title: Excess risk of chronic physical conditions associated with depression and anxiety.
abstract: BACKGROUND
  Depression and anxiety have been reported to be associated with chronic physical conditions. We examined the excess risk of chronic physical conditions associated with depression and/or anxiety within a multivariate framework controlling for demographic and modifiable lifestyle risk factors.
  
  
  METHODS
  We used a retrospective cross-sectional study design. Study participants were adults aged 22-64 years from 2007 and 2009 Medical Expenditure Panel Survey. We defined presence of depression-anxiety based on self-reported depression and anxiety and classified adults into 4 groups: 1) depression only; 2) anxiety only; 3) comorbid depression and anxiety 4) no depression and no anxiety. We included presence/absence of arthritis, asthma, chronic obstructive pulmonary disorder, diabetes, heart disease, hypertension, and osteoporosis as dependent variables. Complementary log-log regressions were used to examine the excess risk associated with depression and/or anxiety for chronic physical conditions using a multivariate framework that controlled for demographic (gender, age, race/ethnicity) and modifiable lifestyle (obesity, lack of physical activity, smoking) risk factors. Bonferroni correction for multiple comparisons was applied and p ≤0.007 was considered statistically significant.
  
  
  RESULTS
  Overall, 7% had only depression, 5.2% had only anxiety and 2.5% had comorbid depression and anxiety. Results from multivariable regressions indicated that compared to individuals with no depression and no anxiety, individuals with comorbid depression and anxiety, with depression only and with anxiety only, all had higher risk of all the chronic physical conditions. ARRs for comorbid depression and anxiety ranged from 2.47 (95% CI: 1.47, 4.15; P = 0.0007) for osteoporosis to 1.64 (95% CI: 1.33, 2.04; P < 0.0001) for diabetes. Presence of depression only was also found to be significantly associated with all chronic conditions except for osteoporosis. Individuals with anxiety only were found to have a higher risk for arthritis, COPD, heart disease and hypertension.
  
  
  CONCLUSIONS
  Presence of depression and/or anxiety conferred an independent risk for having chronic physical conditions after adjusting for demographic and modifiable lifestyle risk factors.
authors.affiliation: Department of Pharmaceutical Sciences and Policy, School of Pharmacy, West Virginia University, P,O, Box 9510, Morgantown, WV 26506-9510, USA. rbhattacharya@hsc.wvu.edu.
authors.forename: Rituparna
authors.initials: R
authors.lastname: Bhattacharya
authors.forename: Chan
authors.initials: C
authors.lastname: Shen
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D001168:Arthritis / Q000453:epidemiology; D001249:Asthma / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003710:Demography; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008019:Life Style; D008297:Male; D009765:Obesity / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D057566:Self Report; D012907:Smoking / Q000453:epidemiology