Co-occurrence Between Mental Disorders and Physical Diseases: a Study of Nationwide Primary-care Medical Records

Overview

Journal Psychol Med

Publisher Cambridge University Press

Specialty Psychology

Date 2024 Nov 18

PMID 39552403

Authors

Matthew R Hanna

Avshalom Caspi

Renate M Houts

Terrie E Moffitt

Fartein Ask Torvik

Affiliations

Soon will be listed here.

Abstract

Background: Mental disorders and physical-health conditions frequently co-occur, impacting treatment outcomes. While most prior research has focused on single pairs of mental disorders and physical-health conditions, this study explores broader associations between multiple mental disorders and physical-health conditions.

Methods: Using the Norwegian primary-care register, this population-based cohort study encompassed all 2 203 553 patients born in Norway from January 1945 through December 1984, who were full-time residents from January 2006 until December 2019 (14 years; 363 million person-months). Associations between seven mental disorders (sleep disturbance, anxiety, depression, acute stress reaction, substance-use disorders, phobia/compulsive disorder, psychosis) and 16 physical-health conditions were examined, diagnosed according to the International Classification of Primary Care.

Results: Of 112 mental-disorder/physical-health condition pairs, 96% of associations yielded positive and significant ORs, averaging 1.41 and ranging from 1.05 (99.99% CI 1.00-1.09) to 2.38 (99.99% CI 2.30-2.46). Across 14 years, every mental disorder was associated with multiple different physical-health conditions. Across 363 million person-months, having any mental disorder was associated with increased subsequent risk of all physical-health conditions (HRs:1.40 [99.99% CI 1.35-1.45] to 2.85 [99.99% CI 2.81-2.89]) and vice versa (HRs:1.56 [99.99% CI 1.54-1.59] to 3.56 [99.99% CI 3.54-3.58]). Associations were observed in both sexes, across age groups, and among patients with and without university education.

Conclusions: The breadth of associations between virtually every mental disorder and physical-health condition among patients treated in primary care underscores a need for integrated mental and physical healthcare policy and practice. This remarkable breadth also calls for research into etiological factors and underlying mechanisms that can explain it.

References

Liu N, Daumit G, Dua T, Aquila R, Charlson F, Cuijpers P . Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry. 2017; 16(1):30-40. PMC: 5269481. DOI: 10.1002/wps.20384. View

Felger J, Lotrich F . Inflammatory cytokines in depression: neurobiological mechanisms and therapeutic implications. Neuroscience. 2013; 246:199-229. PMC: 3741070. DOI: 10.1016/j.neuroscience.2013.04.060. View

Forrest C . Primary care in the United States: primary care gatekeeping and referrals: effective filter or failed experiment?. BMJ. 2003; 326(7391):692-5. PMC: 152368. DOI: 10.1136/bmj.326.7391.692. View

Knegtering H, van der Moolen A, Castelein S, Kluiter H, van den Bosch R . What are the effects of antipsychotics on sexual dysfunctions and endocrine functioning?. Psychoneuroendocrinology. 2003; 28 Suppl 2:109-23. DOI: 10.1016/s0306-4530(02)00130-0. View

Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B . Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007; 370(9590):851-8. DOI: 10.1016/S0140-6736(07)61415-9. View

Lamberts H, Magruder K, Kathol R, Pincus H, Okkes I . The classification of mental disorders in primary care: a guide through a difficult terrain. Int J Psychiatry Med. 1998; 28(2):159-76. DOI: 10.2190/N03F-3F84-7HC0-XR1G. View

Heiberg I, Jacobsen B, Balteskard L, Bramness J, Naess O, Ystrom E . Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness. Acta Psychiatr Scand. 2019; 139(6):558-571. PMC: 6619029. DOI: 10.1111/acps.13017. View

Hetlevik O, Solheim M, Gjesdal S . Use of GP services by patients with schizophrenia: a national cross-sectional register-based study. BMC Health Serv Res. 2015; 15:66. PMC: 4339084. DOI: 10.1186/s12913-015-0719-1. View

Grigoletti L, Perini G, Rossi A, Biggeri A, Barbui C, Tansella M . Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care. Psychol Med. 2009; 39(11):1875-84. DOI: 10.1017/S0033291709005790. View

10.

Luppino F, de Wit L, Bouvy P, Stijnen T, Cuijpers P, Penninx B . Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010; 67(3):220-9. DOI: 10.1001/archgenpsychiatry.2010.2. View

11.

Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C . The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry. 2019; 6(8):675-712. DOI: 10.1016/S2215-0366(19)30132-4. View

12.

Nicholson A, Kuper H, Hemingway H . Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006; 27(23):2763-74. DOI: 10.1093/eurheartj/ehl338. View

13.

Hippisley-Cox J, Parker C, Coupland C, Vinogradova Y . Inequalities in the primary care of patients with coronary heart disease and serious mental health problems: a cross-sectional study. Heart. 2007; 93(10):1256-62. PMC: 2000947. DOI: 10.1136/hrt.2006.110171. View

14.

Moffitt T, Caspi A . Psychiatry's Opportunity to Prevent the Rising Burden of Age-Related Disease. JAMA Psychiatry. 2019; 76(5):461-462. PMC: 8327353. DOI: 10.1001/jamapsychiatry.2019.0037. View

15.

De Hert M, Correll C, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I . Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011; 10(1):52-77. PMC: 3048500. DOI: 10.1002/j.2051-5545.2011.tb00014.x. View

16.

Momen N, Plana-Ripoll O, Agerbo E, Benros M, Borglum A, Christensen M . Association between Mental Disorders and Subsequent Medical Conditions. N Engl J Med. 2020; 382(18):1721-1731. PMC: 7261506. DOI: 10.1056/NEJMoa1915784. View

17.

Verbeke M, Schrans D, Deroose S, De Maeseneer J . The International Classification of Primary Care (ICPC-2): an essential tool in the EPR of the GP. Stud Health Technol Inform. 2006; 124:809-14. View

18.

Starfield B, Shi L, Macinko J . Contribution of primary care to health systems and health. Milbank Q. 2005; 83(3):457-502. PMC: 2690145. DOI: 10.1111/j.1468-0009.2005.00409.x. View

19.

Brink M, Green A, Bojesen A, Lamberti J, Conwell Y, Andersen K . Excess medical comorbidity and mortality across the lifespan in schizophrenia.: A nationwide Danish register study. Schizophr Res. 2018; 206:347-354. DOI: 10.1016/j.schres.2018.10.020. View

20.

Burns T, Cohen A . Item-of-service payments for general practitioner care of severely mentally ill persons: does the money matter?. Br J Gen Pract. 1998; 48(432):1415-6. PMC: 1313136. View