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The role of gender and anxiety in the association between somatic diseases and depression: findings from three combined epidemiological studies in primary care

  • E. Asselmann (a1) (a2) (a3), J. Venz (a1) (a2) (a3), L. Pieper (a1) (a2) (a3), H.-U. Wittchen (a1) (a3) (a4), D. Pittrow (a5) and K. Beesdo-Baum (a1) (a2) (a3)...

Abstract

Aims.

Although associations between various somatic diseases and depression are well established, findings concerning the role of gender and anxiety disorders for these associations remain fragmented and partly inconsistent. Combining data from three large-scaled epidemiological studies in primary care, we aim to investigate interactions of somatic diseases with gender and anxiety disorders in the association with depression.

Methods.

Self-reported depression according to the International Classification of Diseases, Tenth Edition (ICD-10) was assessed in n = 83 737 patients from three independent studies [DETECT (Diabetes Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment), Depression-2000 and Generalized Anxiety and Depression in Primary Care (GAD-P)] using the Depression Screening Questionnaire (DSQ). Diagnoses of depression, anxiety disorders and somatic diseases were obtained from treating physicians via standardised clinical appraisal forms.

Results.

In logistic regressions, adjusted for gender, age group and study, each somatic disease except for arterial hypertension and endocrine diseases was associated with self-reported depression (odds ratio, OR 1.3–2.6) and each somatic disease was associated with physician-diagnosed depression (OR 1.1–2.4). Most of these associations remained significant after additional adjustment for anxiety disorders and other somatic diseases. The associations with depression increased with a higher number of somatic diseases. Cardiovascular diseases (OR 0.8), diabetes mellitus (OR 0.8) and neurological diseases (OR 0.8) interacted with gender in the association with self-reported depression, while endocrine diseases (OR 0.8) interacted with gender in the association with physician-diagnosed depression. That is, the associations between respective somatic diseases and depression were less pronounced in females v. males. Moreover, cardiovascular diseases (OR 0.7), arterial hypertension (OR 0.8), gastrointestinal diseases (OR 0.7) and neurological diseases (OR 0.6) interacted with anxiety disorders in the association with self-reported depression, and each somatic disease interacted with anxiety disorders in the association with physician-diagnosed depression (OR 0.6–0.8). That is, the associations between respective somatic diseases and depression were less pronounced in patients with v. without anxiety disorders; arterial hypertension was negatively associated with self-reported depression only in patients with anxiety disorders, but not in patients without anxiety disorders.

Conclusions.

A range of somatic diseases as well as anxiety disorders are linked to depression – and especially patients with co-/multi-morbidity are affected. However, interactions with gender and anxiety disorders are noteworthy and of relevance to potentially improve recognition and treatment of depression by physicians. Somatic diseases are associated more strongly with depression in males v. females as well as in patients without v. with anxiety disorders, primarily because women and patients with anxiety disorders per se are characterised by considerably increased depression prevalence that only marginally changes in the presence of somatic comorbidity.

Copyright

Corresponding author

*Address for correspondence: E. Asselmann, Ph.D., Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany. (Email: eva.asselmann@tu-dresden.de)

References

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Beesdo, K, Jacobi, F, Hoyer, J, Low, NC, Höfler, M, Wittchen, H-U (2010). Pain associated with specific anxiety and depressive disorders in a nationally representative population sample. Social Psychiatry and Psychiatric Epidemiology 45, 89104.
Bekhuis, E, Boschloo, L, Rosmalen, JG, Schoevers, RA (2015). Differential associations of specific depressive and anxiety disorders with somatic symptoms. Journal of Psychosomatic Research 78, 116122.
Bhattacharya, R, Shen, C, Sambamoorthi, U (2014). Excess risk of chronic physical conditions associated with depression and anxiety. BMC Psychiatry 14, 10.
Bittner, A, Goodwin, RD, Wittchen, H.-U., Beesdo, K, Hofler, M, Lieb, R (2004). What characteristics of primary anxiety disorders predict subsequent major depressive disorder? Journal of Clinical Psychiatry 65, 618626.
Carnethon, MR, Kinder, LS, Fair, JM, Stafford, RS, Fortmann, SP (2003). Symptoms of depression as a risk factor for incident diabetes: findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 1971–1992. American Journal of Epidemiology 158, 416423.
Chou, SP, Huang, B, Goldstein, R, Grant, BF (2013). Temporal associations between physical illnesses and mental disorders – results from the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Comprehensive Psychiatry 54, 627638.
Courtenay, WH (2000). Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Social Science & Medicine 50, 13851401.
DiMatteo, MR, Lepper, HS, Croghan, TW (2000). Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine 160, 21012107.
Egede, LE (2007). Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General Hospital Psychiatry 29, 409416.
Engum, A (2007). The role of depression and anxiety in onset of diabetes in a large population-based study. Journal of Psychosomatic Research 62, 3138.
Ferro, JM, Caeiro, L, Figueira, ML (2016). Neuropsychiatric sequelae of stroke. Nature Reviews Neurology 12, 269280.
Frasure-Smith, N, Lesperance, F (2008). Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Archives of General Psychiatry 65, 6271.
Gerrits, MM, van Oppen, P, van Marwijk, HW, Penninx, BW, van der Horst, HE (2014). Pain and the onset of depressive and anxiety disorders. PAIN 155, 5359.
Gili, M, Comas, A, García-García, M, Monzón, S, Antoni, S-B, Roca, M (2010). Comorbidity between common mental disorders and chronic somatic diseases in primary care patients. General Hospital Psychiatry 32, 240245.
Jacobi, F, Höfler, M, Siegert, J, Mack, S, Gerschler, A, Scholl, L, Busch, MA, Hapke, U, Maske, U, Seiffert, I (2014). Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH). International Journal of Methods in Psychiatric Research 23, 304319.
Kahl, KG, Schweiger, U, Correll, C, Müller, C, Busch, ML, Bauer, M, Schwarz, P (2015). Depression, anxiety disorders, and metabolic syndrome in a population at risk for type 2 diabetes mellitus. Brain and Behavior 5, e00306.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder. Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 30953105.
Kessler, RC, Chiu, WT, Demler, O, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.
Kroenke, K, Spitzer, RL, Williams, JB, Linzer, M, Hahn, SR, de Gruy, FV III, Brody, D (1994). Physical symptoms in primary care: predictors of psychiatric disorders and functional impairment. Archives of Family Medicine 3, 774779.
Kroenke, K, Jackson, JL, Chamberlin, J (1997). Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. The American Journal of Medicine 103, 339347.
Licht, CM, De Geus, EJ, Seldenrijk, A, Van Hout, HP, Zitman, FG, Van Dyck, R, Penninx, BW (2009). Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension 53, 631638.
Lyness, JM, Niculescu, A, Tu, X, Reynolds, CF, Caine, ED (2006). The relationship of medical comorbidity and depression in older, primary care patients. Psychosomatics 47, 435439.
Merikangas, KR, Calkins, ME, Burstein, M, He, J-P, Chiavacci, R, Lateef, T, Ruparel, K, Gur, RC, Lehner, T, Hakonarson, H (2015). Comorbidity of physical and mental disorders in the neurodevelopmental genomics cohort study. Pediatrics 135, e927e938.
Mitchell, AJ, Vaze, A, Rao, S (2009). Clinical diagnosis of depression in primary care: a meta-analysis. The Lancet 374, 609619.
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet 370, 851858.
Munk-Jorgenson, P, Allgulander, C, Dahl, AA, Foldager, L, Holm, M, Rasmussen, I, Virta, A, Huuhtanen, M-T, Wittchen, H-U (2006). Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway and Sweden. Psychiatric Services 57, 17381744.
Nemeroff, CB, Goldschmidt-Clermont, PJ (2012). Heartache and heartbreak [mdash] the link between depression and cardiovascular disease. Nature Reviews Cardiology 9, 526539.
Niles, AN, Dour, HJ, Stanton, AL, Roy-Byrne, PP, Stein, MB, Sullivan, G, Sherbourne, CD, Rose, RD, Craske, MG (2015). Anxiety and depressive symptoms and medical illness among adults with anxiety disorders. Journal of Psychosomatic Research 78, 109115.
Østergaard, SD, Foldager, L (2011). The association between physical illness and major depressive episode in general practice. Acta Psychiatrica Scandinavica 123, 290296.
Pan, A, Sun, Q, Okereke, OI, Rexrode, KM, Hu, FB (2011). Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA 306, 12411249.
Patten, SB (2001). Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. Journal of Affective Disorders 63, 3541.
Patten, SB, Beck, CA, Kassam, A, Williams, JV (2005). Long-term medical conditions and major depression: strength of association for specific conditions in the general population. Canadian Journal of Psychiatry 50, 195202.
Patten, S, Williams, J, Lavorato, D, Wang, J, Jetté, N, Sajobi, T, Fiest, K, Bulloch, A (2016). Patterns of association of chronic medical conditions and major depression. Epidemiology and Psychiatric Sciences 19. Advance online publication. doi: https://doi.org/10.1017/S204579601600072X
Pfaff, JJ, Draper, BM, Pirkis, JE, Stocks, NP, Snowdon, JA, Sim, MG, Byrne, GJ, Lautenschlager, NT, Flicker, LA, Kerse, NM (2009). Medical morbidity and severity of depression in a large primary care sample of older Australians: the DEPS-GP project. Medical Journal of Australia 190, 7580.
Pieper, L, Schulz, H, Klotsche, J, Eichler, T, Wittchen, H-U (2008). Depression als komorbide Störung in der primärärztlichen Versorgung. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 4, 411421.
Pieper, L, Dirmaier, J, Klotsche, J, Thurau, C, Pittrow, D, Lehnert, H, Maerz, W, Koch, U, Wittchen, H-U (2011). Longitudinal associations between depressive symptoms and type 2 diabetes and their impact on mortality in primary care patients. Bundesgesundheitsblatt 54, 98107.
Roberts, LM, Pattison, H, Roalfe, A, Franklyn, J, Wilson, S, Hobbs, FR, Parle, JV (2006). Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Annals of Internal Medicine 145, 573581.
Russ, TC, Stamatakis, E, Hamer, M, Starr, JM, Kivimäki, M, Batty, GD (2012). Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ 345, e4933.
Scott, K, Bruffaerts, R, Tsang, A, Ormel, J, Alonso, J, Angermeyer, M, Benjet, C, Bromet, E, De Girolamo, G, De Graaf, R (2007). Depression–anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. Journal of Affective Disorders 103, 113120.
Shen, T, Lin, C, Liao, C, Wei, C, Sung, F, Kao, C (2016). Major depressive disorder is associated with subsequent adult-onset asthma: a population-based cohort study. Epidemiology and Psychiatric Sciences 18. Advance online publication. doi: https://doi.org/10.1017/S2045796016000664
StataCorp (2015). Stata Statistical Software: Release 14. Stata Corp LP: College Station, TX.
Stegmann, ME, Ormel, J, de Graaf, R, Haro, J.-M., de Girolamo, G, Demyttenaere, K, Kovess, V, Matschinger, H, Vilagut, G, Alonso, J (2010). Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode. Journal of Affective Disorders 124, 3844.
Strik, JJ, Denollet, J, Lousberg, R, Honig, A (2003). Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. Journal of the American College of Cardiology 42, 18011807.
Teesson, M, Mitchell, PB, Deady, M, Memedovic, S, Slade, T, Baillie, A (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry 45, 939946.
Winter, S, Wittchen, H-U, Höfler, M, Spiegel, B, Ormel, H, Müller, N, Pfister, H (2000). Design und methoden der studie ‘depression 2000’. Fortschritte der Medizin 118, 1121.
Wittchen, H-U, Perkonigg, A (1997). DIA-X-Screening Verfahren: Fragebogen DIA-SSQ: Screening für Psychische Störungen; Fragebogen DIA-ASQ: Screening für Angststörungen; Fragebogen DIA-DSQ: Screening für Depressionen. Swets & Zeitlinger bv: Frankfurt.
Wittchen, H-U, Pfister, H (1997). DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12Monate); PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Swets & Zeitlinger: Frankfurt.
Wittchen, H-U, Pittrow, D (2002). Prevalence, recognition and management of depression in primary care in Germany: the depression 2000 study. Human Psychopharmacology 17, S1S11.
Wittchen, HU, Kessler, R, Pfister, H, Höfler, M, Lieb, R (2000). Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatrica Scandinavica 102, 1423.
Wittchen, H-U, Höfler, M, Meister, W (2001). Prevalence and recognition of depressive syndromes in German primary care settings: poorly recognized and treated? International Clinical Psychopharmacology 16, 121135.
Wittchen, H-U, Kessler, RC, Beesdo, K, Krause, P, Höfler, M, Hoyer, J (2002). Generalized anxiety and depression in primary care: prevalence, recognition and management. Journal of Clinical Psychiatry 63, 2434.
Wittchen, H-U, Glaesmer, H, März, W, Stalla, GK, Lehnert, H, Zeiher, AM, Silber, S, Koch, U, Böhler, S, Pittrow, D, Ruf, G, for DETECT Study Group (2005). Cardiovascular risk factors in primary care: methods and baseline prevalence rates – the DETECT program. Current Medical Research and Opinion 21, 619629.

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