Journal
JAMA PSYCHIATRY
Volume 73, Issue 2, Pages 150-158Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jamapsychiatry.2015.2688
Keywords
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Categories
Funding
- National Institute of Mental Health (NIMH) [R01 MH070884]
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- US Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center [FIRCA R03-TW006481]
- Pan American Health Organization
- Eli Lilly Company
- Ortho-McNeil Pharmaceutical
- GlaxoSmithKline
- Bristol-Myers Squibb
- Ministry of Social Protection
- European Commission [QLG5-1999-01042, SANCO 2004123, EAH 20081308]
- Piedmont Region (Italy)
- Fondo de Investigacion Sanitaria
- Instituto de Salud Carlos III, Spain [FIS 00/0028]
- Ministerio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]
- Departament de Salut
- Generalitat de Catalunya, Spain
- Instituto de Salud Carlos III [CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP]
- Grant for Research on Psychiatric and Neurological Diseases and Mental Health from the Japan Ministry of Health, Labour, and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]
- National Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]
- National Council on Science and Technology [CONACyT-G30544-H]
- National Institute of Health of the Ministry of Health of Peru
- Norwegian Financial Mechanism
- European Economic Area Mechanism
- Shenzhen Bureau of Health
- Shenzhen Bureau of Science, Technology, and Information
- Japanese Fund through United Nations Development Group Iraq Trust Fund
- European Fund through United Nations Development Group Iraq Trust Fund
- Ministry of Health
- Israel National Institute for Health Policy and Health Services Research
- National Insurance Institute of Israel
- New Zealand Ministry of Health
- Alcohol Advisory Council
- Health Research Council
- Champalimaud Foundation
- Gulbenkian Foundation
- Foundation for Science and Technology
- Ministry of Public Health
- NIMH [U01-MH60220]
- Robert Wood Johnson Foundation [044708]
- Health Research Council of New Zealand [11/200]
- Polish Ministry of Health
- Substance Abuse and Mental Health Services Administration
- John W. Alden Trust
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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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