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Child Psychiatrist /Adult Psychiatrist

Depression in Older Adults Accelerates Multimorbidity Progression

Keypoint: Older adults with depression are at increased risk for highly complex multimorbidity.

Depression in Older Adults

Older adults with depression have a more rapid progression of multimorbidity and a greater risk of developing highly complex multimorbidity (HCMM), according to study results published in The American Journal of Geriatric Psychiatry.

Multimorbidity – or the presence of 2 or more long-term health conditions – is more prevalent among older individuals and is influenced by the number, severity, and complexity of chronic conditions. Although research indicates that depression may exacerbate the severity of multimorbidity, it is still unclear how the multimorbidity is affected by different subtypes and severity of late-life depression.

To this aim, investigators conducted a population-based cohort study using data from the Korean Longitudinal Study on Cognitive Aging and Dementia, which collects information on community-dwelling older adults (aged 60 years and older). The investigators identified individuals in the dataset who completed the mood status and multimorbidity evaluations, did not exhibit complex multimorbidity (CMM), and underwent a minimum of 1 follow-up assessment within the 8-year follow-up period. The investigators characterized CMM as the presence of 3 or more chronic medical conditions across 3 or more distinct body systems at the initial assessment. Depression was measured through self-administration of the Geriatric Depression Scale (GDS). Participants with scores of 10 to 19 points were considered to have mild depression and scores of 20 and higher qualified as severe depression. The investigators also assessed sociodemographic characteristics, economic status, alcohol consumption, smoking status, and physical activity as potential covariates.

The investigators included a total of 2,486 participants who were followed over an average period of 5.8 years. Among them, 988 (39.7%) participants self-reported experiencing depression at the initial assessment. Individuals who were depressed were older (P =.003) and were more likely to be women (P <.001), widowed or divorced (P <.001), live alone (P =.001), live in poverty (P <.001), and have less education (P <.001) than individuals without depression.

The investigators found that individuals with depression demonstrated a faster progression in total multimorbidity scores (β, 0.132; 95% CI, 0.073-0.192; P <.001) compared with individuals who did not have depression. This change was even more pronounced for individuals with severe depression (β, 0.168; 95% CI, 0.054-0.281; P =.004) relative to those with mild depression (β, 0.125; 95% CI, 0.062-0.188; P <.001).

The investigators also observed that individuals with depression demonstrated a faster progression in complexity scores for multimorbidity (β, 0.065; 95% CI, 0.029-0.102; P =.001) relative to individuals without depression. Again, the complexity score changes were more pronounced for severe depression (β, 0.100; 95% CI, 0.029-0.171; P =.006) compared with mild depression (β, 0.58; 95% CI, 0.018-0.097; P =.004). However, the severity scores for multimorbidity were similar between the groups (β, 0.001; 95% CI, -0.017 to 0.018; P =.870).

Additionally, individuals with depression faced a 44% higher risk of developing highly complex multimorbidity – regardless of depression severity and subtype – relative to those without depression.

“As depression is modifiable through timely screening and appropriate management in primary care and public services, multidisciplinary care, including comprehensive assessment, shared decision-making, and efficient communication of treatment plans, may be required to establish person-centered management of multimorbidity across mental and physical illnesses,” the investigators concluded.

Study limitations include the lack of validation for depression categorization, reliance on self-reported chronic conditions, use of non-validated and self-reported depression assessment, and generalizability of the findings may not extend to other populations beyond community-dwelling Korean older adults.

Note: This article originally appeared on Psychiatry Advisor

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