Rai, D;
Stansfeld, S;
Weich, S;
Stewart, R;
McBride, O;
Brugha, T;
Hassiotis, A;
... Papp, M; + view all
(2016)
Comorbidity in mental and physical illness.
In: McManus, S and Bebbington, P and Jenkins, R and Brugha, T, (eds.)
Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014.
(pp. 323-347).
NHS Digital: Leeds, UK.
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Abstract
Comorbidity refers to the presence of two or more conditions at the same time. In the 2007 report in this series, comorbidity between mental disorders was examined. In this chapter comorbidity across mental disorders, chronic physical conditions, psychological wellbeing and intellectual impairment is profiled. • Physical health conditions were measured by showing participants a list of health conditions and asking whether a health professional had diagnosed them. Five chronic conditions were considered. Mental wellbeing was assessed using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), where a higher score indicates greater psychological wellbeing. Intellectual impairment was also included, assessed using the Natonal Adult Reading Test (NART). • Overall, just over a quarter of adults (27.7%) reported having at least one of the five chronic physical conditions considered in this chapter diagnosed, and present in the last 12 months. High blood pressure was the most common, followed by asthma, diabetes, and cancer. A relatively small number of participants (52; 0.7% of adults) reported epilepsy; analysis by this group should therefore be treated with caution. • There was an association between common mental disorder (CMD) and chronic physical conditions. In people with severe CMD symptoms (revised Clinical Interview Schedule (CIS-R) score 18 or more) over a third (37.6%) reported a chronic physical condition, compared with a quarter (25.3%) of those with no or few symptoms of CMD (CIS-R score 0 to 5). • This pattern held for each of the chronic conditions examined. For xample, people with severe symptoms of CMD (CIS-R score 18+) were twice as likely to have asthma as people with no or few symptoms (CIS-R score 0–5): 14.5% compared with 7.2%. • Having a chronic physical condition was associated with lower levels of mental wellbeing. Overall, the mean WEMWBS score was 51.0 in people with at least one of the five chronic conditions considered, compared with 53.2 in people without a chronic physical condition. • Both the presence of self-reported diagnosed asthma and high blood pressure were associated with a wide range of different mental disorders, including depression, anxiety disorders (such as generalised anxiety disorder (GAD) and phobias), CMD Not Otherwise Specified (NOS), and posttraumatic stress disorder (PTSD). Asthma and high blood pressure were the most common chronic physical conditions examined; the larger sample of people with these conditions meant that statistically significant differences were more likely to be detectable. • Cancer and diabetes were also strongly associated with CMD-NOS, but higher rates of most other mental disorders were not statistically significant for these chronic physical conditions. • Adults with low wellbeing (with the lowest 15% of WEMWBS scores) experienced extremely high levels of psychiatric morbidity, including 21.0% screening positive for PTSD, 25.9% for attention-deficit/hyperactivity disorder (ADHD) and 6.0% for drug dependence. 20.6% of this group had made a suicide attempt. These rates were between 8 and 30 times higher than those for people with the highest mental wellbeing scores. • People with lower intellectual ability were more likely to have poorer mental health than those with average or above average intellectual functioning. • The results indicate that people with one condition tend to be more likely to have another, and that even subthreshold symptoms of common mental disorder are associated with having a chronic physical condition. These findings provide evidence to support the bringing of physical and mental health care provision closer together.
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