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The population impact of common mental disorders and long-term physical conditions on disability and hospital admission

Published online by Cambridge University Press:  21 August 2012

S. Weich ,
P. Bebbington ,
D. Rai ,
S. Stranges ,
O. McBride ,
N. Spiers ,
H. Meltzer  and
T. Brugha
S. Weich*
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
P. Bebbington
Affiliation:
Mental Health Sciences Unit, UCL Faculty of Brain Sciences, London, UK
D. Rai
Affiliation:
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
S. Stranges
Affiliation:
Division of Health Sciences (Statistics & Epidemiology), Warwick Medical School, University of Warwick, Coventry, UK
O. McBride
Affiliation:
Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
N. Spiers
Affiliation:
Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
H. Meltzer
Affiliation:
Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
T. Brugha
Affiliation:
Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
*
*Address for correspondence: S. Weich, M.D., Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. (Email: [email protected])
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Abstract

Background

Long-term physical conditions (LTCs) consume the largest share of healthcare budgets. Although common mental disorders (CMDs) and LTCs often co-occur, the potential impact of improved mental health treatment on severe disability and hospital admissions for physical health problems remains unknown.

Method

A cross-sectional study of 7403 adults aged 16–95 years living in private households in England was performed. LTCs were ascertained by prompted self-report. CMDs were ascertained by structured clinical interview. Disability was assessed using questions about problems with activities of daily living. Population impact and potential preventive gain were estimated using population-attributable fraction (PAF), and conservative estimates were obtained using ‘treated non-cases’ as the reference group.

Results

Of the respondents, 20.7% reported at least one LTC. The prevalence of CMDs increased with the number of LTCs, but over two-thirds (71.2%) of CMD cases in people with LTCs were untreated. Statistically significant PAFs were found for CMDs and recent hospital admission [13.5%, 95% confidence intervals (CI) 6.6–20.0] and severe disability (31.3%, 95% CI 27.1–35.2) after adjusting for LTCs and other confounders. Only the latter remained significant when using the most conservative estimate of PAF (21.8%, 95% CI 14.0–28.9), and this was reduced only slightly when considering only participants with LTCs (18.5%, 95% CI 7.9–27.9).

Conclusions

Better treatments for CMDs in people with LTCs could achieve almost the same population health gain in terms of reducing severe disability as those targeted at the entire population. Interventions to reduce the prevalence of CMDs among people with LTCs should be part of routine medical care.

Keywords

Common mental disordersdisabilitylong-term conditionspopulation attributable fraction
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 5 , May 2013 , pp. 921 - 931
Copyright
Copyright © Cambridge University Press 2012

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