Mental-physical Comorbidity Research Articles

Trajectories of Inflammation in Youth and Risk of Mental and Cardiometabolic Disorders in Adulthood

Research suggests that low-grade, nonresolving inflammation may predate adult mental and physical illness. However, evidence to date is largely cross-sectional or focuses on single disorder outcomes. To examine trajectories of inflammation as measured by C-reactive protein (CRP) levels in a large sample of children and adolescents, and to explore associations between different identified trajectories and mental and related cardiometabolic health outcomes in early adulthood. In a longitudinal cohort study using data from the large UK-based Avon Longitudinal Study of Parents and Children (ALSPAC), latent class growth analysis (LCGA) was used to explore different trajectories of inflammation, with logistic regression exploring association with mental and physical health outcomes. Participants with measurable CRP data and associated mental and cardiometabolic health outcomes recorded were included in the analysis. Data analysis was performed from May 1, 2023, to March 30, 2024. Inflammation was assessed via CRP levels at ages 9, 15, and 17 years. LCGA was used to identify different trajectories of inflammation. Outcomes assessed at age 24 years included psychotic disorders, depressive disorders, anxiety disorders, hypomania, and, as a measure of insulin resistance, Homeostasis Model Assessment (HOMA2) score. A total of 6556 participants (3303 [50.4%] female) were included. Three classes of inflammation were identified: persistently low CRP levels (reference class, n = 6109); persistently raised CRP levels, peaking at age 9 years (early peak, n = 197); and persistently raised CRP levels, peaking at age 17 years (late peak, n = 250). Participants in the early peak group were associated with a higher risk of psychotic disorder (odds ratio [OR], 4.60; 95% CI, 1.81-11.70; P = .008), a higher risk of severe depression (OR, 4.37; 95% CI, 1.64-11.63; P = .02), and higher HOMA2 scores (β = 0.05; 95% CI, 0.01-0.62, P = .04) compared with participants with persistently low CRP. The late peak group was not associated with any outcomes at age 24 years. Low-grade systemic inflammation peaking in midchildhood was associated with specific mental and cardiometabolic disorders in young adulthood. These findings suggest that low-grade persistent inflammation in early life may be an important shared common factor for mental-physical comorbidity and so could be relevant to future efforts of patient stratification and risk profiling.

Psychiatric Comorbidity and Length of Stay in a general hospital

IntroductionPsychiatric comorbidity has a significant impact on the patient’s overall health, with an increased risk of death for those patients with mental-physical comorbidity (Tan et al., 2021). This impacts, among other things, the average hospital stay of a patient with psychiatric comorbidity. For example, an American study shows that psychiatric comorbidity was associated with greater inpatient utilization, including the risk of additional hospitalizations, days of stay, and hospitalization charges (Sayers et al., 2007). Our study aims to confirm these results in patients admitted to a general hospital for any cause and presenting psychiatric comorbidity.ObjectivesTo compare the mean length of stay of patients admitted to a general hospital for any cause according to whether they have psychiatric comorbidity or not.MethodsWe made a descriptive retrospective study through the use of electronic medical records. The drug use history and average day of hospitalization were obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.ResultsThe mean length of stay was longer in patients with psychiatric comorbidity (mean = 9.87 days, SD = 15.45) than in patients without psychiatric comorbidity (mean = 5.23 days, SD = 7.16), the difference being statistically significant for the analysis of variance with a small effect size (F = 18.2; p < 0.001, η²=0.038). The assumption of the equality of variances of the two groups is not fulfilled (Levene F = 29.0; p < 0.01) so Welch’s nonparametric test was applied, whose results do not modify those obtained.NMeanSDSENo psychiatric comorbidity2965.237.160.416Psychiatric comorbidity2389.8715.451.002ConclusionsOur results are in line with other studies, showing a longer mean length of stay in those patients admitted for any cause and with associated psychiatric comorbidity. This highlights the importance of having an integrated psychiatry service in a general hospital, as Bronson points out, where they find a shorter mean length of stay in units that have integrated, proactive psychiatric care (Bronson et al., 2019).ReferencesBronson, B. D., Alam, A., & Schwartz, J. E. (2019). The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. Psychosomatics.Sayers, S. L., Hanrahan, N., Kutney, A., Clarke, S. P., Reis, B. F., & Riegel, B. (2007). Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. Journal of the American Geriatrics Society.Tan, X. W., Lee, E. S., Toh, M., Lum, A., Seah, D., Leong, K. P., Chan, C., Fung, D., & Tor, P. C. (2021). Comparison of mental-physical comorbidity, risk of death and mortality among patients with mental disorders - A retrospective cohort study. Journal of psychiatric research.Disclosure of InterestNone Declared

Sex Differences in Comorbidity Combinations in the Swedish Population.

High comorbidity rates, especially mental–physical comorbidity, constitute an increasing health care burden, with women and men being differentially affected. To gain an overview of comorbidity rates stratified by sex across a range of different conditions, this study examines comorbidity patterns within and between cardiovascular, pulmonary, skin, endocrine, digestive, urogenital, musculoskeletal, neurological diseases, and psychiatric conditions. Self-report data from the LifeGene cohort of 31,825 participants from the general Swedish population (62.5% female, 18–84 years) were analyzed. Pairwise comorbidity rates of 54 self-reported conditions in women and men and adjusted odds ratios (ORs) for their comparison were calculated. Overall, the rate of pairwise disease combinations with significant comorbidity was higher in women than men (14.36% vs. 9.40%). Among psychiatric conditions, this rate was considerably high, with 41.76% in women and 39.01% in men. The highest percentages of elevated mental–physical comorbidity in women were found for musculoskeletal diseases (21.43%), digestive diseases (20.71%), and skin diseases (13.39%); in men, for musculoskeletal diseases (14.29%), neurological diseases (11.22%), and digestive diseases (10%). Implications include the need for integrating mental and physical health care services and a shift from a disease-centered to an individualized, patient-centered focus in clinical care.

Food Insecurity Is Associated with Mental-Physical Comorbidities among U.S. Adults: NHANES 2013 to 2016.

The co-occurrence of mental and physical conditions has increased significantly during the last decade. However, research examining the influence of social factors such as food insecurity is limited. The purpose of this study was to examine the association between food insecurity and mental–physical comorbidity status among U.S. adults. Data for this analysis were drawn from the National Health and Nutrition Examination Survey (NHANES) for the years 2013–2016. Respondents ages 18 and older who reported at least one of three chronic conditions (i.e., type 2 diabetes mellitus, hypertension, and hyperlipidemia) and responded to a nine-item depression scale were included in the analytic sample. The prevalence of food insecurity among those with depression and a cardiometabolic condition was 34% compared to 13% among those with a cardiometabolic condition only. Findings from multinomial logistic regression models indicated that food insecurity was associated with higher risk of mental–physical comorbidity (OR: 3.6, 95% CI: 2.26–5.76). Respondents reporting poor diet and poor self-reported health had higher odds of comorbid depression and cardiometabolic conditions. Female respondents had increased odds of comorbid depression and cardiometabolic conditions. Food insecurity is associated with co-occurring depression and cardiometabolic disease and may have implications for disease management.

Neutral sphingomyelinase mediates the co-morbidity trias of alcohol abuse, major depression and bone defects

Mental disorders are highly comorbid and occur together with physical diseases, which are often considered to arise from separate pathogenic pathways. We observed in alcohol-dependent patients increased serum activity of neutral sphingomyelinase. A genetic association analysis in 456,693 volunteers found associations of haplotypes of SMPD3 coding for NSM-2 (NSM) with alcohol consumption, but also with affective state, and bone mineralisation. Functional analysis in mice showed that NSM controls alcohol consumption, affective behaviour, and their interaction by regulating hippocampal volume, cortical connectivity, and monoaminergic responses. Furthermore, NSM controlled bone–brain communication by enhancing osteocalcin signalling, which can independently supress alcohol consumption and reduce depressive behaviour. Altogether, we identified a single gene source for multiple pathways originating in the brain and bone, which interlink disorders of a mental–physical co-morbidity trias of alcohol abuse—depression/anxiety—bone disorder. Targeting NSM and osteocalcin signalling may, thus, provide a new systems approach in the treatment of a mental–physical co-morbidity trias.

Comparison of mental-physical comorbidity, risk of death and mortality among patients with mental disorders — A retrospective cohort study

AimTo compare the risk of death, the prevalence of comorbid chronic physical illness and mortality among an Asian population of patients with mental disorders. MethodsThis was a retrospective data analysing of medical records of patients with schizophrenia, depression, anxiety, bipolar disorder, alcohol use disorder (AUD) or substance use disorder and the comorbid chronic physical illnesses. The hazard risk of death was calculated with Cox regression and compared between patients with and without comorbid chronic physical illness(es). Odds ratios of specific comorbid chronic physical illness were calculated with logistic regression and mean crude death rate was calculated for patients with different mental disorders. ResultsA total of 56,447 patients with mental disorders were included in the analysis. Compared to patients without comorbid physical illness, patients with mental-physical comorbidity were associated with a higher risk of death [2.36 (2.22–2.52); hazard ratio (95% CI)] and less estimated survival days [2157 (2142–2172) vs 2508 (2504–2513)]. Compared to other mental disorders, those with AUD had the highest prevalence of two or more comorbid chronic physical illnesses and associated with the highest odds of comorbid hypertension, diabetes mellitus, stroke, nephritis, chronic kidney disease, and cancer. The highest one-year crude death rate was similarly observed in patients with AUD. ConclusionsMental-physical comorbidity was associated with a higher risk of death compared to patients with mental disorders only. The highest prevalence of mental-physical comorbidity and mortality were observed in patients with AUD. More attention and resources may be needed to tackle the burden of AUD.

Improving Interprofessional Attitudes Towards Mental and Physical Comorbidities: The Effectiveness of High Fidelity Simulation Training Versus Roleplay

BackgroundTeaching and training methods may be failing to keep up with complex healthcare needs and services. Simulation training is an innovative tool that can be used to train healthcare professions to manage interacting mental and physical health needs, and to improve care through interprofessional collaboration. However, the utilisation and evidence behind simulation training is lacking in relation to mental health care. This paper aims to compare the effects of simulation and roleplay training for mental-physical comorbidities on interprofessional attitudes. MethodsParticipants took part in one of two courses: a simulation workshop (n = 29) or a didactic and roleplay-based course (n = 99). The Readiness for Interprofessional Learning Scale (RIPLS) scores were collected pre- and postcourse and compared by training course. ResultsSimulation showed statistically significant improvements in attitudes towards interprofessional collaboration whereas the roleplay course highlighted no significant changes postcourse. ConclusionsSimulation is an effective educational and training tool that can be applied to mental healthcare and mental-physical comorbidities. Attitudes towards interprofessional collaboration can be improved more effectively through simulation training by increasing knowledge, understanding, and confidence.

MULTIMORBIDITY, MENTAL HEALTH, AND TERMINAL DECLINE IN LATER LIFE

The close interlink between physical and mental health outcomes has long been recognised in gerontological research. Mental-physical comorbidities – the presence of at least one physical health long term condition, and at least one mental health-related long term condition are common in older age individuals. Numerous studies have shown a positive association between the prevalence of multimorbidity and age so, as the population of older individuals in developed nations continues to grow, multimorbidity is likely to become increasingly higher in ageing populations. A major goal in current gerontological neuropsychology and neuroepidemiological research is to better understand how interindividual differences in cognitive and mental health in old age emerge. Cognitive reserve (a marker of brain resilience) may come into play when facing stressors that affect cognitive decline and mental health, such as suffering from chronic diseases. We present data from three different longitudinal studies of ageing i) the Lothian Birth Cohort of 1921, ii) PREVENT and iii) the English Longitudinal Study of Ageing from the United Kingdom. These studies are ideally placed to address key research questions related to mental ageing, psychological health, terminal decline and their determinants. We explored the following objectives: 1) to investigate the association between an increasing number of chronic physical conditions, medication and mental disorders 2) to assess the role of childhood intelligence and education on the terminal decline in later life 3) to investigate the associations between different markers of cognitive reserve and dementia

A cross-sectional study of psychiatric morbidity and quality of life among participants utilizing the preventive health-care services of a tertiary hospital.

Background:The burden of mental disorders has been increasingly recognized and 450 million people globally are suffering from mental illness. Mental–physical comorbidity has adverse effects on the overall outcome. Research is scarce with regard to mental health screening in the context of “preventive health care” in India. Thus, the study aimed to identify the prevalence of mental illness and the effect on quality of life (QOL) among participants attending preventive health-care unit (PHCU).Settings and Design:This was a cross-sectional study conducted in PHCU of a tertiary hospital in Puducherry.Materials and Methods:All consecutive participants (>18 years) attending PHCU were included in the study. The Standard for Clinicians' Interview in Psychiatry (SCIP) screening module, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 1 Cross-Cutting Symptom Measure, Mini-Cog, and Quality of Life Enjoyment and Satisfaction Questionnaire were administered. Relevant diagnostic modules of SCIP were applied to participants who screened positive on SCIP. Data analysis was performed using SPSS (version 17.0).Results:The mean age of participants was 43.38 ± 13.99 years. Of 203 participants enrolled, 28.1% screened positive and 26.1% were confirmed to have psychiatric disorder. About 4% screened positive for cognitive impairment. Most commonly diagnosed disorders were alcohol use disorder and major depressive disorder. The prevalence of depressive disorder was higher in patients with physical disorder. Participants with psychiatric disorder alone or with both psychiatric and physical disorders had significantly poorer QOL (F = 27.13; P < 0.001).Conclusion:One-fourth of the participants attending preventive health-care services were found to have psychiatric disorders. The presence of psychiatric disorder was associated with significantly poorer QOL. This highlights the importance of routine mental health screening in this setting.

Integration of Mental Health Comorbidity in Medical Specialty Programs in 20 Countries

Background: The increasing prevalence of chronic illnesses has been accompanied by a concomitant increase in mental-physical comorbidity. This comorbidity occurs in approximately 30% of individuals, constituting a major problem in medical practice. Methods: A descriptive, cross-sectional study of academic medical specialization programs from 20 different countries was carried out to establish which medical specialties take mental health into account in the design of their training programs and what mental health topics these programs address. Findings: Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs, with some differences found among the 20 countries. In four countries: Bangladesh, Serbia, the Netherlands, and France, 50% of all postgraduate specialty training programs include mental health content. In ten countries: Germany, Sweden, United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel, and Spain, between 20%-49% of all postgraduate specialty training programs include mental health content. In six countries: Brazil, Chile, Colombia, Croatia, Kenya, and the United States, under 20% of all postgraduate specialty training programs include mental health content. Interpretation: While the comorbidity of mental-physical disorders continues to grow, medical practice is becoming fragmented into ever more specific specialties that disregard comprehensive care. For the attention of physical-mental comorbidity, it is necessary to increase mental health content in specialized academic programs, so that all medical professionals are sensitive to the influence of mental pathology in physical illness. Funding Statement: This study was funded by the Department of Research, UNAM School of Medicine. Declaration of Interests: All the authors declare no conflicts of interest. Ethics Approval Statement: Not required.

Longitudinal patterns of mental health service utilisation by those with mental-physical comorbidity in the community

ObjectiveSuccessful healthcare integration demands an understanding of current service utilisation by people with comorbidity. Physical illness may impact on mental health service use (MHSU), but longitudinal studies of comorbidity and MHSU are rare. This study 1) estimated associations between mental-physical comorbidity and longitudinal MHSU patterns; 2) tested whether associations between comorbidity and continuous MHSU are driven by “need”. MethodsSurvey data from a South East London community cohort were used (N = 1052). Common mental disorder symptoms (CMDS) were measured using the Clinical Interview Schedule Revised and self-report of long-standing disorders. A checklist of common conditions measured chronic physical conditions. MHSU captured self-reported use of mental health services in the past year at two time points. “Need” indicators included CMDS at follow-up, suicidal ideation, somatic symptom severity, self-rated health, daily functioning problems and perceived functioning limitations due to emotional health. Analyses used logistic and multinomial regression. ResultsContinuous MHSU (at both time-points) was twice as commonly reported by those with comorbidity than those without physical comorbidity (30.9% vs 12.3%). CMDS at follow-up, suicidal ideation, and perceived functioning limitations due to emotional health only partially explained the association between CMDS-physical comorbidity and continuous MHSU. In the adjusted model, comorbidity remained associated with continuous MHSU (RRR = 3.23, 95% CI: 1.39–7.51; p = .002), while the association for non-comorbid CMDS was fully attenuated (RRR = 1.08, 95% CI: 0.40–2.93; p = .85). ConclusionCMDS-physical comorbidity was strongly associated with continuous MHSU, and “need” did not account for this association, suggesting that comorbidity itself represents a “need” indicator.

Mental and physical comorbidity in an Arab primary health care setting

BackgroundThere are no published studies on the comorbidity of common mental conditions (anxiety, depression, and somatization) and physical illnesses in the Arab world. Our aim was to estimate the prevalence of common mental conditions comorbid with physical illnesses among primary care attenders in Kuwait, and the sociodemographic characteristics associated with this comorbidity.MethodsThe Patient Health Questionnaires for somatization, anxiety and depression (PHQ-SAD) were administered to a representative sample of 1046 attenders (M: F = 429: 617; mean age 37.6, SD 12.7) seen in primary care clinics in Kuwait. Based on well-established cut-off scores, the presence and severity of three mental conditions –depression, anxiety, and somatization—was ascertained; physical diagnoses were ascertained by the attending physicians.ResultsOf 1046 respondents, 442 (42.3%) had at least one mental condition and 670 (64.1%) had a physical illness diagnosis, viz.: diabetes mellitus (248/670 = 37.0%), hypertension (229/670 = 34.2%), asthma (82/670 = 12.2%), non-chronic physical illnesses (63/670 = 9.4%), or heart disease (48/670 = 7.2%), with 34.4% (360/1046) having mental-physical comorbidity. Male: female ratio for the 670 subjects was 287: 383. The unadjusted odds ratio (OR) for having a mental condition in those with a physical illness vs. those without a physical illness was 4.16 (95% C.I. = 3.12, 5.55). Comorbidity was associated with older age, being divorced or widowed, a lower level of education, and poorer living conditions. Regardless of the physical illness, the most frequent comorbid mental disorder was somatization. The prevalence and severity of mental conditions were associated with the number of physical illnesses.ConclusionAs has been reported in other parts of the world, somatization, anxiety, and depression are highly prevalent among primary care attenders in Kuwait and they are typically comorbid with physical illness. Strategies for their prevention and treatment need to take into consideration their association with physical illness and social disadvantage.

Maladaptive Personality Traits and 10-Year Course of Psychiatric and Medical Symptoms and Functional Impairment Following Trauma.

Personality is a major predictor of many mental and physical disorders, but its contributions to illness course are understudied. The current study aimed to explore whether personality is associated with a course of psychiatric and medical illness over 10 years following trauma. World Trade Center (WTC) responders (N = 532) completed the personality inventory for DSM-5, which measures both broad domains and narrow facets. Responders' mental and physical health was assessed in the decade following the WTC disaster during annual monitoring visits at a WTC Health Program clinic. Multilevel modeling was used in an exploratory manner to chart the course of health and functioning, and examine associations of maladaptive personality domains and facets with intercepts (initial illness) and slopes (course) of illness trajectories. Three maladaptive personality domains-negative affectivity, detachment and psychoticism-were uniquely associated with initial posttraumatic stress disorder (PTSD); detachment and psychoticism were also associated with initial functional impairment. Five facets-emotional lability, anhedonia, callousness, distractibility and perceptual dysregulation-were uniquely associated with initial mental and physical health and functional impairment. Anxiousness and depressivity facets were associated with worse initial levels of psychiatric outcomes only. With regard to illness trajectory, callousness and perceptual dysregulation were associated with the increase in PTSD symptoms. Anxiousness was associated with greater persistence of respiratory symptoms. Several personality domains and facets were associated with initial levels and long-term course of illness and functional impairment in a traumatized population. Results inform the role of maladaptive personality in the development and maintenance of chronic mental-physical comorbidity. Personality might constitute a transdiagnostic prognostic and treatment target.

Does the impact of case management vary in different subgroups of multimorbidity? Secondary analysis of a quasi-experiment

Health systems must transition from catering primarily to acute conditions, to meet the increasing burden of chronic disease and multimorbidity. Case management is a popular method of integrating care, seeking to accomplish this goal. However, the intervention has shown limited effectiveness. We explore whether the effects of case management vary in patients with different types of multimorbidity. We extended a previously published quasi-experiment (difference-in-differences analysis) with 2049 propensity matched case management intervention patients, adding an additional interaction term to determine subgroup effects (difference-in-difference-in-differences) by different conceptualisations of multimorbidity: 1) Mental-physical comorbidity versus others; 2) 3+ chronic conditions versus <3; 3) Discordant versus concordant conditions; 4) Cardiovascular/metabolic cluster conditions only versus others; 5) Mental health-associated cluster conditions only versus others; 6) Musculoskeletal disorder cluster conditions only versus others 7) Charlson index >5 versus others. Outcome measures included a variety of secondary care utilisation and cost measures. The majority of conceptualisations suggested little to no difference in effect between subgroups. Where results were significant, the vast majority of effect sizes identified in either direction were very small. The trend across the majority of the results appeared to show very slight increases of admissions with treatment for the most complex patients (highest risk). The exceptions to this, patients with a Charlson index >5 may benefit slightly more from case management with decreased ACSC admissions (effect size (ES): −0.06) and inpatient re-admissions (30 days, ES: −0.05), and patients with only cardiovascular/metabolic cluster conditions may benefit slightly more with decreased inpatient non-elective admissions (ES: −0.12). Only the three significant estimates for the musculoskeletal disorder cluster met the minimum requirement for at least a ‘small’ effect. Two of these estimates in particular were very large. This cluster represented only 0.5% of the total patients analysed, however, so is hugely vulnerable to the effects of outliers, and makes us very cautious of interpreting these as ‘real’ effects. Our results indicate no appropriate multimorbidity subgroup at which to target the case management intervention in terms of secondary care utilisation/cost outcomes. The most complex, highest risk patients may legitimately require hospitalisation, and the intensified management may better identify these unmet needs. End of life patients (e.g. Charlson index >5)/those with only conditions particularly amenable to primary care management (e.g. cardiovascular/metabolic cluster conditions) may benefit very slightly more than others.

Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents.

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.

P.1.k.007 - Mental-physical comorbidity in Korean adults: results from a nationwide general population survey in Korea

P.1.k.007 - Mental-physical comorbidity in Korean adults: results from a nationwide general population survey in Korea

Mental-Physical Comorbidity in Korean Adults: Results from a Nationwide General Population Survey in Korea.

ObjectiveThe aims of this study were to estimate the prevalence of mental-physical comorbidity and health-threatening risk factors in subjects with mental disorders, and the risks of mental disorders in those with physical diseases for the last 12 months in the general Korean population.MethodsKorean Epidemiologic Catchment Area study replication (KECA-R) was conducted for 6,510 adults between August 2006 and April 2007. The Korean version of Composite International Diagnostic Interview 2.1 (K-CIDI) was used in the survey. Prevalence of mental and physical disorders, and risk factors for physical health were calculated, and their associations were evaluated with adjustment for age and sex.ResultsSubjects with any mental disorder showed significantly higher prevalence of chronic physical conditions (adjusted odds ratio, AOR=1.5 to 2.8, p<0.001) and medical risk factors including smoking, heavy drinking, overweight, and hypertension (AOR=1.5 to 4.0, p<0.001). Of those with chronic physical conditions, 21.6% had one or more comorbid mental disorder compared with 10.5% of the subjects without chronic physical disorders (AOR=2.6, p<0.001). Contrary to expectations, depressive disorders did not show significant association with hypertension and prevalence of obesity was not influenced by presence of mental disorders. Further studies should assess these findings.ConclusionThis is the first identification of significant mental-physical comorbidity in the general Korean population. Clinicians and health care officials should keep in mind of its potential adverse effects on treatment outcome and aggravated disease-related socioeconomic burden.

571 Type, Not Number, of Mental-Physical Comorbidities Increases the Severity of GI Symptoms in Patients With More Severe Irritable Bowel Syndrome

BACKGROUND: While irritable bowel syndrome (IBS) is associated with significant mental and physical comorbidity, little is known about the day to day burden (e.g., quality of life [QOL], physical and mental functioning, distress, IBS symptoms) that comorbidity imposes. METHOD: 175 Rome III-diagnosed IBS patients (M age = 41 yrs, 78% Female, 91% Caucasian) completed psychiatric assessments (MINI International Neuropsychiatric Interview), a physical comorbidity checklist as well as the IBS Symptom Severity Scale, IBSQOL, Brief Symptom Inventory (distress, BSI), abdominal pain intensity scale, and the physical (PCS) and mental (MCS) functioning scales of the SF-12 as part of baseline assessment of an NIH clinical trial. RESULTS. IBS patients in this cohort reported an avg. of 5 diagnosed comorbidities (1 mental, 4 physical). Partial correlations indicated that subjects with more comorbidities reported worse QOL after adjusting for confounding variables. The number of physical comorbidities was more strongly associated with the physical aspects of QOL, while the number of mental comorbidities was more strongly correlated with mental aspects of QOL. The number of comorbidities was unrelated to either the intensity of abdominal pain or global severity of IBS symptoms. Multiple linear regression analyses indicated that comorbidity type was more consistently and strongly associated with illness burden indicators than simple disease counts after confounding variables were held constant. Of 10, 296 possible physicalmental comorbidity pairs, 6 of the 10 most frequent dyads involved a combination of conditions (generalized anxiety disorder, major depression, back pain, agoraphobia, tension headache, insomnia) that were consistently associated with illness (QOL, mental and physical functioning, distress) and symptom (IBS symptom severity, abdominal pain intensity) burden indicators. A comorbidity dyad with consistently large effect sizes was low back pain and major depression. For these patients, scores were expected to decrease by 22 points on the IBS QOL, 10.24 on the PCS, 11.76 on the MCS, and increase by 20.61 points on the BSI in comparison to patients who are not diagnosed with MDD and LBP. For the IBS-SSS, the regression coefficient was 89.67. This means that a patient diagnosed with MDD-LBP had IBS symptom severity scores on the IBS-SSS score that, on average, are 89.67 units higher than a patient undiagnosed with MDD and LBP. CONCLUSIONS. Physical-mental comorbidity in IBS is common, associated with increased distress and QOL impairment and, for patients with specific comorbidity profiles, more severe IBS symptoms. The type of reported comorbidities, rather than their number, may be a more useful way of understanding the full scope of their impact in more severely affected IBS patients. This study was funded by NIH Grant DK77738

Physical health and wellbeing of emerging and young adults with mental illness: An integrative review of international literature

Physical health in people with mental illness is often compromised. Chronic physical conditions and disease risk factors occur at higher rates than in the general population. Although substantial research exists regarding mental-physical comorbidities in middle to older-aged adults and mental illness consequential to childhood physical illness, research addressing physical health in young people/emerging adults of 16-24 years with primary mental illnesses is minimal. Health problems often track from youth to adulthood, indicating a need to better recognize and understand the overall health of young people with mental illness. This paper reports findings from an integrative review of published research investigating physical health of emerging/young adults with mental illness. A total of 18 research papers were systematically analysed. The review found that comorbid mental-physical illness/conditions were evident across a wide age span. Specific physical health problems, including pain, gastrointestinal, and respiratory disorders, were apparent in those 16 years to those in their mid-late 20s, and/or with first episode psychosis. Lifestyle risk factors for cardiometabolic disorders occurred with some frequency and originated prior to adulthood. These findings highlight the need for targeted health screening and illness prevention strategies for emerging/young adults with mental health problems and draws attention to the need for young people to be supported in their health-care behaviours.

Correlates of Antidepressant and Anxiolytic, Hypnotic or Sedative Medication Use in an Australian Community Sample

To explore the rates and correlates of antidepressant (AD) and anxiolytic, hypnotic or sedative (AHS) medication use in Australia, and describe possible reasons for their use. Analysis of data from the 2007 National Survey of Mental Health and Wellbeing, a nationally representative household survey of 8841 Australians aged 16 to 85 years. Two primary outcome variables: (i) use of any AD medication; and (ii) use of any AHS medication, in the past 2 weeks. Rates of AD and AHS medication use were 6.8% and 4.7% respectively. AD and AHS medication use were each associated with 12-month affective or anxiety disorder, age, chronic physical illness, sleep difficulties, and impaired role functioning. Psychological distress and lifetime affective or anxiety disorder or 12-month symptoms were associated with AD use; being previously married was associated with AHS use. Potential reasons for use are complex. Almost one third (30.6%) of AD users and half (49.2%) of AHS users did not report symptoms consistent with a 12-month or lifetime affective or anxiety disorder. Chronic physical illness was reported by 68.8% of AD users and 73.5% of AHS users, around half of whom had a 12-month mental disorder. People with mental-physical comorbidity had especially high rates of AD and AHS use. People with musculoskeletal and other conditions that may involve chronic pain had elevated rates of AD and AHS use, even in the absence of a mental disorder. Low rates of medication use in younger adults and high rates of AHS use in older people warrant further investigation. Many AD and AHS users were not assessed as having an affective or anxiety disorder, suggesting that these medications are frequently used for other indications. Findings call for further research to explore the relationship between mental disorders, physical conditions and medication use.