Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T01:30:12.236Z Has data issue: false hasContentIssue false
  • English
  • Français

The population impact of common mental disorders and long-term physical conditions on disability and hospital admission

Published online by Cambridge University Press:  21 August 2012

S. Weich ,
P. Bebbington ,
D. Rai ,
S. Stranges ,
O. McBride ,
N. Spiers ,
H. Meltzer  and
T. Brugha
S. Weich*
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
P. Bebbington
Affiliation:
Mental Health Sciences Unit, UCL Faculty of Brain Sciences, London, UK
D. Rai
Affiliation:
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
S. Stranges
Affiliation:
Division of Health Sciences (Statistics & Epidemiology), Warwick Medical School, University of Warwick, Coventry, UK
O. McBride
Affiliation:
Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
N. Spiers
Affiliation:
Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
H. Meltzer
Affiliation:
Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
T. Brugha
Affiliation:
Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
*
*Address for correspondence: S. Weich, M.D., Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Long-term physical conditions (LTCs) consume the largest share of healthcare budgets. Although common mental disorders (CMDs) and LTCs often co-occur, the potential impact of improved mental health treatment on severe disability and hospital admissions for physical health problems remains unknown.

Method

A cross-sectional study of 7403 adults aged 16–95 years living in private households in England was performed. LTCs were ascertained by prompted self-report. CMDs were ascertained by structured clinical interview. Disability was assessed using questions about problems with activities of daily living. Population impact and potential preventive gain were estimated using population-attributable fraction (PAF), and conservative estimates were obtained using ‘treated non-cases’ as the reference group.

Results

Of the respondents, 20.7% reported at least one LTC. The prevalence of CMDs increased with the number of LTCs, but over two-thirds (71.2%) of CMD cases in people with LTCs were untreated. Statistically significant PAFs were found for CMDs and recent hospital admission [13.5%, 95% confidence intervals (CI) 6.6–20.0] and severe disability (31.3%, 95% CI 27.1–35.2) after adjusting for LTCs and other confounders. Only the latter remained significant when using the most conservative estimate of PAF (21.8%, 95% CI 14.0–28.9), and this was reduced only slightly when considering only participants with LTCs (18.5%, 95% CI 7.9–27.9).

Conclusions

Better treatments for CMDs in people with LTCs could achieve almost the same population health gain in terms of reducing severe disability as those targeted at the entire population. Interventions to reduce the prevalence of CMDs among people with LTCs should be part of routine medical care.

Keywords

Common mental disordersdisabilitylong-term conditionspopulation attributable fraction
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 5 , May 2013 , pp. 921 - 931
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ali, S, Stone, M, Skinner, TC, Robertson, N, Davies, M, Khunti, K (2010). The association between depression and health-related quality of life in people with type 2 diabetes: a systematic literature review. Diabetes and Metabolism Research Review 26, 75–89.CrossRefGoogle ScholarPubMed
Barnard, KD, Skinner, TC, Peveler, R (2006). The prevalence of co-morbid depression in adults with type 1 diabetes: systematic literature review. Diabetic Medicine 23, 445–448.CrossRefGoogle ScholarPubMed
Brady, AR (1998). Adjusted population attributable fractions from logistic regression. In Stata Technical Bulletin, pp. 8–12. Stata Corporation: College Station, TX.Google Scholar
Bruffaerts, R, Vilagut, G, Demyttenaere, K, Alonso, J, AlHamzawi, A, Andrade, LH, Benjet, C, Bromet, E, Bunting, B, de Girolamo, G, Florescu, S, Gureje, O, Haro, JM, He, Y, Hinkov, H, Hu, C, Karam, EG, Lepine, JP, Levinson, D, Matschinger, H, Nakane, Y, Ormel, J, Posada-Villa, J, Scott, KM, Varghese, M, Williams, DR, Xavier, M, Kessler, RC (2012). Role of common mental and physical disorders in partial disability around the world. British Journal of Psychiatry 200, 454–461.CrossRefGoogle ScholarPubMed
Cassano, P, Fava, M (2002). Depression and public health: an overview. Journal of Psychosomatic Research 53, 849–857.CrossRefGoogle Scholar
Chodosh, J, Morton, SC, Mojica, W, Maglione, M, Suttorp, MJ, Hilton, L, Rhodes, S, Shekelle, P (2005). Meta-analysis: chronic disease self-management programs for older adults. Annals of Internal Medicine 143, 427–438.CrossRefGoogle ScholarPubMed
Cooke, D, Newman, S, Sacker, A, DeVellis, B, Bebbington, P, Meltzer, H (2007). The impact of physical illnesses on non-psychotic psychiatric morbidity: data from the household survey of psychiatric morbidity in Great Britain. British Journal of Health Psychology 12, 463–471.CrossRefGoogle ScholarPubMed
Department of Health (2008). Raising the Profile of Long Term Conditions Care: A Compendium of Information. Long Term Conditions Team, Department of Health: Leeds.Google Scholar
Egede, L (2007). Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General Hospital Psychiatry 29, 409–416.CrossRefGoogle ScholarPubMed
Eisner, MD, Blanc, PD, Yelin, EH, Katz, PP, Sanchez, G, Iribarren, C, Omachi, TA (2010). Influence of anxiety on health outcomes in COPD. Thorax 65, 229–234.CrossRefGoogle ScholarPubMed
Foster, G, Taylor, SJ, Eldridge, SE, Ramsay, J, Griffiths, CJ (2007). Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database of Systematic Reviews 2007, issue 4. Art. no.: CD005108. doi:10.1002/14651858.CD005108.pub2.CrossRefGoogle Scholar
Frasure-Smith, N, Lesperance, F, Gravel, G, Masson, A, Juneau, M, Talajic, M, Bourassa, MG (2000). Depression and health-care costs during the first year following myocardial infarction. Journal of Psychosomatic Research 48, 471–478.CrossRefGoogle ScholarPubMed
Ham, C, Dixon, J, Chantler, C (2011). Clinically integrated systems: the future of NHS reform in England? British Medical Journal 342, d905.CrossRefGoogle ScholarPubMed
Harpole, LH, Williams, JW Jr, Olsen, MK, Stechuchak, KM, Oddone, E, Callahan, CM, Katon, WJ, Lin, EH, Grypma, LM, Unützer, J (2005). Improving depression outcomes in older adults with comorbid medical illness. General Hospital Psychiatry 27, 4–12.CrossRefGoogle ScholarPubMed
Heliövaara, M, Aromaa, A, Klaukka, T, Knekt, P, Joukamaa, M, Impivaara, O (1993). Reliability and validity of interview data on chronic diseases. The Mini-Finland Health Survey. Journal of Clinical Epidemiology 46, 181–191.CrossRefGoogle ScholarPubMed
Institute of Medicine (2012). Living Well with Chronic Illness: A Call for Public Health Action. National Academies Press: Washington, DC.Google Scholar
Ipsos, MORI (2011). Long Term Health Conditions 2011 – Research Study. Department of Health: Leeds.Google Scholar
Jagger, C, Gillies, C, Moscone, F, Cambois, E, Van Oyen, H, Nusselder, W, Robine, J-M; the EHLEIS team (2008). Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet 372, 2124–2131.CrossRefGoogle ScholarPubMed
Jones, S, Howard, L, Thornicroft, G (2008). ‘Diagnostic overshadowing’: worse physical health care for people with mental illness. Acta Psychiatrica Scandinavica 118, 169–171.CrossRefGoogle ScholarPubMed
Karakus, MC, Patton, LC (2011). Depression and the onset of chronic illness in older adults: a 12-year prospective study. Journal of Behavioral Health Services and Research 38, 373–382.CrossRefGoogle ScholarPubMed
Katon, W, Ciechanowski, P (2002). Impact of major depression on chronic medical illness. Journal of Psychosomatic Research 53, 859–863.CrossRefGoogle ScholarPubMed
Katon, WJ, Lin, EH, Von Korff, M, Ciechanowski, P, Ludman, EJ, Young, B, Peterson, D, Rutter, CM, McGregor, M, McCulloch, D (2010). Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine 363, 2611–2620.CrossRefGoogle ScholarPubMed
Laurin, C, Labrecque, M, Dupuis, G, Bacon, SL, Cartier, A, Lavoie, KL (2009). Chronic obstructive pulmonary disease patients with psychiatric disorders are at greater risk of exacerbations. Psychosomatic Medicine 71, 667–674.CrossRefGoogle ScholarPubMed
Leventhal, H, Weinman, J, Leventhal, E, Phillips, LA (2008). Health psychology: the search for pathways between behavior and health. Annual Review of Psychology 59, 477–505.CrossRefGoogle ScholarPubMed
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine 22, 465–486.CrossRefGoogle ScholarPubMed
McManus, S, Meltzer, H, Brugha, T, Bebbington, P (editors) (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. NHS Information Centre for Health and Social Care: London.Google Scholar
Merikangas, KR, Ames, M, Cui, L, Stang, PE, Ustun, TB, Von Korff, M, Kessler, RC (2007). The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Archives of General Psychiatry 64, 1180–1188.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Malone, D, Doebbeling, CC (2009). Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. British Journal of Psychiatry 194, 491–499.CrossRefGoogle ScholarPubMed
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851–858.CrossRefGoogle ScholarPubMed
Mykletun, A, Overland, S, Dahl, AA, Krokstad, S, Bjerkeset, O, Glozier, N, Aarø, LE, Prince, M (2006). A population-based cohort study of the effect of common mental disorders on disability pension awards. American Journal of Psychiatry 163, 1412–1418.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2009). Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. National Clinical Practice Guideline 91. National Institute for Health and Clinical Excellence: London.Google Scholar
Ng, TP, Niti, M, Tan, WC, Cao, Z, Ong, KC, Eng, P (2007). Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Archives of Internal Medicine 167, 60–67.CrossRefGoogle ScholarPubMed
ONS (2006). Population estimates for UK, England and Wales, Scotland and Northern Ireland, mid 2006 (http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk-england-and-wales-scotland-and-northern-ireland/2006/index.html). Office for National Statistics.Google Scholar
Patten, SB (2001). Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. Journal of Affective Disorders 63, 35–41.CrossRefGoogle Scholar
Penninx, BW, Beekman, AT, Honig, A, Deeg, DJ, Schoevers, RA, van Eijk, JT, van Tilburg, W (2001). Depression and cardiac mortality: results from a community-based longitudinal study. Archives of General Psychiatry 58, 221–227.CrossRefGoogle ScholarPubMed
Rai, D, Kosidou, K, Lundberg, M, Araya, R, Lewis, G, Magnusson, C (2012). Psychological distress and risk of long-term disability: population-based longitudinal study. Journal of Epidemiology and Community Health 66, 586–592.CrossRefGoogle ScholarPubMed
Rai, D, Skapinakis, P, Wiles, N, Lewis, G, Araya, R (2010). Common mental disorders, subthreshold symptoms and disability: longitudinal study. British Journal of Psychiatry 197, 411–412.CrossRefGoogle ScholarPubMed
Ramey, DR, Fries, JF, Singh, G (1996). The Health Assessment Questionnaire 1995 – Status and Review. In Quality of Life and Pharmacoleconomics in Clinical Trials (ed. Spilker, B.), pp. 227–237. Lippincott-Raven: Philadelphia.Google Scholar
Rockhill, B, Newman, B, Weinberg, C (1998). Use and misuse of population attributable fractions. American Journal of Public Health 88, 15–19.CrossRefGoogle ScholarPubMed
Rollman, BL, Belnap, BH, LeMenager, MS, Mazumdar, S, Houck, PR, Counihan, PJ, Kapoor, WN, Schulberg, HC, Reynolds, CF 3rd (2009). Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial. Journal of the American Medical Association 302, 2095–2103.CrossRefGoogle ScholarPubMed
Rückinger, S, von Kries, R, Toschke, AM (2009). An illustration of and programs estimating attributable fractions in large scale surveys considering multiple risk factors. BMC Medical Research Methodology 9, 7.CrossRefGoogle ScholarPubMed
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption, part II. Addiction 88, 791–804.CrossRefGoogle Scholar
Schram, MT, Baan, CA, Pouwer, F (2009). Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Current Diabetes Review 5, 112–119.CrossRefGoogle ScholarPubMed
Scott, KM, Von Korff, M, Alonso, J, Angermeyer, MC, Bromet, E, Fayyad, J, de Girolamo, G, Demyttenaere, K, Gasquet, I, Gureje, O, Haro, JM, He, Y, Kessler, RC, Levinson, D, Medina Mora, ME, Oakley Browne, M, Ormel, J, Posada-Villa, J, Watanabe, M, Williams, D (2009). Mental-physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys. Psychological Medicine 39, 33–43.CrossRefGoogle ScholarPubMed
Simon, GE, Katon, WJ, Lin, EH, Rutter, C, Manning, WG, Von Korff, M, Ciechanowski, P, Ludman, EJ, Young, BA (2007). Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of General Psychiatry 64, 65–72.CrossRefGoogle ScholarPubMed
Snoek, FJ (2012). Strategies to optimise clinical outcomes for patients with diabetes. British Medical Journal 344, e2673.CrossRefGoogle Scholar
Spiegelman, D, Hertzmark, E, Wand, HC (2007). Point and interval estimates of partial population attributable risks in cohort studies: examples and software. Cancer Causes and Control 18, 571–579.CrossRefGoogle ScholarPubMed
Stafford, L, Berk, M, Reddy, P, Jackson, HJ (2007). Comorbid depression and health-related quality of life in patients with coronary artery disease. Journal of Psychosomatic Research 62, 401–410.CrossRefGoogle ScholarPubMed
Tinetti, ME, Studenski, SA (2011). Comparative effectiveness research and patients with multiple chronic conditions. New England Journal of Medicine 364, 2478–2481.CrossRefGoogle ScholarPubMed
Vogeli, C, Shields, AE, Lee, TA, Gibson, TB, Marder, WD, Weiss, KB, Blumenthal, D (2007). Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine 22 (Suppl. 3), 391–395.CrossRefGoogle ScholarPubMed
Vollebergh, WAM, Iedema, J, Bijl, RV, de Graaf, R, Ormel, J (2001). The structure and stability of common mental disorders. Archives of General Psychiatry 58, 597–603.CrossRefGoogle ScholarPubMed
Von Korff, M, Katon, WJ, Lin, EH, Ciechanowski, P, Peterson, D, Ludman, EJ, Young, B, Rutter, CM (2011). Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial. British Medical Journal 343, d6612.CrossRefGoogle ScholarPubMed
Whooley, M, Unützer, J (2010). Interdisciplinary stepped care for depression after acute coronary syndrome. Archives of Internal Medicine 170, 585–586.CrossRefGoogle ScholarPubMed
Xu, W, Collet, JP, Shapiro, S, Lin, Y, Yang, T, Platt, RW, Wang, C, Bourbeau, J (2008). Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. American Journal of Respiratory Critical Care Medicine 178, 913–920.CrossRefGoogle ScholarPubMed