- People with long-term noncommunicable diseases, such as chronic respiratory diseases, cardiovascular disease (CVD), and diabetes, are at higher risk of developing a mental health condition.
- A new observational study that followed more than 1 million Swedish residents found that having a psychiatric condition increased the risk of death in people with noncommunicable diseases.
- The researchers hope their study will help influence mental health screening and treatment for people living with noncommunicable diseases.
Noncommunicable diseases, which are conditions that are not caused by a pathogen, affect millions of people around the world.
The Centers for Disease Control and Prevention (CDC) estimates that each year, these conditions, including chronic respiratory disease, diabetesY CVD – because 41 million deaths around the world.
Noncommunicable diseases have long-term effects on the body, which is why they can have a profound impact on a person’s life. mental healthaccording to studies.
For example, people living with diabetes are in increased risk to develop anxiety, depressionY eating disorders. Furthermore, people with CVD have a higher probability to experience chronic stressmood disorders, anxiety and post-traumatic stress disorder.
Similarly, people who have chronic respiratory disease are in high risk of developing anxiety and mood disorders.
A research team from the University of Oxford in the UK has shown that the mortality risk among people living with a non-communicable disease is more than doubled if they also have a psychiatric condition.
The researchers believe that improving the evaluation, treatment and follow-up of people with psychiatric conditions could help reduce the mortality risk of people with chronic non-communicable diseases.
The results of this population-based cohort study appear in PLOS Medicine.
Comorbidity means that a person has more than one health condition. The authors of the present study were interested in analyzing cases of people with a non-communicable disease. Y a psychiatric condition.
Today’s medical news spoke with the lead author of the study Dr Seena FazelProfessor 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 in suicide or premature mortality from other conditions, such as epilepsy. Others focused on high-risk groups, such as people at liberty and the homeless.
“In this study, we wanted to examine the mortality risks of three common chronic non-communicable diseases, where the identification of modifiable psychiatric risk factors needed clarification,” he explained to MNT.
During the study, researchers examined data on 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. Disorders included depression, mood disorders, alcohol use disorderdrug use disorder, anxiety disorders, Personality disorder, Bipolar disorderY schizophrenia.
According to the study authors, more than a quarter of the participants had a concurrent lifetime diagnosis of a psychiatric disorder.
At the conclusion of the study, Dr. Fazel and his team found that within 5 years of being diagnosed with a noncommunicable disease, about 7% of the participants died of any cause. They also found that 0.3% of that same group died by suicide.
Researchers associate comorbid psychiatric disorders with higher all-cause mortality. People with chronic respiratory diseases and psychiatric comorbidity had a premature death rate of 15.4%, compared to 5.5% in people with chronic respiratory diseases alone.
Likewise, people with CVD and psychiatric comorbidity had premature mortality rates of 21.1%, compared to 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. People with CVD and psychiatric comorbidity had suicide rates of 1.6%, compared to a suicide rate of 0.1% in people with CVD without psychiatric comorbidity.
The noncommunicable diseases included in the study have a genetic component, so the researchers adjusted their analysis to include siblings as participants in the control group.
They found that premature death and suicide were more common in people with a noncommunicable disease and a psychiatric condition than in a sibling without one.
“Using large population-based data sets that included sibling controls, to better account for confounders, allowed precision in risk estimates,” explained Dr. Fazel.
Discussing the study’s limitations, 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 may help impact screening for comorbid psychiatric conditions in people with NCDs in the future.
“An important implication is that older people admitted to general hospitals with these noncommunicable diseases may miss depression and co-occurring substance use disorders,” he explained. “Our work highlights that these comorbidities are common and important to treat to reduce mortality risks.”
“Second, the role of primary care in diagnosing and treating these comorbidities is another implication, as we know that early intervention improves prognosis,” Dr. Fazel continued.
“Third, even if you detect these psychiatric comorbidities, people need to be linked to effective interventions together. The fragmentation of services into separate general medicine, mental health and addiction services is unlikely to facilitate the identification, treatment and follow-up of people with multimorbidities”.
Dr. David A. Merrilladult and geriatric psychiatrist and director of the Pacific Brain Health Center at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA, also spoke with MNT regarding this study.
He explained that if it isn’t already, screening for psychiatric conditions, such as depression and anxiety, should be a standard part of a medical evaluation for treatment of chronic systemic medical conditions.
He believes these findings support routine screening for depression and anxiety when patients present for medical care.
“It’s very important to make the explicit connection that physical health and mental health go hand in hand,” explained Dr. Merrill.
“You can’t really separate the two, trying to separate them is an artificial construct. We really need to know that addressing physical health helps mental health, and vice versa. Mental health should always be considered when it comes to treating someone’s physical symptoms.”
– David A. Merrill, MD
Dr. Merrill also noted that because noncommunicable diseases affect end-organ function, they have a direct impact on what he calls the final end-organ: 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 have a huge impact on frontal lobe function, so it makes sense that people with systemic illnesses would have more stress on their brain function. So it’s even more important to check in and check in and make sure patients with these medical conditions are getting their mental health needs met.”
As for the next steps in this research, Dr. Fazel said this will include understanding the biological and psychological mechanisms of this increased mortality and suicide risk.
“Our own work is trying to develop simple and scalable ways to predict suicide risk in high-risk populations, and we have published a free online risk calculator for suicide risk called OxMIS for people with serious mental illness,” he said.
“We are conducting a series of studies that extend this predictive modeling work to other high-risk groups, including people who have self-harmed.”
