Harald Baumeister

Increased 12-Month Prevalence Rates of Mental Disorders in Patients with Chronic Somatic Diseases

Background: Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians’ diagnoses and compared with physically healthy probands. Methods: Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders. Results: Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders. Conclusions: There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.

High agreement of self-report and physician-diagnosed somatic conditions yields limited bias in examining mental-physical comorbidity.

OBJECTIVE To quantify the misclassification bias of self-reported somatic diseases and its impact on the estimation of comorbidity with mental disorders. STUDY DESIGN AND SETTING Data were drawn from the German National Health Interview and Examination Survey (N=7,124), which assessed both self-reported and physician-diagnosed somatic diseases. Eight chronic diseases were examined: coronary heart disease, heart failure, asthma, chronic bronchitis, diabetes, cancer, arthrosis, and arthritis. Mental disorders were assessed by means of the Munich-Composite International Interview. RESULTS The agreement of case ascertainment by patient self-report and physician diagnosis was high (kappa: 0.74-0.92), except for arthritis (0.53). False-positive and false-negative disease statuses were partly associated with age, sex, socioeconomic status, somatic comorbidities, marital status, and mood and anxiety disorders. In most conditions, the odds ratios (ORs) of comorbid mental disorders based on self-reported diseases were slightly overestimated with regard to mood disorders (relative OR: 0.91-1.38), whereas there proved to be no such trend regarding anxiety disorders (0.82-1.05). Substance disorders were partly biased without showing an interpretable trend across diseases (0.49-2.58). CONCLUSIONS Evaluation of mental-physical comorbidity based on self-reported and physician-diagnosed physical conditions yielded similar results, with modestly inflated ORs for mood disorders for several self-reported physical conditions.

Mental disorders in patients with obesity in comparison with healthy probands

Objective:Findings concerning the association of obesity and mental disorders are inconsistent. The present epidemiological study investigates adjusted 4-week, 12-month, and lifetime prevalence rates of mental disorders in obese individuals compared with physically healthy probands and overweight individuals. Correlates of the associations are examined.Methods:Prevalence rates were calculated from two large epidemiological surveys from both the general population of Germany and inpatient centers. The surveys investigated subjects with obesity (n=910) and overweight (n=1550), as well as physically healthy probands (n=495). The prevalence rates were based on the Munich-composite international diagnostic interview, a standardized interview for the assessment of mental disorders. Correlates of mental disorders in obese individuals were assessed using self-report questionnaires and medical examinations.Results:The adjusted odds ratios (OR) of obese inpatients and obese patients from the general population were significantly elevated in comparison with healthy probands for the 4-week (OR: 2.2; 2.3), 12-month (OR: 1.8; 2.7) and lifetime (OR: 1.4; 2.0) periods. Prevalence rates of overweight individuals were below those of obese individuals. Mood, anxiety and somatoform disorders were most frequent. In particular, sex, marital status and comorbid musculoskeletal diseases proved to be correlates of an increased risk for mental disorders in obese individuals. The presence of comorbid mental disorders was associated with significantly increased health care use and lower quality of life.Conclusions:There is a strong relationship between obesity and mental disorders. A future task is to improve care of mental disorders in patients with obesity.

Quality of life in medically ill persons with comorbid mental disorders: a systematic review and meta-analysis.

Background: This systematic review aims to investigate the association between comorbid mental disorders and quality of life (QoL) in patients with chronic medical diseases. Methods: Studies investigating adults with diabetes mellitus, coronary artery disease, asthma, chronic back pain and colorectal cancer were included. Two reviewers independently extracted data and assessed methodological criteria. Effect sizes for QoL scores were analyzed in random-effects meta-analyses. Subgroup and sensitivity analyses were conducted. Results: The database search identified 7,291 references and 65 primary studies were included. Medically ill persons with comorbid mental disorders showed a significantly decreased overall (d = –1.10; 95% CI = –1.34 to –0.86), physical (d = –0.64; 95% CI = –0.74 to –0.53) and psychosocial (d = –1.18; 95% CI = –1.42 to –0.95) QoL compared to persons without mental disorders. Subgroup analyses did not reveal significant differences between the examined medical diseases or mental disorders. Conclusion: The review provides evidence of a substantially reduced psychosocial and physical QoL in medically ill patients with comorbid mental disorders. This patient-reported outcome highlights the importance of recognizing and treating comorbid mental disorders in the medically ill.

Adjustment disorder with depressed mood: a critique of its DSM-IV and ICD-10 conceptualisations and recommendations for the future.

Background: The volume of research involving adjustment disorder (AD) is limited. The scientific neglect of AD seems to result from the inadequate operationalisation of AD in DSM-IV and ICD-10. The aims of the present proposal are to discuss the shortcomings of AD conceptualisations and to present recommendations for the future. Sampling and Methods: This conceptual paper is based on an iterative process of debate between the authors. Results: The current operational definition of AD is characterised by 3 main limitations: (1) the inadequately defined clinical significance criterion, (2) the relegation of AD behind other diagnoses and (3) the missed recognition of the importance of contextual factors, such that normal human adaptive processes might be pathologised. Furthermore, subtypes of AD lack operational clarity. Based on a discussion of the limitations, recommendations for DSM-V are presented, including the addition of new subtypes. Conclusions: The revision of AD criteria will reduce the likelihood of false-positive and false-negative diagnoses. These changes will enable the scientific exploration of this common and relevant disorder, and will make epidemiological studies, and ultimately service planning based on these, more reliable than at present.

Health locus of control and health behaviour: Results from a nationally representative survey

The present study aims to examine the association between sociodemographic variables and health locus of control (HLC) as well as HLC and health behaviour. Data from a representative sample of the German adult population, the Telephone Health Survey 2006 (GSTel06; N = 5542), were used. A German version of the MHLC (multidimensional HLC) scales was used. Associations between sociodemographic variables and three dimensions of HLC (internal, powerful others and chance) and between HLC and health behaviour were calculated. In particular, higher age, low socioeconomic status and migration background were associated with higher HLC scores on the powerful others and chance dimension. Subjects scoring high on the chance dimension did less sports activity (OR: 0.8; CI: 0.7–0.9), had less medical teeth protection (0.7; 0.6–0.9), fewer health courses (0.8; 0.7–0.9) and conducted less systematic information-seeking (0.8; 0.6–0.9), while results regarding internal and powerful others HLC remained mainly insignificant. High chance HLC can be regarded as risk factor of adequate health behaviour. The associations between high chance HLC, low socioeconomic status and migration background emphasise the need for treatments and prevention programmes tailored to modify the high chance HLC of socially disadvantaged populations.

Inappropriate prescriptions of antidepressant drugs in patients with subthreshold to mild depression: Time for the evidence to become practice

Recent studies indicate that antidepressant drugs are largely ineffective in patients with subthreshold to mild depression when compared to placebo. In spite of this evidence, researchers continue to judge the prescription of antidepressant drugs to patients with subthreshold to mild depression as an adequate treatment, which in turn serves to further reinforce the undifferentiated treatment strategy adopted by clinicians. The present narrative review critically reflects on current research practice and highlights the need for a more differentiated, evidence-based clinical and research practice.

It is time to adjust the adjustment disorder category.

Purpose of review A recent review highlighted the existing lack of evidence concerning adjustment disorders. It concluded that we should wait to adjust adjustment disorders until evidence is available. This is circular reasoning, fixing the poor definition of adjustment disorders. The present article outlines why we should amend adjustment disorders and which major obstacles need to be removed when revising this category. Recent findings Adjustment disorder is a frequent disorder at least in medical settings. Many of these patients do not fulfill the criteria of a more specific diagnosis, but are still regarded as ‘in need of treatment’. Clinicians appreciate the possibility of assigning adjustment disorders as ‘wild card’ diagnoses. The drawback of this clinical utility consists in the lack of operational diagnostic specificity. This leads to the resistance of adjustment disorders being researched properly, resulting in a substantial proportion of patients receiving treatments that are not evidence based. Thus, there is a need for revision of adjustment disorders. Thereby, the border disputes of what differentiates adjustment disorders from normal human adaptation processes and from other (more specific) disorders need to be solved. Summary Given the high prevalence rates of adjustment disorders and their scientific neglect, it is time to revise adjustment disorders.

Depression and diabetes: treatment and health-care delivery

Despite research efforts in the past 20 years, scientific evidence about screening and treatment for depression in diabetes remains incomplete and is mostly focused on North American and European health-care systems. Validated instruments to detect depression in diabetes, although widely available, only become effective and thus recommended if subsequent treatment pathways are accessible, which is often not the case. Because of the well known adverse effects of the interaction between depression and diabetes, treatment goals should focus on the remission or improvement of depression as well as improvement in glycaemic control as a marker for subsequent diabetes outcome. Scientific evidence evaluating treatment for depression in type 1 and type 2 diabetes shows that depression can be treated with moderate success by various psychological and pharmacological interventions, which are often implemented through collaborative care and stepped-care approaches. The evidence for improved glycaemic control in the treatment of depression by use of selective serotonin reuptake inhibitors or psychological approaches is conflicting; only some analyses show small to moderate improvements in glycaemic control. More research is needed to evaluate treatment of different depression subtypes in people with diabetes, the cost-effectiveness of treatments, the use of health-care resources, the need to account for cultural differences and different health-care systems, and new treatment and prevention approaches.

Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review†

To summarize and critically evaluate the effectiveness of psychological and pharmacological interventions for depression in patients with both diabetes and depression.