Depression and multimorbidity: cross-sectional study of 1,751,841 patients in primary care

Smith, D. J. , Court, H., McLean, G., Martin, D., Langan Martin, J. , Guthrie, B., Gunn, J. and Mercer, S. W. (2014) Depression and multimorbidity: cross-sectional study of 1,751,841 patients in primary care. Journal of Clinical Psychiatry, 75(11), pp. 1202-1208. (doi: 10.4088/JCP.14m09147) (PMID:25470083)

Abstract

Background: Depression is common in many chronic physical health disorders but the nature and extent of physical health comorbidities in depression, particularly within large population-based samples of patients, and how these comorbidities relate to factors such as age, gender and social deprivation, is unknown. We aimed to assess the nature and extent of multiple physical health comorbidities in primary care patients with depression within a large and representative Scottish dataset. Methods: This was a cross-sectional study secondary data analysis of 314 primary care practices in Scotland (from the Primary Care Clinical Informatics Unit at the University of Aberdeen, March 31, 2007), including 143,943 people with depression and 1,280,435 controls. The outcomes assessed were 32 common chronic physical health conditions, adjusted for age, gender and social deprivation. Depression was defined as a Read Code for depression recorded within last year and/or four or more antidepressant prescriptions (excluding low dose tricyclics) within the last year. Findings: Individuals in primary care with depression were significantly more likely than individuals without depression to have every one of the 32 comorbid physical conditions we assessed, even after adjusting for age, gender and deprivation. The depression group were also significantly more likely to have multiple levels of comorbidity, including two physical health conditions (OR 1•55, 95% CI 1•53-1•58), three physical health conditions (OR 1•84, 95% CI 1•81-1•87), four physical health conditions (OR 2•06, 95% CI 2•01-2•11; p<0•001) and five or more physical health conditions (OR 2•65, 95% CI 2•59-2•71; p<0•001). Interpretation: Depression in primary care is associated with a very wide range of physical health comorbidities and considerable medical burden. The nature and extent of this multimorbidity, and the important association with social deprivation has not been previously described within a large and representative dataset of routine primary care data. Our findings have important implications for the integrated management of depression and physical health problems both in the UK and globally.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Martin, Dr Daniel and Smith, Professor Daniel and Mercer, Professor Stewart and Gunn, Professor Jane and Langan-Martin, Dr Julie and Guthrie, Prof Bruce and Court, Dr Helen and McLean, Dr Gary
• Authors: Smith, D. J., Court, H., McLean, G., Martin, D., Langan Martin, J., Guthrie, B., Gunn, J., and Mercer, S. W.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: Journal of Clinical Psychiatry
• Publisher: Physicians Postgraduate Press, Inc.
• ISSN: 0160-6689
• ISSN (Online): 1555-2101