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Characteristic Scale Domain 1. Cardiac 2. Vascular 3. Hematological 4. Respiratory 5. Ophthalmological and ORL 6. Upper gastrointestinal 7. Lower gastrointestinal 8. Hepatic and pancreatic 9. Renal 10. Genitourinary 11. Musculoskeletal and tegumental 12. Neurological 13. Endocrine, metabolic, breast 14. Psychiatric Weight All domains weighted from 0 to 4: 0. No problem 1. Mild 2. Moderate 3. Severe 4. Extremely severe Final score Sum of weights assigned to each domain Characteristic Refusals (n = 115) Participants (n = 238) PValue CIRS = Cumulative Illness Rating Scale. * t test. † χ2 test. Age, years, mean (SD) 56.5 (17.4) 59.0 (14.3) .169* CIRS score, mean (SD) 10.3 (6.2) 10.3 (5.7) .998* No. of diagnoses, mean (SD) 5.5 (3.2) 5.3 (2.8) .485* Male, % 33.9 29.0 .389† Educational level, % <8 years 21.8 8 to 12 years 38.2 Higher level (college or university) 39.5 Missing data 0.5 Household income in Canadian dollars, % <$10,000 8.8 $10,000–$29,999 35.3 $30,000–$49,999 20.5 ≥$50,000 20.2 Missing data 15.2 Self-perceived economic status, % Poverty 15.6 Sufficient 61.3 Wealthy 22.7 Missing data 0.4 Marital status, % Married or cohabiting 68.1 Divorced or separated 10.5 Widower 12.6 Never married 8.8 Persons living in the same dwelling, % 0 18.9 1 46.2 ≥2 34.9 - Table 3.
Multivariate Analysis Controlling for Patients’ Sex, Self-Perceived Social Support, and Self-Perceived Economic Status
Psychological Distress (IDPESQ14 score) Multimorbidity Measure OR (95% CI) P* Pcorr† IDPESQ14 = Indice de Détresse Psychologique de l’Enquête Santé Québec; OR = odds ratio; CI = confidence interval; Pcorr = P corrected ; CIRS = Cumulative Illness Rating Scale. * When patients clustered by physician was not taken into account. † When patients clustered by physician was taken into account. Count of chronic diseases 1.12 (0.97–1.29) .113 .188 Quintiles of CIRS 1/2 1.00 .036 .024 3 1.72 (0.53–5.86) 4 2.99 (1.01–9.74) 5 4.67 (1.61–15.16) Changing CIRS quintile 1.67 (1.19–2.37) .003 .002 Additions to Baseline Model CIRS Quintile Variables Statistical Measures Baseline Model* No. of Chronic Diseases Categorical Ordinal CIRS = Cumulative Illness Rating Scale; n/a = not applicable; ROC = receiver operating characteristic. * Including only the confounding variables (ie, sex, self-perceived social support, and self-perceived economic status). Deviance 216.96 214.44 207.81 207.83 Likelihood ratio test χχ2 (df) n/a 2.53 (1) 9.15 (3) 9.13 (1) P value .112 .027 .003 Measures of explained variation 0.0962 0.1004 0.1299 0.1298 r2(y, p̂) 0.1100 0.1197 0.1446 0.1445 R2 analogue Area under the ROC curve 0.747 0.756 0.776 0.777
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The Article in Brief
Background Psychological distress can increase the effects of illness and contribute to health problems. Even so, little is known about the relationship between psychological distress and multimorbidity (that is, having more than 1 chronic disease). This is a study of the relationship between psychological distress and multiple chronic diseases in family medicine patients. It looks at both the number of chronic diseases a patient has and the severity of the diseases.
What This Study Found Patients with multiple chronic diseases that are more severe had more psychological distress than patients with multiple chronic diseases that are less severe. The risk of psychological distress was almost 5 times higher in patients with the highest burden of disease. Psychological distress was not related to the number of chronic diseases a patient has.
Implications
- This is the first study to analyze the relationship between multimorbidity and psychological distress in a family practice setting, taking severity of illnesses into account.
- Psychological distress may be present in patients with multiple chronic diseases. Clinicians should consider this as they manage the care of these complex patients.
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