Elsevier

General Hospital Psychiatry

Volume 35, Issue 1, January–February 2013, Pages 39-44
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Psychiatric morbidity in chronic respiratory disorders in an Indian service using GMHAT/PC

https://doi.org/10.1016/j.genhosppsych.2012.09.009Get rights and content

Abstract

Objective

The study aimed to assess psychiatric morbidity in stable chronic respiratory disorders and to examine the pattern of psychiatric illness in specific respiratory disorders in Northern India.

Methods

All consecutive patients with stable chronic respiratory illnesses who attended the respiratory disease clinic were recruited in the study. Their healthy attendants were interviewed as a control group. The research clinician, trained in the use of the Global Mental Health Assessment Tool, Primary Care Version (GMHAT/PC), interviewed all the participants. The respiratory consultant made the respiratory illness diagnosis. The data were analyzed comparing the patient and the control group by using relative risk and adjusted odds ratios.

Results

Of 391 patients with respiratory illness, 44.8% had a mental illness identified by GMHAT/PC interview compared with 24.3% of 177 attendants (controls). Anxiety (20.6%), depression (13.2%) and obsessive compulsive disorders (4.6%) were the most frequently identified mental disorders in the respiratory disease group. Chronic obstructive pulmonary disease and bronchial asthma when combined with rhinitis had a significantly higher prevalence of comorbid mental illness than those illnesses alone.

Conclusion

Patients with chronic respiratory illness have high mental health comorbidity. Physicians and practitioners can be trained to identify mental illness using computer-assisted tools such as GMHAT/PC (which is easy to use by clinicians and well accepted by patients). A holistic approach of providing care to such patients may improve their overall outcome and quality of life.

Introduction

The interaction between body and mind is an essential concept to be taken on board by all health professionals [1], [2]. Psychiatric morbidity associated with a physical illness is often overlooked and remains a low priority in most countries [3]. In fact, untreated mental illness is a risk factor for poor outcome in patients with medical diseases and can aggravate the severity of their presentation [4], [5]. However, there is good evidence to suggest that outcome of medical illness improves if comorbid psychiatric illness is effectively treated [6].

Chronic respiratory disorders such as chronic obstructive pulmonary disease (COPD) and asthma have significant public health implications in terms of cost of care as well as quality of life [7], [8]. Dealing with mental health issues is proposed to be a part of rehabilitation programs of chronic respiratory disorders [7], [8]. However, there is a gap in guidelines on assessment as well as management of psychiatric conditions in these patients.

A number of studies have reported a high prevalence of mental illness in patients with respiratory disorders such as asthma, COPD and allergic rhinitis in the Western world [9], [10], [11], [12]. The only Indian study published so far reported a high prevalence of 72% depressive symptoms in COPD patients in central India based on Patient Health Questionnaire-9 (PHQ-9)[13].

PHQ-9 has been validated against psychiatric diagnosis of depression and anxiety disorders in chronic hepatitis patients in a recent study [14]. Psychiatric morbidity in most of these studies was assessed using rating scales. The respiratory diagnosis was usually established by patients’ self-reported symptoms. We therefore planned this study to establish respiratory disorder diagnoses based on objective criteria applied by an experienced respiratory physician and psychiatric diagnoses with a standardized clinical assessment tool used by a trained interviewer.

The present study was planned to assess psychiatric morbidity associated with stable chronic respiratory disorders compared to their healthy accompanying persons, mostly relatives, in Northern India. We also aimed to examine the pattern of psychiatric morbidity in specific respiratory disorders.

Section snippets

Sample

All consecutive patients with stable chronic respiratory illnesses who attended a respiratory disease clinic were recruited. Patients with complicated acute respiratory disorders; those with associated significant other physical illness such as ischemic heart disease, diabetes mellitus, uncontrolled hypertension, renal failure, hepatic failure, congestive heart failure or carcinoma; and patients with a previous history of psychiatric illness were excluded. The sociodemographic profiles of the

Results

We aimed to interview at least 500 consecutive patients in order to get a sufficient number of participants in different subgroups of respiratory disorders to establish a meaningful psychiatric morbidity in this population. The sampling was a convenient one reflecting patients with respiratory disorders who sought a specialist's help. The demographic profile of the patients is shown in Table 1. A total of 568 participants were interviewed using GMHAT/PC. Of those, 391 were patients with

Discussion

Long-term medical conditions have a high psychiatric comorbidity, but the cause and effect relationship is far from clear. In most studies of medical conditions, with some exceptions [17], [21], investigators used psychiatric screening tools that mainly identified common mental conditions such as anxiety and depression and not used ICD-based clinical diagnostic tools [22]. Most studies had no control group. Our decision to use GMHAT/PC was based on the need to detect any mental illness in the

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