Integration of mental health comorbidity in medical specialty programs in 20 countries

Abstract

Methods

A systematic analysis was performed of the medical specialization academic programs of 20 different countries to establish which medical specialties take into account mental health issues in the specialty curricular design and which mental health content these programs address. The criteria that were explored in the educational programs include: 1) name of the medical specialties that take into account mental health content in curriculum design, 2) name of the mental health issues addressed by these programs. After independent review and data extraction, paired investigators compared the findings and reached consensus on all discrepancies before the final presentation of the data. Descriptive statistics evaluated the frequency of the data presented.

Results

Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs. In four countries: Bangladesh, Serbia, the Netherlands and France, 50%of all graduate specialty training programs include mental health content. In ten countries: Germany, Sweden, the United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel and Spain, between 20% and 49% of all graduate specialty training programs include mental health content. In six countries - Brazil, Chile, Colombia, Croatia, Kenya, and the United States-less than 20% of all graduate specialty training programs include mental health content.

Discussion

The proposal that we have made in this article should be taken into account by decision-makers, in order to complement the different postgraduate training programs with mental health issues that are frequently present with other physical symptoms. It is not our intention that the different specialists know how to treat psychiatric comorbidities, but rather pay attention to their existence and implications in the diagnosis, evolution and prognosis of many other diseases. The current fragmentation of medicine into ever finer specialties makes the management of comorbidity ever more difficult: a reorientation of post- graduate training might improve the situation.

Keywords

curriculum development medical education comorbidity medical illness mental illness

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References

Kissane

Maj

Sartorius

Depression and cancer. Chichester: Wiley-Blackwell, 2011.

Kurrle

Brodaty

Hogarth

Physical comorbidities of dementia. Cambridge: Cambridge University Press, 2012.

Sartorius

Comorbidity of mental and physical disorders: a key problem for medicine in the 21st century.

Act Psychiatr Scand 2018; 137: 369–370.

Barnett

Mercer

Norbury

, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education. Lancet 2012; 380: 37–43.

Collaborators

GBDN.

Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18: 459–480.

Fortin

Stewart

Poitras

M-E

, et al. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 2012; 10: 142–151.

Wallace

Salisbury

Guthrie

Managing patients with multimorbidity in primary care.

Br Med J 2015; 350: h176.

Lochner

Cox

CS.

Prevalence of multiple chronic conditions among Medicare beneficiaries, United States, 2010. Prev Chronic Dis 2013; 10.

Sartorious

Comorbidity of mental and physical diseases: a main challenge for medicine of the 21st century. Shanghai Arch Psychiatry 2013; 25: 68–69.

10.

Naylor

Parsonage

McDaid

, et al. Long-term conditions and mental health: the cost of co-morbidities. London: The King’s Fund and Centre for Mental Health. 2012.

11.

Kasteridis

Street

Dolman

, et al. Who would most benefit from improved integrated care? Implementing an analytical strategy in South Somerset. Int J Integr Care 2015; 15: 1.

12.

Scott

Lim

Al-Hamzawi

, et al. Association of mental disorders with subsequent chronic physical conditions: world mental health surveys from 17 countries. JAMA Psychiatry 2016; 73: 150–158.

13.

Ryu

Chamberlain

Pendegraft

, et al. Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records. BMC Psychiatry 2016; 16: 114.

14.

Shih

Davis

Schoenbaum

, et al. Organizing the U.S. health care delivery system for high performance. The commission on a high-performance health system. New York: Commonwealth Fund, 2018.

15.

Cawthorpe

A novel population-based health index for mental disorder.

Perm J 2013; 17: 50–54.

16.

Egede

LE.

Diabetes, major depression and functional disability among U.S. adults.

Diabetes Care 2004; 27: 421–428.

17.

Egede

LE.

Medical cost of depression and diabetes. In: Katon

Maj

Sartorius

(eds) Depression and diabetes. Hoboken: Wiley Blackwell, 2010, pp. 63–79.

18.

Gourevitch

Chatterji

Deb

, et al. On-site medical care in methadone maintenance: associations with health care use and expenditures. J Subst Abus Treat 2007; 32: 143–151.

19.

Paez

Zhao

Hwang

Rising out-of-pocket spending for chronic conditions: a ten-year trend.

Health Aff 2009; 28: 15–25.

20.

Hemming

Loeb

Internal medicine residents' inadequate preparation in mental health. SGIM Forum 2013; 36: 10–11.

21.

Smith

RC.

Educating trainees about common mental health problems in primary care: a (not so) modest proposal. Acad Med 2011; 86: e16.

22.

Smith

Laird-Fick

D'Mello

, et al. Addressing mental health issues in primary care: an initial curriculum for medical residents. Patient Educ Counsel 2014; 94: 33–42.

23.

Halvorson

GC.

Health care reform now! A prescription for change. San Francisco: Jossey-Bass, 2007.

24.

Lenski

Barrick

Ofria

Balancing robustness and evolvability. PLoS Biol 2006; 4: e428.

25.

Borrell-Carrio

Suchman

Epstein

RM.

The biopsychosocial model 25 years later: principles, practice, and scientific inquiry.

Ann Fam Med 2004; 2: 576–582.

26.

Fortin

Soubhi

Hudon

, et al. Multi-morbidity’s many challenges. Time to focus on the needs of this vulnerable and growing population. Br Med J 2007; 334: 1016–1017.

27.

Frandsen

Joynt

Rebitzer

, et al. Care fragmentation, quality, and costs among chronically ill patients. Am J Manag Care 2015; 21: 355–362.

28.

Katon

Lin

EHB

Von Korff

, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010; 363: 2611–2620.

29.

Lloyd

Nouwen

Sartorius

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 Med 2018; 35: 760–769.

30.

Sheehy

Murphy

Barry

Depression in rheumatoid arthritis – underscoring the problem.

Rheumatology (Oxford) 2006; 45: 1325–1327.

31.

Welch

Czerwinski

Ghimire

, et al. Depression and costs of health care. Psychosomatics 2009; 50: 392–401.

32.

Vamos

Mucsi

Keszei

, et al. Comorbid depression is associated with increased healthcare utilization and lost productivity in persons with diabetes: a large nationally representative Hungarian population survey. Psychosomat Med 2009; 71: 501–507.

33.

Gunn

Ayton

Densley

, et al. The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Soc Psychiatry Psychiatr Epidemiol 2010; 47: 175–184.

34.

Livermore

Sharpe

McKenzie

Panic attacks and panic disorder in chronic obstructive pulmonary disease: a cognitive behavioral perspective.

Respir Med 2010; 104: 1246–1253.

35.

Cimpean

Drake

RE.

Treating comorbid medical conditions and anxiety/depression. Epidemiol Psychiatr Sci 2011; 20: 141–150.

36.

Kaplan

Crawford

Cantell

, et al. Comorbidity, co-occurrence, continuum: what’s in a name? Child Care Health Dev 2006; 32: 723–731.

37.

Theis

Helmick

Hootman

JM.

Arthritis burden and impact are greater among U.S. women than men: intervention opportunities.

J Womens Health (Larchmt) 2007; 16: 441–453.

38.

Sale

Gignac

Hawker

The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis. J Rheumatol 2008; 35: 335–342.

39.

Cowley

Dunaway

Teaching psychiatry residents to work at the interface of mental, health and primary care.

Acad Psychiatry 2014; 38: 398–404.

40.

Belsky

The deepest well: healing the long-term effects of childhood adversity: by Nadine Burke Harris, MD. Perm J 2019; 23: 18–75.

41.

Sweeney

Dayo Obure

Maier

, et al. Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience. Sex Transm Infect 2011; 88: 85–99.

42.

Miranda

Kinra

Casas

, et al. Non-communicable diseases in low- and middle-income countries: context, determinants and health policy. Trop Med Int Health 2008; 13: 1225–1234.