Elsevier

Journal of Affective Disorders

Volume 241, 1 December 2018, Pages 461-468
Journal of Affective Disorders

Research paper
Depression and chronic diseases: Co-occurrence and communality of risk factors

https://doi.org/10.1016/j.jad.2018.08.011Get rights and content

Highlights

  • Majority of depressed cases (87%) were undiagnosed.

  • Diabetes, arthritis, asthma, COPD, angina, and stroke were associated with depression.

  • Associations in developing countries were stronger than those in developed ones.

  • Older, female, underweight participants had higher risk of depression.

  • Educated and wealthier participants had lower risk of depression.

Abstract

Background

The aim of current study is to assess the cross-sectional association of chronic non-communicable diseases (diabetes mellitus, arthritis, asthma, chronic lung disease, angina, and stroke) with both diagnosed and undiagnosed depression in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1, a study of adults in six low- and middle-income countries.

Methods

A total of 41,810 participants, aged ≥ 18 years, were included. Depression status was assessed by standard methods derived from the World Mental Health Survey (WHH-CIDI). Undiagnosed depression was defined as a depressed person who did not report history of diagnosis/treatment for depression. Associations between depression/undiagnosed depression and chronic diseases, adjusting for country of residence, demographics and chronic diseases risk factors were assessed.

Results

Depression was detected in 2508 (6.0%) cases, from whom 2098 (87%) were undiagnosed. Diabetes (Odds ratio:1.47[95%CI:1.24,1.75]), arthritis (2.14[1.82,2.52]), asthma (3.36[2.73,4.14]), chronic lung disease (3.74[3.10,4.51]), angina (3.20[2.66,3.85]), and stroke (3.14[2.55,3.86]) were associated with depression (p-values < 0.001). Being older, female, underweight, and having lower education, and lower income were positively associated with depression. The estimated odds ratios were similar for undiagnosed depression.

Limitations

Cross-sectional design of study prevent us to determine whether depression followed exposures in time. About 12% of the participant did not have data for depression status and were excluded from the study.

Conclusions

Most depression cases were undiagnosed. Depression/undiagnosed depression were strongly associated with chronic diseases; stronger than what has been reported in developed countries.

Introduction

Depression is an important public health problem affecting approximately 350 million people worldwide (Hyman et al., 2006). It was the fourth leading cause of disease burden in 2000 (Hyman et al., 2006) and it is projected that depression will become the second leading cause of burden of disease by 2030 (Mathers and Loncar, 2006). In low and middle income countries (LMICs) it is expected that the burden of depression will increase even faster due to rapid social transitions and increased prevalence of “western lifestyle” risk factors (Mathers and Loncar, 2006) and disability attributed to depression is predicted to be larger (Hyman et al., 2006). Moreover, the majority of depression cases remain undiagnosed or untreated, a problem which is more severe in LMICs (Arokiasamy et al., 2017, Berkman et al., 2003, Hyman et al., 2006, Lecrubier, 2007).

Age-related changes and presence of biological risk factors including endocrine, inflammatory or immune, cardiovascular, and neuroanatomical factors make people vulnerable to depression (Clarke and Currie, 2009, Dickens et al., 2002). The positive association between depression and some chronic diseases, such as arthritis and diabetes, in adult populations is well documented for developed countries (Clarke and Currie, 2009, Dickens et al., 2002). In contrast, there are few studies in the LMICs that have documented the association between depression and chronic diseases (Arokiasamy et al., 2017, Lin et al., 2017, Mendenhall et al., 2014). Although development of a chronic disease can lead to a depressive reaction, the association between chronic diseases and depression is believed to be strongly linked due to shared risk factors and pathophysiological pathways(Clarke and Currie, 2009, Dickens et al., 2002, Krishnan et al., 2002). The growing prevalence and burden of depression (Mathers and Loncar, 2006) in LMICs highlights the need for measuring the association between depression and other chronic diseases to help understand depression and plan better strategies and interventions to improve mental and physical health in these countries.

The primary aim of this multi-country, cross-sectional study was to estimate the association between depression and chronic diseases after accounting for possible confounders. The secondary aim was to assess the association between undiagnosed depression and chronic diseases since most depression cases in low and middle-income countries remain undiagnosed.

Section snippets

Study population

The current study used data from the WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007–2010). Details of SAGE are published elsewhere. (Kowal et al., 2012). Briefly, SAGE is a multi-wave longitudinal study in six LMICs namely China, Ghana, India, Mexico, Russian Federation, and South Africa. SAGE includes two cohorts: one nationally representative cohort of adults aged ≥ 50 years and a smaller cohort of those aged 18–49. In WHO SAGE Wave 1 there were 47,443 participants and of

Results

From the total number of participants in the SAGE study, 41,810 (88.1%) had data for depression based on the World Mental Health Survey. The baseline characteristics were different between those with and without depression status (Supplementary Table 1). Two groups were different in socioeconomic factors, risk factors, and comorbidities (Supplementary Table 1). Of those 41,810 participants with data for depression status, 2,508 (6.0%) were found to have depression based on the WMH-CIRI survey.

Summary of findings

This is one of a few studies assessing the association between depression/undiagnosed depression and chronic diseases in LMICs. In our study, the majority of depressed cases were undiagnosed. Our findings showed a surprisingly strong positive association between depression/undiagnosed depression and risk for diabetes mellitus, arthritis, asthma, chronic lung disease, angina, and stroke, after accounting for most important confounders. More than half of participants with depression had at least

Research data

The anonymized datasets is available publicly at: http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/central. Moreover, the SAGE instruments, protocols and meta- and micro-data is available upon completion of the Users Agreement at: www.who.int/healthinfo/systems/sage. The questionnaires and other materials are available at: http://www.who.int/healthinfo/sage/cohorts/en/index2.html. Authors’ contributors

Author statement contributors

ML, SB, NN, PK and MM designed the study. SB, LO, NN and MM supervised data extraction and data cleaning. ML performed data analysis under MM supervision. MB was the senior psychiatrist who leaded interpretation of findings and conclusion. All authors read and approved the final manuscript.

Declaration of interests

All authors stated that there was no financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

Acknowledgements

SAGE was funded by the WHO, the US National Institute on Aging through Interagency Agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) and research grant (R01-AG034479); and Science and Technology Commission of Shanghai Municipality (Grant No. 10XD1403600). MB is supported by an NHMRC Senior Principal Research Fellowship (APP1059660 and APP1156072). The funding sources had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and

References (32)

  • D.G. Blazer

    Depression in late life: review and commentary

    J. Gerontol. Ser. A

    (2003)
  • D.M. Clarke et al.

    Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence

    Med. J. Aust.

    (2009)
  • K.B. DeSalvo et al.

    Dietary guidelines for Americans

    JAMA

    (2016)
  • C. Dickens et al.

    Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis

    Psychosomatic Med.

    (2002)
  • A.R. Dixit et al.

    Prospective study of depression and the risk of heavy alcohol use in women

    Am. J. Psychiatry

    (2000)
  • B.D. Ferguson et al.

    Estimating Permanent Income Using Indicator Variables. Health Systems Performance Assessment: Debates, Methods and Empiricism

    (2003)
  • Cited by (85)

    View all citing articles on Scopus
    View full text