By Anders Prior

Multimorbidity and especially mental-physical multimorbidity is an increasing concern worldwide. It is well-known that psychiatric illness impairs the prognosis in persons with chronic physical disease. However, little is known on the impact of non-syndromic mental stress; mental stress is common in the general population, and psychological problems are an increasingly frequent reason for primary care contacts. In two studies, we aimed to determine whether perceived mental stress is associated with potentially preventable hospitalizations and all-cause mortality in persons with various degrees of multimorbidity.

The Danish Civil Registration System allowed us to individually link health survey data with prospectively collected data from Danish health registers creating a unique population-based cohort.  The Danish National Health Survey 2010 provided data on e.g. perceived stress and lifestyle factors on a representative sample of 118,000 Danish citizens aged 25 or older. Danish health registers provided data on hospitalizations, demographic and socioeconomic factors. We developed a new Danish multimorbidity index based on recorded diagnoses and redeemed medicine prescriptions on all Danish citizens identifying 39 mental and physical long-term conditions. We adjusted for and analyzed the modifying effect of multimorbidity on the study outcomes.

In general, we found that high stress perception was associated with multimorbidity, an increased number of potentially preventable hospitalizations and increased all-cause mortality after adjusting for mental-physical multimorbidity, socioeconomic factors and lifestyle where appropriate, and there often seemed to be dose-response relations. In absolute numbers, persons with multimorbidity had a poorer prognosis and psychiatric conditions aggravated this.

This may be the first step to understand the impact of mental stress on physical health, to discuss mental stress in a general practice setting, and to create the foundation for developing potential interventions and practice guidelines for patients with stress in general practice. Hopefully, this may lead to better care and improved life expectancy of people with stress and chronic disease.

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References

Prior A, Fenger-Grøn M, Larsen KK, et al. The association between perceived stress and mortality among people with multimorbidity: A prospective population-based cohort study. Am J Epidemiol. 2016;184(3):199-210.

Prior A, Vestergaard M, Davydow DS, et al. Perceived stress, multimorbidity, and risk for hospitalizations for ambulatory care-sensitive conditions: A population-based cohort study. Med Care. 2017;55(2):131-139.