TY - JOUR
KW - Adult
KW - Aged
KW - Anxiety Disorders
KW - Comorbidity
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Mental Health
KW - Middle Aged
AU - M. Jürisson
AU - H. Pisarev
AU - A. Uusküla
AU - K. Lang
AU - M. Oona
AU - L. Elm
AU - R. Kalda
A1 - 
AB - BACKGROUND: Multimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population. METHODS: In this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex. RESULTS: Half of the individuals (49.1% (95% CI 49.0-49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1-8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1-6.2) of the study population, and 13.1% (13.0-13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse. CONCLUSIONS: The burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.
AD - Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
BT - PloS one
C5 - Healthcare Disparities
CP - 12
DO - 10.1371/journal.pone.0260464
IS - 12
JF - PloS one
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Multimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population. METHODS: In this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex. RESULTS: Half of the individuals (49.1% (95% CI 49.0-49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1-8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1-6.2) of the study population, and 13.1% (13.0-13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse. CONCLUSIONS: The burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.
PY - 2021
SN - 1932-6203; 1932-6203
T1 - Physical-mental health comorbidity: A population-based cross-sectional study
T2 - PloS one
TI - Physical-mental health comorbidity: A population-based cross-sectional study
U1 - Healthcare Disparities
U2 - 34855807
U3 - 10.1371/journal.pone.0260464
VL - 16
VO - 1932-6203; 1932-6203
Y1 - 2021
Y2 - Dec 2
ER -