J Korean Med Sci.  2021 Apr;36(16):e99. 10.3346/jkms.2021.36.e99.

Combined Effects of Depression and Chronic Disease on the Risk of Mortality: The Korean Longitudinal Study of Aging (2006-2016)

• Kim H
• Kim SH
• Cho YJ

• KMID: 2515083
• DOI: http://doi.org/10.3346/jkms.2021.36.e99

Abstract

Background
The prevalence of depression is much higher in people with chronic disease than in the general population. Depression exacerbates existing physical conditions, resulting in a higher-than-expected death rate from the physical condition itself. In our aging society, the prevalence of multimorbid patients is expected to increase; the resulting mental problems, especially depression, should be considered. Using a large-scale cohort from the Korean Longitudinal Study of Aging (KLoSA), we analyzed the combined effects of depression and chronic disease on all-cause mortality.
Methods
We analyzed 10-year (2006–2016) longitudinal data of 9,819 individuals who took part in the KLoSA, a nationwide survey of people aged 45–79 years. We examined the association between multimorbidity and depression using chi-square test and logistic regression. We used the Cox proportional hazard model to determine the combined effects of multimorbidity and depression on the all-cause mortality risk.
Results
During the 10-year follow up, 1,574 people (16.0%) died. The hazard ratio associated with mild depression increased from 1.35 (95% confidence interval [CI], 1.05–1.73) for no chronic disease to 1.25 (95% CI, 0.98–1.60) for 1 chronic disease, and to 2.00 (95% CI, 1.58–2.52) for multimorbidity. The hazard ratio associated with severe depression increased from 1.73 (95% CI, 1.33–2.24) for no chronic disease, to 2.03 (95% CI, 1.60–2.57) for 1 chronic disease, and to 2.94 (95% CI, 2.37–3.65) for multimorbidity.
Conclusion
Patients with coexisting multimorbidity and depression are at an increased risk of all-cause mortality than those with chronic disease or depression alone.

Keyword

Depression; Chronic Disease; Multimorbidity; All-cause Mortality

Figure

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  Fig. 1 Modified Conceptual framework of relationship between stress vulnerability and depression and health outcome.BMI=body mass index.

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  Fig. 2 Selection of participants for analysis of the combined effect of depression and multimorbidity on all-cause mortality; the Korean Longitudinal Study of Aging, 2006–2016.

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  Fig. 3 Hazard ratios (95% confidence interval) of the combined effect of depression and multimorbidity on all-cause mortality; the Korean Longitudinal Study of Aging, 2006–2016.CESD-10 = the 10-item version of the Center for Epidemiologic Studies Depression scale.

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