Depressive symptoms and the development and progression of physical multimorbidity in a national cohort of Australian women
Objective: Multiple chronic physical conditions (physical multimorbidity) are common in people with depression. This study investigated the association between elevated depressive symptoms and the development and progression of physical multimorbidity in middle-aged women.
Methods: A total of 7,407 women aged 45–50 years were followed up from 1996 to 2016. These women were free from diagnosed depression or chronic physical conditions at baseline. Data on depressive symptoms and chronic physical conditions were updated every 3 years, with depressive symptoms assessed using the Center for Epidemiological Studies–Depression scale. A 1-to-1 matched cohort analysis was conducted to compare the cumulative incidence and odds of physical multimorbidity between women with (depressed cohort) and women without (nondepressed cohort) elevated depressive symptoms, adjusted for sociodemographic and health behavioral factors.
Results: Over 20 years of follow-up, 3,199 women (43.2%) reported elevated depressive symptoms. Of these, 2,035 (63.6%) developed physical multimorbidity. After the onset of elevated depressive symptoms, women had a more than 4-fold increase in cumulative incidence of multimorbidity. Compared with the nondepressed cohort, the odds of the depressed cohort developing multimorbidity before the onset of depressive symptoms was 1.81 (95% confidence interval = 1.49, 2.20). After the onset of depressive symptoms, the odds ratio was 2.38 (95% confidence interval = 2.20, 2.57).
Conclusions: Elevated depressive symptoms were common in women’s midlife. Women with elevated depressive symptoms had increased odds of physical multimorbidity both before and after the onset of depressive symptoms. These findings support the emerging integrated management and prevention of mental and physical multimorbidity.