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Mental disorder comorbidity common in physical conditions
by Liam Davenport
17 October 2007
J Affect Dis 2007; 103: 113?120

Mental and physical disorders co-occur commonly, with comorbid depressive?anxiety disorder particularly associated with physical conditions, and have significant clinical consequences, conclude an international team of researchers.

While it is established that there is significant comorbidity of mental disorders with chronic physical conditions, Kate Scott, from Wellington School of Medicine and Health Sciences in New Zealand, and colleagues point out that previous research has focused on a small range of mental disorders and physical conditions in clinical populations from developed countries. Furthermore, depressive and anxiety disorder comorbidity has rarely been taken into account.

As part of the World Mental Health Surveys initiative, 18 general population surveys were carried out in 17 countries, involving 42,249 people aged over 18 years. The Composite International Diagnostic Interview was used to assess DSM-IV depressive and anxiety disorders in face-to-face interviews, while a standard checklist was used collect information on chronic physical conditions.

In order to examine the relationship between mental disorders and physical conditions, the researchers considered depressive and anxiety disorders both independently and conjointly, they report in the Journal of Affective Disorders.

Adjusting for age and gender, the researchers found that all physical conditions were significantly associated with depressive and/or anxiety disorders, but the strength of the association varied with the physical condition.

For example, the odds ratio for non-comorbid anxiety disorder or comorbid depression?anxiety in patients with obesity was 1.2. Among patients with asthma, the odds ratio for non-comorbid depression was 1.7 while that for non-comorbid anxiety was 1.6, as was the odds ratio for comorbid depression?anxiety. The respective odds ratios in patients with heart disease were 2.0, 1.9, and 2.8, while those for patients with multiple pains were 2.5, 2.3, and 4.5.

Although non-comorbid depressive and anxiety disorders were associated with physical conditions to a comparable degree, comorbid depressive?anxiety disorder was significantly more associated with several physical conditions ? arthritis, ulcer, heart disease, back/neck problems, chronic headache, and multiple pain ? than single mental disorders.

The team writes: ?What is clear is that mental?physical comorbidity is clinically consequential; it has been shown to complicate treatment, alter disease course, contribute to disability and increase mortality risks.?

They add: ?Given the increasing prevalence of chronic conditions and possibly also of anxiety and depressive disorders, improved understanding of the determinants, consequences and management of their comorbidity remains a research priority.?

Abstract
 

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