Somatic and psychiatric co-morbidity in Primary Care patients in Spain

A study of psychiatry morbidity and co-morbid physical illness among convicted and awaiting trial inmates in Jos prison

BACKGROUND

Having a psychiatric diagnosis is still considered a major burden in life. In addition to dealing with stigma regarding mental illness, persons with severe mental illness have an added risk of having co-morbid medical illnesses that can further impair their already turbulent life. The importance of detecting co-morbid medical illnesses is to ensure a holistic treatment. This study assessed the prevalence of psychiatric morbidity and co-morbid physical illness among convicted and awaiting trial inmates in Jos prison.

METHOD

A cross-sectional, descriptive study was carried out among 608 male inmates in Jos maximum security prison, Plateau State, Nigeria. They were screened with self administered GHQ-28 questionnaire and interviewed using CIDI.

RESULTS

More than half (57%) of the studied subjects had a psychiatric disorder with substance use disorder as the commonest (48.7%) diagnosis. Physical co-morbidity was found in (18%) of the subjects with infectious disease (A00-A99) as the commonest source 13 (3.7%) of physical co-morbidity among the subjects. A statistically significant relationship was found between psychiatric disorder and co-morbid physical illness (p = 0.000).

CONCLUSION

The study showed a high rate of psychiatric morbidity and co-morbid physical illness with infectious disease being the commonest source of physical co-morbidity; and substance use disorder the commonest psychiatric disorder among the prison inmates.

[Comorbidity of major depression with other common mental disorders in primary care patients]

INTRODUCTION

Psychiatric comorbidity affects the impact, the prognosis and the management of depression.

AIMS

To determine the prevalence of other common mental disorders in patients with major depression and to analyse their associated comorbidities.

DESIGN

Two-stage cross-sectional study: a) screening (Zung's Self-Rating Depression Scale); b) a standardised psychiatric interview.

SETTINGS

Ten health centres in the province of Tarragona.

PATIENTS

A total of 906 consecutive patients were screened. In the second stage, the 209 patients who gave a positive result and 97 patients who gave a negative result (1/7 at random) were evaluated.

ANALYSIS

The statistical analysis used weights that took into account the two-stage sampling. The frequency with which dysthymia, generalised anxiety disorder, panic disorder and somatisation disorder presented concomitantly with major depression was determined. The characteristics of the depressed patients were compared for different degrees of comorbidity.

RESULTS

In 45.7% (95% CI, 32.8-59.2) of patients with major depression there was one other coexisting mental disorder, in 19.9% (95% CI, 13.7-27.9) two more mental disorders and in 8.3% (95% CI, 4.5-14.8) three more mental disorders. Generalised anxiety disorder was present in 55.2% of depressed patients (95% CI, 41.6-68), panic disorder in 33.8% (95% CI, 21.1-47.1), dysthymia in 15.7% (95% CI, 10.3-23.4) and somatisation disorder in 6.6% (95% CI, 3.3-12.8). In the groups of patients with comorbidity, the depression was more severe and had a greater functional impact. There were no differences in the clinical management variables.

CONCLUSIONS

Psychiatric comorbidity of depression is common in primary care. Most depressed patients suffer from other disorders, often anxiety.

Somatic and psychiatric comorbidity in the general elderly population: results from the ZARADEMP Project

OBJECTIVE

In a representative sample of the elderly population in a southern European city, we tested the hypothesis that there is an association between general somatic and general psychiatric morbidity.

METHODS

A stratified random sample of 4803 individuals aged > or =55 years was selected for the baseline study in the ZARADEMP Project. The elderly were assessed with standardized Spanish versions of instruments, including the Geriatric Mental State (GMS)-AGECAT. Psychiatric cases were diagnosed according to GMS-AGECAT criteria, and somatic morbidity was documented with the EURODEM Risk Factors Questionnaire.

RESULTS

General comorbidity clustered in 19.9% of the elderly when hypertension was removed from the somatic conditions category, with 33.5% of the sample remaining free from both somatic and psychiatric illnesses. General comorbidity was associated with age, female gender, and limited education, but did not increase systematically with age. The frequency of psychiatric illness was higher among the somatic cases than among noncases, and the frequency of somatic morbidity among the psychiatric cases was higher than among noncases. This association between somatic and psychiatric morbidity remained statistically significant after controlling for age, gender, and education [odds ratio (OR)=1.61; confidence interval (CI)=1.38-1.88]. Most somatic categories were associated with psychiatric illness, but after adjusting for demographic variables and individual somatic illnesses, the association remained statistically significant only for cerebrovascular accidents (CVAs) (OR=1.47; CI=1.09-1.98) and thyroid disease (OR=1.67; CI=1.10-2.54).

CONCLUSION

This is the first study to document that there is a positive and statistically significant association between general somatic morbidity and general psychiatric morbidity in the (predominantly) elderly population. CVAs and thyroid disease may have more weight in this association.