Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 1;80(7):690-699.
doi: 10.1001/jamapsychiatry.2023.0777.

Association Between Depression and Physical Conditions Requiring Hospitalization

Philipp Frank  1   2 , G David Batty  1 , Jaana Pentti  3   4 , Markus Jokela  5 , Lydia Poole  6 , Jenni Ervasti  4 , Jussi Vahtera  7 , Glyn Lewis  2 , Andrew Steptoe  8 , Mika Kivimäki  3   4   2
Affiliations

Association Between Depression and Physical Conditions Requiring Hospitalization

Philipp Frank et al. JAMA Psychiatry. .

Abstract

Importance: Depression is associated with an increased risk of physical illness, but the most common causes of hospitalization among people with depression are unclear.

Objective: To examine the association of depression with an array of physical conditions requiring hospital treatment.

Design, setting, and participants: In this outcomewide prospective multicohort study, primary analysis was based on data from the UK Biobank, a population-based study in the United Kingdom. Analyses were repeated in an independent data set of 2 cohorts in Finland, a population-based study and an occupational cohort. Data analysis was conducted between April and September 2022.

Exposures: Self-reported depression, recurrent severe major depression, recurrent moderate major depression, and a single major depressive episode.

Main outcomes and measures: A total of 77 common health conditions ascertained from linkage data to national hospital and mortality registries.

Results: The analytical sample of UK Biobank participants consisted of 130 652 individuals (71 565 women [54.8%]; 59 087 men [45.2%]; mean [SD] age at baseline, 63.3 [7.8] years). The pooled data from the Finnish replication cohorts included 109 781 participants (82 921 women [78.6%]; 26 860 men [21.4%]; mean [SD] age, 42 [10.8] years). In the main analysis, severe/moderately severe depression was associated with the incidence of 29 nonoverlapping conditions requiring hospital treatment during a 5-year follow-up. Twenty-five of these associations remained after adjustment for confounders and multiple testing (adjusted hazard ratio [HR] range, 1.52-23.03) and were confirmed in the analysis of the Finnish cohorts. These included sleep disorders (HR, 5.97; 95% CI, 3.27-10.89), diabetes (HR, 5.15; 95% CI, 2.52-10.50), ischemic heart disease (HR, 1.76; 95% CI, 1.36-2.29), chronic obstructive bronchitis (HR, 4.11; 95% CI, 2.56-6.60), bacterial infections (HR, 2.52; 95% CI, 1.99-3.19), back pain (HR, 3.99; 95% CI, 2.96-5.38), and osteoarthritis (HR, 1.80; 95% CI, 1.46-2.20). The highest cumulative incidence was observed for endocrine and related internal organ diseases (245 per 1000 persons with depression; risk difference relative to unaffected individuals: 9.8%), musculoskeletal diseases (91 per 1000 persons; risk difference, 3.7%), and diseases of the circulatory system and blood (86 per 1000 persons; risk difference, 3.9%). The cumulative incidence was lower for hospital-treated mental, behavioral, and neurological disorders (20 in 1000 persons; risk difference, 1.7%). Depression was also associated with disease progression in people with prevalent heart disease or diabetes, and for 12 conditions, there was evidence of a bidirectional relationship.

Conclusions and relevance: In this study, the most common causes of hospitalization in people with depression were endocrine, musculoskeletal, and vascular diseases, not psychiatric disorders. These findings suggest that depression should be considered as a target for the prevention of physical and mental disease.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Ervasti reported grants from the Academy of Finland, Strategic Research Council (336004) and Finnish Work Environment Fund (200097, 220245) outside the submitted work. Dr Lewis reported grants from University College London during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Profile
FPS indicates Finnish Public Sector Study; HeSSup, Health and Social Support Study.
Figure 2.
Figure 2.. Associations Between Measures of Depression and Main ICD-10 Disease Groups in Individuals From the UK Biobank (UKB) and 2 Finnish Cohorts, the Health and Social Support Study (HeSSup) and Finnish Public Sector Study (FPS)
The ● in the table indicates significance at P < .001 (Bonferroni correction for multiple testing); the – indicates analyses were not possible for this condition because of the low number of cases. ICD-10 indicates International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; PHQ-9, 9-item Patient Health Questionnaire. aHazard ratio for depression as predictor of disease adjusted for age, sex, education, self-reported ethnic origin, smoking, alcohol, and physical activity at baseline. bAnalysis in Finnish cohorts. Analyses on other measures of depression were based on UK Biobank data.
Figure 3.
Figure 3.. Four-Year Cumulative Incidence for 8 Disease Categories Among People With Severe/Moderately Severe Depression (UK Biobank Cohort)
See this image and copyright information in PMC

References

    1. Reiner RC Jr, Olsen HE, Ikeda CT, et al. ; GBD 2017 Child and Adolescent Health Collaborators . Diseases, injuries, and risk factors in child and adolescent health, 1990 to 2017: findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study. JAMA Pediatr. 2019;173(6):e190337-e190337. doi:10.1001/jamapediatrics.2019.0337 - DOI - PMC - PubMed
    1. Vos T, Abajobir AA, Abate KH, et al. ; GBD 2016 Disease and Injury Incidence and Prevalence Collaborators . Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-1259. doi:10.1016/S0140-6736(17)32154-2 - DOI - PMC - PubMed
    1. Doyle F, McGee H, Conroy R, et al. . Systematic review and individual patient data meta-analysis of sex differences in depression and prognosis in persons with myocardial infarction: a MINDMAPS study. Psychosom Med. 2015;77(4):419-428. doi:10.1097/PSY.0000000000000174 - DOI - PubMed
    1. Feng L, Li L, Liu W, et al. . Prevalence of depression in myocardial infarction: a PRISMA-compliant meta-analysis. Medicine (Baltimore). 2019;98(8):e14596. doi:10.1097/MD.0000000000014596 - DOI - PMC - PubMed
    1. Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol. 2019;56(6):631-650. doi:10.1007/s00592-019-01295-9 - DOI - PubMed

Publication types