Association of Mental Disorders With Subsequent Chronic Physical Conditions

Kate M. Scott, Carmen Lim, Ali Al-Hamzawi, Jordi Alonso, Ronny Bruffaerts, José Miguel Caldas-de-Almeida, Silvia Florescu, Giovanni de Girolamo, Chiyi Hu, Peter de Jonge, Norito Kawakami, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Siobhan O'Neill, Marina Piazza, José Posada-Villa, Yolanda Torres, Ronald C. Kessler

Research output: Contribution to journalArticle

Abstract

Importance It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.

Objective To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.

Design, Setting, and Participants Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47 609 individuals; 2 032 942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV–identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.

Main Outcomes and Measures Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.

Results Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.

Conclusions and Relevance These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.

LanguageEnglish
Pages150-158
Number of pages9
JournalJAMA Psychiatry
Volume73
Issue number2
Early online date23 Dec 2015
DOIs
Publication statusE-pub ahead of print - 23 Dec 2015

Fingerprint

Mental Disorders
Odds Ratio
Primary Prevention
Diagnostic and Statistical Manual of Mental Disorders
Chronic Disease
Disruptive, Impulse Control, and Conduct Disorders
Adjustment Disorders
Independent Living
Secondary Care
Health
Survival Analysis
Age of Onset
Self Report
Comorbidity
Primary Health Care
Mental Health
Anxiety
Cross-Sectional Studies
Outcome Assessment (Health Care)

Keywords

  • chronic condition
  • mental health
  • physical health

Cite this

Scott, K. M., Lim, C., Al-Hamzawi, A., Alonso, J., Bruffaerts, R., Caldas-de-Almeida, J. M., ... Kessler, R. C. (2015). Association of Mental Disorders With Subsequent Chronic Physical Conditions. JAMA Psychiatry, 73(2), 150-158. https://doi.org/10.1001/jamapsychiatry.2015.2688
Scott, Kate M. ; Lim, Carmen ; Al-Hamzawi, Ali ; Alonso, Jordi ; Bruffaerts, Ronny ; Caldas-de-Almeida, José Miguel ; Florescu, Silvia ; de Girolamo, Giovanni ; Hu, Chiyi ; de Jonge, Peter ; Kawakami, Norito ; Medina-Mora, Maria Elena ; Moskalewicz, Jacek ; Navarro-Mateu, Fernando ; O'Neill, Siobhan ; Piazza, Marina ; Posada-Villa, José ; Torres, Yolanda ; Kessler, Ronald C. / Association of Mental Disorders With Subsequent Chronic Physical Conditions. In: JAMA Psychiatry. 2015 ; Vol. 73, No. 2. pp. 150-158.
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abstract = "Importance It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.Objective To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.Design, Setting, and Participants Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47 609 individuals; 2 032 942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV–identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.Main Outcomes and Measures Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.Results Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95{\%} CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95{\%} CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95{\%} CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95{\%} CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5{\%} to 13.3{\%} of physical condition onsets.Conclusions and Relevance These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.",
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Scott, KM, Lim, C, Al-Hamzawi, A, Alonso, J, Bruffaerts, R, Caldas-de-Almeida, JM, Florescu, S, de Girolamo, G, Hu, C, de Jonge, P, Kawakami, N, Medina-Mora, ME, Moskalewicz, J, Navarro-Mateu, F, O'Neill, S, Piazza, M, Posada-Villa, J, Torres, Y & Kessler, RC 2015, 'Association of Mental Disorders With Subsequent Chronic Physical Conditions', JAMA Psychiatry, vol. 73, no. 2, pp. 150-158. https://doi.org/10.1001/jamapsychiatry.2015.2688

Association of Mental Disorders With Subsequent Chronic Physical Conditions. / Scott, Kate M.; Lim, Carmen; Al-Hamzawi, Ali; Alonso, Jordi; Bruffaerts, Ronny; Caldas-de-Almeida, José Miguel; Florescu, Silvia; de Girolamo, Giovanni; Hu, Chiyi; de Jonge, Peter; Kawakami, Norito; Medina-Mora, Maria Elena; Moskalewicz, Jacek; Navarro-Mateu, Fernando; O'Neill, Siobhan; Piazza, Marina; Posada-Villa, José; Torres, Yolanda; Kessler, Ronald C.

In: JAMA Psychiatry, Vol. 73, No. 2, 23.12.2015, p. 150-158.

Research output: Contribution to journalArticle

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T1 - Association of Mental Disorders With Subsequent Chronic Physical Conditions

AU - Scott, Kate M.

AU - Lim, Carmen

AU - Al-Hamzawi, Ali

AU - Alonso, Jordi

AU - Bruffaerts, Ronny

AU - Caldas-de-Almeida, José Miguel

AU - Florescu, Silvia

AU - de Girolamo, Giovanni

AU - Hu, Chiyi

AU - de Jonge, Peter

AU - Kawakami, Norito

AU - Medina-Mora, Maria Elena

AU - Moskalewicz, Jacek

AU - Navarro-Mateu, Fernando

AU - O'Neill, Siobhan

AU - Piazza, Marina

AU - Posada-Villa, José

AU - Torres, Yolanda

AU - Kessler, Ronald C.

PY - 2015/12/23

Y1 - 2015/12/23

N2 - Importance It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.Objective To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.Design, Setting, and Participants Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47 609 individuals; 2 032 942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV–identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.Main Outcomes and Measures Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.Results Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.Conclusions and Relevance These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.

AB - Importance It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.Objective To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.Design, Setting, and Participants Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47 609 individuals; 2 032 942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV–identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.Main Outcomes and Measures Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.Results Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.Conclusions and Relevance These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.

KW - chronic condition

KW - mental health

KW - physical health

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DO - 10.1001/jamapsychiatry.2015.2688

M3 - Article

VL - 73

SP - 150

EP - 158

JO - JAMA Psychiatry

T2 - JAMA Psychiatry

JF - JAMA Psychiatry

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Scott KM, Lim C, Al-Hamzawi A, Alonso J, Bruffaerts R, Caldas-de-Almeida JM et al. Association of Mental Disorders With Subsequent Chronic Physical Conditions. JAMA Psychiatry. 2015 Dec 23;73(2):150-158. https://doi.org/10.1001/jamapsychiatry.2015.2688