Psychosis study in Ethiopia, Kenya, South Africa, and Uganda. We used chart review and the WHO-CIDI chronic medical conditions checklist. Descriptive statistics summarized prevalence across schizophrenia (SCZ), schizoaffective disorder (SAD), and bipolar disorder (BD). Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for multimorbidity and major physical comorbidity categories, adjusting for age, sex, marital status, and education. Differences in the number of physical conditions were examined using multivariable linear regression. Findings Among 15,051 individuals (SCZ = 8,530, SAD = 649, BD = 5872), about half endorsed at least one physical comorbidity (42.2% of SCZ, 54.4% of SAD, 49.3% of BD) and 19.3% reported two or more conditions (multimorbidity). Compared with SCZ, BD was associated with higher odds of multimorbidity (aOR 1.33, 95% CI 1.22–1.45), while SAD showed the highest odds (aOR 1.80, 95% CI 1.49–2.17). The most reported categories were pain-related (38.8%), respiratory (10.1%), and cardiovascular conditions (9.8%). Interpretation Adults with psychotic disorders in this multicountry Sub-Saharan African cohort had a substantial burden of physical comorbidity. These findings support integrating routine physical health assessment into psychiatric care, while highlighting the need for longitudinal studies to better understand the temporal relationship between psychotic disorders and physical comorbidity. The higher adjusted odds of reported multimorbidity in SAD warrant further investigation. Funding Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, and United States’ National Institute of Mental Health. This research was also supported [in part] by the Intramural Research Program of the National Institutes of Health (NIH).