Mental disorders and their association with subsequent chronic physical conditions

Importance: It is clear that mental disorders in treatment settings are associated with higher chronic physical condition incidence 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/diagnosis of 10 chronic physical conditions.Design; Setting; Participants: 18 face-to-face cross-sectional household surveys of community-dwelling adults were conducted in 16 countries (n=47,609; person years=2,032,942). The Composite International Diagnostic Interview (CIDI) retrospectively assessed lifetime prevalence and age at onset of DSM-IV mental disorders. Main Outcome Measures: Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated associations of temporally prior first onset of mental disorders with subsequent onset/diagnosis of physical conditions.Results: The vast majority of associations between 16 mental disorders and subsequent onset/diagnosis of 10 physical conditions were statistically significant, with odds ratios ranging from 1.2 to 3.6. 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 7/10 and 10/10 of the physical conditions (ORs 1.2-2.0). An increasing number of mental disorders experienced over the life course was associated with increasing odds of onset/diagnosis of all types of physical conditions. In population attributable risk estimates specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets. Conclusions: If confirmed in prospective studies, these findings suggest that mental disorders of all kinds are associated with increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of the mentally ill may be too narrowly focused on the very small group with the most severe disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders, from early in the disorder course, in primary and secondary care.