Psychiatric-Medical ComorbidityChronic physical conditions and use of health services among persons with mental disorders — results from the Israel National Health Survey
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:
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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:
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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).
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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.
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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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