The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort
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To assess the link between multimorbidity, type of chronic physical health problems and depressive symptoms
The study was a cross-sectional postal survey conducted in 30 General Practices in Victoria, Australia as part of the diamond longitudinal study. Participants included 7,620 primary care attendees; 66% were females; age range from 18 to 76 years (mean = 51years SD = 14); 81% were born in Australia; 64% were married and 67% lived in an urban area. The main outcome measures include the Centre for Epidemiologic Studies Depression Scale (CES-D) and a study-specific self-report check list of 12 common chronic physical health problems.
The prevalence of probable depression increased with increasing number of chronic physical conditions (1 condition: 23%; 2 conditions: 27%; 3 conditions: 30%; 4 conditions: 31%; 5 or more conditions: 41%). Only 16% of those with no listed physical conditions recorded CES-D scores of 16 or above. Across the listed physical conditions the prevalence of ‘probable depression’ ranged from 24% for hypertension; 35% for emphysema; 35% for dermatitis to 36% for stroke. The dose–response relationship is reduced when functional limitations and self-rated health are taken into account, suggesting that these factors mediate the relationship.
A clear dose–response relationship exists between the number of chronic physical problems and depressive symptoms. The relationship between multimorbidity and depression appears to be mediated via self-perceived health related quality of life. Primary care practitioners will identify more cases of depression if they focus on those with more than one chronic health problem, no matter what the problems may be, being especially aware in the group who rate their health as poor/fair.
KeywordsDepression Multimorbidity Primary care Cohort Chronic illness
The diamond study was funded by the National Health and Medical Research Council (ID 299869, 454463 & 566511) and the Victorian Centre for Excellence in Depression and Related Disorders, an initiative between beyondblue and the Victorian Government. Neither funding body had a role in study design; the collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit this manuscript for publication. The listed authors submit this paper on behalf of the diamond project team, including the investigators and researchers involved in the study: A/Professor Kelsey Hegarty, Dr Grant Blashki, Dr Gail Gilchrist, Professor Michael Kyrios, Professor Dimity Pond, Ms Vanessa Madden, Dr David Pierce, Ms Maria Potiriadis, Ms Melina Ramp, Dr Lena Sanci, Dr Jane Sims, Ms Donna Southern, and the casual research staff. We are grateful to the thirty dedicated GPs, their patients and practice staff for making this research possible.
Conflict of interest
All authors declare that the answer to the questions on competing interest form are all ‘No’ and therefore have nothing to declare.
- 2.Stegmann ME, Ormel J, de Graaf R, Haro JM, de Girolamo G, Demyttenaere K, Kovess V, Matschinger H, Vilagut G, Alonso J (2010) Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode. J Affect Disord 124:38–44PubMedCrossRefGoogle Scholar
- 15.Britt HC, Harrison CM, Miller GC, Knox SA (2008) Prevalence and patterns of multimorbidity in Australia. Med J Aus 189:72–77Google Scholar
- 20.Gunn JM, Gilchrist GP, Chondros P, Ramp M, Hegarty KL, Blashki GA, Pond DC, Kyrios M, Herrman HE (2008) Who is identified when screening for depression is undertaken in general practice? Baseline findings from the diagnosis, management and outcomes of depression in primary care (diamond) longitudinal study. Med J Aus 188:S119–S125Google Scholar
- 21.Potiriadis M, Chondros P, Gilchrist G, Hegarty K, Blashki G, Gunn JM (2008) How do Australian patients rate their general practitioner? A descriptive study using the general practice assessment questionnaire. Med J Aus 189:215–219Google Scholar
- 22.Calcino G (1993) Sampling from the HIC data set. In: Calcino G (ed) Proceedings from the General Practice Evaluation Program 1993 work-in-progress conference. Department of Health, Housing, Local Government and Community Services, CanberraGoogle Scholar
- 24.Britt H, Miller G, Charles J, Bayram C, Pan Y, Henderson J, Valenti L, O’Halloran J, Harrison C, Fahridin S (2008) General practice activity in Australia 2006–07. General practice series no 21 Cat no GEP 21. AIHW, CanberraGoogle Scholar
- 25.Australian Institute of Health and Welfare (2008) Australia’s Health 2008. AIHW, CanberraGoogle Scholar
- 26.StataCorp. (2009) Stata Statistical Software: Release 11. StataCorp LP, College Station, TexasGoogle Scholar
- 31.Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol 49:1407–1417PubMedCrossRefGoogle Scholar