Mental and physical comorbidity in an Arab primary health care setting
Affiliations
Affiliations
- Department of Psychiatry, Faculty of Medicine, Safat, Kuwait. alkhadhari@hsc.edu.kw.
- Department of Psychiatry, Faculty of Medicine, Health Sciences Center, PO Box 24923, 13110, Safat, Kuwait. alkhadhari@hsc.edu.kw.
- Abdullah & Shereefa Almehry Health Center (Alkhaldiya Polyclinic), Kuwait City, Kuwait.
- Department of Psychiatry, Faculty of Medicine, Safat, Kuwait.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
Abstract
Background: There are no published studies on the comorbidity of common mental conditions (anxiety, depression, and somatization) and physical illnesses in the Arab world. Our aim was to estimate the prevalence of common mental conditions comorbid with physical illnesses among primary care attenders in Kuwait, and the sociodemographic characteristics associated with this comorbidity.
Methods: The Patient Health Questionnaires for somatization, anxiety and depression (PHQ-SAD) were administered to a representative sample of 1046 attenders (M: F = 429: 617; mean age 37.6, SD 12.7) seen in primary care clinics in Kuwait. Based on well-established cut-off scores, the presence and severity of three mental conditions -depression, anxiety, and somatization-was ascertained; physical diagnoses were ascertained by the attending physicians.
Results: Of 1046 respondents, 442 (42.3%) had at least one mental condition and 670 (64.1%) had a physical illness diagnosis, viz.: diabetes mellitus (248/670 = 37.0%), hypertension (229/670 = 34.2%), asthma (82/670 = 12.2%), non-chronic physical illnesses (63/670 = 9.4%), or heart disease (48/670 = 7.2%), with 34.4% (360/1046) having mental-physical comorbidity. Male: female ratio for the 670 subjects was 287: 383. The unadjusted odds ratio (OR) for having a mental condition in those with a physical illness vs. those without a physical illness was 4.16 (95% C.I. = 3.12, 5.55). Comorbidity was associated with older age, being divorced or widowed, a lower level of education, and poorer living conditions. Regardless of the physical illness, the most frequent comorbid mental disorder was somatization. The prevalence and severity of mental conditions were associated with the number of physical illnesses.
Conclusion: As has been reported in other parts of the world, somatization, anxiety, and depression are highly prevalent among primary care attenders in Kuwait and they are typically comorbid with physical illness. Strategies for their prevention and treatment need to take into consideration their association with physical illness and social disadvantage.
Keywords: Anxiety; Comorbidity; Depression; Mental health; Physical illness; Prevalence; Primary care attenders.
Conflict of interest statement
Ethics approval and consent to participate
The study was approved by the Research and Ethical Committee of the Ministry of Health, Kuwait. Participants gave written informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Similar articles
Diagnostic overlap of depressive, anxiety, stress and somatoform disorders in primary care.
Bener A, Al-Kazaz M, Ftouni D, Al-Harthy M, Dafeeah EE.Asia Pac Psychiatry. 2013 Mar;5(1):E29-38. doi: 10.1111/j.1758-5872.2012.00215.x. Epub 2012 Jul 23.PMID: 23857793
Prevalence of psychiatric morbidity in the primary health clinic attendees in Kuwait.
Alkhadhari S, Alsabbrri AO, Mohammad IH, Atwan AA, Alqudaihi F, Zahid MA.J Affect Disord. 2016 May;195:15-20. doi: 10.1016/j.jad.2016.01.037. Epub 2016 Jan 21.PMID: 26852093
Sexual Dysfunction in Primary Care: An Exploratory Descriptive Analysis of Medical Record Diagnoses.
Heiden-Rootes KM, Salas J, Gebauer S, Witthaus M, Scherrer J, McDaniel K, Carver D.J Sex Med. 2017 Nov;14(11):1318-1326. doi: 10.1016/j.jsxm.2017.09.014.PMID: 29110803
Quality of life and neurotic disorders in general healthcare.
Herrman H, Chopra P.Curr Opin Psychiatry. 2009 Jan;22(1):61-8. doi: 10.1097/YCO.0b013e32831a4750.PMID: 19122537 Review.
Katon W, Lin EH, Kroenke K.Gen Hosp Psychiatry. 2007 Mar-Apr;29(2):147-55. doi: 10.1016/j.genhosppsych.2006.11.005.PMID: 17336664 Review.
Cited by
Vrublevska J, Renemane L, Kivite-Urtane A, Rancans E.Front Psychiatry. 2022 Oct 6;13:972628. doi: 10.3389/fpsyt.2022.972628. eCollection 2022.PMID: 36276320 Free PMC article.
Derisi MM, Nasiri MJ, Aryan A, Moosavi Jarrahi A, Amiri P, Mohseny M.J Res Med Sci. 2022 Feb 18;27:12. doi: 10.4103/jrms.JRMS_864_20. eCollection 2022.PMID: 35342444 Free PMC article. Review.
Renemane L, Kivite-Urtane A, Rancans E.Medicina (Kaunas). 2021 Sep 16;57(9):970. doi: 10.3390/medicina57090970.PMID: 34577893 Free PMC article.
Nazzal Z, Maraqa B, Abu Zant M, Qaddoumi L, Abdallah R.BMC Health Serv Res. 2021 Jun 29;21(1):615. doi: 10.1186/s12913-021-06671-2.PMID: 34182995 Free PMC article.
Johnson Pradeep R, Ekstrand ML, Selvam S, Heylen E, Mony PK, Srinivasan K.J Affect Disord Rep. 2021 Jan;3:100071. doi: 10.1016/j.jadr.2020.100071. Epub 2021 Jan 2.PMID: 33681860 Free PMC article.
KMEL References
References
-
- Sartorius N, Holt RIG, Maj M, editors. Comorbidity of mental and physical disorders. Basel: Karger AG; 2015.
-
- Ohaeri JU, Awadalla AW. Characteristics of subjects with comorbidity of symptoms of generalized anxiety and major depressive disorders and the corresponding threshold and subthreshold conditions in an Arab general population sample. Med Sci Monit. 2012;18:160–173. doi: 10.12659/MSM.882521. - DOI - PMC - PubMed
-
- International Classification of Diseases 10th Revision . WHO. Switzerland: Geneva; 1992.
-
- Diagnostic and Statistical Manual of Mental Disorders 4th Edition . American Psychiatric Association. Washington: DC; 1994.
-
- Serrano-Blanco Antoni, Palao Diego J., Luciano Juan V., Pinto-Meza Alejandra, Luján Leila, Fernández Ana, Roura Pere, Bertsch Jordan, Mercader Mercè, Haro Josep M. Prevalence of mental disorders in primary care: results from the diagnosis and treatment of mental disorders in primary care study (DASMAP) Social Psychiatry and Psychiatric Epidemiology. 2009;45(2):201–210. doi: 10.1007/s00127-009-0056-y. - DOI - PubMed
-
- Egan SJ, Wade TC, Shafran R. The transdiagnostic process of perfectionism. Revisista Psicopatologia y Psicologia Clinica. 2012;17:279–294. doi: 10.5944/rppc.vol.17.num.3.2012.11844. - DOI
-
- Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Beh Ther. 2004;35:205–230. doi: 10.1016/S0005-7894(04)80036-4. - DOI