Elsevier

Journal of Affective Disorders

Volume 292, 1 September 2021, Pages 30-35
Journal of Affective Disorders

Research paper
Multimorbidity study with different levels of depression status

https://doi.org/10.1016/j.jad.2021.05.039Get rights and content

Highlights

  • Positive correlation between multimorbidity and depression status was identified, where the number of multimorbidity increased with the levels of depression status, especially in females, the young and the middle-age.

  • This correlation was visualized by the weighted network. The absolute network density reached the highest in participants with severe depression, and smallest in participants with no depression.

  • Limitations: Due to the cross-sectional study design, causal correlation remained unknown.

Abstract

Objective

Depression is one of the leading causes of disability burden and frequently co-occurs with multiple chronic diseases, but limited research has yet evaluated the correlation between multimorbidity and depression status by sex and age.

Methods

29303 adults from 2005-2016 National Health and Nutrition Examination Survey were involved in the study. The validated Patient Health Questionnaire (PHQ-9) was used to assess depression status. The linear trend of the prevalence of multimorbidity was tested by logistic regressions, which was visualized by the weighted network. Gamma coefficient (γ) was used to evaluate the correlation between multimorbidity and depression status.

Results

The prevalence of multimorbidity in participants with no depression, mild depression, moderate depression and severe depression was 52.1%, 63.0%, 68.4% and 76.1%, respectively (p for trend < 0.001). In network analysis, the absolute network density increased with the levels of depression status (from 4.54 to 15.04). Positive correlation was identified between multimorbidity and depression status (γ=0.21, p<0.001), and the correlation was different by sex and age, where it was stronger in women than men (females: γ=0.23, males: γ=0.16), and stronger in the young and the middle-age (young: γ=0.30, middle-age: γ=0.29, old: γ=0.22).

Limitations

This is a cross-sectional study and thus we cannot draw firm conclusions on causal correlations.

Conclusions

Positive correlation between multimorbidity and depression status was identified, where the number of multimorbidity increased with the levels of depression status, especially in females, the young and the middle-age.

Introduction

The prevalence of chronic diseases is increasing due to the rapid aging of the population and the greater longevity of people with chronic diseases worldwide(Organization, 2011). Along with an increase in the number of those with specific diseases, the prevalence of multimorbidity defined as 2 or more co-occurring chronic diseases is rising(Diederichs et al., 2011; Mollica and Gillespie, 2003). The high prevalence of multimorbidity (exceeding 77% in those 65 years and older) is alarming(Nunes et al., 2016), considering multimorbidity is associated with increased mortalit(Rosbach and Andersen, 2017). The simultaneous presence of multimorbidity is a key challenge facing primary care(Landi et al., 2010; Menotti et al., 2001). Further, depression frequently co-occurs with multiple chronic diseases in complex, costly, and dangerous patterns of multimorbidity. Consequently, it is of great significance to explore the correlation between multimorbidity and depression.

According to the World Health Organization, depression is one of the leading causes of disability around the world and the fourth leading contributor to the global burden of disease(Organization W, 2001). The World Health Organization predicts that by 2030, mental illnesses will be the leading disease burden globally(“World Health Organization Mental Health,” n.d.). Depression affects more than 300 million people worldwide, and approximately 10-25% of females and 7-12% of males have experienced at least one episode of depression during their lifetime(Driscoll et al., 2010; Kessler et al., n.d.). Previous researches have documented the correlation between depression and specific chronic diseases including diabetes, asthma and coronary heart disease(Choi et al., 2019; Dhar and Barton, 2016; Park and Reynolds, 2015). While the majority of studies, which have assessed the medical consequences of depression, have focused on individual chronic diseases, only a few research have evaluated the correlation between multimorbidity and depression status.

Although there are already some researches on multimorbidity and depression status, the prevalence of multimorbidity for participants with different levels of depression status, to our knowledge, is not clearly and has not been studied comprehensively. Moreover, the multimorbidity network for participants with different levels of depression status has not been evaluated well. In this study, we aim to evaluate the linear trend of the prevalence of multimorbidity for participants with different levels of depression based on weighted network, and further evaluate the correlation between multimorbidity and depression status by sex and age. This study is important because it will enable us to find the threat of multimorbidity for participants with different levels of depression status by sex and age, and develop targeted strategies to reduce the burden of chronic disease.

Section snippets

Data collection and study population

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative sample of the non-institutionalized US civilians, selected by a complex, stratified, multistage sample design. The study protocol was approved by the NCHS Institutional Review Board and all informed consent was obtained from all participants. 6 cycles of NHANES (2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014 and 2015-2016) were combined in the present analysis. A total of 29303 individuals aged

Sex-specific and age-specific prevalence of multimorbidity for participants with different levels of depression status

The prevalence of multimorbidity in the participants with no depression, mild depression, moderate depression and severe depression was 52.1%, 63.0%, 68.4% and 76.1% respectively, which showed statistically significant trend (p for trend < 0.001). A similar significant trend was also found in all the sexes and ages (Table 1).

Sex-specific and age-specific analysis of multimorbidity networks for participants with different levels of depression status

Overall, the absolute network density of participants with depression was higher than those with no depression, thus the network of participants with depression was much

Discussion

In our study of community-dwelling adults aged 20 or older, trend analysis suggested that participants who had higher levels of depression status were at a higher prevalence of multimorbidity. Further, similar results in network analysis, the absolute network density increased from 4.54 to 15.04 with the levels of depression status. The greater the absolute network density, the more chronic diseases tended to occur simultaneously. It was alarming that the prevalence of multimorbidity for

Conclusion

Our findings suggested a positive correlation between multimorbidity and depression status, and the number of multimorbidity increased with the levels of depression status, especially in females, the young and the middle-age. These findings underscored the importance of addressing depression status, age and sex differences when developing targeted strategies to reduce the burden of chronic diseases.

Data availability statement

The data that support the findings of this study are openly available in https://www.cdc.gov/nchs/nhanes/. Information from NHANES is made available through an extensive series of publications and articles in scientific and technical journals. For data users and researchers throughout the world, survey data are available on the internet and on easy-to-use CD-ROMs.

Declaration of Competing Interest

None.

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