Psychiatric–Medical ComorbidityComorbidity of major depressive episode and chronic physical conditions in Spain, a country with low prevalence of depression☆
Introduction
Prevalence rates of depression vary among regions worldwide, and they are lower in southern European countries than in the rest of Europe and other regions of the world [1], [2], [3], [4]. Specific mechanisms explaining these variations are poorly understood, but it has been suggested that certain socioeconomic or cultural factors might play a role [5], [6], [7].
A relevant cultural differential characteristic of southern European countries is their more traditional Latin background compared to more secularized and economically developed societies in northern Europe [8], [9], [10]. Latins (or Hispanics) are present in different regions of the world, and they are believed to share some strong cultural features. The “Hispanic paradox” was first described in US Latinos and refers to findings of better mental and physical health outcomes in different Latino communities (including lower prevalences of depression) despite a worse socioeconomic status. This “health advantage” has been linked to specific Latin cultural characteristics [11] such as “simpatía” or familism which facilitate the creation of extended supporting social networks [12], [13] and a more intense religiosity which promotes healthy behaviors and long-term well-being [10], [14].
Major depression is often comorbid with chronic physical disorders, and there is evidence of the influence of environmental factors, either as barriers or facilitators, in the development of these combined disorders [5], [15]. Cross-national studies on comorbid mental and physical conditions are limited, and little is known about how comorbidity varies across the world [16]. Previous research has described specific patterns of mental–physical comorbidity among US Latinos, such as more intense links of depression with respiratory disorders and a less consistent association with cardiovascular disease [17]. The reasons explaining these differences are not known, and due to the lack of studies, it is also unknown whether these specific patterns are also present in other Latin communities outside the United States [7].
The objective of this study was to describe the comorbidity between 12-month major depression episode (MDE) and chronic physical condition (CPC) in the Spanish respondents to the European Study of the Epidemiology of Mental Disorders (ESEMeD-Spain). We estimated the prevalence of MDE among those with CPC and the strength of association among CPCs and MDE. Finally, we estimated the odds of disability and the odds of receiving treatment for the depression in those with pure vs. comorbid MDE.
Section snippets
Methods
The ESEMeD-Spain study was a cross-sectional, general-population, household survey conducted on a representative sample of the noninstitutionalized adult population of Spain. The ESEMeD-Spain study is part of a broader project, the World Mental Health Survey (WMHS), composed of nationally or regionally representative surveys in 27 countries from all regions of the world and 10 in Europe. A more detailed description of these study and methods is available elsewhere [18].
Prevalence of MDE and CPC
A total of 43.2% of respondents had a CPC. In particular, 40.6% had CPC noncomorbid with MDE, and 2.5% had comorbid CPC and MDE conditions (Fig. 1). Chronic pain was the most prevalent CPC general category (28.2%, S.E. 1.4) followed by cardiovascular and respiratory conditions (0.8%, S.E. 0.1 each). The most prevalent comorbid diagnostic category was chronic pain (1.9%, S.E. 0.2), and the most prevalent specific comorbid conditions were back/neck problems and frequent/severe headaches (1.1%,
Discussion
Results show that, in Spain, the likelihood of suffering 12-month MDE was doubled among those with a CPC. The risk of having an MDE was increased in all the physical conditions studied, with a few exceptions. Importantly, having an MDE increased up to 30 times the risk of severe disability among those with CPC, and yet this did not modify the likelihood of receiving treatment for the mental disorder. These findings indicate that, every year, in a country of 47 million inhabitants, around 1.2
Acknowledgments
The ESEMeD project was funded by the European Commission (Contracts QLG5-1999-01042, SANCO 2004123 and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP). The analysis for this paper was carried out in conjunction with the
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Conflict of interest: The authors report no conflicts of interests.