Comorbidity of mental and physical illness in middle age: impact on service utilisation

Abstract

Introduction and objectives.– Comorbidity of mental and physical illness is prevalent among middle-aged adults. It is of public health importance to understand the impact of comorbidity on the use of mental health services. The aim of this study was to examine the prevalence of mental-physical comorbidity in middle age, and its association with mental health service utilisation. Methods.– Data were extracted from the Hong Kong Mental Morbidity Survey. A total of 3075 community-dwelling Chinese adults aged 40–64 years were interviewed from November 2010 to May 2013. Psychiatric diagnoses of common mental disorder (CMD) were established using the Revised Clinical Review Schedule, and the severity of physical illness was assessed by the Cumulative Illness Rating Scale. Participants were asked to report whether they had used any mental health services in the past year and lifetime. Results.– After adjusting for other confounders, participants with CMD were associated with a higher risk of any chronic physical illness (OR = 1.93, 95% CI 1.08–3.43), in particular neurological, cardiac, musculoskeletal, genitourinary and upper gastrointestinal conditions (OR = 2.31 to 4.13). Comorbid mental and physical illnesses increased the likelihood of mental health service use both in the past year (OR = 2.06, 95% CI 1.01–4.29) and in lifetime (OR = 2.45, 95% CI 1.44–4.18). Participants with comorbid conditions were more likely to seek help from psychiatrists but not from general practitioners. Conclusions.– CMD inmidlife that is comorbid with physical health conditions increased the mental health service utilisation. The results emphasise the need for integrated general medical and mental healthcare in this population.