Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom.
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven, Kortenberg, Belgium.
Maturitas. 2018 Jan;107:84-91. doi: 10.1016/j.maturitas.2017.10.007. Epub 2017 Oct 16.
Stress in chronic conditions or multimorbidity (≥2 chronic conditions) has been reported to affect clinical outcomes but there are no studies on the association between stress and chronic conditions/multimorbidity among older adults in low- and middle-income countries (LMICs). Thus, we investigated this association among adults aged ≥50 years across six LMICs.
A cross-sectional analysis using data from the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) was conducted. A perceived stress score [range 0 (lowest stress) -100 (highest stress)] was computed based on two questions from the Perceived Stress Scale. Thirteen chronic conditions were assessed. Multivariable linear regression analyses were conducted.
34,129 adults with a mean age of 62.4 (SD=16.0)years (52.1% females) were included. Overall, 56.6% (95% CI=55.0%-58.2%) had multimorbidity. In the adjusted model including all countries, compared with those with no chronic conditions, higher numbers of chronic conditions were significantly associated with higher stress levels, dose dependently. In a countrywide meta-analysis, multimorbidity was associated with significantly higher stress levels in all countries (especially India and Ghana) although characterized by moderate heterogeneity (I=54.6%). For single chronic conditions, notably high stress scores were observed for depression, stroke, and hearing problems.
Chronic conditions and multimorbidity are associated with higher levels of stress in older adults in LMICs. Given that perceived stress and chronic conditions are collectively associated with worse health outcomes, low-cost, population-level integrated interventions to address stress among those with chronic conditions are urgently needed.
慢性疾病或多种疾病（≥2 种慢性疾病）患者的压力已被报道会影响临床结局，但在中低收入国家（LMICs）中，尚未有研究探讨压力与慢性疾病/多种疾病之间的关系。因此，我们在六个 LMICs 中调查了≥50 岁成年人中这两者之间的关系。
使用来自世界卫生组织全球老龄化和成人健康研究（中国、加纳、印度、墨西哥、俄罗斯、南非）的数据进行了一项横断面分析。基于压力感量表中的两个问题计算了感知压力评分（范围 0（压力最低）-100（压力最高））。评估了 13 种慢性疾病。进行了多变量线性回归分析。
纳入了 34129 名平均年龄为 62.4（SD=16.0）岁（52.1%为女性）的成年人。总体而言，56.6%（95%CI=55.0%-58.2%）患有多种疾病。在包括所有国家的调整模型中，与没有慢性疾病的成年人相比，慢性疾病数量越高，压力水平越高，呈剂量依赖性。在全国范围内的荟萃分析中，多种疾病与所有国家（尤其是印度和加纳）的压力水平显著升高有关，尽管存在中度异质性（I=54.6%）。对于单一的慢性疾病，尤其是抑郁症、中风和听力问题，观察到显著的高压力评分。
在 LMICs 中的老年人群中，慢性疾病和多种疾病与更高的压力水平相关。鉴于感知压力和慢性疾病共同与更差的健康结局相关，迫切需要针对患有慢性疾病的人群实施成本低、面向人群的综合干预措施来解决压力问题。
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