Depression and accumulation of chronic and comorbid conditions, JAMA study finds link

The risk of accumulating chronic and comorbid conditions increases in women with depression and comorbid depression-anxiety across women of all age groups, a recent study published in JAMA Network Open has found. The study also highlighted similar findings for younger men.

Indian alone is home to more than 50 million people who suffer from anxiety and depression.

Both these disorders are associated with an increased risk of multimorbidity and premature death from natural causes. They may also be associated with accelerated aging in the elderly.

A lot of this information comes from the increasing evidence of shared biological mechanisms of these maladies.

The study conducted by researchers at Mayo Clinic tried to compare the risk and rate of accumulating chronic conditions in people with depression, anxiety, and comorbid depression and anxiety vs individuals with neither depression nor anxiety.

"Very few studies have directly compared the longitudinal risks of new chronic conditions or co-occurring conditions in people with depression, anxiety, and comorbid depression and anxiety within a single cohort, and to our knowledge, none has compared the rates of accumulation of chronic illnesses among these same groups of individuals. This is an important question, given the relatively early ages of onset of depression and anxiety and the possibility of a synergistic interaction of depression and anxiety in increasing the prevalence and costs of multimorbidity worldwide," write the authors.

This cohort study used the Rochester Epidemiology Project medical records-linkage system to identify residents of Olmsted County, Minnesota, from January 1, 2005, to December 31, 2014, with follow-up ending December 31, 2017.

The sample was divided into cohorts anchored at birthday ages of 20, 40, and 60 years.

The sample included 40360 individuals across all 3 age cohorts. 21 516 (53.3%) were women.

Individuals were classified at anchoring birthday age as having depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group), using electronically extracted diagnosis codes from the International Classification of Diseases, Ninth Revision in the 5 years before each anchoring birthday. Data were analyzed from August 2020 through November 2021.

The main exposure groups in each age cohort were depression, anxiety, and comorbid depression and anxiety.

The researchers found that :

• The risk of accumulating chronic conditions was significantly increased in women with depression and anxiety.

• The differences in rates of accumulation of chronic conditions were significantly higher for women with depression than for women in the reference group.

• For men, there was a significantly higher risk for accumulating chronic conditions with depression and comorbid depression and anxiety but this finding was exclusive to younger men.

• Rates of accumulation of chronic conditions were significantly higher in men with comorbid depression and anxiety only in the cohort aged 20 years.

• For women, depression and comorbid depression and anxiety were significantly associated with all-cause mortality in the cohorts aged 40 and 60 years, but only depression was associated with all-cause mortality in both birthday cohorts.

• For men, the risk of mortality was significantly increased for depression, but not comorbid depression and anxiety or anxiety alone, in the cohort aged 60 years.

"Our findings suggest that common mechanisms may underly depression and anxiety as well as aging and that these mechanisms may be magnified when depression and anxiety co-occur. Multiple biological mechanisms are implicated in this process, including chronic inflammation, neuroendocrine dysregulation, oxidative stress, mitochondrial dysfunction, and others. Nearly all of these mechanisms are associated with psychosocial stress, thus providing an additional link between common stress-mediated psychiatric disorders, like depression and anxiety, and chronic somatic illnesses," write the authors.