Understanding the relationship between depression and trajectories of physical multimorbidity accrual: longitudinal analysis of UK Biobank data

有越来越多的人谁有多morphies这意味着生活在多种身体和/或精神健康状况。多发性硬化症的增加有许多原因。与过去相比，人们的寿命更长，更有可能在危及生命的疾病中幸存下来（例如，任何心脏病发作后幸存下来的人都将不得不与慢性心脏病一起生活）。寿命延长和从威胁生命的疾病中幸存下来当然是好事，但多发病对卫生服务和研究提出了挑战，这些研究往往侧重于单一疾病。我们需要了解人们如何更好地发展多种条件，这是这项研究的重点。身体状况与抑郁症的结合是非常常见的。大约五分之一的身体状况不良的人患有抑郁症，这种组合与更糟糕的身心健康结果有关。因此，重要的是要了解身体状况和抑郁症之间的关系。现有的研究往往只是在一个时间点上观察人们。这意味着不可能知道抑郁症是否会导致身体疾病，或者身体疾病是否会导致抑郁症，或者两者兼而有之。现有的研究也并不总是解释可能与身体疾病和抑郁症有关的事情，如酗酒或缺乏锻炼。这项研究的目的是研究身体疾病和抑郁症之间的关系，使用英国生物银行研究的50万中年人的数据，随访约10年。计划中的工作有三个要素：第一，我们将开发一些不同的方法来测量人们在中年和老年时的身体状况模式。有三种不同的方法可以做到这一点：（1）简单地计算人们在10年内发展了多少种身体状况;（2）确定他们如何发展新的身体状况的“形状”或轨迹（例如，不发展vs缓慢发展新条件vs迅速发展新条件）;以及（3）识别是否存在一起发展的身体状况组（例如，由吸烟引起的不同状况，但也可能存在意想不到的分组）。我们也会在数据中探索不同的测量抑郁的方法，因为我们不知道抑郁的严重程度是否会影响与身体状况的关系。第二，我们将研究研究开始前的抑郁是否能预测人们在未来10年内的身体状况。我们将使用多种方法来做到这一点，这些方法基于上述测量物理条件模式的不同方式。我们将仔细考虑可能与抑郁症和身体状况模式有关的其他个人特征的影响，如性别，吸烟，酒精，肥胖，以及一个人的贫富程度。第三，我们将研究不同的身体状况模式是否可以预测人们是否会患上新的或复发性抑郁症。同样，我们将仔细考虑可能与抑郁和身体状况模式有关的其他个人特征的影响。这项研究将大大增加我们对中年人身体状况模式的理解，以及身体状况与抑郁症之间的联系。同样的方法可以在未来用于研究身体状况如何与焦虑或精神分裂症等其他心理健康问题联系起来。它还将使更多的研究成为可能，研究抑郁症和身体状况是否有共同的遗传（遗传）原因，或者是否有影响不同疾病（如炎症）的共同机制。最后，更好地了解疾病模式将有助于确定可能需要更多卫生服务帮助的人，以改善他们的生活质量和未来的健康。

There are increasing numbers of people who have multimorbidity which means living with multiple physical and/or mental health conditions. Increasing multimorbidity has a number of causes. People are living longer and are more likely to survive life-threatening illness than in the past (for example, anyone who survives a heart attack will then have to live with chronic heart disease). Living longer and surviving life-threatening illness are of course good things, but multimorbidity poses challenges to health services and research which often focuses on single conditions. We need to understand how people develop multiple conditions better, and this is the focus of this research. The combination of physical conditions with depression is very common. About one in five people with a physical condition have depression, and this combination is associated with worse physical and mental health outcomes. It is therefore important to understand how physical conditions and depression are related. Existing research has often just looked at people at one point in time. This means that it isn't possible to know if depression causes physical disease, or if physical disease causes depression, or both. Existing research also does not always account for things which might be related to both physical disease and depression such as heavy drinking or lack of exercise. The aim of this research is to examine the relationship between physical disease and depression using data for half a million middle-aged people followed up for ~10 years as part of the UK Biobank study. There are three elements to the planned work:First, we will develop a number of different ways of measuring the patterns of physical conditions that people get in middle and older age. There are three different ways of doing this: (1) Simply counting how many physical conditions people develop over 10 years; (2) Identifying the 'shape' or trajectory of how they develop new physical conditions (eg developing none vs slowly developing new conditions vs rapidly developing them); and (3) Identifying if there are groups of physical conditions that develop together (for example, different conditions caused by smoking, but there may be unexpected groupings as well). We will also explore different ways of measuring depression in the data, because we don't know whether the severity of depression affects the relationship with physical conditions. Second, we will examine whether depression before the start of the study predicts how people develop physical conditions over the next 10 years. We will do this using a number of methods, based on the different ways of measuring patterns of physical conditions described above. We will carefully account for the effect of other individual characteristics which might be linked to both depression and patterns of physical condition such as gender, smoking, alcohol, obesity, and how rich or poor a person is. Third, we will examine whether different patterns of physical condition predict whether or not people develop new or recurrent depression. Again, we will carefully account for the effect of other individual characteristics which might be linked to both depression and patterns of physical conditions. The study will add significantly to our understanding of the patterns of physical conditions which people develop in middle age, and the links between physical conditions and depression. The same approach can be used in the future to examine how physical conditions are linked to other mental health problems like anxiety or schizophrenia. It will also make possible additional studies that examine if there are common genetic (inherited) causes of both depression and physical conditions, or if there are common mechanisms affecting different diseases like inflammation. Finally, better understanding of patterns of disease will help identify people who may need more help from health services to improve their quality of life and future health.