Tegethoff Marion, Stalujanis Esther, Belardi Angelo, Meinlschmidt Gunther
Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland.
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.
PLoS One. 2016 Oct 21;11(10):e0165196. doi: 10.1371/journal.pone.0165196. eCollection 2016.
The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.
This 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.
The 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).
Findings 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.
目的是评估患有身心共病的青少年中精神障碍与躯体疾病之间的时间关联。
本文基于美国全国青少年补充共病调查（参与者年龄：13 - 18岁）的加权数据（N = 6483），这是一个具有全国代表性的队列。使用完全结构化的世界卫生组织综合国际诊断访谈评估《精神障碍诊断与统计手册》第四版终生精神障碍的发病情况，并辅以家长报告。终生医疗状况和医生诊断疾病的发病情况通过自我报告进行评估。
精神障碍发病先于躯体疾病发病的最显著时间关联包括情感障碍与关节炎（风险比（HR）= 3.36，95%置信区间（CI）= 1.95至5.77）以及消化系统疾病（HR = 3.39，CI = 2.30至5.00）之间、焦虑障碍与皮肤病（HR = 1.53，CI = 1.21至1.94）之间、物质使用障碍与季节性过敏（HR = 0.33，CI = 0.17至0.63）之间。躯体疾病发病先于精神障碍发病的最显著时间关联包括心脏病与焦虑障碍（HR = 1.89，CI = 1.41至2.52）、癫痫与饮食障碍（HR = 6.27，CI = 1.58至24.96）以及心脏病与任何精神障碍（HR = 1.39，CI = 1.11至1.74）之间。
研究结果表明，精神障碍是生命早期某些躯体疾病的前期危险因素，但反之亦然。我们的结果将精神障碍的相关性从精神健康扩展到躯体健康护理，反之亦然，支持了更综合的身心健康护理方法的概念，并为早期疾病预防和更好的治疗开辟了新的起点，对各个医学学科都具有重要意义。
