The relationship between multiple chronic diseases and depressive symptoms among middle-aged and elderly populations: results of a 2009 korean community health survey of 156,747 participants

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Abstract

Background

The purpose of this study was to investigate the relationship between multiple chronic diseases and depressive symptoms in middle-aged and elderly populations.

Methods

This study was performed using the 2009 Korean Community Health Survey, which targeted adults over the age of 40 ( N = 156,747 participants, 88,749 aged 40–59 years and 67,998 aged ≥60 years). The Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D-K) was used as the measurement tool for depressive symptoms (CES-D-K score over 16). Multiple chronic diseases were defined as the concurrent presence of two or more chronic diseases.

Results

The prevalence and risk ratios (RRs) of experiencing depressive symptoms increased in the presence of multiple chronic diseases and with the number of comorbidities. The RRs of experiencing depressive symptoms according to the presence of multiple chronic diseases were higher in the middle-aged population (adjusted RR, 1.939, 95% confidence limits (CL), 1.82-2.06) than in the elderly population (adjusted RR, 1.620, 95% CL, 1.55-1.69). In particular, middle-aged women who suffer from 4 or more chronic diseases have the highest RR (adjusted RR, 4.985, 95% CL, 4.13-6.03) for depressive symptoms.

Conclusions

Multiple chronic diseases are closely associated with depressive symptoms in middle-aged and elderly populations. Given the mutual relationship between multiple chronic diseases and depressive symptoms, attention to and the assessment of depressive symptoms are needed in people with multiple chronic diseases.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4798-2) contains supplementary material, which is available to authorized users.

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Most cited references 42

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Epidemiology and treatment of depression in patients with chronic medical illness

Wayne. J. Katon (2011)

There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.

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Association of depression and diabetes complications: a meta-analysis.

Jennifer M de Groot, R R Anderson, K Freedland … (2015)

The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes complications in studies of type 1 and type 2 adult patients with diabetes. MEDLINE and PsycINFO databases were searched for articles examining depression and diabetes complications in type 1 and type 2 diabetes samples published between 1975 and 1999. Meta-analytic procedures were used. Studies were reviewed for diabetes type, sample size, statistical tests, and measures of diabetes complications and depression. Significance values, weighted effect sizes r, 95% confidence intervals (CI), and tests of homogeneity of variance were calculated for the overall sample (k = 27) and for subsets of interest. A total of 27 studies (total combined N = 5374) met the inclusion criteria. A significant association was found between depression and complications of diabetes (p < .00001, z = 5.94). A moderate and significant weighted effect size (r = 0.25; 95% CI: 0.22-0.28) was calculated for all studies reporting sufficient data (k = 22). Depression was significantly associated with a variety of diabetes complications (diabetic retinopathy, nephropathy, neuropathy, macrovascular complications, and sexual dysfunction). Effect sizes were in the small to moderate range (r = 0.17 to 0.32). These findings demonstrate a significant and consistent association of diabetes complications and depressive symptoms. Prospective, longitudinal studies are needed to identify the pathways that mediate this association.

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Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes.

Deyi Zheng, Leonard Egede, Kit N Simpson (2002)

This study ascertained the odds of diagnosed depression in individuals with diabetes and the relation between depression and health care use and expenditures. First, we compared data from 825 adults with diabetes with that from 20,688 adults without diabetes using the 1996 Medical Expenditure Panel Survey (MEPS). Second, in patients with diabetes, we compared depressed and nondepressed individuals to identify differences in health care use and expenditures. Third, we adjusted use and expenditure estimates for differences in age, sex, race/ethnicity, health insurance, and comorbidity with analysis of covariance. Finally, we used the Consumer Price Index to adjust expenditures for inflation and used SAS and SUDAAN software for statistical analyses. Individuals with diabetes were twice as likely as a comparable sample from the general U.S. population to have diagnosed depression (odds ratio 1.9, 95% CI 1.5-2.5). Younger adults (<65 years), women, and unmarried individuals with diabetes were more likely to have depression. Patients with diabetes and depression had higher ambulatory care use (12 vs. 7, P < 0.0001) and filled more prescriptions (43 vs. 21, P < 0.0001) than their counterparts without depression. Finally, among individuals with diabetes, total health care expenditures for individuals with depression was 4.5 times higher than that for individuals without depression ($247,000,000 vs. $55,000,000, P < 0.0001). The odds of depression are higher in individuals with diabetes than in those without diabetes. Depression in individuals with diabetes is associated with increased health care use and expenditures, even after adjusting for differences in age, sex, race/ethnicity, health insurance, and comorbidity.

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Author and article information

Contributors

JooYeon Seo: rirooroo@naver.com

BoYoul Choi: bychoi@hanyang.ac.kr

Shinah Kim: gdindus@hanmail.net

HyeYoung Lee: smile0129@naver.com

DongHoon Oh:

ORCID: http://orcid.org/0000-0001-9338-643X

+82-2-2220-0662 , seulhahmc@gmail.com

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 25 October 2017

Publication date PMC-release: 25 October 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 844

Affiliations

[1 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Institute for Health and Society, College of Medicine, , Hanyang University, ; 222 Wangsimni–ro, Sungdong–Gu, Seoul, 04763 South Korea

[2 ]ISNI 0000 0001 1364 9317, GRID grid.49606.3d, Department of Preventive Medicine, College of Medicine, , Hanyang University, ; Seoul, South Korea

[3 ]ISNI 0000 0004 0647 1313, GRID grid.411983.6, Center for Farmers’ Safety & Health, , Dankook University Hospital, ; Cheonan, South Korea

[4 ]Seulha Mental Health Clinic, Jeju, South Korea

Author information

DongHoon Oh http://orcid.org/0000-0001-9338-643X

Article

Publisher ID: 4798

DOI: 10.1186/s12889-017-4798-2

PMC ID: 5657127

PubMed ID: 29070021

SO-VID: c8770ecc-8137-444c-8545-117a475810c1

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 April 2017

Date accepted : 22 September 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003669, Korea Centers for Disease Control & Prevention;

Award ID: 2010–02–CON–22–P

Award Recipient : BoYoul Choi

Custom metadata

ScienceOpen disciplines: Public health

Keywords: community surveys,comorbidity,depressive symptoms,epidemiologic studies,republic of korea

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ScienceOpen disciplines: Public health

Keywords: community surveys, comorbidity, depressive symptoms, epidemiologic studies, republic of korea

The relationship between multiple chronic diseases and depressive symptoms among middle-aged and elderly populations: results of a 2009 korean community health survey of 156,747 participants

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Jiangsu Journal of Preventive Medicine

Most cited references 42

Epidemiology and treatment of depression in patients with chronic medical illness

Association of depression and diabetes complications: a meta-analysis.

Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes.

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