Patterns of multimorbidity and some psychiatric disorders: A systematic review of the literature

Accepting multiple conditions in psychiatry: From comorbidity to multimorbidity

The concept of multimorbidity in psychiatry refers to the coexistence of multiple health conditions without conceptualizing a central disorder referring to a patient-centered approach that views every diagnosis equally. It emphasizes a shift from focusing on an index disorder to considering interrelated symptoms crucial in psychiatry due to frequent multimorbidity patterns. In clinical practice, multimorbidity guides patient-centered care helping to address the holistic needs of patients and challenging the organization of mental health care. In research, multimorbidity reshapes study outcomes and promotes the development of patient-reported outcome questionnaires, also posing ethical challenges and advocating for the inclusion of multimorbid patients in personalized interventions. Finally, multimorbidity in psychiatry has public health implications aligning with the socioecological systems perspective. This notion aims to improve prognosis, care, and health costs while impacting global mortality and challenging the conceptualization and organization of psychiatric care.

Multimorbidity characteristics in older adults and their associated factors in complex networks: a cross-sectional study

Background

Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the older adults in Jiangsu, China is relatively lacking.

Methods

We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patterns in old adults.

Results

The mean age of these patients was 72.0 ± 8.7 years, and the male-to-female ratio was 1: 1.53. These patients during the COVID-19 period (from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases (I10-I15)," "Other forms of heart disease (I30-I52)," "Diabetes mellitus (E10-E14)," "ischaemic heart diseases (I20-I25)" and "Cerebrovascular diseases (I60-I69)." The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by diabetes mellitus, other forms of heart disease, and ischaemic heart diseases (I20-I25).

Conclusion

In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in most periods. However, during the pandemic period, we should pay more attention to diseases that require urgent treatment, such as malignant tumors. For different periods, the spectrum of diseases we focus on should change accordingly.

Multimorbidity and its association with mental health in an adult population of Peru

BACKGROUND

Motivation for the study. The presence of multimorbidity is increasingly frequent in the general population, and this may be associated with mental health problems. Main findings. The presence of multimorbidity, and a great number of chronic conditions, was associated with a higher prevalence of depressive symptoms, anxiety and perceived stress in an adult population in a region of northern Peru. Implications. Our findings suggest the need for adequate mental health management in patients with more than one chronic disease.

OBJECTIVE.

To evaluate the association between multimorbidity and mental health in adults aged 30 to 69 years.

MATERIALS AND METHODS.

Secondary data analysis of a population-based study conducted in the peri-urban area of Tumbes in the northern coast of Peru. The dependent variables were: depressive symptoms, using the PHQ-9; anxiety symptoms, using the Goldberg scale; and perceived stress, assessed with the Cohen's 14-question scale. The exposure variable was the presence of multimorbidity (presence or not of two or more chronic conditions and the number of chronic conditions). We assessed associations using crude and adjusted Poisson regression models.

RESULTS.

Data from 1600 participants were analyzed, mean age was 48.1 years (SD: 10.5), and 50.4% were women. The prevalence of multimorbidity was 15.9%, 23.3% presented depressive symptoms, 42.0% anxiety symptoms and 31.4% had high levels of perceived stress. The multivariable model showed that multimorbidity was associated with a higher prevalence of depressive symptoms (61%, 95%CI: 32% - 98%), anxiety symptoms (46%, 95%CI: 28% - 66%) and high (22%, 95%CI: 14% - 33%) but not moderate levels of perceived stress (6%; 95%CI: 0% - 12%). A higher number of chronic conditions was associated with higher prevalence of depressive symptoms, anxiety symptoms, and perceived stress levels.

CONCLUSIONS.

The presence of multimorbidity is associated with a higher prevalence of depressive symptoms, anxiety symptoms, and perceived stress levels. Our results suggest the need for adequate mental health management in patients with multimorbidity.

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme

BACKGROUND

Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders.

METHODS AND FINDINGS

This cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10).

CONCLUSIONS

BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

Chronic Disease Patterns and Their Relationship With Health-Related Quality of Life in South Korean Older Adults With the 2021 Korean National Health and Nutrition Examination Survey: Latent Class Analysis

BACKGROUND

Improved life expectancy has increased the prevalence of older adults living with multimorbidities, which likely deteriorates their health-related quality of life (HRQoL). Understanding which chronic conditions frequently co-occur can facilitate person-centered care tailored to the needs of individuals with specific multimorbidity profiles.

OBJECTIVE

The study objectives were to (1) examine the prevalence of multimorbidity among Korean older adults (ie, those aged 65 years and older), (2) investigate chronic disease patterns using latent class analysis, and (3) assess which chronic disease patterns are more strongly associated with HRQoL.

METHODS

A sample of 1806 individuals aged 65 years and older from the 2021 Korean National Health and Nutrition Examination Survey was analyzed. Latent class analysis was conducted to identify the clustering pattern of chronic diseases. HRQoL was assessed by an 8-item health-related quality of life scale (HINT-8). Multiple linear regression was used to analyze the association with the total score of the HINT-8. Logistic regression analysis was performed to evaluate the odds ratio of having problems according to the HINT-8 items.

RESULTS

The prevalence of multimorbidity in the sample was 54.8%. Three chronic disease patterns were identified: relatively healthy, cardiometabolic condition, arthritis, allergy, or asthma. The total scores of the HINT-8 were the highest in participants characterized as arthritis, allergy, or asthma group, indicating the lowest quality of life.

CONCLUSIONS

Current health care models are disease-oriented, meaning that the management of chronic conditions applies to a single condition and may not be relevant to those with multimorbidities. Identifying chronic disease patterns and their impact on overall health and well-being is critical for guiding integrated care.

Findings from the Indonesian family life survey on patterns and factors associated with multimorbidity

The prevalence of multimorbidity tends to increase with age, but it is now also reported in the middle-aged population, which has a negative impact on healthcare systems and health outcomes. This study aims to analyze the patterns and factors associated with multimorbidity in Indonesia. This national cross-sectional population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among middle-aged (40-59 years old) and elderly (≥ 60 years old) respondents. Information on all chronic diseases was assessed using a self-reported questionnaire. Sociodemographic and health-related behavioral factors were obtained from self-reported data. Binary logistic regression analysis was used to identify the factors associated with multimorbidity. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. The study recruited 11,867 respondents. The prevalence of multimorbidity was 18.6% (95% CI 17.9-19.3) with which 15.6% among middle age (95% CI 14.95-16.25) and 24.9% among the elderly (95% CI 24.12-25.68). Hypertension was the most commonly reported disease (23.2%) in all combinations of multimorbidity and among all age groups. Socio-demographic factors: elderly (AOR: 1.66; 95% CI 1.46-1.89), female (AOR: 1.42; 95% CI 1.20-1.69), living in the urban area (AOR: 1.22; 95% CI 1.09-1.38), higher educational level (AOR: 2.49; 95% CI 1.91-3.26), unemployed (AOR: 1.63; 95% CI 1.44-1.84), and higher economic level (AOR: 1.41; 95% CI 1.18-1.68) were associated with multimorbidity. Poor health behavior factors: being former smokers (AOR: 2.03; 95% CI 1.65-2.51) and obesity (AOR: 1.53; 95% CI 1.35-1.75) were also associated with multimorbidity. The prevalence of multimorbidity in the middle-aged and elderly population in Indonesia is relatively high, particularly in populations with poor health behaviors. Therefore, healthcare professionals should integrate more patient-specific factors when designing and implementing tailored interventions to manage multimorbidity in Indonesia.