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Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)

Published online by Cambridge University Press:  25 January 2024

Konstantinos N. Fountoulakis
Affiliation:
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
Grigorios N. Karakatsoulis*
Affiliation:
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
Seri Abraham
Affiliation:
Pennine Care NHS Foundation Trust, Heywood, UK Manchester Metropolitan University, Manchester, UK Core Psychiatry Training, Health Education England North West, Manchester, UK
Kristina Adorjan
Affiliation:
Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
Helal Uddin Ahmed
Affiliation:
Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
Renato D. Alarcón
Affiliation:
Section of Psychiatry and Mental Health, Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado, Lima, Peru Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, MN, USA
Kiyomi Arai
Affiliation:
School of Medicine and Health Science, Institute of Health Science Shinshu University, Matsumoto, Japan
Sani Salihu Auwal
Affiliation:
Department of Psychiatry, Bayero University, Kano, Nigeria Aminu Kano Teaching Hospital, Kano, Nigeria
Michael Berk
Affiliation:
IMPACT – The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Sarah Bjedov
Affiliation:
Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Julio Bobes
Affiliation:
Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain Department of Psychiatry, Hospital Universitario Central de Asturias, Oviedo, Spain ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
Teresa Bobes-Bascaran
Affiliation:
ISPA, INEUROPA, CIBERSAM, Oviedo, Spain Mental Health Center of La Corredoria, Oviedo, Spain Department of Psychology, University of Oviedo, Oviedo, Spain
Julie Bourgin-Duchesnay
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
Cristina Ana Bredicean
Affiliation:
Department of Neuroscience, Discipline of Psychiatry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Laurynas Bukelskis
Affiliation:
Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
Akaki Burkadze
Affiliation:
Mental Hub, Tbilisi, Georgia NGO Healthcare Research and Quality Agency, Tbilisi, Georgia
Indira Indiana Cabrera Abud
Affiliation:
Hospital San Juan de Dios Hospital, Guadalajara, Mexico
Ruby Castilla-Puentes
Affiliation:
Janssen Research and Development, Johnson & Johnson, American Society of Hispanic Psychiatry and WARMI Women Mental Health, Cincinnati, OH, USA
Marcelo Cetkovich
Affiliation:
Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
Hector Colon-Rivera
Affiliation:
APM Board Certified in General Psychiatry and Neurology, Addiction Psychiatry, & Addiction Medicine, UPMC, DDAP, Philadelphia, PA, USA
Ricardo Corral
Affiliation:
Department of Teaching and Research, Hospital Borda, Buenos Aires, Argentina University of Buenos Aires, Buenos Aires, Argentina
Carla Cortez-Vergara
Affiliation:
Universidad Peruana Cayetano Heredia, Clínica AngloAmericana, Lima, Peru
Piirika Crepin
Affiliation:
Sanitaire and Social Union for Accompaniment and Prevention, Center of Ambulatory Psychiatry of Narbonne and Lezigan, Narbonne, France
Domenico De Berardis
Affiliation:
Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL Teramo, Teramo, Italy School of Nursing, University of L’Aquila, Italy Department of Neuroscience and Imaging, School of Psychiatry, University of Chieti, Chieti, Italy
Sergio Zamora Delgado
Affiliation:
Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
David De Lucena
Affiliation:
Departamento de Fisiología e Farmacología, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
Avinash De Sousa
Affiliation:
Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India Desousa Foundation, Mumbai, Maharashtra, India
Ramona Di Stefano
Affiliation:
Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L’Aquila, L’Aquila, Italy
Seetal Dodd
Affiliation:
IMPACT – The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
Livia Priyanka Elek
Affiliation:
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
Anna Elissa
Affiliation:
Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
Berta Erdelyi-Hamza
Affiliation:
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
Gamze Erzin
Affiliation:
Department of Psychiatry, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
Martin J. Etchevers
Affiliation:
Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
Peter Falkai
Affiliation:
Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
Adriana Farcas
Affiliation:
Centre of Neuroscience, Queen’s University, Kingston, Ontario, Canada
Ilya Fedotov
Affiliation:
Department of Psychiatry and Narcology, Ryazan State Medical University n.a. Academician I.P. Pavlov, Ryazan, Russia
Viktoriia Filatova
Affiliation:
State Budgetary Institution of the Rostov Region “Psychoneurological Dispensary”, Rostov-on-Don, Russia
Nikolaos K. Fountoulakis
Affiliation:
Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
Iryna Frankova
Affiliation:
Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
Francesco Franza
Affiliation:
“Villa dei Pini” Psychiatric Rehabilitation Center, Avellino, Italy Psychiatric Studies Centre, Provaglio d’Iseo, Italy
Pedro Frias
Affiliation:
Hospital Magalhães Lemos, Porto, Portugal
Tatiana Galako
Affiliation:
Department of Psychiatry, Medical Psychology and Drug Abuse, Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
Cristian J. Garay
Affiliation:
Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
Leticia Garcia-Álvarez
Affiliation:
ISPA, INEUROPA, CIBERSAM, Oviedo, Spain Department of Psychology, University of Oviedo, Oviedo, Spain
Maria Paz García-Portilla
Affiliation:
Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain ISPA, INEUROPA, CIBERSAM, Oviedo, Spain Mental Health Center of La Ería, Oviedo, Spain
Xenia Gonda
Affiliation:
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
Tomasz M. Gondek
Affiliation:
Specialty Training Section, Polish Psychiatric Association, Wroclaw, Poland
Daniela Morera González
Affiliation:
Instituto Nacional de Psiquiatría Ramón De la Fuente Muñiz, Mexico City, Mexico
Hilary Gould
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, USA
Paolo Grandinetti
Affiliation:
Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL Teramo, Teramo, Italy
Arturo Grau
Affiliation:
Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile Universidad Diego Portales, Santiago, Chile
Violeta Groudeva
Affiliation:
Department of Diagnostic Imaging, University Hospital Saint Ekaterina, Sofia, Bulgaria
Michal Hagin
Affiliation:
Forensic Psychiatry Unit, Abarbanel Mental Health Center, Bat Yam, Israel
Takayuki Harada
Affiliation:
Faculty of Human Sciences, Education Bureau of the Laboratory Schools, University of Tsukuba, Tokyo, Japan
Tasdik M. Hasan
Affiliation:
Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK Public Health Foundation, Dhaka, Bangladesh
Nurul Azreen Hashim
Affiliation:
Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Jan Hilbig
Affiliation:
Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
Sahadat Hossain
Affiliation:
Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
Rossitza Iakimova
Affiliation:
Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry “Saint Naum”, Sofia, Bulgaria
Mona Ibrahim
Affiliation:
Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Felicia Iftene
Affiliation:
Department of Psychiatry, Queens University, Kingston, ON, Canada
Yulia Ignatenko
Affiliation:
Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
Matias Irarrazaval
Affiliation:
Ministry of Health, Millenium Institute for Research in Depression and Personality, Santiago, Chile
Zaliha Ismail
Affiliation:
Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Jamila Ismayilova
Affiliation:
National Mental Health Center of the Ministry of Health of the Republic of Azerbaijan, Baku, Azerbaijan
Asaf Jakobs
Affiliation:
Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA New York Medical College, Valhalla, NY, USA
Miro Jakovljević
Affiliation:
School of Medicine, University of Zagreb, Zagreb, Croatia
Nenad Jakšić
Affiliation:
Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Afzal Javed
Affiliation:
Institute of Applied Health Research, University of Birmingham, Birmingham, UK Warwick Medical School, University of Warwick, Coventry, UK Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
Helin Yilmaz Kafali
Affiliation:
Department of Child Psychiatry, Ankara City Hospital, Ankara, Turkey
Sagar Karia
Affiliation:
Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
Olga Kazakova
Affiliation:
Faculty of Medicine, Lund University, Malmö, Sweden
Doaa Khalifa
Affiliation:
Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Olena Khaustova
Affiliation:
Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
Steve Koh
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, USA
Svetlana Kopishinskaia
Affiliation:
International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia Kirov State Medical University, Kirov, Russia
Korneliia Kosenko
Affiliation:
Department of Psychiatry, Drug Abuse and Psychology, Odessa National Medical University, Odessa, Ukraine
Sotirios A. Koupidis
Affiliation:
Occupational and Environmental Health Sector, Public Health Policy Department, School of Public Health, University of West Attica, Athens, Greece
Illes Kovacs
Affiliation:
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
Barbara Kulig
Affiliation:
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
Alisha Lalljee
Affiliation:
Desousa Foundation, Mumbai, Maharashtra, India
Justine Liewig
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
Abdul Majid
Affiliation:
Department of Psychiatry, SKIMS Medical College, Srinagar, India
Evgeniia Malashonkova
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
Khamelia Malik
Affiliation:
Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
Najma Iqbal Malik
Affiliation:
Department of Psychology, University of Sargodha, Sargodha, Pakistan
Gulay Mammadzada
Affiliation:
Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
Bilvesh Mandalia
Affiliation:
Desousa Foundation, Mumbai, Maharashtra, India
Donatella Marazziti
Affiliation:
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy Brain Research Foundation onus, Lucca, Italy
Darko Marčinko
Affiliation:
Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia School of Medicine, University of Zagreb, Zagreb, Croatia
Stephanie Martinez
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, USA
Eimantas Matiekus
Affiliation:
Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
Gabriela Mejia
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, USA
Roha Saeed Memon
Affiliation:
Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
Xarah Elenne Meza Martínez
Affiliation:
Postgraduate Program in Psychiatry, National Autonomous University of Honduras, Tegucigalpa, Honduras
Dalia Mickevičiūtė
Affiliation:
Private outpatient clinics “JSC InMedica Klinika”, Vilnius, Lithuania
Roumen Milev
Affiliation:
Department of Psychiatry, Queens University, Kingston, ON, Canada
Muftau Mohammed
Affiliation:
Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
Alejandro Molina-López
Affiliation:
General Office for the Psychiatric Services of the Ministry of Health, Mexico City, Mexico
Petr Morozov
Affiliation:
Department of Postgraduate Education, Russian National Research Medical University n.a. N.I. Pirogov, Moscow, Russia
Nuru Suleiman Muhammad
Affiliation:
Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Filip Mustač
Affiliation:
Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Mika S. Naor
Affiliation:
Sackler School of Medicine New York State American Program, Tel Aviv University, Tel Aviv-Yafo, Israel
Amira Nassieb
Affiliation:
Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Alvydas Navickas
Affiliation:
Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
Tarek Okasha
Affiliation:
Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Milena Pandova
Affiliation:
Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry “Saint Naum”, Sofia, Bulgaria
Anca-Livia Panfil
Affiliation:
Compartment of Liaison Psychiatry, “Pius Brinzeu” County Emergency Clinical Hospital, Timisoara, Romania
Liliya Panteleeva
Affiliation:
Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyz Republic
Ion Papava
Affiliation:
Department of Neuroscience, Discipline of Psychiatry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Mikaella E. Patsali
Affiliation:
School of Social Sciences, Hellenic Open University, Patras, Greece Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
Alexey Pavlichenko
Affiliation:
Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
Bojana Pejuskovic
Affiliation:
Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinical Department for Crisis and Affective Disorders, Institute of Mental Health, Belgrade, Serbia
Mariana Pinto Da Costa
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
Mikhail Popkov
Affiliation:
Department of the Introduction to Internal Medicine and Family Medicine, International Higher School of Medicine, Bishkek, Kyrgyz Republic
Dina Popovic
Affiliation:
Abarbanel Mental Health Center, Bat-Yam, Israel
Nor Jannah Nasution Raduan
Affiliation:
Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Francisca Vargas Ramírez
Affiliation:
Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile Universidad Diego Portales, Santiago, Chile
Elmars Rancans
Affiliation:
Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia Riga Centre of Psychiatry and Narcology, Riga, Latvia
Salmi Razali
Affiliation:
Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Federico Rebok
Affiliation:
Servicio de Emergencia, Acute inpatient Unit, Hospital Moyano, Buenos Aires, Argentina Argentine Institute of Clinical Psychiatry (IAPC), Buenos Aires, Argentina
Anna Rewekant
Affiliation:
General Psychiatry Unit I, Greater Poland Neuropsychiatric Center, Kościan, Poland
Elena Ninoska Reyes Flores
Affiliation:
Department of Psychiatry, National Autonomous University of Honduras, Tegucigalpa, Honduras
María Teresa Rivera-Encinas
Affiliation:
Centro de Investigación en Salud Pública, Facultad de Medicina, Universidad de San Martín de Porres, Instituto Nacional de Salud Mental “Honorio Delgado – Hideyo Noguchi”, Lima, Perú
Pilar Saiz
Affiliation:
Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain ISPA, INEUROPA, CIBERSAM, Oviedo, Spain Mental Health Center of La Corredoria, Oviedo, Spain
Manuel Sánchez de Carmona
Affiliation:
Faculty of Health Sciences, Anahuac University, Mexico City, Mexico
David Saucedo Martínez
Affiliation:
Department of Psychiatry, Escuela Nacional de Medicina, TEC de Monterrey, Servicio de geriatría. Hospital Universitario “José Eleuterio González” UANL, Monterrey, Nuevo León, Mexico
Jo Anne Saw
Affiliation:
Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Görkem Saygili
Affiliation:
Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
Patricia Schneidereit
Affiliation:
Klinik für Allgemeine Psychiatrie und Psychotherapie Ost, Psychiatrische Institutsambulanz, Klinikum am Weissenhof, Weissenhof, Germany
Bhumika Shah
Affiliation:
DY Patil Medical College, Navi Mumbai, Maharashtra, India
Tomohiro Shirasaka
Affiliation:
Department of Psychiatry, Teine Keijinkai Medical Center, Sapporo, Japan
Ketevan Silagadze
Affiliation:
Mental Hub, Tbilisi, Georgia
Satti Sitanggang
Affiliation:
Psychiatric Unit, Pambalah Batung General Hospital, South Kalimantan, Amuntai, Indonesia
Oleg Skugarevsky
Affiliation:
Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
Anna Spikina
Affiliation:
Saint Petersburg Psychoneurological Dispensary No. 2, Saint Petersburg, Russia
Sridevi Sira Mahalingappa
Affiliation:
Derbyshire Healthcare NHS Foundation Trust, The Liasion Team, Royal Derby Hospital, Derby, Derbyshire, UK
Maria Stoyanova
Affiliation:
Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry “Saint Naum”, Sofia, Bulgaria
Anna Szczegielniak
Affiliation:
Department of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
Simona Claudia Tamasan
Affiliation:
Compartment of Liaison Psychiatry, “Pius Brinzeu” County Emergency Clinical Hospital, Timisoara, Romania
Giuseppe Tavormina
Affiliation:
Psychiatric Studies Centre, Provaglio d’Iseo, Italy European Depression Association and Italian Association on Depression, Brussels, Belgium Bedforshire Center for Mental Health Research, University of Cambridge, Cambridge, UK
Maurilio Giuseppe Maria Tavormina
Affiliation:
Psychiatric Studies Centre, Provaglio d’Iseo, Italy
Pavlos N. Theodorakis
Affiliation:
Health Policy, WHO Regional Office for Europe, Copenhagen, Denmark
Mauricio Tohen
Affiliation:
Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, Nm, USA
Eva Maria Tsapakis
Affiliation:
“Agios Charalambos” Mental Health Clinic, Heraklion, Crete, Greece 1st Department of Academic Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
Dina Tukhvatullina
Affiliation:
Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
Irfan Ullah
Affiliation:
Kabir Medical College, Gandhara University, Peshawar, Pakistan
Ratnaraj Vaidya
Affiliation:
Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Johann M. Vega-Dienstmaier
Affiliation:
Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
Jelena Vrublevska
Affiliation:
Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia Riga Centre of Psychiatry and Narcology, Riga, Latvia Institute of Public Health, Riga Stradins University, Riga, Latvia
Olivera Vukovic
Affiliation:
Faculty of Medicine, University of Belgrade, Belgrade, Serbia Department of Research and Education, Institute of Mental Health, Belgrade, Serbia
Olga Vysotska
Affiliation:
Educational and Research Center − Ukrainian Family Medicine Training Center, Bogomolets National Medical University, Kyiv, Ukraine
Natalia Widiasih
Affiliation:
Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
Anna Yashikhina
Affiliation:
International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
Panagiotis E. Prezerakos
Affiliation:
Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece
Daria Smirnova
Affiliation:
International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
*
Corresponding author: Gregory Karakatsoulis; Email: gregkarakatsoulis@gmail.com
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Abstract

Background

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

Methods

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

Results

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

Conclusions

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Type
Original Research
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Introduction

The prevalence of medical illnesses is reported to be high among people with mental illness. In fact, mentally ill people are more likely than the general population to develop medical conditions, develop them at a younger age, and die earlier from them.Reference Hoffman, Rice and Sung1Reference Parks, Svendsen, Singer, Foti and Mauer3 In a population-based cohort study of 4.6 million people in Denmark (from 1994 to 2007), results indicated that 5 years after their first contact with the healthcare system for heart disease, 8.26% of people with a comorbid severe mental disorder had died, versus 2.86% of those without.Reference Laursen, Munk-Olsen, Agerbo, Gasse and Mortensen4

It has been reported that approximately 50–90% of people with severe psychiatric disorders have at least one chronic medical illnessReference Gold, Kilbourne and MJJofp5 and the rates are even higher in those with comorbid substance-use disorders.Reference Batki, Meszaros and Strutynski6 Obesity, diabetes, hypertension, and dyslipidemia, a cluster of conditions also known as metabolic syndrome, occur at rates 1.5 to 5 times greater than the rates seen in the general populationReference Correll7 and at a rate 2 to 3 times higher in schizophrenia and bipolar disorder in comparison to the general population,Reference Correll7, Reference Suppes, McElroy and Hirschfeld8 with the use of atypical antipsychotics being an additional risk factor.Reference Fenton and Chavez9 The rates seem to increase with the severity of mental disorders.Reference Parekh and Barton10 From a reverse angle, almost half of the general population suffers from a chronic somatic conditionReference Hoffman, Rice and Sung1 and those persons with more somatic disorders tend to have more psychiatric disorders.Reference Neeleman, Ormel and Bijl2

This leads to greater symptom burden and functional impairment, poorer quality of life, higher costs, and excess mortality,Reference Viron and Stern11, Reference Lawrence, Kisely and Pais12 especially in elderly patients with psychiatric disorders.Reference Katon13, Reference Druss and Walker14

There are only a few studies that have investigated the prevalence and the patterns of lifetime co-occurrence of mental health conditions with a broader range of somatic conditions in large study samples. The current study aimed to investigate the rates of mental disorders in the general population as well as somatic multi-comorbidity and its relationship to specific mental disorders and their treatment, with the use of the COMET-G dataset. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

Material and methods

The data used in this study is from the COVID-19 Mental Health International for the General Population (COMET-G) study, the main findings of which have been already published.Reference Fountoulakis, Apostolidou and Atsiova15Reference Patsali, Mousa and Papadopoulou20 The full protocol used is available in the web appendix of the first published COMET study.Reference Fountoulakis, Karakatsoulis and Abraham17

The data were collected online and anonymously from April 2020 to March 2021. Announcements and advertisements were made on social media and news sites, but no other organized effort was taken. The first page included a declaration of consent which everybody accepted by continuing with the participation.

Approval was initially given by the Ethics Committee of the Faculty of Medicine, Aristotle University of Thessaloniki, Greece, and locally concerning each participating country.

The study sample included data from 40 countries (Figure 1) concerning 55,589 responses, but for the current article, complete data were available for 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender).

Figure 1. Map of the 40 participating countries.

The contribution of each country and the gender and age composition, as well as details concerning various sociodemographic variables (marital status, education, work, etc.), have been already reported.Reference Fountoulakis, Apostolidou and Atsiova15Reference Patsali, Mousa and Papadopoulou20

The study population was self-selected, and the only limitation was age >17. It was not possible to apply post-stratification on the sample as it was done in a previous study,Reference Fountoulakis, Apostolidou and Atsiova15 because this would mean that we would utilize a similar methodology across many different countries and the population data needed were not available for all.

The protocol, which is also available in previous publications,Reference Fountoulakis, Karakatsoulis and Abraham17 included the registration of already existing (not emerged during the pandemic) somatic and mental disorders. The questions B2, B3, B5, and B6 were used as the source of variables for the current study. The current treatment status was registered but not its history. The COVID-19 pandemic acted as a stressful condition and triggered the emergence of both somatic and mental disorders even de novo, but previous history could serve as a fair approximation for the lifetime prevalence of various medical conditions in the study sample in a quasi-epidemiological frame for the time point just before the pandemic.

The complete list of conditions registered and their grouping is shown in Table 1. All the data were self-reported, no clinical assessment was made and this constitutes a significant problem for the interpretation of the results. A composite score reflecting the presence of hypertension, dyslipidemia, diabetes mellitus, and obesity (0–4) was created and used as a factor reflecting the presence and severity of the metabolic syndrome.

Table 1. Percentages of Major Groups of Somatic Disorders and Specific Disorders in the Patients with Psychiatric Disorders’ Diagnostic Groups and Also Under the Age of 46

Note: Of the 545 calculable RRs, 73 were below 1, 114 between 1 and 1.5 and the rest 358 were above 1.5.

Statistical analysis

  • Detailed descriptive statistics were calculated and tables were created.

  • The t-test was used to search for differences between groups, with the p-level of p < 0.001 used as the level of significance since many tests were performed.

  • Risk ratios (RR) were calculated as the ratio of the percentage of pathological state divided by the percentage of nonpathological state.

The statistical package SPSS v.29 (Aristotle University of Thessaloniki, Greece) was used for the analysis.

Results

Demographics

The study sample included data from 40 countries (Figure 1). In total, data from 54,826 participants were utilized (aged 35.45 ± 13.51 years); of them, 35,489 were females (64.73%; aged 35.80 ± 13.61 years) and 18,725 males (34.15%; aged 34.90 ± 13.29 years), while 612 declared “nonbinary gender” (1.11%; aged 31.64 ± 13.15 years). The age means and standard deviations were identical to the original study sample of 55,589 subjects.Reference Fountoulakis, Apostolidou and Atsiova15, Reference Fountoulakis, Karakatsoulis and Abraham17 Less than 6.5% of the participants were older than 60 years.

Rates of somatic and mental disorders and multicomorbidity

Approximately 24.5% of the whole study sample reported that they had a history of at least one somatic disorder, and a similar 26.14% of any mental disorder. As a group, mental disorders were by far the most prevalent group of medical conditions, with cardiovascular disorders following with 6.41% (Table 2). Comorbidities of any somatic with any mental disorder were reported by 8.21% of the total study sample.

Table 2. Prevalence of Somatic and Mental Disorders in the Study Sample

History of depression was the most frequently reported mental disorder (>12%) followed by anxiety (approximately 8%). History of nonaffective psychoses and bipolar disorders were reported by 1% each. An impressive >20% had a lifetime history of self-injury and >10% had attempted suicide in the past (Table 2).

A significant proportion of patients with a history of a somatic disorder, ranging roughly from one-third to almost two-thirds, were also suffering from a mental disorder, with the risk ratio (RR) of somatic patients to suffer also from a mental disorder being >1 in all cases. The highest RR was for neurologic (1.80) and autoimmune disorders (1.73), while in patients with five comorbid groups of medical conditions, the RR was as high as 2.30 (Table 2).

The age distribution of healthy subjects and patients with psychiatric disorders in the study sample (Table 3) suggests that patients with psychiatric disorders tend to be younger. In Figure 2, the age distribution relative to the percentage in the age group 21–25 years (standardized to 1 or 100%) is graphically shown. Ages above 35 are under-represented in the bipolar and psychotic groups (Figure 2).

Table 3. Percentages of Subjects of Diagnostic Groups in Age Groups and the Relative Contribution of Age Groups to the Population within Each Diagnostic Group in Comparison to the 21–25 Age Group (Standardized as Equal to 1)

Figure 2. Contribution of age groups relative to the 21–25 years group which is used as reference (=1 or 100%). In the nonpatients with psychiatric disorders group, there is a decline in participation with age. A similar pattern is observed in patients with psychiatric disorders in general, but in the subgroups of bipolar and psychotic patients, this decline in participation occurs already after the age of 25, suggesting the presence of an early impairment resulting in a lack of participation in social activities. Premature death probably plays a role.

The number of somatic disorders was a number produced by counting the groups of somatic disorders present in an individual, as well as diabetes, cancer, and HIV (see the list in Table 1). Thus this number is an underestimation of the number of individual medical conditions present; instead, it represents the number of body systems suffering. This number increases with age in all diagnostic groups, and it is consistently higher in the groups of patients with psychiatric disorders, with the highest values in bipolar and psychotic patients (Table 4). A graphic representation of the increase in the number of comorbid somatic disorders with increasing age in the different diagnostic groups is shown in Figure 3. Figure 3 suggests that already since a very young age (early 20s) the burden of somatic disorders appears in patients with psychiatric disorders, almost 15–20 years earlier in comparison to the general population, and this advancement is retained throughout the life span with only limited attenuation. Also, the contribution to the study sample by patients with psychosis collapses after the age of 55 (Figure 3, point C), by bipolar patients after the age of 60 (point D), and by depressive patients after the age of 65 (point E), and this under-representation could reflect either the development of severe disability or premature death.

Table 4. Means and Standard Deviations of the Number of Somatic Disorders Present in Patients with Psychiatric Disorders in Comparison to the Rest of the Study Sample in Different Age Groups

Figure 3. Plot of the number of somatic disorders (y-axis) versus age groups (x-axis). Patients with psychiatric disorders and controls manifest parallel lines with similar slopes, but patients with psychiatric disorders start from a higher baseline. This suggests that somatic comorbidity occurs approximately 15 years earlier and since the 20s for patients with psychiatric disorders (line A) and although this difference is attenuated in middle age, it is kept at the size of 10 years (line B). Psychotic (point C), bipolar (point D), and depressed patients (point E) are not able to keep up with the rest of the patients with psychiatric disorders’ line and their lines collapse at the ages of 55, 56–60, and 65, respectively. This confirms the interpretation of disability accumulated with age and premature death.

A composite score reflecting the presence of hypertension, dyslipidemia, diabetes mellitus, and obesity (0–4) was created. Patients with psychiatric disorders had a slightly higher but significant metabolic score in comparison to the general population (0.09 ± 0.32 vs 0.08 ± 0.29, t = −3.529, df: 54824, p < 0.001).

Treatment of mental disorders

The majority of patients with mental disorders were not under any kind of treatment (59.44%). This was true mainly for anxiety and depression, whereas for the more severe disorders, the majority of patients were under some kind of treatment (Table 5). Unfortunately, the majority of patients were not under treatment at all and from those under treatment, only a small minority was receiving treatment as recommended, for example, 7.62% of bipolar patients and 10.2% of psychotic patients were treated with psychotherapy alone, and respectively 16.8% and 7.24% with antidepressant plus psychotherapy and 15.55% and 11.5% with antidepressant monotherapy. Eventually, this mistreatment concerned the vast majority of patients under treatment in the bipolar (60.04% of 67.19%; ie, 9/10 of patients under any kind of treatment) and the psychotic groups (43.23% of 67.35%; ie, 2/3 of patients under any kind of treatment). It is not possible to identify the respective percentages in the other diagnostic groups but the lowest percentages are equally disappointing (Table 5).

Table 5. Percentages of treatment options in the diagnostic subgroups of subjects with a mental health history

Note: For anxiety, depression, and “other” one can not be certain whether not receiving any treatment at present represents a problem since some patients might not need treatment after a certain period of time and after the first episode of the disorder. However, this is not the case with bipolar disorder and psychosis, for whom one can definitely conclude on their treatment quality.

a Not recommended treatment option.

b Not under treatment.

The t-test concerning the relation of the use of specific treatment options (grouping variable any treatment option) in the patients with psychiatric disorders subsample only, and the metabolic composite score (tested variable), returned no significant effect for antipsychotics (t = 1.138, df: 40225, p = 0.254), antidepressants (t = 1.079, df: 40225, p = 0.280), or psychotherapy (t = 1.762, df: 40225, p = 0.080), either in monotherapy or in combination. The only significant effect concerned a general effect of the use of benzodiazepines (0.02 ± 0.15 vs 0.007 ± 0.08, t = −9.618, df: 40225, p < 0.001).

Patients with psychiatric disorders had a slightly higher but significant metabolic score in comparison to the general population (0.09 ± 0.32 vs 0.08 ± 0.29, t = −3.529, df: 54824, p < 0.001).

An interesting finding was that 1.65% of those who did not report any history of mental disorders were under psychotherapy, and 0.80% were taking benzodiazepines suggesting that they were suffering from some type of life stress or interpersonal difficulties.

Discussion

The current paper reports on the prevalence of mental and somatic disorders and multicomorbidity in a large convenient sample from 40 countries. The first question is how appropriate this study sample is for such a quasi-epidemiological study, and subsequently, how reliable and how valid are the rates that are reported. Since the data were obtained by self-reporting from a self-selected sample, the only way to assess validity is to compare the findings concerning a specific topic with already known answers on this topic.

Following this pathway, it seems that our reporting is quite in accord with the literature concerning the prevalence of major mental disorders, including anxiety,Reference Bourdon, Rae, Locke, Narrow and Regier21, Reference Wittchen and Jacobi22 depression,Reference Goodwin, Dierker, Wu, Galea, Hoven and Weinberger23, Reference Lim, Tam, Lu, Ho, Zhang and Ho24 bipolar disorder,Reference Bebbington and Ramana25Reference Fountoulakis and Fountoulakis28 and psychosis,Reference Eaton29, Reference McGrath, Saha, Chant and Welham30 as well as self-injury.Reference Agley and Xiao31Reference Lucena, Rossi, Azevedo and Pereira33 While the history of suicidal attempts was found to pass 10%, the rates reported in the literature vary between 2% and 5%,Reference Fountoulakis, Grammatikopoulos, Koupidis, Siamouli and Theodorakis34Reference Schmidtke, Bille-Brahe and De Leo40 however, the variability is great and it seems that selective retrieval of memories is involved. This is evident since studies in adolescents report rates around 20%,Reference Liu, Huang and Liu41, Reference Van Meter, Knowles and Mintz42 while surveys in middle-aged individuals report much lower lifetime rates. Overall, the general pattern of mental disorder rates supports the validity of our study sample and the results of the current study.

On the other hand, the rates of somatic disorders reported by the current study appear to be much lower than those reported in the literature. One explanation could be that in our study sample, less than 6.5% were older than 60 years. However, even disorders with onset at an early age had very low rates. Migraine was found in less than 1% while in the literature the prevalence is reported to be approximately 10%.Reference Amiri, Kazeminasab and Nejadghaderi43 Epilepsy was found in 0.1% while the literature suggests a prevalence of 0.7%.Reference Fiest, Sauro and Wiebe44 The celiac disease rate was below 0.1% while the literature suggests a prevalence rate of 1%.Reference Singh, Arora and Strand45 However, the mean number of co-existing somatic disorders is in accord with the literature.Reference Bobo, Yawn, Sauver, Grossardt, Boyd and Rocca46 If one looks at the percentages of specific disorders in the subsample of patients with any somatic disorder, then the picture is different with hypertension at 23.15% and diabetes at 9.53% which are in accord with data from electronic registries,Reference Wu, Zhu and Ghitza47 but other rates were still low, eg, ischaemic heart disease at 0.88% and migraine at 1.14%. A general comment is that registry studies appear to report similar rates to ours, while studies targeting specific disorders report significantly higher values, probably because they study in-depth, more specific populations and they include the biases of studying more severely ill populations. Many of these in-depth studies report so high rates that one is difficult to believe, and eventually, their summary would imply that everybody suffers from something even at a very early age. On the other hand, it should be noted that in the current study, the registration of somatic disorders was based on self-reporting which means that there was no clinical or laboratory investigation of the subject. Thus, an additional explanation for these discrepancies is a combination of the lack of knowledge on underlying diseases by the person; for example, asthma is not known in half of those suffering from it,Reference Nolte, Nepper-Christensen and Backer48, Reference de Marco, Cerveri, Bugiani, Ferrari and Verlato49 with the presence of a systematic bias in our study sample toward an overall more healthy sample.

Even after taking into consideration an under-reporting of somatic disorders, mental disorders emerge as the most prevalent group of medical conditions (lifetime prevalence >25%) and this is in accord with the literature.Reference Collins, Patel and Joestl50Reference Bertolote and Fleischmann55 Also in accord with the literature is the finding that comorbidity of any somatic with any mental disorder was found in 8.21% of the total study sample.Reference Bobo, Yawn, Sauver, Grossardt, Boyd and Rocca46 The presence of multiple somatic disorders increases dramatically the likelihood of the presence of a mental disorderReference Neeleman, Ormel and Bijl2, Reference Bobo, Yawn, Sauver, Grossardt, Boyd and Rocca46, Reference Ronaldson, Arias de la Torre and Prina56 and this is again in accord with the literature, which however refers mostly to older persons.Reference Yao, Cao and Han57Reference Galenkamp, Braam, Huisman and Deeg59 In bipolar and psychotic patients, this multi-comorbidity increases dramatically the disability and maybe the chances for premature death. From a reverse point of view, depending on the somatic disorder, somatic patients suffer from a comorbid mental condition with rates varying from one to two-thirds (Table 2).

The visual inspection of the lines in Figures 2 and 3 suggests that the age distribution is more or less similar in the two major diagnostic groups (Figure 2) and the increase in the number of somatic disorders with increasing age manifests the same slope but it initiates from a higher baseline for patients with psychiatric disorders (Figure 3). The exceptions, however, are interesting, and they concern mainly patients with bipolar disorder and psychosis but also depressed patients, to a lesser, extend. Their absolute numbers in these diagnostic subgroups are not sufficient to affect the line of the whole group of patients with psychiatric disorders. In Figure 2, it is evident that while the participation is similar across all diagnostic groups for the age group 21–25, it sharply declines already after the age of 25 for bipolar and psychotic patients while the other diagnostic groups manifest a pattern similar to that of the normal population. In Figure 3, the lines for psychotic, bipolar, and depressed patients deviate from the bundle of lines of the subgroups of patients with psychiatric disorders, at different ages for each of these groups. While the rest of the lines are monotonous, the lines of these three groups have the shape of an upside-down U.

An interpretation could be that after the age of 55, only the very mild psychotic cases with low somatic comorbidity participated in the current study, while those that would keep the line monotonous “dropped out” of the study. The respected age is 60 for bipolar patients and 66–70 for patients with unipolar depression. This observation that depressed, bipolar, and psychotic patients with high somatic multicomorbidity did not participate in the study after a certain age, probably reflects the presence of a significant disability in these patients, or even premature death.Reference de Mooij, Kikkert and Theunissen60Reference Weye, Momen and Christensen63 Another observation from Figure 3 and Table 4 is that patients with psychiatric disorders manifest somatic conditions several years ahead of controls; this advancement probably attenuates with passing age as controls tend to catch up, however, it never disappears, and it probably contributes to disability and premature death. At the age of 20, it is approximately 15 years and eventually, it is reduced to 10 years in middle age. This time advancement is identical to the years of premature death for patients with psychiatric disorders that are reported in the literature.Reference Viron and Stern11, Reference de Mooij, Kikkert and Theunissen60Reference Chesney, Goodwin and Fazel62, Reference Colton and Manderscheid64Reference Harris and Barraclough67

The most impressive finding concerning the treatment of mental disorders was that the majority of bipolar and psychotic patients under treatment were receiving an unrecommended treatment option. The finding that the majority of patients were not under treatment at all was expected. However, the finding that above 90% of bipolar patients and 75% of patients with psychosis receive an inappropriate or they do not receive any treatment at all, was alarming, but not unexpected since similar reports can be found in the literature.Reference Fond, Tinland and Boucekine68 If these severe mental disorders, that have the most clear-cut treatment guidelines are treated so ineffectively, then probably other mental disorders with less robust guidelines or in the case of milder and not “classical” manifestations of mental disorders, the lack of treatment or false treatments is probably the standard.

The finding that neither antipsychotics nor antidepressants were related to the development of metabolic syndrome was also unexpected,Reference Correll7Reference Fenton and Chavez9 while the relationship of benzodiazepines to metabolic syndrome was a surprise, although warnings for their potential to produce such an effect do exist in the literature.Reference Gramaglia, Ramella Gigliardi and Olivetti69Reference Chevassus, Mourand, Molinier, Lacarelle, Brun and Petit72 Also the finding that patients with psychiatric disorders have more frequent metabolic syndrome is in accord with the literature.Reference Correll7

The findings of the current study confirm previous reports on mental-somatic comorbidity and the problematic treatment of patients with psychiatric disorders. Thus, they point to the urgent need for better education and training of undergraduate medical students in the field of mental health. Physicians of almost every clinical specialty but also all those who have personal contact with patients will face high rates of behaviors due to the presence of mental disorders. Being able to understand and put behaviors in the correct clinical frame will not only improve the work of the physician and the professional environment, but it could also improve the general health of a large number of patients. Psychiatry should be upgraded in Medical Schools since not only it concern the numerically biggest group of medical patients that carry the biggest disability burden, but it seems that it is the field with the most trans-specialty and interdisciplinary value and application.

Additionally, our results point to the urgent need for better training of psychiatrists in the treatment of patients with psychiatric disorders, especially of the most severely ill. Training based on modern technocratic methods and ways of clinical work, which is more or less standard in the rest of medicine, seems to be an unmet need in psychiatry and it takes a toll on patients. Even if the results of the current study overestimate the problem, still there seems to be much room for improvement concerning the treatment and the outcome of patients with psychiatric disorders at an international level.

Conclusion

With the reservation concerning the quality of the study sample which is self-selected online, the current paper reports that mental disorders might be the most common among all medical disorders and their appearance is especially high in patients with somatic multicomorbidity. Depending on the somatic diagnosis, from one to two-thirds of somatic patients suffer from some mental disorder. Mental disorders themselves are more often accompanied by somatic multicomorbidity and maybe with a 10–20 years earlier age at onset. The more severe mental disorders are characterized by increased disability after mid-age and probably premature death. The grim picture is completed with the finding that the vast majority of these patients might not receive appropriate treatment according to standard recommendations, or, even worse, no treatment at all. The above point to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents and also during life-long education and training.

Strengths and limitations

The strengths of the current paper include the large number of persons who filled out the questionnaire and the large bulk of information obtained. However, important is that the results are reasonable, they make sense and they are straightforward. For example, psychosis is the first diagnostic group whose participation in the study collapses (Figure 3), followed by the bipolar and then by the depressive, while the participation of the anxious group is similar to that of the general population. Overall the findings fit well with the literature, they fill gaps and expose correlations.

The major limitation was that the data were obtained anonymously online through the self-selection of the responders, without any clinical or laboratory investigation. The utilization of “personal medical history” was a fair approximation for the morbidity of the study sample without the effect of the pandemic, but still, it is an approximation open to debate.

Author contribution

All authors contributed equally to the paper. K.N.F. and D.S. conceived and designed the study. The other authors participated in formulating the final protocol, designing and supervising the data collection, and creating the final dataset. K.N.F. and D.S. did the data analysis and wrote the first draft of the paper. All authors participated in interpreting the data and developing further stages and the final version of the paper.

Disclosures

Co-authors do not have anything to disclose.

Competing interest

The authors declare that they have no competing interests.

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Figure 0

Figure 1. Map of the 40 participating countries.

Figure 1

Table 1. Percentages of Major Groups of Somatic Disorders and Specific Disorders in the Patients with Psychiatric Disorders’ Diagnostic Groups and Also Under the Age of 46

Figure 2

Table 2. Prevalence of Somatic and Mental Disorders in the Study Sample

Figure 3

Table 3. Percentages of Subjects of Diagnostic Groups in Age Groups and the Relative Contribution of Age Groups to the Population within Each Diagnostic Group in Comparison to the 21–25 Age Group (Standardized as Equal to 1)

Figure 4

Figure 2. Contribution of age groups relative to the 21–25 years group which is used as reference (=1 or 100%). In the nonpatients with psychiatric disorders group, there is a decline in participation with age. A similar pattern is observed in patients with psychiatric disorders in general, but in the subgroups of bipolar and psychotic patients, this decline in participation occurs already after the age of 25, suggesting the presence of an early impairment resulting in a lack of participation in social activities. Premature death probably plays a role.

Figure 5

Table 4. Means and Standard Deviations of the Number of Somatic Disorders Present in Patients with Psychiatric Disorders in Comparison to the Rest of the Study Sample in Different Age Groups

Figure 6

Figure 3. Plot of the number of somatic disorders (y-axis) versus age groups (x-axis). Patients with psychiatric disorders and controls manifest parallel lines with similar slopes, but patients with psychiatric disorders start from a higher baseline. This suggests that somatic comorbidity occurs approximately 15 years earlier and since the 20s for patients with psychiatric disorders (line A) and although this difference is attenuated in middle age, it is kept at the size of 10 years (line B). Psychotic (point C), bipolar (point D), and depressed patients (point E) are not able to keep up with the rest of the patients with psychiatric disorders’ line and their lines collapse at the ages of 55, 56–60, and 65, respectively. This confirms the interpretation of disability accumulated with age and premature death.

Figure 7

Table 5. Percentages of treatment options in the diagnostic subgroups of subjects with a mental health history