The comorbidity between mental and physical disorders is one of today’s greatest healthcare industry challenges worldwide. In retrospect, mental illness comorbidity also has the potential to be one of the most transformational targets in the evolution of healthcare, with the grandest financial gains.
Today, the emerging fields of mind-body and biopsychosocial research are revealing that integrated care that addresses the whole person and both their physical and mental health is the future of comorbidity management and prevention. Meanwhile, smart digital health systems in the augmented mental health space are set to be instrumental in facilitating the sorely needed integration of physical and mental healthcare and medicine.
What is Mental Illness Comorbidity?
When a mental illness or behavioral disorder (e.g., a psychological health problem like depression) is experienced simultaneously with a physical health problem this is known as physical-mental comorbidity.
With physical-mental comorbidities, the mental and physical ailments interact in such a way so as to worsen the impact of each illness on the individual, and can even promote the spiralling development of further comorbidities.
The entanglement is broad in scope. For almost any health problem, people with physical illnesses have a higher chance of developing psychological illness, and people with psychological illness have a higher chance of developing physical illnesses.
Likewise, from cancer, diabetes, or work-related injuries commonly comorbid with depression; to obesity often comorbid with eating disorders; or addiction regularly comorbid with anxiety disorders, improving mental health can substantially reduce the burden of, and promote recovery from, other comorbid diseases.
The long and short of it is that as mental illness rates are increasing in countries areound the globe, so is physical-mental comorbidity prevalence. Researchers advocate that without strategic interference, physical-mental illness comorbidity will continue to proliferate due to a variety of proposed reasons, the simplest of which being the generational increases in life expectancy we are experiencing today.
$$$ The Extortionate Cost of Physical-Mental Comorbidity $$$
According to a 2013 analysis, just 1 in 20 people worldwide had no physical health problems, and a third of the world's population (2.3 billion individuals) experienced more than five ailments. In this context, its clear the cost associated with the high rate of mental-physical comorbidity is extortionate.
Historically a grossly underestimated issue (that is being drastically under resources) accurate estimates of the global cost impact of physical-mental comorbidity are hard to come by.
Putting comorbidities aside, mental illness costs healthcare trillions annually. It is almost unfathomable how this number would grow if comorbidities were fully considered.
A retrospective study published in January 2018 on the costs associated with psychiatric comorbidities in a German university hospital provides perspective on the cost of comorbidity at the institutional level.
Psychiatric comorbidities were associated with an increase in hospital costs per episode of 40% (€1344 per patient per episode) and an increase in reimbursement per episode of 28% (€1004 per patient per episode). After controlling for length of stay, patients with psychological comorbidities had a daily cost and daily reimbursement at €207 and €151 more per day than patients without psychological comorbidities.
Augmented Mental Health Solutions to Tackle Physical-Mental Comorbidity
Evidence has long shown that improving mental health even slightly can drastically improve health outcomes and the related costs.
Professor of International Mental Health and global mental health leader, Vikram Patel, explains the grand importance of targeting mental health when considering comorbidity:
There is no health without mental health. I think we know, through a large body of evidence, that mental health and physical health interact with each other in very diverse and intimate ways. Therefore, any attempt that we make to improve the mental health of individuals and populations will inevitably have a positive impact on the physical health of those individuals and populations. Therefore, investing in global mental health is, ultimately, an investment in global health.
Now, research and early implementation is demonstrating that augmented mental health is a choice model for large-scale comorbidity prevention, treatment, and postvention.
Improved Treatment, Prevention, and Costs of Physical-Mental Comorbidity
In essence, augmented mental health extends treatment and care beyond the clinic into real-life settings with the aid of smart devices for objective, continuous, and remote mental health monitoring that facilitates highly individualized and perfectly timed remote care in home environments.
The possibilities for targeting and preventing specific physical-mental illness comorbidities with impressive new systems using smart wearables—like the the world’s first emotion-detecting wristband Feel or the new Apple Watch app Cognition Kit for high fidelity, real-time monitoring of mood and cognition—are numerous.
An early example of augmented mental health solutions having therapeutic efficacy in treating physical-mental comorbidity is research on the Indiana Cancer Pain and Depression (INCPAD) Trial. The study assessed a platform for improving pain and depression in patients with cancer, combining centralized telecare management coupled with automated pain and depression monitoring.
With the augmented mental health system, nurse care calls were triggered when automated monitoring indicated inadequate symptom improvement, nonadherence to medication, side effects, suicidal ideation, or when a patient requested to be contacted.
Scores of the severity of both pain and depression were markedly improved for patients using the system in comparison with patients who received normal, non-augmented care. The patients receiving augmented mental health care also reclaimed 60.3 more depression-free days per year than the usual care control group.
Considering that the costs of setting up and providing the augmented mental health care (e.g., nurse care manager time cost and capital expenditure for the startup and maintenance of the automated symptom monitoring) were $19.72 for every depression-free day gained, and that one day of workday productivity loss costs substantially more (although this varies with salary), this demonstrates financial incentive for adopting augmented mental health care.
Even at the level of subclinical mental health problems, general stress, and burnout, the depth and breadth of potential illness prevention insights that can be obtained with augmented mental health systems is priceless.
Looking at the big picture, augmented mental health-based research and development is set to be invaluable in integrated care settings and in advancing our poor understanding of the mind–body relationship and how it relates to physical-mental illness comorbidity.
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