Pan Tianxin, Mercer Stewart W, Zhao Yang, McPake Barbara, Desloge Allissa, Atun Rifat, Hulse Emily Susannah Grace, Lee John Tayu
Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia.
Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
BMC Public Health. 2021 Feb 18;21(1):376. doi: 10.1186/s12889-021-10414-7.
The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China.
Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes.
After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss.
Mental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China.
精神和身体慢性疾病的共病情况（精神 - 身体共病）对低收入和中等收入国家的卫生系统及更广泛的经济而言，是一个日益严峻且在很大程度上未得到解决的挑战。本研究调查了精神和身体慢性疾病对中国残疾、工作生产力和社会参与的独立及综合（相加或协同）影响。
面板数据研究设计采用了中国健康与养老追踪调查（2011年、2015年）的两波数据，包括5616名年龄≥45岁的参与者、12种身体慢性疾病和抑郁症。我们使用随机效应回归模型的面板数据方法来评估精神 - 身体共病与结果之间的关系。
在调整社会经济和人口因素后，身体慢性疾病数量的增加与残疾可能性更高独立相关（调整后的优势比（AOR）= 1.39；95%置信区间：1.33，1.45）、提前退休（AOR = 1.37 [1.26，1.49]）以及病假天数增加（1.25天[1.16，1.35]）。抑郁症与残疾独立相关（AOR = 3.78 [3.30，4.34]）、病假天数增加（2.18天[1.72，2.77]）以及社会参与可能性较低（AOR = 0.57 [0.47，0.70]），但与提前退休无关（AOR = 1.24 [0.97，1.58]）。身体慢性疾病和心理健康之间在残疾、工作生产力和社会参与方面存在微小且无统计学意义的相互作用，表明精神 - 身体共病对生产力损失具有相加效应。
精神 - 身体共病对个人、卫生系统和社会造成了重大的负面健康和经济影响。需要开展更多研究来应对精神 - 身体共病的挑战，为可应用于中国工作场所和更广泛社区的干预措施的制定提供信息。
