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Accumulating Health Problems Tied to Increased Risk of Depression and Anxiety

A new study in The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences has found people with multiple chronic conditions reported persistently high levels of anxiety and depression, and worse physical function. And compared to white study participants, those who identified as non-white experienced worse health-related quality of life as multiple chronic health conditions increased, the study found.

“As people get older, it’s not just that they develop hypertension and that’s it. It’s that these conditions — which are often very manageable — start to accumulate, and, unfortunately, along with that come some negative quality-of-life side effects,” said corresponding study author Eileen Graham, PhD, FGSA, an associate professor of medical social sciences in the social determinants of health division at Northwestern University Feinberg School of Medicine.

What may begin in earlier adulthood as a less severe condition may increase in severity with age and may be compounded by developing other conditions. For example, a person may be diagnosed with hypertension in midlife, then later develop type-2 diabetes and arthritis.

“There are so many unknowns with a complicated care regimen, such as needing to coordinate with multiple doctors, taking contra-indicating drugs and dealing with possible complications, it can lead to anxiety in patients,” Graham said. “Between that and the impaired physical function that is associated with having multiple conditions, all of these may contribute to higher reports of depressive symptoms.”

The most sobering finding, Graham added, was the decreased quality of life from the presence of two or more long-term health conditions — known as multimorbidity — among racial minorities.

“I was disappointed, but not entirely surprised, to see that the effect of multimorbidity on quality of life was much starker among non-white individuals,” Graham said. “This points to a greater need to understand how the health care system can better support people from underrepresented communities.”

The chronic conditions experienced by people in the study were wide ranging, Graham said. They included angina, hypertension, high cholesterol, liver disease, thyroid disease, celiac disease, chronic kidney disease, gout, arthritis, peripheral artery disease, diabetes, lung fluid, bronchitis, cataracts, deafness, hearing problems, hip fracture, asthma, emphysema, and cancer.

The study found higher depression among people with circulatory, musculoskeletal, metabolic and respiratory diseases, but not for digestive diseases, kidney or ear disease, cataracts or cancer. Those with respiratory diseases tended to start out with high rates of depression but their depression improved over time.

Graham said more research is needed that explores what sorts of supports are needed for older adults to mitigate these impacts. Better coordination among care providers to help alleviate patient anxiety surrounding care regimens could help, Graham said, or assistance from health care systems to help patients build a more robust support network.

The study, titled “Longitudinal Associations Between Multimorbidities and Patient-Reported Quality of Life,” used data from the Health Literacy and Cognitive Function Among Older Adults Longitudinal Study, a prospective cohort study of adults in late midlife and older adulthood. Participants were enrolled from August 2008 through October 2010 from one academic general internal medicine clinic and six federally qualified health centers in the Chicago area.

Throughout the study, participants reported anxiety, depression, and physical function using the Patient Reported Outcomes Information System (PROMIS), chronic conditions and socio-demographic characteristics.

Other authors include Olivia E. Atherton, PhD, Daniel K. Mroczek, PhD, Chloe McGhee, BS, Lily Pieramici, Marquita Lewis-Thames, PhD, Laura Curtis, MS, David Cella, PhD, Lauren Opsasnick, MS, Rebecca Lovett, PhD, Rachel O’Conor, PhD, and Michael S. Wolf, PhD. Research reported in this publication was supported, in part, by the National Institutes on Aging (grant P30AG059988 and K01AG070107). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences is a peer-reviewed publication of the Gerontological Society of America (GSA), the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure includes a nonpartisan public policy institute, the National Academy on an Aging Society, and GSA is also home to the National Center to Reframe Aging and the National Coordinating Center for the Resource Centers for Minority Aging Research.

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