People with depression often suffer from comorbid, chronic physical diseases. Little is known about how demographic characteristics such as age and sex influence the prevalence of chronic physical diseases comorbid with depression. Therefore, this study aimed to explore the age and sex differences in the prevalence of diverse, chronic physical diseases comorbid with depression.
This cross-sectional survey were conducted with the participants (n=45,598) of the Korean National Health and Nutrition Examination Survey (KNHANES). Using log-binomial regression, age adjusted prevalence ratios (APR) of chronic physical diseases of participants with depression and those without depression were estimated for each sex and age group.
The APR of most chronic physical diseases were significantly higher among respondents with depression than those without depression. Chronic physical diseases that showed the highest APR were asthma in adult male respondents (APR=3.46) and adult female respondents (APR=2.19) and chronic renal failure in elderly male respondents (APR=8.36) and elderly female respondents (APR=1.94).
Prevalence ratios of the chronic physical diseases comorbid with depression differed according to sex and age groups. Collaborative care strategies should be designed according to demographic characteristics of the population.
Depression is a mood disorder frequently causing impairment in many areas of functioning, and has a relatively high prevalence ranging from 2% to 15% [
The relationship between depression and chronic physical diseases can further be associated with other factors such as age and sex. Previous studies have reported that the impact of depression on health conditions such as chronic medical disorders and health-related quality of life is unequally distributed among different population groups of age, sex, marital status, economy, and employment [
This study used the Korean National Health and Nutrition Examination Survey (KNHANES). The KNHANES included cross-sectional health interview survey, health examination survey, and nutrition survey conducted with a representative sample of non-institutionalized Korean civilian population [
Data about depression, arthritis, angina or myocardial infarction, stroke, tuberculosis, asthma, chronic renal failure, atopic dermatitis, thyroid gland disease, cancer (stomach, liver, colorectal, and breast) and cirrhosis of the liver were collected using questions about being diagnosed; for example, “Have you ever been diagnosed with depression by a physician?” [
Metabolic syndrome was measured in the health examination. These health examinations were conducted in local community health centers and clinics, and standardized protocols were used to assess anthropometry, blood pressure, and laboratory indices. Metabolic syndrome was considered to be present if at least 3 of the following 5 criteria were satisfied: 1) abdominal obesity (waist circumference of ≥85 cm), measured using a Korean-specific standard; 2) high blood pressure (SBP of ≥130 mm Hg or DBP of ≥85 mm Hg); 3) a high TG level (≥150 mg/dL); 4) a low HDL-C level (<50 mg/dL); and 5) elevated FPG (≥100 mg/dL). We used the version of the National Cholesterol Education Program’s Adult Treatment Panel III criteria recommended by the American Heart Association and the National Heart, Lung, and Blood Institute [
We defined adults as respondents aged 19–64 years, and elderly as respondents aged 65 years and above.
The age-standardized prevalence rates for comorbidity of depression with chronic physical diseases were estimated using the standard population from the Population Projections for Korea: 2010–2016 (based on the 2010 census). Log-binomial regression was performed to estimate age adjusted prevalence ratios (APRs) of chronic physical diseases for respondents with depression and those without depression. We used SAS software version 9.4 (SAS institute Inc., Cary, NC, USA) for all analyses.
Of the total population (n=45,598), 3.7% (n=1,860) had been diagnosed with depression by physicians. Of the adults aged 19–64 years (n=34,837), 3.4% (n=1,289) and 5.1% (n=571) of the elderly aged 65 years and above (n=10,761) were diagnosed with depression. Of male respondents (n=19,263), 1.8% (n=355) and 5.4% (n=1,505) of female respondents (n=26,335) reported that they had depression (
As shown in
The APR of most chronic physical diseases were significantly higher among respondents with depression than those without depression. We specifically focused on the chronic physical diseases that were highly associated with depression (with APR higher than 2). Arthritis showed the highest APR of 2.41 (95% CI=2.27–2.40) in the adult male group, followed by the elderly male group (APR=2.06, 95% CI=2.03–2.09). The APR of arthritis was higher in adult respondents than elderly respondents and in men than women. Similarly, asthma showed the highest APR of 3.46 (95% CI=3.42–3.51) in the adult male group, followed by the elderly male group (APR=2.33, 95% CI=2.27–2.40). Like arthritis, APR of this disease was higher in adult respondents than elderly respondents and in men than women. The APR of chronic renal failure was remarkably higher in elderly male group than other groups. There was a difference in the APR of chronic renal failure between the elderly group and adult group among men (APR=8.36, 95% CI=8.01–8.72 vs. APR=1.57, 95% CI=1.49–1.66), but not among women (APR=1.94, 95% CI=1.87–2.02 vs. APR=2.05, 95% CI=1.99–2.10). Thyroid gland disease also showed higher APR in elderly male group than other groups. There was a difference in the APR of thyroid gland disease between the elderly group and adult group among men (APR=3.60, 95% CI=3.44–3.77 vs. APR=1.45, 95% CI=1.40–1.50), but not among women (APR=1.22, 95% CI=1.20–1.24 vs. APR=1.44, 95% CI=1.43–1.46). Cirrhosis of the liver also showed higher APR in the elderly male group than other groups. There was a difference in the APR of cirrhosis of the liver between the elderly group and adult group among both men (APR=2.27, 95% CI=2.13–2.42 vs. APR=1.69, 95% CI=1.60–1.78) and women (APR=1.36, 95% CI=1.28–1.45 vs. APR=0.53, 95% CI=0.49–0.58) Stroke (APR=1.79, 95% CI=1.75–1.82) and cancer (APR=1.66, 95% CI=1.64–1.69) had higher APRs in the adult female group than other groups (
Among the respondents with depression, though prevalence rates of chronic renal failure were lower than other physical diseases, APRs of this disease were fairly high, compared to those without depression, showing a maximum of 8-fold increase in elderly male respondents with depression compared to those without depression. On the contrary, the prevalence rates of metabolic syndrome were very high, but APRs of this disease was relatively low in respondents with depression because of its high prevalence among both, respondents with and those without depression (
To our knowledge, this study is the first to present APRs of diverse, chronic physical diseases related to depression among sex and age groups separately. Our results have shown that the prevalence of most chronic physical diseases are significantly higher among respondents with depression than those without depression and associations between depression and chronic physical diseases is unequally distributed across sex and agegroups.
The noticeable result was that elderly male respondents with depression were much more vulnerable to chronic physical diseases (i.e., arthritis, angina, asthma, renal failure, thyroid gland disease, and cirrhosis of the liver) than elderly female respondents with depression, although the prevalence of depression in elderly female respondents was about three times higher than in elderly male respondents (6.9% and 2.4% respectively). There were more chronic physical diseases that showed an APR higher than 2 in elderly male respondents than any other groups. Such diseases include arthritis, asthma, chronic renal failure, thyroid gland disease, and cirrhosis (APRs of 2.06, 2.33, 8.36, 3.60, and 2.27, respectively). Our finding is consistent with the results of a Korean study which found that the association between depressive symptoms and a number of physical illnesses is stronger in older male respondents than older female respondents and having one or more physical illnesses increased the risk of suicidal ideation in older male respondents, but not in older female respondents [
Such a high comorbidity of depression with physical diseases among older male respondents may be partially explained by the vulnerability of older men in a post-retirement environment and widowhood. Isolation and loneliness related to changes in role identity after retirement or loss of a partner or a relationship was found to be more detrimental for elderly male subjects than elderly female subjects [
Especially, chronic renal failure has shown the highest APR (APR=8.36, 95% CI=8.01–8.72) in elderly male respondents with depression among all sex and age groups in our findings. Little is known about why chronic renal failure is disproportionately common in elderly men with depression compared to those without depression. However, the facts that the annual incidence of chronic renal failure increases rapidly with advancing age, and is three times higher in male patients than female patients who are 75 years old or more [
Previous studies have reported the comorbidity between depression and arthritis, especially rheumatoid arthritis. In a cross-sectional study, almost three-fourths (71.5%) of rheumatoid arthritis patients were found to have depression, and the level of depression was strongly associated with rheumatoid arthritis disease activity [
There were several limitations that should be considered when interpreting the results. First, the cross-sectional design of this study did not allow the investigation of the temporal or causal relationship between depression and a chronic physical disease. The association between depression and chronic physical diseases is increasingly considered to be bidirectional [
Despite these limitations, the strength of our study was that we used a large, nationally representative sample, and showed the differences in the prevalence of diverse, chronic physical diseases comorbid with depression across sex and age groups, which, to our knowledge, had not been established through previous studies. Our findings suggested that the prevalence of chronic physical diseases that are more likely to occur in patients with depression was different in different groups in the population. For example, older male respondents with depression showed a much higher risk of having chronic renal failure than the other groups. Thus, professionals in the fields of mental and physical health should realize the seriousness of physical diseases comorbid with depression, and collaborative care strategies should be designed according to demographic characteristics of the population. Future studies will be needed to further explore the depth of depression’s effect on a chronic disease according to the characteristics of the population.
This study was supported by an Intramural Research Grant (No R2017-A) from the National Center for Mental Health, Ministry of Health & Welfare, Republic of Korea.
Demographic characteristics of the samples according to presence of lifetime depression diagnosis among Koreans (aged 19 years or over)
Total | Depression (N=1,860) | Non-depression (N=14,504) | p-value |
|
---|---|---|---|---|
Age groups, year, N (%) |
<0.0001 | |||
19–64 | 34,837 (85.8) | 1,289 (3.4) | 33,548 (96.6) | |
≥65 | 10,761 (14.2) | 571 (5.1) | 10,190 (94.9) | |
Sex, N (%) |
<0.0001 | |||
Male | 19,263 (49.2) | 355 (1.8) | 18,908 (98.2) | |
Female | 26,335 (50.8) | 1,505 (5.4) | 24,830 (94.6) | |
Education, N (%) |
<0.0001 | |||
≥High school | 28,364 (71.2) | 832 (2.8) | 27,532 (97.2) | |
<High school | 17,088 (28.8) | 1,019 (5.8) | 16,069 (94.2) | |
Arthritis | 6,180 (9.7) | 535 (22.8) | 5,645 (9.2) | <0.0001 |
Angina or myocardial infarction | 1,132 (1.8) | 87 (3.1) | 1,045 (1.7) | <0.0001 |
Stroke | 1,001 (1.5) | 76 (2.7) | 925 (1.5) | <0.0001 |
Tuberculosis | 2,255 (4.4) | 116 (5.4) | 2,139 (4.4) | <0.0001 |
Asthma | 1,480 (2.9) | 133 (7.0) | 1,347 (2.8) | <0.0001 |
Chronic renal failure | 196 (0.4) | 22 (0.9) | 174 (0.3) | <0.0001 |
Atopic dermatitis | 1,112 (2.9) | 55 (2.9) | 1,057 (2.9) | 0.9983 |
Thyroid gland disease | 1,655 (3.0) | 140 (6.2) | 1,515 (2.8) | <0.0001 |
Cancer |
740 (1.2) | 47 (2.3) | 693 (1.2) | 0.0015 |
Cirrhosis of the liver | 120 (0.2) | 8 (0.3) | 112 (0.2) | 0.4688 |
Metabolic syndrome | 13,965 (28.5) | 615 (30.9) | 13,350 (28.4) | 0.0644 |
statistical significance of difference between groups with and without depression,
% population weighted proportions,
any cancer including stomach, liver, colorectal, and breast cancers
Age-standardized prevalence of chronic physical diseases according to presence of lifetime depression diagnosis among Korean males
Adult male (aged 19–64 years) |
Elderly male (aged 65 years or older) |
|||||
---|---|---|---|---|---|---|
Depression (N=238) |
Non-depression (N=14,504) |
APR (95% CI) | Depression (N=117) |
Non-depression (N=4,404) |
APR (95% CI) | |
Prevalence (SE) | Prevalence (SE) | Prevalence (SE) | Prevalence (SE) | |||
Arthritis | 7.02 (1.84) | 2.86 (0.15) | 2.41 (2.38–2.44) | 10.72 (1.89) | 5.47 (0.25) | 2.06 (2.03–2.09) |
Angina or myocardial infarction | 1.71 (0.68) | 1.26 (0.10) | 1.26 (1.22–1.29) | 4.99 (1.35) | 2.90 (0.19) | 1.89 (1.85–1.93) |
Stroke | 1.87 (0.72) | 1.02 (0.10) | 1.60 (1.56–1.64) | 4.22 (1.25) | 2.82 (0.18) | 1.37 (1.34–1.41) |
Tuberculosis | 4.70 (1.32) | 4.44 (0.18) | 1.01 (0.99–1.03) | 5.35 (1.52) | 4.69 (0.24) | 1.22 (1.19–1.24) |
Asthma | 7.53 (2.13) | 1.99 (0.13) | 3.46 (3.42–3.51) | 3.83 (1.42) | 1.64 (0.14) | 2.33 (2.27–2.40) |
Chronic renal failure | 0.52 (0.50) | 0.25 (0.04) | 1.57 (1.49–1.66) | 1.83 (0.82) | 0.24 (0.05) | 8.36 (8.01–8.72) |
Atopic dermatitis | 3.31 (1.21) | 2.72 (0.16) | 1.31 (1.28–1.33) | 0.40 (0.30) | 0.49 (0.08) | 1.04 (0.96–1.12) |
Thyroid gland disease | 0.88 (0.45) | 0.73 (0.07) | 1.45 (1.40–1.50) | 1.30 (0.59) | 0.45 (0.07) | 3.60 (3.44–3.77) |
Cancer |
1.33 (0.75) | 0.72 (0.07) | 1.54 (1.49–1.59) | 2.33 (1.19) | 1.90 (0.16) | 1.22 (1.18–1.26) |
Cirrhosis of the liver | 0.54 (0.39) | 0.21 (0.04) | 1.69 (1.60–1.78) | 0.59 (0.41) | 0.35 (0.07) | 2.27 (2.13–2.42) |
Metabolic syndrome | 40.93 (3.58) | 34.47 (0.44) | 1.13 (1.13–1.14) | 18.91 (2.25) | 19.13 (0.39) | 1.02 (1.01–1.03) |
any cancer including stomach, liver, colorectal, and breast cancers.
APR: age-adjusted prevalence ratio
Age-standardized prevalence of chronic physical diseases according to presence of lifetime depression diagnosis among Korean females
Chronic physical diseases | Adult female (aged 19–64 years) |
Elderly female (aged 65 years or older) |
||||
---|---|---|---|---|---|---|
Depression (N=1,051) |
Non-depression (N=19,044) |
APR (95% CI) | Depression (N=454) |
Non-depression (N=5,786) |
APR (95% CI) | |
Prevalence (SE) | Prevalence (SE) | Prevalence (SE) | Prevalence (SE) | |||
Arthritis | 15.26 (1.10) | 8.86 (0.22) | 1.65 (1.64–1.65) | 21.02 (1.21) | 18.04 (0.35) | 1.16 (1.15–1.16) |
Angina or myocardial infarction | 0.95 (0.22) | 0.90 (0.08) | 1.12 (1.10–1.14) | 3.54 (0.61) | 2.19 (0.15) | 1.74 (1.72–1.76) |
Stroke | 1.16 (0.31) | 0.59 (0.06) | 1.79 (1.75–1.82) | 3.01 (0.55) | 1.99 (0.16) | 1.41 (1.39–1.43) |
Tuberculosis | 3.85 (0.62) | 2.93 (0.14) | 1.29 (1.28–1.31) | 2.68 (0.52) | 1.68 (0.13) | 1.58 (1.55–1.60) |
Asthma | 5.13 (0.78) | 2.31 (0.12) | 2.19 (2.17–2.21) | 4.19 (0.78) | 2.58 (0.17) | 1.55 (1.53–1.57) |
Chronic renal failure | 0.57 (0.24) | 0.31 (0.05) | 2.05 (1.99–2.10) | 0.63 (0.24) | 0.31 (0.05) | 1.94 (1.87–2.02) |
Atopic dermatitis | 3.01 (0.61) | 2.96 (0.15) | 1.12 (1.10–1.13) | 0.57 (0.23) | 0.36 (0.06) | 1.56 (1.51–1.62) |
Thyroid gland disease | 6.92 (0.89) | 4.42 (0.16) | 1.44 (1.43–1.46) | 2.82 (0.54) | 2.35 (0.16) | 1.22 (1.20–1.24) |
Cancer |
1.30 (0.36) | 0.85 (0.07) | 1.66 (1.64–1.69) | 1.74 (0.59) | 1.29 (0.12) | 1.24 (1.21–1.27) |
Cirrhosis of the liver | 0.07 (0.05) | 0.10 (0.02) | 0.53 (0.49–0.58) | 0.17 (0.12) | 0.16 (0.05) | 1.36 (1.28–1.45) |
Metabolic syndrome | 17.59 (1.27) | 13.53 (0.28) | 1.19 (1.18–1.19) | 17.97 (1.22) | 18.06 (0.37) | 0.99 (0.98–1.00) |
any cancer including stomach, liver, colorectal, and breast cancers.
APR: age-adjusted prevalence ratio