Large-scale evidence of a general disease ('d') factor accounting for both mental and physical health disorders in...

It is unknown whether there is a general factor that accounts for the propensity for both physical and mental conditions in different age groups and how it is associated with lifestyle and well-being.

We analyzed health conditions data from the Millennium Cohort Study (MCS) (age = 17; N = 19,239), the National Child Development Study (NCDS) (age = 44; N = 9293), and the English Longitudinal Study of Ageing (ELSA) (age ≥ 50; N = 7585). The fit of three Confirmatory Factor models was used to select the optimal solution by Comparative Fit Index, Tucker-Lewis Index, and Root Mean Square Error of Approximation. The relationship among d factor, lifestyles, and well-being was further explored.

Supporting the existence of the d factor, the bi-factor model showed the best model fit in 17-year-olds (MCS:CFI = 0.97, TFI = 0.96, RMSEA = 0.01), 44-year-olds (NCDS:CFI = 0.96, TFI = 0.95, RMSEA = 0.02), and 50+ year-olds (ELSA:CFI = 0.97, TFI = 0.96, RMSEA = 0.02). The d factor scores significantly correlated with lifestyle and well-being, suggesting healthier lifestyles were associated with a reduced likelihood of physical and mental health comorbidities, which in turn improved well-being.

Contrary to the traditional dichotomy between mental and physical conditions, our study showed a general factor underlying the comorbidity across mental and physical diseases, related to lifestyle and well-being. Our results inform the conceptualization of mental and physical illness as well as future research assessing risk and pathways of disease transmission, intervention, and prevention. Our results also provide a strong rationale for a systematic screening for mental disorders in individuals with physical conditions and vice versa, and for integrated services addressing multimorbidity.