Does ‘existential unease’ predict adult multimorbidity? Analytical cohort study on embodiment based on the Norwegian HUNT population

Abstract

ObjectivesMultimorbidity is prevalent, and knowledge regarding its aetiology is limited. The general pathogenic impact of adverse life experiences, comprising a wide-ranging typology, is well documented and coherent with the concept allostatic overload (the long-term impact of stress on human physiology) and the notion embodiment (the conversion of sociocultural and environmental influences into physiological characteristics). Less is known about the medical relevance of subtle distress or unease. The study aim was to prospectively explore the associations between existential unease (coined as a meta-term for the included items) and multimorbidity.SettingOur data are derived from an unselected Norwegian population, the Nord-Trøndelag Health Study, phases 2 (1995–1997) and 3 (2006–2008), with a mean of 11 years follow-up.ParticipantsThe analysis includes 20 365 individuals aged 20–59 years who participated in both phases and was classified without multimorbidity (with 0–1 disease) at baseline.MethodsFrom HUNT2, we selected 11 items indicating ‘unease’ in the realms of self-esteem, well-being, sense of coherence and social relationships. Poisson regressions were used to generate relative risk (RR) of developing multimorbidity, according to the respondents' ease/unease profile.ResultsA total of 6277 (30.8%) participants developed multimorbidity. They were older, more likely to be women, smokers and with lower education. 10 of the 11 ‘unease’ items were significantly related to the development of multimorbidity. The items ‘poor self-rated health’ and ‘feeling dissatisfied with life’ exhibited the highest RR, 1.55 and 1.44, respectively (95% CI 1.44 to 1.66 and 1.21 to 1.71). The prevalence of multimorbidity increased with the number of ‘unease’ factors, from 26.7% for no factor to 49.2% for 6 or more.ConclusionsIn this prospective study, ‘existential unease’ was associated with the development of multimorbidity in a dose–response manner. The finding indicates that existential unease increases people's vulnerability to disease, concordant with current literature regarding increased allostatic load.

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

“…179,180,181,182,183 There is also evidence that poor mental health and psychosocial risk factors such as feeling dissatisfied with life, not feeling calm, having sleep problems that affect work, and financial concerns are predictive of multimorbidity in various age groups. 184,185 Other evidence has similarly shown that living in a family compared to living alone, and being part of a large social network, are protective factors for multimorbidity occurrence. 186 The relationship between mental health and physical conditions is complex, but appears to be bidirectional and may arise due to shared biological factors, or mediated by various lifestyle and treatment specific factors.…”

Multimorbidity prevalence in Canada: a comparison of Northern Territories with Provinces, 2013/14

“…In Iceland, multimorbidity (2+ conditions) prevalence was estimated at 35% using primary care data (n = 221,822) [14]. Analysis of a prospective rural northern cohort in Norway identified multimorbidity (2+ conditions) prevalence of 30.8% (n = 20,365) [15]. In Sweden, a study including people ages 77 to 100 years (n = 1,099) found a prevalence of multimorbidity (2+ conditions) of 55%.…”

“…Canadian studies have produced evidence regarding these risk factors for multimorbidity, and have highlighted the role of socioeconomic disparities in multimorbidity [3,[11][12][13]. Other circumpolar countries have investigated multimorbidity prevalence, patterns, predictors, and prescribing practices, with varying results, and prevalence estimates ranging from 21.6% to 55%, depending on participants, data source, and included conditions [14][15][16][17].…”

Time trends of comparative self-rated health in adults aged 25-34 in the Northern Sweden MONICA study, 1990-2014

“…The concept of allostatic load gives, by measuring psychophysiological stressors, a quantifiable measure of the pressure put on regulatory systems in the body striving to uphold equilibrium or homeostasis. The concept encompasses the concept of embodiment, how sociocultural and environmental influences translate to the human body) [ 32 ]. Researchers conclude: “It is becoming increasingly clear how subtle yet longstanding challenges impact on the human physiology and predispose to disease…likewise, it is acknowledged that it is subjective experience, not objectively quantifiable events, that becomes biologically inscribed.” [ 32 ].…”