title: Psychological and physical co-morbidity among urban South African women.
abstract: OBJECTIVE
  There is substantial evidence for the links between poverty and both physical and mental health; but limited research on the relationship of physical and mental health problems exists in low- and middle-income countries. The objective of this paper is to evaluate the prevalence and co-morbidity of psychological distress among women with common physical diseases in a socio-economically disadvantaged urban area of South Africa.
  
  
  METHODS
  Women enrolled in the Birth to twenty (Bt20) cohort study were evaluated for this paper. Bt20 was founded in 1990 and has followed more than 3,000 children and their caregivers since birth; this study evaluates the health of the caregivers (average age 44) of these children. Psychological distress was evaluated by administering the General Health Questionnaire (GHQ-28) and we evaluated the presence of physical disease by self-report.
  
  
  RESULTS
  Forty percent of the sample presented with psychological distress using the GHQ scoring method. More than half of the women who reported a history of a physical disease, including diabetes, heart attack, asthma, arthritis, osteoporosis, epilepsy, and tuberculosis, reported psychological disorder. Presence of one physical disease was not associated with increased rates of psychological distress. However, women who reported two diseases had increased rates of psychological symptoms, and this upward trend continued with each additional physical disease reported (measured to five).
  
  
  CONCLUSIONS
  These data indicate high prevalence rates of co-morbid psychological distress among women with physical disease. This argues for the need of greater mental health support for women living with physical diseases.
authors.affiliation: Medical Research Council/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa ; Science, Technology, and International Affairs Program, Walsh School of Foreign Service, Georgetown University, Washington, District of Columbia, United States of America.
authors.forename: Emily
authors.initials: E
authors.lastname: Mendenhall
authors.forename: Linda M
authors.initials: LM
authors.lastname: Richter
authors.forename: Alan
authors.initials: A
authors.lastname: Stein
authors.forename: Shane A
authors.initials: SA
authors.lastname: Norris
mesh_terms: D000328:Adult; D002947:Cities / Q000453:epidemiology* / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology