Effect of comorbid depression on health-related quality of life of patients with chronic diseases: A South Korean nationwide study (2007–2015)

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Abstract

Objective

Patients with chronic physical diseases often have concomitant depression. Depression influences an individual's health and his or her overall health-related quality of life (HRQoL). The extent to which depression incrementally worsens HRQoL in patients with ≥1 comorbid physical chronic diseases remains unclear.

Methods

This cross-sectional study is based on data of 50,844 respondents (age, ≥19 years) who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) (2007–2015). HRQoL was measured using the modified EuroQol five-dimensional (EQ-5D) score. Mean HRQoL scores were compared between subgroups of respondents with or without depression. The association between HRQoL and disease status was evaluated using multiple regression models after controlling for sociodemographic variables.

Results

HRQoL score decreased when depression was concomitant. HRQoL score of respondents who had ≥3 chronic diseases with concomitant depression (mean = 0.83, SE = 0.010) were significantly lower (p = 0.002) than those of respondents who had ≥3 chronic diseases but no concomitant depression (mean = 0.87, SE = 0.007). Moreover, respondents with ≥3 chronic diseases comorbid with depression showed the largest negative association (coefficient = −0.133, p < 0.001) with HRQoL among all disease status groups.

Conclusion

Presence of depression incrementally worsened individual's HRQoL when comorbid with other physical diseases. Especially, depression showed substantial negative effect on HRQoL level in patients with ≥2 physical diseases.

Introduction

Depression is estimated to affect ~350 million people worldwide (lifetime prevalence: 3%–16.9%), and it accounts for 7.5% of years lived with disability worldwide, which is the largest contributor to nonfatal health loss [1]. According to the Survey of Mental Disorders in Korea, 2016, the lifetime prevalence of MDD in South Korea is 5.0%, and the 12-month prevalence is 1.5% [2]. Patients with depression often have comorbid conditions, such as diabetes, arthritis, asthma, chronic obstructive pulmonary disease, heart disease, and hypertension [3,4]. There is a bidirectional relationship between depression and chronic diseases [5]. Despite this bidirectional relationship, depression itself is an independent risk factor for various chronic diseases, such as diabetes, cancer, and heart disease [6,7]. In addition, patients with chronic diseases who have concomitant depression have a worse health status compared with those who do not have concomitant depression [8].

Depression affects an individual's health as well as his or her overall health-related quality of life (HRQoL). HRQoL is a measure of an individual's subjective perception of his/her own health which is a widely used parameter for assessing the health state of a population [9]. HRQoL is also a useful measure for evaluating health policies pertaining to health promotion and those aimed at reducing health inequality [10]. Various studies have shown that depression [[10], [11], [12]] and chronic diseases [13,14] have a negative impact on an individual's HRQoL. Wu et al. [10] found that individuals with ≥1 comorbid chronic diseases had lower HRQoL compared to those with no comorbid chronic diseases. However, to the best of our knowledge, no study has investigated the extent to which comorbid depression incrementally worsens HRQoL of patients with one or more physical chronic diseases. Moreover, nationwide studies on HRQoL, depression, and physical chronic diseases are scarce.

The objective of this study was to investigate the effect of depression on HRQoL compared with that of other chronic diseases (i.e., asthma, diabetes, hypertension, cancer, and arthritis). We selected asthma, diabetes, hypertension, certain cancers, and arthritis because these diseases were previously linked to depression [3,4] and decreased HRQoL [8,15]. In particular, we aimed to investigate the extent to which comorbid depression incrementally worsens HRQoL of patients with one or more chronic physical diseases.

Section snippets

Study sample

This study used a cross-sectional data from Korean National Health and Nutrition Examination Survey (KNHANES). KNHANES is comprised of health interview, health examination, and nutrition surveys, which was conducted on a representative sample of civilian, non-institutionalized Korean population by the Korea Centers for Disease Control and Prevention (KCDC) since 1998 [16]. The survey was designed using a stratified multistage probability sampling strategy based on geographical region, sex and

Characteristics of the study population

Among the 50,844 respondents (mean age, 45.47 ± 0.13 years; women, 57.65%), the prevalence of having depression alone was 1.96%. Among patients who had a single disease, hypertension (10.91%) was the most prevalent disease followed by arthritis (5.72%). The percentage of respondents who had ≥3 chronic diseases comorbid with depression was 0.95% (Table 1). Among individuals with asthma, diabetes, hypertension, cancer, and arthritis, the prevalence of having comorbid depression were 8.55%

Discussion

In this study, we assessed the effect of depression on HRQoL and compared this effect with that of other physical chronic diseases (i.e., asthma, diabetes, hypertension, cancer, and arthritis). We investigated the added effect of depression on HRQoL of patients with ≥1 chronic physical diseases. The presence of depression and comorbid chronic physical disease was more associated with a decrease in HRQoL. Especially, the decrement effect of depression on HRQoL was substantial for respondents

Declaration of conflicting interests

The authors declare that there are no conflicts of interest.

Funding

This study was supported by an Intramural Research Grant (No R2018-A) from the National Center for Mental Health, Ministry of Health & Welfare, Republic of Korea.

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