Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China.
National Institute of Health Data Science of China, Shandong University, Jinan, China; Institute for Global Health, Faculty of Population Health Sciences, University College London, London, United Kingdom.
J Affect Disord. 2024 Jun 1;354:434-442. doi: 10.1016/j.jad.2024.03.090. Epub 2024 Mar 18.
The association between physical multimorbidity and depression differs by populations. However, no direct inter- or intrapopulation comparison of the association has been conducted. Thus, this study aims to estimate the association in China and the United States and reveal inter- and intrapopulation differences in the association.
Middle-aged and older adults from the China Health and Retirement Longitudinal Study and the Health and Retirement Study were included. Physical multimorbidity was defined as the simultaneous presence of two or more chronic physical conditions and depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Generalized estimating equation model and stratification multilevel method were the main statistical models.
The presence of physical multimorbidity was associated with a higher risk of depression in both China (RR = 1.360 [95 % CI: 1.325-1.395]) and the US (RR = 1.613 [95 % CI: 1.529-1.701]). For individuals at a low risk of multimorbidity, multimorbidity was associated with 47.4 % (95 % CI: 1.377-1.579) and 71.1 % (95 % CI: 1.412-2.074) increases in the likelihood of depression in China and the US. The effect size was smaller for individuals at a moderate or high risk. However, the cross-national differences were greater for those with a high risk of multimorbidity.
The self-report measures, attribution bias.
Compared to Chinese adults, the presence of physical multimorbidity led to an additional increase in depressive symptoms for American counterparts. The association was stronger for individuals at a low risk of multimorbidity, but cross-national differences were observed mostly among individuals at a high risk.
身体多病共存与抑郁之间的关系因人群而异。然而，目前还没有对这种关联进行直接的人群内或人群间比较。因此，本研究旨在评估中国和美国人群中的这种关联，并揭示关联中的人群内和人群间差异。
本研究纳入了中国健康与退休纵向研究和健康与退休研究中的中年及以上成年人。身体多病共存定义为同时存在两种或两种以上的慢性身体疾病，抑郁症状则通过流行病学研究中心抑郁量表进行测量。主要的统计模型为广义估计方程模型和分层多级方法。
在中国（RR=1.360 [95% CI：1.325-1.395]）和美国（RR=1.613 [95% CI：1.529-1.701]），身体多病共存均与更高的抑郁风险相关。对于多病共存低危个体，多病共存与抑郁风险增加相关，其关联在中国和美国的比值比（OR）分别为 47.4%（95% CI：1.377-1.579）和 71.1%（95% CI：1.412-2.074）。对于中危或高危个体，其效应量较小。然而，对于多病共存高危个体，跨国差异更大。
本研究采用的是自我报告测量方法，可能存在归因偏差。
与中国成年人相比，身体多病共存会导致美国成年人的抑郁症状进一步增加。这种关联在多病共存低危个体中更强，但在跨国比较中，主要存在于多病共存高危个体中。
