Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS)

Age-related differences in the number of chronic diseases in association with trajectories of depressive symptoms: a population-based cohort study

BACKGROUND

The number of chronic diseases has been associated with changes in depressive symptoms over time among middle-aged and older adults. This study aimed to explore the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association.

METHODS

A total of 12,974 middle-aged and older Chinese adults (≥ 45 years) participated in the China Health and Retirement Longitudinal Study (CHARLS) in waves 2011, 2013, 2015, 2018, and 2020. The number of chronic diseases was determined by self-reported hospital diagnosis of hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, heart diseases, stroke, kidney diseases, digestive diseases, emotional, nervous, or psychiatric problems, memory-related disease, arthritis or rheumatism, asthma, and then obtaining the total number of chronic diseases. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Group-based trajectory modeling (GBTM) was adopted to capture the trajectories of depressive symptoms over time. Multinomial logistic regressions were conducted to examine the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association.

RESULTS

Four distinct trajectories of depressive symptoms were observed in 34.68% individuals in mild, 40.76% in moderate, 19.41% in increasing, and 5.15% in severe group. Compared to participants without chronic diseases, those with one, two, three or more chronic diseases had a 1.81, 3, and 7.49-fold higher risk of developing severe depressive symptom trajectory, respectively. Moreover, the association between the number of chronic diseases and severe depressive symptoms trajectory differed by age (45-59 and ≥ 60 years) (P for interaction < 0.05).

CONCLUSION

Participants with middle age may play a promoting role in the association between the number of chronic disease and severe depressive symptoms. The severe depressive symptoms intervention may be more beneficial for middle-aged adults.

Inter- and intrapopulation differences in the association between physical multimorbidity and depressive symptoms

BACKGROUND

The association between physical multimorbidity and depression differs by populations. However, no direct inter- or intrapopulation comparison of the association has been conducted. Thus, this study aims to estimate the association in China and the United States and reveal inter- and intrapopulation differences in the association.

METHODS

Middle-aged and older adults from the China Health and Retirement Longitudinal Study and the Health and Retirement Study were included. Physical multimorbidity was defined as the simultaneous presence of two or more chronic physical conditions and depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Generalized estimating equation model and stratification multilevel method were the main statistical models.

RESULTS

The presence of physical multimorbidity was associated with a higher risk of depression in both China (RR = 1.360 [95 % CI: 1.325-1.395]) and the US (RR = 1.613 [95 % CI: 1.529-1.701]). For individuals at a low risk of multimorbidity, multimorbidity was associated with 47.4 % (95 % CI: 1.377-1.579) and 71.1 % (95 % CI: 1.412-2.074) increases in the likelihood of depression in China and the US. The effect size was smaller for individuals at a moderate or high risk. However, the cross-national differences were greater for those with a high risk of multimorbidity.

LIMITATIONS

The self-report measures, attribution bias.

CONCLUSIONS

Compared to Chinese adults, the presence of physical multimorbidity led to an additional increase in depressive symptoms for American counterparts. The association was stronger for individuals at a low risk of multimorbidity, but cross-national differences were observed mostly among individuals at a high risk.

Gender-specific association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms

BACKGROUND

In the era of rapid aging with a rising prevalence of multimorbidity, complex interactions between physical and psychological conditions have challenged the health care system. However, little is known about the association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms, especially in developed countries.

METHODS

This population-based cohort study used data from the Health and Retirement Study. A total of 22,335 middle-aged and older adults participated in the 2014 (T1), 2016 (T2), and 2018 (T3) waves of the cohort were included. The accumulation of chronic conditions and disability were defined as the number of chronic diseases and the five activities of daily living. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. A longitudinal mediation model with a cross-lagged panel model was run. As robust check, the models were applied with a longer follow-up period (from 2012 to 2018). Additionally, results were estimated in China.

RESULTS

Bidirectional associations have been found among the accumulation of chronic conditions, disability, and depressive symptoms, especially between disability and depression. Disability (T2) mediated 11.11 % and 16.87 % of the association between the accumulation of chronic conditions (T1) and depression (T3) for men and women in the United States. The results were consistent in robust analysis.

CONCLUSIONS

This study found that men and women routinely experienced disability and depressive symptoms because of the accumulation of chronic conditions. In terms of depressive symptoms, women were more sensitive to the accumulation of chronic conditions through disability.

Depression in Brazilian farmers: prevalence and associated factors

BACKGROUND

The unique characteristics of rural areas and agricultural work can contribute to the genesis of diseases, including mental disorders such as depression.

AIMS

To estimate the prevalence of and factors associated with depression symptoms in Brazilian farmers.

METHODS

A cross-sectional epidemiological study involving 784 farmers of the state of Espírito Santo/Brazil was carried out. Depression was identified using the Mini-International Neuropsychiatric Interview. Hierarchical logistic regression was used to assess the associated factors.

RESULTS

The prevalence of depression symptoms among farmers was 16.8% (n = 132). Of those experiencing symptoms, 6.1% (n = 48) we're currently experiencing a depressive episode, and 10.7% (n = 84) a recurrent depressive episodes. The associated factors were: female gender (OR 1.63; 95% CI 1.04-2.54), not owning the land (OR 1.79; 95% CI 1.11-2.89), professional dissatisfaction (OR 1.99; 95% CI 1.18-3.35), previous pesticide poisoning (OR 2.87; 95% CI 1.45-5.67), complex multimorbidity (OR 1.95; 95% CI 1.15-3.31) and occurrence of previous depressive episodes (OR 9.83; 95% CI 4.39-21.99).

CONCLUSIONS

A high prevalence of depression symptoms was identified among rural workers. Sociodemographic, occupational, clinical, and professional dissatisfaction factors were associated with a higher risk of depression symptoms in this population.

The impact of chronic diseases on psychological distress among the older adults: the mediating and moderating role of activities of daily living and perceived social support

OBJECTIVES

Previous literature has shown that chronic diseases and psychological distress are correlated. However, the mediating and moderating mechanisms underlying this relationship have not been sufficiently studied. The purpose of this study was to explore the role played by activities of daily living (ADL) and perceived social support.

METHOD

Face-to-face questionnaire-based surveys were conducted with 3250 valid participants (age ≥60 years). Participants were assessed using the Barthel Index, Perceived Social Support Scale, and Depression Anxiety Stress Scale-21.

RESULTS

1) Chronic diseases had a significant direct effect on psychological distress in older adults; 2) the relationship between chronic diseases and psychological distress was partially mediated by ADL; and 3) the impact of chronic diseases on psychological distress was significantly moderated by perceived social support. More importantly, perceived social support was a protective factor that could effectively alleviate the adverse effects of chronic diseases on psychological distress.

CONCLUSION

The results add to the existing literature by uncovering the underlying mechanisms between chronic diseases and mental health. These findings have implications for early intervention and prevention of mental health problems in older adults.

Gender differences in the association between multimorbidity and depression in older Korean adults: an analysis of data from the National Survey of Older Koreans (2011-2017)

OBJECTIVES

Previous studies have shown that people with multimorbidity have a higher risk of depression than those without multimorbidity. However, few studies have examined the association between depression and multimorbidity in men and women separately. Since the rates of depression and multimorbidity are different in men and women, it is necessary to examine whether gender differences affect their association.

METHODS

This study included 30,138 participants (aged ≥ 65 years) from the National Survey of Older Koreans (2011-2017). Depression was defined using the Korean version of the Geriatric Depression Scale (SGDS-K). Multimorbidity was defined as people who had 2 or more chronic diseases, including arthritis, diabetes, heart disease, hypertension, pulmonary disease, cancer, stroke, or osteoporosis. Multiple logistic regression analysis was performed to determine the association between depression and multimorbidity.

RESULTS

In total, 22.2% and 30.7% of men and women, respectively, had depression. Those with multimorbidity had a higher risk of depression than those without chronic conditions; specifically, the difference in risk among men was greater than that among women. Age was considered a moderator for women. While the effects of pulmonary disease, stroke, and cancer were especially substantial in the integrated analysis, gender differences were observed related to various chronic conditions comorbid with heart disease.

CONCLUSIONS

There are gender differences in the association between multimorbidity and depression among older Korean adults. Therefore, gender-specific care should be provided to reduce depression in older adults with multimorbidity.

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.

Bidirectional association between depression and multimorbidity in middle-aged and elderly Chinese adults: a longitudinal cohort study

BACKGROUND

Few studies have investigated the bidirectional association between depression and multimorbidity from a longitudinal perspective. We aimed to explore the bidirectional relationship between depression and multimorbidity in a middle-aged and elderly Chinese population.

METHODS

Participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) were included. Depression was measured with a 10-item version of the Center for Epidemiological Studies Depression Scale (CESD-10). In stage I, we assessed the association of baseline depression with follow-up multimorbidity. In stage II, we examined whether multimorbidity increases the risk of depression. Logistic regression models were used to estimate the odds ratios (ORs) and confidence intervals (CIs). The ORs were then converted to risk ratios (RRs) using a proposed formula.

RESULTS

A total of 7056 subjects without multimorbidity and 7587 subjects without depression at baseline were included in stage I and stage II. In stage I, the adjusted RRs (95% CIs) of depressed participants developing one disease, two diseases, three diseases, and ≥4 diseases were 1.15 (0.96-1.35), 1.64 (1.36-1.99), 1.84 (1.44-2.35) and 2.42 (1.75-3.34), respectively. In stage II, compared with individuals without any disease, the adjusted RRs (95% CIs) of developing depression for individuals carrying one disease, two diseases, three diseases, and ≥4 diseases were 1.08 (0.96-1.22), 1.39 (1.22-1.57), 1.46 (1.23-1.70) and 1.62 (1.34-1.93), respectively.

CONCLUSIONS

Baseline depression increases the risk of future multimorbidity, and multimorbidity also contributes to an increased risk of incident depression in middle-aged and elderly Chinese adults.

Primary healthcare personnel challenges and barriers on the management of patients with multimorbidity in Albania

The number of people living with chronic conditions is increasing worldwide with most of these people receiving the needed healthcare services in primary healthcare (PHC) settings. The objective of this study was to explore the main challenges and barriers that PHC providers confront while treating multimorbid patients. This is a qualitative study utilising semi-structured individual in-depth interviews. The study took place in Vlora City, which is the biggest city located in south Albania. Τhe two biggest PHC centres of the city were enrolled. Purposive sampling method was used to recruit PHC practitioners. Main criteria of participation in the study were being fully employed at the enrolled primary care centres, having worked for at least 1 year and to deal with multimorbid patients in daily practice. Data collection took place from September 2019 to January 2020. In total, 36 semi-structured interviews took place with 23 (63.9%) nurses and 12 (33.3%) physicians (general practitioners/family doctors). Communication problems and disputes, lack of materials/equipment and the inappropriate infrastructure, miscommunication and problems in doctor-nurse relationships, coordination problems, lack of protocols and problems in the referral system were reported as the main challenges and barriers that the PHC personnel confront. The findings of this study are critical in understanding challenges that PHC personnel face when dealing with multimorbid patients in PHC settings. The emerged knowledge contributes significantly in a better understanding of the actual situation and to inform health policy makers on how to deal with the existing problems.

A randomized controlled trial of internet-delivered cognitive behaviour therapy to prevent the development of depressive disorders in older adults with multimorbidity

BACKGROUND

Multimorbidity, which commonly impacts older adults is associated with higher rates of depression. We aimed to investigate whether internet delivered cognitive-behaviour therapy (iCBT) could prevent depressive disorders in older adults with multimorbidity who were not currently depressed.

METHOD

302 primary care and community participants aged 65 years and over, who had multimorbidity but did not meet criteria for a depressive disorder were randomised to an intervention group who received an eight-week, five session iCBT (n = 150) or to a control group (n = 152) who received treatment as usual. Diagnostic interviews were conducted at baseline, and three and six months after the intervention period, where indicated, and the presence of depressive disorder was the primary outcome.

RESULTS

The intention to treat, chi-square analyses indicated there were significantly fewer cases of depressive disorder in the treatment group compared to the control group by six-month follow-up (χ²(1,302) = 5.21, p = .02).

LIMITATIONS

The main limitations of this RCT are a short follow up period and low proportion of participants who developed depressive disorders. Participants were relatively well educated, with a majority having English as their first language.

CONCLUSIONS

These results indicate that depressive disorder was prevented in the first six months following iCBT with three times the number of cases of depressive disorder in the control group compared to the treatment group. Further research is required to determine whether iCBT can be effective for preventing depressive disorder in this population over a longer time period.