50 slides on Physical health Mental health Comorbidity (ajmitchell Nov2012))

1,243 views

Published on

This is a talk given as a keynote lecture at the University of northampton, 07-Nov-2012 on the topic of physical health-mental health comorbidity.

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,243
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
99
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

50 slides on Physical health Mental health Comorbidity (ajmitchell Nov2012))

  1. 1. Physical Health / Mental Health: Evidence based exploration of co-morbidity Alex J Mitchell ajm80@le.ac.ukLong term conditions and mental health, Northampton November 2012
  2. 2. Alex J Mitchell (2012)Contents 1. Psychiatric ‐ Physical illness Comorbidity 2. Psychiatric complications of Specific Physical illnesses 3. Psychiatric Physical Comorbidity => Burden 4. Psychiatric Physical Comorbidity => Mortality 5. Medical Care for Psychiatric Patients 6. Monitoring and Treatment
  3. 3. National ReportsAlex J Mitchell (2012)
  4. 4. 1. Psychiatric ‐ Physical illness Comorbidity Large Surveys
  5. 5. Alex J Mitchell (2012)2007 Australian National Survey of MentalHealth and Wellbeing (n= 8841, 16-85 years) Women 19% 8% anxiety affective 3.9 12.6 2.5 1.6 0.2 0.8 substance use 1.7 4%
  6. 6. Alex J Mitchell (2012)Washington State Survey (n=23,000) 69% 31% alone 32% 5% alone 36% 5% alone
  7. 7. Alex J Mitchell (2012)Depressive Symptoms in MedicalConditions (on CES-D8) n=8400
  8. 8. Alex J Mitchell (2012)Mental Health Comorbidity in Medical dis(n=8800 (WMH-CIDI 3.0) 35 50% Any affective disorder Any anxiety disorder 29.7 30 Any affective or anxiety disorder 25.6 25 23.3 23.4 22.5 21.9 21.2 20.5 19.7 20 18.7 17.4 17.6 15 13.5 12.8 11.4 10 9.6 10 7.9 7 6.8 5 5 0 n es HD er n a is o m tio nc rit et iti rC th di th nd ab Ca As n o Ar Di Co Co ke ro l al ica sic St ys hy Ph yP No AnData from Teesson et al.Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Aus NZJP 2011 Nov;45(11):939-46.
  9. 9. Alex J Mitchell (2012)Gili: Mental Comorbidity in Medical dis(n=8000 PRIME-MD Spain) > 0.7 42% 0.604 0.6 Affective Disorder Anxiety Disorder Alcohol Use Disorder 0.566 0.514 0.5 0.477 0.47 > 0.411 0.412 0.418 0.42 0.4 0.38 0.385 0.365 0.346 0.294 0.3 0.281 0.259 0.217 0.2 0.13 0.129 0.093 0.084 0.1 0.064 0.072 0.066 0 e e e e e e e e as as as as as as as as ise se ise ise ise ise ise ise di ld ld d d d d d tic lic lar ry ica al ica al to pa bo tin let u g og sc ira lo He ta es ke ol va co sp Me st os ur io On in Re ul Ne rd ro scCa st Mu GaData from Gili et al.- Comorbidity between common mental disorders and chronic somatic diseases in primary care patients. General HospitalPsychiatry 2010; 32: 240-245 PRIME-MD interview DSMIV 1925 GPs 8000 patients. 57% vs 49%
  10. 10. 2. Psychiatric complications of Specific Phys illness Whats new?
  11. 11. Prevalence of depression in Oncology settings Plumb & Holland (1981) Proportion meta-analysis plot [random effects] 0.7750 (0.6679, 0.8609) Levine et al (1978) 0.5600 (0.4572, 0.6592) Ciaramella and Poli (2001) 0.4900 (0.3886, 0.5920) Massie et al (1979) 0.4850 (0.4303, 0.5401)70 studies involving 10,071 individuals;14 countries. Bukberg et al (1984) Passik et al (2001) 0.4194 (0.2951, 0.5515) 0.4167 (0.2907, 0.5512)16.3% (95% CI = 13.9% to 19.5%) Baile et al (1992) Morton et al (1984) Hall et al (1999) 0.4000 (0.2570, 0.5567) 0.3958 (0.2577, 0.5473) 0.3722 (0.3139, 0.4333) Burgess et al (2005) 0.3317 (0.2672, 0.4012) Jenkins et al (1991) 0.3182 (0.1386, 0.5487)Mj 15% Mn 19% Adj 20% Anx 10% Dysthymia 3% Green et al (1998) 0.3125 (0.2417, 0.3904) Kathol et al (1990) 0.2961 (0.2248, 0.3754) Hosaka and Aoki (1996) 0.2800 (0.1623, 0.4249) Fallowfield et al (1990) 0.2565 (0.2054, 0.3131) Golden et al (1991) 0.2308 (0.1353, 0.3519) Spiegel et al (1984) 0.2292 (0.1495, 0.3261) Evans et al (1986) 0.2289 (0.1438, 0.3342) Grandi et al (1987) 0.2222 (0.0641, 0.4764) Maunsell et al (1992) 0.2146 (0.1605, 0.2772) Berard et al (1998) 0.2100 (0.1349, 0.3029) Joffe et al (1986) 0.1905 (0.0545, 0.4191) Berard et al (1998) 0.1900 (0.1184, 0.2807) Devlen et al (1987) 0.1889 (0.1141, 0.2851) Leopold et al (1998) 0.1887 (0.0944, 0.3197) Akizuki et al (2005) 0.1797 (0.1376, 0.2283) Razavi et al (1990) 0.1667 (0.1189, 0.2241) Gandubert et al (2009) 0.1597 (0.1040, 0.2300) Alexander et al (1993) 0.1333 (0.0594, 0.2459) Kugaya et al (1998) 0.1328 (0.0793, 0.2041) Payne et al (1999) 0.1290 (0.0363, 0.2983) Ibbotson et al (1994) 0.1242 (0.0776, 0.1853) Prieto et al (2002) 0.1227 (0.0825, 0.1735) Morasso et al (1996) 0.1121 (0.0593, 0.1877) Desai et al (1999) [early] 0.1111 (0.0371, 0.2405) Silberfarb et al (1980) 0.1027 (0.0587, 0.1638) Costantini et al (1999) 0.0985 (0.0535, 0.1625) Morasso et al (2001) 0.0985 (0.0535, 0.1625) Ozalp et al (2008) 0.0971 (0.0576, 0.1510) Love et al (2002) 0.0957 (0.0650, 0.1346) Alexander et al (2010) 0.0900 (0.0542, 0.1385) Coyne et al (2004) 0.0885 (0.0433, 0.1567) Kawase et al (2006) 0.0851 (0.0553, 0.1240) Walker et al (2007) 0.0831 (0.0568, 0.1165) Grassi et al (1993) 0.0828 (0.0448, 0.1374) Grassi et al (2009) 0.0826 (0.0385, 0.1510) Reuter and Hart (2001) 0.0761 (0.0422, 0.1244) Lee et al (1992) 0.0660 (0.0356, 0.1102) Pasacreta et al (1997) 0.0633 (0.0209, 0.1416) Sneeuw et al (1994) 0.0540 (0.0367, 0.0761) Singer et al (2008) 0.0519 (0.0300, 0.0830) Katz et al (2004) 0.0500 (0.0104, 0.1392) Mehnert et al (2007) 0.0472 (0.0175, 0.1000) Lansky et al (1985) 0.0455 (0.0291, 0.0676) Derogatis et al (1983) 0.0372 (0.0162, 0.0720) Hardman et al (1989) 0.0317 (0.0087, 0.0793) Massie and Holland (1987) 0.0147 (0.0063, 0.0287) Colon et al (1991) 0.0100 (0.0003, 0.0545) combined 0.1730 (0.1375, 0.2116) 0.0 0.3 0.6 0.9 proportion (95% confidence interval)
  12. 12. 3 < 2 years2.5 2 to 10 years > 10 years 1.99 2 1.461.5 1.32 1.29 1.12 1.05 10.5 0 Depression Anxiety
  13. 13. 3. Psychiatric Physical Comorbidity => Burden How to measure burden? Subjective Objective
  14. 14. Impairment: Days totally out of role per year 50 (Alonso n=63,000) WHO WHM survey x 24co. Yearly DOR45 Unique 42.9 42.7 PAR% 41.2 39.840 39.3 36.635 34.4 33.8 30.6302520 17.3 15.215 14.310 9 7.3 7.7 5.15 3.9 2.6 2.2 2.5 1.8 1.7 1.9 1.4 1 0.3 0.10 Depression Panic disorder PTSD Specific phobia Social phobia Bipolar disorder GAD Alcohol abuse Drug abuse
  15. 15. Alex J Mitchell (2012)2007 Auz National Survey of Mental Health& Wellbeing(n=8800 18-65) 120 109.2 100 80 73.2 72 64.8 60 48 40 31.2 26.4 20 12 0 ly n ity on n n ly y er io on o tio nl on id rd iti iti dit ro di rb nd on so nd er on on de mo co iti rd co di lc lc or nd so ty Co l al ica ica dis ica xie co di ic ys ys ys ys ty an l e ica tiv ph xie ph ph ph d ys fec an An nd or d d Ph an an Af a , ive ety ty ive y, ct ie xi iet ffe ct nx an nx ffe ]A ]A e, ,a ]A [2 tiv [2 ive [2 fec ct af ffe No ]A [3Teesson et al.Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Aus NZJP 2011 Nov;45(11):939-46.
  16. 16. n=245 404 participants from 60 countriesQuality of life: Moussavi et al (2007) Lancet 2007; 370: 851–58
  17. 17. 4. Psychiatric Physical Comorbidity => Mortality Whats new? Morbidity  Mortality
  18. 18. Alex J Mitchell (2012)Mortality and Depression - IHD Psychosomatic Med (2004) Barth et al
  19. 19. Alex J Mitchell (2012)Mortality after MI => +11%
  20. 20. Alex J Mitchell (2012) Five-year Mortality rates 30 People with schizophrenia 28% People without schizophrenia 25 22% 20 19% 15 12% 10 9% 8% 5 0 CHD Diabetes StrokeHippisley-Cox J et al (2006) A comparison of survival rates for people with mental healthproblems and the remaining population with specific conditions.Disability Rights Commission. Equal treatment: closing the gap, July 2006 Slide credit: Dr Alan Farmer, Worcestershire Mental Health Partnership NHS Trust
  21. 21. Alex J Mitchell (2012)Schizophrenia – all cause mortality >Pooled estimate=2.50 Saha (2007) AGP (95% CI=2.18‐2.83)Mortality Gap: 22.5 yrs
  22. 22. Alex J Mitchell (2012)Osborne – Mortality CVD
  23. 23. Alex J Mitchell (2012)Problem….poor matching  Severity and type of mental illness  Age matched  Suicides  socioec, IQ, education  BP, smoking, BMI
  24. 24. Alex J Mitchell (2012)Mortality HR by Hospital Admission Diag.for 1million men born b1951-b1958 10 9.01 9 8 7.66 7 6 5 4.3 3.9 4 3.56 3.41 3.28 2.98 3 2 1 0 58 8 58 58 8 58 58 8 95 95 95 19 19 19 19 19 -1 -1 -1 1- 1- - - 1- 51 51 51 51 51 95 5 5 19 19 19 19 19 19 19 t1 ar ol a y on es e en ni it us oh ol os al si re tm ip on lc e s ch ph us B nc re A rs y zo ep dj ta Ps Pe bs A hi D Sc er ic Su t th ro O eu NGale CR, Arch Gen Psychiatry. 2012 Aug;69(8):823-31. Adj for suicide, age socioec, bmi, IQ, BP, education
  25. 25. Sc hi zo ph Sc re hi ni zo a ph 19 Sc re 51 0 2 4 6 8 10 12 14 16 18 20 hi ni -1 zo a 95 ph 19 8 re 59 2.98 ni -1 a 96 19 7 68 4.12 -1 97 B 6 ip 5.05 ol ar B 19 ip 51 ol ar -1 95 B 19 8 ip 59 3.41 ol ar -1 96 19 7 68 D -1 ep 97 re 6 ss D 4.21 4.44 io ep n re 19 ss 51 D io -1 ep n 95 re 19 8 for 1million men born b1951-b1958 ss 59 io -1 n 96 Su 19 7 68 3.56 3.83 bs -1 ta 97 nc 6 Su e 5.75 bs us ta e Mortality HR by Hospital Admission Diag. nc 19 Su e 51 bs us -1 ta e 95 nc 19 8 e 59 7.66 us -1 e 96 19 7 68 13.1 -1 97 6 17.2Gale CR, Arch Gen Psychiatry. 2012 Aug;69(8):823-31. Adj for suicide, age socioec, bmi, IQ, BP, education Alex J Mitchell (2012)
  26. 26. Alex J Mitchell (2012)Mortality trends in Stockholm County1976–79 to 1990–95, cardiovascular causes of death 1.4 Patients with schizophrenia* 1976–79 period of reference 1.2 1.0 Deaths/100,000 0.8 0.6 General population** 0.4 0.2 0 1976–79 1980–85 1986–89 1990–95**Standardised by the sex and age distribution of the patients Osby et al 2000
  27. 27. Alex J Mitchell (2012)Cardiovascular disease is primary cause ofdeath in persons with mental illness* 50 Percentage of deaths 40 10-20% 30 20 10 0 MO OK RI TX UT VA Heart disease Cancer Cerebrovascular Chronic respiratory Accidents Diabetes Influenza/pneumonia Suicide*Average data from 1996–2000 Lutterman et al 2003; Colton & Manderscheid 2006
  28. 28. Alex J Mitchell (2012)
  29. 29. Depression as arisk for dementia RR = 1.75 Over mean of 7 years
  30. 30. 5. Medical Care for Psychiatric Patients Psychiatric Care Comparative Care
  31. 31. Alex J Mitchell (2012)Quality of Care comparisons Psychiatric Care vs Psychiatric Care General patients Medical patients Psychiatric Care vs Medical Care Medical patients Medical patients Medical Care vs Medical Care Medical patients Psychiatric patients
  32. 32. Alex J Mitchell (2012)% Receiving Any treatment for Depression 20 n=84,850 face-to-face interviews 17.9 18 16 15.4 13.8 14 12 11.3 10.9 10.9 10 8.8 8.1 8 7.2 6.8 6 5.6 5.5 4.3 4 3.4 2 0 SA n ca e n m a ly na y e el e ce nd ds m ai m bi an pa n Ita ra u i hi an U ai la fr co n Sp om co gi m Ja Is rla C A kr a Fr el In er In Ze ol U h B he G w ut h C ew et ig Lo SoH N N Wang P et al (2007) Lancet 2007; 370: 841–50

×