title: Does 'existential unease' predict adult multimorbidity? Analytical cohort study on embodiment based on the Norwegian HUNT population.
abstract: Multimorbidity is prevalent, and knowledge regarding its aetiology is limited. The general pathogenic impact of adverse life experiences, comprising a wide-ranging typology, is well documented and coherent with the concept allostatic overload (the long-term impact of stress on human physiology) and the notion embodiment (the conversion of sociocultural and environmental influences into physiological characteristics). Less is known about the medical relevance of subtle distress or unease. The study aim was to prospectively explore the associations between existential unease (coined as a meta-term for the included items) and multimorbidity.
  
  
  
  Our data are derived from an unselected Norwegian population, the Nord-Trøndelag Health Study, phases 2 (1995-1997) and 3 (2006-2008), with a mean of 11 years follow-up.
  
  
  
  The analysis includes 20 365 individuals aged 20-59 years who participated in both phases and was classified without multimorbidity (with 0-1 disease) at baseline.
  
  
  
  From HUNT2, we selected 11 items indicating 'unease' in the realms of self-esteem, well-being, sense of coherence and social relationships. Poisson regressions were used to generate relative risk (RR) of developing multimorbidity, according to the respondents' ease/unease profile.
  
  
  
  A total of 6277 (30.8%) participants developed multimorbidity. They were older, more likely to be women, smokers and with lower education. 10 of the 11 'unease' items were significantly related to the development of multimorbidity. The items 'poor self-rated health' and 'feeling dissatisfied with life' exhibited the highest RR, 1.55 and 1.44, respectively (95% CI 1.44 to 1.66 and 1.21 to 1.71). The prevalence of multimorbidity increased with the number of 'unease' factors, from 26.7% for no factor to 49.2% for 6 or more.
  
  
  
  In this prospective study, 'existential unease' was associated with the development of multimorbidity in a dose-response manner. The finding indicates that existential unease increases people's vulnerability to disease, concordant with current literature regarding increased allostatic load.
authors.affiliation: Department of Family Medicine, University of Iceland and Primary Health Care of the Capital Area, Reykjavik, Iceland.|General Practice Research Unit, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Margret Olafia
authors.initials: MO
authors.lastname: Tomasdottir
authors.affiliation: Department of Family Medicine, University of Iceland and Primary Health Care of the Capital Area, Reykjavik, Iceland.|General Practice Research Unit, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Johann Agust
authors.initials: JA
authors.lastname: Sigurdsson
authors.affiliation: General Practice Research Unit, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Halfdan
authors.initials: H
authors.lastname: Petursson
authors.affiliation: General Practice Research Unit, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Anna Luise
authors.identifier: 0000-0001-7186-5974
authors.initials: AL
authors.lastname: Kirkengen
authors.affiliation: General Practice Research Unit, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Ivar Lund Nilsen
authors.affiliation: General Practice Research Unit, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Irene
authors.initials: I
authors.lastname: Hetlevik
authors.affiliation: General Practice Research Unit, Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Linn
authors.initials: L
authors.lastname: Getz
mesh_terms: D000328:Adult; D052636:Allostasis; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D015444:Exercise; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010549:Personal Satisfaction; D011446:Prospective Studies; D012649:Self Concept
keywords: Allostatic overload; Embodiment; Existential unease; Multimorbidity; Stress