Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates

The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20 percent of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.

The Relationship between Depressive Symptoms in Outpatients with Chronic Illness and Health Care Costs

PURPOSE: To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs. PATIENTS AND METHODS: Data were compared between outpatients with depressive symptoms and those without depressive symptoms. Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder. RESULTS: A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms. CONCLUSION: In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses.

Prevalence and Correlates of Depressive Symptoms among Community-Dwelling Low Income Elderly / 신경정신의학

OBJECTIVES: This study aimed to investigate the prevalence and correlates of depressive symptoms in community-dwelling low income elderly. METHODS: A community survey of 1,351 low income residents aged 65 or over was conducted in Buk district of Gwangju, Korea. Depressive symptom was evaluated by the Korean Form of the Geriatric Depression Scale (KGDS). Their sociodemographic factors, the precence of chronic physical illness, and cognitive functions were investigated. RESULTS: The prevalence rate of depressive symptoms was 69.8%. In multiple logistic regression, chronic physical illness (Odds Ratio:2.68, 95% Confidence Interval : 1.98-3.63), low education (Odds Ratio : 1.84, 95% Confidence Interval : 1.39-2.43), and cognitive impairment (Odds Ratio : 1.61, 95% Confidence Interval : 1.20-2.16) were independently associated with depressive symptoms. CONCLUSION: Depressive symptoms in community-dwelling low income elderly were very common, particularly related to current chronic physical illnesses. The results of this study can be useful for the development of community-based prevention and management programs for depression. Of elderleg.

Prevalence and Correlates of Depressive Symptoms among Community-Dwelling Low Income Elderly / 신경정신의학

OBJECTIVES: This study aimed to investigate the prevalence and correlates of depressive symptoms in community-dwelling low income elderly. METHODS: A community survey of 1,351 low income residents aged 65 or over was conducted in Buk district of Gwangju, Korea. Depressive symptom was evaluated by the Korean Form of the Geriatric Depression Scale (KGDS). Their sociodemographic factors, the precence of chronic physical illness, and cognitive functions were investigated. RESULTS: The prevalence rate of depressive symptoms was 69.8%. In multiple logistic regression, chronic physical illness (Odds Ratio:2.68, 95% Confidence Interval : 1.98-3.63), low education (Odds Ratio : 1.84, 95% Confidence Interval : 1.39-2.43), and cognitive impairment (Odds Ratio : 1.61, 95% Confidence Interval : 1.20-2.16) were independently associated with depressive symptoms. CONCLUSION: Depressive symptoms in community-dwelling low income elderly were very common, particularly related to current chronic physical illnesses. The results of this study can be useful for the development of community-based prevention and management programs for depression. Of elderleg.