Association between Mental Disorders and Subsequent Medical Conditions
Open accessAbstract
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 ClinicalTrials.gov number, NCT03847753.).
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Anxiety disorders are associated with a whole range of physical disorders, with hazard ratios in the range of 1.17-1.73 for ten condition groups and between 1.13 and 2.40 for individual conditions.
“anxiety disorders are associated with a whole range of physical disorders, with hazard ratios in the range of 1.17-1.73 for ten condition groups and between 1.13 and 2.40 for the individual conditions 167 .”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [167]
The Results (Relative Risk of Subsequent Medical Condition; page unavailable) report increased risks across many mental-disorder–medical-condition pairs, supporting the broad association. But our copy gives no anxiety-specific hazard-ratio ranges matching 1.17–1.73 or 1.13–2.40, and it describes nine broad medical-condition categories, not ten. (LLM, conf=0.83)
Experimental — accuracy not yet measuredMental health problems predict poor outcomes in major life domains, such as occupational attainment, physical health, and mortality.
“given that mental health problems predict poor outcomes in major life domains, such as occupational attainment (59), physical health (60), and mortality (61).”
From Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies (2023) · cites this paper as [61]
The strength of the association of anxiety disorders with cardiovascular disease is only in the middle of the range of associations with physical disorders.
“The strength of the association of anxiety disorders with cardiovascular disease is only in the middle of that range.”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [167]
The Results section reports a range and median of hazard ratios across mental-disorder and medical-condition pairs, but gives no value or ranking for anxiety disorders and cardiovascular disease. Searches for anxiety disorders with circulatory or cardiovascular conditions found no passage establishing that this association falls in the middle of the range. (LLM, conf=0.72)
Experimental — accuracy not yet measuredPresence of ASD and/or ADHD with any distinct additional medical condition (comorbidity or multimorbidity) may be confounded by previous exposures (such as socioeconomic factors, environmental factors, and childhood abuse).
“However, it should be noted that presence of ASD and/or ADHD with any distinct additional medical condition (the so-called comorbidity or multimorbidity) may be confounded by previous exposures (such as socioeconomic factors, environmental factors, and childhood abuse).60”
From Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis (2022) · cites this paper as [60]
Technical quality control was applied to the core PGC cohorts using PGC standards, including thresholds for SNP and subject missingness, heterozygosity, case-control missingness, Hardy-Weinberg equilibrium, and Mendelian errors.
“Technical Quality control was performed on the core PGC cohorts separately according to standards developed by the PGC3 including SNP missingness < 0.05 (before sample removal); subject missingness < 0.02; autosomal heterozygosity deviation (| Fhet | < 0.2); SNP missingness < 0.02 (after sample removal); difference in SNP missingness between cases and controls < 0.02; and SNP Hardy-Weinberg”
From Mapping genomic loci implicates genes and synaptic biology in schizophrenia (2022) · cites this paper as [3]
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- Authors
- Momen, N. C., Plana-Ripoll, O., Agerbo, E., Benros, M. E., Børglum, A. D., Christensen, M. K., Dalsgaard, S., Degenhardt, L., de Jonge, P., Debost, J.-C. P. G., Fenger-Grøn, M., Gunn, J. M., Iburg, K. M., Kessing, L. V., Kessler, R. C., Laursen, T. M., Lim, C. C. W., Mors, O., Mortensen, P. B., Musliner, K. L., Nordentoft, M., Pedersen, C. B., Petersen, L. V., Ribe, A. R., Roest, A. M., Saha, S., Schork, A. J., Scott, K. M., Sievert, C., Sørensen, H. J., Stedman, T. J., Vestergaard, M., Vilhjalmsson, B., Werge, T., Weye, N., Whiteford, H. A., Prior, A., & McGrath, J. J.
- Affiliations
- From the National Center for Register-based Research (N.C.M., O.P.-R., E.A., M.K.C., S.D., J.-C.P.G.D., T.M.L., P.B.M., K.L.M., C.B.P., L.V.P., B.V., N.W., J.J.M.), Center for Integrated Register-based Research (E.A., P.B.M., C.B.P.), the Departments of Biomedicine–Human Genetics (A.D.B.) and Public Health (M.K.C., M.F.-G., K.M.I., M.V., A.P.), the Center for Integrative Sequencing (A.D.B.), and the Big Data Center for Environment and Health (C.B.P.), Aarhus University, the Lundbeck Foundation...
- Aarhus University (DK)
- Aarhus University Hospital (DK)
- University of Copenhagen (DK)
- Harvard University (US)
- Translational Genomics Research Institute (US)
- University of Otago (NZ)
- ORCID
- Momen, Natalie C.
- Agerbo, Esben
- Benros, Michael E.
- Børglum, Anders D.
- Christensen, Maria K.
- Dalsgaard, Søren
- Degenhardt, Louisa
- Debost, Jean-Christophe P.G.
- Fenger-Grøn, Morten
- Gunn, Jane M.
- Iburg, Kim M.
- Kessing, Lars V.
- Kessler, Ronald C.
- Laursen, Thomas M.
- Lim, Carmen C.W.
- Mors, Ole
- Mortensen, Preben B.
- Musliner, Katherine L.
- Nordentoft, Merete
- Pedersen, Carsten B.
- Petersen, Liselotte V.
- Ribe, Anette R.
- Roest, Annelieke M.
- Saha, Sukanta
- Schork, Andrew J.
- Scott, Kate M.
- Sørensen, Holger J.
- Stedman, Terry J.
- Vestergaard, Mogens
- Werge, Thomas
- Weye, Nanna
- Whiteford, Harvey A.
- Prior, Anders
- McGrath, John J.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-04-30
- Volume
- 382
- Issue
- 18
- Pages
- 1721-1731
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7261506
- OpenAlex
- W3018354989
- Cited by
- 481
- References
- 39
- Citations by year
- 2026: 51 · 2025: 84 · 2024: 90 · 2023: 72 · 2022: 87 · 2021: 72 · 2020: 24
- FWCI
- 69.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- New England Journal of Medicine (publishedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- PubMed Central (acceptedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Det Frie Forskningsråd (7025-00078B, 8020-00013B)
- Lundbeckfonden (R155-2012-11280, R155-2014-1724, R248-2017-2003, R268-2016-3925, R276-2017-4581, R278-2018-1411, R303-2018-3551, iPSYCH grant R102-A9118)
- National Health and Medical Research Council (John Cade Fellowship (APP1056929), Senior Principal Research Fellowship)
- National Institute on Drug Abuse (R01DA1104470)
- Aarhus Universitets Forskningsfond (AUFF-E-2015-FLS-8-61)
- Novo Nordisk Fonden (Grant 22018, NNF18OC0031194)
- National Institutes of Health (R01, grant ES026993)
- European Commission (Horizon 2020, grant 667302)
- Helsefonden (Grant 19-8-0260)
- Danmarks Grundforskningsfond (Niels Bohr Professorship)
- H2020 Marie Skłodowska-Curie Actions (837180)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- mental illness, comorbidities, health conditions, physical health risks, eating disorders, circulatory diseases, musculoskeletal disorders, schizophrenia, developmental disorders, organic mental disorders, cancer
- MeSH terms
- Adult, Mental Disorders, Cardiovascular Diseases, Denmark, Disease, Female, Humans, Male, Middle Aged, Musculoskeletal Diseases, Neoplasms, Risk, Schizophrenia, Sex Factors, Cohort Studies, Female Urogenital Diseases, Male Urogenital Diseases
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