Validation of the Korean Version of the 15-Item CommunityAssessment of Psychic Experiences in a College Population

Objective@#To investigate the reliability and validity of the Korean version of the Community Assessment of Psychic Experiences-15item positive scale (CAPE-15) in college students. @*Methods@#This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviewsto investigate the instrument’s diagnostic validity. The initial screening involved 1,749 college students. The modified Korean versionof Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in theComprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. @*Results@#Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristiccurve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resultedin the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficientsof correlation between the CAPE-15 and mKPQ-16 were significant. @*Conclusion@#The Korean version of the CAPE-15 is a good instrument for screening for psychosis risk in collegiate settings. The validationof this scale could contribute to the early identification of psychosis in the Korean community. Psychiatry Investig 2020;17(4):306-311

Factors Affecting the Duration of Untreated Psychosis in Community-Dwelling Patients with Schizophrenia Spectrum Disorder / 대한정신분열병학회지

Objectives@#This study aimed to identify factors affecting the duration of untreated psychosis (DUP) in patients with schizophrenia spectrum disorder. @*Methods@#Six-hundred patients with schizophrenia spectrum disorder were recruited from mental health welfare centers in Gwangju Metropolitan City and Gyeonggi-do. Subjects were categorized into two groups according to median DUP. Demographic and clinical characteristics were compared between the two groups. @*Results@#The mean DUP was 80.8 weeks, and the median DUP was 15.9 weeks. Patients with Medicaid, higher age, and longer duration of the schizophrenia prodrome were more likely to have a longer DUP. The DUP was shorter in patients who were consulted by family/relatives prior to treatment. Patients visiting university hospitals were more likely to have a shorter DUP compared with those visiting psychiatric clinics or small-sized mental hospitals, i.e., with less than 100 beds. A multivariate regression analysis showed that the duration of the prodrome was a factor that significantly affected DUP. @*Conclusion@#The vulnerable group of patients with schizophrenia with a long DUP should be monitored closely. Moreover, it is necessary to develop a strategy to identify patients who have an insidious course of psychosis to reduce the DUP.

A social psychiatric approach to suicide prevention

Suicide is the fifth-leading cause of death in Korea, accounting for 4.4% of all deaths. Therefore, suicide is a serious medical problem, as well as a social problem. In this paper, we provide a social psychiatric perspective on suicide and recommend suicide prevention strategies based on programs with roots in the Gwangju mental health pilot project and an analysis of suicide patterns in Seoul. First, early intervention and active case management are mandatory to prevent suicide among individuals with mental illnesses such as depression, schizophrenia, and alcohol use disorder. To this end, mental health and welfare centers, addiction management centers, suicide prevention centers, and care program after a suicide attempt in the emergency department of general hospitals should collaborate via a multidisciplinary approach. Second, crisis intervention should be provided in collaboration with the police, government officials, and mental health agencies to people who are at immediate risk of suicide. Additionally, case management services should be expanded for individuals who are treated at hospitals for psychiatric illness. Third, social welfare services should be offered to low-income individuals at risk of suicide. Fourth, the mass media should restrict reporting about suicide and follow the relevant reporting guidelines. Finally, access to methods of committing suicide, such as charcoal for burning and agrichemical poisoning, should be regulated by the government. Proactive psychosocial strategies implemented with government support will prevent suicide-related deaths and decrease the suicide rate in Korea.

Physical Health Literacy and Health-related Behaviors in Patients with Psychosis

OBJECTIVE: This study compared the levels of knowledge of physical illnesses and patterns of health behaviors between patients with psychosis and the general population. METHODS: A total of 712 participants were included in the study; 292 patients with a schizophrenia spectrum disorder and 420 healthy controls matched for age and gender. Questionnaires were administered to study participants to determine the level of knowledge of chronic physical illnesses such as cancer, hypertension, and diabetes mellitus and health-related behavior. Results from the two study groups were compared to identify differences in knowledge of physical illness and health-related behaviors. RESULTS: Compared with healthy controls, patients with psychosis were less likely to undergo regular medical check-ups and engage in exercise. Patients with psychosis had poorer knowledge of physical illnesses, and were more likely to smoke, be overweight, or have diabetes. Patients with psychosis were significantly less likely to acknowledge the importance of early detection of cancer and controlling hypertension and diabetes, independent of education and type of medical insurance. Patients who smoked were significantly less likely to agree with the statement on the relationship between smoking and physical illnesses. Patients not undergoing regular medical check-ups were significantly less likely to agree with statements concerning the need for cancer screening. CONCLUSION: Patients with psychosis demonstrated lower levels of knowledge of physical illnesses and a lack of understanding of preventive behaviors. Low levels of knowledge were associated with poor health-related behaviors. Education of physical health should be provided to patients with psychosis.

Factors Associated with Suicidal Behavior of Psychiatric Inpatients / 신경정신의학

OBJECTIVES: This study examined the factors associated with suicidal behavior in psychiatric inpatients. METHODS: The medical records of 208 psychiatric inpatients were reviewed retrospectively. The factors related to suicide attempts and ideation at the time of admission, and during outpatient follow-up, were investigated. RESULTS: In total, 120 patients (57.7%) with a history of at least one suicide attempt, and 163 patients (78.4%) who reported active suicide ideation (e.g., a suicide plan or intention to commit suicide) at the time of admission were reviewed. Being unmarried or divorced, substance abuse, impulsivity, and a poor social support system were associated with a history of suicide attempts. The suicidal ideation group had significantly higher rates of coexisting depression, severe depressive symptoms, hopelessness, and impulsivity, as well as a lower incidence of moral objection to suicide and high religiosity. In total, 15 out of 193 patients (7.8%) who were followed-up at outpatient clinics attempted suicide after discharge. Patients who attempted suicide or reported suicidal ideation at the outpatient clinic after discharge were significantly more likely to have a history of previous suicide attempts, or have had active suicide ideation at the time of admission. Good social support and high responsibility to family were inversely associated with suicidal ideation as an outpatient. CONCLUSION: A history of suicide attempts and ideation at the time of hospital admission were the risk factors for future outpatient suicidal behavior. Further study is warranted to develop a checklist and assessment measures of the various risk and protective factors associated with suicidal behavior.

A Comparative Study of Burnout, Stress, and Resilience among Emotional Workers

OBJECTIVE: To investigate associations between stress, resilience, and burnout in three emotional job sectors. METHODS: We conducted a multi-group comparative study using structural equation modeling and latent mean analysis. In total, 806 participants (403 call center consultants, 270 mental health workers, and 133 school counselors) completed self-administered questionnaires including the Perceived Stress Scale, Korean version of the Connor-Davidson Resilience Scale, and Maslach Burnout Inventory-General Survey. RESULTS: Stress had significant direct effects on resilience and burnout, and resilience had significant direct effects on burnout in all groups. Resilience partially mediated these relationships among call center consultants and school counselors. Stress and burnout were highest in call center consultants, followed, in order, by mental health workers and school counselors. Resilience was highest in school counselors, followed, in order, by mental health workers and call center consultants. The effect size of the latent mean difference was highest for burnout, followed, in order, by resilience and stress. CONCLUSION: Our findings suggest that stress caused by emotional labor can contribute to burnout. Interventions targeted at different sectors are needed to reduce burnout.

Association between Obsessive-Compulsive Symptoms and Long-Term Cardiac Outcomes in Patients with Acute Coronary Syndrome: Effects of Depression Comorbidity and Treatment

OBJECTIVE: The role of obsessive-compulsive symptoms (OCS) in patients with acute coronary syndrome (ACS) is not well elucidated. This study investigated the association between OCS and the long-term prognosis of ACS in tandem with depression comorbidity and treatment.METHODS: A cross-sectional baseline study and a nested 24-week double-blind escitalopram-placebo controlled trial were carried out between May 2007 and March 2013, and then a 5–12-year follow-up for major adverse cardiac events (MACE) was conducted. A total of 1,152 patients with ACS were stratified by baseline depression comorbidity and treatment allocation into four groups: no depression (706 patients), depression and taking escitalopram (149 patients), depression and taking a placebo (151 patients), and depression and receiving medical care as usual (CAU; 146 patients). OCS were evaluated using the Symptom Checklist-90-Revised Obsessive-Compulsive symptom domain. During the follow-up, Kaplan-Meier event rates for MACE outcomes were calculated, and hazard ratios were estimated using Cox regression models after adjusting for a range of covariates.RESULTS: A higher OCS score at baseline was associated with a worse ACS prognosis after adjusting for relevant covariates and across MACE outcomes. This association varied according to the depression comorbidity. The association was significant in patients without depression and depressive patients receiving placebos and CAU, but not in depressive patients on escitalopram.CONCLUSION: Evaluating OCS and depression is recommended during the early phase of ACS. Treatment for OCS may improve the long-term cardiac outcomes of patients with ACS.

Factors Associated with Suicidal Ideation among Community-Dwelling Elderly / 생물치료정신의학

OBJECTIVES: The purpose of this study was to investigate factors associated with suicidal ideation among community-dwelling elderly.METHODS: In total, 492 community-dwelling elderly(over 60 years of age) participated in this study. Data on sociodemographic characteristics, medical history and suicidal ideation during the past 12 months were analyzed. Various measures including the Korean Mini Mental Status Exam in the Korean version of the CERAD assessment packet (MMSE-KC), Short form of the Geriatric Depression Scale(SGDS), Korean version of Quality of Life-Alzheimer's Disease (KQOL-AD), and Subjective Successful Aging(SSA) questionnaire were administered.RESULTS: The prevalence rate of suicidal ideation was 26.4%. According to the binary logistic regression, SSA(OR 0.99, 95% CI 0.97–1.00, p=0.020) and SGDS(OR 1.28, 95% CI 1.16–1.41, p <0.001) scores were independently associated with suicidal ideation.CONCLUSION: Among community-dwelling elderly, depressive symptoms increased the risk of suicidal ideation, whereas subjective evaluations of successful aging decreased the risk. Thus, appropriate interventions for depressive symptoms are needed to prevent the elderly individuals from developing suicidal ideation.

Causes of Patient Mortality in Community Mental Health and Welfare Centers and Addiction Management Centers / 생물치료정신의학

OBJECTIVES: Serious mental illnesses and substance use disorder have a high level of early mortality. This study aimed to identify the causes of their deaths among patients who had been under the care of community mental health and welfare centers and addiction management centers.METHODS: We collected information on deceased individuals, whose mortality was attributable to various causes of death, from 10 Community Mental Health Centers and Addiction Centers in Gwangju Metropolitan City. The primary variables collected included psychiatric diagnosis, cause of death, smoking habits, admission history, and several socio-demographic factors.RESULTS: A total of 214 deaths among service users were studies. In Community Mental Health Centers, 109 deaths were identified, with causes that may be itemized as follows : 27 suicides(24.8%), 56 physical illnesses( 51.4%), 14 accidents(12.8%), and 12 unknown causes(11.0%). Among the physical illnesses reported, cardiovascular illness and cancer were the most common causes of death. A history of frequent admission was common among those that had died by suicide(88.9%), compared with that observed among general service users(62.0%). In Addiction Centers, 105 deaths were identified, with causes that may be itemized as follows : 7 suicides(6.7%), 71 physical illnesses(68.3%), 7 accidents(6.7%), and 20 unknown causes(19.0%). Among the physical illnesses reported, sudden death, hepatic disorder, cancer, and cardiovascular disorder were the most common causes of death.CONCLUSION: Case managers should give due consideration to and carefully manage the physical health of individuals accessing mental health services via community mental health centers and addiction centers.

A social psychiatric approach to suicide prevention

Suicide is the fifth-leading cause of death in Korea, accounting for 4.4% of all deaths. Therefore, suicide is a serious medical problem, as well as a social problem. In this paper, we provide a social psychiatric perspective on suicide and recommend suicide prevention strategies based on programs with roots in the Gwangju mental health pilot project and an analysis of suicide patterns in Seoul. First, early intervention and active case management are mandatory to prevent suicide among individuals with mental illnesses such as depression, schizophrenia, and alcohol use disorder. To this end, mental health and welfare centers, addiction management centers, suicide prevention centers, and care program after a suicide attempt in the emergency department of general hospitals should collaborate via a multidisciplinary approach. Second, crisis intervention should be provided in collaboration with the police, government officials, and mental health agencies to people who are at immediate risk of suicide. Additionally, case management services should be expanded for individuals who are treated at hospitals for psychiatric illness. Third, social welfare services should be offered to low-income individuals at risk of suicide. Fourth, the mass media should restrict reporting about suicide and follow the relevant reporting guidelines. Finally, access to methods of committing suicide, such as charcoal for burning and agrichemical poisoning, should be regulated by the government. Proactive psychosocial strategies implemented with government support will prevent suicide-related deaths and decrease the suicide rate in Korea.

Suicidal Ideation Predicts Functioning and Quality of Life Over One Year after Acute Coronary Syndrome

OBJECTIVE: This study investigated the associations of suicidal ideation (SI) evaluated within 2 weeks after an acute coronary syndrome (ACS) episode with functioning, disability, and quality of life (QOL) at a 1-year follow-up assessment. METHODS: This study recruited 1152 consecutive patients within 2 weeks of a confirmed ACS episode; 828 of these patients who were followed up 1 year later comprised the study sample. SI was determined at baseline using the “suicidal thoughts” item of the MontgomeryÅsberg Depression Rating Scale. At both examinations, social and occupational functioning were measured by the Social and Occupational Functioning Assessment Scale (SOFAS), disability was estimated by World Health Organization Disability Assessment Schedule-12 (WHODAS-12), and QOL was assessed using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF). Baseline covariates included sociodemographic data, depression characteristics, cardiovascular risk factors, and current cardiac status. RESULTS: SI at baseline was independently associated with less improved or decreased scores on the SOFAS, WHODAS-12, and WHOQOL-BREF over 1 year after adjusting for relevant covariates. CONCLUSION: SI within 2 weeks of an ACS episode predicted poorer functioning and QOL at a 1-year follow-up assessment. Thus, the simple evaluation of SI in patients with recently developed ACS could be helpful in screening for functioning and QOL during the chronic phase of this disease.

Factors Related to Physical Health Monitoring in Community-Dwelling Patients with Schizophrenia Spectrum Disorder / 대한정신분열병학회지

OBJECTIVES: To identify factors related to physical health monitoring of patients with schizophrenia spectrum disorder. METHODS: A total of 172 patients with schizophrenia spectrum disorder registered in mental health welfare centers and rehabilitation facilities in Gwangju were recruited. Physical health monitoring was defined by two health behaviors; fasting blood tests within recent 2 years in all participants and routine medical check-ups covered by national insurance within recent 5 years in participants aged 40 years or older. Demographic and clinical characteristics including overweight, metabolic syndrome and knowledge about physical illness were compared according to physical health monitoring. RESULTS: Prevalence of overweight and metabolic syndrome were 62.8% and 40.1%, respectively. The rates of fasting blood tests and routine medical check-ups were 34.9% and 67.9%, respectively. The rates of fasting blood tests were significantly higher in general hospital and university hospital compared to mental hospital or private clinic. Rates of routine medical check-ups were significantly lower in individuals using daily rehabilitation service and smokers. Knowledge about cancer and chronic illness were significantly better in individuals receiving routine medical check-ups compared with those not receiving it. CONCLUSION: Education about physical health should be integrated to mental health service in community mental health center.

BDNF Methylation and Suicidal Ideation in Patients with Acute Coronary Syndrome

OBJECTIVE: Patients with acute coronary syndrome (ACS) are at an increased risk of suicide. It is well known that epigenetic mechanisms may explain the pathophysiology of suicidal behavior including suicidal ideation (SI), but no study has explored these mechanisms in ACS populations. METHODS: In total, 969 patients were initially recruited within 2 weeks of the acute coronary event and, 711 patients were successfully followed up 1 year after ACS. SI was evaluated using the relevant items on the Montgomery-Åsberg Depression Rating Scale and covariates potentially affecting SI were estimated. RESULTS: Brain-derived neurotrophic factor (BDNF) hypermethylation was associated with SI in both the acute and chronic phases of ACS, although the association was not statistically significant in the acute phase after applying Bonferroni’s correction. CONCLUSION: These results suggested that BDNF hypermethylation may have played a role in an epigenetic predisposition for SI in ACS patients, particularly during the chronic phase.

Association Between Vitamin D Insufficiency and Metabolic Syndrome in Patients With Psychotic Disorders

OBJECTIVE: This study examined the association between vitamin D and metabolic syndrome in patients with psychotic disorders. METHODS: The study enrolled 302 community-dwelling patients with psychotic disorders. Sociodemographic and clinical characteristics, including blood pressure, physical activity, and dietary habit were gathered. Laboratory examinations included vitamin D, lipid profile, fasting plasma glucose, HbA1c, liver function, and renal function. Vitamin D insufficiency was defined as <20 ng/mL. Clinical characteristics associated with vitamin D insufficiency were identified. RESULTS: Among the 302 participants, 236 patients (78.1%) had a vitamin D insufficiency and 97 (32.1%) had metabolic syndrome. Vitamin D insufficiency was significantly associated with the presence of metabolic syndrome (p=0.006) and hypertension (p=0.017). Significant increases in triglycerides and alanine transaminase were observed in the group with a vitamin D insufficiency (p=0.002 and 0.011, respectively). After adjusting for physical activity and dietary habit scores, vitamin D insufficiency remained significantly associated with metabolic syndrome and hypertension. CONCLUSION: Vitamin D insufficiency was associated with metabolic syndrome and was particularly associated with high blood pressure, although the nature, direction and implications of this association are unclear.

School Counselors' Recognition of the Ultra-High Risk for Psychosis

The ability to identify students at ultra-high risk (UHR) for psychosis in school settings is crucial for enabling appropriate referral to a clinician and positive therapeutic results. The aim of this study was to examine school counselors' recognition of the diagnosis and appropriate treatment recommendations for students at UHR for psychosis. In total, 132 school counselors completed surveys, including questions relating to a vignette about a student at UHR for psychosis. In total, 12.4% of the sample provided the correct diagnosis, much lower than that for other schizophrenia spectrum disorders and non-psychotic disorders, including depressive disorder. Although most school counselors preferred psychiatrists as the first-line treatment for students at UHR for psychosis, counseling centers were also mentioned as potential treatment options. In terms of medication, antipsychotics were preferred over other medication classes. It is necessary to design appropriate educational and training programs for school counselors to promote identification and effective referral of those at UHR for psychosis.

Factors Associated with Quality of Life, Anxiety and Depression in Patients with Intracranial Meningioma

OBJECTIVE: This study was aimed to investigate factors associated with quality of life (QOL), anxiety and depression in patients with intracranial meningioma. METHODS: This is the cross-sectional study of patient with intracranial meningioma in Korea. The European Organisation for Research and Treatment of Cancer QOL Questionnaire 30 and hospital anxiety depression scale were used to assess QOL, anxiety and depressive mood. Multivariate linear regression analysis was used to analyze the related factors. RESULTS: 37 patients in total enrolled to be analyzed. In QOL, general health came out low in the patient group with peritumoral edema. Functional scales got lower as patients had higher neurotic tendency and bigger size of tumor. Symptoms scales got higher as patients' neurotic tendency got higher or as patients had peritumoral edema. Anxiety came out highly related to neurotic tendency and depression found to be related to young age, low agreeableness, high neurotic tendency, and having peritumoral edema. CONCLUSION: The QOL, anxiety and depression of meningioma patients were both related to their personal character traits and disease-related factors. More attention is needed for the QOL and mental health of intracranial meningioma patients.

Validation of the Korean version of the 16-Item Prodromal Questionnaire in a Non-Help-Seeking College Population

OBJECTIVE: To examine the reliability and validity of the Korean version of the 16-item Prodromal Questionnaire (KPQ-16) in non-help-seeking university students. METHODS: Among 2,246 university students participated in the initial screening, 257 subjects with KPQ-16 scores ≥4 were interviewed. The criteria for ultra-high risk (UHR) of psychosis of the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. An exploratory modified version of the questionnaire (mKPQ-16), to which three items from the Eppendorf Schizophrenia Inventory were added, was also used to compensate for items on thought and cognitive problems. RESULTS: Seventeen subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve (AUROC) was highest for the mKPQ-16 total score (AUROC=0.831, p < 0.001). The use of cutoff total scores of 7 for the mKPQ-16 and 6 for the KPQ-16 resulted in the best balance of sensitivity (76.5% and 64.7%, respectively) and specificity (75.4% and 71.2%, respectively). CONCLUSION: The Korean versions of the PQ-16 are good instruments for screening for psychosis risk in university students. This validation of a questionnaire version with a small number of items may make it feasible to screen large numbers of young adults in the community.

Attitude Towards Psychiatric Treatment and Prejudice Against Psychiatric Medications in General Population / 대한정신분열병학회지

OBJECTIVES: This study was performed to examine attitudes and prejudice toward psychiatric treatment and medications in the general population. METHODS: This mental health survey was performed in a total of 850 members of the general population. The survey used the Hospital Anxiety and Depression Scale, Perceived Stress Scale (PSS), and a 7-item questionnaire regarding psychiatric treatment and medication. RESULTS: With regard to attitudes toward psychiatric treatment, 50.7% of subjects reported that they would accept psychiatric treatment if they had a problem (passive), 34.6% reported acceptance even if they had no problems (active), and 14.7% reported not wanting to receive psychiatric treatment under any conditions (negative). A total of 64.0% of subjects agreed with the statement “I will be disadvantaged in getting a job due to disclosure of any psychiatric treatment without my permission.” The likelihood of a negative attitude and prejudice toward psychiatric treatment were significantly higher in men and in people >40 years old. The acceptance of psychiatric treatment was significantly lower in those who felt that such treatment would have a negative effect on employment opportunities. Prejudice against psychiatric medication was significantly more common in the group with a negative attitude toward treatment, and in people with depression and a history of suicide attempts. Groups with prejudice toward psychiatric medications scored significantly higher on the PSS. CONCLUSION: The findings suggested that a negative attitude toward psychiatric treatment is associated with prejudice toward psychiatric treatment and medications. It is necessary to actively provide public education to reduce prejudice against psychiatric treatment and medications in the general population.

Effects of Escitalopram on Anxiety in Patients with Acute Coronary Syndrome: A Randomized Controlled Trial

OBJECTIVE: There are no evidence-based practices for treating anxiety in patients with acute coronary syndrome (ACS). Thus, we investigated the effects of escitalopram on anxiety in this population. METHODS: We enrolled 217 patients with ACS who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for depressive disorders into a randomized double-blind placebo-controlled study. Patients received either escitalopram or placebo over a 24-week period. Anxiety symptoms were evaluated using the Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A). A HADS-A score >7 was classified as an anxiety disorder. Baseline evaluations included sociodemographic and clinical characteristics, such as depressive symptoms, cardiovascular risk factors, and current cardiac status. RESULTS: Independent of improvements in depression and without any differences in safety profiles, escitalopram treatment was significantly more efficacious in treating and reducing anxiety than placebo over a 24-week period. CONCLUSION: Escitalopram can be recommended as an effective and safe treatment option for anxiety in patients with ACS.

Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population

OBJECTIVE: This study aimed to investigate the longitudinal effects of anxiety, depression, and their comorbidity on physical disorders and disability in an elderly Korean population. METHODS: In total, 1,204 community-dwelling elders were evaluated at baseline, and of these 909 (75%) were re-assessed two years later. Anxiety and depression were identified at baseline using questions from the community version of the Geriatric Mental State diagnostic schedule (GMS-B3). Participants were assessed for functional disability and for 11 physical disorders both at baseline and at follow-up. RESULTS: Anxiety alone was associated with the incidence of heart disease, depression alone with the incidence of asthma, and comorbid anxiety and depression with incidence of eyesight problem, persistent cough, asthma, hypertension, heart disease, and gastrointestinal problems. Comorbid anxiety and depression were associated with an increase in the number of physical disorders and the degree of disability during the two-year follow-up, compared to anxiety or depression alone or the absence of anxiety or depression. CONCLUSION: Anxiety, depression, and particularly their comorbidity should be assessed in the elderly population considering their longitudinal effects on physical disorders and disability. Future study is required to determine whether interventions aimed at these disorders can mitigate their impacts.