Skip to main content

Advertisement

SpringerLink
Log in

Anxiety disorders and physical comorbidity: increased prevalence but reduced relevance of specific risk factors for hospital-based mortality during a 12.5-year observation period in general hospital admissions

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Anxiety disorders (AD) are associated with an increase in physical comorbidities, but the effects of these diseases on hospital-based mortality are unclear. Consequently, we investigated whether the burden of physical comorbidity and its relevance on hospital-based mortality differed between individuals with and without AD during a 12.5-year observation period in general hospital admissions. During 1 January 2000 and 30 June 2012, 11,481 AD individuals were admitted to seven General Manchester Hospitals. All comorbidities with a prevalence ≥1 % were compared with those of 114,810 randomly selected and group-matched hospital controls of the same age and gender, regardless of priority of diagnoses or specialized treatments. Comorbidities that increased the risk of hospital-based mortality (but not mortality outside of the hospital) were identified using multivariate logistic regression analyses. AD individuals compared to controls had a substantial excess comorbidity, but a reduced hospital-based mortality rate. Twenty-two physical comorbidities were increased in AD individuals compared with controls, which included cardiovascular diseases and their risk factors. The most frequent physical comorbidities in AD individuals were hypertension, asthma, cataract, and ischaemic heart disease. Risk factors for hospital-based mortality in AD individuals were lung cancer, alcoholic liver disease, respiratory failure, heart failure, pneumonia, bronchitis, non-specific dementia, breast cancer, COPD, gallbladder calculus, atrial fibrillation, and angina. The impact of atrial fibrillation, angina, and gallbladder calculus on hospital-based mortality was higher in AD individuals than in controls. In contrast, other mortality risk factors had an equal or lower impact on hospital-based mortality in sample comparisons. Therefore AD individuals have a higher burden of physical comorbidity that is associated with a reduced risk of general hospital-based mortality. Atrial fibrillation, angina, and gallbladder calculus are major risk factors for general hospital-based mortality in AD individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baxter AJ, Vos T, Scott KM, Ferrari AJ, Whiteford HA (2014) The global burden of anxiety disorders in 2010. Psychol Med 11:1–12

  2. Michael T, Zetsche U, Margraf J (2007) Epidemiology of anxiety disorders. Psychiatry 6(4):136–142

    Article  Google Scholar 

  3. Kessler RC, Aguilar-Gaxiola S, Alonso J et al (2009) The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psychiatr Soc 18:23–33

    Article  Google Scholar 

  4. Andrews G, Henderson S, Hall W (2001) Relevance, comorbidity, disability and service utilization. Overview of the australian national mental health survey. Br J Psychiatry 178:145–153

    Article  CAS  PubMed  Google Scholar 

  5. Härter MC, Conway KP, Merikangas KR (2003) Associations between anxiety disorder and physical illness. Eur Arch Clin Neurosci 253(6):312–320

    Google Scholar 

  6. Sareen J, Jacobi F, Cox BJ, Belik SL, Clara I, Stein MB (2006) Disability and poor quality of life associated with comorbid anxiety disorder and physical conditions. Arch Intern Med 166:2109–2116

    Article  PubMed  Google Scholar 

  7. Roy-Byrne PP, Davidson KW, Kessler RC et al (2008) Anxiety disorder and comorbid medical illness. Gen Hosp Psychiatry 30:208–225

    Article  PubMed  Google Scholar 

  8. Russ TC, Stamatakis E, Hamer M, Starr JM, Kivimäki M, Batty GD (2012) Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ 345:e4933

    Article  PubMed Central  PubMed  Google Scholar 

  9. Denollet J, Maas K, Knottnerus A, Keyzer JJ, Pop VJ (2009) Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women. J Clin Epidemiol 62:452–456

    Article  PubMed  Google Scholar 

  10. Chen YH, Tsai SY, Lee HC, Lin HC (2009) Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study. Psychosom Med 71:798–804

    Article  PubMed  Google Scholar 

  11. Chen YH, Hu CJ, Lee HC, Lin HC (2010) An increased risk of stroke among panic disorder patients: a 3-year follow-up study. Can J Psychiatry 55:43–49

    PubMed  Google Scholar 

  12. Cheng YF, Leu HB, Su CC et al (2013) Association between panic disorder and risk of atrial fibrillation: a nationwide study. Psychosom Med 75:30–35

    Article  PubMed  Google Scholar 

  13. United Nations, Department of Economic and Social Affairs, Population Division (2012) Population Ageing and Development 2012. United Nations website. http://www.un.org/esa/population/publications/2012WorldPopAgeingDev_Chart/2012PopAgeingandDev_WallChart.pdf. Accessed: 26 September 2014

  14. Campbell-Sills L, Stein MB, Sherbourne CD et al (2013) Effects of medical comorbidity on anxiety outcomes in primary care. Psychosom Med 75:713–720

    Article  PubMed Central  PubMed  Google Scholar 

  15. George LM, Maddock K (1979) Accuracy of in-hospital activity notifications for infectious diseases. Br Med J 1:1332–1339

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Schoepf D, Heun R, Weiffenbach O, Herrmann S, Maier W (2003) The 4-week prevalence of somatoform disorders and associated psychosocial impairment. Nervenarzt 74(3):245–251

    Article  CAS  PubMed  Google Scholar 

  17. Phung TK, Andersen BB, Høgh P, Kessing LV, Mortensen PB, Waldemar G (2007) Validity of dementia diagnoses in the Danish in-hospital registers. Dement Geriatr Cogn Disord 24(3):220–228

    Article  PubMed  Google Scholar 

  18. Schoepf D, Heun R (2014) Bipolar disorder and comorbidity: increased prevalence and increased relevance of comorbidity for hospital-based mortality during a 12.5-year observation period in general hospital admissions. J Affect Disord 169:170–178

    Article  PubMed  Google Scholar 

  19. Schoepf D, Uppal H, Potluri R, Chandran S, Heun R (2014) Comorbidity and its relevance on general hospital-based mortality in major depressive disorder: a naturalistic 12-year follow-up in general hospital admissions. J Psychiatr Res 54:28–35

    Article  Google Scholar 

  20. Schoepf D, Potluri R, Uppal H, Heun R (2014) Physical comorbidity and its relevance on mortality in schizophrenia: a naturalistic 12-year follow-up in general hospital admissions. Eur Arch Psychiatry Clin Neurosci 264(1):3–28

    Article  PubMed  Google Scholar 

  21. Schoepf D, Potluri R, Uppal H, Natalwala A, Heun R (2012) Type-2 diabetes mellitus in schizophrenia: increased prevalence and major risk factor of excess mortality in a naturalistic 7-year follow up. Eur Psychiatry 27(1):33–42

    Article  CAS  PubMed  Google Scholar 

  22. Heun R, Schoepf D, Potluri R, Natalwala A (2013) Alzheimer’s disease and co-morbidity: increased prevalence and possible risk factors of excess mortality in a naturalistic 7-year follow-up. Eur Psychiatry 28(1):40–48

    Article  CAS  PubMed  Google Scholar 

  23. Hirschfeld RMA (2001) The comorbidity of major depression and anxiety disorder: recognition and management in primary care. Prim Care Companion J Clin Psychiatry 3:244–254

    Article  PubMed Central  PubMed  Google Scholar 

  24. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B (2007) Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 146(5):317–325

    Article  PubMed  Google Scholar 

  25. Atlantis E, Fahey P, Cochrane B, Smith S (2013) Bidirectional associations between clinically relevant depression or anxiety and chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. Chest. doi:10.1378/chest.12-1911

    Google Scholar 

  26. Holt RI, Phillips DIW, Jameson KA, Cooper C, Dennison EM, Peveler RC (2013) The relationship between depression, anxiety and cardiovascular disease: findings from the Hertfordshire Cohort Study. J Affect Disord 150(1):84–90

  27. Mykletun A, Bjerkeset O, Overland S, Prince S, Dewey M, Stewart R (2009) Levels of anxiety and depression as predictors of mortality: the HUNT study. Br J Psychiatry 195:118–125

    Article  PubMed  Google Scholar 

  28. Grasbeck A, Rorsman B, Hagnell O, Isberg PE (1996) Mortality of anxiety syndromes in a normal population: the Lundby study. Neuropsychobiology 33:118–126

    Article  CAS  PubMed  Google Scholar 

  29. Lane D, Carroll D, Ring C, Beevers DG, Lip GY (2001) Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosom Med 63:221–230

    Article  CAS  PubMed  Google Scholar 

  30. Lavretsky H, Mistry R, Bastani R et al (2003) Symptoms of depression and anxiety predict mortality in elderly veterans enrolled in the UPBEAT program. Int J Geriatr Psychiatry 18:183–184

    Article  CAS  PubMed  Google Scholar 

  31. Holwerda TJ, Schoevers RA, Dekker J, Deeg DJH, Jonker C, Beekman ATF (2007) The relationship between generalized anxiety disorder, depression and mortality in old age. Int J Geriatr Psychiatry 22:241–249

    Article  PubMed  Google Scholar 

  32. Herrmann C, Brand-Driehorst S, Buss U, Ruger U (2000) Effects of anxiety and depression on 5-year mortality in 5057 patients referred for exercise testing. J Psychosom Res 48:455–462

    Article  CAS  PubMed  Google Scholar 

  33. Lee WE, Wadsworth ME, Hotopf M (2006) The protective role of trait anxiety: a longitudinal cohort study. Psychol Med 36:345–351

    Article  CAS  PubMed  Google Scholar 

  34. Beary M, Hodgson R, Wildgust HJ (2012) A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications. J Psychopharmacol 26(5):52–61

    Article  PubMed  Google Scholar 

  35. Garin N, Olaya B, Perales J, Moneta MV, Miret M, Ayuso-Mateos JL, Haro JM (2014) Multimorbidity patterns in a national representative sample of the Spanish adult population. PLoS One 9(1):e84794. doi:10.1371/journal.pone.0084794

    Article  PubMed Central  PubMed  Google Scholar 

  36. Kessler RC, Ormel J, Demler O, Stang PE (2003) Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the National Comorbidity Survey. J Occup Environ Med 45:1257–1266

    Article  PubMed  Google Scholar 

  37. Player MS, Peterson LE (2011) Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med 41(4):365–377

    Article  PubMed  Google Scholar 

  38. Rozanski A, Kubzansky LD (2005) Psychologic functioning and physical health: a paradigm of flexibility. Psychosom Med 67(Suppl 1):47–53

    Article  Google Scholar 

  39. McCauley E, Katon W, Russo J, Richardson L, Lozano P (2007) Impact of anxiety and depression on functional impairment in adolescents with asthma. Gen Hosp Psychiatry 29(3):214–222

    Article  PubMed Central  PubMed  Google Scholar 

  40. Lavoie KL, Bacon SL, Barone S, Cartier A, Ditto B, Labrecque M (2006) What is worse for asthma control and quality of life: depressive disorders, anxiety disorder, or both? Chest 130:1039–1047

    Article  PubMed  Google Scholar 

  41. Evans DL, Charney DS, Lewis L et al (2005) Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 58:175–189

    Article  PubMed  Google Scholar 

  42. Brown ES, Suppes T, Khan DA, Carmody TJ (2002) Mood changes during prednisone bursts in outpatients with asthma. J Clin Psychopharmacol 22:55–61

    Article  PubMed  Google Scholar 

  43. Smoller JW, Simon NM, Pollack MH, Kradin R, Stern T (1999) Anxiety in patients with pulmonary disease: comorbidity and treatment. Semin Clin Neuropsychiatry 4(2):84–97

    CAS  PubMed  Google Scholar 

  44. Smoller JW, Pollack MH, Otto MW, Rosenbaum JF, Kradin RL (1996) Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations. Am J Respir Crit Care Med 154(1):6–17

    Article  CAS  PubMed  Google Scholar 

  45. Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ (2012) Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 125(6):773–781

    Article  PubMed  Google Scholar 

  46. Leske MC, Wu SY, Hennis A, Connel AM, Hyman L, Schachet A (1999) Diabetes, hypertension, and central obesity as cataract risk factors in a black population. The Barbados Eye Study. Ophthalmology 106(1):35–41

    Article  CAS  PubMed  Google Scholar 

  47. Javadi MA, Zarel-Ghanavati S (2008) Cataracts in diabetic patients: a review article. J Opthalmic Vis Res 2(1):52–65

    Google Scholar 

  48. Eramudugolla R, Wood J, Anstey KJ (2013) Co-morbidity of depression and anxiety in common age-related eye diseases: a population based study of 662 adults. Front Aging Neurosci 5:1–9

    Article  Google Scholar 

  49. Nattel S, Opie LH (2006) Controversies in atrial fibrillation. Lancet 367:262–272

    Article  PubMed  Google Scholar 

  50. Samokhvalov AV, Irving HM, Rehm J (2010) Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 17(6):706–712

    Article  PubMed Central  PubMed  Google Scholar 

  51. Magnani JW, Rienstra M, Lin H et al (2011) Atrial fibrillation: current knowledge and future directions in epidemiology and genetics. Circulation 124:1982–1993

    Article  PubMed Central  PubMed  Google Scholar 

  52. Eaker ED, Sullivan LM, Kelly-Hayes M, D`Agostino B, Benjamin EJ (2005) Tension and anxiety and the prediction of the 10 year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham offspring study. Psychosom Med 67(5):692–696

    Article  PubMed  Google Scholar 

  53. Patel D, McConkey ND, Sohaney R, McNeil A, Jedrzejczyk A, Armaganijan L (2013) A systematic review of depression and anxiety in patients with atrial fibrillation: the mind-heart link. Cardiovasc Psychiatry Neurol 2013(2013):1–11. Article ID 159850. doi:10.1155/2013/159850

  54. Smoller JW, Pollack MH, Wassertheil-Smoller S, Jackson RD, Obermann A, Wong ND, Sheps D (2007) Panic attacks and risk of incident cardiovascular events in postmenopausal women in the women’s health initiative observational study. Arch Gen Psychiatry 64:1153–1160

    Article  PubMed  Google Scholar 

  55. Van Oudenhove L, Vandenberghe J, Geeraerts B, Vos R, Persoons P, Demyttenaere K, Fischler B, Tack J (2007) Relationship between anxiety and gastric sensimotor function in functional dyspepsia. Psychosom Med 69:455–463

    Article  PubMed  Google Scholar 

  56. Elixhauser A, Steiner C, Harris R, Coffey RM (1998) Comorbidity measures for use of administrative data. Med Care 36(1):8–27

    Article  CAS  PubMed  Google Scholar 

  57. Nicholson A, Kuper H, Hemingway H (2006) Depression as an etiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146538 participants in 54 observational studies. Eur Heart J 27(23):2763–2774

    Article  PubMed  Google Scholar 

  58. Seldenrijk A, Vogelzangs N, van Oppen P, Penninx B, van Schaik A (2013) Depression, vascular conditions and chronicity. In: Schoepf D (Ed) Psychiatric disorders—new frontiers in affective disorders. InTech, pp 279-294.doi:10.5772/51623

Download references

Acknowledgments

We are extremely grateful to R. Potluri and H. Uppal for their support in provision, preparation of the data, and its analysis.

Conflict of interest

Both authors declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany

    Dieter Schoepf & Reinhard Heun

  2. Department of Psychiatry, Radbourne Unit Royal Derby Hospital, Derby, UK

    Reinhard Heun

Authors
  1. Dieter Schoepf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reinhard Heun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dieter Schoepf.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schoepf, D., Heun, R. Anxiety disorders and physical comorbidity: increased prevalence but reduced relevance of specific risk factors for hospital-based mortality during a 12.5-year observation period in general hospital admissions. Eur Arch Psychiatry Clin Neurosci 265, 387–398 (2015). https://doi.org/10.1007/s00406-014-0566-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-014-0566-9

Keywords

Search

Navigation