Abstract
BackgroundThe objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.MethodsThis article bases upon weighted data (N = 6483) from the National Comorbidity Survey Adolescent Supplement (participant age: 13–18 years), a nationally representative United States cohort. Onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders was assessed with the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Onset of lifetime medical conditions and doctor-diagnosed diseases was assessed by self-report.ResultsThe most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63). The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74).ConclusionsFindings suggest that mental disorders are antecedent risk factors of certain physical diseases in early life, but also vice versa. Our results expand the relevance of mental disorders beyond mental to physical health care, and vice versa, supporting the concept of a more integrated mental-physical health care approach, and open new starting points for early disease prevention and better treatments, with relevance for various medical disciplines.
Highlights
As the health of young people contributing to future population health and global economic development has been neglected yet, it has become a ‘pressing issue’ [1]
The most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63)
The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74)
Summary
As the health of young people contributing to future population health and global economic development has been neglected yet, it has become a ‘pressing issue’ [1]. The relevance of the integration of mental and physical health arises from adult studies documenting the systematic co-occurrence of mental disorders and physical diseases [3, 5,6,7,8,9,10]. Findings from longitudinal studies suggest that depression may be a risk factor for the development of cardiovascular diseases such as high blood pressure and coronary heart disease [11,12,13], autoimmune diseases such as type 1 diabetes, Crohn’s disease, and psoriasis [14], asthma, back pain, and migraines [12]. Posttraumatic stress disorder has been found to precede coronary heart disease [17], type II diabetes [18], and respiratory diseases [19], whereas irritable bowel syndrome may be an antecedent risk factor of epilepsy [20]. The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.
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