title: Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents.
abstract: BACKGROUND
  The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.
  
  
  METHODS
  This article bases upon weighted data (N = 6483) from the National Comorbidity Survey Adolescent Supplement (participant age: 13-18 years), a nationally representative United States cohort. Onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders was assessed with the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Onset of lifetime medical conditions and doctor-diagnosed diseases was assessed by self-report.
  
  
  RESULTS
  The most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63). The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74).
  
  
  CONCLUSIONS
  Findings suggest that mental disorders are antecedent risk factors of certain physical diseases in early life, but also vice versa. Our results expand the relevance of mental disorders beyond mental to physical health care, and vice versa, supporting the concept of a more integrated mental-physical health care approach, and open new starting points for early disease prevention and better treatments, with relevance for various medical disciplines.
authors: Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland.
authors: Marion
authors: M
authors: Tegethoff
authors: Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland.
authors: Esther
authors: E
authors: Stalujanis
authors: Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland.
authors: Angelo
authors: A
authors: Belardi
authors: Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.|Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany.
authors: Gunther
authors: G
authors: Meinlschmidt
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D011795:Surveys and Questionnaires