Common mental disorder and physical illness in the Renfrew and Paisley (MIDSPAN) study
Introduction
The comorbidity of psychiatric disorders with chronic health conditions is a topic of considerable clinical and policy interest. It is important that both clinicians and policy makers recognise the implications for health-related quality of life that result from comorbidity of psychiatric disorders with chronic medical illnesses.
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Physical illness
There are several potential mechanisms for the association of physical and psychiatric disorders. Psychiatric disturbance may be either a consequence of the experience of physical symptoms or an example of reporting bias, or the result of common risk factors for both physical and psychiatric disorders or it may be an aetiological agent in physical illness.
Using specific measures of depression, community studies have consistently found associations among psychiatric disorder and coronary heart
Respiratory disease and psychological distress
Chronic obstructive pulmonary disease (COPD) may be complicated further by psychiatric comorbidity. Evidence of increased likelihood of the development of depression in patients with COPD has been found in case–control studies [24], [25] and community surveys [26], [27], [28]. However, the evidence for a significant risk of depression in COPD patients remains inconclusive, perhaps due to the poor methodological quality of these studies [29].
In summary, the associations between psychological
Method
The study population and measurement techniques have been described previously [30], [31].
Prevalence of GHQ caseness by risk factors
At baseline, 15.4% (583/3783) of men and 20.3% (949/4683) of women were possible cases of psychiatric disorder on the GHQ.
For both men and women, the prevalence of GHQ caseness was highest in the first quintile of systolic blood pressure (SBP) and lowest in the fourth quintile. There was a statistically significant difference between quintiles of SBP in women but not men (Table 1). There was no consistent association between the prevalence of GHQ caseness and quintiles of DBP.
Prevalence of GHQ
Discussion
The prevalence rate of GHQ caseness found in this study was low compared to that of other community studies [38], [39]. Such a low prevalence rate may reflect stoicism in the sample. Prevalence of GHQ caseness tended to decrease with higher SBP in women. Similarly, GHQ caseness prevalence increased with poorer lung function. Male respondents with angina, whether confirmed or not by ECG, had the highest GHQ caseness prevalence rate. Female respondents with ECG-confirmed angina had a lower GHQ
Conclusion
GHQ caseness was shown to be associated with both CHD and respiratory symptoms and markers. It is unlikely that the relationship between psychological distress and respiratory outcomes arises solely through smoking, as this was controlled for in multivariate analysis. The association is likely to be due to the pain and disability associated with these outcomes. Similarly, with CHD, psychological distress is also likely to be a consequence of the pain and discomfort associated with these
Acknowledgements
The work presented in this article was supported by a grant from the British Heart Foundation (grant no. PG/98170). We would also like to thank Professor Anthony Mann for kindly providing us with information on his initial validation study of the GHQ, and Pauline MacKinnon and Jane Gow for preparation of the data set.
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