Aoki Takuya, Yamamoto Yosuke, Shimizu Sayaka, Fukuhara Shunichi
Department of Healthcare Epidemiology, Kyoto University, Kyoto, Japan.
Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.
Fam Med Community Health. 2020 Jan 5;8(1):e000234. doi: 10.1136/fmch-2019-000234. eCollection 2020.
The associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies. However, whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear. This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms.
This study was designed as a nationwide cross-sectional survey in Japan.
General sample of the Japanese population.
Adult Japanese residents were selected by a quota sampling method. Data were analysed from 1788 residents who reported one or more chronic health conditions.
Among four physical multimorbidity patterns: cardiovascular-renal-metabolic (CRM), skeletal-articular-digestive (SAD), respiratory-dermal (RDE) and malignant-digestive-urologic (MDU), multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms (aOR=1.68, 95% CI: 1.21 to 2.31 for the pattern score highest quartile, compared with the lowest quartile), followed by SAD and MDU patterns (aOR=1.41, 95% CI: 1.01 to 1.98 for the SAD pattern score highest quartile; 1.41, 95% CI: 1.01 to 1.96 for the MDU pattern score highest quartile, compared with the lowest quartile). In contrast, the CRM pattern score was not significantly associated with depressive symptoms (aOR=1.31, 95% CI: 0.90 to 1.89 for the pattern score highest quartile, compared with the lowest quartile).
Physical multimorbidity patterns have different associations with depressive symptoms. Among these patterns, patients with the RDE pattern may be at a higher risk for developing depressive symptoms. This study reinforces the evidence that cluster pattern of chronic health conditions is a useful measure for clinical management of multimorbidity as it is differently associated with mental health status, which is one of the crucial outcomes for multimorbid patients.
多项研究已对躯体多种疾病共病与抑郁症状之间的关联进行了调查。然而，慢性身体疾病模式与抑郁症状的关联是否存在相对差异仍不明确。本研究旨在调查躯体多种疾病共病模式与抑郁症状之间的关联。
本研究设计为在日本全国范围内进行的横断面调查。
日本人群的一般样本。
采用配额抽样方法选取成年日本居民。对报告有一项或多项慢性健康状况的1788名居民的数据进行了分析。
在四种躯体多种疾病共病模式中：心血管 - 肾脏 - 代谢（CRM）、骨骼 - 关节 - 消化（SAD）、呼吸 - 皮肤（RDE）和恶性肿瘤 - 消化 - 泌尿（MDU），多变量逻辑回归分析显示，RDE模式与抑郁症状的关联最强（最高四分位数模式得分与最低四分位数相比，调整后比值比[aOR]=1.68，95%置信区间[CI]：1.21至2.31），其次是SAD和MDU模式（SAD模式最高四分位数模式得分与最低四分位数相比，aOR=1.41，95%CI：1.01至1.98；MDU模式最高四分位数模式得分与最低四分位数相比，aOR=1.41，95%CI：1.01至1.96）。相比之下，CRM模式得分与抑郁症状无显著关联（最高四分位数模式得分与最低四分位数相比，aOR=1.31，95%CI：0.90至1.89）。
躯体多种疾病共病模式与抑郁症状的关联不同。在这些模式中，患有RDE模式的患者出现抑郁症状的风险可能更高。本研究强化了以下证据，即慢性健康状况的聚类模式是对多种疾病共病进行临床管理的有用指标，因为它与心理健康状况存在不同关联，而心理健康状况是患有多种疾病的患者的关键结局之一。
