Skip to main content
    • Aa
    • Aa

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)...

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.


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).


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.


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.

Corresponding author
*Address for correspondence: K. M. Scott, Ph.D., Department of Psychological Medicine, Otago University, Wellington, PO Box 7343Wellington South, New Zealand. (Email:
Hide All
A Ahlbom , L Alfredsson (2005). Interaction: a word with two meanings creates confusion. European Journal of Epidemiology 20, 563564.

T Andersson , L Alfredsson , H Kallberg , S Zdravkovic , A Ahlbom (2005). Calculating measures of biological interaction. European Journal of Epidemiology 20, 575579.

HK Armenian , LA Pratt , J Gallo , WW Eaton (1998). Psychopathology as a predictor of disability: a population-based follow-up study in Baltimore, Maryland. American Journal of Epidemiology 148, 269275.

MA Buist-Bouwman , R de Graaf , WAM Vollebergh , J Ormel (2005). Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatrica Scandinavica 111, 436443.

LC Campbell , DJ Clauw , FJ Keefe (2003). Persistent pain and depression: a biopsychosocial perspective. Biological Psychiatry 54, 399409.

GP Chrousos , T Kino (2007). Glucocorticoid action networks and complex psychiatric and/or somatic disorders. Stress 10, 213219.

PS Ciechanowski , WJ Katon , JE Russo (2000). Depression and diabetes. Archives of Internal Medicine 160, 32783285.

S Cohen , D Janicki-Deverts , GE Miller (2007). Psychological stress and disease. Journal of the American Medical Association 298, 16851687.

S Cohen , MS Rodriguez (1995). Pathways linking affective disturbances and physical disorders. Health Psychology 14, 374380.

R DerSimonian , N Laird (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.

BG Druss , SC Marcus , RA Rosenheck , M Olfson , MA Tanielian , HA Pincus (2000). Understanding disability in mental and general medical conditions. American Journal of Psychiatry 157, 14851491.

LE Egede (2004). Diabetes, major depression, and functional disability among US adults. Diabetes Care 27, 421428.

DL Evans , DS Charney , L Lewis , JM Golden , K Ranga Rama Krishnan , CB Nemeroff , JD Bremner , RM Carney , JC Coyne , MR Delong , N Frasure-Smith , AH Glassman , PW Gold , I Grant , L Gwyther , G Ironson , RL Johnson , AM Kanner , WJ Katon , PG Kaufmann , FJ Keefe , T Ketter , TP Laughren , J Leserman , CG Lyketsos , WM McDonald , BS McEwan , AH Miller , D Musselman , C O'Connor , JM Petitto , BG Pollock , RG Robinson , SP Roose , J Rowland , Y Sheline , DS Sheps , G Simon , D Spiegel , A Stunkard , T Sunderland , P Tibbits , WJ Valvo (2005). Mood disorders in the medically ill: scientific review and recommendations. Biological Psychiatry 58, 175189.

RD Hays , KB Wells , CD Sherbourne , W Rogers , K Spritzer (1995). Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Archives of General Psychiatry 52, 1119.

C Heim , CB Nemeroff (1999). The impact of early adverse experiences on brain systems involved in the pathophysiology of anxiety and affective disorders. Biological Psychiatry 46, 15091522.

B Hyland , F Judd , S Davidson , D Jolley , B Hocking (2003). Case managers' attitudes to the physical health of their patients. Australian and New Zealand Journal of Psychiatry 37, 710714.

AS Karlamangla , BH Singer , BS McEwen , JW Rowe , TE Seeman (2002). Allostatic load as a predictor of functional decline: MacArthur studies of successful aging. Journal of Clinical Epidemiology 55, 696710.

RC Kessler , P Bergland , WT Chiu , O Demler , S Heeringa , E Hiripi , R Jin , B-E Pennell , EE Walters , A Zaslavsky , H Zheung (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 6992.

RC Kessler , PE Greenberg , KD Mickelson , LM Meneades , PS Wang (2001). The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine 43, 218225.

RC Kessler , J Ormel , O Demler , PE Stang (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.

RC Kessler , B Ustun (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.

JK Kiecolt-Glaser , L McGuire , TF Robles , R Glaser (2002). Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annual Review of Psychology 53, 83107.

AM Kolk , GJ Hanewald , S Schagen , CM Gijsbers van Wijk (2002). Predicting medically unexplained physical symptoms and health care utilization. A symptom-perception approach. Journal of Psychosomatic Research 52, 3544.

DM Kriegsman , BW Penninx , JT Van Eijk , AJ Boeke , DJ Deeg (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. Journal of Clinical Epidemiology 49, 14071417.

BS McEwen (2003). Mood disorders and allostatic load. Biological Psychiatry 54, 200207.

BS McEwen (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological Reviews 87, 873904.

KR Merikangas , M Ames , L Cui , PD Stang , B Ustun , M Von Korff , R Kessler (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.

S Moussavi , S Chatterji , E Verdes , A Tandon , V Patel , B Ustun (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851858.

J Ormel , GIJM Kempen , DJH Deeg , EI Brilman , E Sonderen , J Relyveld (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.

J Sareen , F Jacobi , BJ Cox , S-L Belik , I Clara , MB Stein (2006). Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Archives of Internal Medicine 166, 21092116.

N Schmitz , J Wang , A Malla , A Lesage (2007). Joint effect of depression on chronic conditions on disability: results from a population-based study. Psychosomatic Medicine 69, 332338.

KM Scott , R Bruffaerts , A Tsang , J Ormel , J Alonso , MC Angermeyer , C Benjet , E Bromet , G de Girolamo , R de Graaf , I Gasquet , O Gureye , JM Haro , Y He , RC Kessler , D Levinson , ZN Mneimneh , MA Oakley Browne , J Posada-Villa , DJ Stein , T Takeshima , M Von Korff (2007). Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health surveys. Journal of Affective Disorders 103, 113120.

KM Scott , MA Oakley Browne , MA McGee , JE Wells (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.

L Sharpe , L Curran (2006). Understanding the process of adjustment to illness. Social Science and Medicine 62, 11531166.

KB Wells , JM Golding , MA Burnam (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.

KB Wells , A Stewart , RD Hays , MA Burnam , W Rogers , M Daniels , S Berry , S Greenfield , J Ware (1989 b). The functioning and well-being of depressed patients. Journal of the American Medical Association 262, 914919.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 12
Total number of PDF views: 120 *
Loading metrics...

Abstract views

Total abstract views: 507 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th October 2017. This data will be updated every 24 hours.