Having multiple long-term physical health problems may increase the risk of depression later in life, a study suggests.
People with more than one respiratory condition were most likely to develop depression and anxiety later on, researchers found.
They suggest this has possible implications for future healthcare services if the coronavirus pandemic brings about increases in long-term respiratory issues.
Experts say the study indicates the importance of integrating mental health support early into care plans for those with multiple physical health conditions.
According to the researchers, this large-scale study was the first to identify patterns of physical multi-morbidity and examine the extent to which these patterns predicted both new onset and persistent common mental health disorders in middle-aged UK adults.
Lead author Dr Amy Ronaldson, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, said: “Our large-scale analysis has shown that people with two or more physical health conditions are at greater risk of developing depression and anxiety later in life, compared with those who have none or one physical health condition.
“What is really interesting is that this risk seems to be greater in those with certain combinations of physical conditions, which has implications for how the integration of mental and physical healthcare should be implemented.”
More than a quarter of adults registered with primary care services in the UK currently have two or more physical health problems, known as multi-morbidity, and this is predicted to rise in coming years.
Previous research established a link between multiple physical health problems and poor mental health.
However, little is known about how specific patterns of physical health conditions precede the development of depression and anxiety.
Researchers analysed data from UK Biobank on more than 150,000 middle-aged people.
They investigated the relationship between physical health multi-morbidity measured at one time point and depression and anxiety assessed four to six years later.
Researchers took into account the influence of variables such as age, gender and socio-economic status.
They found that people with three physical health conditions had almost double the odds of developing depression later in life compared with those with one or no physical health conditions.
The risk of future depression increased proportionally with the number of physical health conditions, the study suggests.
Those with a number of respiratory health conditions such as asthma and emphysema had the greatest odds of experiencing depression later – more than three times the odds of those with no physical multi-morbidity.
Patterns of long-term health conditions where gastrointestinal conditions such as irritable bowel syndrome co-occurred with painful conditions such as back pain or arthritis were also strong predictors of developing depression, the research suggests.
It also investigated the relationship between multi-morbidity and later experiences of anxiety.
Similar results to depression were found in that two or more physical health conditions increased the odds of developing anxiety later in life.
Senior author Dr Alexandru Dregan, from the IoPPN, said: “The finding that the different patterns of physical health conditions confer different levels of risk of later developing depression and anxiety could help inform services as to which patients require which kind of support.
“Further research is needed to investigate the mechanisms that link the different clusters with depression and anxiety, which can ultimately help us to develop better approaches to supporting those with long-term conditions better and providing more integrated care.”
Published in The Lancet Regional Health – Europe, the research was part-funded by the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre.