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

Development and evaluation of an integrated multispecialty clinic for people with multiple long-term conditions

Introduction

The number of people with multiple long-term conditions (MLTC) is increasing. People with MLTC experience fragmentation of care due to single-disease-orientated healthcare organisation and have increased morbidity and mortality. We developed an innovative clinic model whereby people with MLTC are assessed by a team of specialists together in one appointment to form a consensus management plan in real time. We report the outcomes together with patient and clinician feedback.

Methods

A multispecialty clinic was established to assess adults referred from the community or secondary care with MLTC. Patients were seen together by three or more relevant specialists and a coordinated plan was developed. To evaluate the clinic, we collected patient outcomes and obtained feedback from patients and clinicians in the clinic and from primary care clinicians.

Results

Twenty seven patients were assessed in the multispecialty clinic with a mean age of 64.6 years; 89% had diabetes, 70.4% hypertension, 63% CKD stages 3-5, and 51.9% had heart failure. Patients were taking a mean of 10 medications. Referrals were from primary care (51.9%) and secondary care, with the commonest reason being fluid overload (29.6%). On average, 1.7 medication changes were made per patient. Compared to the 6-month period before the clinic, in the 6 months after the clinic there was a significant reduction in interactions of patients with the acute hospital services (emergency department, same-day emergency care unit and acute inpatient medicine service). In a survey of 11 patients, all reported high satisfaction with the novel clinic format. A survey of seven clinicians, including a pharmacist and trainee doctor, demonstrated positive experiences of the clinic, confidence in the clinical decision making and enhanced learning. Primary care physicians also appreciated the coordinated plan across several specialties.

Discussion

In our pilot multispecialty clinic, people with MLTC were able to develop a real-time consensus plan with a group of specialists. Our approach was associated with fewer unscheduled healthcare interactions after the clinic. Our after-clinic survey showed positive responses from patients and clinicians. Future studies could examine how such a service could be rolled out to a wider group of people effectively and efficiently.

Physical health trajectories of young people with neurodevelopmental conditions: a protocol for a systematic review of longitudinal studies

INTRODUCTION

There is now emerging evidence to suggest a longitudinal association between specific neurodevelopmental conditions (NDCs) in childhood or adolescence (ie, autism, attention deficit hyperactivity disorder (ADHD) and tic disorders) and certain physical long-term conditions (LTCs) in adulthood. However, to date, this literature has never been comprehensively collated and appraised. As a result, our understanding of all the future health risks that young people with NDCs may collectively be at risk of is limited, and the factors which drive these adult health outcomes also remain obscure.

METHODS AND ANALYSIS

A search strategy has been developed in collaboration with two medical librarians and will be used to conduct systematic searches of MEDLINE, EMBASE, APA PsycINFO, CINAHL and Web of Science. Prospective longitudinal studies exploring the association between three common NDCs in childhood or adolescence (ie, ADHD, autism and tic disorders <18 years of age) and any physical LTC in adulthood (ie, >18 years of age) will be selected through title and abstract review, followed by a full-text review. Data extracted will include the definition of exposure and outcome, mediators or moderators investigated, confounders adjusted for, and crude and adjusted effect estimates. Risk of bias assessment will be conducted. Results will be synthesised narratively and, if the data allow, a meta-analysis will also be conducted.

ETHICS AND DISSEMINATION

Ethics approval is not applicable for this study since no original data will be collected. The results of the review will be widely disseminated locally, nationally and internationally through peer-reviewed publications, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42024516684.

Burden of psychological symptoms and disorders among individuals with hepatitis B: a systematic review, meta-analysis and meta-regression

Introduction

Hepatitis B is a highly contagious viral infection that has long been a significant global health concern. Given its adverse effects on the course of the disease, evaluating psychiatric outcomes is important. Despite indications of an increased risk of psychological outcomes among those with hepatitis B, the extent of this association remains unclear.

Methods

This PRISMA-adherent systematic review (PROSPERO: CRD42024564246) searched PubMed, Embase, Cochrane, and PsycINFO for all studies evaluating the prevalence and risk of anxiety and depressive symptoms in individuals with hepatitis B. Random effects meta-analyses and meta-regression were used for primary analysis.

Results

A total of 31 studies were included. We identified a high prevalence of depressive symptoms (Proportion=19%, 95% CI: 11-31) and anxiety (Proportion=30%, 95% CI: 18-45) among individuals with hepatitis B. There was also a significantly increased risk of depressive symptoms (RR=1.45, 95% CI: 1.00-2.09, P=0.049) and anxiety (RR=1.40, 95% CI: 1.11-1.78) in individuals with hepatitis B compared to controls. Subgroup analyses indicated that older age and chronic hepatitis B infection were associated with a higher prevalence of anxiety and depressive symptoms. The systematic review found that being single, unemployed, having a lower income, a lower education level, high comorbidities, and a family history of mental illness were significant risk factors for poorer psychological outcomes.

Conclusion

Our study highlights an increased vulnerability to anxiety and depressive symptoms among individuals with hepatitis B. We emphasize the urgent need for early detection and additional support for this at-risk group.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024564246.

Associations between multimorbidity burden and objective and patient-reported sleep outcomes among people with HIV

BACKGROUND

We aimed to provide insights into the effects of comorbidities on sleep health in people with HIV by assessing associations between multimorbidity patterns and sleep outcomes in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) sub-study.

METHODS

Principal component analysis identified six multimorbidity patterns among participants with HIV ( n  = 1073) at baseline: cardiovascular diseases (CVDs), sexually transmitted diseases, metabolic, mental/joint, neurological and cancer/other. Burden z scores were calculated for each individual/pattern. A subset of 478 participants completed sleep assessments at follow-up, including questionnaires [Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep Related Impairment (SRI)] and overnight oximetry [4% oxygen desaturation index (ODI) and percentage of time with oxygen saturation (SpO 2 ) <90%). Multivariable regression assessed associations between burden z scores and sleep measures.

RESULTS

Amongst 309 participants [median (interquartile range) age 53 (47-59) years], 21% had insomnia (ISI ≥15). Higher Mental/Joint z scores were associated with increased odds of insomnia [aOR 1.06 (95% CI 1.03-1.09)] and worse PROMIS-SRI [1.34 (1.22-1.48)] and PROMIS-SD [1.27 (1.16-1.39)] scores. Higher metabolic and neurological z scores were associated with worse PROMIS-SRI scores ( P  < 0.01). Higher CVDs z scores were associated with worse ISI and PROMIS-SRI scores, and a higher percentage of time with SpO 2 below 90% (all P 's < 0.01).

CONCLUSION

This study is among the first to describe specific multimorbidity patterns linked to poorer sleep outcomes in people with HIV. Findings suggest the need for targeted sleep interventions based on multimorbidity profiles, which may mitigate broader health risks associated with poor sleep.

Beyond the surface: understanding psychiatric disorders in individuals with spinal cord injury- a narrative exploration

PURPOSE

Spinal Cord Injury (SCI) presents a life-threatening condition that compromises the spinal cord's integrity. Among the complications affecting SCI patients are psychiatric disorders, whose causal mechanisms remain elusive. These disorders are often attributed to multifactorial aspects, encompassing physiological, neurobiological, psychological, and social factors. In the context of SCI patients, we are interested in identifying the specific factors that contribute to the development of psychiatric disorders in this population, emphasizing the critical need for prevention strategies and comprehensive therapeutic management, ultimately aiming to improve the affected patients' quality of life.

METHODS

The process of searching and selecting information was performed between August and December of 2023, utilizing PubMed, ResearchGate, and NCBI as the requisite databases for this review. To ensure precise information retrieval, keywords were strategically employed, focusing on publications spanning from 1985 to the present. MeSH terms, including spinal cord injury, acute spinal cord injury, psychiatric disorders, neuropsychiatry, cognitive impairment, and chronic pain, were applied. A total of 127 articles were identified through electronic searches, and 55 of these were chosen for inclusion in this review. The consulted studies encompassed various types, such as meta-analyses, systematic reviews, animal model experiments, and others.

RESULTS

Various factors contributing to the onset of psychiatric disorders in patients with SCI were proposed, all grounded in evidence: neurobiological pathology; cognitive impairment; the impact of systemic diseases on psychological well-being; and, lastly, the correlation between chronic pain and diminished daily functionality, experiences widely encountered by SCI patients.

CONCLUSION

The diagnosis of psychiatric disorders remains largely clinical and syndromic, with unclear causal mechanisms. Understanding psychiatric symptoms in SCI patients requires further investigation. Key contributing factors include neurobiological pathology linked to SCI, cognitive impairment, systemic and organ-specific diseases, and chronic pain associated with reduced functionality. We emphasize the importance of therapeutic and rehabilitative measures that address both physical and psychological health to improve overall quality of life.

Multimorbidity clusters and their contribution to well-being among the oldest old: Results based on a nationally representative sample in Germany

AIM

Our aim was to identify multimorbidity clusters and, in particular, to examine their contribution to well-being outcomes among the oldest old in Germany.

METHODS

Data were taken from the large nationally representative D80+ study including community-dwelling and institutionalized individuals aged 80 years and over residing in Germany (n = 8,773). The mean age was 85.6 years (SD: 4.1). Based on 21 chronic conditions, latent class analysis was carried out to explore multimorbidity (≥2 chronic conditions) clusters. Widely used tools were applied to quantify well-being outcomes.

RESULTS

Approximately nine out of ten people aged 80 and over living in Germany were multimorbid. Four multimorbidity clusters were identified: relatively healthy class (30.2 %), musculoskeletal class (44.8 %), mental illness class (8.6 %), and high morbidity class (16.4 %). Being part of the mental disorders cluster was consistently linked to reduced well-being (in terms of low life satisfaction, high loneliness and lower odds of meaning in life), followed by membership in the high morbidity cluster.

CONCLUSIONS

Four multimorbidity clusters were detected among the oldest old in Germany. Particularly belonging to the mental disorders cluster is consistently associated with low well-being, followed by belonging to the high morbidity cluster. This stresses the need for efforts to target such vulnerable groups, pending future longitudinal research.

A syndemic approach to the study of Covid-19-related death: a cohort study using UK Biobank data

BACKGROUND

The Covid-19 pandemic showed higher infection, severity and death rates among those living in poorer socioeconomic conditions. We use syndemic theory to guide the analyses to investigate the impact of social adversity and multiple long-term conditions (MLTC) on Covid-19 mortality.

METHODS

The study sample comprised 154 725 UK Biobank participants. Structural equation modeling was used to investigate pathways between traumatic events, economic deprivation, unhealthy behaviors, MLTC, for Covid-19 mortality. Cox regression analysis was used to investigate MLTC and Covid-19 mortality. We also tested effect modification by traumatic events, economic deprivation and unhealthy behaviors.

RESULTS

Covid-19 mortality (n = 186) was directly explained by overall level of MLTC. Economic deprivation and unhealthy behaviors contributed to Covid-19 death indirectly via their negative impact on MLTC. The risk for Covid-19 mortality grew exponentially for every quintile of predicted scores of MLTC. The presence of traumatic events, economic deprivation or unhealthy behaviors did not modify the impact of MLTC on Covid-19 mortality.

CONCLUSIONS

Results suggest a serially causal pathway between economic deprivation and unhealthy behaviors leading to MLTC, which increased the risk of Covid-19 mortality. Policies to tackle the social determinants of health and to mitigate the negative impact of multimorbidity are needed.

Multimorbidity patterns and influencing factors in older Chinese adults: a national population-based cross-sectional survey

Background

This study aims to develop specific multimorbidity relationships among the elderly and to explore the association of multidimensional factors with these relationships, thereby facilitating the formulation of personalised strategies for multimorbidity management.

Methods

Cluster analysis identified chronic conditions that tend to cluster together, and then association rule mining was used to investigate relationships within these identified clusters more closely. Stepwise logistic regression analysis was conducted to explore the relationship between influencing factors and different health statuses in older adults. The results of this study were presented by network graph visualisation.

Results

A total of 15 045 individuals were included in this study. The average age was 73.0 ± 6.8 years. The number of patients with multimorbidity was 7426 (49.4%). The most common binary disease combination was hypertension and depression. The four major multimorbidity clusters identified were the tumour-digestive disease cluster, the metabolic-circulatory disease cluster, the metal-psychological disease cluster, and the age-related degenerative disease cluster. Cluster analysis by sex and region revealed similar numbers and types of conditions in each cluster, with some variations. Gender and number of medications had a consistent effect across all disease clusters, while aging, body mass index (BMI), waist-to-hip ratio (WHR), cognitive impairment, plant-based foods, animal-based foods, highly processed foods and marital status had varying effects across different disease clusters.

Conclusions

Multimorbidity is highly prevalent in the older population. The impact of lifestyle varies between different clusters of multimorbidity, and there is a need to implement different strategies according to different clusters of multimorbidity rather than an integrated approach to multimorbidity management.

Can social adversity and mental, physical and oral multimorbidity form a syndemic? A concept and protocol paper

Background

Clustering mental, physical and oral conditions reduce drastically the life expectancy. These conditions are precipitated and perpetuated by adverse social, economic, environmental, political and healthcare contextual factors, and sustained through bidirectional interactions forming potentially a 'syndemic'. No previous study has investigated such potential syndemic. Thus, the present project aimed to (i) test for syndemic interactions between social adversity (socioeconomic adversity and traumatic events) and mental, physical and oral multimorbidity using the syndemic theoretical framework; and (ii) determine whether the syndemic relationships vary by age, sex and ethnicity.

Methods

Data from three large-scale population-based databases: UK BioBank, US National Health and Nutrition Examination Survey (NHANES) and the Research with East London Adolescents Community Health Survey (RELACHS) will be analysed. Structural equation modelling (SEM) will be utilised to conceptualise syndemic factors and model complex relationships between directly observed and indirectly observed (latent) variables (syndemic constructs).

Discussion

the syndemic conceptualisation provides a valuable framework to understand health and illness, and hence to better design and deliver effective and cost-effective preventative and curative integrated (syndemic) care to improve patient and population health. Such syndemic care aims to address the social determinants of health, whilst simultaneously managing all interlocked conditions.

Effects of physical multimorbidity on cognitive decline trajectories among adults aged 50 years and older with different wealth status: a 17-year population-based cohort study

This study aimed to investigate the effects of physical multimorbidity on the trajectory of cognitive decline over 17 years and whether vary across wealth status. The study was conducted in 9035 respondents aged 50+ at baseline from nine waves (2002-2019) of the English Longitudinal Study of Aging. A latent class analysis was used to identify patterns of physical multimorbidity, and mixed multilevel models were performed to determine the association between physical multimorbidity and trajectories of cognitive decline. Joint analyses were conducted to further verify the influence of wealth status. Four patterns of physical multimorbidity were identified. Mixed multilevel models with quadratic terms of time and status/patterns indicated significant non-linear trajectories of multimorbidity on cognitive function. The magnitude of the association between complex multisystem patterns and cognitive decline increased the most as follow-up progressed. Individuals with high wealth and hypertension/diabetes patterns have significantly lower composite global cognitive z scores over time as compared with respiratory/osteoporosis patterns. Physical multimorbidity at baseline is associated with the trajectory of cognitive decline, and the magnitude of the association increased over time. The trend of cognitive decline differed in specific combinations of wealth status and physical multimorbidity.

Capturing the human impact of living with multiple long-term conditions in routine electronic health records - lost in translation?

Background

Living with multiple long-term conditions (MLTCs) involves 'work'. A recent qualitative synthesis identified eight patient-centred work themes: 'learning and adapting', 'accumulation and complexity', 'investigation and monitoring', 'health service and administration' and 'symptom', 'emotional', 'medication' and 'financial' work. These themes may be underrepresented in electronic health records (EHRs). This study aimed to evaluate the representation of these themes and their constituent concepts in EHR data in a general population and among individuals with history of a mental health condition.

Methods

Using the OpenCodelists builder from OpenSAFELY, clinical code lists corresponding to work concepts were developed using Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) and validated by two clinicians. Additional concepts were engineered within the Clinical Practice Research Datalink (CPRD) and the Secure Anonymised Information Linkage (SAIL) Databank. We analysed trends in recording rates over 20 years across a SAIL general population cohort (n=5,180,602) and a CPRD cohort comprising individuals with a mental health diagnosis (n=3,616,776) and matched controls (n=4,457,225).

Results

55 code lists and seven engineered concepts were developed across the themes. The proportion of patients with codes related to 'investigation and monitoring' exceeded 40%, while 'accumulation and complexity' and 'financial work' were poorly represented (<2% and <1% of the study population respectively). Recording was generally higher among individuals with a mental health diagnosis history.

Conclusion

While EHR data captures some aspects of MLTC work, patient-centred concepts are under-represented. Future research should explore reasons behind variability in coding practices, and innovative methods for enriching structured records with patient-centred data.

Association of cardiovascular-kidney-metabolic health and social connection with the risk of depression and anxiety

BACKGROUND

To explore the association of cardiovascular-kidney-metabolic (CKM) health with the risk of depression and anxiety and to investigate the joint association of CKM health and social connection with depression and anxiety.

METHODS

This prospective cohort study included 344 956 participants from the UK Biobank. CKM syndrome was identified as a medical condition with the presence of metabolic risk factors, cardiovascular disease, and chronic kidney disease, and was classified into five stages (stage 0-4) in this study. Loneliness and social isolation status were determined by self-reported questionnaires. Cox proportional hazards models were applied for analyses.

RESULTS

Compared with participants in stage 0, the HRs for depression were 1.17 (95% CI 1.10-1.25), 1.40 (95% CI 1.33-1.48), and 2.14 (95% CI 1.98-2.31) for participants in stage 1, 2-3, and 4, respectively. Similarly, participants in stage 2-3 (HR = 1.20, 95% CI 1.14-1.26) and stage 4 (HR = 1.63, 95% CI 1.51-1.75) had greater risks of incident anxiety. We found additive interactions between loneliness and CKM health on the risk of depression and anxiety. Participants simultaneously reported being lonely and in stage 4 had the greatest risk of depression (HR = 4.44, 95% CI 3.89-5.07) and anxiety (HR = 2.58, 95% CI 2.21-3.01) compared with those without loneliness and in stage 0. We also observed an additive interaction between social isolation and CKM health on the risk of depression.

CONCLUSIONS

Our findings suggest the importance of comprehensive interventions to improve CKM health and social connection to reduce the disease burden of depression and anxiety.

Mental health of primary health care physicians and nurses following prolonged infection control rules: a national survey in China

Introduction

This study examined the prevalence and correlates of probable mental health disorders, including psychological distress, somatization, depression, anxiety, phobic anxiety (PHO), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and insomnia among Chinese primary health care (PHC) physicians and nurses amid the post-pandemic period in 2022.

Method

Region-stratified sampling was conducted to recruit a national sample of 4,246 respondents from 31 July 2022 to 12 August 2022. A total of 692 primary healthcare institutions were identified in 30 provincial-level administrative regions of China. An online questionnaire was used for assessing probable mental health disorders using Symptoms Checklist-90-Revised (SCL-90-R) and PTSD Checklist for DSM-5 (PCL-5), and sleeping problems using Insomnia Severity Index (ISI). Data on demographics and work were also collected. Bivariate analysis and multiple logistic regression were conducted to identify significant correlates of probable mental health disorders.

Results

A total of 4,246 valid questionnaires were identified. Results showed that relative to the prevalence of probable mental health disorders among health care workers at the early stage of the pandemic in China, there was an overall decreased prevalence except for somatization, PHO, and OCD among the current PHC physicians and nurses. Multiple logistic regressions showed that significant risk factors of common probable mental health disorders, namely psychological distress, SOM, DEP, ANX, PHO, OCD, PTSD, and insomnia, were female gender, multimorbidity, history of psychiatric disorders, quarantine experience, never asking anyone for help, and overtime work.

Conclusion

Attention should be given to preexisting psychiatric and multimorbid conditions, social support, and work-related stressors. Regular assessment and psychological interventions are needed to enhance the mental health of PHC professionals even after public health crisis.

The greener the living environment, the better the health? Examining the effects of multiple green exposure metrics on physical activity and health among young students

The sedentary and less active lifestyle of modern college students has a significant impact on the physical and mental well-being of the college community. Campus Green Spaces (GSs) are crucial in promoting physical activity and improving students' health. However, previous research has focused on evaluating campuses as a whole, without considering the diverse spatial scenarios within the campus environment. Accordingly, this study focused on the young people's residential scenario in university and constructed a framework including a comprehensive set of objective and subjective GSs exposure metrics. A systematic, objective exposure assessment framework ranging from 2D (GSs areas), and 2.5D (GSs visibility) to 3D (GSs volume) was innovatively developed using spatial analysis, deep learning technology, and unmanned aerial vehicle (UAV) measurement technology. Subjective exposure metrics incorporated GSs visiting frequency, GSs visiting duration, and GSs perceived quality. Our cross-sectional study was based on 820 university students in Nanjing, China. Subjective measures of GSs exposure, physical activity, and health status were obtained through self-reported questionnaires. The Generalized Linear Model (GLM) was used to evaluate the associations between GSs exposure, physical activity, and perceived health. Physical activity and social cohesion were considered as mediators, and path analysis based on Structural Equation Modeling (SEM) was used to disentangle the mechanisms linking GSs exposure to the health status of college students. We found that (1) 2D indicator suggested significant associations with health in the 100m buffer, and the potential underlying mechanisms were: GSs area → Physical activity → Social cohesion → Physical health → Mental health; GSs area → Physical activity → Social cohesion → Mental health. (2) Subjective GSs exposure indicators were more relevant in illustrating exposure-response relationships than objective ones. This study can clarify the complex nexus and mechanisms between campus GSs, physical activity, and health, and provide a practical reference for health-oriented campus GSs planning.

Association between physical multimorbidity and common mental health disorders in rural and urban Malawian settings: Preliminary findings from Healthy Lives Malawi long-term conditions survey

In low-income Africa, the epidemiology of physical multimorbidity and associated mental health conditions is not well described. We investigated the multimorbidity burden, disease combinations, and relationship between physical multimorbidity and common mental health disorders in rural and urban Malawi using early data from 9,849 adults recruited to an on-going large cross-sectional study on long-term conditions, initiated in 2021. Multimorbidity was defined as having two or more measured (diabetes, hypertension) or self-reported (diabetes, hypertension, disability, chronic pain, HIV, asthma, stroke, heart disease, and epilepsy) conditions. Depression and anxiety symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder scale (GAD-7) and defined by the total score (range 0-27 and 0-21, respectively). We determined age-standardized multimorbidity prevalence and condition combinations. Additionally, we used multiple linear regression models to examine the association between physical multimorbidity and depression and anxiety symptom scores. Of participants, 81% were rural dwelling, 56% were female, and the median age was 30 years (Inter Quartile Range 21-43). The age-standardized urban and rural prevalence of multimorbidity was 14.1% (95% CI, 12.5-15.8%) and 12.2% (95% CI, 11.6-12.9%), respectively. In adults with two conditions, hypertension, and disability co-occurred most frequently (18%), and in those with three conditions, hypertension, disability, and chronic pain were the most common combination (23%). Compared to adults without physical conditions, having one (B-Coefficient (B) 0.79; 95% C1 0.63-0.94%), two- (B 1.36; 95% CI 1.14-1.58%), and three- or more- physical conditions (B 2.23; 95% CI 1.86-2.59%) were associated with increasing depression score, p-trend <0.001. A comparable 'dose-response' relationship was observed between physical multimorbidity and anxiety symptom scores. While the direction of observed associations cannot be determined with these cross-sectional data, our findings highlight the burden of multimorbidity and the need to integrate mental and physical health service delivery in Malawi.

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Characteristics of Comorbid Physical Disease in Patients With Severe Mental Illness in South Korea: A Nationwide Population-Based Study (2014-2019)

OBJECTIVE

The purpose of this study was to identify the associations of chronic physical disease between patients with severe mental illness (SMI) and the general population of South Korea.

METHODS

This study was conducted with National Health Insurance Corporation data from 2014 to 2019. A total of 848,058 people were diagnosed with SMI in this period, and the same number of controls were established by matching by sex and age. A descriptive analysis was conducted on the sociodemographic characteristics of patients with SMI. Conditional logistic regression analysis was performed to identify the associations between comorbid physical disease in patients with SMI and those of the general population. SAS Enterprise Guide 7.1 (SAS Inc, Cary, NC, USA) were used to perform all statistical tests.

RESULTS

The analysis revealed significant differences in medical insurance, income level, and Charlson Comorbidity Index weighted by chronic physical disease, between patients with SMI and the general population. Conditional logistic regression analysis between the two groups also revealed significant differences in eight chronic physical diseases except hypertensive disease.

CONCLUSION

This study confirmed the vulnerability of patients with SMI to chronic physical diseases and we were able to identify chronic physical disease that were highly related to patients with SMI.

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)

BACKGROUND

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

METHODS

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

RESULTS

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

CONCLUSIONS

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Sex Differences in the Role of Multimorbidity on Poststroke Disability: The Taiwan Stroke Registry

BACKGROUND AND OBJECTIVES

Multimorbidity is common in patients who experience stroke. Less is known about the effect of specific multimorbidity patterns on long-term disability in patients with stroke. Furthermore, given the increased poststroke disability frequently seen in female vs male patients, it is unknown whether multimorbidity has a similar association with disability in both sexes. We assessed whether specific multimorbidity clusters were associated with greater long-term poststroke disability burden overall and by sex.

METHODS

In the Taiwan Stroke Registry, an ongoing nationwide prospective registry, patients with first-ever ischemic stroke were enrolled; this analysis is restricted to those individuals surviving to at least 6 months poststroke. Using a hierarchical clustering approach, clusters of prestroke multimorbidity were generated based on 16 risk factors; the algorithm identified 5 distinct clusters. The association between clusters and 12-month poststroke disability, defined using the modified Rankin Scale (mRS), was determined using logistic regression models, with additional models stratified by sex. The longitudinal association between multimorbidity and functional status change was assessed using mixed-effects models.

RESULTS

Nine-thousand eight hundred eighteen patients with first-ever ischemic stroke were included. The cluster with no risk factors was the reference, "healthier" risk group (N = 1,373). Patients with a cluster profile of diabetes, peripheral artery disease (PAD), and chronic kidney disease (CKD) (N = 1882) had significantly greater disability (mRS ≥ 3) at 1 month (OR [95% CI] = 1.36 [1.13-1.63]), 3 months (OR [95% CI] = 1.27 [1.04-1.55]), and 6 months (OR [95% CI] = 1.30 [1.06-1.59]) but not at 12 months (OR [95% CI] = 1.16 [0.95-1.42]) than patients with a healthier risk factor profile. In the sex-stratified analysis, the associations with this risk cluster remained consistent in male patients (OR [95% CI] = 1.42 [1.06-1.89]) at 12 months, who also had a higher comorbidity burden, but not in female patients (OR [95% CI] = 0.95 [0.71-1.26]), who had higher proportions of severe strokes and severe disability (p-interaction = 0.04).

DISCUSSION

Taiwanese patients with multimorbidity, specifically the concurrent presence of diabetes, PAD, and CKD, had higher odds of a worse functional outcome in the first 6 months poststroke. Clusters of multimorbidity may be less informative for long-term disability in female patients. Further studies should evaluate other mechanisms for worse disability in female patients poststroke.

Somatic disease burden and depression risk in late life: a community-based study

AIMS

Co-occurring somatic diseases exhibit complex clinical profiles, which can differentially impact the development of late-life depression. Within a community-based cohort, we aimed to explore the association between somatic disease burden, both in terms of the number of diseases and their patterns, and the incidence of depression in older people.

METHODS

We analysed longitudinal data of depression- and dementia-free individuals aged 60+ years from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression diagnoses were clinically ascertained following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision over a 15-year follow-up. Somatic disease burden was assessed at baseline through a comprehensive list of chronic diseases obtained by combining information from clinical examinations, medication reviews and national registers and operationalized as (i) disease count and (ii) patterns of co-occurring diseases from latent class analysis. The association of somatic disease burden with depression incidence was investigated using Cox models, accounting for sociodemographic, lifestyle and clinical factors.

RESULTS

The analytical sample comprised 2904 people (mean age, 73.2 [standard deviation (SD), 10.5]; female, 63.1%). Over the follow-up (mean length, 9.6 years [SD, 4 years]), 225 depression cases were detected. Each additional disease was associated with the occurrence of any depression in a dose-response manner (hazard ratio [HR], 1.16; 95% confidence interval [CI]: 1.08, 1.24). As for disease patterns, individuals presenting with sensory/anaemia (HR, 1.91; 95% CI: 1.03, 3.53), thyroid/musculoskeletal (HR, 1.90; 95% CI: 1.06, 3.39) and cardiometabolic (HR, 2.77; 95% CI: 1.40, 5.46) patterns exhibited with higher depression hazards, compared to those without 2+ diseases (multimorbidity). In the subsample of multimorbid individuals (85%), only the cardiometabolic pattern remained associated with a higher depression hazard compared to the unspecific pattern (HR, 1.71; 95% CI: 1.02, 2.84).

CONCLUSIONS

Both number and patterns of co-occurring somatic diseases are associated with an increased risk of late-life depression. Mental health should be closely monitored among older adults with high somatic burden, especially if affected by cardiometabolic multimorbidity.

Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis

BACKGROUND

The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design.

METHODS

Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL.

RESULTS

Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (β =  - 6.527; Standard Error [SE] = 1.579), mental-component scale (β =  - 3.765; SE = 1.590) and short-form six-dimension utility index (β =  - 0.075; SE = 0.017).

CONCLUSION

This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.

Comorbidities are associated with self-reported sleep-disordered breathing and insomnia: a cross-sectional study from China

PURPOSE

We aimed to examine the associations of comorbidities with self-reported sleep-disordered breathing (SDB) and insomnia among Chinese adults.

METHODS

The study used data from a community-based cross-sectional survey performed in China in 2018-2020. Multivariable logistic regression models were used to analyze the associations of 12 comorbidities with SDB and insomnia.

RESULTS

A total of 4329 Han Chinese adults aged ≥ 18 years were enrolled. Of these, 1970 (45.5%) were male, with a median age of 48 years (interquartile range: 34-59). Compared with the participants without any conditions, adjusted ORs for SDB and insomnia for those with ≥ 4 comorbidities were 2.33 (95% CI: 1.58, 3.43, P-trend < 0.001) and 3.89 (95% CI: 2.69, 5.64, P-trend < 0.001), respectively. Seven comorbidities (hypertension, hyperlipidemia, coronary heart disease (CHD), bone and joint disease, neck or lumbar disease, chronic digestive diseases, and chronic urological disease) were positively associated with both SDB and insomnia. Cancer and chronic obstructive pulmonary disease (COPD) were also independently associated with insomnia. Of all comorbidities, cancer was most strongly associated with insomnia (OR = 3.16; 95% CI: 1.78, 5.63; P < 0.001), and CHD was most strongly associated with SDB (OR = 1.77; 95% CI: 1.19, 2.64; P < 0.001).

CONCLUSIONS

The findings showed that adults with an increasing number of comorbidities had higher odds for SDB and insomnia, which were independent of sociodemographic and lifestyle factors.

Severe mental illness, race/ethnicity, multimorbidity and mortality following COVID-19 infection: nationally representative cohort study

BACKGROUND

The association of COVID-19 with death in people with severe mental illness (SMI), and associations with multimorbidity and ethnicity, are unclear.

AIMS

To determine all-cause mortality in people with SMI following COVID-19 infection, and assess whether excess mortality is affected by multimorbidity or ethnicity.

METHOD

This was a retrospective cohort study using primary care data from the Clinical Practice Research Database, from February 2020 to April 2021. Cox proportional hazards regression was used to estimate the effect of SMI on all-cause mortality during the first two waves of the COVID-19 pandemic.

RESULTS

Among 7146 people with SMI (56% female), there was a higher prevalence of multimorbidity compared with the non-SMI control group (n = 653 024, 55% female). Following COVID-19 infection, the SMI group experienced a greater risk of death compared with controls (adjusted hazard ratio (aHR) 1.53, 95% CI 1.39-1.68). Black Caribbean/Black African people were more likely to die from COVID-19 compared with White people (aHR = 1.22, 95% CI 1.12-1.34), with similar associations in the SMI group and non-SMI group (P for interaction = 0.73). Following infection with COVID-19, for every additional multimorbidity condition, the aHR for death was 1.06 (95% CI 1.01-1.10) in the SMI stratum and 1.16 (95% CI 1.15-1.17) in the non-SMI stratum (P for interaction = 0.001).

CONCLUSIONS

Following COVID-19 infection, patients with SMI were at an elevated risk of death, further magnified by multimorbidity. Black Caribbean/Black African people had a higher risk of death from COVID-19 than White people, and this inequity was similar for the SMI group and the control group.

Multimorbidity patterns in the German general population aged 40 years and over

AIM

The aim of this study was to identify and describe multimorbidity patterns among middle-aged and older community-dwelling individuals in Germany. Moreover, we aimed to determine potential gender differences in multimorbidity patterns.

METHODS

We analysed data from the most recent (sixth) wave (2017) of the large nationally representative German Ageing Survey (DEAS). Altogether n = 6,554 individuals participated, mean age was 62.0 (ranging from 43 to 92 years). Latent Class Analysis was performed to identify multimorbidity patterns, based on 13 chronic conditions and diseases. Multimorbidity was defined as the presence of at least two chronic conditions.

RESULTS

Altogether, 53.3% of individuals were multimorbid. We identified and clinically described five multimorbidity patterns: the relatively healthy class (45.1%), the high morbidity class (10.8%), the arthrosis/inflammatory/mental illnesses class (20.6%), the hypertension-metabolic illness class (21.7%), and the cardiovascular/cancer class (1.7%). Our analysis revealed that women compared to men have higher relative risk (IRR = 1.61, 95% CI 1.25-2.06) of being in the arthrosis/inflammatory/mental illnesses class, compared to the relatively healthy class. Furthermore, we found that, depending on which multimorbidity pattern individuals belong to, they differ greatly in terms of socio-demographic factors, health behaviour, and lifestyle factors.

CONCLUSIONS

We showed that the many chronic diseases cluster in a non-random way. Five clinically meaningful multimorbidity patterns were identified. Gender differences were apparent only in one class, namely in the arthrosis/inflammatory/mental illnesses class.

Topic modeling identifies novel genetic loci associated with multimorbidities in UK Biobank

Many diseases show patterns of co-occurrence, possibly driven by systemic dysregulation of underlying processes affecting multiple traits. We have developed a method (treeLFA) for identifying such multimorbidities from routine health-care data, which combines topic modeling with an informative prior derived from medical ontology. We apply treeLFA to UK Biobank data and identify a variety of topics representing multimorbidity clusters, including a healthy topic. We find that loci identified using topic weights as traits in a genome-wide association study (GWAS) analysis, which we validated with a range of approaches, only partially overlap with loci from GWASs on constituent single diseases. We also show that treeLFA improves upon existing methods like latent Dirichlet allocation in various ways. Overall, our findings indicate that topic models can characterize multimorbidity patterns and that genetic analysis of these patterns can provide insight into the etiology of complex traits that cannot be determined from the analysis of constituent traits alone.

Depression and Anxiety in Heart Transplant Recipients: Prevalence and Impact on Post-Transplant Outcomes

BACKGROUND

Depression and anxiety (DA) are common mental disorders in patients with chronic diseases, but the research regarding their prevalence in heart transplantation (HTx) is still limited.

METHODS

We performed an analysis of the prevalence and prognostic relevance of DA in patients who underwent HTx between 2010 and 2018 in Germany. Data were obtained from Allgemeine Ortskrankenkasse (AOK), which is the largest public health insurance provider.

RESULTS

Overall, 694 patients were identified. More than a third of them were diagnosed with DA before undergoing HTx (n = 260, 37.5%). Patients with DA more often had an ischaemic cardiomyopathy (p < 0.001) and a history of previous myocardial infarction (p = 0.001) or stroke (p = 0.002). The prevalence of hypertension (p < 0.001), diabetes (p = 0.004), dyslipidaemia (p < 0.001) and chronic kidney disease (p = 0.003) was higher amongst transplant recipients with DA. Patients with DA were more likely to suffer an ischaemic stroke (p < 0.001) or haemorrhagic stroke (p = 0.032), or develop septicaemia (p = 0.050) during hospitalisation for HTx. Our analysis found no significant differences between the groups with respect to in-hospital mortality. The female sex and mechanical circulatory support were associated with an inferior prognosis. Pretransplant non-ischaemic cardiomyopathy was related to a favourable outcome.

CONCLUSIONS

DA affect up to a third of the population undergoing HTx, with a greater prevalence in patients with comorbidities. DA are associated with a higher incidence of stroke and septicaemia after HTx.

Psychological wellbeing of Australian community health service staff during the COVID-19 pandemic: a longitudinal cohort study

BACKGROUND

Hospital clinical staff have reported poor psychosocial wellbeing during the COVID-19 pandemic. Little is known about community health service staff who undertake various roles including education, advocacy and clinical services, and work with a range of clients. Few studies have collected longitudinal data. The aim of this study was to assess the psychological wellbeing of community health service staff in Australia during the COVID-19 pandemic at two time points in 2021.

METHODS

A prospective cohort design with an anonymous cross-sectional online survey administered at two time points (March/April 2021; n = 681 and September/October 2021; n = 479). Staff (clinical and non-clinical roles) were recruited from eight community health services in Victoria, Australia. Psychological wellbeing was assessed using the Depression, Anxiety and Stress Scale (DASS-21) and resilience using the Brief Resilience Scale (BRS). General linear models were used to measure the effects of survey time point, professional role and geographic location on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics.

RESULTS

There were no significant differences in respondent sociodemographic characteristics between the two surveys. Staff's mental health declined as the pandemic continued. Adjusting for dependent children, professional role, general health status, geographic location, COVID-19 contact status and country of birth; depression, anxiety and stress scores were significantly higher for respondents in the second survey than the first (all p < 0.001). Professional role and geographic location were not statistically significantly associated with scores on any of the DASS-21 subscales. Higher levels of depression, anxiety and stress were reported among respondents who were younger, and had less resilience or poorer general health.

CONCLUSIONS

The psychological wellbeing of community health staff was significantly worse at the time of the second survey than the first. The findings indicate that the COVID-19 pandemic has had an ongoing and cumulative negative impact on staff wellbeing. Staff would benefit from continued wellbeing support.

Addressing inequity in palliative care provision for older people living with multimorbidity. Perspectives of community-dwelling older people on their palliative care needs: A scoping review

BACKGROUND

Older people living with multimorbidity are projected to become the main recipients of palliative care in the coming decades, yet there is limited evidence regarding their expressed palliative care needs to inform person-centred care.

AIM

To understand the palliative care needs of community-dwelling people aged ⩾60 living with multimorbidity in the last 2 years of life.

DESIGN

A scoping review following Arksey and O'Malley.

DATA SOURCES

Three international electronic databases (CINAHL, Ovid Medline, PsycINFO) were searched from March 2018 to December 2021. Reference lists were hand searched. Eligible papers were those reporting empirical data on older people's needs.

RESULTS

From 985 potential papers, 28 studies were included, published between 2002 and 2020; sixteen quantitative, nine qualitative and three mixed methods. Data were extracted and presented under the holistic palliative care domains of need: physical, psychological, social, spiritual, and additionally practical needs. Different measurement tools (n = 29) were used, of which 20 were multidimensional. Primacy in reporting was given to physical needs, most commonly pain and function. Social and practical needs were often prioritised by older people themselves, including maintaining social connections and accessing and receiving individualised care.

CONCLUSION

Identifying the palliative care needs that matter most to older people with multimorbidity requires the recognition of their concerns, as well as their symptoms, across a continuum of living and dying. Available evidence is superficial. Supporting end of life provision for this growing and underserved population necessitates a shift to tailored multidimensional tools and community focussed integrated care services.

The relationship between air pollution and multimorbidity: Can two birds be killed with the same stone?

Air pollution and multimorbidity are two of the most important challenges for Public Health worldwide. Although there is a large body of evidence linking air pollution with the development of different single chronic conditions, the evidence about the relationship between air pollution and multimorbidity (the co-occurrence of multiple long-term conditions) is sparse. To obtain evidence about this relationship could be challenging and different aspects should be considered, such as its multifaceted and complex nature, the specific pollutants and their potential influence on health, their levels of exposure over time, or the data that could be used for its study. This evidence could be instrumental to inform the development of new recommendations and measures to reduce harmful levels of air pollutants, as means to prevent the development of multimorbidity and reduce its burden.

Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries

PURPOSE

Multimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs.

METHODS

Cross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations.

RESULTS

The final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient - 5.89; 95% CI - 6.83, - 4.95), 3 (- 8.35; - 9.63, - 7.06), 4 (- 10.87; - 12.37, - 9.36), and ≥ 5 (- 13.48; - 15.91, - 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%).

CONCLUSION

A greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.

Economic evaluations of interventional opportunities for the management of mental-physical multimorbidity: a systematic review

OBJECTIVES

Economic evaluations of interventions for people with mental-physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.

DESIGN

A systematic review.

DATA SOURCES

MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022.

ELIGIBILITY CRITERIA

We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded.

DATA EXTRACTION AND SYNTHESIS

Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted.

RESULTS

A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods.

CONCLUSIONS

Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions.

PROSPERO REGISTRATION NUMBER

CRD42022302036.

Use of urgent, emergency and acute care by mental health service users: A record-level cohort study

BACKGROUND

People with serious mental illness experience worse physical health and greater mortality than the general population. Crude rates of A&E attendance and acute hospital admission are higher in people with serious mental illness than other hospital users. We aimed to further these findings by undertaking a standardised comparison of urgent and emergency care pathway use among users of mental health services and the general population.

METHODS

Retrospective cohort analysis using routine data from 2013-2016 from the CUREd dataset for urgent and emergency care contacts (NHS 111, ambulance, A&E and acute admissions) and linked mental health trust data for Sheffield, England. We compared annual age- and sex-standardised usage rates for each urgent and emergency care service between users of mental health services and those without a recent history of mental health service use.

RESULTS

We found marked differences in usage rates for all four urgent and emergency care services between the general population and users of mental health services. Usage rates and the proportion of users were 5-6 times and 3-4 times higher in users of mental health services, respectively, for all urgent and emergency care services. Users of mental health services were often more likely to experience the highest or lowest acuity usage characteristics.

CONCLUSIONS

Current users of mental health services were heavily over-represented among urgent and emergency care users, and they made more contacts per-person. Higher service use among users of mental health services could be addressed by improved community care, more integrated physical and mental health support, and more proactive primary care. A complex pattern of service use among users of mental health services suggests this will need careful targeting to reduce avoidable contacts and optimise patient outcomes.

Physical multimorbidity, depressive symptoms, and social participation in adults over 50 years of age: findings from the English Longitudinal Study of Ageing

OBJECTIVES

The aim of the current study was to identify specific patterns of physical multimorbidity and examine how these patterns associated with changes in social participation over time.

METHODS

We used latent class analysis to identify clusters of physical multimorbidity in 11,391 older adults. Mixed effects regression models were used to assess associations between physical multimorbidity clusters and changes in social participation over 15 years.

RESULTS

Four clusters of physical multimorbidity were identified. All physical multimorbidity clusters were associated with a reduction in cultural engagement (e.g. visits to theatre, cinema, museums) over time, with the strongest association seen in the complex/multisystem cluster (β = -0.26, 95% CI = -0.38 to -0.15). Similar results emerged for leisure activities. Adjusting for depressive symptoms fully attenuated some associations. All physical multimorbidity clusters were associated with an increase in civic participation over time.

CONCLUSIONS

Physical multimorbidity reduced some aspects of social participation over time, with specific combinations of conditions having increased risk of reductions.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2017847.

Associations between air pollution and multimorbidity in the UK Biobank: A cross-sectional study

Background

Long-term exposure to air pollution concentrations is known to be adversely associated with a broad range of single non-communicable diseases, but its role in multimorbidity has not been investigated in the UK. We aimed to assess associations between long-term air pollution exposure and multimorbidity status, severity, and patterns using the UK Biobank cohort.

Methods

Multimorbidity status was calculated based on 41 physical and mental conditions. We assessed cross-sectional associations between annual modeled particulate matter (PM)2.5, PMcoarse, PM10, and nitrogen dioxide (NO2) concentrations (μg/m3-modeled to residential address) and multimorbidity status at the baseline assessment (2006-2010) in 364,144 people (mean age: 52.2 ± 8.1 years, 52.6% female). Air pollutants were categorized into quartiles to assess dose-response associations. Among those with multimorbidity (≥2 conditions; n = 156,395) we assessed associations between air pollutant exposure levels and multimorbidity severity and multimorbidity patterns, which were identified using exploratory factor analysis. Associations were explored using generalized linear models adjusted for sociodemographic, behavioral, and environmental indicators.

Results

Higher exposures to PM2.5, and NO2 were associated with multimorbidity status in a dose-dependent manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) [PM2.5: adjusted odds ratio (adjOR) = 1.21 (95% CI = 1.18, 1.24); NO2: adjOR = 1.19 (95 % CI = 1.16, 1.23)]. We also observed dose-response associations between air pollutant exposures and multimorbidity severity scores. We identified 11 multimorbidity patterns. Air pollution was associated with several multimorbidity patterns with strongest associations (Q4 vs. Q1) observed for neurological (stroke, epilepsy, alcohol/substance dependency) [PM2.5: adjOR = 1.31 (95% CI = 1.14, 1.51); NO2: adjOR = 1.33 (95% CI = 1.11, 1.60)] and respiratory patterns (COPD, asthma) [PM2.5: adjOR = 1.24 (95% CI = 1.16, 1.33); NO2: adjOR = 1.26 (95% CI = 1.15, 1.38)].

Conclusions

This cross-sectional study provides evidence that exposure to air pollution might be associated with having multimorbid, multi-organ conditions. Longitudinal studies are needed to further explore these associations.

Physical multimorbidity and wish to die among adults aged ≥65 years: A cross-sectional analysis of the Irish Longitudinal Study on Ageing

BACKGROUND

Physical multimorbidity (i.e., ≥2 chronic conditions) may induce feelings of wish to die (WTD), but there is limited literature on this topic, while the mediators in this association are largely unknown. Thus, the aim of the present study was to investigate this association and its mediators among older Irish adults.

METHODS

Cross-sectional, nationally representative data from Wave 1 of the Irish Longitudinal Study on Ageing 2009-2011 were analyzed. Information on self-reported lifetime diagnosis of 14 chronic physical conditions were obtained. WTD was defined as answering affirmatively to the question "In the last month, have you felt that you would rather be dead?" Multivariable logistic regression and mediation analyses were conducted.

RESULTS

Data on 2941 adults aged ≥65 years [mean (SD) age 73.2 (5.2) years; 45.0 % males] were analyzed. Physical multimorbidity was associated with 3.39 (95%CI 1.58, 7.28) times higher odds for WTD. This association was largely explained by pain (% mediated 28.1 %), followed by depression (19.4 %), sleep problems (18.4 %), perceived stress (13.0 %), loneliness (10.4 %), anxiety (8.1 %), and disability (7.2 %).

CONCLUSIONS

Multimorbidity was associated with increased odds for WTD among Irish older adults. Addressing the identified mediators may contribute to reducing feelings of WTD among older adults with multimorbidity.

Prospective associations between depression and risk of hospitalisation for infection: Findings from the UK Biobank

BACKGROUND

Associations between depression and non-communicable disease have been well-described. However, the evidence for its role in the development of infectious disease is less understood. We aimed to examine prospective associations between depression and risk of hospitalisation for infection in middle-aged adults from the UK Biobank (linked with Hospital Episode Statistics) and assessed the role of several depression-related factors.

METHODS

We assessed prospective associations between depression status at the baseline assessment (2006-2010) and hospitalisations for infection up to the end of March 2016 in 460,418 middle-aged adults enrolled in the UK Biobank (mean age = 56.23 ± 8.11 years, 53.5% female). Cox regression was used to assess associations between depression and subsequent hospitalisations for any infections, as well as infection subtypes, viral infections, and bacterial infections. Amongst those with depression, we also examined the role of depression duration, the age of onset, and the use of antidepressants in hospitalisation risk.

RESULTS

Depression at baseline was prospectively associated with an increased risk of hospitalisation for infection (adjusted hazard ration (aHR) = 1.20, 95% confidence interval (CI) = 1.16 to 1.25). This association was found for all infection subtypes apart from infections of the central nervous system (p = 0.911) and the skin (p = 0.313). Receipt of a depression diagnosis in late adulthood and use of antidepressants (but only in those with none/mild depressive symptoms at baseline) increased the risk of hospitalisation for infection amongst those with depression.

CONCLUSIONS

These findings suggest that depression might be a risk factor which could be used to identify those at risk of hospitalisation for infection. Future research is required to understand the underlying factors that might result in this increased risk, so that targeted interventions can be developed.

FUNDING

AD and AR are funded by Guy's Charity grant number EIC180702 (MLTC Challenge Fund); AD and JAT are co-funded by MRC and NIHR through grant number MR/S028188/1. IB is supported by the NIHR Maudsley BRC and by the NIHR Collaboration for Leadership in Applied Health Research and Care South Londnoo at King's College Hospital NHS Foundation Trust, King's College London. The views expressed are those of the author[s] and not necessarily those of the ESRC, NIHR, the Department of Health and Social Care or King's College London.

Healthy minds live in healthy bodies – effect of physical health on mental health: Evidence from Australian longitudinal data

It is well known that physical and mental health are closely related, with growing evidence for biological and behavioural pathways. Mostly the research has focussed on mental health as the key driver of this inter-connection; the extent physical health shapes mental health has received less attention. We aim to derive robust estimates of the unique role physical health may play in shaping mental health outcomes. To do so we use a novel approach, incorporating longitudinal and instrumental variable methods which can address the reciprocal relationship between physical and mental health, and the endogeneity of physical health, before estimating the physical to mental health pathway. A sample of 209,442 observations (or 24,966 unique individuals) aged 15 and over spanning 18 years (2002–2019) was extracted from the Household Income and Labour Dynamics in Australian Survey (HILDA). We find that physical activity and health shocks erode mental health via their impact on physical health with a one point improvement (or worsening) in physical health scores (0–100) resulting in a rise (or decline) of 0.43 points (or 43%) in mental health score.

Physical multimorbidity and psychological distress among Chinese older adults: Findings from Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Research has linked multimorbidity with psychological distress among people with multimorbidity but the available findings are inconsistent. This study was to investigate the prevalence of multimorbidity and incidence of psychological distress in a nationally representative sample of Chinese older adults and examine the association between multimorbidity and psychological distress in this population.

METHODS

This study was a cross-sectional, secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Participants' socio-demographic characteristics and clinical information were obtained. Psychological distress including anxiety and depression were assessed by the Generalized Anxiety Disorder-7 (GAD-7) and the Center for Epidemiologic Studies Depression Scale (10-item CES-D). Binary logistic regression was used to ascertain the association between multimorbidity and psychological distress with covariates adjustment.

RESULTS

Compared with those without physical chronic conditions, having five or more physical chronic conditions was associated with the likelihood of depression after covariates adjustment.

CONCLUSION

Psychological distress is a common health issue among Chinese older adults with multimorbidity. Having multimorbidity might not be associated with psychological distress represented by anxiety and depression. Management of multimorbidity among this population would benefit from more attention on the mental health domain.

Persistent pain and long-term physical and mental conditions and their association with psychological well-being; data from 10,744 individuals from the Lolland-Falster health study

INTRODUCTION

Persistent pain (PP) and long-term conditions are all associated with psychological well-being. Less is known about their associations with reduced psychological well-being when co-occurring. We investigated how PP and long-term physical and mental conditions relate to psychological well-being when occurring together.

METHOD

Data collected in the Danish population-based Lolland-Falster Health study were used in this cross-sectional study. Participants aged ≥18 years completing questions concerning PP, long-term conditions and psychological well-being were included. PP and long-term conditions were defined as conditions lasting 6 months or longer. Psychological well-being was assessed by the World Health Organization Well-Being Index (WHO-5). Multiple linear regression investigated combinations of PP and physical and mental long-term conditions and their associations with WHO-5.

RESULTS

Of 11,711 participants, 10,744 had available data. One third had PP (n = 3250), while 6144 (57%), 213 (2%) and 946 (9%) reported having only physical conditions, only mental conditions or both, respectively. All combinations of PP and long-term conditions were negatively associated with WHO-5. PP in combination with mental (-23.1 (95% CI -28.3 to -17.8)) or both physical and mental conditions (-25.1 (-26.7 to -23.52) yielded the strongest negative associations. Two or more pain sites together with long-term physical and mental conditions was associated with a lower WHO-5 score (-6.2 (-8.9 to -3.5) compared to none or one pain site.

CONCLUSION

The presence of PP and long-term conditions, in particular mental conditions, were strongly associated with worse psychological well-being. This highlights the importance of assessing psychological well-being in individuals with PP and long-term conditions.

Vitamin D and the risk of treatment-resistant and atypical depression: A Mendelian randomization study

Observational evidence has implicated vitamin D levels as a risk factor in major depressive disorder (MDD). Confounding or reverse causation may be driving these observed associations, with studies using genetics indicating little evidence of an effect. However, genetic studies have relied on broad definitions of depression. The genetic architecture of different depression subtypes may vary since MDD is a highly heterogenous condition, implying potentially diverging requirements in therapeutic approaches. We explored the associations between vitamin D and two subtypes of MDD, for which evidence of a causal link could have the greatest clinical benefits: treatment-resistant depression (TRD) and atypical depression (AD). We used a dual approach, combining observational data with genetic evidence from polygenic risk scores (PRS) and two-sample Mendelian randomization (MR), in the UK Biobank. There was some evidence of a weak association between vitamin D and both incident TRD (Ncases = 830) and AD (Ncases = 2366) in observational analyses, which largely attenuated when adjusting for confounders. Genetic evidence from PRS and two-sample MR, did not support a causal link between vitamin D and either TRD (Ncases = 1891, OR = 1.01 [95%CI 0.78, 1.31]) or AD (Ncases = 2101, OR = 1.04 [95%CI 0.80, 1.36]). Our comprehensive investigations indicated some evidence of an association between vitamin D and TRD/AD observationally, but little evidence of association when using PRS and MR, mirroring findings of genetic studies of vitamin D on broad depression phenotypes. Results do not support further clinical trials of vitamin D in these MDD subtypes but do not rule out that small effects may exist that require larger samples to detect.