SEEMEDJ 2022, Vol 6, No 2 Somatic Illnesses and Mental Disorders Treatment
54 Southeastern European Medical Journal, 2022; 6(2)
Original article
Comorbidity of Somatic Illnesses on People With Treated Mental
Disorders – A New Challenge in Medicine 1
Romana Marušić 1,2, Adriana Levaković 2, Dunja Degmečić 2,3, Tatjana Bačun 2,4*
1 Department of Internal Medicine, National Memorial Hospital Vukovar, Croatia
2 Faculty of Medicine, J.J. Strossmayer University, Osijek, Croatia
3 Department of Psychiatry, University Hospital Centre, Osijek, Croatia
4 Division of Endocrinology, Department of Internal Medicine, University Hospital Centre, Osijek; Croatia
*Corresponding author: Tatjana Bačun, tbacun@gmail.com
Received: Apr 12, 2022; revised version accepted: Oct 20, 2022; published: Nov 28, 2022
KEYWORDS: chronic diseases, comorbidity, mental disorders
Abstract
Aim. Comorbidities pose a major challenge for 21st century medicine. The mutual pathophysiological
effect of one disease on another can significantly affect their course and prognosis. The aims of this
study were to examine the frequency of comorbidities and the most common psychiatric and
somatic comorbidities and to determine the difference in the incidence of certain diseases by gender
and age.
Methods. Data were recorded in several groups: demographic characteristics, psychiatric and
somatic diagnoses classified according to gender, age, and the legally determined ability to work,
and correlations of somatic and psychiatric diagnoses.
Results. The most common psychiatric diagnoses in men were post-traumatic stress disorder (PTSD)
(25%) and alcoholism (23%), while in women these were recurrent depressive disorder (19%) and
psychosis (10%). A statistically significant difference was found in the incidence of alcoholism and
PTSD, which are more common in men than in women. The most common somatic diseases in both
sexes were arterial hypertension (M = 33%, F = 46%) and diabetes mellitus (M = 18%, F = 32%).
Statistically significant differences were found in the frequency of hypertension (p = 0.03) and
epilepsy (p = 0.002), which are more common in men. The ratio alcoholism-hypertension (p = 0.03),
alcoholism-diabetes (p < 0.0001), alcoholism-COPD (p < 0.001) was statistically significant.
Conclusion. It is extremely important to improve the multidisciplinary approach and cooperation in
treatment in order to reduce the number of hospitalizations, emergency interventions and suicides
and to improve the patients’ quality of life and life expectancy.
(Marušić R, Levaković A, Degmečić D, Bačun T*. Comorbidity of Somatic Illnesses on People With
Treated Mental Disorders – A New Challenge in Medicine. SEEMEDJ 2022; 6(2); 54-66)
SEEMEDJ 2022, Vol 6, No 2 Somatic Illnesses and Mental Disorders Treatment
55 Southeastern European Medical Journal, 2022; 6(2)
Introduction
Comorbidity indicates the presence of two or
more different diseases or disorders
simultaneously and poses a major challenge for
21st century medicine (1). People with a chronic
physical illness are 1.5 to 2 times more likely to
develop a mental disorder (2).
It is estimated that 25% of the general population
has some form of mental disorder. Of these, as
many as 68% have one or more physical
comorbidities (3). Due to the extended average
lifespan, the prevalence of multimorbidity is
increasing; in Australia, it is 75% for people aged
65 to 74 and over 80% for people aged 75 and
above. A study conducted in Ontario showed a
multimorbidity of 7 to 35 % in people between
the ages of 18 and 65 (4). In Croatia, the
prevalence of multimorbidity is 79.8 % for people
over 65 (5).
Mental disorders are a major public health
problem that has a significant impact on the
health of people with chronic diseases and can
change the course of their illness and their
prognosis. Depression is present in 40% of
people with hypertension; the prevalence is
36.6% in men and as much as 63.4% in women. In
somatically healthy individuals with depressive
disorder, the risk of coronary heart disease is
increased 1.5- to 2-fold, while in individuals with
coronary heart disease, the risk of myocardial
infarction is increased 1.5- to 4.5-fold (2). Some
studies show that the prevalence of depressive
disorders in people with diabetes ranges from 8
to 15% (6). Only 25% to 50% of people with
diabetes who suffer from depression get
diagnosed and treated (7). The risk of
complications of the disease is increased as
much as 4 times due to the reduced ability to
regulate glucose metabolism (1, 8). Other studies
show that as many as 47.6% of young people
with insulin-dependent diabetes develop a
mental disorder after ten years, most often one
year after diagnosis (2).
The cost of hospital treatment of patients with
comorbid depression was increased 1.5-fold
compared with other patients. The positive
correlation of psychological comorbidities with
the length of hospital stays, doctor visits, and
longer sick leave has also been proven, which
leads to a reduced quality of life and higher
treatment costs (2). One study showed that
every fifth person in physical rehabilitation
suffers from a comorbid mental disorder. This
has an adverse effect on the outcome of
rehabilitation due to the patient’s reduced
motivation, cooperation, and active participation
in the rehabilitation process (9).
Due to the high incidence of comorbidities of
physical and mental illnesses, it is important to
conduct preventive examinations, personalized
pharmacotherapy and psychotherapy, and
educational programs for medical professionals.
An integrative approach and timely recognition
and treatment can reduce mortality, morbidity,
and overall treatment costs (10).
The aims of our research were to examine the
frequency of comorbidities and the most
common psychiatric and somatic comorbidities
and to determine the difference in the incidence
of certain diseases by gender and age.
Patients and methods
Patients and study design
The research was organized as a cross-sectional
study with historical data. It was approved by
the Ethics Committee of the Faculty of Medicine
Osijek, Josip Juraj Strossmayer University
in Osijek. The study was conducted on 137
subjects who were hospitalized at the Clinic for
Psychiatry of the Clinical Hospital Center Osijek.
Data were collected from the hospital
information system of the Clinical Hospital
Center Osijek over a period of one year. Inclusion
criterion was diagnosis of any somatic illness in
psychiatric patients.
Methods
Data were categorized in several groups:
demographic characteristics of respondents,
psychiatric and somatic diagnoses classified
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56 Southeastern European Medical Journal, 2022; 6(2)
according to gender, age, and the legally
determined ability to work (up to 65 years), and
correlations of somatic and psychiatric
diagnoses. To examine the correlation between
somatic and psychiatric diagnoses, only
diagnoses for which frequency was higher than
3% (N ≥ 7 for psychiatric, N ≥ 5 for somatic
diagnoses) in total population and somatic
diagnoses that are applicable in both genders
came into consideration.
Statistical analysis
R software was used to perform statistical
analysis of the collected data. Descriptive data
are expressed in frequency and share for
nominal variables and arithmetic and standard
deviation for numerical variables that have a
normal distribution. The normality of distribution
was examined using the Kolmogorov-Smirnov
test. Differences of category variables were
tested by binomial, χ2, and Fisher’s exact test,
and the degree of correlation was examined by
the φ test. Differences of numerical variables
with normal distribution were tested by
Student’s t-test. The level of statistical
significance was set at p < 0.05.
Results
The study included 137 respondents, of whom
95 (70%) were men and 42 (30%) were women.
The mean age of men was 55.9 ± 12.1 (22 to 87)
and women 56.9 ± 13.5 (16 to 80). Of the 137
respondents, 2% were aged between 18 and 30,
76% were between 30 and 65, and 23% were
over 65. A statistically significant difference was
found in the number of respondents by sex, in
the group aged 35 to 65 years (p < 0.0001).
Respondents were divided according to
employment into employed, unemployed, and
retired ones: A statistically significant difference
was found between retired men and women (p
< 0.0001) (Table 1).
Table 1. Demographic characteristics of respondents
Male Female Total p
Age 55.9+12,2 56.9+13,5 0.68
Age category
16-30 2(20%) 1(2%) 3(2%) 0.56
30-65 73(77%) 30(71%) 103(76%) < 0.0001
65 + 20(20%) 11(26%) 31(23%) 0.15
Employment status
Employed 15(16%) 3(7%) 18(13%) < 0.05
Unemployed 22(23%) 16(39%) 38(28%) 0.41
Retired 57(60%) 22(54%) 79(59%) < 0.0001
The most common psychiatric diagnoses in men
were post-traumatic stress disorder (PTSD)
(25%), alcoholism (23%), recurrent depressive
disorder (13%), while in women the most
common ones were recurrent depressive
disorder (19%), psychosis (10%), alcoholism,
PTSD, and anxiety-depressive disorder (7%). A
statistically significant difference was found in
the incidence of alcoholism and PTSD, which
were more common in men than in women
(Table 2).
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Table 2. Psychiatric diagnoses of respondents
Male Female Total p
Alcoholism 33(23%) 4(7%) 37(18%) < 0.0001
Recurrent depressive disorder 18(13% 11(19%) 29(14%) 0.26
PTSD* 35(25%) 4(7%) 39(19%) < 0.0001
Psychoorganic syndrome 7(5%) 2(3%) 9(4%) 0.18
Anxiety-depressive disorder 3(2%) 4(7%) 7(3%) 1
Psychosis 8(6%) 6(10%) 14(7%) 0.79
Another inorganic psychotic disorder 1(1%) 0(0%) 1(0%)
Pervasive developmental disorder 0(0%) 1(2%) 1(0%)
Mild mental retardation 4(3%) 1(2%) 5(2%) 0,27
Delirium tremens 3(2%) 0(0%) 3(1%)
Organic insane disorder 1(1%) 3(5%) 4(2%) 0,62
Schizophrenia 6(4%) 3(5%) 9(4%) 0.5
Borderline depressive decompensation 4(3%) 3(5%) 7(3%) 1
Depressive disorder 10(7%) 3(5%) 13(6%) 0.09
Bipolar affective disorder 2(1%) 4(7%) 6(3%) 0.68
Crisis 1(1%) 4(7%) 5(2%) 0.37
OCD* 3(2%) 0(0%) 3(1%)
Schizoaffective disorder 2(1%) 3(5%) 5(2%) 1
Organic emotionally labile disorder 0(0%) 3(5%) 3(1%)
Anorexia nervosa 1(1%) 0(0%) 1(0%)
*PTSD – Post-traumatic stress disorder, OCD – Obsessive-compulsive disorder
Of the somatic diagnoses, the most common
diagnoses in both sexes were arterial
hypertension (M = 33%, F = 46%), diabetes
mellitus (M = 18%, F = 32%) and epilepsy (M = 15%,
F = 8%). Statistically significant differences were
found in the frequency of arterial hypertension
(p = 0.03) and epilepsy (p = 0.002), which were
more common in men (Table 3).
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Table 3. Somatic diagnoses of respondents
Male Female Total p
Arterial hypertension 41(33%) 23(46%) 64(36%) 0.03
Diabetes mellitus 23(18%) 16(32%) 39(22%) 0.34
Epilepsy 19(15%) 4(8%) 23(13%) 0.002
COPD* 5(4%) 2(4%) 7(4%) 0.45
Liver cirrhosis 1(1%) 0(0%) 1(1%)
Gastric ulcer 2(2%) 0(0%) 2(1%)
Pneumonia 2(2%) 0(0%) 2(1%)
Hashimoto's thyroiditis 0(0%) 1(2%) 1(1%)
Multiple sclerosis 1(1%) 0(0%) 1(1%)
Lumbosacral pain 2(2%) 0(0%) 2(1%)
Esophagitis 0(0%) 0(0%) 0(0%)
Chronic gastritis 5(4%) 0(0%) 5(3%)
Venous ulcer 1(1%) 0(0%) 1(1%)
Pulmonary embolism 0(0%) 1(2%) 1(1%)
NHL* 1(1%) 0(0%) 1(1%)
Angina pectoris 3(2%) 0(0%) 3(2%)
Esophageal cancer 1(1%) 0(0%) 1(1%)
Psoriasis 4(3%) 0(0%) 4(2%) 1
Prostate hyperplasia 5(4%) 0(0%) 5(3%)
Parkinson’s disease 3(2%) 0(0%) 3(2%)
Acute renal failure 1(1%) 0(0%) 1(1%)
Cystitis 1(1%) 0(0%) 1(1%)
Hepatitis 1(1%) 0(0%) 1(1%)
Cervicobrachial syndrome 0(0%) 1(2%) 1(1%)
GERD* 1(1%) 0(0%) 1(1%)
SLE* 0(0%) 2(4%) 2(1%)
Urine retention 1(1%) 0(0%) 1(1%)
Hodgkin’s disease 1(1%) 0(0%) 1(1%)
*COPD – Chronic obstructive pulmonary disease, NHL – Non-Hodgkin's lymphoma, GERD – Gastroesophageal reflux disease,
SLE – Systemic lupus erythematosus
Since we were interested in the frequency of
psychiatric diagnoses among respondents, we
divided them into groups based on their
employment status and age. The most common
illness-related psychiatric diagnoses among
retired respondents were recurrent depressive
disorder (31%), PTSD (26%), and alcoholism (12%).
Unemployed respondents were most often
diagnosed with alcoholism (25%), recurrent
depressive disorder (16%), and PTSD (14%).
Similar diagnoses were most common among
employed respondents: alcoholism (33%) and
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PTSD (11%). χ2 showed a significant statistical
difference in the number of patients with PTSD
and recurrent depressive disorder among
retired, unemployed, and employed
respondents under the age of 65 (Table 4).
Table 4. Psychiatric diagnoses according to the employment status
Retired Unemployed Employed
> 65 < 65 > 65 < 65 p
Alcoholism 5(12%) 10(12%) 13(25%) 9(33%) 0.8
Psychosis 5(12%) 0(0%) 4(8%) 2(7%)
PTSD* 2(5%) 21(26%) 7(14%) 3(11%) 0.0004
Schizophrenia 2(5%) 5(16%) 2(4%) 0(0%)
Borderline depressive decompensation 0(0%) 3(4%) 2(4%) 2(7%) 0.98
Depressive disorder 5(12%) 2(2%) 5(10%) 2(7%) 0.63
Bipolar affective disorder 0(0%) 4(5%) 1(2%) 1(4%) 0.5
Mixed anxiety-depressive disorder 0(0%) 3(4%) 3(6%) 1(4%) 0.85
Recurrent depressive disorder 5(12%) 25(31%) 8(16%) 2(7%) < 0.0001
Organic emotionally labile disorder 3(7%) 0(0%) 0(0%) 0(0%)
Mild mental retardation 0(0%) 2(2%) 0(0%) 1(4%)
Crisis 1(2%) 1(1%) 1(2%) 287%) 0.96
Psychoorganic syndrome 10(24%) 5(6%) 0(0%) 0(0%)
Organic delusional disorder 2(5%) 0(0%) 1(1%) 1(4%)
Anorexia nervosa 0(0%) 0(0%) 1(2%) 0(0%)
Schizoaffective disorder 0(0%) 0(0%) 4(8%) 0(0%)
Pervasive developmental disorder 0(0%) 0(0%) 0(0%) 0(0%)
Delirium tremens 1(2%) 0(0%) 0(0%) 1(4%)
OCD* 0(0%) 0(0%) 0(0%) 0(0%)
*PTSD – Post-traumatic stress disorder, OCD – Obsessive-compulsive disorder
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Figure 1. Correlation of somatic and psychiatric diagnoses
* PTSD – Post-traumatic stress disorder, COPD – Chronic obstructive pulmonary disease
With the aim of roughly determining the
correlation of somatic and psychiatric
diagnoses, a graph was made to reflect that
correlation (Figure 1).
We took the most significant diagnoses from the
graph and made a matrix in which we tested the
statistical significance and correlation of the
most common diagnoses:
1. Psychiatric diagnoses: alcoholism, recurrent
depressive disorder, PTSD, mixed anxiety-
depressive disorder, schizophrenia, depressive
disorder
2. Somatic diagnoses: hypertension, diabetes
mellitus, epilepsy, COPD, gastritis.
The ratios alcoholism-hypertension (p = 0.03),
alcoholism-diabetes mellitus (p < 0.0001),
alcoholism-COPD (p < 0.001) were statistically
significant, which means that respondents
treated for alcoholism had a lower risk for
hypertension, diabetes, and COPD, although the
correlation was almost equal to zero (Φ1 = 0.03,
Φ2 = 0, Φ3 = 0.004) (Table 5).
0
5
10
15
20
25
Hypertension Diabetes mellitus Epilepsy COPD Gastritis
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Table 5. Correlation of somatic and psychiatric disorders
HYPERTENSION DIABETES MELLITUS EPILEPSY COPD GASTRITIS
Yes No p φ Yes No p φ Yes No p φ Yes No p Φ Yes No p
Yes 12 25 5 32 14 23 1 36 2 35
Alcoholism 0.03 0.03
<0.000
1 0.18 0.18
<0.00
1 0.004
0.6
2
No 52 45 59 38 50 47 6 92 1 94
Recurrent Yes 15 14 8 21 1 28 3 26 2 27
depressive 0.678 1 0.03 0.03 0.17 0.3
disorder No 49 56 31 74 22 83 4
10
1 3 102
Yes 20 19 12 27 5 34 3 36 2 37
PTSD 0.7 0.84 0.46 0.41 0.63
No 44 51 27 68 18 77 4 91 3 92
Psychoorga
nic Yes 6 3 4 5 1 8 0 9 1 8
syndrome 0.31 0.45 1 0.29
No 58 67 35 90 22 103 7
11
8 4 121
Mixed
anxiety- Yes 5 2 4 3 0 7 1 6 0 7
depressive 0.26 0.19 0.32
disorder No 59 68 35 92 23
10
4 6
12
1 5 122
Yes 5 4 3 6 1 8 0 9 0 9
Psychosis 0.74 0.72 1
No 59 66 36 89 22
10
3 7
11
8 5 120
Yes 2 6 3 5 1 7 1 7 0 8
Schizophren
ia 0.28 0.69 1 0.36
No 62 64 36 90 22
10
4 6
12
0 5 121
Borderline Yes 4 3 1 6 1 6 2 6 0 7
depressive 0.7 0.67 1 0.056
decompens
ation No 60 67 38 89 22
10
5 5
12
1 5 122
Depressive Yes 8 4 2 10 2 10 1 11 0 12
disorder 0.23 0.5 1 0.49
No 56 66 37 85 21
10
1 6
11
6 5 117
Bipolar Yes 2 4 2 4 2 4 0 6 0 6
affective 0.69 1 0.27
disorder No 62 66 37 91 21
10
7 7
12
1 5 123
* PTSD – Post-traumatic stress disorder, COPD – Chronic obstructive pulmonary disease
Discussion
Comorbidities of physical and mental disorders
occur with high frequency, and they are most
often present in people over 65 years of age. In
this study, a statistically significant difference
was found in the incidence of PTSD and
alcoholism in men and women; they were
significantly more common in men, while
recurrent depressive disorder was more
common in women.
In our research, PTSD is almost four times more
common in men. It is estimated that 3 to 6% of
the population suffers from PTSD. Seeing as
some studies show that about 49.8% of people
who were in the war develop PTSD, these
findings can be related to the Croatian War of
Independence in the early 1990s. PTSD was
most often diagnosed in retired respondents
under the age of 65 (26% of respondents), which
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we can also attribute to the recent Croatian war
history. Although several studies show
increased incidence of somatic diseases in
patients who suffer from PTSD, our study did not
show a statistically significant correlation
between PTSD and certain somatic diseases (11,
12, 13). One of the possible reasons could be a
small number of participants in our study. PTSD
is often associated with physical comorbidities
ranging from nonspecific dizziness, tinnitus, and
blurred vision to chronic pain, diabetes,
cardiovascular, respiratory, and gastrointestinal
diseases. There is also increased risk of cancer,
arthritis, autoimmune and inflammatory
diseases. In our study, the most common
somatic disease in patients with PTSD was
hypertension. A high ratio of patients with PTSD
have unhealthy lifestyles and habits such as
heavy smoking, low physical activity, and
obesity, which lead to development of vascular,
degenerative, and other types of somatic
disorders (14). As many as 80% of people have
at least one mental disorder with PTSD, the most
common being depressive disorder, generalized
anxiety disorder, and addictive disorder. Due to
non-cooperation, the frequency of
hospitalizations and relapses is high (15).
Therefore, it is important to identify individuals
suffering from this disease, encourage them to
cope with the problem, and take care of their
mental and physical health to avoid further
consequences and comorbidities (16).
In our study, the most common mental disorder
in women was recurrent depressive disorder
(19%). The most common comorbidity with a
recurrent depressive disorder was hypertension
(4). Studies have shown that individuals with
depression are more likely to develop
hypertension, strokes, and ischemic heart
disease. There is a pathophysiological
connection between depression and
hypertension because both disorders are
characterized by increased sympathetic tone
and increased secretion of adrenocorticotropic
hormone and cortisol. Moreover, depressed
patients may have difficulty adhering to their
therapy regimen, resulting in poor blood
pressure control (17). The prevalence of
depression is 10 to 15%, with over 350 million
people currently affected. Risk factors for
developing depression disorder include
stressful events, genetic predisposition,
disability, illness, previous treatment for
depression disorder and sleep problems.
Somatic chronic diseases increase the risk of
developing depression due to reduced quality
of life, difficulty coping with diagnosis, pain, and
rejection of the environment (4). Also, the
prevalence of depression in people who suffer
from at least one chronic illness is 9.3 to 23% and
differs greatly from people who do not suffer
from any chronic disorder (3.2 %). Increased
prevalence of depressive disorders has been
noticed in people suffering from cardiovascular
diseases (17-27%), diabetes (11-31%), and arthritis
(10-24%) (4, 17).
In this research, 25% of men and 7% of women
were treated for alcoholism. It is estimated that
43% of the world's population consumes alcohol
(18). In Croatia, about 6% of the population
suffers from alcohol dependence, which
amounts to about 250,000 people (19). Spirits
(44.8 %) and beer (34.3 %) are most often
consumed. Alcoholism is twice as common in
men than in women, with the highest frequency
between the ages of 20 and 24 (18). Alcoholics
have twice the risk of developing other mental
illnesses; these are most often anxiety disorders,
affective disorders, personality disorders.
Psychiatric disorders are thought to precede the
development of alcoholism, except for
obsessive-compulsive disorder and depression,
which occur after alcohol use disorder (20). In
addition, there is also a great link with various
physical comorbidities.
In our study, the most common somatic
diseases in patients treated for alcoholism were
epilepsy and hypertension. Alcohol has a
significant effect on the central nervous system,
leading to symptoms of mania, depression, and
epileptic seizures. Chronic alcohol consumption
is related to multiple central and peripheral
nervous system dysfunctions due to the direct
action of alcohol or its derivatives and vitamin
deficiencies associated with alcoholism (21).
According to data from 2012, alcohol
consumption was associated with 5.5% of
cancers (7.2% in men and 3.5% in women) and
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with 5.8% of deaths in oncological patients (22).
The most common cancers associated with
alcohol use are cancers of the oral cavity,
pharynx, larynx, esophagus, liver, breast, and
colon. The carcinogenic potential is linearly
dependent on the amount of consumed alcohol
(23). Alcohol consumption has a dual effect on
the cardiovascular system; it has a
cardioprotective effect in small doses (one
standard drink), but it is harmful in large doses
(24). The consumption of two standard drinks is
considered to have a protective effect in
diabetes mellitus but consuming four standard
drinks a day results in negative effects. Since
most of the alcohol is metabolized in the liver,
liver diseases are not uncommon; chronic liver
diseases that lead to cirrhosis are the most often
(25). Primary alcoholic dementia accounts for
10% of all dementias (26).
Arterial hypertension is the most common
somatic disease in this study. It affected 33% of
men and 46% of women, a total of 36% of the
respondents. Hypertension and coronary heart
disease cause significant morbidity in patients,
reduce the quality of life, and increase treatment
costs. Psychosocial factors that lead to anxiety
disorders play a role in the development of
hypertension. Increased autonomic excitation
via the hypothalamic-pituitary axis leads to an
increase in circulating catecholamines, which
increases the risk of hypertension and
proinflammatory conditions, which in turn leads
to the development of coronary heart disease
(27). Also, hypertension intensifies symptoms of
anxiety and the frequency of panic attacks. In
one study, a significantly higher incidence of
panic attacks was noticed in patients with
hypertension (17%) compared to normotensive
patients (11%) (28). Other anxiety disorders are
also common; monitoring cardiac activity or
avoiding certain activities often results in
reduced quality of life in patients with
hypertension (29).
Diabetes mellitus is the second most common
somatic diagnosis in our respondents (22%). We
found a higher incidence in women (32%) than in
men (18%). 30% of patients with diabetes suffer
from a mental disorder. Patients with
schizophrenia are two to four times more likely
to develop diabetes compared to the general
population (30). The prevalence rates of
depression and anxiety are significantly higher in
diabetics; some studies have reported that the
risk is increased by as much as 50-100%. The
correlation is two-way, depression disorder
results from years of uncontrolled or poorly
controlled diabetes. Depression disorder, on the
other hand, activates neurohormonal and
neurotransmitter changes that stimulate the
hypothalamic-pituitary axis and the adrenal
gland, which releases more cortisol and other
hormones responsible for insulin resistance (30,
31). The prevalence of diabetes in depressed
adult patients is significantly higher in women
than in men. A study conducted in Saudi Arabia
reported that 37% of patients with type 1
diabetes mellitus, 37.9% of patients with type 2
diabetes mellitus, and 13.6% of patients with
gestational diabetes suffer from depression.
Another study reported that 46.15% of patients
have these comorbidities, of which 36.7% suffer
from severe depression. What is more, levels of
glycosylated hemoglobin (HbA1c) are
significantly higher in people with depression
compared with those who do not suffer from it
(30).
Epilepsy affected 15% of men and 8% of women,
a total of 13% of respondents. It is estimated that
the most common mental illness in comorbidity
with epilepsy is depression, and its incidence is
about 35%. In patients in whom epilepsy is poorly
controlled, the incidence is about 50%, while in
patients with well-controlled seizures it is about
10 to 20% (31). One study showed that 16.7% of
patients with epilepsy have some sort of anxiety
disorder; most people had frequent panic
attacks (81.2%). Older age of patients and later
onset of epileptic seizures are associated with a
higher incidence of anxiety disorders (32).
Comorbidities of physical and mental illnesses
are a major challenge in medicine. The mutual
pathophysiological effect of one disease on
another can significantly affect the course and
prognosis of the disease. Due to the diverse
symptoms experienced by people with
multimorbidity, diagnoses are often missed,
which can lead to major consequences. It is
extremely important to improve cooperation in
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treatment and the multidisciplinary approach to
the patient in order to reduce the number of
hospitalizations, emergency interventions,
suicides and improve the patients’ quality of life
and life expectancy.
Acknowledgement. None.
Disclosure
Funding. No specific funding was received for
this study.
Competing interests. None to declare.
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Author contribution. Acquisition of data: RM, AL, DD, TB
Administrative, technical or logistic support: RM, AL, DD, TB
Analysis and interpretation of data: RM, AL, DD, TB
Conception and design: RM, AL, DD, TB
Critical revision of the article for important intellectual
content: RM, AL, DD, TB
Drafting of the article: RM, AL, DD, TB
Final approval of the article: RM, AL, DD, TB
Guarantor of the study: RM, AL, DD, TB
Obtaining funding: RM, AL, DD, TB
Provision of study materials or patients: RM, AL, DD, TB
Statistical expertise: RM, AL, DD, TB
Other: RM, AL, DD, TB