Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Centre for Biomedical Research on Mental Health (CIBERSAM), Spain.
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Centre for Biomedical Research on Mental Health (CIBERSAM), Spain.
J Affect Disord. 2022 Nov 15;317:176-184. doi: 10.1016/j.jad.2022.08.110. Epub 2022 Aug 30.
Comorbid depression and anxiety is associated with worse health outcomes compared to depression or anxiety occurring in isolation, but there is little data on its association with multimorbidity. Thus, we investigated this association across 47 low- and middle-income countries, and further explored whether having anxiety symptoms in addition to depression is associated with significant declines in health outcomes among those with multimorbidity.
Cross-sectional, predominantly nationally representative, community-based data were analyzed from the World Health Survey. DSM-IV depression was assessed with the Composite International Diagnostic Interview. Anxiety symptoms referred to severe/extreme problems with worry or anxiety. Ten chronic conditions and health status across five domains (cognition, interpersonal activities, sleep/energy, self-care, pain/discomfort) were assessed. Multivariable regression analyses conducted.
Data included 237,952 adults aged ≥18 years [mean age (SD) 38.4 (16.0); 50.8 % females]. Compared to no chronic conditions, 2 (OR = 6.86; 95%CI = 5.59-8.42), 3 (OR = 12.33; 95%CI = 9.72-15.63), and ≥4 (OR = 26.55; 95%CI = 20.21-35.17) chronic conditions were associated with significantly higher odds for comorbid depression/anxiety symptoms (vs. no depression or anxiety symptoms) in the multinomial logistic regression model. Among those with depression and multimorbidity, anxiety symptoms were associated with significantly worse health status across all domains.
Cross-sectional design, depression and anxiety symptoms were not based on a clinical assessment.
Comorbid depression/anxiety is common in people with multimorbidity, and anxiety symptoms in people with depression and multimorbidity signify worse health status. Future studies should assess the utility of screening for and treating comorbid depression/anxiety in patients with multimorbidity in terms of clinical outcomes.
与单独发生的抑郁或焦虑相比，共患抑郁和焦虑与更差的健康结局相关，但关于其与多种疾病的关联的数据很少。因此，我们在 47 个低收入和中等收入国家中调查了这种关联，并进一步探讨了在患有多种疾病的人群中，除了抑郁之外还有焦虑症状是否与健康结局的显著下降有关。
使用来自世界卫生调查的横断面、主要为全国代表性的社区为基础的数据进行分析。使用复合国际诊断访谈评估 DSM-IV 抑郁。焦虑症状是指严重/极度的担忧或焦虑问题。评估了十种慢性疾病和五个领域（认知、人际活动、睡眠/能量、自我护理、疼痛/不适）的健康状况。进行了多变量回归分析。
数据包括 237952 名年龄≥18 岁的成年人[平均年龄（标准差）38.4（16.0）；50.8%为女性]。与无慢性疾病相比，有 2 种（OR=6.86；95%CI=5.59-8.42）、3 种（OR=12.33；95%CI=9.72-15.63）和≥4 种（OR=26.55；95%CI=20.21-35.17）慢性疾病的个体更有可能出现共患抑郁/焦虑症状（与无抑郁或焦虑症状相比），在多变量逻辑回归模型中。在患有抑郁和多种疾病的个体中，焦虑症状与所有领域的健康状况显著恶化相关。
横断面设计，抑郁和焦虑症状不是基于临床评估。
共患抑郁/焦虑在患有多种疾病的人群中很常见，而在患有抑郁和多种疾病的人群中，焦虑症状则预示着更差的健康状况。未来的研究应该评估在多种疾病患者中筛查和治疗共患抑郁/焦虑的临床效果。
