Bidirectional association between physical multimorbidity and subclinical depression in Chinese older adults: Findings from a prospective cohort study

Association of chronic pain with incidence and progression of cardiometabolic multimorbidity in middle-aged and older populations: a multicohort study

Introduction

Chronic pain is associated with single cardiometabolic diseases (CMDs). Less is known about the association of chronic pain with the co-occurrence of multiple CMDs, known as cardiometabolic multimorbidity (CMM).

Objectives

This study aims to examine the association between chronic pain and incidence of CMM and if it existed, to what extent chronic pain relates to the progression of specific CMD-related multimorbidity (MM).

Methods

We pooled individual-level data of 59,134 participants from 4 cohort studies across 18 countries between 2010 and 2020. Participants aged 45 years or older, free of CMDs (diabetes, heart diseases, and stroke), and with self-reported chronic pain status at baseline were included. Multinomial logistic regression was performed on the association of chronic pain with incident CMM and the progression of specific CMD-related MM.

Results

One-third (21,204) of participants reported chronic pain at baseline. After 8 to 9 years, 1344 (2.3%) developed CMM. Chronic pain was associated with the onset of each CMD (odds ratio [OR] range 1.12-1.37) and CMM combinations (OR range 1.57-2.09). It is also linked with the increased odds of more CMDs (1, 2, and 3) during the follow-up. For example, OR increased from 1.31 for individuals with one CMD, to 1.57 for those with 2 CMDs, to 2.09 for those with 3 CMDs. Chronic pain was also associated with developing all CMD-related MM (OR range 1.26-1.88). Compared with those with diabetes only, participants with chronic pain were more likely to progress to diabetes and heart diseases, as well as diabetes, heart diseases, and stroke.

Conclusion

Chronic pain is associated with incidence and progression of CMM, whose management should be considered in primary and secondary prevention of CMM among middle-aged and older populations.

The association between the ten-year trajectory of multimorbidity and depressive symptoms among the middle-aged and older adults: Results from the China Health and Retirement Longitudinal Study

BACKGROUND

Despite the established link between chronic conditions and depressive symptoms in recent decades, research into the temporal dynamics between multimorbidity and the occurrence of depressive symptoms remains scarce.

METHODS

A total of 15,882 Chinese middle-aged and older adults with 63,246 observations from the China Health and Retirement Longitudinal Study were included in the present study. Depressive symptoms were evaluated using a 10-item CESD scale, with a threshold set at 12 points. Group-based trajectory modeling was used to examine the multimorbidity developmental trajectories. The risk of depressive symptoms was analyzed using mixed effect logistic regression models.

RESULTS

Among the final included 15,896 participants, 37.6 % reported states of multimorbidity, and 25.7 % were detected as depressive symptoms. In the fully adjusted model, those with multimorbidity were 2.36 (2.24 to 2.49) times more likely to present depressive symptoms, and the likelihood increased 1.38 (1.36 to 1.40) times with each additional chronic condition. Four distinct multimorbidity trajectory groups were identified: no-new-condition group (32.6 %), slow growth group (42.9 %), steady growth group (19.7 %), and rapid growth group (4.9 %). Compared to the no-new-condition group, the likelihood of developing depressive symptoms was greater in the subsequent three groups, with ORs of 1.53 (1.39 to1.71), 2.54 (2.24 to 2.89), and 4.40 (3.62 to 5.34), respectively.

CONCLUSION

Our results highlight the substantial health effects of accumulating multimorbidity on depressive symptoms, showing a direct link between risk and accumulation rate. We urge focusing on depressive symptoms in those with multimorbidity to tackle the significant healthcare challenges arising from concurrent physical and mental health issues.

Association Between Multimorbidity and Depression in Older Adults: Evidence From Six Large Longitudinal Cohorts

BACKGROUND

Multimorbidity may increase the risk of depression in older adults, but the global average effect of multimorbidity on depression remains unknown. This research aimed to exclude the regional heterogeneity to quantify the exposure-response association between multimorbidity and depression in older adults worldwide.

METHOD

We collected 23,947 participants aged 65 years or above from six large prospective cohorts from developed and developing countries, including Mexico, South Korea, Europe, America, China, and England. Multimorbidity was defined as an individual experiencing two or more chronic conditions simultaneously at baseline. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) or the EURO-D scale in each wave. We utilized Stratified Cox proportional hazards models to assess the effects of multimorbidity on depression in each cohort. Meta-analysis was then applied to obtain the average effects across cohorts.

RESULTS

Multimorbidity was significantly associated with depression in each cohort and the pooled HR for depression excluding the heterogeneity among six cohorts was 1.30 (95% CI: 1.25-1.37, Z = 10.28, p < 0.001). Compared with participants without any chronic condition, those with 1, 2, and ≥3 chronic conditions had HRs for depression of 1.15 (95% CI: 1.09-1.21, Z = 5.10, p < 0.001), 1.37 (95% CI: 1.29-1.45, Z = 10.00, p < 0.001), and 1.57 (95% CI: 1.45-1.70, Z = 10.9, p < 0.001), respectively. The effects of multimorbidity on depression were more pronounced in males (HR: 1.40 in males vs. 1.25 in females) and participants aged between 65 and 74 years (HR: 1.36 in 65-74 years vs. 1.22 in 75 years and older).

CONCLUSION

Older adults with multimorbidity are more likely to suffer depression. Effective strategies should be developed for older adults, including preventing and managing chronic conditions and improving mental health services.

The longitudinal association between physical health and depressive symptoms over eight years: Evidence from the health and retirement study

BACKGROUND

The bidirectional relationship between physical health (PH) and depressive symptoms (DS) remains unclear.

METHODS

Data were extracted from the Health and Retirement Study in the United States. PH was measured with a composite of chronic diseases, functional limitations and difficulties in basic and instrumental activities of daily living, and DS with a modified Center for Epidemiological Studies of Depression. Latent growth curve models (LGCM) were employed to examine how the change in PH or DS affected their mutual trajectories in later life. In addition, multilevel models were utilized.

RESULTS

There were 6144 participants included, with an average age of 69.82 ± 6.85 years at baseline, of whom 3686 (59.99 %) were women. PH scores increased from 5.65 in 2010 to 7.72 in 2018, while depression scores increased from 1.14 to 1.31. LGCM results showed that the initial levels of PH and DS were associated (β = 0.558, P < .001), and the initial level of PH could predict the trajectory of DS (β = 0.089, P < .001). Likewise, the initial level of DS was also related to initial PH (β = -0.563, P < .001) but couldn't predict the trajectory of PH. Furthermore, the slopes of PH and DS were predicted bidirectionally by each other. Two-level logistic models further demonstrated the bidirectional association between PH and DS.

CONCLUSION

There was a bidirectional association between physical health and depressive symptoms, which highlights the necessity of comprehensive health management for older adults with poor physical health or depression symptoms.

Association between consumption of fruits and vegetables in midlife and depressive symptoms in late life: the Singapore Chinese Health Study

OBJECTIVES

Epidemiological evidence of how midlife intake of fruits and vegetables affects the likelihood of depressive symptoms in late life remains limited and controversial. We examined this association in an Asian cohort.

DESIGN

Prospective population-based cohort study.

SETTING

Chinese living in Singapore.

PARTICIPANTS

A total of 13,738 adults from the Singapore Chinese Health Study.

MEASUREMENTS

The consumption of 14 fruits and 25 vegetables were assessed using a validated 165-item food-frequency questionnaire at baseline (1993-1998), when participants were aged 45-74 years (mean age 52.4 years). Depressive symptoms were evaluated using the Geriatric Depression Scale during the third follow-up interviews (2014-2016), when participants were aged 61-96 years (mean age 72.5 years), and depression was defined by ≥5 out of 15 scores. Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

After a mean follow-up of 19.6 years, depressive symptoms were identified among 3,180 participants. Consumption of fruits was inversely associated with the odds of depressive symptoms in a dose-response manner: comparing extreme quartiles, the OR (95% CI) of depressive symptoms was 0.71 (0.63-0.81; P-trend <0.01). Intake of several types of fruits, especially orange, tangerine, banana, papaya and watermelon, was associated with reduced odds, and this inverse association was similar across subgroups of fruits categorized by glycemic index. Conversely, intake of vegetables was not associated with the odds of depressive symptoms.

CONCLUSIONS

Our findings support population-based recommendation of having sufficient fruit intake early in life to reduce the likelihood of depressive symptoms in late life.

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.

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

This study explores the bidirectional association between multimorbidity and falls in Chinese middle-aged and elderly adults. Participants aged 45 and above from the China Health and Retirement Longitudinal Study were included. Binary logistic regression assessed the impact of chronic conditions on fall incidence (stage I), while multinomial logistic regression examined the relationship between baseline falls and multimorbidity (stage II). The fully adjusted odds ratios (ORs) for one, two, or three or more chronic conditions were 1.34, 1.65, and 2.02, respectively. Among participants without baseline falls, 28.61% developed two or more chronic conditions during follow-up, compared to 37.4% of those with a history of falls. Fully adjusted ORs for one, two, or three or more chronic conditions in those with a history of falls were 1.21, 1.38 and 1.70, respectively. The bidirectional relationship held in sensitivity and subgroup analyses. A bidirectional relationship exists between multimorbidity and falls in Chinese middle-aged and elderly adults. Strengthening chronic condition screening and treatment in primary healthcare may reduce falls risk, and prioritizing fall prevention and intervention in daily life is recommended.

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.

Secular trends in the incidence of major depressive disorder and dysthymia in China from 1990 to 2019

BACKGROUND

Depression is increasingly recognized as a worldwide serious, public health concern. A better understanding of depression is important for advancing its management and learning the difference between major depressive disorder (MDD) and dysthymia. Our aim is to conduct a concurrent analysis of the trends of both MDD and dysthymia in China.

METHODS

The data on depression from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 (GBD 2019). To determine the average annual percent changes (AAPC) and relative risks (RRs), joinpoint regression and the age-period-cohort models were employed, respectively.

RESULTS

The incidence number of MDD and dysthymia continuously increased in China from 1990 to 2019, however, the age-standardized rates (ASR) had a decreasing trend in both men and women. The results from joinpoint regression showed that a declining trend was presented in young people (< 50 years) but an increased trend in the elderly (≥ 50 years) both in men and women, during 1990-2019. Age is the most influential factor for MDD and dysthymia. Age RRs for MDD incidence had an overall increasing trend with age. Period RR in MDD presented a U-shaped pattern, while Cohort RRs presented an inverted U-shaped pattern. On the other hand, RRs in dysthymia for period and cohort effects had no statistical significance, only the age effect presented an inverted U-shaped pattern.

CONCLUSIONS

The disparities in trends observed between MDD and dysthymia during the period of 1990-2019 indicated the significance of distinguishing between these two disorders. The age, period and cohort effects all had a greater impact on MDD than on dysthymia, and age effects presented different influential patterns in these two. To alleviate the burden of depressive disorders in China, proactive measures need to be implemented, with particular attention to the elderly population.

Depressive symptoms, alone or together with physical comorbidity, are predictive of healthcare use and spending in older adults

OBJECTIVE

Depressive symptoms and physical comorbidity are common health problems in older adults and are both posing increasingly considerable challenges to global healthcare systems. This study investigated the relationships of depressive symptoms, alone or together with physical comorbidity, with healthcare utilization and spending among older adults, as well as examined sex differences.

METHODS

We used data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 and enrolled 6519 participants. Depressive symptoms was operationalized following the Center for Epidemiological Studies Depression Scale and physical comorbidity was assessed according to the presence of 11 physical non-communicable diseases. The relationships of depressive symptoms and comorbidity with healthcare outcomes were examined using mixed-effects regression models.

RESULTS

Compared with the neither depressive symptoms nor physical comorbidity category, older adults classified as depressive symptoms-only, physical comorbidity-only or both conditions were all associated with elevated risks for healthcare use and spending (all OR/IRR > 1; all p < 0.001). Depressive symptoms and physical comorbidity in combination consistently led to higher risks for studied endpoints than either condition alone (outpatient visit: OR = 3.50, outpatient visit number: IRR = 3.39, inpatient visit: OR = 3.35, hospitalization days: IRR = 2.82, catastrophic health expenditure: OR = 1.70; all p-trend < 0.001). Stratification analyses revealed similar relationships irrespective of sex.

CONCLUSION

Depressive symptoms and physical comorbidity are separately and jointly associated with increased healthcare utilization and spending among Chinese older adults. These two conditions in combination lead to highest risks than either condition alone. Early screen for depressive symptoms, alone or together with physical comorbidity, may offer implications for appropriate policy interventions.

Late-life depression and multimorbidity trajectories: the role of symptom complexity and severity

INTRODUCTION

as late-life depression is associated with poor somatic health, we aimed to investigate the role of depression severity and symptom phenotypes in the progression of somatic multimorbidity.

METHODS

we analysed data from 3,042 dementia-free individuals (60+) participating in the population-based Swedish National Study on Aging and Care in Kungsholmen. Using the baseline clinical assessment of 21 depressive symptoms from the Comprehensive Psychopathological Rating Scale, we: (i) diagnosed major, minor (in accordance with DSM-IV-TR) and subsyndromal depression; (ii) extracted symptom phenotypes by applying exploratory network graph analysis. Somatic multimorbidity was measured as the number of co-occurring chronic diseases over a 15-year follow-up. Linear mixed models were used to explore somatic multimorbidity trajectories in relation to baseline depression diagnoses and symptom phenotypes, while accounting for sociodemographic and behavioural factors.

RESULTS

in multi-adjusted models, relative to individuals without depression, those with major (β per year: 0.33, 95% confidence interval [CI]: 0.06-0.61) and subsyndromal depression (β per year: 0.21, 95%CI: 0.12-0.30) experienced an accelerated rate of somatic multimorbidity accumulation, whereas those with minor depression did not. We identified affective, anxiety, cognitive, and psychomotor symptom phenotypes from the network analysis. When modelled separately, an increase in symptom score for each phenotype was associated with faster multimorbidity accumulation, although only the cognitive phenotype retained its association in a mutually adjusted model (β per year: 0.07, 95%CI: 0.03-0.10).

CONCLUSIONS

late-life major and subsyndromal depression are associated with accelerated somatic multimorbidity. Depressive symptoms characterised by a cognitive phenotype are linked to somatic health change in old age.

Bidirectional Association Between Probable Depression and Multimorbidity Among Middle-Aged and Older Adults in Thailand

Introduction

The purpose of this study was to assess the bidirectional association between multimorbidity (MM) and probable depression in a longitudinal study in Thailand.

Methods

We analyzed longitudinal data of participants 45 years and older from two consecutive waves (in 2015 and 2017) of Health, Aging, and Retirement in Thailand (HART). Probable depression was assessed using the Center for Epidemiological Studies Depression scale. Logistic regression analysis was conducted to assess the association between baseline probable depression and incident physical MM, and baseline physical MM and incident probable depression.

Results

In all, 2712 participants without MM at baseline and 2684 without probable depression at baseline were included. At follow-up 15.6% of probable depression cases and 11.4% of nonprobable depression cases developed physical MM, and at follow-up 13.3% of physical MM cases and 8.9% of nonphysical MM cases developed probable depression. In the final logistic regression analysis, adjusted for age, sex, marital status, income, education, body mass index, physical activity, smoking tobacco, alcohol use, and social engagement, probable depression at baseline was positively associated with incident physical MM (aOR: 1.50, 95% CI: 1.09 to 2.06), and physical MM at baseline was positively associated with incident probable depression (aOR: 1.47, 95% CI: 1.07 to 2.02).

Discussion

Baseline physical MM increases the risk of incident probable depression and baseline probable depression increases the risk of incident physical MM among middle-aged and older adults in Thailand.

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.