A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.

Diagnostic and Statistical Manual of Mental Disorders (DSM):

• Axis I disorder:

  • diorders in depressive, anxiety, disruptive, mood, and substance abuse
  • diagnosed earlier

• Personality disorder:

  • not diagnosed untill late adolescence or early adulthood
  • usually co-occurs with Axis I disorders
  • lack of study on the long-term separate and combined impact with Axis I disorders

Parent study: Children in the Community Study

Longitudinal study time frame:

• Study initiated in 1975 (aged 9-18)
• Follow-up Wave 2 in 1983: mental disorder was assessed (mean age: 13.7)
• Follow-up Wave 3 in 1985-1986: physical health were assessed (mean age: 16.4)
• Follow-up Wave 4 in 1991-1994: physical health was assessed (mean age: 22.4)
• Follow-up Wave 6 in 2001-2004: physical health was assessed (mean age: 33.2)

Participants’ demographic and socio-economic status were collected at baseline, and health behavior factors were collected longitudinally.

739 participants were included in this analysis.

1. Axis I disorders were assessed using Diagnostic Interview Schedule for Children (DISC-I)

2. Axis II disorder (PD) was assessed using age-adapting items from the Personality Diagnostic Questionnaire and Structured Clinic Interview

1. Pain: whether the participants reported a lot of headaches or stomach aches in the past year

2. Physical illness: whether the participant was diagnosed with the following diseases in the past year

   • severe allergies, musculoskeletal disease, neurological disease, chronic respiratory disease, chronic gastrointestinal disease, urinary disease, cardiovascular disease, severe vision or hearing problems, cancer, diabetes

An overall physical health scale was created by aggregating the following items: chronic pain and physical problem, sick days, energy level, headaches and stomachaches, and getting sick.

• Chen, H., Cohen, P., Crawford, T. N., Kasen, S., Guan, B., & Gorden, K. (2009). Impact of early adolescent psychiatric and personality disorder on long-term physical health: a 20-year longitudinal follow-up study. Psychological medicine, 39(5), 865–874. https://doi.org/10.1017/S0033291708004182

• Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association : Washington, DC.

• Chen H, Cohen P, Kasen S, Johnson JG, Berenson K, Gordon K. Impact of Adolescent Mental Disorders and Physical Illnesses on Quality of Life 17 Years Later. Arch Pediatr Adolesc Med. 2006;160(1):93–99. doi:10.1001/archpedi.160.1.93

• Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Patricia Chou, S., June Ruan, W., & Huang, B. (2005). Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions. Journal of psychiatric research, 39(1), 1–9. https://doi.org/10.1016/j.jpsychires.2004.05.004

• Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005). Quality-of-life impairment in depressive and anxiety disorders. The American journal of psychiatry, 162(6), 1171–1178. https://doi.org/10.1176/appi.ajp.162.6.1171

• Telles-Correia, D., Saraiva, S., & Gonçalves, J. (2018). Mental Disorder-The Need for an Accurate Definition. Frontiers in psychiatry, 9, 64. https://doi.org/10.3389/fpsyt.2018.00064

SAS code:

proc mixed data=tmp1.pmedicine method=ml noclprint covtest noitprint;
class id ;
model zhealth = agec22 anyax1 anyax1*agec22 anypd anypd*agec22
               / solution ddfm=bw notest;
random intercept agec22 /subject=id;
run;

R code:

library(nlme)
model <- lme(
  health ~ agec22 + anyax1 + anyax1*agec22 + anypd + anypd*agec22,
  random = ~ 1 + agec22 | id,
  data = tmp1,
  method = "ML",
  control = list(msMaxIter = 100, msVerbose = TRUE)
)