Descriptions of Activities of the Association > Management of Comorbidity of Mental and Physical Disorders

Management of Comorbidity of Mental and Physical Disorders

People with mental disorders often suffer from physical illness. This fact is insufficiently emphasized resulting in sub-optimal care and, in many instances, increased mortality. Similarly, people in treatment for a physical illness often have (unrecognized) mental illnesses. These are often not given much attention, leading to a longer duration and poorer prognosis of both the mental and physical illnesses.

The Association has therefore decided to devote a part of its activity to the recognition of the importance and possible action regarding problems related to comorbid mental and physical illnesses. Work started with a review of evidence and the publication of these reviews. This was followed by the development of educational materials and a series of meetings, symposia at major congresses which attracted large audiences. Finally, the Association carried out a large international study of diabetes and depression.

a) Books

  • Leucht S, Burkard T, Henderson J.H, Maj M, Sartorius N. (2007) Physical Illness and Schizophrenia: A Review of Evidence, Cambridge University Press (ISBN 978-0-521-88264-4)
  • Maj M, Sartorius N, Tasman A, Gureje O (eds) (2008) The WPA Educational Series on Depressive Disorders. Revision of 2008. Volume II: Physical Illness and Depression; World Psychiatric Association, Geneva.
  • Katon W, Maj M, Sartorius N (2010) Depression and Diabetes. Wiley-Blackwell ISBN 978-0-470-68838-0
  • Glassman A, Maj M, Sartorius N (2010). Depression and Heart Disease. Wiley-Blackwell (ISBN 978-0-470-71057-9)
  • O’Hara, J McCarthy, J & Bouras N (eds) (2010) Intellectual Disability and Ill Health: A Review of Evidence. ISBN 978-0-521-72889-8. Cambridge University Press
  • Gordon A.J (2010). Physical illness and drugs of abuse: a review of the evidence. Cambridge University Press (ISBN 978-0-521-13347-0)
  • Kissane DW, Maj M, Sartorius N (2011) Depression and Cancer. Wiley-Blackwell (ISBN 978-0-470-68966-0)
  • Sartorius N, Holt R.I.G., Maj M. (eds.) (2015). Comorbidity of Mental and Physical Disorders. Karger, Vol. 179, 188p, (ISBN 9 783318 026030)
  • Kurrle S, Brodaty H and Hogarth R. (2012) Physical Comorbidities of Dementia, Cambridge University Press, Cambridge, UK
  • Sartorius N, Holt R.I.G., Maj M, (2015) Comorbidity of Mental and Physical Disorders. Karger Publications, Basel, Switzerland

The information presented in the books by Katon et al., Glassman et al. and Kissane et al. has also been presented in sets of slides suitable for teaching purposes and these slides were included in the WPA Educational Materials. They can be freely downloaded from the WPA website.

b) Articles

  • Leucht S, Burkard T, Henderson J, Maj M, Sartorius N. (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatrica Scandinavica. 116:317-333.
  • Sartorius N, (2013) Comorbidity of mental and physical diseases: a main challenge for medicine of the 21st century. Shanghai Archives of Psychiatry, Apr; 25(2): 68-69.
  • Chew-Graham C, Sartorius N, Cimino LC, Gask L. (2014) Diabetes and depression in general practice: meeting the challenge of managing comorbidity. Br J Gen Pract. 64(625):386-7. https://doi: 10.3399/bjgp14X680809
  • Chen C, Si TM, Xiang YT, Ungvari GS, Wang CY, He. YL, Kua EH, Fujii S, Sim K, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH, Shinfuku N. (2015) Prevalence and prescription of antidepressants in depression with somatic comorbidity in Asia: The Research on East Asian Psychotropic Prescription Patterns study. Chin Med J. (Engl)128(7): 853-8. Doi 10.4103/0366.6999.154272.
  • Fiorillo A, Sartorius N. (2021) Mortality gap and physical comorbidity of people with severe mentla disorders: the public health scandal. Annals of General Psychiatry. 20:52.
  • Heinze G, Sartorius N, Sanchez DPG, Bernard-Fuentes B, Cawthorpe D, Cimino L, Cohen D, Lecic-Tosevski D, Filipcvic I, Lloyd C, Mohan I, Ndetei D, Poyurovsky M, Rbbamo G, Starostina E, Yifeng W, EstefaniaLimon L. (2021) Integration of mentla health comorbidity in medical specialty programs in 20 countries. The International Journal of Psychiatry in Medicine, Vol. 56(4) 278-293.

c) Webinars and lectures

In 2019, the president of AMH has been entrusted with the Chairmanship of the WPA Action Plan Working Group on Comorbidity. The Group developed several symposia and training courses presented at the World Congresses of Psychiatry and organized two Webinars on the topic in 2022. The webinars are available on the WPA website,  among its educational materials. A description of the Working Group’s activities is published.


II) Educational Materials

In addition to the slide sets mentioned above and the webinars on the WPA website, the Association has also produced two sets of material – in hard copy and in form of a slide set concerning the recognition and management of comorbid mental and physical illness for General Partitioners: Goldberg D, Gask L, Sartorius N. (1998) Training physicians in mental health skills. Published by the Institute of Psychiatry, University of London, London, UK.


III) The Diabetes and Depression program

In July 2010 The AIMHP has initiated a major international program dealing with depression and diabetes. The program brought together a number of international organizations.

  • The American Association of Clinical Endocrinologists
  • American Diabetes Organization
  • Association of European Psychiatrists
  • Associacion Latinoamericana de Diabetes (ALAD)
  • Collegium Internationale Neuro-Psychopharmacologicum (CINP)
  • Diabetes UK
  • European Association for the Study of Diabetes/Psychosocial Aspects of Diabetes
  • Global Alliance of Mental Illness Advocacy Network (GAMIAN) – Europe
  • International Council of Nurses
  • International Diabetes Federation
  • International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)
  • International Society for Affective Disorders
  • International Society of Behavioral Medicine
  • Project Hope
  • World Association of Social Psychiatry
  • World Federation for Mental Health
  • World Organization of Family Doctors (Wonca)
  • World Psychiatric Association

The program also included a number of educational activities for General Practitioners (Belgium, China, Slovenia) and nurses (Botswana, Ethiopia, Kenya, south Africa and Uganda).

In addition, the AIMHP initiated and led a major international study on depression and diabetes involving centers of investigation in (Asia (China, India) Africa, South America and Europe. In all more than 3000 persons with diabetes have been included in the study involving: 14 countries (Argentina, Bangladesh, China, Germany, India, Italy, Kenya, Mexico, Pakistan, Poland, Russia, Serbia, Uganda and Ukraine).

IV) Courses, symposia, lectures

The AIMHP organized a number of symposia, lectures, courses and workshops on dealing with comorbidity of depression in diabetes for psychiatrists and mental health service staff. The organizations listed above participated in the conduct of these events. Many of these events were linked with major international meetings. The program also included a number of educational activities for General Practitioners (Belgium, China, Slovenia) and nurses (Botswana, Ethiopia, Kenya South Africa and Uganda).


List of publications for INTERPRET-DD

Lloyd CE, on behalf of the INTERPRET-DD study investigators. The INTERPRET-DD study of diabetes and depression: a protocol. Diabetic Medicine, 2015; 32: 925–934

Lloyd CE, Nouwen A, Sartorius N, on behalf of the INTERPRET-DD Investigators. Prevalence and correlates of depressive disorders in people with type 2 diabetes. Results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) Study; a collaborative study carried out in 14 countries. Diabetic Medicine 2018; DOI 10.1111/dme.13611

Santosh K Chaturvedi, Shayanth Manche Gowda, Helal Uddin Ahmed, Fahad D Alosaimi, Nicola Andreone, Alexey Bobrov, Viola Bulgari, Giuseppe Carrà, Gianluca Castelnuovo, Giovanni de Girolamo, Tomasz Gondek, Nikola Jovanovic, Thummala Kamala, Andrzej Kiejna, Nebojsa Lalic, Dusica Lecic-Tosevski, Fareed Minhas, Victoria Mutiso, David Ndetei, Golam Rabbani, Suntibenchakul Somruk, Sathyanarayana Srikanta, Rizwan Taj, Umberto Valentini, Olivera Vukovic, Wolfgang Wölwer, Larry Cimino, Arie Nouwen, Cathy Lloyd, and Norman Sartorius. More anxious than depressed a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus; prevalence and correlates. General Psychiatry 2020 2019; 32(4): e100076

Cichon, Ewelina; Kiejna, Andrzej; Kokoszka, Andrzej; Gondek, Tomasz; Rajba, Beata; Lloyd, Cathy and Sartorius, Norman (2020). Validation of the Polish version of WHO-5 as a screening instrument for depression in adults with diabetes. Diabetes Research and Clinical Practice, 159, article no. 107970.

Lloyd CE, Sartorius N, Ahmed HU, Alvarez A, Bahendeka S, Bobrov AE et al. Factors associated with the onset of Major Depressive Disorder in adults with type 2 diabetes living in 12 different countries; results from the INTERPRET-DD prospective study. Epidemiology & Psychiatric Sciences 2020, Jun 2;29:e134. doi: 10.1017/S2045796020000438.

Lloyd, C. E.; Sartorius, N.; Ahmed, H. U.; Alvarez, A.; Bahendeka, S.; Bobrov, A. E.; Burti, L.; Chaturvedi, S. K.; Gaebel, W.; de Girolamo, G.; Gondek, T. M.; Guinzbourg, M.; Heinze, M. G.; Khan, A.; Kiejna, A.; Kokoszka, A.; Kamala, T.; Lalic, N. M.; Lecic-Tosevski, D.; Mannucci, E.; Mankovsky, B.; Müssig, K.; Mutiso, V.; Ndetei, D.; Nouwen, A.; Rabbani, G.; Srikanta, S. S.; Starostina, E. G.; Shevchuk, M.; Taj, R.; Valentini, U.; van Dam, K.; Vukovic, O. and Wölwer, W. (2020). Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: results from the INTERPRET-DD prospective study. Epidemiology and Psychiatric Sciences, 29(e134) pp. 1–9.

Lu, Yanhui; Xing, Pengbo; Cai, Xue; Luo, Dan; Li, Ruxue; Lloyd, Cathy; Sartorius, Norman and Li, Mingzi (2020). Prevalence and Risk Factors for Diabetic Peripheral Neuropathy in Type 2 Diabetic Patients From 14 Countries: Estimates of the INTERPRET-DD Study. Frontiers in Public Health, 8, article no. 534372.

Cichoń E, Kiejna A, Kokoszka A, Gondek TM, Radzio R, Jastrzębski A, Andrzejewska BE, Alosaimi FD, Lloyd CE, Sartorius N. People with diabetes need a lower cut-off than others for depression screening with PHQ-9. PLoS One. 2020 Oct 23;15(10):e0240209. doi: 10.1371/journal.pone.0240209. eCollection 2020.

Heinze, Gerhard; Sartorius, Norman; Guizar Sanchez, Diana Patricia; Bernard-Fuentes, Napoleón; Cawthorpe, David; Cimino, Larry; Cohen, Dan; Lecic-Tosevski, Dusica; Filipcic, Igor; Lloyd, Cathy; Mohan, Isaac; Ndetei, David; Poyurovsky, Michael; Rabbani, Golam; Starostina, Elena; Yifeng, Wei and EstefaníaLimon, Limón (2021). Integration of mental health comorbidity in medical specialty programs in 20 countries. The International Journal of Psychiatry in Medicine, 56(4) pp. 568–581.

Tomasz M. Gondek, Andrzej Kiejna, Ewelina Cichoń, Andrzej Kokoszka, Alexey Bobrov, Giovanni de Girolamo, Dusica Lecic-Tosevski, Boris Mankovsky, Karsten Müssig, Wolfgang Wölwer, Cathy E. Lloyd, Norman Sartorius, Arie Nouwen. Anxiety disorders as predictors of suicidality among people with Type 2 Diabetes Mellitus: Findings of a study in 6 European countries. Submitted Psychosomatic Medicine (August 2021).

Bobrov, A. E.; Starostina, E. G.; Agamamedova, I. N.; Volodina, M. N.; Karacheva, Yu. V.; Nikitina, T. E.; Parpara, M. A.; Subbotnikova, O. A.; Tsarenko, D. M.; Nouwen, A.; Lloyd, C. and Sartorius, N. (2021). Mental disorders in type 2 diabetes. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 121(7) pp. 22–30.

Cichoń, Ewelina; Kiejna, Andrzej; Gondek, Tomasz M; Obrębski, Marcin; Sutkowska, Edyta; Lloyd, Cathy E. ; Sartorius, Norman and Kokoszka, Andrzej (2021). PAID-PL—The Polish Version of the Problem Areas in Diabetes Scale: Perfect Reliability and a One-Factor Structure. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy , 14 pp. 4433–4441.

Kokoszka, Andrzej; Pacura, Agata; Kostecka, Barbara; Lloyd, Cathy E. and Sartorius, Norman (2022). Body self-esteem is related to subjective well-being, severity of depressive symptoms, BMI, glycated hemoglobin levels, and diabetes-related distress in type 2 diabetes. PLOS ONE , 17(2), article no. e0263766.

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