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Association between Mental Disorders and Subsequent Medical Conditions

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  • Natalie C Momen
  • Oleguer Plana-Ripoll
  • Esben Agerbo
  • Michael E Benros
  • Anders D Børglum
  • Maria K Christensen
  • Søren Dalsgaard
  • Louisa Degenhardt
  • Peter de Jonge
  • Jean-Christophe P G Debost
  • Morten Fenger-Grøn
  • Jane M Gunn
  • Kim M Iburg
  • Lars V Kessing
  • Ronald C Kessler
  • Thomas M Laursen
  • Carmen C W Lim
  • Ole Mors
  • Preben B Mortensen
  • Katherine L Musliner
  • Merete Nordentoft
  • Carsten B Pedersen
  • Liselotte V Petersen
  • Anette R Ribe
  • Annelieke M Roest
  • Sukanta Saha
  • Andrew J Schork
  • Kate M Scott
  • Carson Sievert
  • Holger J Sørensen
  • Terry J Stedman
  • Mogens Vestergaard
  • Bjarni Vilhjalmsson
  • Thomas Werge
  • Nanna Weye
  • Harvey A Whiteford
  • Anders Prior
  • John J McGrath
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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.).

Original languageEnglish
JournalThe New England journal of medicine
Volume382
Issue number18
Pages (from-to)1721-1731
Number of pages11
ISSN0028-4793
DOIs
Publication statusPublished - 30 Apr 2020

    Research areas

  • 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

ID: 59921298