General health and quality-of-life measures in active, recent, and comorbid mental disorders: a population-based health 2000 study
Introduction
Psychiatric disorders and their comorbidity are common in the general population. Their impact on health, psychological well-being, and quality of life (QoL) is large and growing [1]. The major epidemiologic studies, the Epidemiologic Catchment Area (ECA) and the National Comorbidity Survey (NCS), found that most subjects with diagnosable psychiatric disorders have several separate disorders at least at some point of their lives [2], [3], [4], [5]. The importance of psychiatric comorbidity has been emphasized in recent research, indicating increased morbidity and complicated course of the disorders, and poorer effectiveness of treatment [6], [7], [8], [9], [10], [11].
In addition to comorbidity, the state of a psychiatric disorder, either active or symptoms partially or fully remitted, is likely to be of importance for subjective distress and QoL [12], [13]. Although full remission of symptoms and recovery from illness are ideal treatment goals, relapses and residual symptoms are common [14]. This makes measuring functional outcomes and QoL important also for people who have previously had psychiatric disorders.
Research on subjective distress and QoL in comorbid psychiatric disorders in the general population has used varying diagnostic instruments and outcome measures [15]. Anxiety- and depressive symptoms, and psychological distress can be detected from general and clinical populations by simple symptom questionnaires, such as the Beck Depression Inventory (BDI) [16] and the General Health Questionnaire (GHQ) in their different versions. Their psychometric properties have been evaluated in detecting psychiatric disorders [17], [18]. Quality-of-life instruments can be either condition-specific or generic, the latter allowing comparison between different conditions. Quality-of-life measures can target either general or health-related QoL (HRQoL), the latter containing those domains of QoL that health and health care can influence. Unfortunately, there is no gold standard of QoL measurement but a wide variety of measures that might produce conflicting results [19]. Thus, the simultaneous use of several measures based on varying operationalizations of QoL is of great importance. In the clinical world, symptom questionnaires are used to monitor course of treatment, but QoL instruments have so far rarely been used for this purpose. Quality-of-life measurement could ideally help in recognizing the aspects of illness or care that matter most to the global well-being of each individual patient.
We compared the subjective health and QoL of people with pure and comorbid forms of the most common psychiatric disorders with people having a chronic physical condition, type 2 diabetes mellitus (T2DM). We chose T2DM because the diagnosis was based on either laboratory measurements taken in the study or treatment history. Thus, as in mental disorders, the impact of disease could be investigated regardless of whether it had been previously diagnosed or not. In addition, T2DM is a common chronic disease, with increasing incidence worldwide and with large and well-documented effects on individuals and public health [20], [21], [22], [23].
Our study aimed to evaluate psychological distress, HRQoL, and self-rated general health (SRGH) ratings of people with active or recent (but currently subdiagnostic) states of alcohol use, anxiety and depressive disorders, pure and comorbid forms of these disorders, and T2DM, in a representative sample of Finnish population. We investigated also how using mental health services, in the context of diagnosed disorders, would associate with the measures of well-being in this study.
Section snippets
Methods
The Health 2000 Study was a multidisciplinary epidemiologic survey in mainland Finland involving a regionally stratified sampling frame and weighing procedure to obtain a nationally representative sample of subjects from the general population, aged 30 years and older (N = 8028). The study was carried out in 2000 to 2001 and coordinated by the National Public Health Institute. Project details and methodology have been published earlier [24], [25], [26].
Data were collected via initial home (n =
Results
The basic results of the analysis are presented in Tables 1-3. Men had slightly lower psychological distress ratings (mean GHQ-12 scores were 1.68 for males and 1.95 for females, t = -3.56, P < .001) and had higher HRQoL ratings (0.92 and 0.91 on 15D for males and females, t = 2.99, P < .005; and 0.86 and 0.84 on EQ-5D for males and females, t = 4.93, P < .001) than women. Scores for SRGH did not differ between sexes (males, 7.47; females, 7.46; not significant).
In depressive disorders, anxiety
Discussion
Our results suggest that mental disorders and especially the comorbidity of mental disorders have remarkable impact on well-being on individual and on population level. Despite its huge public health and economic importance, in our study, diabetes was associated with minimal psychological distress and only modest decrease of self-rated health and HRQoL. People with recent—but without currently diagnosable—mental disorders had significantly worse scores on most measures when compared to those
References (47)
- et al.
Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study
Lancet
(1997) - et al.
The epidemiology of anxiety disorders: the Epidemiologic Catchment Area (ECA) experience
J Psychiatr Res
(1990) - et al.
Clinical and psychosocial outcome of patients affected by panic disorder with or without agoraphobia: results from a naturalistic follow-up study
Eur Psychiatry
(2002) - et al.
Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation
Clin Psychol Rev
(1988) - et al.
Type 2 diabetes: principles of pathogenesis and therapy
Lancet
(2005) EuroQol: the current state of play
Health Policy
(1996)- et al.
Diagnostic criteria for diabetes mellitus and other categories of glucose intolerance: 1997 criteria by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (ADA), 1998 WHO consultation criteria, and 1985 WHO criteria. World Health Organization
Diabetes Res Clin Pract
(1999) - et al.
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Lancet
(2007) - et al.
Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey
Arch Gen Psychiatry
(1994) - et al.
Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study
JAMA
(1990)
Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication
Arch Gen Psychiatry
Recognition and treatment of depression with or without comorbid anxiety disorders
CNS Spectr
The prevalence of DSM-IV personality disorders in psychiatric outpatients
Am J Psychiatry
Does recovery from substance use disorder matter in patients with bipolar disorder?
J Clin Psychiatry
Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study
Am J Psychiatry
The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization
Am J Orthop
Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders
Arch Gen Psychiatry
Monitoring depression treatment outcomes with the patient health questionnaire-9
Med Care
Psychosocial disability before, during, and after a major depressive episode: a 3-wave population-based study of state, scar, and trait effects
Arch Gen Psychiatry
Distress and functioning in mixed anxiety and depressive disorder
Psychiatry Clin Neurosci
The validity of two versions of the GHQ in the WHO study of mental illness in general health care
Psychol Med
Differentiation of depressive disorders from generalized anxiety by the Beck Depression Inventory
J Clin Psychol
One thousand health-related quality-of-life estimates
Med Care
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