Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.
Psychol Med. 2013 May;43(5):921-31. doi: 10.1017/S0033291712001705. Epub 2012 Aug 21.
Long-term physical conditions (LTCs) consume the largest share of healthcare budgets. Although common mental disorders (CMDs) and LTCs often co-occur, the potential impact of improved mental health treatment on severe disability and hospital admissions for physical health problems remains unknown. Method A cross-sectional study of 7403 adults aged 16-95 years living in private households in England was performed. LTCs were ascertained by prompted self-report. CMDs were ascertained by structured clinical interview. Disability was assessed using questions about problems with activities of daily living. Population impact and potential preventive gain were estimated using population-attributable fraction (PAF), and conservative estimates were obtained using 'treated non-cases' as the reference group.
Of the respondents, 20.7% reported at least one LTC. The prevalence of CMDs increased with the number of LTCs, but over two-thirds (71.2%) of CMD cases in people with LTCs were untreated. Statistically significant PAFs were found for CMDs and recent hospital admission [13.5%, 95% confidence intervals (CI) 6.6-20.0] and severe disability (31.3%, 95% CI 27.1-35.2) after adjusting for LTCs and other confounders. Only the latter remained significant when using the most conservative estimate of PAF (21.8%, 95% CI 14.0-28.9), and this was reduced only slightly when considering only participants with LTCs (18.5%, 95% CI 7.9-27.9).
Better treatments for CMDs in people with LTCs could achieve almost the same population health gain in terms of reducing severe disability as those targeted at the entire population. Interventions to reduce the prevalence of CMDs among people with LTCs should be part of routine medical care.
长期身体状况（LTCs）占据医疗保健预算的最大份额。尽管常见精神障碍（CMDs）和 LTCs 通常同时发生，但改善心理健康治疗对严重残疾和因身体健康问题住院的潜在影响尚不清楚。方法：对居住在英格兰私人住宅中的 7403 名 16-95 岁成年人进行了一项横断面研究。通过提示性自我报告确定 LTCs。通过结构化临床访谈确定 CMDs。使用有关日常生活活动问题的问题评估残疾。使用人群归因分数（PAF）估计人群影响和潜在预防收益，并使用“治疗非病例”作为参考组获得保守估计。
在受访者中，有 20.7%报告至少有一种 LTC。CMDs 的患病率随 LTCs 的数量增加而增加，但超过三分之二（71.2%）的有 LTCs 的 CMD 病例未经治疗。调整 LTCs 和其他混杂因素后，发现 CMDs 和最近住院的统计上显著 PAF[13.5%，95%置信区间（CI）6.6-20.0]和严重残疾（31.3%，95%CI 27.1-35.2]。使用 PAF 的最保守估计（21.8%，95%CI 14.0-28.9）时，只有后者仍然具有统计学意义，而仅考虑有 LTCs 的参与者时，这一数字仅略有下降（18.5%，95%CI 7.9-27.9）。
在有 LTCs 的人群中更好地治疗 CMDs，可以在减少严重残疾方面实现与针对整个人群相同的人群健康收益。减少有 LTCs 的人群中 CMDs 患病率的干预措施应成为常规医疗护理的一部分。
