以全球化角度探討精神病疾患與身體疾病盛行率的相關性

A Global Perspective on the Association between the Prevalences of Psychiatric Disorders and Medical Illnesses

背景：精神病疾患與身體疾病常見有共病的現象，但至今仍缺乏以全球化角度來研究此 現象，所以我們進行下列研究，探討精神病疾患與身體疾病的盛行率是否存在有相關性。方 法：世界衛生組織曾調查14 個區域（共69 個國家）的疾病盛行率，我們利用Pearson’s correlation 及hierarchical cluster analysis 分析其中9 種精神病疾患與7 種身體疾病其盛行率的相 關性。結果：我們發現顯著的相關性存在於數種精神病疾患與身體疾病間。相關性最高的前 六項，依序為物質使用疾患與慢性阻塞性肺病(r = 0.884)，思覺失調症與糖尿病 (r = 0.833)， 物質使用疾患與糖尿病 (r = 0.803)，思覺失調症與退化性關節炎 (r = 0.800)，物質使用疾患與 風濕性關節炎 (r = 0.799)，雙極性情感疾患與退化性關節炎 (r = 0.783)，上述 p 值均 < 0.001。 討論：這結果與很多臨床的發現是一致的，對精神病疾患與身體疾病間相互間有關連性的可 能，提供更多的證據。精神病疾患與身體疾病共病的現象不只與藥物治療有關，一些因子可 能共同存在於精神病疾患與身體疾病。

Background: High rates of comorbidity of psychiatric disorders and medical illnesses have been commonly reported. Few studies have addressed these associations in a global perspective. We intended to test the hypothesis that high prevalences of psychiatric disorders could be correlated to higher prevalences of medical illnesses. Method: We obtained the prevalences for 9 psychiatric disorders and 7 medical illnesses for 69 countries grouped as 14 epidemiological subregions of the world from the WHO Global Burden of Disease Project. Results: The study results showed that signifi cant positive correlations of the prevalences of some psychiatric disorders and medical illnesses, particularly drug use disorder vs. chronic obstructive pulmonary disease (r = 0.884), schizophrenia vs. diabetes mellitus (r = 0.833), drug use disorder vs. diabetes mellitus (r = 0.803), schizophrenia vs. osteoarthritis (r = 0.800), drug use disorder vs. rheumatoid arthritis (r = 0.799), and bipolar disorder vs. osteoarthritis (r = 0.783) (all p < 0.001). No signifi cant correlations exited between depressive, anxiety disorders, and medical illnesses. Additionally, some not directly related diseases were close in the hierarchical cluster analysis. Conclusion: Our results agree with clinical reports and strengthen the close linking between some psychiatric disorders and medical illnesses. The two corresponding groups of diseases may share some risk factors, and the comorbidity is not dependent of side effects of psychopharmacological medications completely. This study also demonstrates how global epidemiological study can evaluate the hypotheses for comorbidity successfully.