Self-reported Physical Health as a Mediator of the Effects of BMI on Depression among People with Multiple Chronic Conditions

Background: The current study examined whether the association between body mass index (BMI) and symptoms of depression is mediated by self-reported physical health among Chinese people with multiple chronic conditions (MCCs). Methods: This was a secondary analysis based on a previous cross-sectional survey using the Hospital Anxiety and Depression Scale (HADS) and Short Form-12 (SF-12). A convenience sample of Chinese people with MCCs (n = 351) was recruited and a mediation effect model using SPSS PROCESS was employed. Results: The results showed that self-reported physical health acted as a full mediator in the association between BMI and depression only for men with MCCs. Conclusions: The findings of this study suggest that decreased physical health should be of primary importance in the management of MCCs. Further intervention addressing weight control could be a strategy of particular interest for improving the mental health of people with MCCs.

body mass index; depression; multiple chronic conditions; obesity; physical health

[1] Zhang X, Zhang M, Zhao Z, Huang Z, Deng Q, Li Y, et al. Geo-graphic Variation in Prevalence of Adult Obesity in China: Re-sults from the 2013–2014 National Chronic Disease and Risk Factor Surveillance. Annals of Internal Medicine. 2020; 172: 291.

[2] Holley-Mallo R, Golden A. Obesity and Men’s Health. Nursing Clinics of North America. 2021; 56: 599–607.

[3] Djalalinia S, Qorbani M, Peykari N, Kelishadi R. Health im-pacts of Obesity. Pakistan Journal of Medical Sciences. 2015; 31: 239–242.

[4] Sailer D. Obesity: entrance port to multimorbidity. Wiener Medizinische Wochensschrift 1998; 148: 388–392.

[5] Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic litera-ture review and meta-analysis. Ageing Research Reviews. 2019; 53: 100903.

[6] Larkin J, Foley L, Smith SM, Harrington P, Clyne B. The ex-perience of financial burden for people with multimorbidity: a systematic review of qualitative research. Health Expectations. 2020; 24: 282–295.

[7] Yao S, Cao G, Han L, Chen Z, Huang Z, Gong P, et al. Prevalence and Patterns of Multimorbidity in a Nationally Representative Sample of Older Chinese: Results from the China Health and Retirement Longitudinal Study. The Journals of Gerontology: Series A. 2020; 75: 1974–1980.

[8] Jantaratnotai N, Mosikanon K, Lee Y, McIntyre RS. The in-terface of depression and obesity. Obesity Research & Clinical Practice. 2017; 11: 1–10.

[9] Patsalos O, Keeler J, Schmidt U, Penninx BWJH, Young AH, Himmerich H. Diet, Obesity, and Depression: A Systematic Re-view. Journal of personalized medicine. 2021; 11: 176.

[10] Herhaus B, Kersting A, Brähler E, Petrowski K. Depression, anxiety and health status across different BMI classes: a rep-resentative study in Germany. Journal of Affective Disorders. 2020; 276: 45–52.

[11] Zhou Q, Wang T, Basu K. Negative association between BMI and depressive symptoms in middle aged and elderly Chinese: Results from a national household survey. Psychiatry Research. 2018; 269: 571–578.

[12] de Wit LM, van Straten A, van Herten M, Penninx BW, Cui-jpers P. Depression and body mass index, a u-shaped associa-tion. BMC Public Health. 2009; 9: 14.

[13] Milaneschi Y, Simmons WK, van Rossum EFC, Penninx BW. Depression and obesity: evidence of shared biological mecha-nisms. Molecular Psychiatry. 2019; 24: 18–33.

[14] Pratt LA, Brody DJ. Depression and obesity in the U.S. adult household population, 2005–2010. NCHS Data Brief. 2014; 1–8.

[15] Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, et al. Overweight, Obesity, and Depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry. 2010; 67: 220.

[16] Cheng C, Yang C, Inder K, Chan SW. Illness Perceptions, Cop-ing Strategies, and Quality of Life in People with Multiple Chronic Conditions. Journal of Nursing Scholarship. 2020; 52: 145–154.

[17] Department of Disease Control MoHotPsRoC. Guidelines for Prevention and Control of Overweight and Obesity in Chi-nese Adults People Public Health Publishing Company, Beijing. 2006.

[18] Wang W, Chair SY, Thompson DR, Twinn SF. A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease. Journal of Clinical Nursing. 2009; 18: 1908–1915.

[19] Lam ETP, Lam CLK, Fong DYT, Huang WW. Is the SF-12 ver-sion 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese? Journal of Eval-uation in Clinical Practice. 2013; 19: 200–208.

[20] Hayes AF, Rockwood NJ. Regression-based statistical medi-ation and moderation analysis in clinical research: Observa-tions, recommendations, and implementation. Behaviour Re-search and Therapy. 2017; 98: 39–57.

[21] Parker G, Brotchie H. Gender differences in depression. Inter-national Review of Psychiatry. 2010; 22: 429–436.

[22] Davoud A, Abazari M. The Relationship between Quality of Life and Physical Activity, Worry, Depression, and Insomnia in Preg-nant Women. Iranian Journal of Psychiatry. 2020; 15: 159–168.

[23] Cha KM, Chung YK, Lim KY, Noh JS, Chun M, Hyun SY, et al. Depression and insomnia as mediators of the relationship be-tween distress and quality of life in cancer patients. Journal of Affective Disorders. 2017; 217: 260–265.

[24] Mourady D, Richa S, Karam R, Papazian T, Hajj Moussa F, El Osta N, et al. Associations between quality of life, physical ac-tivity, worry, depression and insomnia: A cross-sectional de-signed study in healthy pregnant women. PLoS ONE. 2017; 12: e0178181.

[25] Sitlinger A, Zafar SY. Health-Related Quality of Life: The Im-pact on Morbidity and Mortality. Surgical Oncology Clinics of North America. 2018; 27: 675–684.

[26] Pokrajac-Bulian A, Kukić M, Bašić-Marković N. Quality of life as a mediator in the association between body mass index and negative emotionality in overweight and obese non-clinical sam-ple. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2015; 20: 473–481.

[27] Nortvedt MW, Riise T, Sanne B. Are men more depressed than women in Norway? Validity of the Hospital Anxiety and De-pression Scale. Journal of Psychosomatic Research. 2006; 60: 195–198.

[28] Lee J-, Park SK, Ryoo J-, Oh C-, Choi J-, McIntyre RS, et al. U- shaped relationship between depression and body mass index in the Korean adults. European Psychiatry. 2017; 45: 72–80.

[29] McCrea RL, Berger YG, King MB. Body mass index and com-mon mental disorders: exploring the shape of the association and its moderation by age, gender and education. International Journal of Obesity. 2012; 36: 414–421.

[30] González-Chica DA, Hill CL, Gill TK, Hay P, Haag D, Stocks N. Individual diseases or clustering of health conditions? As-sociation between multiple chronic diseases and health-related quality of life in adults. Health and Quality of Life Outcomes. 2017; 15: 244.