Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
PLoS One. 2022 Nov 10;17(11):e0276279. doi: 10.1371/journal.pone.0276279. eCollection 2022.
The rising prevalence of multimorbidity poses challenges to health systems globally. The objectives of this study were to investigate: 1) the association between multimorbidity and depressive symptoms; and 2) whether social support plays a protective role in this association.
A prospective population-based cohort study was conducted to analyze baseline and 3-year follow-up data of 16,729 community dwelling participants aged 65 and above in the Canadian Longitudinal Study of Aging (CLSA). Multimorbidity was defined as having three or more chronic conditions. The 10-item Center for Epidemiologic Studies Depression scale (CESD-10) was used to measure depressive symptoms. The 19-item Medical Outcomes Study (MOS) Social Support Survey was employed to assess perceived social support. Multivariate logistic regression models were used to examine the association between multimorbidity, social support and depressive symptoms.
Multimorbidity was very common among participants with a prevalence of 70.6%. Fifteen percent of participants had depressive symptoms at baseline. Multimorbidity was associated with increased odds of having depressive symptoms at 3-year follow-up (adjusted odds ratio, aOR = 1.51, 95% CI 1.33, 1.71), and developing depressive symptoms by follow-up among those with no depressive symptoms at baseline (aOR = 1.65, 95% CI 1.42, 1.92). Social support was consistently associated with decreased odds of depressive symptoms, regardless of level of multimorbidity.
Multimorbidity was positively associated with depressive symptoms over time, but social support served as a protective factor. As a modifiable, protective factor, emphasis should be placed in clinical practice to assess social support and refer patients to appropriate services, such as support groups. Similarly, health policy should focus on ensuring that older adults have access to social support opportunities as a way to promote mental health among older adults. Community organizations that offer social activities or support groups play a key role in this respect and should be adequately supported (e.g., with funding).
多种疾病的患病率不断上升给全球卫生系统带来了挑战。本研究旨在调查：1）多种疾病与抑郁症状之间的关系；2）社会支持在这种关系中是否起到保护作用。
本研究为前瞻性基于人群的队列研究，分析了加拿大老龄化纵向研究（CLSA）中 16729 名年龄在 65 岁及以上、居住在社区的参与者的基线和 3 年随访数据。多种疾病定义为患有三种或更多种慢性疾病。采用 10 项流行病学研究中心抑郁量表（CESD-10）衡量抑郁症状。采用 19 项医疗结局研究（MOS）社会支持量表评估感知社会支持。采用多变量逻辑回归模型来检验多种疾病、社会支持与抑郁症状之间的关系。
参与者中多种疾病的患病率非常高，为 70.6%。15%的参与者在基线时存在抑郁症状。多种疾病与 3 年随访时出现抑郁症状的几率增加相关（调整后的优势比，aOR=1.51，95%CI 1.33，1.71），与基线时无抑郁症状但随访时出现抑郁症状的几率增加相关（aOR=1.65，95%CI 1.42，1.92）。无论多种疾病的严重程度如何，社会支持均与抑郁症状的几率降低相关。
多种疾病与抑郁症状随时间呈正相关，但社会支持是一个保护因素。社会支持作为一个可改变的保护因素，在临床实践中应强调评估社会支持，并将患者转介给适当的服务，如支持小组。同样，卫生政策应注重确保老年人有机会获得社会支持，以促进老年人的心理健康。提供社交活动或支持小组的社区组织在这方面发挥着关键作用，应得到充分支持（例如，提供资金）。
