This document summarizes research on the relationship between physical and mental health conditions. It finds that around 16-20% of cancer patients experience depression, and rates of other mental health issues like anxiety are also elevated in various physical illnesses. Longer time since diagnosis is linked to higher rates of some mental health problems. Having a physical and mental health condition simultaneously is associated with much greater impairment and higher health care costs and mortality risk compared to having just one or neither. Integrated treatment of both physical and mental health issues is recommended.
50 slides on Physical health Mental health Comorbidity (ajmitchell Nov2012))
1. Physical Health / Mental Health:
Evidence based exploration of co-morbidity
Alex J Mitchell ajm80@le.ac.uk
Long term conditions and mental health, Northampton November 2012
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
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
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Data 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. 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
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Data from Gili et al.- Comorbidity between common mental disorders and chronic somatic diseases in primary care patients. General Hospital
Psychiatry 2010; 32: 240-245 PRIME-MD interview DSMIV 1925 GPs 8000 patients. 57% vs 49%
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. 3
< 2 years
2.5 2 to 10 years
> 10 years
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2
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1.5
1.32
1.29
1.12
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Depression Anxiety
14. Impairment: Days totally out of role per year
50
(Alonso n=63,000) WHO WHM survey x 24co.
Yearly DOR
45 Unique
42.9 42.7
PAR%
41.2
39.8
40 39.3
36.6
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33.8
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Depression Panic disorder PTSD Specific phobia Social phobia Bipolar disorder GAD Alcohol abuse Drug abuse
15. Alex J Mitchell (2012)
2007 Auz National Survey of Mental Health
& Wellbeing(n=8800 18-65)
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Survey of Mental Health and Wellbeing. Aus NZJP 2011 Nov;45(11):939-46.
16. n=245 404 participants from 60 countries
Quality of life: Moussavi et al (2007) Lancet 2007; 370: 851–58
20. Alex J Mitchell (2012)
Five-year Mortality rates
30 People with schizophrenia 28%
People without schizophrenia
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Hippisley-Cox J et al (2006) A comparison of survival rates for people with mental health
problems 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
24. Alex J Mitchell (2012)
Mortality HR by Hospital Admission Diag.
for 1million men born b1951-b1958
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Alex J Mitchell (2012)
26. Alex J Mitchell (2012)
Mortality trends in Stockholm County
1976–79 to 1990–95, cardiovascular causes of death
1.4
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1976–79 period of reference
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**Standardised by the sex and age distribution of the patients Osby et al 2000
27. Alex J Mitchell (2012)
Cardiovascular disease is primary cause of
death 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
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. Alex J Mitchell (2012)
% Receiving Any treatment for Depression
20
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