Abstract
The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20% of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.
Highlights
Emphasis on somatic morbidities is the focus of Millennium Development Goals [1] and supports the view that mental health has little relevance to the world’s development agenda, despite the evidence that mental disorders are amongst the most important causes of disability, poor quality of life, and premature death in some age groups
We propose a number of characteristics that, according to the literature, might be risk factors for psychiatric and chronic medical illnesses [6]
We examined whether the tendency of medical illnesses and psychiatric disorders to co-occur differs between specific diagnoses
Summary
Emphasis on somatic morbidities is the focus of Millennium Development Goals [1] and supports the view that mental health has little relevance to the world’s development agenda, despite the evidence that mental disorders are amongst the most important causes of disability, poor quality of life, and premature death in some age groups. The co-occurrence of medical and psychiatric morbidity is a well-known phenomenon observed among most of health service attendees [2,3,4]. The comorbidity of psychiatric and somatic conditions is even more relevant to developing countries, where there are insufficient primary care units and well-trained personnel in most deprived areas, obstructing equitable access to health care facilities by the poor population. Episodes of ill-health seem to be unevenly distributed among populations and some individuals might experience more disorders than others.
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