Physical multimorbidity predicts the onset and persistence of anxiety: A prospective analysis of the Irish Longitudinal Study on Ageing

Lee Smith, Jae Il Shin, Louis Jacob, Felipe Schuch, Damiano Pizzol, Guillermo F López Sánchez, Pinar Soysal, Mark A Tully, Laurie T Butler, Yvonne Barnett, Nicola Veronese, Seoyeon Park, Ai Koyanagi

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BACKGROUND: The aims of the present study were to examine prospective associations of multimorbidity (i.e., ≥2 chronic conditions) at baseline with incident and persistent anxiety over a two-year follow-up period among Irish older adults, and to quantify the extent to which sleep, pain, and disability mediate the multimorbidity-anxiety relationship.

METHODS: Data from The Irish Longitudinal Study on Aging (TILDA) conducted between 2009 and 2011 with a follow-up after two years were analyzed. Anxiety referred to score ≥ 8 on the anxiety section of the Hospital Anxiety and Depression Scale. Lifetime diagnosis of 14 chronic conditions was obtained. Outcomes were incident and persistent anxiety at two-year follow-up.

RESULTS: Data on 5871 adults aged ≥50 years at baseline were analyzed [Mean (SD) age 63.3 (9.0) years; 51.2% women]. After adjustment for potential confounders, compared to no chronic physical conditions at baseline, ≥3 chronic conditions were associated with a significant 1.89 (95% CI = 1.16-3.08) times higher risk for new onset anxiety at follow-up. Furthermore, having 1, 2, and ≥3 conditions at baseline were associated with significant 1.48 (95% CI 1.02, 2.14), 1.74 (95% CI 1.19, 2.53), and 1.84 (95% CI 1.27, 2.68) times higher risk for persistent anxiety at follow-up. Sleep problems, pain, and disability were identified as significant mediators, explaining 22.9%-37.8% of the associations.

CONCLUSION: Multimorbidity was associated with both new onset and persistent anxiety among Irish older adults. Future interventional studies should examine whether addressing the identified mediators may lead to lower risk for incident or persistent anxiety among those with physical multimorbidity.

Original languageEnglish
Pages (from-to)71-76
Number of pages6
JournalJournal of Affective Disorders
Early online date20 Apr 2022
Publication statusPublished (in print/issue) - 15 Jul 2022

Bibliographical note

Funding Information:
Dr. Guillermo F. López Sánchez is funded by the European Union – Next Generation EU .

Publisher Copyright:
© 2022 Elsevier B.V.


  • Multimorbidity
  • Anxiety
  • Older adults
  • Cohort
  • Epidemiology


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