Sick and Sad: A Multistate Analysis of Chronic Conditions and Depression Onset among Aging Adults in Europe

Florencia Bathory , Centre d'Estudis Demogràfics
Solveig A Cunningham, Netherlands Interdisciplinary Demographic Institute and Emory University

Population ageing in Europe has intensified concerns about multimorbidity and its mental health consequences. This study examines the how chronic conditions affect the onset of depression on mid- and older adults in Europe. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 4-9 (2011-2022), we apply continuous-time multistate models to analyze transitions between depression states (with/without depressive symptoms) European countries among people with and without chronic conditions. Depression is measured using the EURO-D scale (where having four or more symptoms indicate presence of depression); chronic conditions are assessed through physician-diagnosed diseases at baseline. We estimate time spent in each state (with and without depression) from age 50, stratified by chronic condition status and gender. We control for the effects of confounders: age, education, income and partnership status. We also consider potential mediators and modificators in this relationship: chronic pain and activity limitations, following the hypothesis that these may trigger depression; social participation, physical activity and welfare regime, considering that they may protect the individuals from the onset of depression. Chronic conditions significantly increased the risk of depression onset by 24% among men and 41% for women. They also live a higher proportion of years with depression, compared to those with no chronic conditions at baseline (11.6% vs. 8.4% for men, 20.4% vs. 15.8% for women). Functional limitations and chronic pain mediate the relationship between chronic conditions and depression among our study population, while physical activity and social participation are associated with lower incidence of depression.

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 Presented in Session 23. Mental Health, Cognition and Wellbeing