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Mental disorders may increase risk for chronic physical conditions

Analysis of world mental health surveys from 17 countries indicated mental disorders were significantly associated with onset or diagnosis of chronic physical conditions.

“Much evidence has accrued from record linkage and clinical studies attesting to the higher incidence of chronic physical conditions and associated earlier mortality among individuals with severe mental illness, as well as among those with common mental disorders. However, the findings of these studies are limited to those who receive treatment, so it is less clear whether mental disorders in the community (untreated and treated) might be linked with subsequent risk of chronic physical conditions,” Kate M. Scott, MA (ClinPsych), PhD, of University of Otago, Dunedin, New Zealand, and colleagues wrote.

To assess associations between mood disorders, anxiety disorders, impulse control disorders and substance abuse disorders with subsequent onset or diagnosis of chronic physical conditions, researchers conducted 18 face-to-face cross-sectional household surveys of community-dwelling adults in 17 countries (n = 47,609). Chronic conditions included arthritis, chronic pain, heart disease, stroke, hypertension, diabetes, asthma, chronic lung disease, peptic ulcer and cancer.

Most associations between mental disorders and subsequent onset or diagnosis of chronic physical conditions were statistically significant, with odds ratios ranging from 1.2 (95% CI, 1-1.5) for obsessive-compulsive disorder and diabetes to 3.6 (95% CI, 2-6.6) for bulimia nervosa and diabetes.

These associations were attenuated when adjusting for mental disorder comorbidity, but mood, anxiety, substance use and impulse control disorders remained significantly associated with seven to 10 of the chronic conditions, with odds ratios ranging from 1.2 (95% CI, 1.1-1.3) to 2 (95% CI, 1.4-2.8).

An increasing number of mental disorders over the course of life was significantly associated with increasing odds for onset or diagnosis of chronic conditions, with odds ratios ranging from 1.3 (95% CI, 1.1-1.6) to 1.8 (95% CI, 1.4-2.2) for one mental disorder and 1.9 (95% CI, 1.4-2.7) to 4 (95% CI, 2.5-6.5) for five or more mental disorders.

Specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets, according to population-attributable risk estimates.

“The study findings need to be confirmed in prospective designs, but they suggest that the deleterious effects of mental disorders on physical health (if causal) accumulate over the life course and increase with mental disorder comorbidity. If this is the case, then given the early onset of most mental disorders and the similarly early etiopathogenesis of many chronic physical conditions, treatment of all mental disorders should optimally incorporate attention to physical health and health behaviors, with this parallel focus on physical health beginning as early in the course of the mental disorder as possible,” the researchers concluded. – by Amanda Oldt

Disclosure: Scott reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.