Mental Disorder, Physical Health, & Social Functioning
A survey of the point prevalence of schizophrenia within three regions of Scotland was undertaken in 1996, replicating a similar survey conducted in 1981. In comparison to the 1981 study, the patients studied in 1996 had both more positive and negative symptoms and more nonschizophrenic symptoms. Some of the symptoms encountered involved physical health.
An increasing number of epidemiologic studies have demonstrated that depression is a serious illness in its own right and that depressive disorder, and depressive symptoms without a formal depressive disorder being present, can have a serious impact on the general physical health of an individual. The Medical Outcome Study looked carefully at this association by evaluating processes and outcomes of care for patients with the chronic conditions of hypertension, diabetes, coronary heart disease, and depression. Patients with either a current depressive disorder or depressive symptoms in the absence of a disorder tended to have worse physical health, poorer social role functioning, worse perceived current health, and (perceived) greater bodily pain than did patients without a chronic depressive condition. Further, the poor functioning associated with depression or depressive symptoms was equal or worse than that associated with eight major medical conditions, and the effects of depressive symptoms and chronic medical conditions were addictive. For example, the combination of advanced coronary artery disease and depressive symptoms was associated with roughly twice the reduction in social functioning than was found with either condition alone. These authors and subsequent studies concluded that it was important to correctly assess and treat depression in all health care settings in order to improve overall patient outcome, reduce patient and family suffering, and reduce societal costs. The Medical Outcome Study was one of the first to directly compare the social and occupational costs of physical and psychiatric disorders, emphasizing that psychiatric disorders are a major public health concern. More recent research has extended these findings.
Spitzer and colleagues found that depression, anxiety, somatoform disorders, and eating disorders were associated with considerable impairment in health- related quality of life scales. As in the Medical Outcome Study, impairment was found in patients with subclinical symptoms and in those with clinically diagnosable disorders. Mental disorders appeared to contribute to overall impairment to a greater degree than did medical conditions.
From 1982 to 1996, the comorbidity of physical and psychiatric disorders was studied in an unselected 1966 northern Finland birth cohort. In comparison to individuals without a psychiatric diagnosis, psychiatric patients were found to have been hospitalized more frequently for injuries, poisonings, or indefinite symptoms. Men were more commonly hospitalized with a variety of gastrointestinal and circulatory disturbances; women with a comorbid psychiatric disorder were more commonly hospitalized with respiratory disorders, vertebral column disorders, gynecologic disorders, or induced abortions. Epilepsy, nervous and sensory organ disorders in general, and inflammatory disorders of the bowels were more common in patients with schizophrenia as compared to those without the disease. The National Treatment Outcome Research Study, the first large-scale prospective, multisite treatment outcome study of drug users in the United Kingdom, found an extensive range of psychological and physical health problems among this population. Studies looking at the comorbid features of physical and psychological health have consistently demonstrated a high correlation, and these findings have given leaders in the health, social service, and criminal justice systems impetus to plan integrated approaches to this vulnerable, and at least dually afflicted, population.