Associations Between Somatic Multimorbidity Patterns and Depression in a Longitudinal Cohort of Middle-Aged and Older Chinese

doi:10.1016/j.jamda.2019.11.028

Journal of the American Medical Directors Association

Volume 21, Issue 9, September 2020, Pages 1282-1287.e2

https://doi.org/10.1016/j.jamda.2019.11.028 Get rights and content

Abstract

Objectives

Depressive symptoms are commonly seen among patients with multiple chronic somatic conditions, or somatic multimorbidity (SMM); however, little is known about the relationships between depressive symptoms and different SMM combinations. Our study aimed to delineate the patterns of SMM and their longitudinal associations with depressive symptoms among a nationally representative sample of middle-aged and older Chinese adults.

Design

We employed a longitudinal design.

Setting and Participants

Older adults (N = 10,084) aged ≥45 years from the China Health and Retirement Longitudinal Study 2011-2015 participated (mean age = 57.7 years at baseline; 53.3% men).

Methods

Sixteen chronic somatic conditions were ascertained at baseline via questionnaires. Depression was assessed with the Center for Epidemiological Studies Depression Scale at baseline and during follow-up. Patterns of SMM were identified via exploratory factor analyses. Generalized estimating equations were used to evaluate the longitudinal associations between patterns of SMM and the presence of depressive symptoms at follow-up.

Results

Compared with participants with no somatic condition, those with 1, 2, and 3 or more somatic conditions had a 21%, 66%, and 111% greater risk, respectively, for the presence of depressive symptoms. Increased factor scores for 4 patterns identified, cardio-metabolic pattern [adjusted odds ratio (AOR) 1.12, 95% confidence interval (CI) 1.06, 1.20], respiratory pattern (AOR 1.25, 95% CI 1.17, 1.33), arthritic-digestive-visual pattern (AOR 1.29, 95% CI 1.22, 1.37), and hepatic-renal-skeletal pattern (AOR 1.09, 95% CI 1.02, 1.16), were all associated with a higher risk of having depressive symptoms.

Conclusions and Implications

All SMM patterns were independently associated with depression among middle-aged and older Chinese adults, with greater odds for people with comorbid arthritic-digestive-visual conditions and respiratory conditions. Clinical practitioners should treat the middle-aged and older population under a multiple-condition framework combining SMM and mental disorders.

Section snippets

Study Population and Data Collection

Our study used data from the China Health and Retirement Longitudinal Study (CHARLS), a national cohort composed of 1 baseline investigation in 2011 with biennial follow-ups. Two follow-up surveys were successfully conducted in 2013 and 2015, respectively. The CHARLS national baseline survey used a multistage sampling strategy within 28 provinces, 150 counties and districts, and 450 villages and urban communities across the country. Details of the CHARLS survey have been described elsewhere.²⁵

Results

Table 1 and Supplementary Table 2 show the baseline sociodemographics, health characteristics, and incidence of depression of study population. Of the 10,084 participants aged 45 years and older, the mean age was 57.7 years, and 46.7% were women. Overall, the incidence rates of depression were 79.1 per 1000 person-years. Compared with participants without SMM, those with SMM were more likely to be older; widowed, divorced, or never married; urban residents; former smokers; former drinkers; and

Discussion

This study examined SMM patterns and their longitudinal associations with depressive symptoms among a nationally representative sample of community-dwelling middle-aged and older Chinese adults. Depressive symptoms were more likely in people with SMM compared with people without SMM or those who had no somatic condition. There were 4 SMM patterns identified: cardio-metabolic, respiratory, arthritic-digestive-visual, and hepatic-renal-skeletal, which were positively associated with a higher risk

Conclusions and Implications

In conclusion, high scores for 4 distinct SMM patterns were associated with depression. Further, although certain somatic conditions may not be associated with depression, their combinations may have a strong association with subsequent depression, suggesting that groups of somatic conditions may have a synergistic effect on mental health. Our study also helps explore possible interactions between different somatic conditions and improve approaches for managing SMM as well as mental health in

Acknowledgments

We thank the China Health and Retirement Longitudinal Study research and field team for collecting the data.

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Citation Excerpt :
However, there was no significant association between the number of chronic conditions and psychological distress including anxiety and depression. This unexpected finding was inconsistent with previous studies in China (Yao et al., 2020; You et al., 2019), the UK (Foster and Niedzwiedz, 2021), and Australia (Gunn et al., 2012). This disagreement might be explained by several reasons.
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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.
Compared with those without physical chronic conditions, having five or more physical chronic conditions was associated with the likelihood of depression after covariates adjustment.
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.

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: This work was supported by 2 grants from National Natural Science Foundation of China (grant number 81703304 and 81973130). The sponsors did not play a role in the study design, methods, subject recruitment, data collections, analysis, and preparation of the manuscript.

: The authors declare no conflicts of interest.

View full text

Original StudyAssociations Between Somatic Multimorbidity Patterns and Depression in a Longitudinal Cohort of Middle-Aged and Older Chinese

Abstract

Objectives

Design

Setting and Participants

Methods

Results

Conclusions and Implications

Section snippets

Study Population and Data Collection

Results

Discussion

Conclusions and Implications

Acknowledgments

J Affect Disord

J Affect Disord

Ageing Res Rev

J Affect Disord

Psychoneuroendocrinology

J Affect Disord

Gen Hosp Psychiatry

Biol Psychiatry

J Clin Epidemiol

Chest

J Cardiol

EBioMedicine

Lancet

Int J Nurs Stud

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

Lancet

Late-life depression and the association with multimorbidity and polypharmacy: A cross-sectional study

Fam Pract

Depression and multimorbidity: A cross-sectional study of 1,751,841 patients in primary care

J Clin Psychiatry

The association of depression and multimorbidity in the elderly: Implications for the assessment of depression

Psychogeriatrics

Risk factors of geriatric depression in rural China based on a generalized estimating equation

Int Psychogeriatr

The relationship of depression in asthma-chronic obstructive pulmonary disease overlap syndrome

PLoS One

Bidirectional association between depression and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies

Diabetes Care

The prevalence of chronic physical diseases comorbid with depression among different sex and age groups in South Korea: A population-based study, 2007-2014

Psychiatry Investig

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

BMC Psychiatry

Anti-inflammatory treatment and risk for depression after first-time stroke in a cohort of 147 487 Danish patients

J Psychiatry Neurosci

Original Study
Associations Between Somatic Multimorbidity Patterns and Depression in a Longitudinal Cohort of Middle-Aged and Older Chinese