Multimorbidity of overweight and obesity alongside anxiety and depressive disorders in individuals with spinal cord injury

Abstract

Objective

To compare the prevalence of anxiety/depression and overweight/obesity (Aim 1) and the multimorbidity of these conditions (Aim 2) in a sample of adults with and without spinal cord injury (SCI). Aim 3 was to examine whether overweight/obese individuals with SCI differ on the prevalence of anxiety/depressive disorders compared to non-overweight/obese individuals with SCI.

Design

Retrospective cohort study.

Participants

Individuals ≥16 years old who had patient encounters between January 1, 2011, and February 28, 2018. In total, 761 598 individuals were included, of which 3136 had SCI.

Main Outcome Measures

Individuals were identified as diagnosed with SCI, anxiety and/or depressive disorders, and overweight/obesity using the International Classification of Diseases.

Results

Age-adjusted odds ratios (ORs) were calculated using logistic regression. In contrast to non-SCI individuals, those with SCI had increased odds of anxiety disorders (OR: 3.58, 95% CI [3.29–3.90]), depressive disorders (OR: 4.33, 95% CI [3.95–4.74]), and overweight/obesity (OR: 3.08, 95% CI [2.80–3.38]). Pertaining to multimorbidity, individuals with SCI had increased odds of having overweight/obesity alongside anxiety disorders (OR: 4.30, 95% CI [3.71–4.98]) and overweight/obesity alongside depressive disorders (OR: 4.69, 95% CI [4.01–5.47]) compared to those without SCI. Individuals with SCI who were diagnosed as overweight/obese had increased odds of having anxiety disorders (OR: 2.54, 95% CI [2.06–3.13]), and depressive disorders (OR: 2.70, 95% CI [2.18–3.36]), relative to non-overweight/obese individuals with SCI.

Conclusions

This work is among the first to find evidence that individuals with SCI are at heightened odds of overweight/obesity alongside anxiety and/or depressive disorders. This early work holds clinical implications for treating these interrelated comorbidities in SCI.

Keywords:

• Physical disability
• Mental health
• Weight gain
• Multimorbidity

Notes

1 World Health Organization defines overweight as BMI ≥ 25 and obese as BMI ≥ 30, though it has been argued that these cut-offs may be inaccurate for individuals with SCI (see Method section for further discussion).

2 The Hershey Medical Center (located in Hershey, PA) is a 548-bed hospital that averages over one million outpatient visits and nearly 75,000 emergency visits per year.