- People with long-term noncommunicable diseases, such as chronic respiratory disease, cardiovascular disease (CVD), and diabetes, are at increased risk of developing a mental health condition.
- A new observational study following over 1 million Swedish residents found that having a psychiatric condition increased the risk of death in people with noncommunicable diseases.
- The researchers hope that their study will help influence mental health screening and treatment for people living with noncommunicable diseases.
Noncommunicable diseases, which are conditions that are not due to a pathogen, affect millions of people the world over.
The Centers for Disease Control and Prevention (CDC) estimate that each year, these conditions — including chronic respiratory disease, diabetes, and CVD — cause 41 million deaths worldwide.
Noncommunicable diseases have long-term effects on the body, and that is why they can have a profound impact on a person’s mental health, according to research.
For instance, people living with diabetes are at increased risk of developing anxiety, depression, and eating disorders. Moreover, individuals with CVD have a higher likelihood of experiencing chronic stress, mood disorders, anxiety, and post-traumatic stress disorder.
Similarly, people who have a chronic respiratory disease are at elevated risk of developing anxiety and mood disorders.
A research team from the University of Oxford in the United Kingdom has shown that the mortality risk among people living with a noncommunicable disease is more than doubled if they also have a psychiatric condition.
The researchers believe that improving the assessment, treatment, and follow-up of people with psychiatric conditions could help reduce the mortality risk for those with chronic noncommunicable diseases.
The results of this population-based cohort study appear in PLOS Medicine.
What is comorbidity?
Comorbidity means that a person has more than one health condition. The authors of the current study were interested in analyzing cases of individuals with a noncommunicable disease and a psychiatric condition.
Medical News Today spoke with the study’s lead author Dr. Seena Fazel, a professor of forensic psychiatry and honorary consultant forensic psychiatrist at the University of Oxford.
He explained that previous studies revolved around the effects of psychiatric comorbidities on suicide or premature mortality from other conditions, such as epilepsy. Others focused on groups at high risk, such as individuals on release from prison and people without housing.
“In this study, we wanted to examine mortality risks for three common chronic noncommunicable diseases, where identification of modifiable psychiatric risk factors needed clarification,” he explained to MNT.
Psychiatric comorbidity and noncommunicable diseases
During the study, the researchers examined data from 1,074,222 people born between 1932 and 1995. Of the participants, 255,579 had diabetes, 249,825 had chronic respiratory diseases, and 568,818 had CVD.
The researchers also identified psychiatric disorders using medical records. The disorders included depression, mood disorders, alcohol use disorder, drug misuse disorder, anxiety disorders, personality disorders, bipolar disorder, and schizophrenia.
According to the study authors, more than one-quarter of the participants had a co-occurring lifetime diagnosis of a psychiatric disorder.
Analyzing the results
At the conclusion of the study, Dr. Fazel and his team found that within 5 years of diagnosis of a noncommunicable disease, about 7% of the participants died from any cause. They also found that 0.3% of that same group died by suicide.
The researchers associate comorbid psychiatric disorders with higher all-cause mortality. People with chronic respiratory disease and psychiatric comorbidity had a premature death rate of 15.4%, compared with 5.5% in individuals with chronic respiratory disease alone.
Likewise, people with CVD and psychiatric comorbidity showed premature mortality rates of 21.1%, compared with 9.1% for those without comorbid psychiatric disorders.
The study authors also found that the suicide rate was higher in people with comorbid psychiatric disorders. Individuals with CVD and psychiatric comorbidity showed suicide rates of 1.6%, compared with a 0.1% suicide rate in those with CVD without psychiatric comorbidity.
The noncommunicable diseases included in the study have a genetic component, which is why the researchers adjusted their analysis to include siblings as the participants in the control group.
They found that premature death and suicide were more common in people with both a noncommunicable disease and a psychiatric condition than they were in a sibling with neither.
“The use of large population-based data sets that included sibling controls — to better account for confounds — allowed for precision in the risk estimates,” Dr. Fazel explained.
Affecting future diagnosis and treatment
Discussing the limitations of the study, the authors explain how they “relied on secondary care data to assess psychiatric comorbidities, which may have led to missing some patients with less severe comorbidities.”
However, Dr. Fazel believes this research can help impact screening for comorbid psychiatric conditions in people with noncommunicable diseases in the future.
“One important implication is that older people admitted to general hospitals with these noncommunicable diseases can have co-occurring depression and substance use disorders overlooked,” he explained. “Our work highlights that these comorbidities are common and important to treat to reduce mortality risks.”
“Second, the role of primary care to diagnose and treat these comorbidities is another implication — as we know that early intervention improves prognosis,” Dr. Fazel continued.
“Third, even if you screen for these psychiatric comorbidities, individuals need to be linked to effective interventions in a joined-up way. The fragmentation of services into separate general medical, mental health, and addiction services is unlikely to facilitate the identification, treatment, and follow-up of people with multimorbidities.”
Dr. David A. Merrill, an adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, CA, also spoke with MNT regarding this study.
He explained that if it is not already, screening for psychiatric conditions, such as depression and anxiety, should be a standard part of a medical evaluation for the treatment of systemic chronic medical illnesses.
He believes these findings support routine screening for depression and anxiety when patients present for care for medical reasons.
“It’s very important to make the explicit connection that physical health and mental health go hand in hand,” Dr. Merrill explained.
“You can’t really separate the two — trying to separate the two is an artificial construct. We really need to know that addressing physical health helps mental health, and vice versa. Mental health always needs to be taken into account when trying to treat someone’s physical symptoms.”
– Dr. David A. Merrill
Dr. Merrill also pointed out that, because noncommunicable diseases affect end organ function, they have a direct impact on what he calls the ultimate end organ — the brain.
“Mood and thoughts about suicide often arise in the frontal lobe of the brain,” he explained. “We know that oxygenation, blood supply, and blood sugar levels highly impact the function of the frontal lobe, so it makes sense that individuals with systemic diseases have more stress on their brain function. So it’s all the more important to check in and check up and make sure patients with these medical conditions are having their mental health needs met.”
As for the next steps for this research, Dr. Fazel said this will include understanding the biological and psychological mechanisms for this increased mortality and suicide risk.
“Our own work is trying to develop simple and scalable ways to predict the risk of suicide in high-risk populations, and we have published a free online risk calculator for suicide risk called OxMIS for people with severe mental illness,” he said.
“We are conducting a series of studies extending this prediction modeling work to other high-risk groups, including people who have self-harmed.”
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