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Mental–physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys

Published online by Cambridge University Press:  26 March 2008

K. M. Scott ,
M. Von Korff ,
J. Alonso ,
M. C. Angermeyer ,
E. Bromet ,
J. Fayyad ,
G. de Girolamo ,
K. Demyttenaere ,
I. Gasquet  and
O. Gureje
...Show all authors
K. M. Scott*
Affiliation:
Department of Psychological Medicine, Otago University, Wellington, New Zealand
M. Von Korff
Affiliation:
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA
J. Alonso
Affiliation:
Health Services Research Unit, Institute of Municipal d'Investigacio Medica (IMIM), Barcelona, Spain
M. C. Angermeyer
Affiliation:
Department of Psychiatry, University of Leipzig, Germany
E. Bromet
Affiliation:
SUNY Stony Brook, Stony Brook, New York, USA
J. Fayyad
Affiliation:
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
G. de Girolamo
Affiliation:
Department of Mental Health, AUSL di Bologna, Italy
K. Demyttenaere
Affiliation:
Department of Neurosciences and Psychiatry, University Hospital, Gasthuisberg, Leuven, Belgium
I. Gasquet
Affiliation:
Hôpitaux de Paris, Paris, France
O. Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
J. M. Haro
Affiliation:
Sant Joan de Deu-SSM, Barcelona, Spain
Y. He
Affiliation:
Shanghai Mental Health Centre, Shanghai, People's Republic of China
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
D. Levinson
Affiliation:
Mental Health Services, Ministry of Health, Jerusalem, Israel
M. E. Medina Mora
Affiliation:
National Institute of Psychiatry, Mexico City, Mexico
M. Oakley Browne
Affiliation:
Department of Rural and Indigenous Health, School of Rural Health, Monash University, Australia
J. Ormel
Affiliation:
Department of Psychiatry, University Medical Centre, Groningen, The Netherlands
J. Posada-Villa
Affiliation:
Development Rehabilitation System FSC, Saldarriaga Concha Foundation, Bogota, Colombia
M. Watanabe
Affiliation:
Department of Public Health, Jichi Medical University, Tochigi, Japan
D. Williams
Affiliation:
Harvard School of Public Health, Boston, MA, USA
*
*Address for correspondence: K. M. Scott, Ph.D., Department of Psychological Medicine, Otago University, Wellington, PO Box 7343Wellington South, New Zealand. (Email: [email protected])
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Abstract

Background

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.

Method

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).

Results

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.

Conclusions

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

Co-morbiditydisabilityinteractionmentalphysical
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 1 , January 2009 , pp. 33 - 43
Copyright
Copyright © 2008 Cambridge University Press

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