title: Association of Mental Disorders With Subsequent Chronic Physical Conditions: World Mental Health Surveys From 17 Countries.
abstract: OBJECTIVE
  It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease.
  
  
  OBJECTIVE
  To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions.
  
  
  METHODS
  Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47,609 individuals; 2,032,942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV-identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015.
  
  
  METHODS
  Lifetime history of physical conditions was ascertained via self-report of physician's diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions.
  
  
  RESULTS
  Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets.
  
  
  CONCLUSIONS
  These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Scott
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Carmen
authors.initials: C
authors.lastname: Lim
authors.affiliation: College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Hamzawi
authors.affiliation: Hospital del Mar Research Institute, Par de Salut Mar, Barcelona, Spain4Pompeu Fabra University, and Centro de Investigación Biomedica en Red en Epidemiología y Salud Pública, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven, Campus Gasthuisberg, Gasthuisberg, Belgium.
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.affiliation: Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Caldas-de-Almeida
authors.affiliation: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.affiliation: St John of God Clinical Research Centre, and IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: Shenzhen Institute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China.
authors.forename: Chiyi
authors.initials: C
authors.lastname: Hu
authors.affiliation: University of Groningen, University Medical Center, Groningen Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation, Groningen, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.affiliation: Department of Mental Health, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
authors.affiliation: National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Moskalewicz
authors.affiliation: Institut Hospital del Mar d'Investigacio Medica-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Navarro-Mateu
authors.affiliation: School of Psychology, University of Ulster, Ulster, Northern Ireland.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: National Institute of Health, Lima, Peru.
authors.forename: Marina
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Universidad El Bosque, Bogota, Colombia.
authors.forename: José
authors.initials: J
authors.lastname: Posada-Villa
authors.affiliation: Center for Excellence on Research in Mental Health Medellin, Colombia.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Torres
authors.affiliation: Department of Health Care Policy, Harvard University Medical School, Boston, Massachusetts.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000569:Americas / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D055815:Young Adult