Comorbidity of mental and physical disorders

Comorbidity constitutes a major challenge for healthcare professionals and the healthcare system, particularly, comorbidity of psychological and physical disorders. The economic cost of comorbidity to healthcare system and society is potentially substantial. The prevalence of comorbid mental and physical disorders has not only been given inadequate attention but also grossly underestimated. The relationship between physical and psychological comorbidities is complex and the casual relationship established for one physical or mental disorder may not hold good for another disorder.

The book presents evidence about the magnitude and consequences of comorbidity of psychological and physical disorders from a personal and societal perspective. It comprises three major sections. The first section of the book contains chapters that provide public health aspects of comorbidity in terms of its conceptualization, cost and interaction of comorbidity with factors arising out of socio-economic development. The comorbidity of diabetes and depression has been presented as a model to understand different ways in which comorbidity of mental and physical disorders can be conceptualized. The model also highlights a variety of pharmacological and psychological interventions that represent the integrative, social and community perspectives. The public health perspective has been used to provide an overview of the existing understanding of key determents and shared pathways behind non-communicable diseases and common psychological disorders, their prevention and control, and implications of emerging frameworks that target risk factors which can be modified.

The second section includes review chapters which provide evidence about comorbidity using two approaches. The first approach addresses issues pertaining to comorbidity of mental disorders with specific physical disorders of major public health importance, such as diabetes, dementia, cardiovascular illness, cancer and infectious diseases. As a part of the second approach to the understanding of evidence about physical comorbidity in mental and behavioural disorders, the chapters examine substance abuse, eating and anxiety disorders.

The third group of chapters in the book deal with management of comorbidity of mental and physical illness in terms of the role of general practitioners and family physicians, the training of health care personnel, challenges in person-centred services, and a framework of optional strategies to prevent comorbid mental/physical disorders. The book ends with concluding remarks and specific recommendations by the editors.

Though clinical and community studies have consistently provided evidence that a substantial proportion of people suffer from comorbid mental and physical disorders, limited attention has been given to this population of patients. In this context, bringing together the existing empirical work on comorbidity of physical and mental disorders and their adverse consequences, the editors have made a significant contribution in the direction. This book emphasizes the need for reintegration of psychiatry and medicine with an ultimate goal of providing optimal health care to this vulnerable patient population with comorbidity of mental and physical disorders. The specific recommendations made by the editors would serve as a road map to address this problem. In conclusion, this volume is an essential read for psychiatrists and other mental health professionals, general practitioners, family physicians, students, researchers, public health policymakers and other health care professionals.