Epidemiology Department, Columbia Mailman School of Public Health, United States.
Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
J Affect Disord. 2017 Oct 1;220:1-7. doi: 10.1016/j.jad.2017.05.027. Epub 2017 May 15.
We assessed comorbid associations of 12-month DSM-IV mood/any anxiety disorders with chronic physical conditions within the São Paulo (SP) Megacity Mental Health cross-sectional survey of 5037 participants and explored whether strength of comorbid associations were modified when controlling for demographics.
Chi-square tests and logistic regressions were used to examine comorbid associations of DSM-IV mood/anxiety disorders as measured by the WHO Composite International Diagnostic Interview (CIDI 3.0), and self-reported chronic physical conditions among adults from the SP Megacity Mental Health Survey.
Among those with any mood or anxiety disorder, chronic pain disorder was the most common physical condition (48.9% and 44.9%, respectively). Significant unadjusted odds ratios (OR) of comorbidity were found between diagnosis of two or more physical conditions and any mood disorders (3.08, 95% CI: 2.27-4.17), and any anxiety disorders (2.49, 95% CI: 1.95-3.17). Comorbidities remained significant when stratified by gender and controlling for marital status, household income, and education (latter two only included within anxiety models).
These results cannot be generalized to other cities or rural populations. Homeless and institutionalized populations were not surveyed. Due to cross-sectional study design, the direction of association between chronic disease/chronic disease risk factors and mood disorders is unclear.
Dual burden of chronic physical conditions and mood/anxiety disorders is a notable problem among the São Paulo Megacity Survey population, with enhanced comorbidity experienced by community members with multiple physical conditions. Clinicians should consider these findings in understanding healthcare delivery for individuals suffering from both psychiatric disorders and chronic physical conditions.
我们评估了 12 个月 DSM-IV 心境/任何焦虑障碍与圣保罗（SP）大都市横断面调查 5037 名参与者中的慢性躯体疾病的共病关联，并探讨了当控制人口统计学因素时，共病关联的强度是否发生了变化。
采用卡方检验和逻辑回归检验 WHO 复合国际诊断访谈（CIDI 3.0）测量的 DSM-IV 心境/焦虑障碍与 SP 大都市心理健康调查中成年人自我报告的慢性躯体疾病之间的共病关联。
在患有任何心境或焦虑障碍的人中，慢性疼痛障碍是最常见的躯体疾病（分别为 48.9%和 44.9%）。在诊断两种或多种躯体疾病和任何心境障碍（3.08，95%CI：2.27-4.17）以及任何焦虑障碍（2.49，95%CI：1.95-3.17）之间，发现未调整的比值比（OR）具有显著的共病关系。当按性别分层并控制婚姻状况、家庭收入和教育程度（后两者仅包括在焦虑模型中）时，共病仍然显著。
这些结果不能推广到其他城市或农村地区。无家可归者和收容所居民未接受调查。由于横断面研究设计，慢性疾病/慢性疾病危险因素与心境障碍之间的关联方向尚不清楚。
慢性躯体疾病和心境/焦虑障碍的双重负担是圣保罗大都市调查人群中的一个显著问题，患有多种躯体疾病的社区成员的共病率更高。临床医生应在理解同时患有精神疾病和慢性躯体疾病的个体的医疗保健服务时考虑到这些发现。
