Prospective Associations between Chronic Diseases and Three Year Incidence of DSM-IV Psychiatric Disorders. Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

The strong associations between chronic medical illnesses and psychiatric disorders are well documented. Further, this physical-mental comorbidity is associated with increased medical costs, amplification of somatic symptoms, increased morbidity and mortality from physical illnesses, and reduced quality of life. However, most previous studies are cross-sectional and large-scale nationwide prospective data remain scarce. In the current investigation we conducted a three-year follow up study of the prediction of incident psychiatric disorders by chronic medical conditions. Data were collected in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Predictors were self reported past year health care provider-diagnosed chronic diseases at baseline (2001-2). Outcomes were three year incidences of DSM-IV psychiatric disorders assessed at follow up (2004-5). In addition to sociodemographic characteristics and health-related risky behaviors, e.g., BMI status: under weight, normal, overweight and obese; and smoking and drinking status, we controlled for comorbid physical and psychiatric disorders at baseline in multivariable logistic regression analyses. Gastric ulcer predicted the largest number of psychiatric disorders: major depressive, panic, social phobia and generalized anxiety (ORs= 1.50 - 1.82, all ps < 0.05). Hypertension and arthritis predicted an equal number of incident psychiatric disorders (ORs= 1.37 - 2.04, all ps < 0.05). Coronary heart disease doubled the risk of incident panic disorder. Our findings highlight the need for front-line clinicians to recognize the mental health implications of medical illnesses identified in primary care and initiate appropriate treatments that may mitigate the mental health risks of chronic medical conditions.