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Mental–physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys

  • K. M. Scott (a1), M. Von Korff (a2), J. Alonso (a3), M. C. Angermeyer (a4), E. Bromet (a5), J. Fayyad (a6), G. de Girolamo (a7), K. Demyttenaere (a8), I. Gasquet (a9), O. Gureje (a10), J. M. Haro (a11), Y. He (a12), R. C. Kessler (a13), D. Levinson (a14), M. E. Medina Mora (a15), M. Oakley Browne (a16), J. Ormel (a17), J. Posada-Villa (a18), M. Watanabe (a19) and D. Williams (a20)...
Abstract
Background

The relationship between mental and physical disorders is well established, but there is less consensus as to the nature of their joint association with disability, in part because additive and interactive models of co-morbidity have not always been clearly differentiated in prior research.

Method

Eighteen general population surveys were carried out among adults as part of the World Mental Health (WMH) Survey Initiative (n=42 697). DSM-IV disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). Chronic physical conditions (arthritis, heart disease, respiratory disease, chronic back/neck pain, chronic headache, and diabetes) were ascertained using a standard checklist. Severe disability was defined as on or above the 90th percentile of the WMH version of the World Health Organization Disability Assessment Schedule (WHODAS-II).

Results

The odds of severe disability among those with both mental disorder and each of the physical conditions (with the exception of heart disease) were significantly greater than the sum of the odds of the single conditions. The evidence for synergy was model dependent: it was observed in the additive interaction models but not in models assessing multiplicative interactions. Mental disorders were more likely to be associated with severe disability than were the chronic physical conditions.

Conclusions

This first cross-national study of the joint effect of mental and physical conditions on the probability of severe disability finds that co-morbidity exerts modest synergistic effects. Clinicians need to accord both mental and physical conditions equal priority, in order for co-morbidity to be adequately managed and disability reduced.

Copyright
Corresponding author
*Address for correspondence: K. M. Scott, Ph.D., Department of Psychological Medicine, Otago University, Wellington, PO Box 7343Wellington South, New Zealand. (Email: kate.scott@otago.ac.nz)
References
Hide All
Ahlbom, A, Alfredsson, L (2005). Interaction: a word with two meanings creates confusion. European Journal of Epidemiology 20, 563564.
Andersson, T, Alfredsson, L, Kallberg, H, Zdravkovic, S, Ahlbom, A (2005). Calculating measures of biological interaction. European Journal of Epidemiology 20, 575579.
APA (1994). DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th edn.American Psychiatric Association: Washington, DC.
Armenian, HK, Pratt, LA, Gallo, J, Eaton, WW (1998). Psychopathology as a predictor of disability: a population-based follow-up study in Baltimore, Maryland. American Journal of Epidemiology 148, 269275.
Buist-Bouwman, MA, de Graaf, R, Vollebergh, WAM, Ormel, J (2005). Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatrica Scandinavica 111, 436443.
Campbell, LC, Clauw, DJ, Keefe, FJ (2003). Persistent pain and depression: a biopsychosocial perspective. Biological Psychiatry 54, 399409.
Chrousos, GP, Kino, T (2007). Glucocorticoid action networks and complex psychiatric and/or somatic disorders. Stress 10, 213219.
Ciechanowski, PS, Katon, WJ, Russo, JE (2000). Depression and diabetes. Archives of Internal Medicine 160, 32783285.
Cohen, S, Janicki-Deverts, D, Miller, GE (2007). Psychological stress and disease. Journal of the American Medical Association 298, 16851687.
Cohen, S, Rodriguez, MS (1995). Pathways linking affective disturbances and physical disorders. Health Psychology 14, 374380.
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, De Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takashima, T, Uda, H, Karam, EG, Fayad, JA, Karam, AN, Mneimneh, ZN, Medina Mora, ME, Borges, G, Lara, C, De Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association 291, 25812590.
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.
Dew, MA (1998). Psychiatric disorder in the context of physical illness. In Adversity, Stress and Psychopathology (ed. Dohrenwend, B. P.), pp. 177218. Oxford University Press: New York.
Druss, BG, Marcus, SC, Rosenheck, RA, Olfson, M, Tanielian, MA, Pincus, HA (2000). Understanding disability in mental and general medical conditions. American Journal of Psychiatry 157, 14851491.
Egede, LE (2004). Diabetes, major depression, and functional disability among US adults. Diabetes Care 27, 421428.
Evans, DL, Charney, DS, Lewis, L, Golden, JM, Ranga Rama Krishnan, K, Nemeroff, CB, Bremner, JD, Carney, RM, Coyne, JC, Delong, MR, Frasure-Smith, N, Glassman, AH, Gold, PW, Grant, I, Gwyther, L, Ironson, G, Johnson, RL, Kanner, AM, Katon, WJ, Kaufmann, PG, Keefe, FJ, Ketter, T, Laughren, TP, Leserman, J, Lyketsos, CG, McDonald, WM, McEwan, BS, Miller, AH, Musselman, D, O'Connor, C, Petitto, JM, Pollock, BG, Robinson, RG, Roose, SP, Rowland, J, Sheline, Y, Sheps, DS, Simon, G, Spiegel, D, Stunkard, A, Sunderland, T, Tibbits, P, Valvo, WJ (2005). Mood disorders in the medically ill: scientific review and recommendations. Biological Psychiatry 58, 175189.
Goodyer, IM (2007). The hypothalamic–pituitary–adrenal axis: cortisol, DHEA and mental and behavioral function. In Depression and Physical Illness (ed. Steptoe, A.), pp. 280298. Cambridge University Press: London.
Hays, RD, Wells, KB, Sherbourne, CD, Rogers, W, Spritzer, K (1995). Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Archives of General Psychiatry 52, 1119.
Heim, C, Nemeroff, CB (1999). The impact of early adverse experiences on brain systems involved in the pathophysiology of anxiety and affective disorders. Biological Psychiatry 46, 15091522.
Hyland, B, Judd, F, Davidson, S, Jolley, D, Hocking, B (2003). Case managers' attitudes to the physical health of their patients. Australian and New Zealand Journal of Psychiatry 37, 710714.
Karlamangla, AS, Singer, BH, McEwen, BS, Rowe, JW, Seeman, TE (2002). Allostatic load as a predictor of functional decline: MacArthur studies of successful aging. Journal of Clinical Epidemiology 55, 696710.
Kehoe, R, Wu, S-Y, Leske, MC, Chylack, LT (1994). Comparing self-reported and physician reported medical history. American Journal of Epidemiology 139, 813818.
Kessler, RC, Bergland, P, Chiu, WT, Demler, O, Heeringa, S, Hiripi, E, Jin, R, Pennell, B-E, Walters, EE, Zaslavsky, A, Zheung, H (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 6992.
Kessler, RC, Greenberg, PE, Mickelson, KD, Meneades, LM, Wang, PS (2001). The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine 43, 218225.
Kessler, RC, Ormel, J, Demler, O, Stang, PE (2003). Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the National Comorbidity Survey. Journal of Occupational and Environmental Medicine 45, 12571266.
Kessler, RC, Ustun, B (2004). The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.
Kiecolt-Glaser, JK, McGuire, L, Robles, TF, Glaser, R (2002). Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annual Review of Psychology 53, 83107.
Kolk, AM, Hanewald, GJ, Schagen, S, Gijsbers van Wijk, CM (2002). Predicting medically unexplained physical symptoms and health care utilization. A symptom-perception approach. Journal of Psychosomatic Research 52, 3544.
Kriegsman, DM, Penninx, BW, Van Eijk, JT, Boeke, AJ, Deeg, DJ (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. Journal of Clinical Epidemiology 49, 14071417.
McEwen, BS (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine 338, 171179.
McEwen, BS (2003). Mood disorders and allostatic load. Biological Psychiatry 54, 200207.
McEwen, BS (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological Reviews 87, 873904.
Merikangas, KR, Ames, M, Cui, L, Stang, PD, Ustun, B, Von Korff, M, Kessler, R (2007). The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Archives of General Psychiatry 64, 11801188.
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851858.
NCHS (1994). Evaluation of National Health Interview Survey diagnostic reporting. Vital and Health Statistics. Series 2 120, 1116.
Ormel, J, Kempen, GIJM, Deeg, DJH, Brilman, EI, Sonderen, E, Relyveld, J (1998). Functioning, wellbeing, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions. Journal of the American Geriatrics Society 46, 3948.
Ormel, J, Petukhova, M, Chatterji, S, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Bromet, EJ, Burger, H, Demyttenaere, K, de Girolamo, G, Haro, JM, Hwang, I, Karam, E, Kawakami, N, Lepine, JP, Medina-Mora, ME, Posada-Villa, J, Sampson, N, Scott, KM, Ustun, B, Von Korff, M, Williams, D, Zhang, M, Kessler, RC (in press). Disability and treatment of specific mental and physical disorders across the world: results from the WHO World Mental Health surveys. British Journal of Psychiatry.
Sareen, J, Jacobi, F, Cox, BJ, Belik, S-L, Clara, I, Stein, MB (2006). Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Archives of Internal Medicine 166, 21092116.
Schettini Evans, A, Frank, SJ (2004). Adolescent depression and externalizing problems: testing two models of comorbidity in an inpatient sample. Adolescence 39, 118.
Schmitz, N, Wang, J, Malla, A, Lesage, A (2007). Joint effect of depression on chronic conditions on disability: results from a population-based study. Psychosomatic Medicine 69, 332338.
Scott, KM, Bruffaerts, R, Tsang, A, Ormel, J, Alonso, J, Angermeyer, MC, Benjet, C, Bromet, E, de Girolamo, G, de Graaf, R, Gasquet, I, Gureye, O, Haro, JM, He, Y, Kessler, RC, Levinson, D, Mneimneh, ZN, Oakley Browne, MA, Posada-Villa, J, Stein, DJ, Takeshima, T, Von Korff, M (2007). Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health surveys. Journal of Affective Disorders 103, 113120.
Scott, KM, McGee, M, Wells, J, Oakley Browne, M (2006 a). Disability in Te Rau Hinengaro: the New Zealand Mental Health Survey (NZMHS). Australian and New Zealand Journal of Psychiatry 40, 889895.
Scott, KM, Oakley Browne, MA, McGee, MA, Wells, JE (2006 b). Mental-physical comorbidity in Te Rau Hinengaro: the New Zealand Mental Health Survey (NZMHS). Australian and New Zealand Journal of Psychiatry 40, 882888.
Sharpe, L, Curran, L (2006). Understanding the process of adjustment to illness. Social Science and Medicine 62, 11531166.
Stein, MB, Cox, BJ, Afifi, TO, Belik, S-L, Sareen, J (2006). Does co-morbid depressive illness magnify the impact of chronic physical illness: a population-based perspective. Psychological Medicine 36, 587596.
SUDAAN (2002). SUDAAN software, version 8.0.1. Research Triangle Institute: Research Triangle Park, NC.
Van Puymbroeck, CM, Zautra, AJ, Harakas, PP (2007). Chronic pain and depression: twin burdens of adaptation. In Depression and Physical Illness (ed. Steptoe, A.), pp. 145164. Cambridge University Press: London.
Von Korff, M, Crane, PK, Ormel, J, Alonso, J, Angermeyer, MC, Bruffaerts, R, de Girolamo, G, Gureje, O, de Graaf, R, Huang, Y, Iwata, N, Karam, EG, Kovess, V, Lara, C, Levinson, D, Posada-Villa, J, Scott, KM, Vilagut, G (in press). Modifications to the WHODAS-II for the World Mental Health Surveys: lessons learned. Journal of Clinical Epidemiology.
Wells, KB, Golding, JM, Burnam, MA (1989 a). Affective, substance use, and anxiety disorders in persons with arthritis, diabetes, heart disease, high blood pressure, or chronic lung conditions. General Hospital Psychiatry 11, 320327.
Wells, KB, Stewart, A, Hays, RD, Burnam, MA, Rogers, W, Daniels, M, Berry, S, Greenfield, S, Ware, J (1989 b). The functioning and well-being of depressed patients. Journal of the American Medical Association 262, 914919.
WHO (2001). International Classification of Functioning, Disability and Health. World Health Organization: Geneva.
Wolter, KM (1985). Introduction to Variance Estimation. Springer-Verlag: New York.
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