PSYCHOLOGICAL-FACTORS IN ILLNESS AND RECOVERY

To review evidence that psychological factors affect the course of phy sical illness three areas are examined: epidemiological evidence showi ng the levels of psychiatric disturbance co-morbid with physical illne ss; health services research showing the burden of disease and care as sociated with this co-morbidity; randomised, controlled trials of psyc hological interventions in cancer, myocardial infarction and irritable bowel syndrome. There is substantial psychiatric co-morbidity with ph ysical illness which is associated with increased disability, mortalit y and utilisation of health-care resources (primary care visits, hospi talization, length of hospital stay, cost). A small number of controll ed intervention studies have shown the efficacy of psychological inter ventions to prolong survival in cancer and myocardial infarction, and to improve symptomatology in irritable bowel syndrome and other chroni c somatizing conditions. Psychological factors do significantly affect outcomes of physical illness. The role of psychological treatments, a longside somatic therapies, needs further study.