Multiple Chronic Conditions, Spouse’s Depressive Symptoms, and Gender within Marriage

Using random coefficient growth curve analysis, this study utilizes 12 waves of data from the Health and Retirement Study (1994–2016; person-waves = 145,177) to examine the association between multiple chronic conditions (MCC) and depressive symptoms among older adults. Applying cumulative disadvantage and intersectionality theories, we also test whether the association between MCC and depressive symptoms differs by race, nativity, and gender. Findings reveal that MCC prevalence is highest among U.S.-born black women, whereas depressive symptoms are highest among foreign-born Hispanic women. Compared to men, MCC has a stronger effect on women’s depressive symptoms. Furthermore, the MCC–depressive symptoms association is strongest for foreign-born Hispanic women. Despite an increase in MCC in the transition from midlife to late life, all race–nativity–gender groups experience a decline in depressive symptoms as they age. The decline in depressive symptoms is steepest for U.S.-born black and foreign-born Hispanic women. Study implications are discussed.

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Onset of Multiple Chronic Conditions and Depressive Symptoms: A Life Events Perspective

Innovation in Aging ◽

10.1093/geroni/igx022 ◽

2017 ◽

Vol 1 (2) ◽

Cited By ~ 7

Author(s):

Maureen Wilson-Genderson ◽

Allison R Heid ◽

Rachel Pruchno

Keyword(s):

Heart Disease ◽

Depressive Symptoms ◽

Pulmonary Disease ◽

Chronic Conditions ◽

Clinical Care ◽

Psychological Impact ◽

Multiple Chronic Conditions ◽

Care Providers ◽

The Subject ◽

Independent Effects

Abstract Background While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions. Methods Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWLSM research panel. Longitudinal multilevel modeling was used to examine the effects that transitioning to having a diagnosis of multiple chronic conditions has on depressive symptoms. Results Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic conditions had significantly higher levels of depressive symptoms than people who did not make this transition. The diagnosis of arthritis, diabetes, heart disease, and pulmonary disease, but not hypertension had independent effects, increasing depressive symptoms. Conclusions Having a diagnosis of multiple chronic conditions leads to increases in depressive symptoms, but not all illnesses have the same effect. Findings highlight the need for clinicians to be aware of mental health risks in patients diagnosed with multiple chronic conditions, particularly those with a diagnosis of arthritis, diabetes, heart disease, and pulmonary disease. Clinical care providers should take account of these findings, encouraging psychosocial supports for older adults who develop multiple chronic conditions to minimize the negative psychological impact of illness diagnosis.

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Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability

Annals of Behavioral Medicine ◽

10.1093/abm/kaz061 ◽

2019 ◽

Vol 54 (7) ◽

pp. 455-469

Author(s):

Courtney A Polenick ◽

Kira S Birditt ◽

Angela Turkelson ◽

Helen C Kales

Keyword(s):

Depressive Symptoms ◽

Chronic Conditions ◽

Functional Disability ◽

Well Being ◽

Multiple Chronic Conditions ◽

Individual Level ◽

Growth Curve Models ◽

Rate Of Increase ◽

The Individual ◽

Retirement Study

Abstract Background Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability. Purpose We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability. Methods The U.S. sample included 3,991 couples drawn from nine waves (1998–2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner’s baseline depressive symptoms, and each partner’s number of chronic conditions across waves. Results Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels. Conclusions Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges.

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Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial

BMC Geriatrics ◽

10.1186/s12877-020-01638-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Maureen Markle-Reid ◽

Carrie McAiney ◽

Rebecca Ganann ◽

Kathryn Fisher ◽

Amiram Gafni ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Study Protocol ◽

Chronic Conditions ◽

Transitional Care ◽

Multiple Chronic Conditions ◽

Care Intervention ◽

Hospital To Home ◽

Implementation Trial

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Changes in Depressive Symptoms among Older Adults with Multiple Chronic Conditions: Role of Positive and Negative Social Support

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph14010016 ◽

2016 ◽

Vol 14 (1) ◽

pp. 16 ◽

Cited By ~ 7

Author(s):

SangNam Ahn ◽

Seonghoon Kim ◽

Hongmei Zhang

Keyword(s):

Social Support ◽

Older Adults ◽

Depressive Symptoms ◽

Chronic Conditions ◽

Multiple Chronic Conditions

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‘You learn to live with all the things that are wrong with you’: gender and the experience of multiple chronic conditions in later life

Ageing and Society ◽

10.1017/s0144686x11001243 ◽

2012 ◽

Vol 33 (2) ◽

pp. 342-360 ◽

Cited By ~ 52

Author(s):

LAURA HURD CLARKE ◽

ERICA BENNETT

Keyword(s):

Older Adults ◽

Chronic Conditions ◽

Later Life ◽

Physical Symptoms ◽

Multiple Chronic Conditions ◽

Biographical Disruption ◽

Masculine Norms ◽

Loss Of Autonomy ◽

And Gender ◽

Depth Interviews

ABSTRACTThis article examines how older adults experience the physical and social realities of having multiple chronic conditions in later life. Drawing on data from in-depth interviews with 16 men and 19 women aged 73+ who had between three and 14 chronic conditions, we address the following research questions: (a) What is it like to have multiple chronic conditions in later life? (b) How do older men and women ‘learn to live’ with the physical and social realities of multiple morbidities? (c) How are older adults’ experiences of illness influenced by age and gender norms? Our participants experienced their physical symptoms and the concomitant limitations to their activities to be a source of personal disruption. However, they normalised their illnesses and made social comparisons in order to achieve a sense of biographical flow in distinctly gendered ways. Forthright in their frustration over their loss of autonomy and physicality but resigned and stoic, the men's stories reflected masculine norms of control, invulnerability, physical prowess, self-reliance and toughness. The women were dismayed by their bodies’ altered appearances and concerned about how their illnesses might affect their significant others, thereby responding to feminine norms of selflessness, sensitivity to others and nurturance. We discuss the findings in relation to the competing concepts of biographical disruption and biographical flow, as well as successful ageing discourses.

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THE ASSOCIATION BETWEEN MULTIPLE CHRONIC CONDITIONS AND DEPRESSIVE SYMPTOMS: DISTINCTIONS BY RACE, GENDER, AND AGE

Innovation in Aging ◽

10.1093/geroni/igz038.1148 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S314-S314

Author(s):

Christy L Erving ◽

Cleothia Frazier

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Lived Experience ◽

Chronic Conditions ◽

Mental Health Problems ◽

White Male ◽

Psychological Services ◽

Multiple Chronic Conditions ◽

Gender And Age ◽

Nationally Representative

Abstract Multiple chronic conditions (MCC)—the co-occurrence of two or more chronic diseases—is a serious concern due to its high prevalence among middle-age and older-adults, and its association with increased disability, mortality risk, and healthcare costs. A growing body of work has shown that chronic physical conditions are associated with depressive symptoms. While MCC and depression affect a substantial proportion of older adults in general, there are important status variations in disease burden along the dimensions of race, gender, and age. This study employs an intersectional and multi-hierarchical approach to assess how these status characteristics (race, gender, and age) may condition the MCC-depression association. We use data from the 1994-2014 waves of the Health and Retirement Study (HRS), a nationally representative data source providing a longitudinal survey of U.S. adults over the age of 50 biennially. Results revealed that MCC was positively associated with depression in general. However, Black Americans, women, and younger adults were more likely to experience depression relative to their White, male, and older counterparts, respectively. The findings suggest that the lived experience of MCC differs by social status, and is perhaps due (in part) to status differences in access to social resources to counteract the potentially deleterious psychological effects of MCC. This research has also has practical implications: given the strong MCC-depression association, older adults with MCC should be offered psychological services to decrease the likelihood of developing mental health problems due to the stress associated with having multiple chronic conditions.

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Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052615 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2615

Author(s):

Hankyung Jun ◽

Emma Aguila

Keyword(s):

Mental Health ◽

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Race And Ethnicity ◽

Chronic Conditions ◽

Private Insurance ◽

The United States ◽

Mental Illnesses ◽

Multiple Chronic Conditions

Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions.

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