Depression and self-care in older adults with multiple chronic conditions: A multivariate analysis

AIMS: To investigate the relationship between depression and self-care behaviors in older individuals with multimorbidity. DESIGN: Cross-sectional study. Data were collected between April 2017-June 2019. METHODS: Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 was used to measure depression and Self-Care of Chronic Illness Inventory was used to measure self-care maintenance, monitoring and management. The relationship between depression and self-care was evaluated by performing two sets of univariate analyses, followed by multivariate and step-down analyses. The second set was performed to control for the number of chronic conditions, age and cognitive function. RESULTS: The sample (N=366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self-care maintenance and monitoring and a significant negative association between depression and multivariate self-care. Step-down analysis showed that self-care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age and cognitive function. CONCLUSION: In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviors (e.g. physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity. IMPACT: The results of this study may help guide clinical practice. In patients with depressive symptoms, self-care maintenance behaviors should be assessed first, as a potential first indicator of poor self-care.