Hanna Matthew R, Caspi Avshalom, Houts Renate M, Moffitt Terrie E, Torvik Fartein Ask
Department of Psychology & Neuroscience, Duke University, Durham, NC, USA.
Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
Psychol Med. 2024 Nov 18;54(15):1-13. doi: 10.1017/S0033291724002575.
Mental disorders and physical-health conditions frequently co-occur, impacting treatment outcomes. While most prior research has focused on single pairs of mental disorders and physical-health conditions, this study explores broader associations between multiple mental disorders and physical-health conditions.
Using the Norwegian primary-care register, this population-based cohort study encompassed all 2 203 553 patients born in Norway from January 1945 through December 1984, who were full-time residents from January 2006 until December 2019 (14 years; 363 million person-months). Associations between seven mental disorders (sleep disturbance, anxiety, depression, acute stress reaction, substance-use disorders, phobia/compulsive disorder, psychosis) and 16 physical-health conditions were examined, diagnosed according to the International Classification of Primary Care.
Of 112 mental-disorder/physical-health condition pairs, 96% of associations yielded positive and significant ORs, averaging 1.41 and ranging from 1.05 (99.99% CI 1.00-1.09) to 2.38 (99.99% CI 2.30-2.46). Across 14 years, every mental disorder was associated with multiple different physical-health conditions. Across 363 million person-months, having any mental disorder was associated with increased subsequent risk of all physical-health conditions (HRs:1.40 [99.99% CI 1.35-1.45] to 2.85 [99.99% CI 2.81-2.89]) and vice versa (HRs:1.56 [99.99% CI 1.54-1.59] to 3.56 [99.99% CI 3.54-3.58]). Associations were observed in both sexes, across age groups, and among patients with and without university education.
The breadth of associations between virtually every mental disorder and physical-health condition among patients treated in primary care underscores a need for integrated mental and physical healthcare policy and practice. This remarkable breadth also calls for research into etiological factors and underlying mechanisms that can explain it.
精神障碍与身体健康状况经常同时出现，影响治疗效果。虽然大多数先前的研究集中在精神障碍与身体健康状况的单一配对上，但本研究探讨了多种精神障碍与身体健康状况之间更广泛的关联。
利用挪威初级保健登记册，这项基于人群的队列研究涵盖了1945年1月至1984年12月在挪威出生的所有2203553名患者，他们从2006年1月至2019年12月为全职居民（14年；3.63亿人月）。根据国际初级保健分类，研究了七种精神障碍（睡眠障碍、焦虑、抑郁、急性应激反应、物质使用障碍、恐惧症/强迫症、精神病）与16种身体健康状况之间的关联。
在112对精神障碍/身体健康状况中，96%的关联产生了正向且显著的比值比，平均为1.41，范围从1.05（99.99%CI 1.00 - 1.09）到2.38（99.99%CI 2.30 - 2.46）。在14年期间，每种精神障碍都与多种不同的身体健康状况相关联。在3.63亿人月的时间里，患有任何精神障碍都与随后所有身体健康状况的风险增加相关（风险比：1.40[99.99%CI 1.35 - 1.45]至2.85[99.99%CI 2.81 - 2.89]），反之亦然（风险比：1.56[99.99%CI 1.54 - 1.59]至3.56[99.99%CI 3.54 - 3.58]）。在不同性别、年龄组以及有无大学教育的患者中均观察到了关联。
在初级保健中接受治疗的患者中，几乎每种精神障碍与身体健康状况之间关联的广度凸显了综合精神和身体医疗保健政策及实践的必要性。这种显著的广度也呼吁对能够解释它的病因因素和潜在机制进行研究。
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