Comorbidity of mental and physical illness: new insights and synthesis

The Robert Wood Johnson Foundation's Synthesis Project has produced an excellent report and accompanying policy brief entitled Mental disorders and medical comorbidity. The publications provide a variety of insights and policy implications that I believe are right on the money. They transcend partisan positions on health insurance and delivery reform to deliver valuable lessons that can be applied now.The critical finding is as follows: Comorbidity of mental and physical illness is common. Sixty-eight percent of adults with a mental disorder have one or more medical conditions. And 29 percent with a medical disorder have a mental health comorbidity.There are four reasons why rates of comorbidity are so high:

1. Both mental illness and chronic medical conditions are common. One in four adults have a mental disorder and almost one in two have a chronic medical condition.
2. Mental illness is a risk factor for a chronic medical condition and vice versa. For example, the more chronic medical conditions the more likely a patient is to have depression, too.
3. Causes of mental and physical disorders are interrelated and complicated. For example, pain from illness can lead to depression while major depression is linked to diseases that are characterized by inflammation, e.g., cardiovascular illness.
4. Early trauma, stress, poverty can lead to both mental and physical problems.

The financial and social costs of comorbidity are very high.The report and brief outline various policy implications of the findings:

• Health insurance should include mental health coverage
• Integrated care models such as Accountable Care Organizations and Patient Centered Medical Homes should focus on the integration of medical and mental health care
• Mental health and substance abuse systems should be incorporated into health information exchanges
• Primary prevention is imperative to address common risk factors for comorbidity
• Secondary prevention should include screening for mental health conditions in medical settings and medical issues in mental health settings