Elsevier

General Hospital Psychiatry

Volume 30, Issue 3, May–June 2008, Pages 226-232
General Hospital Psychiatry

Psychiatric-Medical Comorbidity
Chronic physical conditions and use of health services among persons with mental disorders — results from the Israel National Health Survey

https://doi.org/10.1016/j.genhosppsych.2008.02.007Get rights and content

Abstract

Objective

This study aimed to determine the association between common mental disorders and common chronic physical conditions and the contribution of mental disorders to the likelihood of being a higher user of health services.

Method

A representative sample extracted from the National Population Register of noninstitutionalized residents of Israel aged 21 or older were interviewed at their homes between May 2003 and April 2004. Mental disorders were assessed using a revised version of the World Mental Health Composite International Diagnostic Interview. Chronic physical conditions were measured via a checklist of chronic physical disorders.

Results

Current mood or anxiety disorders were found to be associated with higher likelihood of chronic pain, cardiovascular conditions, diabetes and respiratory conditions beyond the sociodemographic characteristics and the risk factors (BMI or smoking). Current mood or anxiety disorders increased the likelihood of being a higher user of primary care beyond the effects of gender, population group, self-evaluation of general health, chronic pain or chronic conditions.

Conclusion

The results regarding the prevalence of mental–physical comorbidity emphasize the need for integration in the physical and mental care of people with mental disorders.

Introduction

The comorbidity of physical and mental disorders was documented in clinical settings and in general population surveys [1], [2], [3]. There is also considerable evidence that comorbid depression is related to increased use of medical resources and costs [4], [5], [6], [7], amplification of physical symptoms [8], additive functional impairment [1], [3] and decreased ability to adhere to medications [8], [9].

The Israel National Health Survey (INHS) 2003–2004 [10] was the first to assess common mental disorders in the general adult population in Israel and provides for the first time the opportunity to check both the comorbidity of chronic physical and mental disorders in the general population and the effects of mental disorders on the use of general health services.

The objectives of the current investigation were to (a) determine the association between Any Mood, Anxiety or Substance Abuse Disorders (AMASD) and common chronic physical conditions after adjusting for sociodemographic and health risk factors and to (b) determine the unique contribution of chronic physical conditions and AMASD to the likelihood of being higher users of primary care and hospitalization among young adults, middle-age adults and old people.

Section snippets

Methods

The Israeli survey is part of the World Health Organization (WHO) World Mental Health (WMH) Surveys Initiative and followed the procedures established by it. The sample was extracted from the National Population Register and comprised noninstitutionalized de jure residents aged 21 and above. The sample was representative of the adult population, reflecting its distribution by gender, age groups and population groups: Arabs, immigrants (post-1990 immigrants from the former USSR) and Jews and

Chronic physical condition status of people with mental disorders

Two thirds [66.6% (62.1–70.8)] of the population with AMASD have at least one of the chronic physical conditions or any chronic pains included in the survey compared with less than half [46.2% (44.8–47.7)] of the population who suffer from these conditions among those without mental disorders.

Table 1 shows the prevalence of several chronic conditions among people with and without AMASD. Those with mental disorders had higher rates of chronic pain [56.1% (50.7–61.4) vs. those without mental

Discussion

The current investigation replicates previous studies from other countries showing high levels of comorbidity between common mental disorders and chronic physical conditions/disorders. The results highlight the following facts:

  • 1.

    Adults with common mental disorders in Israel, in all age groups, carry a higher burden of chronic physical conditions (and chronic pains) than age-matched adults without mental disorders. Two thirds (66.6%) of adults aged 21 and above with AMASD had at least one of the

Key points

The following are the key points of this study:

  • Current mood or anxiety disorders increased the odds of having chronic pain, cardiovascular conditions, diabetes and respiratory conditions beyond the sociodemographic characteristics and the risk factors (BMI or smoking).

  • Current mood or anxiety disorders increased the likelihood of being a higher user of primary care beyond the effects of gender, population group, self-evaluation of general health, chronic pain or other chronic conditions.

  • Current

Acknowledgments

The National Health Survey was funded by the Ministry of Health with additional support from the Israel National Institute for Health Policy and Health Services Research and the Israel National Insurance Institute. The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or of the government.

The Israel Health Survey was carried out in conjunction with the WHO/WMH Survey Initiative. We

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