Exploring the Comorbidity Between Mental Disorders and General Medical Conditions

NCT03847753 | Completed

• 1 other identifier: COMO-GMC
• Study Type: observational
• Target: 5,940,299
• Locations: 0 countries
• Sites: N/A

Brief Summary

Mental disorders have been shown to be associated with a number of general medical conditions (also referred to as somatic or physical conditions). The investigators aim to undertake a comprehensive study of comorbidity among those with treated mental disorders, by using high-quality Danish registers to provide age- and sex-specific pairwise estimates between the ten groups of mental disorders and nine groups of general medical conditions. The investigators will examine the association between all 90 possible pairs of prior mental disorders and later GMC categories using the Danish national registers. Depending on whether individuals are diagnosed with a specific mental disorder, the investigators will estimate the risk of receiving a later diagnosis within a specific GMC category, between the start of follow-up (January 1, 2000) or at the earliest age at which a person might develop the mental disorder, whichever comes later. Follow-up will be terminated at onset of the GMC, death, emigration from Denmark, or December 31, 2016, whichever came first. Additionally for dyslipidemia, follow-up will be ended if a diagnosis of ischemic heart disease was received. A "wash-out" period will be employed in the five years before follow-up started (1995-1999), to identify and exclude prevalent cases from the analysis. Individuals with the GMC of interest before the observation period will be considered prevalent cases and excluded from the analyses (i.e. prevalent cases were "washed-out"). When estimating the risk of a specific GMC, the investigators will consider all individuals to be exposed or unexposed to the each mental disorder depending on whether a diagnosis is received before the end of follow-up. Persons will be considered unexposed to a mental disorder until the date of the first diagnosis, and exposed thereafter.

Conditions

Organic, Including Symptomatic, Mental Disorders; Substance Use; Schizophrenia; Mood [Affective] Disorders; Neurotic, Stress-related and Somatoform Disorders; Eating Disorder; Disorders of Adult Personality and Behavior; Mental Retardation; Disorder of Psychological Development; Behavioural Disorder; Hypertension; Dyslipidemias; Ischemic Heart Disease; Atrial Fibrillation; Heart Failure; Peripheral Occlusive Disease; Stroke; Diabetes Mellitus; Thyroid Disorder; Gout; Chronic Pulmonary Disease; Allergy; Chronic Gastritis; Chronic Liver Disease; Inflammatory Bowel Diseases; Diverticular Disease of Large Intestine; Chronic Kidney Diseases; Prostate Disorders; Connective Tissue Disorder; Osteoporosis; Pain; HIV/AIDS; Anemia; Cancer; Vision Disorders; Hearing Disorders; Migraine; Epilepsy; Parkinson Disease; Multiple Sclerosis; Neuropathy

Keywords

Comorbidity

Outcome Measures

Primary Outcomes (9)

• Risk of circulatory system general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: hypertension, dyslipidemia, ischemic heart disease, atrial fibrillation, heart failure, peripheral arterial occlusive disease, stroke. Records in the Danish National Prescription Register for at least one of the following types of medications: antihypertensives, lipid-lowering drugs, antianginal drugs (at least two prescriptions for a type of medication in one year). Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Risk of Endocrine System general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: diabetes mellitus, thyroid disorders, gout. Records in the Danish National Prescription Register for at least one of the following types of medications: antidiabetic, thyroid therapy drugs (at least two prescriptions for a type of medication in one year). Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Risk of Pulmonary System general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: chronic pulmonary disease, allergy. Records in the Danish National Prescription Register for at least one of the following types of medications: obstructive airway disease drugs, non-sedative antihistamines and/or nasal antiallergics (at least two prescriptions for a type of medication in one year). Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Risk of Gastrointestinal System general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: ulcer/chronic gastritis, chronic liver disease, inflammatory bowel disease, diverticular disease of intestine. Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Risk of Urogenital System general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: chronic kidney disease, prostate disorders. Records in the Danish National Prescription Register for at least one of the following types of medications: prostate hyperplasia therapy drugs (at least two prescriptions for a type of medication in one year). Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Musculoskeletal System general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: connective tissue disorders, osteoporosis. Records in the Danish National Prescription Register for at least one of the following types of medications: osteoporosis drugs (at least two prescriptions for a type of medication in one year) or repeated prescriptions for analgesics (at least four times in one year). Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Risk of Neurological System general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: vision problems, hearing problems, migraine, epilepsy\*, Parkinson's Disease, multiple sclerosis, neuropathies. Records in the Danish National Prescription Register for at least one of the following types of medications: specific anti-migraine drugs, antiepileptic drugs\* (at least two prescriptions for a type of medication in one year) \*Both a diagnosis of epilepsy AND two prescriptions of an antiepileptic drug in one year are required. Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Risk of Hematological System general medical conditions

  These will be ascertained using the following criteria: Diagnosis in the Danish National Patient Register or death in the Cause of Death register, for at least one of the following diseases: HIV/AIDS, anemias. Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

• Risk of Cancers

  These will be ascertained using the following criteria: Cancer diagnosis in the Danish National Patient Register or death in the Cause of Death register. Hazard ratios (HRs), with 95% confidence intervals, will be obtained to compare risk of diagnosis with a general medical condition in those with previous mental disorders, compared to those without. All persons, sex-specific and lagged (accounting for time since mental disorder diagnosis) HRs will be obtained. Additionally absolute risks will be calculated.

  Diagnosed during the study period (2000-2016), after at least 1 year of age

Study Arms (1)

Danish population

The cohort includes all those born in Denmark between 1900-2015, and who resided there in the period of 2000-2016.Whether they received a diagnosis of one of the following mental disorders will be ascertained: Organic Disorders, Substance Use Disorders, Schizophrenia Disorders, Mood Disorders, Eating Disorders, Neurotic Disorders, Personality Disorders, Intellectual Disorders, Developmental Disorders, Behavioral Disorders The risk of receiving a later diagnosis of one of the following types of general medical conditions will then be estimated: Circulatory, Endocrine, Pulmonary and Allergy, Gastrointestinal, Urogenital, Musculoskeletal, Hematological, Cancer, Neurological

Other: Organic Disorders; Other: Substance Use Disorders; Other: Schizophrenia Disorders; Other: Mood disorders; Other: Neurotic disorders; Other: Eating Disorders; Other: Personality Disorders; Other: Intellectual Disorders; Other: Developmental Disorders; Other: Behavioral Disorders

Interventions

Organic Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Substance Use Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Schizophrenia Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Mood disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Neurotic disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Eating Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Personality Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Intellectual Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Developmental Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Behavioral Disorders OTHER

Individuals were considered to have a specific mental disorder from the date they received a relevant diagnosis registered in the Danish Psychiatric Central Research Register.

Danish population

Eligibility Criteria

• Age: 1 Year+
• Sex: all
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

All individuals born in Denmark between 1900-2015 and who resided there between 2000-2016

You may qualify if:

• Born in Denmark between 1900-2015
• Resided in Denmark during the study period (2000-2016)

You may not qualify if:

• Excluded from analyses for each specific GMC, if considered a prevalent case of that GMC (i.e. ascertained to have a diagnosis for the GMC during the washout period of 1995-1999)

Sponsors & Collaborators

• University of Aarhus: lead

Related Publications (1)

• Momen NC, Plana-Ripoll O, Agerbo E, Benros ME, Borglum AD, Christensen MK, Dalsgaard S, Degenhardt L, de Jonge P, Debost JPG, Fenger-Gron M, Gunn JM, Iburg KM, Kessing LV, Kessler RC, Laursen TM, Lim CCW, Mors O, Mortensen PB, Musliner KL, Nordentoft M, Pedersen CB, Petersen LV, Ribe AR, Roest AM, Saha S, Schork AJ, Scott KM, Sievert C, Sorensen HJ, Stedman TJ, Vestergaard M, Vilhjalmsson B, Werge T, Weye N, Whiteford HA, Prior A, McGrath JJ. Association between Mental Disorders and Subsequent Medical Conditions. N Engl J Med. 2020 Apr 30;382(18):1721-1731. doi: 10.1056/NEJMoa1915784.

  PMID: 32348643 DERIVED

MeSH Terms

Conditions

Mental Disorders; Substance-Related Disorders; Schizophrenia; Mood Disorders; Somatoform Disorders; Feeding and Eating Disorders; Behavior; Intellectual Disability; Hypertension; Dyslipidemias; Myocardial Ischemia; Atrial Fibrillation; Heart Failure; Stroke; Diabetes Mellitus; Thyroid Diseases; Gout; Hypersensitivity; Inflammatory Bowel Diseases; Renal Insufficiency, Chronic; Prostatic Diseases; Connective Tissue Diseases; Osteoporosis; Pain; Acquired Immunodeficiency Syndrome; Anemia; Neoplasms; Vision Disorders; Hearing Disorders; Migraine Disorders; Epilepsy; Parkinson Disease; Multiple Sclerosis

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Neurodevelopmental Disorders; Vascular Diseases; Cardiovascular Diseases; Lipid Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Heart Diseases; Arrhythmias, Cardiac; Pathologic Processes; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Glucose Metabolism Disorders; Endocrine System Diseases; Arthritis; Joint Diseases; Musculoskeletal Diseases; Crystal Arthropathies; Rheumatic Diseases; Purine-Pyrimidine Metabolism, Inborn Errors; Metabolism, Inborn Errors; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Immune System Diseases; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Genital Diseases, Male; Genital Diseases; Skin and Connective Tissue Diseases; Bone Diseases, Metabolic; Bone Diseases; HIV Infections; Blood-Borne Infections; Communicable Diseases; Infections; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Virus Diseases; Slow Virus Diseases; Immunologic Deficiency Syndromes; Hematologic Diseases; Hemic and Lymphatic Diseases; Sensation Disorders; Eye Diseases; Ear Diseases; Otorhinolaryngologic Diseases; Headache Disorders, Primary; Headache Disorders; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases

Study Officials

• John J McGrath, MD, PhD

  National Centre for Register-Based Research, Aarhus University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 17 Years
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 7, 2019
• First Posted: February 20, 2019
• Study Start: January 1, 2000
• Primary Completion: December 31, 2016
• Study Completion: January 31, 2020
• Last Updated: May 22, 2020

Record last verified: 2020-04

Data Sharing

• IPD Sharing: Will not share