Multimorbilidad y su asociación con la salud mental en una población adulta del Perú

Alejandro M. Angulo-Ramírez; Flavio C. Costa-Berlanga; Antonio Bernabé-Ortiz

doi:10.17843/rpmesp.2024.414.13610

Authors

Alejandro M. Angulo-Ramírez Universidad Científica del Sur, Lima, Perú https://orcid.org/0000-0003-2093-3564
Flavio C. Costa-Berlanga Universidad Científica del Sur, Lima, Perú https://orcid.org/0000-0003-0813-3935
Antonio Bernabé-Ortiz Universidad Científica del Sur, Lima, Perú https://orcid.org/0000-0002-6834-1376

DOI:

https://doi.org/10.17843/rpmesp.2024.414.13610

Keywords:

Chronic conditions, multimorbidity, depression, anxiety, stress, mental health

Abstract

Objective. To evaluate the association between multimorbidity and mental health in adults aged 30 to 69 years. Materials and methods. Secondary data analysis of a population-based study conducted in the
peri-urban area of Tumbes in the northern coast of Peru. The dependent variables were: depressive symptoms, using the PHQ-9; anxiety symptoms, using the Goldberg scale; and perceived stress, assessed with
the Cohen’s 14-question scale. The exposure variable was the presence of multimorbidity (presence or not of two or more chronic conditions and the number of chronic conditions). We assessed associations using crude and adjusted Poisson regression models. Results. Data from 1600 participants were analyzed, mean age was 48.1 years (SD: 10.5), and 50.4% were women. The prevalence of multimorbidity was 15.9%, 23.3% presented depressive symptoms, 42.0% anxiety symptoms and 31.4% had high levels of perceived stress. The multivariable model showed that multimorbidity was associated with a higher prevalence of depressive symptoms (61%, 95%CI: 32% - 98%), anxiety symptoms (46%, 95%CI: 28% - 66%) and high (22%, 95%CI: 14% - 33%) but not moderate levels of perceived stress (6%; 95%CI: 0% - 12%). A higher number of chronic conditions was associated with higher prevalence of depressive symptoms, anxiety symptoms, and perceived stress levels. Conclusions. The presence of multimorbidity is associated with a higher prevalence of depressive symptoms, anxiety symptoms, and perceived stress levels. Our results suggest the need for adequate mental health management in patients with multimorbidity.

Downloads

Download data is not yet available.

References

Global Burden of Disease 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204

countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 2022;9(2):137-50. doi: 10.1016/S2215-0366(21)00395-3.

Mejía-Zambrano H, Ramos-Calsín L. Prevalencia de los principales trastornos mentales durante la pandemia por COVID-19. Rev Neuropsiquiatr 2022;185(1):72-82. doi: 10.20453/rnp.v85i1.4157.

Ruiz-Frutos C, Palomino-Baldeón JC, Ortega-Moreno M, Villavicencio-Guardia MDC, Dias A, Bernardes JM, et al. Effects of the

COVID-19 Pandemic on Mental Health in Peru: Psychological Distress. Healthcare (Basel) 2021;9(6):691. doi: 10.3390/healthcare9060691.

Basto-Abreu A, Barrientos-Gutierrez T, Wade AN, Oliveira de Melo D, Semeão de Souza AS, Nunes BP, et al. Multimorbidity

matters in low and middle-income countries. J Multimorb Comorb 2022;12:26335565221106074. doi: 10.1177/26335565221106074

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care,

research, and medical education: a cross-sectional study. Lancet 2012;380(9836):37-43. doi: 10.1016/S0140-6736(12)60240-2.

Huaquía-Díaz AM, Chalán-Dávila TS, Carrillo-Larco RM, Bernabe-Ortiz A. Multimorbidity in Latin America and the Caribbean: a

systematic review and meta-analysis. BMJ Open 2021;11(7):e050409. doi: 10.1136/bmjopen-2021-050409.

Miranda JJ, Bernabe-Ortiz A, Gilman RH, Smeeth L, Malaga G, Wise RA, et al. Multimorbidity at sea level and high-altitude urban

and rural settings: The CRONICAS Cohort Study.] J Comorb 2019;9:2235042x19875297. doi: 10.1177/2235042X19875297.

The Academy of Medical Sciences. Multimorbidity: a priority for global health research. London, UK: AMS; 2018.

Filipčić I, Bajić Ž, Filipčić I. The onset and accumulation of physical multimorbidity in severe and common mental disorders. Curr Opin

Psychiatry 2020;33(5):484-90. doi: 10.1097/YCO.0000000000000635.

Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: A systematic review and meta-analysis. J Affect Disord 2017;221:36-46. doi: 10.1016/j.jad.2017.06.009.

Romain AJ, Marleau J, Baillot A. Association between physical multimorbidity, body mass index and mental health/disorders in a

representative sample of people with obesity. J Epidemiol Community Health 2019;73(9):874-80. doi: 10.1136/jech-2018-211497.

Bernabe-Ortiz A, Perel P, Miranda JJ, Smeeth L. Diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM in Peruvian population. Prim Care Diabetes 2018;12(6):517-25. doi: 10.1016/j.pcd.2018.07.015.

Instituto Nacional de Estadística e Informática. Censos Nacionales 2017: XII de Población, VII de Vivienda y III de Comunidades Indígenas. Lima, Peru: INEI; 2018 [updated 2018; visitado 2024 Julio 18]; Disponible en: https://www.inei.gob.pe/estadisticas/censos/.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama 2003;289(19):2560-72. doi: 10.1001/jama.289.19.2560.

American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022;45(Suppl 1):S17-S38. doi: 10.2337/dc22-S002.

Del Brutto OH, Idrovo L, Mosquera A, Díaz-Calderón E, Santibáñez R, Navas C, et al. [Validation of a screening questionnaire for stroke detection in Spanish-speaking communities]. Rev Neurol 2004;39(4):301-4.

Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Beck JD, et al. Self-reported measures for surveillance of periodontitis. J Dent Res 2013;92(11):1041-7. doi: 10.177/0022034513505621.

Duarte J, Clavería LE, de Pedro-Cuesta J, Sempere AP, Coria F, Calne DB. Screening Parkinson’s disease: a validated questionnaire of high specificity and sensitivity. Mov Disord 1995;10(5):643-9. doi: 10.1002/mds.870100518.

Baader T, Molina JL, Venezian S, Rojas C, Farías R, Fierro-Freixenet C, et al. [Validity and utility of PHQ9 (Patient Helth Questionnaire) in the diagnosis of depression in user patients of primary care in Chile]. Rev Chil Neuro-psiquiatr 2012;50(1):10-22. doi: 10.4067/S0717-92272012000100002.

Calderón M, Gálvez-Buccollini JA, Cueva G, Ordoñez C, Bromley C, Fiestas F. [Validation of the Peruvian version of the PHQ-9 for diagnosing depression]. Rev Peru Med Exp Salud Publica 2012;29(4):578-9. doi: 10.1590/s726-46342012000400027.

Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, et al. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis. Jama 2020;323(22):2290-300. doi: 10.1001/jama.2020.6504.

Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9(1):139-45. doi: 10.1017/s0033291700021644.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24(4):385-96.

The DHS Program. Wealth index construction. Rockvile, MD; 2021 [updated 2021; visitado 2024 August 29]; Disponible en: https://dhsprogram.com/topics/wealth-index/Wealth-Index-Construction.cfm.

Rubio Valladolid G, Bermejo Vicedo J, Caballero Sánchez-Serrano MC, Santo-Domingo Carrasco J. [Validation of the Alcohol Use Disorders Identification Test (AUDIT) in primary care]. Rev Clin Esp 1998;198(1):11-4.

Castro-de-Araujo LFS, Cortes F, de Siqueira Filha NT, Rodrigues EDS, Machado DB, de Araujo JAP, et al. Patterns of multimorbidity

and some psychiatric disorders: A systematic review of the literature. Front Psychol 2022;13:940978. doi: 10.3389/fpsyg.2022.

Gould CE, O’Hara R, Goldstein MK, Beaudreau SA. Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. Int J Geriatr Psychiatry 2016;31(10):1105-15. doi: 10.002/gps.4532.

Saneei P, Esmaillzadeh A, Keshteli AH, Reza Roohafza H, Afshar H, Feizi A, et al. Combined Healthy Lifestyle Is Inversely Associated

with Psychological Disorders among Adults. PLoS One 2016;11(1):e0146888.

Petersen I, Rathod S, Kathree T, Selohilwe O, Bhana A. Risk correlates for physical-mental multimorbidities in South Africa: a cross-sectional study. Epidemiol Psychiatr Sci 2019;28(4):418-26. doi: 10.1017/S2045796017000737.

Stubbs B, Vancampfort D, Veronese N, Schofield P, Lin PY, Tseng PT, et al. Multimorbidity and perceived stress: a population-based

cross-sectional study among older adults across six low- and middle-income countries. Maturitas 2018;107:84-91. doi: 10.1016/j.maturitas.2017.10.007.

Vancampfort D, Koyanagi A, Ward PB, Veronese N, Carvalho AF, Solmi M, et al. Perceived Stress and Its Relationship With Chronic

Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries. Am

J Epidemiol 2017;186(8):979-89. doi: 10.1093/aje/kwx159.

Villarreal-Zegarra D, Segovia-Bacilio P, Paredes-Angeles R, Vilela-Estrada AL, Cavero V, Diez-Canseco F. Provision of community mental health care before and during the COVID-19 pandemic: A time series analysis in Peru. Int J Soc Psychiatry 2023;69(8):1996-2006. doi: 10.1177/00207640231185026.

Cusihuaman-Lope N, Vilela-Estrada AL, Cavero V, Villarreal-Zegarra D, Diez-Canseco F. Experiences of users and family members on the care received at community mental health centers in Lima and Callao during the COVID-19 pandemic. Rev Peru Med Exp Salud Publica 2023;40(3):278-86. doi: 10.17843/rpmesp.2023.403.2717.