【摘要】有报道称，患有躯体疾病的人患后续精神障碍的风险较高。然而，之前的研究只考虑了几对疾病，或者只报告了相对风险。这项研究旨在系统地探索躯体疾病与后续精神疾病之间的关联。本研究调查了2000年至2021年期间居住在丹麦的7,673,978人，并对他们进行了总计1.193亿人年的跟踪调查。该研究评估了九大类身体疾病（心血管、内分泌、呼吸、胃肠道、泌尿生殖、肌肉骨骼、血液和神经系统疾病以及癌症），涵盖了31种特定疾病，以及随后的精神障碍诊断风险，涵盖了十个ICD-10分组（器质性，包括症状性精神障碍；因使用精神活性物质引起的精神障碍；精神分裂症和相关疾病；情绪障碍；神经性、压力相关和躯体形式障碍；饮食失调；人格障碍；智力障碍；广泛性发育障碍；以及通常在儿童和青少年时期发病的行为和情绪障碍）。使用泊松回归，计算了身体疾病和精神障碍对的总体和时间依赖性发病率比 (IRR)，并根据年龄、性别和日历时间进行了调整。使用Aalen-Johansen估计量估计绝对风险。总共有646,171人（8.4%）在随访期间被确诊患有精神障碍。除癌症外，所有躯体疾病都与精神障碍风险增加有关。对于九大类躯体疾病和精神障碍，IRR的中位点估计值为1.51（范围：0.99-1.84；四分位数间距：1.29-1.59）。IRR范围从癌症后的0.99（95% CI：0.98-1.01）到肌肉骨骼疾病后的1.84（95% CI：1.83-1.85）。在诊断出躯体疾病后，风险随时间而变化。确诊躯体疾病后15年内累积精神障碍发病率从癌症的3.73%（95% CI：3.67-3.80）到呼吸系统疾病的10.19%（95% CI：10.13-10.25）不等。这些数据表明，大多数躯体疾病与后续精神障碍风险增加有关。治疗躯体疾病的临床医生应时刻警惕可能出现的继发性精神障碍。

      【关键词】躯体疾病、精神障碍、共病、人群队列、绝对风险、发病率、呼吸系统疾病、肌肉骨骼疾病、癌症

      [Abstract] People with physical diseases are reported to be at elevated risk of subsequent mental disorders. However, previous studies have considered only a few pairs of conditions, or have reported only relative risks. This study aimed to systematically explore the associations between physical diseases and subsequent mental disorders. It examined a population-based cohort of 7,673,978 people living in Denmark between 2000 and 2021, and followed them for a total of 119.3 million person-years. The study assessed nine broad categories of physical diseases (cardiovascular, endocrine, respiratory, gastrointestinal, urogenital, musculoskeletal, hematological and neurological diseases, and cancers), encompassing 31 specific diseases, and the subsequent risk of mental disorder diagnoses, encompassing the ten ICD-10 groupings (organic, including symptomatic, mental disorders; mental disorders due to psychoactive substance use; schizophrenia and related disorders; mood disorders; neurotic, stress-related and somatoform disorders; eating disorders; personality disorders; intellectual disabilities; pervasive developmental disorders; and behavioral and emotional disorders with onset usually occurring in childhood and adolescence). Using Poisson regression, the overall and time-dependent incidence rate ratios (IRRs) for pairs of physical diseases and mental disorders were calculated, adjusting for age, sex and calendar time. Absolute risks were estimated with the Aalen-Johansen estimator. In total, 646,171 people (8.4%) were identified as having any mental disorder during follow-up. All physical diseases except cancers were associated with an elevated risk of any mental disorder. For the nine broad pairs of physical diseases and mental disorders, the median point estimate of IRR was 1.51 (range: 0.99-1.84; interquartile range: 1.29-1.59). The IRRs ranged from 0.99 (95% CI: 0.98-1.01) after cancers to 1.84 (95% CI: 1.83-1.85) after musculoskeletal diseases. Risks varied over time after the diagnosis of physical diseases. The cumulative mental disorder incidence within 15 years after diagnosis of a physical disease varied from 3.73% (95% CI: 3.67-3.80) for cancers to 10.19% (95% CI: 10.13-10.25) for respiratory diseases. These data document that most physical diseases are associated with an elevated risk of subsequent mental disorders. Clinicians treating physical diseases should constantly be alert to the possible development of secondary mental disorders.

[Key words] Physical diseases, mental disorders, comorbidity, population-based cohort, absolute risk, incidence rate, respiratory diseases, musculoskeletal diseases, cancers

      论文原文：Natalie C. Momen, Søren Dinesen Østergaard, Uffe Heide-Jorgensen, Henrik Toft Sørensen, John J. McGrath, Oleguer Plana-Ripoll (2024). Associations between physical diseases and subsequent mental disorders: a longitudinal study in a population-based cohort. World Psychiatry. Volume23, Issue 3, Pages 421-431. October 2024.

https://doi.org/10.1002/wps.21242