Associations between physical multimorbidity patterns and common mental health disorders in middle-aged adults: A prospective analysis using data from the UK Biobank

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Abstract

Background: We aimed to identify specific patterns of physical multimorbidity, defined as the presence of two or more physical long-term conditions, and to examine the extent to which these specific patterns could predict future incident and persistent common mental health disorders (CMDs) in middle-aged adults enrolled in the UK Biobank.
Methods: We assessed prospective associations between physical multimorbidity status at the baseline assessment (2006-2010) and depression and anxiety ‘caseness’ according to the Patient Health Questionnaire (PHQ)-9 and the Generalised Anxiety Disorder Assessment (GAD)-7 at the follow-up assessment (2016) in 154,367 middle-aged adults enrolled in the UK Biobank (median age: 57 years, interquartile range=50-62 years, 56.5% female, mean duration of follow-up: 7.6 years, standard deviation=0.87). Patterns of physical multimorbidity were identified using exploratory factor analysis. Logistic regression was used to assess prospective associations between physical multimorbidity patterns at baseline and both incident and persistent depression and anxiety at follow-up.
Findings: Compared to those with no physical multimorbidity, having two (adjusted odds ratio (aOR) =1.41, 95%CI 1.32 to 1.53), three (aOR=1.94, 95%CI 1.76 to 2.14), four (aOR=2.38, 95%CI 2.07 to 2.74), and five or more (aOR=2.89, 95%CI 2.42 to 3.45) physical conditions was prospectively associated with incident depression at follow-up in a dose response manner. Similar trends emerged for incident anxiety, persistent depression, and persistent anxiety, but associations were strongest for incident CMDs. Regarding specific patterns of physical MM, the respiratory pattern (aOR=3.23, 95%CI 2.44 to 4.27) and the pain/gastrointestinal pattern (aOR=2.19, 95%CI 1.92 to 2.50) emerged as the strongest predictors of incident depression. Similar results emerged for incident anxiety.
Interpretation: These findings highlight patterns of physical multimorbidity with the poorest prognosis for both emerging and persisting depression and anxiety. These findings might have significant implications for the implementation of integrated mental and physical healthcare and facilitate the development of targeted preventative interventions and treatment for those with physical multimorbidity.
Original languageEnglish
JournalThe Lancet Regional Health - Europe
Publication statusAccepted/In press - 2021

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