Significant Associations Between Mental Illness and Chronic Disease

Lexa W. Lee

October 24, 2007 (New Orleans) — A new study from the Centers for Disease Control and Prevention (CDC) shows a strong association between mental illness and chronic diseases and with their related risk factors.
Researchers led by Tara Strine, an epidemiologist at the CDC, in Atlanta, Georgia, report significant relationships between depression and anxiety and chronic diseases such as asthma, cardiovascular disease, and diabetes, as well as the adverse health behaviors such as smoking or inactivity that are risk factors for these diseases.
"It is time to examine mental and physical health as a combined entity in our public health efforts," the authors conclude.
Their findings were reported here at the 2007 American Psychiatric Association 59th Institute on Psychiatric Services.
Major Causes of Morbidity and Mortality
Depression and anxiety are 2 major causes of morbidity leading to mortality, the authors write. They are associated with impaired health, excess disability, and chronic disease.
The current study used data from the 2006 Behavior Risk Factor Surveillance System (BRFSS) Anxiety and Depression Module and was designed to examine the association of depression and anxiety and certain chronic disease and adverse health behaviors among adults living in the community.
The investigators believe this to be the first state-based study examining the relationship between current depression, using the Patient Health Questionnaire, PHQ-8 (a random-digit, state-based telephone survey of participants at least 18 years old), a lifetime diagnosis of anxiety or depression, chronic illness, obesity, and adverse health behaviors (smoking, lack of exercise, heavy drinking).
Data collected in 38 states, the District of Columbia, Puerto Rico, and the US Virgin Islands were available for 217,379 participants. The prevalence of current depression was 8.7%; a lifetime diagnosis of depression was present in 15.7%, and a lifetime diagnosis of anxiety was seen in 11.3%.
West Virginia had the highest rate of current depression, at 13.7%, and Arkansas had the highest rate of lifetime diagnosis of depression, at 21.3%. Chronic diseases like cardiovascular disease, diabetes, and asthma and risk factors such as obesity, smoking, physical inactivity, and heavy drinking were all significantly associated with current depression and a lifetime diagnosis of anxiety or depression.
The investigators concluded that there is a strong association of mental illness with chronic diseases and related adverse behaviors. This suggests a need to employ an integrated, multidimensional approach to healthcare, they conclude.
"The strengths of the study include the large sample size and the ability to combine it with data about chronic diseases and adverse health behaviors," Ms. Strine told Medscape Psychiatry. "However, we weren't able to include people in institutions, those without telephones, and those unable to complete the survey due to their diseases or mental illness."American Psychiatric Association 59th Institute on Psychiatric Services: Poster 166. Presented October 13, 2007.