Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases

Abstract

Objectives: Depression frequently co-occurs with multiple chronic diseases in complex, costly, and dangerous patterns of multimorbidity. The field of health psychology may benefit from evaluating the temporal characteristics of depression's associations with common diseases, and from determining whether depression is a central connector in multimorbid disease clusters. The present review addresses these issues by focusing on 4 of the most prevalent diseases: hypertension, ischemic heart disease, arthritis, and diabetes.

Method: Study 1 assessed how prior chronic disease diagnoses were associated with current depression in a large, cross-sectional, population-based study. It assessed depression's centrality using network analysis accounting for disease prevalence. Study 2 presents a systematic scoping review evaluating the extent to which depression was prospectively associated with the onset of the 4 prevalent chronic diseases.

Results: In Study 1 depression had the fourth highest betweenness centrality ranking of 26 network nodes and centrally connected many existing diseases and unhealthy behaviors. In Study 2 depression was associated with subsequent incidence of ischemic heart disease and diabetes across multiple meta-analyses. Insufficient information was available about depression's prospective associations with incident hypertension and arthritis.

Conclusions: Depression is central in patterns of multimorbidity and is associated with incident disease for several of the most common chronic diseases, justifying the focus on screening and treatment of depression in those at risk for developing chronic disease. Future research should investigate the mediating and moderating roles of health behaviors in the association between depression and the staggered emergence over time of clusters of multimorbid chronic diseases. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Figure 1.

Illustrative visualization of the centrality of depression in a network of multimorbid conditions and behaviors in 2,311 patients with complete data for all represented variables above in the Nova Scotia Health Survey 1995 (MacLean et al., 1996). Gray circular nodes represent medical conditions, blue rectangular nodes represent mood disorders (i.e., depression, anxiety), and green triangles represent unhealthy behaviors. The size of all circular and triangular nodes (i.e., all nodes other than depression) reflects degree of betweenness centrality. The betweenness centrality for depression was the fourth highest (17.18) out of all 26 nodes in the figure. The thickness of the lines connecting nodes represents the ratio of phi/phi_max. That ratio was used as the visualized statistic for the association between each pair of nodes to adjust for differences in prevalence among the nodes. Only associations are represented for which the absolute value of the phi/phi_max ratio was greater than or equal to .01. The values vary as follows: very thin lines: > = .01 and <.05; thin lines: >= .05 and <.15; medium thickness lines: > = .15 and <.20; thick lines: >= .20 and <.25; very thick lines: > = .25. Positive and negative associations are represented by solid and dotted lines, respectively. Blue lines highlight the associations with depression, and gray lines represent associations among nondepression nodes. See the online article for the color version of this figure.

Figure 2.

Association between number of previously diagnosed medical conditions and proportion of participants with current depression. The percentage value text appearing over each bar indicates the proportion of participants having the relevant number of medical conditions. CES-D = Center for Epidemiologic Studies Depression. See the online article for the color version of this figure.

Figure 3.

Number of high-quality systematic reviews that investigated depression as a prospective risk marker for the development of medical conditions. Note that 27 total studies were included from the 25 included systematic review papers because one systematic review addressed three of the four diseases (ischemic heart disease, diabetes, and arthritis; Bica et al., 2017). See the online article for the color version of this figure.