The complex interplay between depression and multimorbidity in late life: risks and pathways

Triolo, Federico; Harber-Aschan, Lisa; Murri, Martino Belvederi; Calderón‐Larrañaga, Amaia; Vetrano, Davide Liborio; Sjöberg, Linnea; Marengoni, Alessandra; Dekhtyar, Serhiy

doi:10.1016/j.mad.2020.111383

Cited by 70 publications

(54 citation statements)

References 117 publications

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“…Several covariates were included, and their selection was informed by previous literature and theory. Sociodemographic variables such as age, gender, ethnicity (White/ethnic minority group), social deprivation, education level, and employment status are known to be associated with both physical multimorbidity and common mental health disorders and were therefore included as covariates [ 8 , 33 , 34 ]. Deprivation was based on Townsend deprivation indices [35] derived from aggregated data on car ownership, household overcrowding, owner occupation and unemployment.…”

Section: Methodsmentioning

confidence: 99%

“…Employment status was also coded into three categories: employed, retired, unemployed/volunteer/carer. Health behaviours such as alcohol intake (number of units of alcohol consumed per week), smoking (current or past smoker), and physical activity, and factors related to health behaviour such as body mass index (BMI) are known to be associated with physical and mental health status so were included as covariates [ 8 , 36 ]. Physical activity was assessed with a modified version of the International Physical Activity Questionnaire that recorded total physical activity (e.g., mild, moderate, vigorous) performed over the previous seven days.…”

Section: Methodsmentioning

confidence: 99%

“…The relationship between physical multimorbidity and depression is generally thought to be bidirectional [8] . Most of the current evidence is, however, based on clinical and/or older populations where common mental health disorders are less well captured [9] , [10] , [11] , [12] , [13] , [14] .…”

Section: Introductionmentioning

confidence: 99%

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Associations between physical multimorbidity patterns and common mental health disorders in middle-aged adults: A prospective analysis using data from the UK Biobank

Ronaldson

Torre

Prina

et al. 2021

The Lancet Regional Health - Europe

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Background We aimed to identify specific patterns of physical multimorbidity, defined as the presence of two or more physical long-term conditions, and to examine the extent to which these specific patterns could predict future incident and persistent common mental health disorders (CMDs) in middle-aged adults enrolled in the UK Biobank. Methods We assessed prospective associations between physical multimorbidity status at the baseline assessment (2006–2010) and depression and anxiety ‘caseness’ according to the Patient Health Questionnaire (PHQ)-9 and the Generalised Anxiety Disorder Assessment (GAD)-7 at the follow-up assessment (2016) in 154,367 middle-aged adults enrolled in the UK Biobank (median age: 57 years, interquartile range = 50–62 years, 56.5% female, mean duration of follow-up: 7.6 years, standard deviation = 0.87). Patterns of physical multimorbidity were identified using exploratory factor analysis. Logistic regression was used to assess prospective associations between physical multimorbidity patterns at baseline and both incident and persistent depression and anxiety at follow-up. Findings Compared to those with no physical multimorbidity, having two (adjusted odds ratio (aOR) =1.41, 95%CI 1.32 to 1.53), three (aOR = 1.94, 95%CI 1.76 to 2.14), four (aOR = 2.38, 95%CI 2.07 to 2.74), and five or more (aOR = 2.89, 95%CI 2.42 to 3.45) physical conditions was prospectively associated with incident depression at follow-up in a dose response manner. Similar trends emerged for incident anxiety, persistent depression, and persistent anxiety, but associations were strongest for incident CMDs. Regarding specific patterns of physical MM, the respiratory pattern (aOR = 3.23, 95%CI 2.44 to 4.27) and the pain/gastrointestinal pattern (aOR = 2.19, 95%CI 1.92 to 2.50) emerged as the strongest predictors of incident depression. Similar results emerged for incident anxiety. Interpretation These findings highlight patterns of physical multimorbidity with the poorest prognosis for both emerging and persisting depression and anxiety. These findings might have significant implications for the implementation of integrated mental and physical healthcare and facilitate the development of targeted preventative interventions and treatment for those with physical multimorbidity. Funding AR is supported by Guy's Charity grant number EIC180702; JAT is funded by Medical Research Council (MRC) number MR/SO28188/1; AD is funded by Guy's Charity grant number EIC180702 and MRC grant number MR/SO28188/1. JD is part supported by the ESRC Centre for Society and Mental Health at King's College London (ES/S012567/1), grants from the ESRC (ES/S002715/1), by the Health Foundation working together with the Academy of Medical Sciences, for a Clinician Scientist Fellowship, and by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsle...

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Associations between physical multimorbidity patterns and common mental health disorders in middle-aged adults: A prospective analysis using data from the UK Biobank

Ronaldson

Torre

Prina

et al. 2021

The Lancet Regional Health - Europe

View full text Add to dashboard Cite

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“…Such framework has also helped uncover how clinical correlates of somatic diseases, such as pain and dyspnea, were linked to several depressive symptoms in individuals with chronic pain and chronic obstructive pulmonary disease, respectively [ 14 , 15 ]. Yet, studies on older adults with multiple co-occurring diseases (i.e., multimorbidity), which detrimentally impact functional status, and increase the vulnerability to depression, are currently lacking [ 16 – 18 ]. Identifying whether late-life depression is associated with different somatic diseases through distinct bridge symptoms might hold clinical value for diagnostic and treatment purposes.…”

Section: Introductionmentioning

confidence: 99%

Bridging late-life depression and chronic somatic diseases: a network analysis

et al. 2021

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The clinical presentation of late-life depression is highly heterogeneous and likely influenced by the co-presence of somatic diseases. Using a network approach, this study aims to explore how depressive symptoms are interconnected with each other, as well as with different measures of somatic disease burden in older adults. We examined cross-sectional data on 2860 individuals aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, Stockholm. The severity of sixteen depressive symptoms was clinically assessed with the Comprehensive Psychopathological Rating Scale. We combined data from individual clinical assessment and health-registers to construct eight system-specific disease clusters (cardiovascular, neurological, gastrointestinal, metabolic, musculoskeletal, respiratory, sensory, and unclassified), along with a measure of overall somatic burden. The interconnection among depressive symptoms, and with disease clusters was explored through networks based on Spearman partial correlations. Bridge centrality index and network loadings were employed to identify depressive symptoms directly connecting disease clusters and depression. Sadness, pessimism, anxiety, and suicidal thoughts were the most interconnected symptoms of the depression network, while somatic symptoms of depression were less interconnected. In the network integrating depressive symptoms with disease clusters, suicidal thoughts, reduced appetite, and cognitive difficulties constituted the most consistent bridge connections. The same bridge symptoms emerged when considering an overall measure of somatic disease burden. Suicidal thoughts, reduced appetite, and cognitive difficulties may play a key role in the interconnection between late-life depression and somatic diseases. If confirmed in longitudinal studies, these bridging symptoms could constitute potential targets in the prevention of late-life depression.

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“…When common mental disorders such as depression and anxiety manifest in clinically complex individuals, their combined consequences increase dramatically [3] . Co-existing chronic conditions interact with each other, influencing the development of mental disorders, especially depression, through several pathways [4] . Despite the accumulating epidemiological evidence of multimorbidity as a driver of poor mental health in late life, our understanding of how these processes unfold is still limited.…”

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confidence: 99%