Psychosocial patient characteristics and GP-registered chronic morbidity: A prospective study
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
References (59)
- et al.
Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases
J Clin Epidemiol
(1998) Rethinking disease: where do we go from here?
Ann Epidemiol
(1996)- et al.
Marginal impact of psycho-social factors on multimorbidity: results of an explorative nested case-control study
Soc Sci Med
(2000) Social ties and health: the benefits of social integration
AEP
(1996)- et al.
Life events, sense of coherence and health: gender differences on the Kibbuts
Soc Sci Med
(1991) - et al.
Stress and humoral immunity: a review of the human studies
Adv Neuroimmunol
(1994) Differentiating among internality, powerful others, and chance
- et al.
Organic and psychosocial risk factors for duodenal ulcer
J Psychosom Res
(1995) - et al.
Comorbidity or multimorbidity: what's in a name? A review of literature
Eur J Gen Pract
(1996) - et al.
Stress, immunity and illness — a review
Psychol Med
(1987)
The disease-prone personality. A meta-analytic view of the construct
Am Psychol
Is there a disease-prone personality? Synthesis and evaluation of the theoretical and empirical literature
Issues Ment Health Nurs
Life events, vulnerability and illness: a selected review
Fam Pract
Stress, social support, control and coping: a social epidemiological view
WHO Reg Publ Eur Ser
Social class, susceptibility and sickness
Am J Epidemiol
The relation between health locus of control and multimorbidity: a case control study
PAID
Computerized health information in the Netherlands: a registration network of family practices
Br J Gen Pract
ICHPPC-2 defined international classification of health problems in primary care
Unlocking patients' records in general practice for research, medical education and quality assurance: the Registration Network Family Practices
Completeness of cancer registration in Limburg, The Netherlands
Int J Epidemiol
Morbidity in responders and non-responders in a register-based population survey
Fam Pract
De relatie tussen ingrijpende gebeurtenissen, coping-stijlen en klachten
Gezondheid Gedrag
De Utrechtse Coping Lijst (UCL): validiteit en betrouwbaarheid
Gedrag Gezondheid
De betrouwbaarheid en validiteit van de Utrechtse Coping Lijst . Een longitudinaal onderzoek bij schoolverlaters
Gedrag Gezondheid
Effect of hospital stay on health locus of control beliefs
West J Nurs Res
Health locus of control scales
Het meten van ‘life events’: de Vragenlijst Recent Meegemaakte Gebeurtenissen (VRMG)
Ned Tijdschr Psychol
Langdurige moeilijkheden gemeten volgens zelfbeoordelingsvragenlijst en semi-gestructureerd interview
Gedrag Gezondheid
Cited by (31)
Risk factors for multimorbidity in adulthood: A systematic review
2023, Ageing Research ReviewsSocioeconomic status and multimorbidity: a systematic review and meta-analysis
2018, Australian and New Zealand Journal of Public HealthThe European General Practice Research Network Presents a Comprehensive Definition of Multimorbidity in Family Medicine and Long Term Care, Following a Systematic Review of Relevant Literature
2013, Journal of the American Medical Directors AssociationCitation Excerpt :Of the 13 other excluded articles, four were editorials with no exclusion/inclusion criteria, seven were using multimorbidity without a clear description, and two were excluded on the basis of poor quality (ie, the average score awarded by the four researchers was less than 14 out of 28). Table 2 shows the 54 included articles.11,16–68 Data extraction found 132 different definitions, as well as 241 lists, classifications, scales, or indexes used to evaluate multimorbidity.
Aging with multimorbidity: A systematic review of the literature
2011, Ageing Research ReviewsCitation Excerpt :Consistently across studies, older persons, women, and persons from low social classes were more likely to be affected by multimorbidity. Four articles examined incidence and risk factors for multimorbidity (Table 2); three of them were embedded in the same population-based study from The Netherlands (van den Akker et al., 1998, 2000, 2001b) and one was carried out in Germany (Nagel et al., 2008). Disease ascertainment in these studies was based on general practitioners’ records.
Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years
2007, Public HealthCitation Excerpt :Stressful life events have been found to be associated with increased SL among men.8,9 Social support seems to protect the individual from the negative effect of stress, and weak support is connected with increased morbidity and mortality.10,11 According to Antonovsky, ‘sense of coherence’ (SOC) is a measure of an individual's psychological resources for coping with life stress.12