The Society of Behavioral Medicine’s (SBM’s) Multi-Morbidities Special Interest Group (MM SIG) has been busy this past year and has several projects for the near future, but first: M. Bryant Howren, PhD, MPH, has assumed the position of co-chair for the SIG. He’ll be working alongside MM SIG Chair Jerry Suls, PhD. Bryant is deputy director of the Veterans Rural Health Resource Center at the Iowa City Veterans Affairs Hospital and a faculty member at the University of Iowa. His expertise and experience adds much to the scope of the MM SIG because patients with co-existing primary medical and psychiatric conditions comprise a substantial part of the VA’s constituency.
In other news, the MM SIG has had extensive discussions about areas of common interest with the Military and Veterans Health SIG and the Cancer SIG. We hope to sponsor future symposia and panels with members of the Military SIG to explore how knowledge from clinical epidemiology and network medicine can provide predictions about what disease pairs or triads should emerge at greater than chance levels among veterans and older adults. Also, common genetic, metabolomics, and psychosocial factors may provide insights about the pathogenesis of co-occurring conditions and thereby have implications for prevention and clinical treatment guidelines.
The MM SIG and Cancer SIG are hoping to co-sponsor a symposium for SBM’s 2017 Annual Meeting that considers how cancer survivors and other medical populations can better cope or prevent the emergence of additional conditions. Beside the fact that cancer is more common in older adults (and multi-morbidity increases with age), cancer and/or its treatment can produce acute- and late-term effects (e.g., cardiopathology). This symposium will consider cognitive/affective factors, the role of physical exercise, and the broad-scale effects of inflammation for understanding physical and psychological well-being in the context of multi-morbidity.
Additionally, the MM SIG plans to offer several awards to authors of the best 2017 Annual Meeting posters and papers that address questions involving multi-morbidity’s etiology, prevention, or implications for medical or behavioral intervention.
The February 2016 issue of JAMA Psychiatry published an important study by Scott et al. that involved 17 countries and more than 47,000 people, providing some of the best evidence about mental and physical comorbidity. Associations between mental disorders and subsequent chronic medical conditions ranged between 1.2 and 3.6, in terms of odds ratios. A dose-response pattern was evident; as number of comorbid mental conditions increased so did diagnosis of physical disease.
An accompanying editorial by Walker and Druss emphasized the implications: elevated risk of poor physical health in patients with mental disorders and, conversely, elevated risk of mental disorders in persons with poor physical health both signal the need for coordination and collaboration between clinicians to improve care. The editorial also notes that optimizing function and quality of life is often the most salient concern raised by patients who have multiple conditions. Our take-away message is that multi-morbidity requires priority-setting discussions between patients and health providers writ large, but acquiring self-management skills may require input from behavioral medicine. This is one reason the MM SIG has made overtures to SBM’s Integrated Primary Care SIG.