Department of Economics and Business Economics

Association between Mental Disorders and Subsequent Medical Conditions

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  • Natalie C. Momen
  • Oleguer Plana-Ripoll
  • Esben Agerbo
  • Michael E. Benros, University of Copenhagen
  • ,
  • Anders D. Børglum
  • Maria Klitgaard Christensen
  • Søren Dalsgaard
  • Louisa Degenhardt, University of New South Wales
  • ,
  • Peter de Jonge, Department of Psychology and Neuroscience, Duke University, Durham & Department of Psychology , University of Amsterdam, the Netherlands, Interdisciplinary Center
  • ,
  • Jean Christophe P.G. Debost
  • Morten Fenger-Grøn, Research Unit for General Practice, Aarhus University
  • ,
  • Jane M. Gunn, Melbourne Medical School
  • ,
  • Kim M. Iburg, Department of Health, Public Health, England
  • ,
  • Lars V. Kessing, Psychiatric Center Copenhagen, Faculty of Health and Medical Sciences
  • ,
  • Ronald C. Kessler, University of Groningen, Harvard University
  • ,
  • Thomas M. Laursen
  • Carmen C.W. Lim, Queensland Brain Institute, Queensland Health Pathology Service
  • ,
  • Ole Mors
  • Preben B. Mortensen
  • Katherine L. Musliner
  • Merete Nordentoft, University of Copenhagen
  • ,
  • Carsten B. Pedersen
  • Liselotte V. Petersen
  • Anette R. Ribe
  • ,
  • Annelieke M. Roest, Department of Clinical Developmental Psychology, VU University Amsterdam, Netherlands., Interdisciplinary Center
  • ,
  • Sukanta Saha, Queensland Brain Institute, Queensland Health Pathology Service
  • ,
  • Andrew J. Schork, Aarhus University, University of Copenhagen, Translational Genomics Research Institute
  • ,
  • Kate M. Scott, University of Otago
  • ,
  • Carson Sievert, Sievert Consulting
  • ,
  • Holger J. Sørensen, University of Copenhagen
  • ,
  • Mogens Vestergaard
  • Terry J. Stedman, Queensland Health Pathology Service
  • ,
  • Bjarni Vilhjalmsson
  • Thomas Werge, Faculty of Health and Medical Sciences, Lundbeck Foundation GeoGenetics Center, University of Copenhagen
  • ,
  • Nanna Weye
  • Harvey A. Whiteford, Queensland Health Pathology Service, University of Queensland, University of Washington
  • ,
  • Anders Prior
  • John J. McGrath

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 number, NCT03847753.).

Original languageEnglish
JournalThe New England Journal of Medicine
Pages (from-to)1721-1731
Number of pages11
Publication statusPublished - 2020

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