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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 606-611. doi: 10.19723/j.issn.1671-167X.2023.04.006

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Association between depression and chronic diseases among middle-aged and older Chinese adults

Chun-su ZHU1,2,Zhi-wei LIAN3,Yi-min CUI1,2,*()   

  1. 1. Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
    2. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
    3. Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
  • Received:2020-08-06 Online:2023-08-18 Published:2023-08-03
  • Contact: Yi-min CUI E-mail:cui.pharm@pkufh.com

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Abstract:

Objective: To examine the association between depressive symptoms and chronic diseases among middle-aged and older Chinese adults within a national investigation. Methods: Data used in current analysis were obtained from a nationally representative, cross-sectional population-based survey of China health and retirement longitudinal study, which were conducted in 2011 using four-stage probability-proportional-to-size sampling methods. A total of 10 420 participants who were aged 45 years and above from 28 provinces in mainland China were included. Information on demographic characteristics (e.g., age, gender, education level), lifestyle factors (e.g., smoking status and drinking frequency) and chronic diseases (e.g., hypertension, diabetes, and stroke) were collected by well-trained interviewers at the interviewees' homes using a standardized questionnaire. Depressive symptoms were measured using the 10-item version of the center for epidemiological studies depression scale (CESD-10, which was a widely used standard tool in Chinese population, and elevated depressive symptoms were defined by a cut-off ≥10. Multivariate Logistic regression analysis was carried out to assess the association between depressive symptoms and chronic diseases (including hypertension, diabetes, heart disease, dyslipidemia and stroke), adjusting for age, gender, education level, marital status, ethnicity, place of residence, bady mass index (BMI) and other potential confounding factors. Results: Among the 10 420 participants, the mean age was (59.2±9.4) years, and 48.2% of them were men. There were 3 900 (37.4%) participants who had a depression rating score of 10 or greater, indicative of elevated depressive symptoms. The results of multivariate Logistic regression analysis demonstrated that diabetes (OR=1.230, 95%CI: 1.080-1.401), hypertension (OR=1.335, 95%CI: 1.205-1.480), heart disease (OR=1.953, 95%CI: 1.711-2.229), and stroke (OR=2.269, 95%CI: 1.704-3.020) were significantly associated with depressive symptoms (P < 0.05), after full adjustment of age, gender, education level, marital status, ethnicity, residency and other potential confounders. While no significant relationship was found between dyslipidemia and depressive symptoms (P>0.05). The prevalence of elevated depressive symptoms increased parallel with the number of chronic diseases (Ptrend < 0.001). Conclusion: Depressive symptoms were significantly associated with chronic diseases (including diabetes, hypertension, heart disease, and stroke), which suggests that psychological factors, such as depressive symptoms should be taken into consideration in the prevention and control of chronic diseases.

Key words: Middle-aged and older population, Depressive symptoms, Chronic diseases, Cross-sectional study

CLC Number: 

  • R181.3

Table 1

Characteristics by depressive-symptom status of mid-aged population"

Characteristics Full sample(n=10 420) Depression disorderP value
No (n=6 520) Yes (n=3 900)
Age/years, $\bar x \pm s$ 59.2±9.4 58.7±9.3 60.0±9.4 <0.001
Gender, n (%) <0.001
   Male 5 018 (48.2) 3 484 (53.4) 1 534 (39.3)
   Female 5 402 (51.8) 3 036 (46.6) 2 366 (60.7)
Residence, n (%) <0.001
   Urban 3 675 (35.3) 2 554 (39.2) 1 121 (28.7)
   Rural 6 745 (64.7) 3 966 (60.8) 2 779 (71.3)
Education, n (%) <0.001
   Primary school and below 7 128 (68.4) 4 073 (62.5) 3 055 (78.3)
   Middle school 2 182 (20.9) 1 560 (23.9) 622 (15.9)
   High school 940 (9.0) 741 (11.4) 199 (5.1)
   Above high school 170 (1.6) 146 (2.2) 24 (0.6)
Ethnicity, n (%) 0.275
   Han 9 971 (95.7) 6 250 (95.9) 3 721 (95.4)
   Others 449 (4.3) 270 (4.1) 179 (4.6)
Marital status, n (%) <0.001
   Married 9 159 (87.9) 5 903 (90.5) 3 256 (83.5)
   Separated or divorced or never married 209 (2.0) 92 (1.4) 117 (3.0)
   Widowed 1 052 (10.1) 525 (8.1) 527 (13.5)
BMI /(kg/m2)，$\bar x \pm s$ 23.5±3.9 23.8±4.0 23.1±3.8 <0.001
Sleep duration, n (%) <0.001
   <6 h 3 051 (29.3) 1 343 (20.6) 1 708 (43.8)
   6-8 h 6 519 (62.6) 4 596 (70.5) 1 923 (49.3)
   ≥8 h 850 (8.2) 581 (8.9) 269 (6.9)
Smoking, n (%) <0.001
   Current 3 252 (31.2) 2162 (33.2) 1 090 (27.9)
   Never 6 212 (59.6) 3707 (56.9) 2 505 (64.2)
   Past 956 (9.2) 651 (10.0) 305 (7.8)
Alcohol use, n (%) <0.001
   Never 6 968 (66.9) 4 139 (63.5) 2 829 (72.5)
   Less than once a month 825 (7.9) 551 (8.5) 274 (7.0)
   At least once a month 2 627 (25.2) 1 830 (28.1) 797 (20.4)

Table 2

Chronic disease by depressive-symptom status of mid-aged population"

Characteristics Full sample(n=10 420) Depression disorderP value OR
No (n=6 520) Yes (n=3 900)
Diabetes, n (%) 0.049
      No 9 179 (88.1) 5 775 (88.6) 3 404 (87.3) 1 (ref)
      Yes 1 241 (11.9) 745 (11.4) 496 (12.7) 1.130 (1.001-1.275)
Hypertension, n (%) <0.001
      No 7 935 (76.2) 5 067 (77.7) 2 868 (73.5) 1(ref)
      Yes 2 485 (23.8) 1 453 (22.3) 1 032 (26.5) 1.255 (1.145-1.376)
Heart disease, n (%) <0.001
   No 9 234 (88.6) 5 941 (91.9) 3 293 (84.4) 1(ref)
   Yes 1 186 (11.4) 579 (8.9) 607 (15.6) 1.891 (1.675-2.136)
Stroke, n (%) <0.001
   No 10 197 (97.9) 6 420 (98.5) 3 777 (96.8) 1(ref)
   Yes 223 (2.1) 100 (1.5) 123 (3.2) 2.091 (1.601-2.730)
Dyslipidemia, n (%) 0.307
   No 6 915 (66.4) 4 303 (66.0) 2 612 (67.0) 1(ref)
   Yes 3 505 (33.6) 2 217 (34.0) 1 288 (33.0) 0.957 (0.880-1.041)
Number of comorbid chronic disease <0.001
   0 4 898 (47.0) 3 178 (48.7) 1 720 (44.1) 1(ref)
   1 3 284 (31.5) 2 049 (31.4) 1 235 (31.7) 1.114 (1.016-1.221)
   2 1 518 (14.6) 914 (14.0) 604 (15.5) 1.221 (1.085-1.374)
   ≥3 720 (6.9) 379 (5.8) 341 (8.7) 1.662 (1.420-1.946)

Table 3

Model adjusted association between depressive symptoms and chronic diseases"

Items Model 1 Model 2
Diabetes
   No 1 (ref) 1 (ref)
   Yes 1.097 (0.970-1.241) 1.230 (1.080-1.401)
Hypertension
   No 1 (ref) 1 (ref)
   Yes 1.158 (1.054-1.272) 1.335 (1.205-1.480)
Heart disease
   No 1 (ref) 1 (ref)
   Yes 1.735 (1.533-1.963) 1.953 (1.711-2.229)
Stroke
   No 1 (ref) 1 (ref)
   Yes 2.031 (1.549-5.661) 2.269 (1.704-3.020)
Dyslipidemia
   No 1 (ref) 1 (ref)
   Yes 0.930 (0.854-1.013) 1.025 (0.935-1.123)
Number of comorbid chronic disease
   0 1 (ref) 1 (ref)
   1 1.070 (0.974-1.174) 1.167 (1.057-1.288)
   2 1.113 (0.986-1.256) 1.335 (1.171-1.523)
   ≥3 1.518 (1.293-1.781) 2.052 (1.721-2.447)
   Ptrend <0.001 <0.001

Table 4

Age subgroup analysis on association between depressive symptoms and chronic diseases"

Items 45-59 60-74 ≥75
Diabetes
   No 1 (ref) 1 (ref) 1 (ref)
   Yes 1.182 (0.980-1.425) 1.242 (1.018-1.515) 1.434 (0.891-2.309)
Hypertension
   No 1 (ref) 1(ref) 1 (ref)
   Yes 1.434 (1.229-1.672) 1.269 (1.089-1.479) 1.206 (0.852-1.707)
Heart disease
   No 1 (ref) 1(ref) 1 (ref)
   Yes 2.066 (1.689-2.528) 1.902(1.568-2.306) 1.943 (1.226-3.079)
Stroke
   No 1 (ref) 1 (ref) 1 (ref)
   Yes 2.627 (1.640-206) 2.234 (1.492-3.345) 1.679 (0.718-3.927)
Dyslipidemia
   No 1 (ref) 1 (ref) 1 (ref)
   Yes 1.057 (0.931-1.200) 0.970 (0.839-1.121) 1.055 (0.739-1.507)
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