title: Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries.
abstract: BACKGROUND
  Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).
  
  
  METHODS
  Cross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity.
  
  
  RESULTS
  Overall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98-3.57).
  
  
  CONCLUSIONS
  Our large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust,Denmark Hill,London SE5 8AZ,UK.
authors.forename: B
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: KU Leuven Department of Rehabilitation Sciences,Leuven,Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Vancampfort
authors.affiliation: Geriatrics Division, Department of Medicine-DIMED,University of Padova,Padova,Italy.
authors.forename: N
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy,Hannover Medical School,Hannover,Germany.
authors.forename: K G
authors.initials: KG
authors.lastname: Kahl
authors.affiliation: Department of Cancer and Molecular Medicine,University of Leicester,Leicester,UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: Department of Psychiatry,Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine,Kaohsiung,Taiwan.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of Psychiatry,Tsyr-Huey Mental Hospital,Kaohsiung Jen-Ai's Home,Taiwan.
authors.forename: P-T
authors.initials: PT
authors.lastname: Tseng
authors.affiliation: Kyambogo University,Kampala,Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Mugisha
authors.affiliation: Department of Neurosciences,University of Padova,Padova,Italy.
authors.forename: M
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine,Federal University of Ceará,Fortaleza, CE 60430-040,Brazil.
authors.forename: A F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Research and Development Unit,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu,Dr. Antoni Pujadas, 42,Sant Boi de Llobregat,Barcelona 08830,Spain.
authors.forename: A
authors.initials: A
authors.lastname: Koyanagi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D000076322:Multimorbidity; D055815:Young Adult
keywords: Depression; low- and middle-income countries; multimorbidity; physical health; psychiatry