Mental–physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys
- 26 March 2008
- journal article
- Published by Cambridge University Press (CUP) in Psychological Medicine
- Vol. 39 (1), 33-43
- https://doi.org/10.1017/s0033291708003188
Abstract
The relationship between mental and physical disorders is well established, but there is less consensus as to the nature of their joint association with disability, in part because additive and interactive models of co-morbidity have not always been clearly differentiated in prior research. Eighteen general population surveys were carried out among adults as part of the World Mental Health (WMH) Survey Initiative (n=42 697). DSM-IV disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). Chronic physical conditions (arthritis, heart disease, respiratory disease, chronic back/neck pain, chronic headache, and diabetes) were ascertained using a standard checklist. Severe disability was defined as on or above the 90th percentile of the WMH version of the World Health Organization Disability Assessment Schedule (WHODAS-II). The odds of severe disability among those with both mental disorder and each of the physical conditions (with the exception of heart disease) were significantly greater than the sum of the odds of the single conditions. The evidence for synergy was model dependent: it was observed in the additive interaction models but not in models assessing multiplicative interactions. Mental disorders were more likely to be associated with severe disability than were the chronic physical conditions. This first cross-national study of the joint effect of mental and physical conditions on the probability of severe disability finds that co-morbidity exerts modest synergistic effects. Clinicians need to accord both mental and physical conditions equal priority, in order for co-morbidity to be adequately managed and disability reduced.Keywords
This publication has 54 references indexed in Scilit:
- Modified WHODAS-II provides valid measure of global disability but filter items increased skewnessJournal of Clinical Epidemiology, 2008
- Disability and treatment of specific mental and physical disorders across the worldThe British Journal of Psychiatry, 2008
- Psychological Stress and DiseaseJAMA, 2007
- The Impact of Comorbidity of Mental and Physical Conditions on Role Disability in the US Adult Household PopulationArchives of General Psychiatry, 2007
- Joint Effect of Depression and Chronic Conditions on Disability: Results From a Population-Based StudyPsychosomatic Medicine, 2007
- Calculating measures of biological interactionEuropean Journal of Epidemiology, 2005
- Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health SurveysJAMA, 2004
- The Effects of Chronic Medical Conditions on Work Loss and Work CutbackJournal of Occupational and Environmental Medicine, 2001
- Understanding Disability in Mental and General Medical ConditionsAmerican Journal of Psychiatry, 2000
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986