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Mental health
Research
Ageing and mental health: changes in self-reported health due to physical illness and mental health status with consecutive cross-sectional analyses
  1. Geir Fagerjord Lorem1,
  2. Henrik Schirmer2,3,
  3. Catharina E A Wang4,5,
  4. Nina Emaus1
  1. 1Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
  2. 2Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
  3. 3Division of Cardiothoracic and Respiratory Medicine, University Hospital of Northern Norway, Tromsø, Norway
  4. 4Department of Psychology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
  5. 5Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway
  1. Correspondence to Professor Geir Fagerjord Lorem; geir.lorem{at}uit.no

Abstract

Objectives It is known that self-reported health (SRH) declines with increasing age and that comorbidity increases with age. We wished to examine how age transfers its effect to SRH through comorbid disease and mental illness and whether these processes remained stable from 1994 until 2008. The hypothesis is that ageing and/or the increased age-related burden of pathology explains the declining SRH.

Setting The Tromsø Study (TS) is a cohort study using a survey approach with repeated physical examinations. It was conducted in the municipality of Tromsø, Norway, from 1974 to 2008.

Participants A total of 21 199 women and 19 229 men participated.

Primary and secondary outcome measures SRH is the outcome of interest. We calculated and compared the effect sizes of age, comorbidity and mental health symptoms using multimediator analysis based on OLS regression.

Results Ageing had a negative impact on SRH, but the total effect of age decreased from 1994 to 2007. We assessed the direct effect of age and then the proportion of indirect age-related effects through physical illness and mental health symptoms on the total effect. The direct effect of age represented 79.3% of the total effect in 1994 and decreased to 58.8% in 2007. Physical illness emerged as an increasingly important factor and increased its influence from 15.7% to 41.2% of the total effect. Age alone had a protective effect on mental health symptoms and this increased (2.5% to 17.3%), but we found a stronger association between mental health symptoms and physical disease in the later waves of the study (increasing from 3.7% to 14.8%).

Conclusions The results suggest that the effect on SRH of mental health symptoms caused by physical illness is an increasing public health problem. Treatment and care for specific medical conditions must therefore focus more strongly on how these conditions affect the patient's mental health and address these concerns accordingly.

  • ageing
  • self-reported health
  • comorbid disease
  • MENTAL HEALTH
  • EPIDEMIOLOGY

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013629

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    Footnotes

    • Contributors GFL, HS, CEAW and NE had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; involved in acquisition, analysis or interpretation of data and contributed to critical revision of the manuscript for important intellectual content. GFL, HS and NE involved in study concept and design. GFL contributed to statistical analysis and drafting of the manuscript. The Tromsø Study of UiT The Arctic University of Norway provided the data.

    • Funding This study was supported by UiT The Arctic University of Tromsø (EUTRO 8010.00055).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We received the data from the Tromsø study. The data contain sensitive health information about the participants. Data cannot be made publicly available without compromising participant confidentiality and privacy. Directives from the Research Ethical Committee and the Norwegian Data Protection Authority thus prohibit us from making the minimal data set publicly available. Data are available from the Tromsø study for researchers who meet the criteria for access to confidential data (https://en.uit.no/prosjekter/prosjekt?p_document_id=80172). Furthermore, all variables are described in the NESSTAR database: http://tromsoundersokelsen.uit.no/webview/.