Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among ...low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.
Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.
The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 95% confidence interval (CI) 1.83-2.55, 1.45 (95% CI 1.22-1.73), and 2.11 (95% CI 1.87-2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54-4.37).
Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.
Objective
Physical activity (PA) is good for health, yet several small‐scale studies have suggested that depression is associated with low PA. A paucity of nationally representative studies ...investigating this relationship exists, particularly in low‐ and middle‐income countries (LMICs). This study explored the global association of PA with depression and its mediating factors.
Method
Participants from 36 LMICs from the World Health Survey were included. Multivariable logistic regression analyses were undertaken exploring the relationship between PA and depression.
Results
Across 178 867 people (mean ± SD age = 36.2 ± 13.5 years; 49.9% male), the prevalence of depression and the prevalence of low PA were 6.6% and 16.8% respectively. The prevalence of low PA was significantly higher among those with depression vs. no depression (26.0% vs. 15.8%, P < 0.0001). In the adjusted model, depression was associated with higher odds for low PA (OR = 1.42; 95% CI = 1.24–1.63). Mediation analyses demonstrated that low PA among people with depression was explained by mobility limitations (40.3%), pain and discomfort (35.8%), disruptions in sleep and energy (25.2%), cognition (19.4%) and vision (10.9%).
Conclusion
Individuals with depression engage in lower levels of PA in LMICs. Future longitudinal research is warranted to better understand the relationships observed.
The goal was to analyze the association of religiosity with suicidal ideation and suicide attempts in a UK nationally representative sample.
This study used cross-sectional data from 7403 people who ...participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). Religion was assessed with the question 'Do you have a specific religion?' with 'yes' and 'no' answer options. Lifetime and past 12-month suicidal ideation and suicide attempts were assessed. The association between religiosity and suicidality was studied in multivariable logistic regression models adjusted for sociodemographic, behavioural, and psychopathological factors.
Compared to those without a religion, the prevalence of past 12-month suicidal ideation (3.2% vs. 5.4%), past 12-month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion. In the fully adjusted model, having a religion was significantly associated with lower odds for all types of suicidality except past 12-month suicide attempts: suicidal ideation (past 12-month: OR = 0.71, 95% CI = 0.51-0.99; lifetime: OR = 0.83, 95% CI = 0.69-0.99) and suicide attempts (past 12-month: OR = 0.71, 95% CI = 0.35-1.45; lifetime: OR = 0.69, 95% CI = 0.53-0.90).
There is a negative association between religiosity and suicidality in the UK. Future studies should focus on the underlying mechanisms.
Background:
The overarching aim of this study was to evaluate the effectiveness over time of government interventions and policy restrictions and the impact of determinants on spread and mortality ...during the first-wave of the COVID-19 pandemic, globally, regionally and by country-income level, up to 18 May 2020.
Methods:
We created a global database merging World Health Organization daily case reports (from 218 countries/territories) with other socio-demographic and population health measures from 21 January to 18 May 2020. A four-level government policy interventions score (low to very high) was created based on the Oxford Stringency Index.
Results:
Our results support the use of very high government interventions to suppress both COVID-19 spread and mortality effectively during wave one globally compared to other policy levels of control. Similar trends in virus propagation and mortality were observed in all country-income levels and specific regions.
Conclusions:
Rapid implementation of government interventions was needed to contain the first wave of the COVID-19 outbreak and to reduce COVID-19-related mortality.
Comorbid depression and anxiety is associated with worse health outcomes compared to depression or anxiety occurring in isolation, but there is little data on its association with multimorbidity. ...Thus, we investigated this association across 47 low- and middle-income countries, and further explored whether having anxiety symptoms in addition to depression is associated with significant declines in health outcomes among those with multimorbidity.
Cross-sectional, predominantly nationally representative, community-based data were analyzed from the World Health Survey. DSM-IV depression was assessed with the Composite International Diagnostic Interview. Anxiety symptoms referred to severe/extreme problems with worry or anxiety. Ten chronic conditions and health status across five domains (cognition, interpersonal activities, sleep/energy, self-care, pain/discomfort) were assessed. Multivariable regression analyses conducted.
Data included 237,952 adults aged ≥18 years mean age (SD) 38.4 (16.0); 50.8 % females. Compared to no chronic conditions, 2 (OR = 6.86; 95%CI = 5.59–8.42), 3 (OR = 12.33; 95%CI = 9.72–15.63), and ≥4 (OR = 26.55; 95%CI = 20.21–35.17) chronic conditions were associated with significantly higher odds for comorbid depression/anxiety symptoms (vs. no depression or anxiety symptoms) in the multinomial logistic regression model. Among those with depression and multimorbidity, anxiety symptoms were associated with significantly worse health status across all domains.
Cross-sectional design, depression and anxiety symptoms were not based on a clinical assessment.
Comorbid depression/anxiety is common in people with multimorbidity, and anxiety symptoms in people with depression and multimorbidity signify worse health status. Future studies should assess the utility of screening for and treating comorbid depression/anxiety in patients with multimorbidity in terms of clinical outcomes.
•Data on 237,952 adults aged ≥18 years from 47 low- and middle-income countries were analyzed.•Multimorbidity was associated with higher odds for comorbid depression/anxiety symptoms.•Among those with multimorbidity and depression, having anxiety symptoms was associated with significantly worse health outcomes.
•Few studies have examined associations between physical multimorbidity and sedentary behaviour in older adults.•We analysed cross-sectional data from a large population-based sample of adults aged ...≥50 years.•Sedentary behaviour increased with the number of chronic physical conditions.•People with ≥4 conditions had greater odds of high sedentary behavior.•Prospective studies are needed to clarify the directionality and potential underlying mechanisms.
Physical multimorbidity, defined as the presence of two or more chronic physical conditions, is widespread and reduces life expectancy and quality of life in older adults. Sedentary behavior (SB) is increasingly identified as a risk factor for a range of chronic physical conditions, independent of physical activity.
To investigate associations between physical multimorbidity and SB in older adults.
We used cross-sectional data from a population-based sample of 6903 adults aged ≥50 years who participated in the Irish Longitudinal Study on Ageing (TILDA) in 2009-2011. We conducted multivariable linear and logistic regression analyses to assess associations between multimorbidity and SB.
Self-reported minutes/day of SB and high SB (≥ 8 h/day).
We found that most of the 14 individual chronic physical conditions included here were associated with greater SB. Those with stroke (OR = 2.63, 95 % CI = 1.69, 4.10) and cirrhosis (OR = 2.53, 95 %CI = 1.19, 5.41) were the most likely to be classified with high SB. Time spent in SB and the prevalence of high SB increased linearly with number of chronic conditions. Multivariable regression models adjusting for sociodemographic and psychological factors, disability, social network, and physical activity showed that, compared with people with none, those with ≥4 chronic physical conditions had 1.45 times greater odds (OR = 1.45, 95 % CI = 1.09, 1.93) of high SB and higher mean minutes/day of SB (β = 21.37, 95 % CI = 5.53, 37.20).
Our results suggest that physical multimorbidity is associated with SB and highlight the need for prospective research to examine the directionality and mechanisms of these associations.
This study investigated the association between sedentary behavior (SB) and anxiety, and explored factors that influence this relationship in six low- and middle-income countries.
Cross-sectional ...data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Multivariable linear and logistic regression analyses were conducted to assess the association between anxiety and self-reported SB. Potentially influential factors were examined with mediation analysis.
The sample consisted of 42,469 adults aged≥18years (50.1% female; mean age 43.8years). After adjusting for sociodemographics and country, people with anxiety engaged in 24 (95%CI=7–41) more minutes per day of SB than non-anxious individuals; the corresponding figure for the elderly (≥65years) was much higher (55min; 95% CI=29–81). Anxiety was associated with a 2.0 (95%CI=1.5–2.7) times higher odds for high SB (i.e., ≥8h/day). Overall, the largest proportion of the high SB-anxiety relationship was explained by mobility limitations (46.8%), followed by impairments in sleep/energy (44.9%), pain/discomfort (31.7%), disability (27.0%), cognition (13.3%), and physical activity levels (6.3%).
Anxiety was significantly associated with high SB, particularly among older adults. Future longitudinal studies are warranted to disentangle the potentially complex interplay of factors that may influence the anxiety-SB relationship.
•People with anxiety have a two-fold higher odds for being sedentary (+8 hours/day).•Mobility problems, pain and disability should be considered.•Cognitive problems influenced the relation between sedentary behavior and anxiety.
Background
Childhood adversities (CAs) have been associated with adult‐onset chronic pain. However, to date, most single country studies on this association have been undertaken in Western countries. ...This study examined the association in Japan where information is scarce.
Methods
Data were drawn from the World Mental Health Survey Japan, a population‐based cross‐sectional survey undertaken in 11 areas of Japan in 2002–2006. We analyzed data from adults aged ≥20 years who provided information on CAs occurring before age 18 years and chronic pain (n = 1740). Cox proportional hazard models were used to estimate the risk for different forms of adult‐onset chronic pain (arthritis/rheumatism, neck/back pain, headache and any pain) as a function of the presence of 11 different types of CA and the number of CAs.
Results
In the adjusted models, significant associations were observed between: physical abuse and neck/back pain (HR 2.55) and any pain (HR 1.88); sexual abuse and any pain (HR 2.84). Significant dose‐dependent relationships were also observed between a greater number of CAs and some adult‐onset chronic pain conditions (neck/back and any pain).
Conclusions
The results of this study suggest that in Japan, some forms of CA may be associated with certain types of adult‐onset chronic pain, in particular neck/back pain.
Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health ...co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).
Cross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity.
Overall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98-3.57).
Our large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.
Objective
To assess the association between psychotic symptoms and smoking among community‐dwelling adults in 44 countries.
Method
Data from the World Health Survey (WHS) for 192 474 adults aged ≥18 ...years collected in 2002–2004 were analyzed. The Composite International Diagnostic Interview was used to identify four types of past 12‐month psychotic symptoms. Smoking referred to current daily and non‐daily smoking. Heavy smoking was defined as smoking ≥30 tobacco products/day.
Results
The pooled age–sex‐adjusted OR (95% CI) of psychotic symptoms (i.e., at least one psychotic symptom) for smoking was 1.35 (1.27–1.43). After adjustment for potential confounders, compared to those with no psychotic symptoms, the ORs (95% CIs) for smoking for 1, 2, and ≥3 psychotic symptoms were 1.20 (1.08–1.32), 1.25 (1.08–1.45), and 1.36 (1.13–1.64) respectively. Among daily smokers, psychotic symptoms were associated with heavy smoking (OR = 1.45, 95% CI = 1.10–1.92), and individuals who initiated daily smoking at ≤15 years of age were 1.22 (95% CI = 1.05–1.42) times more likely to have psychotic symptoms.
Conclusions
An increased awareness that psychotic symptoms are associated with smoking is important from a public health and clinical point of view. Future studies that investigate the underlying link between psychotic symptoms and smoking prospectively are warranted.
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