Institute of Health and Wellbeing, Mental Health and Wellbeing Research Group, University of Glasgow, Glasgow, UK.
NHS Greater Glasgow and Clyde, East Renfrewshire Integrated Learning Disability Team, Barrhead Health & Care Centre, Barrhead, UK.
J Intellect Disabil Res. 2018 May;62(5):444-453. doi: 10.1111/jir.12483. Epub 2018 Mar 12.
People with intellectual disabilities face a much greater burden and earlier onset of physical and mental ill-health than the general adult population. Physical-mental comorbidity has been shown to result in poorer outcomes in the general population, but little is known about this relationship in adults with intellectual disabilities.
To identify whether physical ill-health is associated with mental ill-health in adults with intellectual disabilities and whether the extent of physical multi-morbidity can predict the likelihood of mental ill-health. To identify any associations between types of physical ill-health and mental ill-health.
A total of 1023 adults with intellectual disabilities underwent comprehensive health assessments. Binary logistic regressions were undertaken to establish any association between the independent variables: total number of physical health conditions, physical conditions by International Classification of Disease-10 chapter and specific physical health conditions; and the dependent variables: problem behaviours, mental disorders of any type. All regressions were adjusted for age, gender, level of intellectual disabilities, living arrangements, neighbourhood deprivation and Down syndrome.
The extent of physical multi-morbidity was not associated with mental ill-health in adults with intellectual disabilities as only 0.8% of the sample had no physical conditions. Endocrine disease increased the risk of problem behaviours [odds ratio (OR): 1.22, 95% confidence interval (CI): 1.02-1.47], respiratory disease reduced the risk of problem behaviours (OR: 0.73, 95% CI: 0.54-0.99) and mental ill-health of any type (OR: 0.73, 95% CI: 0.58-0.92), and musculoskeletal disease reduced the risk of mental ill-health of any type (OR: 0.84, 95% CI: 0.73-0.98). Ischaemic heart disease increased the risk of problem behaviours approximately threefold (OR: 3.29, 95% CI: 1.02-10.60).
The extent of physical multi-morbidity in the population with intellectual disabilities is overwhelming, such that associations are not found with mental ill-health. Mental health interventions and preventative measures are essential for the entire population with intellectual disabilities and should not be focussed on subgroups based on overall health burden.
与普通成年人群体相比，智力残疾者面临更大的身心疾病负担和更早的身心疾病发病。身体-心理合并症已被证明会导致普通人群的预后更差，但对于智力残疾成年人，人们对此类关系知之甚少。
确定身体不适是否与智力残疾成年人的心理健康相关，以及身体多病的严重程度是否可以预测心理健康不佳的可能性。确定身体不适的类型与心理健康不佳之间的任何关联。
共有 1023 名智力残疾成年人接受了全面的健康评估。采用二元逻辑回归分析，确定独立变量（身体疾病的总数、国际疾病分类-10 章的身体疾病和特定的身体疾病）与因变量（任何类型的行为问题、精神障碍）之间的任何关联。所有回归均根据年龄、性别、智力残疾程度、居住安排、社区贫困程度和唐氏综合征进行调整。
身体多病的严重程度与智力残疾成年人的心理健康不佳无关，因为只有 0.8%的样本没有身体疾病。内分泌疾病增加行为问题的风险[优势比（OR）：1.22，95%置信区间（CI）：1.02-1.47]，呼吸道疾病降低行为问题的风险（OR：0.73，95%CI：0.54-0.99）和任何类型的精神健康问题（OR：0.73，95%CI：0.58-0.92），肌肉骨骼疾病降低任何类型的精神健康问题的风险（OR：0.84，95%CI：0.73-0.98）。缺血性心脏病使行为问题的风险增加约三倍（OR：3.29，95%CI：1.02-10.60）。
智力残疾人群中身体多病的程度是压倒性的，因此与心理健康不佳没有关联。对于整个智力残疾人群体，心理健康干预和预防措施至关重要，而不应根据总体健康负担将其重点放在亚组上。
