Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents

Abstract

BackgroundThe objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.MethodsThis 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.ResultsThe 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).ConclusionsFindings 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.

Chronicity of mental comorbidity in children with new‐onset physical illness

“…Converging findings from recent population and clinical studies suggest that children, adolescents, and young people with chronic physical illnesses are disproportionately affected by mental illness compared with those without physical illness (Butler et al, ; Ferro, ; Tegethoff, Belardi, Stalujanis, & Meinlschmidt, ). Collectively, these studies have provided robust evidence that the risk for mental illness is similar across different physical illnesses (Ferro, ; Merikangas et al, ; Tegethoff et al, ; Tegethoff, Stalujanis, Belardi, & Meinlschmidt, ). Findings show that the magnitudes of association between physical and mental illness are relatively homogeneous, suggesting a common underlying risk for these children and supporting the noncategorical approach to studying the burden and outcomes of physical illness in pediatric populations (Stein & Silver, ).…”

“…The few prospective studies that have investigated aspects of chronicity present some limitations: focus on a single physical and mental illness (Butwicka, Frisen, Almqvist, Zethelius, & Lichtenstein, ); conduct cross‐sectional analysis of longitudinal data (Jones et al, ); or examine the chronicity of the physical but not mental illness (Goodwin et al, ; Quach & Barnett, ). Although most research examines the onset of mental illness following a diagnosis of a physical illness, there is some evidence that the relationship may be bidirectional and mediated by shared biological or psychosocial mechanisms (Tegethoff et al, ).…”

Anxiety and malocclusion are associated with temporomandibular disorders in adolescents diagnosed by RDC/TMD. A cross‐sectional study

“…It is well known that psychosocial problems in children and adolescents are more frequent than in the past, and also that they are an association of mental disorders and physical diseases in adolescents with mental‐physical comorbidity . In adolescents, there is a positive correlation between increased age and the presence of signs and symptoms of TMD, so the emotional aspects seem to be significant factors in the presence of those disorders .…”

Enhancing metabolic monitoring for children and adolescents using second‐generation antipsychotics

“…Age-inappropriate weight gain is associated with an increased risk of obesity, metabolic syndrome, diabetes, and cardiovascular disease in adulthood (Maayan & Correll 2010;Panagiotopoulos et al 2009;Tegethoff et al 2016). Age-inappropriate weight gain is associated with an increased risk of obesity, metabolic syndrome, diabetes, and cardiovascular disease in adulthood (Maayan & Correll 2010;Panagiotopoulos et al 2009;Tegethoff et al 2016).…”

“…Of particular concern in paediatric populations is the development of rapid and significant weight gain during critical periods of development. Age-inappropriate weight gain is associated with an increased risk of obesity, metabolic syndrome, diabetes, and cardiovascular disease in adulthood (Maayan & Correll 2010;Panagiotopoulos et al 2009;Tegethoff et al 2016). Weight gain affecting children and adolescents prescribed psychotropic medication can impact their self-image and lead to distress and social isolation, which impedes improvement of psychiatric symptoms and contributes to decreased compliance to SGA treatment and quality of life (McCloughen & Foster 2011;Monteleone et al 2009).…”