Muhammad Ajmal Zahid
Professor of Psychiatry, Faculty of Medicine, Kuwait University
Title: Mental and physical comorbidity in an Arab national primary health care setting
Biography
Biography: Muhammad Ajmal Zahid
Abstract
Statement of the Problem: A considerable number of patients attending the primary health clinics suffer from co-morbid
psychiatric disorders.
Objectives: To estimate the prevalence of the comorbidity between common mental disorders (anxiety/depression/
somatization) and common chronic physical illnesses among primary health care attendees, and explore the relationship of
comorbidity with type of illness and socio-demographic characteristics.
Method: The Physical Health Questionnaires (PHQ-SADs) were administered to a randomized sample of 1046 primary
clinic attendees in all the five governorates of the country over a 5-month period. Physical diagnoses were ascertained by the
attending physicians based on ICD-10 criteria.
Results: Of 1046 respondents, 442 (42.25%) had at least one mental disorder, while 670 (64.1%) had a physical illness
diagnosis, viz: diabetes mellitus (37.01%), hypertension (34.18%), heart diseases (7.2%) and non-chronic physical illnesses
(9.4%). Physical comorbidity was significantly associated with older age, divorce, illiteracy, and poorer living conditions. Just
over one third 34.4% (360 out of 1046) of the patients had physical-mental comorbidity. 53.7% (360 out of 670) of those with
physical illness had mental comorbidity while 21.8% (82 out of 376) of those without physical illness had at least one mental
disorder (OR=4.1, P<0.001). The commonest comorbid mental disorders were somatization and the simultaneous presence
of all 3 mental disorders. There was an increase in the prevalence of mental disorders with increase in the number of physical
illnesses. Similarly, the severity of mental illnesses (higher psychopathology scores) was associated with the increasing number
of physical illneses. Subjects with heart diseases and asthma consistently had higher psychopathology scores.
Conclusion: The findings call for the primary care physicians to be sensitive to the psychosocial context of patients who
present primarily with physical conditions; more so for patients with multiple medical illnesses and social disadvantage.