Comorbidity between common mental disorders and chronic somatic diseases in primary care patients

doi:10.1016/j.genhosppsych.2010.01.013

General Hospital Psychiatry

Volume 32, Issue 3, May–June 2010, Pages 240-245

https://doi.org/10.1016/j.genhosppsych.2010.01.013 Get rights and content

Abstract

Objective

To estimate the prevalence of the most common mental disorders in primary care patients with chronic somatic diseases based on physicians' diagnoses and compared with healthy probands.

Method

A systematic sample of 7940 adult primary care patients was recruited by 1925 general practitioners (GPs) in a large cross-sectional national epidemiological study. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used as standardized instrument for the assessment of mental disorders. Medical diagnoses were provided by patient's GP.

Results

The prevalence rate of mental disorder was significantly higher in patients with chronic somatic diseases (56.8%) compared with physically healthy subjects (48.9%; OR: 1.37). Prevalence of depressive and anxiety disorders is higher among individuals with neurological, oncological or liver disease. The differences are significant in all comparisons, with the exception of anxiety disorders in patients with musculoskeletal disorders. There is an increase in prevalence rates of mental disorders according to the number of somatic diseases.

Conclusions

The study provides evidence of the comorbidity of common mental disorders and somatic diseases. We need a predominant focus on affective and anxiety disorders in primary care patients with chronic somatic diseases. Symptoms overlap makes it necessary to discriminate these differences more in detail in future studies.

Introduction

Chronic somatic diseases are the main cause of disability throughout the world [1]. Mental diseases likewise affect a large percentage of the population and constitute another important cause of morbidity, mortality and disability [2], [3]. Different studies have reported a high prevalence of mental disorders in patients with chronic somatic illnesses. Metabolic, gastrointestinal and pulmonary diseases, as well as cardiovascular, muskuloeskeletal and neurological diseases show the highest prevalence rates of mental disorder [4], [5], [6], although no powerful association between any specific medical illness with a particular mental disorder has been found [7]. Such comorbidity in turn results in a poorer prognosis, increased resource utilization, higher costs, disability and poorer treatment compliance [8], [9], [10].

Most of these studies have analyzed the prevalences of mental disorders in populations with specific chronic diseases such as asthma, arteriosclerosis or cancer, and have been limited to the prevalences of affective or somatization disorders, or to elderly population groups [8], [11], [12], [13], [14]. The NIMH Epidemiological Catchment Area Study [15] was the first study to include a broad range of chronic medical disorders and mental illnesses, though the medical diagnoses were based on reports from the patients themselves not on the information supplied by the attending physicians. Furthermore, all the subjects were outpatients and were recruited from general population. Recently, the World Mental Health Surveys included a limited range of self-reported chronic physical conditions (arthritis, heart disease, respiratory disease, chronic back/neck pain, chronic headache and diabetes) [10]. The differences in mental disorders rates among medical patients suggest that epidemiological data are largely dependent on clinical setting, sample composition, psychopathology, chronicity, age, inconsistent diagnostic criteria, overlapping symptoms and other features [16], [17].

Most of these comorbidity studies were conducted in specialized services or specific groups and so might not be generalized to primary care patients. According to several epidemiologic studies, between 20% and 53% of primary care patients have a mental disorder [18], [19], [20], [21], [22]. Patients with medical–psychiatric comorbidity compose the majority of the population seen in primary care (PC). The aim of the present study was to estimate the comorbidity of common psychiatric disorders (affective and anxiety disorders) and complete range of medical diseases in a large sample of primary care patients; additionally, to analyze the relationship between the amount of somatic comorbidity and the higher risk for common mental disorders; to estimate if the prevalence rates of affective and anxiety disorders differ between different types of chronic somatic diseases; and finally, to find significant association between any specific medical illness and a particular mental disorder. This is the first nationwide cross-sectional epidemiological study carried out in the primary care setting in Spain and the largest in a European country.

Section snippets

Sample and procedure

A Spanish national cross-sectional epidemiological study was designed. Two thousand general practitioners (GPs) — distributed proportionally by provinces and health centers in Spain's 17 regional communities — were randomly selected to participate in this study. Male/female, rural/urban and age proportions were as well guaranteed. One thousand nine hundred twenty-five GPs joined the study after having received an open invitation (96.2% was the response rate). The GPs were instructed in the use

Results

Patients with medical diseases showed an increased risk of having any mental disorder compared with physically healthy subjects. When multivariate logistic regression analyses were conducted with adjustments for differences in sex, age, education and employment status, the prevalence rate of mental disorder (Table 1) was significantly higher in patients with chronic somatic diseases (56.8%) compared with physically healthy subjects (48.9%; AOR: 1.46).

Table 2 shows increased prevalence rates of

Discussion

The main conclusion drawn from our study is the high comorbidity between the most common mental conditions (depressive and anxiety disorders) and medical diseases in patients seen in the primary care setting. To date, the great majority of studies analyzing medical–psychiatric comorbidity are not population-based or have not been conducted in the primary care setting [17]. The investigation of comorbidity in population-based samples or in PC is essential in order to minimize the effect or

Acknowledgments

We thank all the Spanish GP physicians of the SCREEN GROUP who participated in data collection.

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A similar phenomenon was also observed by Gili et al. in a nationwide, cross-sectional study of mental and somatic comorbidity in primary care patients in Spain (Barnett et al., 2012). According to a recently published Swedish study, the prevalence of mental disorders in the population of Region Stockholm increased from 13.2% in 2011 to 16.1% in 2017 (Gili et al., 2010). In that study, 49.3% of those using any mental health care services for mental care did so with a primary care provider, and the most common reasons for seeking that care were depression, anxiety, and stress disorders.
Multimorbidity of mental and physical disorders may be common. Our objectives were to estimate the prevalence of mental disorders and determine physical-mental multimorbidity relationships adjusted for sex and age within a primary care population in Region Stockholm, Sweden.
From 2.4 million Region Stockholm inhabitants, we included adult patients with ≥ 1 primary care consultation from 2013 through 2017. We clustered 40 physical diagnoses into 9 categories and grouped mental disorders into mild-moderate (i.e., depression, anxiety, stress disorder, sleep disturbance) or severe (i.e., bipolar disorder, schizophrenia).
Of 1 105 065 patients, mean age was 49 years, 56% were females, and nearly one-third had a mental disorder (97% mild-moderate). Adjusted odds ratios (AOR) for mild-moderate and severe mental disorders were highest in patients with alcohol abuse (AOR=3.7, 95% CI 3.6–3.8; AOR=7.2, 95% CI 6.7–7.6, respectively) vs. those with no abuse. Higher odds for either level of mental comorbidity occurred in patients with chronic heart failure (CHF), cerebrovascular disease, Transient ischemic attack (TIA), Chronic obstructive pulmonary disease (COPD), Gastroesophageal reflux disease- irritable bowel syndrome (GERD-IBS), chronic pain, dementia, nicotine dependence, and Parkinson’s disease. For mild-moderate mental disorders, AOR in males was highest (1.45) at age 28 and was below 1.0 after age 46; AOR in females was highest (1.30) at age 38 and was below 1.0 after age 38. For severe mental disorders, AOR was below 1.0 after age 58 in males and after age 62 in females.
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^☆: The project was possible due to an unrestricted educational grant from Almirall Spain.

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Psychiatry and Primary CareComorbidity between common mental disorders and chronic somatic diseases in primary care patients☆

Abstract

Objective

Method

Results

Conclusions

Introduction

Section snippets

Sample and procedure

Results

Discussion

Acknowledgments

Eur Neuropsychopharmacol: J Eur Coll Neuropsychopharmacol

J Affect Disord

Gen Hosp Psychiatry

Psychosomatics

Gen Hosp Psychiatry

Psychosomatics

Gen Hosp Psychiatry

Am J Med

J Affect Disord

J Affect Disord

J Psychosom Res

Psychosomatics

Biol Psychiatry

Updated projections of global mortality and burden of disease 2002–2030: data sources, methods and results

Disability and treatment of specific mental and physical disorders across the world

Br J Psychiatry

Increased 12-month prevalence rates of mental disorders in patients with chronic somatic disease

Psychother Psychosom

Cost-effectiveness of systematic depression treatment among people with diabetes mellitus

Arch Gen Psychiatry

Psychiatry and Primary Care
Comorbidity between common mental disorders and chronic somatic diseases in primary care patients☆