Influence of Social Determinants of Health on Cardiovascular Risk among Patients with Schizophrenia in Mandalay, Myanmar

Main Article Content

Thet Phoo Wai
Yajai Sitthimongkol
Thitipong Tankampuan


Purpose: To examine the influence of Social Determinants of Health (SDH) on cardiovascular (CV) risk among patients with schizophrenia.

Design: Predictive correlational research.

Methods: One hundred and forty-five patients with schizophrenia who were attending the Outpatient Department at Psychiatric Hospital in Mandalay, Myanmar were recruited by convenience sampling. Data were collected using demographic and SDH information, and CV RISK tool. Descriptive statistics and linear regression were used for data analysis.

Main findings: The findings revealed that 6.3% of the sample were at risk of cardiovascular disease. Education, income, employment, marital status, family support, antipsychotic drugs, duration of illness, and residence jointly accounted for 18% of the variance explained in CV risk (R2 = .18, F (8, 136) = 3.82, p < .001). Among these factors, residence, duration of illness, and employment were significant predictors of CV risk (gif.latex?\beta = .31, p < .001; gif.latex?\beta = .22, p = .007; gif.latex?\beta = .16, p = .050, respectively).

Conclusion and recommendations: This study showed that SDH including residence, illness, and employment were significant predictors of CV risk among patients with schizophrenia. Psychiatric nurses should conduct screening for CV risk at the time of diagnosis of schizophrenia. Supported employment, and behavioral interventions to promote physical activity should be implemented to prevent cardiovascular diseases particularly in patients who were unemployed, had long duration of illness and living in rural areas.

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Wai, T. P., Sitthimongkol, Y. ., & Tankampuan, T. . (2024). Influence of Social Determinants of Health on Cardiovascular Risk among Patients with Schizophrenia in Mandalay, Myanmar. Nursing Science Journal of Thailand, 42(2), 105–120. Retrieved from
Research Articles


Correll CU, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large‐scale meta‐analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16(2):163-80. doi: 10.1002/wps.20420.

Ratna VVJ, Vempadapu M, Kolakota RK, Mugada V. Risk of cardiovascular disease in schizophrenia: a mini review. Asian Journal of Research in Pharmaceutical Science. 2019;9(2):131-6. doi: 10.5958/2231-5659.2019.00019.5.

Correll CU, Ng-Mak DS, Stafkey-Mailey D, Farrelly E, Rajagopalan K, Loebel A. Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis. Ann Gen Psychiatry. 2017;16:9. doi: 10.1186/s12991-017-0133-7.

Kapıcı Y, Güc B, Tekin A, Abuş S. The relationship of ten-year cardiovascular disease risk and clinical features in patients with schizophrenia. Noro Psikiyatr Ars. 2023;60(3):231-5. doi: 10.29399/npa.28292.

Saldanha NC, Balasundaram S, Sarkar S, Hanifah M. Prevalence and correlates of metabolic syndrome among psychiatric inpatients at a tertiary care center. Telangana Journal of Psychiatry. 2021;7(2):114-21. doi: 10.4103/tjp.tjp_33_21.

Jahrami HA, Faris MAE, Saif ZQ, Hammad LH. Assessing dietary and lifestyle risk factors and their associations with disease comorbidities among patients with schizophrenia: a case–control study from Bahrain. Asian J Psychiatr. 2017;28:115-23. doi: 10.1016/j.ajp.2017.03.036.

Asaye S, Bekele S, Tolessa D, Cheneke W. Metabolic syndrome and associated factors among psychiatric patients in Jimma University Specialized Hospital, South West Ethiopia. Diabetes Metab Syndr. 2018;12(5):753-60. doi: 10.1016/j.dsx.2018.04.037.

Odeigah LO, Agede OA, Ogunjemilua SB, Obalowu IA, Mutalub YB. Interplay between lipid profile and weight-related outcomes in healthy overweight adults: in-sights from comprehensive analyses. Pan Afri J Life Sci. 2023;7(2):676-81. doi: 10.36108/pajols/3202/70.0270.

Bailey JM, Wye PM, Wiggers JH, Bartlem KM, Bowman JAJPmr. Family carers: a role in addressing chronic disease risk behaviours for people with a mental illness? Prev Med Rep. 2017;7:140-6. doi: 10.1016/j.pmedr.2017.05.014.

World Health Organization. Non-communicable diseases country profile 2018. Geneva: World Health Organization; 2018. 223 p.

Healthy People 2020: Social determinants of health [Internet]. Washington, DC: Office of Disease Prevention and Health Promotion. [updated 2022] Available from:

Krisberg K. Shift toward social determinants transforming public health work: targeting causes of health disparities. The Nation's Health. 2016;46(5):1-21.

Evason N. Myanmar (Burmese) culture [Internet]. The Cultural Atlas; 2017. Available from:

Central Statistical Organization, UNDP, World Bank. Myanmar living condition survey 2017: key indicators report. 2nd ed. Nay Pyi Taw and Yangon, Myanmar: Ministry of Planning and Finance, UNDP and World Bank. 2018. 188 p.

Zdrenghea D, Guşetu G, Zdrenghea M, Cismaru G, Caloian B, Vaidean G, et al. CV RISK– A new relative cardiovascular risk score. Med Hypotheses. 2019;132:109362. doi: 10.1016/j.mehy.2019.109362.

SPSS Inc. PASW Statistics for Windows, version 18.0. Chicago, IL: SPSS Inc.; 2009.

Haddad C, Hallit S, Salameh P, Bou-Assi T, Zoghbi M. Coronary heart disease risk in patients with schizophrenia: a Lebanese cross-sectional study. J Comorb. 2017;7(1):79-88. doi: 10.15256/joc.2017.7.107.

Rossom R, Hooker S, O’Connor P, Crain A, Sperl-Hillen J. Cardiovascular risk for patients with and without schizophrenia, schizoaffective disorder, or bipolar disorder. J Am Heart Assoc. 2022;11:e021444. doi: 10.1161/JAHA.121.021444.

Jeemon P, Harikrishnan S, Ganapathi S, Sivasankaran S, Binukumar B, Padmanabhan S, et al. Efficacy of a family-based cardiovascular risk reduction intervention in individuals with a family history of premature coronary heart disease in India (PROLIFIC): an open-label, single-centre, cluster randomised controlled trial. Lancet Glob Health. 2021;9(10):e1442-50. doi: 10.1016/S2214-109X(21)00319-3.

Aye SKK, Hlaing HH, Htay SS, Cumming R. Multimorbidity and health seeking behaviours among older people in Myanmar: a community survey. PLoS One. 2019;14(7):e0219543. doi: 10.1371/journal.pone.0219543.

Saw YM, Than TM, Thaung Y, Aung S, Shiao LW-S, Win EM, et al. Myanmar's human resources for health: current situation and its challenges. Heliyon. 2019;5(3):e01390. doi: 10.1016/j.heliyon.2019.e01390.

Lin K, Lin S, Sein TT. The challenges faced by service providers on satellite mental health-care facilities in Yangon, Myanmar: a qualitative study. J Health Res. 2020;36(1):89-98. doi: 10.1108/JHR-02-2020-0029.

Kumari S, Dahuja S, Singh U. Association of clinical factors with socio-occupational functioning among individuals with schizophrenia. Ind Psychiatry J. 2023;32(1):65-70. doi: 10.4103/ipj.ipj_141_20.

Algren MH, Ekholm O, Nielsen L, Ersbøll AK, Bak CK, Andersen PT. Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study. BMC Public Health. 2018;18(1):250. doi: 10.1186/s12889-018-5170-x.