Psychosocial patient characteristics and GP-registered chronic morbidity: A prospective study

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Abstract

Objective: The aim of this study was to get a profile of patients who are vulnerable to get multiple chronic, recurrent or high-impact diseases in a limited time period. We studied the incidence rates of morbidity and multimorbidity, and the influence of psychosocial characteristics on their occurrences. Method: Cohort study with 3551 subjects. Baseline measurement of psychosocial characteristics and a 2-year follow-up period for morbidity. The relations were evaluated using multiple logistic regression analysis. Results: After adjustment for basic socio-demographic variables, a high internal locus of control belief was found to be protective [odds ratio (OR)=0.82] for the occurrence of morbidity, negative life events increased the risk (OR=1.22). Characteristics specifically protective for the occurrence of multimorbidity as compared to monomorbidity were: a high internal locus of control belief (OR=0.73), living as a couple or in a family as compared to living alone (OR=0.68) and a large social network (OR=0.41). Conclusion: It appears that certain patient characteristics are specifically related to the occurrence of multimorbidity. This provides opportunities for the future development of preventive interventions.

Introduction

Many people are suffering from multiple diseases. This health problem, called multimorbidity [1], is a population-wide problem. Although far more frequent among the elderly, also among people under age 20, a considerable prevalence of multimorbidity was found (10%), using a broad nosological spectrum of chronic, recurrent and high-impact diseases [2]. The general practitioner (GP), who — as in some other European countries — acts as a gate-keeper in the Dutch health care system, is often confronted with complex health care situations of patients who have co-occurring diseases. Generally, it is not clear why some patients have a number of diseases at the same time or in a limited time period and others do not. Therefore, apart from the more classical approach of studying the etiologies of specific diseases, there is an interest in the determinants of general disease susceptibility, disease-prone personalities, and frailty [3], [4], [5], [6], [7], [8]. Syme and Berkman [9] suggested that a generalized body response in relation to psychosocial variables instead of specific diseases should be studied.

Because no studies on determinants of multimorbidity are available yet, possible determinants of multimorbidity have to be derived from determinants of health in general and from suggestions done by previously mentioned researchers and other experts. This kind of research aims at the improvement of profiles of patients who are at higher risk of getting multiple disease and may facilitate the development of future preventive interventions as well as more effective prediction and monitoring of patients.

Previously, we did cross-sectional and retrospective studies [2], [10], [11] on this subject. These studies showed a strong increase of multiple disease with rising age as well as an increased risk for subjects with a lower socio-economic status. When adjusted for the socio-demographic variables, the occurrence of two or more diseases in a 3-year period (multimorbidity), compared to the occurrence of just one disease, was found to be related to certain coping styles, an external health locus of control, long-term difficulties, negative life events, and a smaller social network [10]. However, cross-sectional and retrospective designs do not allow conclusions regarding causality. Therefore, we started a prospective study, using the psychosocial data from the retrospective study as a baseline measurement.

This report describes the results of a 2-year follow-up of this study population: a prospective study of the influence of psychosocial characteristics on the occurrence of morbidity and multimorbidity as registered in general practice. The main research question for this study was: what is the influence of coping style, life events, health locus of control, long-term difficulties, type of living arrangement, and social network on the occurrence of morbidity and multimorbidity in a period of 2 years after baseline measurement?

Section snippets

Context

This study was carried out within the context of the Registration Network Family Practices (RNH) [12]. This is a continuous and computerized database in general practice with a target population of about 100,000 people. All relevant health problems are registered in the database. A health problem is defined as ‘anything that has required, does or may require health care management and has affected or could significantly affect a person's physical or emotional well-being.’ Health problems are

Results

The mean number of new diseases registered on the problem list between January 1996 and December 1997 was 0.4 (S.D. 0.8, range 0–8), with 73.9% and 91.4% of the subjects not getting morbidity and multimorbidity, respectively, during the follow-up period.

The ‘basic model’ (Table 2) showed that the risk of getting two or more new diseases during follow-up as opposed to getting one new disease was increasing with age, and higher for men compared to women. The occurrence of new morbidity (subjects

Discussion

In this study, we evaluated the impact of psychosocial characteristics on (multi)morbidity during a follow-up period of 2 years. When adjusted for basic socio-demographic variables and health status at baseline, morbidity was only related to internal locus of control and negative life events. Multimorbidity during follow-up showed relations with the internal health locus of control, the type of living arrangement, and the size of social network. So, whereas there were little indications for an

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