Brendon Stubbs1, Davy Vancampfort2, Nicola Veronese3, Patricia Schofield4, Pao-Yen Lin5, Ping-Tao Tseng6, Marco Solmi7, Trevor Thompson8, André F Carvalho9, Ai Koyanagi10. 1. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom. Electronic address: brendonstubbs@kcl.ac.uk. 2. KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven, Kortenberg, Belgium. 3. National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy. 4. Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom. 5. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 6. Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan. 7. Department of Neurosciences, University of Padova, Padova, Italy. 8. Faculty of Education and Health, University of Greenwich, London, United Kingdom. 9. Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil. 10. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
Abstract
BACKGROUND: Stress in chronic conditions or multimorbidity (≥2 chronic conditions) has been reported to affect clinical outcomes but there are no studies on the association between stress and chronic conditions/multimorbidity among older adults in low- and middle-income countries (LMICs). Thus, we investigated this association among adults aged ≥50 years across six LMICs. METHODS: A cross-sectional analysis using data from the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) was conducted. A perceived stress score [range 0 (lowest stress) -100 (highest stress)] was computed based on two questions from the Perceived Stress Scale. Thirteen chronic conditions were assessed. Multivariable linear regression analyses were conducted. RESULTS: 34,129 adults with a mean age of 62.4 (SD=16.0)years (52.1% females) were included. Overall, 56.6% (95% CI=55.0%-58.2%) had multimorbidity. In the adjusted model including all countries, compared with those with no chronic conditions, higher numbers of chronic conditions were significantly associated with higher stress levels, dose dependently. In a countrywide meta-analysis, multimorbidity was associated with significantly higher stress levels in all countries (especially India and Ghana) although characterized by moderate heterogeneity (I2=54.6%). For single chronic conditions, notably high stress scores were observed for depression, stroke, and hearing problems. CONCLUSION: Chronic conditions and multimorbidity are associated with higher levels of stress in older adults in LMICs. Given that perceived stress and chronic conditions are collectively associated with worse health outcomes, low-cost, population-level integrated interventions to address stress among those with chronic conditions are urgently needed.
BACKGROUND: Stress in chronic conditions or multimorbidity (≥2 chronic conditions) has been reported to affect clinical outcomes but there are no studies on the association between stress and chronic conditions/multimorbidity among older adults in low- and middle-income countries (LMICs). Thus, we investigated this association among adults aged ≥50 years across six LMICs. METHODS: A cross-sectional analysis using data from the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) was conducted. A perceived stress score [range 0 (lowest stress) -100 (highest stress)] was computed based on two questions from the Perceived Stress Scale. Thirteen chronic conditions were assessed. Multivariable linear regression analyses were conducted. RESULTS: 34,129 adults with a mean age of 62.4 (SD=16.0)years (52.1% females) were included. Overall, 56.6% (95% CI=55.0%-58.2%) had multimorbidity. In the adjusted model including all countries, compared with those with no chronic conditions, higher numbers of chronic conditions were significantly associated with higher stress levels, dose dependently. In a countrywide meta-analysis, multimorbidity was associated with significantly higher stress levels in all countries (especially India and Ghana) although characterized by moderate heterogeneity (I2=54.6%). For single chronic conditions, notably high stress scores were observed for depression, stroke, and hearing problems. CONCLUSION: Chronic conditions and multimorbidity are associated with higher levels of stress in older adults in LMICs. Given that perceived stress and chronic conditions are collectively associated with worse health outcomes, low-cost, population-level integrated interventions to address stress among those with chronic conditions are urgently needed.
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