Relationship Between Mental Health Diagnoses and Physical Diseases in Adolescents

National study of adolescents finds some mental health concerns may be risk factors for physical diseases, and vice versa


A new study, published in PLoS ONE, investigates the relationship between the time of onset of mental and physical health diagnoses in adolescents. The results of the national cohort study, with data from the United States, indicate that some mental health diagnoses may be risk factors for certain physical diseases. Results also suggest that some physical diseases may put adolescents at risk for mental health issues.

“Our results may pave the way to improve diagnostic approaches, prevention and treatment of mental-physical comorbidity, for example by considering that treatment of a mental disorder may have implications for a physical disease, and vice versa,” write the researchers, led by Marion Tegethoff, a research scientist at the University of Basel in Switzerland.

Mental health issues and chronic physical diseases both place a large burden on global health care systems. Studies in adults suggest that many mental health diagnoses may be risk factors for physical illnesses (e.g., depression as a risk factor for cardiovascular diseases and autoimmune diseases, PTSD as a risk factor for heart disease and diabetes).

“The healthcare significance of mental-physical comorbidity is underlined by diminished quality of life and unfavorable course of disease, substantial healthcare costs, higher treatment demand, longer treatment duration, and impaired treatment response in persons with mental-physical comorbidity,” state the researchers.

Photo credit: Flickr
Photo credit: Flickr

Currently there is little research on the co-occurrence of mental and physical disorders in children and adolescents and these studies tend to use clinical samples rather than the general population. However, studies that have been conducted suggest a bidirectional link between mental health concerns and physical diseases in youth (e.g., epilepsy as a risk factor for ADHD).

In an effort to fill this gap in the literature, the current study sought “to estimate in adolescents with mental-physical comorbidity the temporal association of mental disorders and physical diseases.” The researchers used data from the National Comorbidity Survey Replication Adolescent Supplement. They conducted clinical interviews with a nationally representative sample of 6,483 adolescents, as well as gathered data from their parents. About two thirds of the participants were Caucasian. The researchers use hazard ratios (HRs) to report their findings.

The researchers report, “the clear temporal relationships between mental disorders and physical diseases for specific comorbidity patterns suggest that certain mental disorders may be risk factors of certain physical diseases at early life stages, and vice versa.”

Results show that affective disorders may be a risk factor for arthritis (HR = 3.36) and digestive system diseases (HR = 3.39), and anxiety disorders may be a risk factor for skin diseases (HR = 1.53). Substance use disorders may be a protective factor for seasonal allergies (HR = 0.33). In the opposite direction, results show that heart diseases may be a risk factor for any mental disorder (HR = 1.39) and anxiety disorders (HR = 1.89), and epilepsy may be a risk factor for eating disorders (HR = 6.27).

The authors argue that the findings support an integrative care approach to mental health. They suggest that the results “open new starting-points for early disease prevention and better treatments.” The researchers conclude, “Our findings carry relevance for psychiatric and medical health care and the roles of psychiatrists and other medical specialists in patient management, and they can inform research priorities and guide task forces, health policy plans and medical education.”



Tegethoff, M., Stalujanis, E., Belardi, A., & Meinlschmidt, G. (2016). Chronology of onset of mental disorders and physical diseases in mental-physical comorbidity – A national representative survey of adolescents. PLoS ONE, 11(10), e0165196. doi:10.1371/journal.pone.0165196 (Abstract)


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Shannon Peters
MIA Research News Team: Shannon Peters is a doctoral student at the University of Massachusetts Boston and has a master’s degree in mental health counseling. She is particularly interested in exploring the impacts of medicalization and pathologizing the experiences of individuals who have been affected by trauma. She is engaged in research on the effects of institutional corruption and financial conflicts of interest on research and practice.


  1. Hmm, next thing you know, professionals will be making the claim that depression causes a hangnail. I am so bleeping tired of it being blamed for everything under the sun.

    Regarding integrative care that brings in psychiatry to a PCP’s office, it will mean more prescriptions for psych meds being written and less investigating by primary care doctors regarding the complaints of the patients. Why do any work when you can write a prescription for a psych med and send the patient on their merry way?

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    • Not if it’s something where the altered mental state is induced by a physical condition. Then the GP’s reward for a simple psychiatric drugging is a malpractice suit for not treating the malady of origin. Shrinks, themselves, are usually safe from this as nobody’s surprised that they’re ignorant of such things.

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  2. “The researchers report, “the clear temporal relationships between mental disorders and physical diseases for specific comorbidity patterns suggest that certain mental disorders may be risk factors of certain physical diseases at early life stages, and vice versa.”
    I’m thinking this outcome is a result of “treatment” (which is almost always prescribed drugs) and “prevention” efforts will likely funnel more kids into the system for future drugging.
    I think the best approach to overcome the current MO is to direct educational efforts toward parents who don’t understand that there is a price their child will pay for the quick fix.

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  3. This is scientific reductionism at its very worst. The obvious hypothesis to explore is what the prior living conditions of the people in the studies were like to find correlations that really connect physical and emotional difficulties. For instance, the ACE studies at Kaiser showed that kid who experienced abuse and neglect or other childhood trauma were more likely to have both physical AND emotional difficulties in adulthood. Additionally, physiological insults like lead poisoning and other pollution effects have also been shown to associate with both physical and emotional difficulties as life progresses. They are looking at effects instead of causes, and postulating that two effects which occur more likely together are somehow causing each other. This is particularly idiotic, since of course not all depressed people have the physiological difficulties nor do all with the physical difficulties have the correlated emotional problems. It should be clear that looking for an earlier cause for both conditions is the simplest explanation if you want to be scientific. But these folks either don’t understand that or don’t want to. Baffling, disappointing, but not really that surprising. The level of scientific integrity in the psychiatric world is remarkably low.

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  4. These studies never seem to specify whether people have been on medication for their ‘mental health’ diagnoses – in fact the very fact they these have been ‘diagnosed’ suggests that they will have been taking prescribed medication. My thinking on this article is detailed in my own recent MIA article observing the diagnosis of Medically Unexplained or Somatic Symptoms …

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  5. Not surprisingly, connecting “mental disorders” to “physical diseases” would tend to legitimize (strengthen the position of) psychiatry. Ditto, confusing “cause” and “effect”. As “mental health treatment” (i.e. psychiatric drugs) cause a slew of physical ill health conditions, I don’t think it is as helpful as one might imagine to connect the two, quite the reverse. The focus here is on “disease” rather than “health” because you’ve skirted the idea of prevention. A big problem we’ve got now is that in the “mental health” arena many “preventative” measures are actually causal/causative. For one thing, you don’t have a “behavioral disorder”, for instance, before the diagnosticians are called in. Obviously, physical sickness is going to be disturbing, however making a “mental disturbance” out of physical illness is something that I’d hope physicians would in general strive to avoid (i.e. prevent).

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  6. Shannon,
    Emotional problems and severe distress are not “disorders”. People’s understandable lived reactions to factors impinging on them, whether of a psychosocial and/or biological nature, are not disorders or illnesses. Please get this right in your reporting.

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