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