Association between Mental Disorders and Subsequent Medical Conditions.
Adult
Cardiovascular Diseases
/ etiology
Cohort Studies
Denmark
/ epidemiology
Disease
/ etiology
Female
Female Urogenital Diseases
/ etiology
Humans
Male
Male Urogenital Diseases
/ etiology
Mental Disorders
/ complications
Middle Aged
Musculoskeletal Diseases
/ etiology
Neoplasms
/ etiology
Risk
Schizophrenia
/ complications
Sex Factors
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
30 04 2020
30 04 2020
Historique:
entrez:
30
4
2020
pubmed:
30
4
2020
medline:
19
5
2020
Statut:
ppublish
Résumé
Persons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions. We used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses. A total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder. Most mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753.).
Sections du résumé
BACKGROUND
Persons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions.
METHODS
We used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses.
RESULTS
A total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder.
CONCLUSIONS
Most mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753.).
Identifiants
pubmed: 32348643
doi: 10.1056/NEJMoa1915784
pmc: PMC7261506
mid: NIHMS1590466
doi:
Banques de données
ClinicalTrials.gov
['NCT03847753']
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1721-1731Subventions
Organisme : National Health and Medical Research Council
ID : Senior Principal Research Fellowship
Pays : International
Organisme : NIEHS NIH HHS
ID : R01 ES026993
Pays : United States
Organisme : H2020 Marie Skłodowska-Curie Actions
ID : 837180
Pays : International
Organisme : Det Frie Forskningsråd
ID : 8020-00013B
Pays : International
Organisme : Lundbeckfonden
ID : R278-2018-1411
Pays : International
Organisme : Lundbeckfonden
ID : R155-2012-11280
Pays : International
Organisme : National Health and Medical Research Council
ID : John Cade Fellowship (APP1056929)
Pays : International
Organisme : Lundbeckfonden
ID : R248-2017-2003
Pays : International
Organisme : Lundbeckfonden
ID : R276-2017-4581
Pays : International
Organisme : Helsefonden
ID : Grant 19-8-0260
Pays : International
Organisme : NIH HHS
ID : R01, grant ES026993
Pays : United States
Organisme : Aarhus Universitets Forskningsfond
ID : AUFF-E-2015-FLS-8-61
Pays : International
Organisme : Lundbeckfonden
ID : iPSYCH grant R102-A9118
Pays : International
Organisme : Lundbeckfonden
ID : R303-2018-3551
Pays : International
Organisme : Danmarks Grundforskningsfond
ID : Niels Bohr Professorship
Pays : International
Organisme : NIDA NIH HHS
ID : R01DA1104470
Pays : United States
Organisme : Novo Nordisk Fonden
ID : NNF18OC0031194
Pays : International
Organisme : Lundbeckfonden
ID : R155-2014-1724
Pays : International
Organisme : Lundbeckfonden
ID : R268-2016-3925
Pays : International
Organisme : European Commission
ID : Horizon 2020, grant 667302
Pays : International
Organisme : NIDA NIH HHS
ID : R01 DA044170
Pays : United States
Organisme : Det Frie Forskningsråd
ID : 7025-00078B
Pays : International
Organisme : Novo Nordisk Fonden
ID : Grant 22018
Pays : International
Informations de copyright
Copyright © 2020 Massachusetts Medical Society.
Références
Lancet. 2019 Nov 16;394(10211):1827-1835
pubmed: 31668728
Pediatrics. 2015 Apr;135(4):e927-38
pubmed: 25755242
Schizophr Res. 2018 Nov;201:62-69
pubmed: 29891274
Am J Epidemiol. 2016 Aug 1;184(3):199-210
pubmed: 27407085
PLoS One. 2014 Mar 17;9(3):e91973
pubmed: 24638040
JAMA Psychiatry. 2014 May;71(5):573-81
pubmed: 24806211
Schizophr Res. 1999 Nov 9;40(1):67-74
pubmed: 10541009
Dement Geriatr Cogn Disord. 2007;24(3):220-8
pubmed: 17690555
Lancet. 2007 Sep 8;370(9590):851-8
pubmed: 17826170
Stroke. 2013 Jun;44(6):1555-60
pubmed: 23686976
Int J Cardiol. 2013 Oct 15;168(6):5293-9
pubmed: 23993321
Scand J Public Health. 2011 Jul;39(7 Suppl):54-7
pubmed: 21775352
Gen Hosp Psychiatry. 2014 Mar-Apr;36(2):142-9
pubmed: 24342112
Scand J Public Health. 2011 Jul;39(7 Suppl):38-41
pubmed: 21775349
BMC Med. 2011 Nov 01;9:118
pubmed: 22044777
Br J Psychiatry Suppl. 1992 Oct;(18):75-83
pubmed: 1389045
Int J Psychiatry Med. 2011;42(4):421-36
pubmed: 22530402
Schizophr Res. 1994 Jun;12(3):185-94
pubmed: 7914430
J Psychosom Res. 2015 Aug;79(2):130-6
pubmed: 26094010
JAMA Psychiatry. 2019 Mar 1;76(3):259-270
pubmed: 30649197
J Pain. 2015 Oct;16(10):1054-64
pubmed: 26168877
Biostatistics. 2000 Dec;1(4):423-39
pubmed: 12933565
Br J Psychiatry. 1998 Jul;173:11-53
pubmed: 9850203
JAMA Psychiatry. 2016 Feb;73(2):150-8
pubmed: 26719969
Clin Epidemiol. 2015 Nov 17;7:449-90
pubmed: 26604824
Am J Psychiatry. 2004 Jun;161(6):1090-5
pubmed: 15169698
Scand J Public Health. 2011 Jul;39(7 Suppl):22-5
pubmed: 21775345
Scand J Public Health. 2011 Jul;39(7 Suppl):26-9
pubmed: 21775346
JAMA. 2011 Sep 21;306(11):1241-9
pubmed: 21934057
Diabetologia. 2014 Apr;57(4):699-709
pubmed: 24488082
J Autism Dev Disord. 2010 Feb;40(2):139-48
pubmed: 19728067
Transl Psychiatry. 2017 Jan 24;7(1):e1007
pubmed: 28117839
PLoS One. 2013 Jun 24;8(6):e66742
pubmed: 23826124
Br J Psychiatry. 2009 Jun;194(6):491-9
pubmed: 19478286
Eur Psychiatry. 1998 Dec;13(8):392-8
pubmed: 19698654
J Psychosom Res. 2015 Nov;79(5):333-9
pubmed: 26526305
Lancet Psychiatry. 2017 Dec;4(12):937-945
pubmed: 29122573
Br J Psychiatry. 2012 May;200(5):374-80
pubmed: 22442099
Clin Pract Epidemiol Ment Health. 2009 Feb 12;5:4
pubmed: 19216741