Physical Comorbidities in Depression Co-Occurring with Anxiety: A Cross Sectional Study in the Czech Primary Care System

Prevalence of Mental Disorders Among Patients with Multimorbidity Visiting Primary Care Settings in Slums of Karachi, Pakistan

BACKGROUND

Anxiety and depression often exacerbate multimorbidity conditions, leading to increased disability rates among affected individuals.

OBJECTIVE

The study aimed to assess the mental health status of individuals with multimorbidity belonging to the marginalized population of Karachi, Pakistan. Specifically, the prevalence of anxiety and depression was investigated.

METHODS

A multicenter cross-sectional study was conducted between July 2022 and June 2023 in 10 primary healthcare clinics located in 4 peri-urban areas of Karachi. A total of 9331 participants were included in the study. The Patient Health Questionnaire 4 (PHQ-4), Generalized Anxiety Disorder 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) were used to assess symptoms of anxiety and depression. The data collected were analyzed using the statistical analysis system (SAS) version 9.4.

RESULTS

Among the study participants, 2894 (31%) were men and 5534 (59.3%) were women. The prevalence of moderate to severe anxiety was 31% among men and 59.3% among women. The age group between 41 and 60 years exhibited the highest rates of moderate to severe anxiety, 19.3% as evaluated by GAD-7 and 34.6% by PHQ-9. The Pathan ethnic group had the highest prevalence of anxiety (11%) and depression (28.3%) in the neighborhoods. Unemployed participants showed moderate to severe anxiety in 21.3% of the cases and moderate to severe depression in 25.5% of the cases.

CONCLUSION

The study revealed a significant cooccurrence of anxiety and depression among individuals with multimorbidity in the marginalized population of Karachi, Pakistan. Furthermore, the presence of anxiety symptoms in multimorbidity patients with depression indicates a more unfavorable health state. It is essential to explore the implementation of screening measures and therapeutic interventions for comorbid anxiety and depression in this population to improve clinical outcomes.

Depression severity partially mediates the association between thyroid function and psychotic symptoms in first-episode, drug-naive major depressive disorder patients with comorbid anxiety at different ages of onset

BACKGROUND

Anxiety and psychotic symptoms are common in patients with major depressive disorder (MDD), with a strong association with thyroid function. Age of onset contributes to the heterogeneity of MDD patients. This study aimed to assess the prevalence of psychotic symptoms in MDD patients with comorbid anxiety and to explore the relationship between thyroid function and psychotic symptoms by ages of onset.

METHODS

A total of 894 first-episode, drug-naïve Chinese Han MDD patients with comorbid anxiety were recruited. Thyroid function and psychometric measures including Hamilton Anxiety Scale, Hamilton Depression Scale, and Positive and Negative Syndrome Scale were evaluated. Patients were divided into early adulthood onset (EAO, < 45 years old) and mid-adulthood onset (MAO, ≥ 45 years old) groups.

RESULTS

The MAO subgroup had a higher prevalence of psychotic symptoms compared to EAO subgroup. TSH and TPOAb levels were positively correlated with psychotic symptoms severity, with a more pronounced effect in MAO subgroup. Furthermore, MDD severity partially mediated the effects of TPOAb and TSH levels on psychotic symptoms in both subgroups.

LIMITATIONS

A causal relationship could not be demonstrated with this cross-sectional study, and the results should be limited to first-episode, drug-naïve MDD patients without considering more potential confounders. Moreover, the male-to-female ratio imbalance is present.

CONCLUSIONS

Our results indicated that age of onset moderated the association between thyroid function and psychotic symptom, and depression severity partially mediated the effects of thyroid function on psychotic symptoms, suggesting thyroid function may serve as a biomarker of psychotic symptoms in MDD patients with anxiety.

Physical health and comorbid anxiety and depression across the first year postpartum in Ireland (MAMMI study): A longitudinal population-based study

INTRODUCTION

Little is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period.

METHODS

A longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an additional six assessed at each postpartum data collection point.

RESULTS

2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % postpartum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth. Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and gradually decreased thereafter. Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum.

CONCLUSION

Reports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.

Effectiveness of social support-based interventions in preventing depression in people without clinical depression: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The evidence available on the association between social support and prevention of depression has been basically obtained from observational studies.

AIM

We evaluated the effectiveness of social support-based interventions for the prevention of depression in people without clinical depression.

METHODS

Systematic review and meta-analysis (SR/MA) of randomized controlled trials (RCT), which were searched for in MEDLINE, EMBASE, CENTRAL, WOS, PsycINFO, OpenGrey and other sources from the inception dates to June 8, 2022. We selected RCTs that assessed the effectiveness of social support-based interventions as compared to controls, included subjects without baseline clinical depression, and measured as results a reduction in depressive symptoms and/or the incidence of new cases of depression. Pooled standardized mean differences (SMDs) were calculated from random effects models.

RESULTS

Nine RCTs involving 927 patients from North America, Asia and Europe were included. The pooled SMD was -0.43 [95% confidence interval (CI) -0.82 to -0.04; p = .031]. Sensitivity analyses confirmed the robustness of results. Heterogeneity was substantial [I² = 80% (95% CI: 64% to 89%)]. A meta-regression model that included usual care as comparator and the continent (Europe), explained 53% of heterogeneity. Eight RCTs had a moderate overall risk of bias and one had a high risk of bias. Follow-up was ⩾1 year in only three RCTs. There was no statistical evidence of publication bias. The quality of evidence, as measured on GRADE guidelines, was low.

CONCLUSION

Social support-based interventions had a small preventive effect on depression. Longer RCTs with a low risk of bias are necessary.

Association of Subclinical Hypothyroidism With Anxiety Symptom in Young First-Episode and Drug-Naïve Patients With Major Depressive Disorder

BACKGROUNDS

Subclinical hypothyroidism (SCH) was reported to be associated with depression; however, its role in coexisting anxiety symptom in young patients with major depressive disorder (MDD) remains unclear. The objective of this study was to explore the relationship between SCH and anxiety symptom in young first-episode and drug-naïve (FEDN) MDD patients.

METHODS

A total of 520 outpatients diagnosed as FEDN MDD with SCH were recruited in this study. Their socio-demographic, clinical data and thyroid function parameters were collected. The Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD) were employed to measure the severity of anxiety symptom and depressive symptom, respectively. Based on the HAMA scores, patients who scored ≥ 25 were defined as anxious major depressive disorder (A-MDD) while others as non-anxious major depressive disorder (NA-MDD).

RESULTS

The prevalence rate of A-MDD was 15.8% in young FEDN MDD patients with comorbid SCH. Moreover, serum thyroid stimulating hormone (TSH) levels were significantly higher in patients with A-MDD compared with those with NA-MDD (p < 0.001). Multivariate binary logistic regression analysis indicated that A-MDD was associated with serum TSH levels with an odds ratio (OR) of 1.602. Serum TSH level of 6.17 mIU/L was the critical value to distinguish A-MDD and NA-MDD, with sensitivity of 0.805 and specificity of 0.539. There were no statistically significant differences between NA-MDD and A-MDD patients in terms of socio-demographic variables, serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidases antibody (TPOAb) and anti-thyroglobulin (TgAb) levels.

CONCLUSIONS

A-MDD patients presented higher serum TSH level. It is suggested that serum TSH level may be a potential biomarker for predicting moderate and severe anxiety symptoms in young FEDN MDD patients with SCH.

Urban-Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

Introduction: Multimorbidity has become one of the key issues in the public health sector. This study aimed to explore the urban–rural differences in patterns and associated factors of multimorbidity in China and to provide scientific reference for the development of health management strategies to reduce health inequality between urban and rural areas.

Methods: A cross-sectional study, which used a multi-stage random sampling method, was conducted effectively among 3,250 participants in the Shanxi province of China. The chi-square test was used to compare the prevalence of chronic diseases among older adults with different demographic characteristics. The Apriori algorithm and multinomial logistic regression were used to explore the patterns and associated factors of multimorbidity among older adults, respectively.

Results: The findings showed that 30.3% of older adults reported multimorbidity, with significantly higher proportions in rural areas. Among urban older adults, 10 binary chronic disease combinations with strong association strength were obtained. In addition, 11 binary chronic disease combinations and three ternary chronic disease combinations with strong association strength were obtained among rural older adults. In rural and urban areas, there is a large gap in patterns and factors associated with multimorbidity.

Conclusions: Multimorbidity was prevalent among older adults, which patterns mainly consisted of two or three chronic diseases. The patterns and associated factors of multimorbidity varied from urban to rural regions. Expanding the study of urban–rural differences in multimorbidity will help the country formulate more reasonable public health policies to maximize the benefits of medical services for all.

Health-economic evaluation of psychological interventions for depression prevention: Systematic review

Psychological interventions have been proven to be effective to prevent depression, however, little is known on the cost-effectiveness of psychological interventions for the prevention of depression in various populations. A systematic review was conducted using PubMed, PsycINFO, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Econlit, NHS Economic Evaluations Database, NHS Health Technology Assessment and OpenGrey up to January 2021. Only health-economic evaluations based on randomized controlled trials of psychological interventions to prevent depression were included. Independent evaluators selected studies, extracted data and assessed the quality using the Consensus on Health Economic Criteria and the Cochrane Risk of Bias Tool. Twelve trial-based economic evaluations including 5929 participants from six different countries met the inclusion criteria. Overall, the quality of most economic evaluations was considered good, but some studies have some risk of bias. Setting the willingness-to-pay upper limit to US$40,000 (2018 prices) for gaining one quality adjusted life year (QALY), eight psychological preventive interventions were likely to be cost-effective compared to care as usual. The likelihood of preventive psychological interventions being more cost-effective than care as usual looks promising, but more economic evaluations are needed to bridge the many gaps that remain in the evidence-base. ETHICS: As this systematic review is based on published data, approval from the local ethics committee was not required.

Moderators of psychological and psychoeducational interventions for the prevention of depression: A systematic review

Psychological and psychoeducational interventions have proven to be effective in preventing depression. However, the identification of the patients that benefit the most from each type of intervention has not yet been established. A systematic review was performed of the literature on moderators of preventive psychological and psychoeducational interventions for depression in all types of population. A search was performed on PubMed, PsycINFO, Web of Science, Embase, Cochrane Central Register of Controlled Trials and OpenGrey up to July 2019. Fulfillment of eligibility criteria, data collection, and study quality assessment were assessed by two independent researchers. Outcomes were moderators of the reduction of depressive symptoms or the incidence of depression. Twenty-seven moderator effect studies performed in 19 randomized controlled trials were included. Thirty-four potential sociodemographic, clinical, interpersonal, personality and life-event moderators were evaluated. Baseline depressive symptoms, gender, age, baseline parental depression and social support were the most frequently studied potential moderators. In interventions for children and adolescents, the moderator for which evidence was strongest was having parents free of depression at baseline. Psychological and psychoeducational interventions seem to be more effective in children and adolescents who exhibit a lower use of substances and whose parents do not have symptoms of depression at baseline. In adults, a lower age was associated with greater effects of preventive interventions. ETHICS: As this systematic review is based on published data, approval from the local ethics committee was not required.

Physical health among patients with common mental health disorders in primary care in Europe: a scoping review

Introduction:

Mental disorders are increasingly common among adults in both the developed and developing world and are predicted by the WHO to be the leading cause of disease burden by 2030. Many common physical conditions are more common among people who also have a common mental disorder. This scoping review aims to examine the current literature about the prevention, identification and treatment of physical problems among people with pre-existing mental health disorders in primary care in Europe.

Methods:

The scoping review framework comprised a five-stage process developed by Arksey & O’Malley (2005). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Both quantitative and qualitative studies were included, with no restriction on study design.

Results:

The initial search identified 299 studies, with a further 28 added from the hand-search (total n = 327) of which 19 were considered relevant to the review research question and included for full analysis. Depression was the mental health condition most commonly studied (nine studies), followed by depression and anxiety (seven studies), with three studies examining any mental disorder. Eleven studies examined the effects of various interventions to address physical and mental comorbidity, with the most commonly studied intervention being collaborative care.

Conclusions:

With just 19 studies meeting our criteria for inclusion, there is clearly a paucity of research in this area. Further research is essential in order to understand the pathophysiological mechanisms underlying the association between mental disorders and chronic conditions.

Effects of an exercise program linked to primary care on depression in elderly: fitness as mediator of the improvement

PURPOSE

The present study aimed to analyse the effects of 12 months of participation in a public physical activity program linked to primary care on depression level and fitness, and to determine which fitness components were responsible for the improvement in depression using mediation analysis.

METHODS

Participants of this program were 2768 middle-aged and older adults from 67 municipalities throughout the Spanish region of Extremadura. In the analysis only participants with depression and without any missing values for fitness variables were included. This sample was 303 for exercise group and 74 for control group. Socio-demographic data, Geriatric Depression Scale and some fitness tests were applied at baseline and 1 year later. Exercise group performed the program 3 days/week for 50-60 min per session involving brisk walking with intermittent flexibility, strength and balance activities/exercises. Socializing within the group was encouraged in all sessions. Data analysis included analysis of covariance, chi-squared and effect size statistics. Additionally, a parallel model of mediation analysis was performed to determine the indirect effect of the participation in the exercise program on depression through improvements in fitness.

RESULTS

A considerable reduction from mild, moderate or severe depression to non-depression were obtained for exercise group (68%) P-value < .05. The parallel mediation analysis showed that flexibility (sit-and-reach [β - 0.04 (- 0.07 to - 0.01)], back scratch [β - 0.06 (- 0.12 to - 0.02)]) and cardiorespiratory fitness (6-min walk [β - 0.09 (- 0.15 to - 0.04)]) were mediators of the reduction in depression.

CONCLUSION

This exercise program was effective in improving depression in older adults. Integrating aerobic and flexibility exercises in a group-based program of physical activity programs could improve the severity of depression in this population.

Prevalence of anxiety and depressive symptoms and their association with multimorbidity and demographic factors: a community-based, cross-sectional survey in Karachi, Pakistan

OBJECTIVE

This study aimed to estimate the prevalence of anxiety and depressive symptoms and their association with multimorbidity and the demographic characteristics of adults aged 30 years and above in Karachi, Pakistan.

DESIGN

Observational cross-sectional study.

STUDY SETTING AND PARTICIPANTS

The study was carried out among a general population aged 30 years and above residing in the Gulshan-e-Iqbal town of Karachi, Pakistan. The study participants were recruited using the systematic random sampling approach based on the inclusion criteria. The data collected from 2867 participants were analysed.

MAIN OUTCOME MEASURES

The primary outcome of the study was the prevalence of anxiety and depressive symptoms, measured with the Aga Khan University Anxiety Depression Scale. The secondary outcome was the association of anxiety and depressive symptoms with multimorbidity as well as with the sociodemographic characteristics of the participants, using binary logistic regression.

RESULTS

Out of 2867 individuals, 27.4% reported having anxiety and depressive symptoms. The multivariate logistic regression model revealed that the presence of multimorbidity (adjusted OR (AOR)=1.33, 95% CI 1.11 to 1.58), female gender (AOR=2.40, 95% CI 2.01 to 2.87), illiteracy (AOR=1.51, 95% CI 1.09 to 2.07), more children (AOR=0.74, 95% CI 0.59 to 0.93) and visiting a faith healer (AOR=2.29, 95% CI 1.82 to 2.88) were the significant factors associated with anxiety and depressive symptoms.

CONCLUSION

This study revealed a moderately high prevalence of anxiety and depressive symptoms among adults aged 30 years and above in Karachi, Pakistan. The key variables associated with anxiety and depressive symptoms were multimorbidity, female gender, lower level of education, more children and visiting faith healers.

Prevalence of Chronic Health Conditions in Australian Adults with Depression and/or Anxiety

The association between psychotic illness and poor physical health is now clearly articulated in the literature. By contrast the impact of depression and/or anxiety on physical health is considerably less understood, despite depression being the leading cause of disability worldwide and is associated with significantly higher prevalence of physical comorbidities than found in the general population. An Australia national cross-sectional population-based survey was conducted to ascertain the prevalence of chronic physical health conditions in persons with, and without depression and/or anxiety, allowing for demographic characteristics and lifestyle factors. The telephone-based survey was conducted using trained interviewers. Survey questions included those eliciting information about demographics, health status, and health behaviours. Independent t-tests and chi square tests showed demographic, health behaviours, and physical illness differed between those with and without depression and/or anxiety. Heart disease, high blood pressure, stroke, cancer, arthritis, chronic neck and/or back pain, and asthma were significantly higher in participants diagnosed with depression and/or anxiety. Binary logistic regression showed the strongest predictor of chronic illness was having a diagnosis of depression and/or anxiety. Depression and anxiety present major health problems impacting a considerable proportion of the population. A greater understanding of the associated physical health issues should provide impetus to broaden the physical health and mental illness research agenda to include these diagnoses.

Genetic Risk for Psychiatric Disorders and Telomere Length

Background: Previous studies have revealed associations between psychiatric disorder diagnosis and shorter telomere length. Here, we attempt to discern whether genetic risk for psychiatric disorders, or use of pharmacological treatments (i.e., antidepressants), predict shorter telomere length and risk for aging-related disease in a United Kingdom population sample.

Methods: DNA samples from blood were available from 351 participants who were recruited as part of the South East London Community Health (SELCoH) Study, and for which whole-genome genotype data was available. Leukocyte telomere length was characterized using quantitative polymerase chain reactions. Individualized polygenic risk scores for major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SCZ) were calculated using Psychiatric Genomics Consortium summary statistics. We subsequently performed linear models, to discern the impact polygenic risk for psychiatric disorders (an etiological risk factor) and antidepressant use (common pharmacological treatment) have on telomere length, whilst accounting for other lifestyle/health factors (e.g., BMI, smoking).

Results: There were no significant associations between polygenic risk for any of the psychiatric disorders tested and telomere length (p > 0.05). Antidepressant use was significantly associated with shorter telomere length and this was independent from a depression diagnosis or current depression severity (p ≤ 0.01). Antidepressant use was also associated with a significantly higher risk of aging-related disease, which was independent from depression diagnosis (p ≤ 0.05).

Conclusion: Genetic risk for psychiatric disorders is not associated with shorter telomere length. Further studies are now needed to prospectively characterize if antidepressant use increases risk for aging-related disease and telomere shortening, or whether people who age faster and have aging-related diseases are just more likely to be prescribed antidepressants.

Prenatal food restriction induces neurobehavioral abnormalities in adult female offspring rats and alters intrauterine programming

The higher risk of adult neuropsychiatric diseases in individuals with low fetal birth weight may be related to brain-derived neurotrophic factor (BDNF) signaling pathway inhibition. Here, we investigated whether prenatal food restriction (PFR) induces neurobehavioral alterations in adult female offspring and explored the underlying intrauterine programming mechanism. Pregnant Wistar rats in the PFR group were fed 50% of the daily food intake of control rats from gestational day (GD) 11 to 20; some pregnant rats were sacrificed at GD20, and the remaining female pups had normal delivery and were fed a post-weaning high-fat diet (HFD) and half of them were exposed to an unpredictable chronic stress (UCS) from postnatal week (PW) 21. All adult female offspring were sacrificed at PW24. At GD20, PFR altered fetal hippocampal structure and function, increased glucocorticoid receptor (GR) expression, and decreased mineralocorticoid receptor (MR), BDNF and synaptic plasticity-related gene expressions. At PW24, PFR induced depression-like behavioral abnormalities in adult rat offspring fed an HFD. These rats exhibited depression- and anxiety-like behavioral changes after HFD/UCS. Furthermore, the hippocampal morphology of the PFR group showed abnormal changes in adult offspring fed an HFD and more serious damage after HFD/UCS. These changes were accompanied by increased serum corticosterone levels, elevated GR expression, and reduced expression of the BDNF signaling pathway and synaptic plasticity-related genes in the hippocampus. In conclusion, PFR may induce neurobehavioral abnormalities in adult offspring, especially those exposed to UCS, through high levels of glucocorticoids, which increase hippocampal GR expression and decrease BDNF expression.

Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: Meta-analysis and systematic review

The present study pooled the prevalence of sleep disturbances and depression in community-dwelling older adults (mean age≥60years) and quantified the strength of evidence of the relationship between these two problems. From 23 cross-sectional studies and five sets of baseline data, a high pooled prevalence of sleep disturbances (30.5%), depressive symptoms (18.1%) and coexisting disorders (10.6%) were found. In the 23 cohort studies, self-reported sleep disturbances increased the risk of the onset of depression (relative risk [RR]=1.92). Persistent sleep disturbances increased the risk of the development (RR=3.90), recurrence (RR=7.70), and worsening (RR=1.46) of depression in older adults. Little support was found for a predictive role for objective sleep characteristics in the development of depression. Older adults with depression had a higher risk of developing (RR=1.72) and worsening (RR=1.73) symptoms of sleep disturbances. This review emphasizes the importance of timely interventions in incipient sleep disturbances and depression among older adults, preventing the development of more serious comorbidities.

Depressive Disorder, Anxiety Disorder and Chronic Pain: Multiple Manifestations of a Common Clinical and Pathophysiological Core

INTRODUCTION

A high proportion of depressive disorders are accompanied by anxious manifestations, just as depression and anxiety often present with many painful manifestations, or conversely, painful manifestations cause or worsen depressive and anxious expressions. There is increasingly more evidence of the pathophysiological, and neurophysiological and technical imaging similarity of pain and depression.

METHODS

Narrative review of the pathophysiological and clinical aspects of depression and chronic pain comorbidity. Research articles are included that emphasise the most relevant elements related to understanding the pathophysiology of both manifestations.

RESULTS

The pathological origin, physiology and clinical approach to these disorders have been more clearly established with the latest advances in biochemical and cellular techniques, as well as the advent of imaging technologies. This information is systematised with comprehensive images and clinical pictures.

CONCLUSIONS

The recognition that the polymorphism of inflammation-related genes generates susceptibility to depressive manifestations and may modify the response to antidepressant treatments establishes that the inflammatory response is not only an aetiopathogenic component of pain, but also of stress and depression. Likewise, the similarity in approach with images corroborates not only the structural, but the functional and pathophysiological analogy between depression and chronic pain. Knowledge of depression-anxiety-chronic pain comorbidity is essential in the search for effective therapeutic interventions.

Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study

OBJECTIVE

The aim of this study was to explore mental health care utilization patterns in primary and specialized mental health care of people with unexplained or explained physical symptoms.

METHODS

Data were derived from the first wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face cohort study among the general population aged 18-64 years. We selected subjects with medically unexplained symptoms (MUS) only (MUSonly; n=177), explained physical symptoms only (PHYonly, n=1,952), combined MUS and explained physical symptoms (MUS + PHY, n=209), and controls without physical symptoms (NONE, n=4,168). We studied entry into mental health care and the number of treatment contacts for mental problems, in both primary care and specialized mental health care. Analyses were adjusted for sociodemographic characteristics and presence of any 12-month mental disorder assessed with the Composite International Diagnostic Interview 3.0.

RESULTS

At the primary care level, all three groups of subjects with physical symptoms showed entry into care for mental health problems significantly more often than controls. The adjusted odds ratios were 2.29 (1.33, 3.95) for MUSonly, 1.55 (1.13, 2.12) for PHYonly, and 2.25 (1.41, 3.57) for MUS + PHY. At the specialized mental health care level, this was the case only for MUSonly subjects (adjusted odds ratio 1.65 [1.04, 2.61]). In both the primary and specialized mental health care, there were no significant differences between the four groups in the number of treatment contacts once they entered into treatment.

CONCLUSION

All sorts of physical symptoms, unexplained as well as explained, were associated with significant higher entry into primary care for mental problems. In specialized mental health care, this was true only for MUSonly. No differences were found in the number of treatment contacts. This warrants further research aimed at the content of the treatment contacts.