Association between physical multimorbidity and common mental health disorders in rural and urban Malawian settings

In low-income Africa, the epidemiology of physical multimorbidity and associated mental health conditions is not well described. We investigated the multimorbidity burden, disease combinations, and relationship between physical multimorbidity and common mental health disorders in rural and urban Malawi using early data from 9,849 adults recruited to an on-going large cross-sectional study on long-term conditions, initiated in 2021. Multimorbidity was defined as having two or more measured (diabetes, hypertension) or self-reported (diabetes, hypertension, disability, chronic pain, HIV, asthma, stroke, heart disease, and epilepsy) conditions. Depression and anxiety symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder scale (GAD-7) and defined by the total score (range 0–27 and 0–21, respectively). We determined age-standardized multimorbidity prevalence and condition combinations. Additionally, we used multiple linear regression models to examine the association between physical multimorbidity and depression and anxiety symptom scores. Of participants, 81% were rural dwelling, 56% were female, and the median age was 30 years (Inter Quartile Range 21–43). The age-standardized urban and rural prevalence of multimorbidity was 14.1% (95% CI, 12.5–15.8%) and 12.2% (95% CI, 11.6–12.9%), respectively. In adults with two conditions, hypertension, and disability co-occurred most frequently (18%), and in those with three conditions, hypertension, disability, and chronic pain were the most common combination (23%). Compared to adults without physical conditions, having one ( B -Coefficient ( B ) 0.79; 95% C1 0.63–0.94%), two- ( B 1.36; 95% CI 1.14–1.58%), and three- or more- physical conditions ( B 2.23; 95% CI 1.86–2.59%) were associated with increasing depression score, p -trend

Anxiety · Asthma · Comorbidity · Confidence interval · Cross-sectional study · Diabetes mellitus · Mental health · Multimorbidity · Physical therapy · Psychiatry · Quartile · Chronic Disease Management Strategies · Health disparities and outcomes · Healthcare Systems and Reforms · Medicine · Epidemiology · Internal Medicine

• Interdisciplinary perspectives on multimorbidity in Africa

  Open Access•Justin Dixon, Ben Morton et al.•PLOS Global Public Health•2024

  Añadir item

• A call to action to address rural mental health disparities

  Open Access•Dawn A Morales, Crystal L Barksdale et al.•Journal of Clinical and…•2020

  Añadir item

• A classification of chronic pain for ICD-11

  Open Access•Rolf‐Detlef Treede, Rolf-Detlef Treede et al.•Pain•2015

  Añadir item

• An overview of systematic reviews on the public health consequences of social isolation and loneliness

  Open Access•N Leigh-Hunt, D Bagguley et al.•Public Health•2017

  Añadir item

• Defining Comorbidity

  Open Access•Jose M Valderas, Barbara Starfield et al.•The Annals of Family Medicine•2009

  Añadir item

• The role of inflammation in depression

  Open Access•Abraham H Miller, Andrew H Miller et al.•Nature Reviews Immunology•2016

  Añadir item

• Multimorbidity and depression

  Open Access•Jennifer R Read, Lesley Sharpe et al.•Journal of Affective Disorders•2017

  Añadir item

• A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression

  Open Access•Laura Manea, Simon Gilbody et al.•General Hospital Psychiatry•2015

  Añadir item

• The association between social relationships and depression

  Open Access•Ziggi Ivan Santini, Ai Koyanagi et al.•Journal of Affective Disorders•2015

  Añadir item

• The Critical Relationship Between Anxiety and Depression

  Ned H Kalin•American Journal of Psychiatry•2020

  Añadir item

• Global and regional prevalence of multimorbidity in the adult population in community settings

  Open Access•Saifur Rahman Chowdhury, Dipak Chandra Das et al.•EClinicalMedicine•2023

  Añadir item

• State of the Art Review

  Open Access•Beth E Cohen, Donald Edmondson et al.•The Journal of Clinical…•2015

  Añadir item

• Mental Health Service Provision in Low- and Middle-Income Countries

  Open Access•Shanaya Rathod, Narsimha R Pinninti et al.•Health Services Insights•2017

  Añadir item

• A Brief Measure for Assessing Generalized Anxiety Disorder

  Robert L Spitzer, Carmen Pérez de los Ríos et al.•A.M.A. Archives of Internal…•2006

  Añadir item

• The PHQ-9

  Kurt Kroenke, Robert L Spitzer et al.•Journal of General Internal…•2001

  Añadir item

• Patterns of multimorbidity in India

  Open Access•Jonas Prenissl, Jan-Walter De Neve et al.•PLOS Global Public Health•2022

  Añadir item

• Impact of the Acceptance of Disability on Self-Esteem among Adults with Disabilities

  Open Access•Yun Hwa Jung, Soo Hyun Kang et al.•International Journal of…•2022

  Añadir item

• Multimorbidity Patterns in the General Population

  Open Access•Ignatios Ioakeim‐Skoufa, Beatriz Poblador‐Plou et al.•International Journal of…•2020

  Añadir item

• Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities

  Open Access•Jennifer H Madans, Mitchell Loeb et al.•BMC Public Health•2011

  Añadir item

• Access to health care for people with disabilities in rural Malawi

  Open Access•Josephine Harrison, Josephine A K Harrison et al.•BMC Public Health•2020

  Añadir item

• Burden and changes in HIV/Aids morbidity and mortality in Southern Africa Development Community Countries, 1990–2017

  Open Access•Philimon Gona, Clara M Gona et al.•BMC Public Health•2020

  Añadir item

• Physical Multimorbidity and Social Participation in Adult Aged 65 Years and Older From Six Low- and Middle-Income Countries

  Open Access•Ruimin Ma, Eugenia Romano et al.•The Journals of Gerontology…•2021

  Añadir item

• Experiences of multimorbidity in urban and rural Malawi

  Open Access•Edith Chikumbu, Christopher Bunn et al.•PLOS Global Public Health•2022

  Añadir item