Adzrago David, Williams David R, Williams Faustine
Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
Department of Social and Behavioral Sciences, Department of African and African American Studies, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.
Soc Psychiatry Psychiatr Epidemiol. 2025 Jan;60(1):181-199. doi: 10.1007/s00127-024-02730-1. Epub 2024 Jul 17.
Psychological distress significantly contributes to the burdens of morbidity and mortality in the United States (U.S.), but our understanding is limited with regards to the risk factors associated with psychological distress. We used nationally representative data to examine (1) the comorbidities of chronic diseases and their risks for psychological distress and (2) the ways in which chronic diseases combine with demographic factors such as sex, race/ethnicity, immigration status, and health insurance coverage to affect the patterning of psychological distress.
We analyzed the 2005-2018 National Health Survey Interview cross-sectional data on U.S. adults aged ≥ 18 years (n = 351,457). We fitted sequential multivariable logistic regression models.
There was a dose-response relationship between the number of chronic diseases and psychological distress, with increased number of chronic diseases associated with increased psychological distress risk. Females (vs. males) and those without health insurance (vs. insured) were more likely to experience psychological distress. Immigrants (vs. non-immigrants) and racial/ethnic minorities (vs. White individuals) were less likely to experience psychological distress. There were significant interactions between chronic diseases and insurance coverage, immigration status, and race/ethnicity, but the three-way interactions were not statistically significant with psychological distress: chronic disease status vs. immigration status vs. health insurance coverage, and chronic disease vs. race/ethnicity vs. immigration status.
The findings suggest a critical need to consider the complex ways in which chronic diseases and psychosocial factors combine to affect psychological distress and their implications for tailoring mental health screening, initiatives to reduce distress, and prevention strategies for effectively addressing health-related disparities in the general population.
心理困扰对美国的发病和死亡负担有显著影响，但我们对与心理困扰相关的风险因素的了解有限。我们使用全国代表性数据来研究：（1）慢性病的合并症及其导致心理困扰的风险；（2）慢性病与性别、种族/族裔、移民身份和医疗保险覆盖等人口统计学因素相结合影响心理困扰模式的方式。
我们分析了2005 - 2018年全国健康调查访谈中18岁及以上美国成年人（n = 351,457）的横断面数据。我们拟合了序贯多变量逻辑回归模型。
慢性病数量与心理困扰之间存在剂量反应关系，慢性病数量增加与心理困扰风险增加相关。女性（与男性相比）和没有医疗保险的人（与有保险的人相比）更容易出现心理困扰。移民（与非移民相比）和种族/族裔少数群体（与白人相比）出现心理困扰的可能性较小。慢性病与保险覆盖、移民身份和种族/族裔之间存在显著的交互作用，但慢性病状况与移民身份与医疗保险覆盖、慢性病与种族/族裔与移民身份之间的三方交互作用在心理困扰方面无统计学意义。
研究结果表明，迫切需要考虑慢性病和心理社会因素相结合影响心理困扰的复杂方式，以及它们对定制心理健康筛查、减轻困扰的举措和有效解决普通人群健康相关差异的预防策略的影响。
