Psychological Medicine

Original Articles

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

S. Weicha1 c1, P. Bebbingtona2, D. Raia3, S. Strangesa4, O. McBridea5, N. Spiersa6, H. Meltzera6 and T. Brughaa6

a1 Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK

a2 Mental Health Sciences Unit, UCL Faculty of Brain Sciences, London, UK

a3 Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK

a4 Division of Health Sciences (Statistics & Epidemiology), Warwick Medical School, University of Warwick, Coventry, UK

a5 Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland

a6 Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK

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.

(Received April 03 2012)

(Revised June 19 2012)

(Accepted July 04 2012)

(Online publication August 21 2012)

Key words

  • Common mental disorders;
  • disability;
  • long-term conditions;
  • population attributable fraction

Correspondence

c1 Address for correspondence: S. Weich, M.D., Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. (Email: S.Weich@warwick.ac.uk)

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