Biosocial mechanisms linking depression with physical illness: Commonalities across chronic illnesses
Lead Research Organisation:
University College London
Department Name: Epidemiology and Public Health
Abstract
The purpose of this research is to understand more about biosocial pathways in health by studying depression symptoms and how they relate to physical illnesses such as diabetes, heart disease and cancer. We already know that people suffering from these diseases are more likely to experience symptoms of depression than those without them. We also know that people who experience depression symptoms are more likely to develop a physical illness later in life. However, as yet, we are not sure why depression symptoms and physical illnesses are related in these ways.
I am particularly interested in the biological pathways linking depression symptoms and physical illnesses. These pathways include things like how our bodies respond to stress and how well our immune system works. For example, I am interested in a substance called cortisol which is released by the body when we feel stressed or sad. I am also interested in part of the immune system which is responsible for levels of inflammation. Research has shown that cortisol and inflammation do not work as well as they should in people who have depression symptoms or a physical illness. Therefore, I am interested in finding out whether changes in these things can explain the link between depression symptoms and physical illness morbidity in people who suffer from a variety of different physical illnesses.
My research fits in well with the ESRC's priorities for this award: biosocial research and secondary analyses of longitudinal data. I am proposing to conduct biosocial research since I am planning to study the biology of a problem that society is facing. In addition, I intend to use longitudinal data that has already been collected, but has not yet been used to answer the questions I am interested in. I will use two main methods to analyse my data: quantitative analyses of existing data and qualitative analyses of a new study. I will use data from studies such as Whitehall II, the English Longitudinal Study of Ageing (ELSA), and Midlife in the United States study (MIDUS) among others. Using these datasets will allow me to partly answer my questions using statistical analyses. In addition, I will conduct a qualitative study in order to speak to individuals living with either a mental or physical illness about their experiences of depression symptoms. This will enable me to explore how people think, feel and cope with their illnesses and their mood.
This research is important for a number of reasons. First of all, research has shown that people who have depression symptoms and a physical illness are likely to experience more symptoms of their physical illness than those without depression symptoms. In other words, they are more likely to feel sicker than those without depression symptoms. This links to the second important reason. If we understand why people with physical illness also get depression symptoms then we can improve our treatment of these individuals. At the moment, our current treatment options are not always very effective. So, not only do these people suffer more symptoms of their illness, their depression symptoms do not always go away with treatment. If we can improve treatment, then we can reduce suffering. Another reason that this research is important is the scale of the problem. Currently a lot of people with a physical illness also experience depression symptoms. Sadly, research has shown that a lot of these patients do not get identified by doctors as needing extra help. I plan to raise awareness of this issue during the course of my fellowship by ensuring I reach out to policymakers, health professionals and the public.
I am particularly interested in the biological pathways linking depression symptoms and physical illnesses. These pathways include things like how our bodies respond to stress and how well our immune system works. For example, I am interested in a substance called cortisol which is released by the body when we feel stressed or sad. I am also interested in part of the immune system which is responsible for levels of inflammation. Research has shown that cortisol and inflammation do not work as well as they should in people who have depression symptoms or a physical illness. Therefore, I am interested in finding out whether changes in these things can explain the link between depression symptoms and physical illness morbidity in people who suffer from a variety of different physical illnesses.
My research fits in well with the ESRC's priorities for this award: biosocial research and secondary analyses of longitudinal data. I am proposing to conduct biosocial research since I am planning to study the biology of a problem that society is facing. In addition, I intend to use longitudinal data that has already been collected, but has not yet been used to answer the questions I am interested in. I will use two main methods to analyse my data: quantitative analyses of existing data and qualitative analyses of a new study. I will use data from studies such as Whitehall II, the English Longitudinal Study of Ageing (ELSA), and Midlife in the United States study (MIDUS) among others. Using these datasets will allow me to partly answer my questions using statistical analyses. In addition, I will conduct a qualitative study in order to speak to individuals living with either a mental or physical illness about their experiences of depression symptoms. This will enable me to explore how people think, feel and cope with their illnesses and their mood.
This research is important for a number of reasons. First of all, research has shown that people who have depression symptoms and a physical illness are likely to experience more symptoms of their physical illness than those without depression symptoms. In other words, they are more likely to feel sicker than those without depression symptoms. This links to the second important reason. If we understand why people with physical illness also get depression symptoms then we can improve our treatment of these individuals. At the moment, our current treatment options are not always very effective. So, not only do these people suffer more symptoms of their illness, their depression symptoms do not always go away with treatment. If we can improve treatment, then we can reduce suffering. Another reason that this research is important is the scale of the problem. Currently a lot of people with a physical illness also experience depression symptoms. Sadly, research has shown that a lot of these patients do not get identified by doctors as needing extra help. I plan to raise awareness of this issue during the course of my fellowship by ensuring I reach out to policymakers, health professionals and the public.
Planned Impact
Who will benefit from this research?
A wide range of beneficiaries are expected from this work. Specifically, it is anticipated that academics, policy makers, health professionals and the wider community are all likely to benefit from the output of the proposed programme of work.
How will they benefit from this research?
1. Academics. The knowledge generated by this research is likely to have a significant impact on scientific understanding and theory surrounding the issue of depression symptoms in those individuals with a comorbid physical illness. The inclusive nature of the research to capture different methods of measuring psychological distress (depression symptoms, negative affect, etc.) and multiple physical illnesses (coronary heart disease, diabetes, cancer etc.) will allow me to look for common biological pathways across a wide range of diseases. Therefore, my research findings are likely to appeal to academics working across a variety of disciplines such as the medical sciences, psychology, public health and epidemiology, biology and social sciences.
2. Policymakers. There is growing interest among policymakers in issues surrounding wellbeing and life satisfaction. The national government has signalled its commitment to wellbeing through initiating and maintaining the work on personal wellbeing in the UK conducted by the Office for National Statistics (http://www.ons.gov.uk/ons/dcp171778_319478.pdf). Public Health England is encouraging novel methods of reducing depression and risk of chronic disease. One of the aims of my research is to examine the influence of psychological distress on the onset of physical illness. As such, my findings are likely to be of interest to policymakers, particularly with regards to the organisation of services. The proposed programme of work is likely to fuel ideas, knowledge and debate among policymakers.
3. Health professionals. The UK's IAPT (Improving Access to Psychological Treatment) programme recently listed depression symptoms in those with a physical illness as a priority group of individuals to target for treatment. Therefore, greater understanding of depression symptoms and physical illness, and the implications for patient care, is likely to be of interest to a wide range of health professionals, including GPs, psychologists, community health workers, and gerontologists.
4. Wider community. Since I am particularly interested in subclinical levels of distress, my findings are not just restricted to those with clinically diagnosable depression. As such, my findings should resonate with those living with physical illness, and their friends and relatives. My qualitative work will ensure that my research remains grounded in the experiences, thoughts and feelings of 'real' people. By impacting policymakers and health professionals, I hope to ultimately help those living with physical and mental illnesses.
A wide range of beneficiaries are expected from this work. Specifically, it is anticipated that academics, policy makers, health professionals and the wider community are all likely to benefit from the output of the proposed programme of work.
How will they benefit from this research?
1. Academics. The knowledge generated by this research is likely to have a significant impact on scientific understanding and theory surrounding the issue of depression symptoms in those individuals with a comorbid physical illness. The inclusive nature of the research to capture different methods of measuring psychological distress (depression symptoms, negative affect, etc.) and multiple physical illnesses (coronary heart disease, diabetes, cancer etc.) will allow me to look for common biological pathways across a wide range of diseases. Therefore, my research findings are likely to appeal to academics working across a variety of disciplines such as the medical sciences, psychology, public health and epidemiology, biology and social sciences.
2. Policymakers. There is growing interest among policymakers in issues surrounding wellbeing and life satisfaction. The national government has signalled its commitment to wellbeing through initiating and maintaining the work on personal wellbeing in the UK conducted by the Office for National Statistics (http://www.ons.gov.uk/ons/dcp171778_319478.pdf). Public Health England is encouraging novel methods of reducing depression and risk of chronic disease. One of the aims of my research is to examine the influence of psychological distress on the onset of physical illness. As such, my findings are likely to be of interest to policymakers, particularly with regards to the organisation of services. The proposed programme of work is likely to fuel ideas, knowledge and debate among policymakers.
3. Health professionals. The UK's IAPT (Improving Access to Psychological Treatment) programme recently listed depression symptoms in those with a physical illness as a priority group of individuals to target for treatment. Therefore, greater understanding of depression symptoms and physical illness, and the implications for patient care, is likely to be of interest to a wide range of health professionals, including GPs, psychologists, community health workers, and gerontologists.
4. Wider community. Since I am particularly interested in subclinical levels of distress, my findings are not just restricted to those with clinically diagnosable depression. As such, my findings should resonate with those living with physical illness, and their friends and relatives. My qualitative work will ensure that my research remains grounded in the experiences, thoughts and feelings of 'real' people. By impacting policymakers and health professionals, I hope to ultimately help those living with physical and mental illnesses.
Publications
Frank P
(2019)
Systemic low-grade inflammation and subsequent depressive symptoms: Is there a mediating role of physical activity?
in Brain, behavior, and immunity
Hackett RA
(2019)
Loneliness and biological responses to acute stress in people with Type 2 diabetes.
in Psychophysiology
Panagi L
(2021)
Enjoyment of life predicts reduced type 2 diabetes incidence over 12 years of follow-up: findings from the English Longitudinal Study of Ageing.
in Journal of epidemiology and community health
Panagi L
(2019)
Happiness and Inflammatory Responses to Acute Stress in People With Type 2 Diabetes.
in Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
Panagi L
(2019)
Sex differences in interleukin-6 stress responses in people with Type 2 diabetes.
in Psychophysiology
Poole L
(2018)
Depressive symptoms predict incident chronic disease burden 10 years later: Findings from the English Longitudinal Study of Ageing (ELSA).
in Journal of psychosomatic research
Poole L
(2020)
Subjective wellbeing as a determinant of glycated hemoglobin in older adults: longitudinal findings from the English Longitudinal Study of Ageing.
in Psychological medicine
Poole L
(2020)
The combined association of depressive symptoms and C-reactive protein for incident disease risk up to 12 years later. Findings from the English Longitudinal Study of Ageing (ELSA).
in Brain, behavior, and immunity
| Description | I used two main methods to address the aims of this grant: (1) secondary analysis of existing data and (2) the collection of original research data through the use of qualitative interviews. In terms of the first approach, I have conducted novel analyses of the English Longitudinal Study of Ageing (ELSA) data set, which provides nationally representative data of the English population of thousands of adults aged 50 years and older, as well as the Diabetes Study which looks at stress biology in adults with type II diabetes. I have used this data to address my first two aims: 1. How do depression symptoms relate to a variety of physical illnesses, and are there similarities and differences in the specific types of depression symptoms experienced? 2. Why do depression symptoms relate to different physical illnesses, and are there biological explanations for the association? The first question has been addressed in a series of original papers, examining the association between depression and risk of future illness in people who were healthy to begin with. In 3 papers I have specifically explored the overlap between depression and a key somatic symptom linked to depression - poor sleep symptoms. These papers showed that people with high levels of depressive symptoms commonly experience disruption to their sleep, and when these two factors are considered together, both high depressive symptoms and sleep problems are important for the onset of future diseases such as heart disease, cancer and arthritis. In addition to this work, I have also examined the association between high levels of depressive symptoms and the risk of developing multiple diseases 10 years later, showing there is indeed a positive association. This paper also explored the contribution of different types of depressive symptoms and chronic illness burden, finding that somatic symptoms (such as tiredness, changes to appetite) are particularly detrimental to disease burden, but not cognitive/affective symptoms (such as sadness, anhedonia). Interestingly, in secondary analyses this paper showed that depression was associated with cardiac diseases but not diabetes. This prompted a second series of papers to better understand the link between depression and physical illness, and underlying biological processes, in particular in diabetes patients. With regards to the second research question, I have co-authored several papers using data from the Diabetes Study, exploring the psychobiology of type II diabetes. Specifically, together with my PhD student, we have investigated the role of sex, happiness and loneliness in the biological stress response in people with type II diabetes, showing that all these factors play an important role in understanding the dysregulation of biological systems in people with type II diabetes. This is important to my work since stress and depression show dysregulation to similar biological systems including the neuroendocrine system and inflammation. I have published 2 additional papers using data from ELSA to show that wellbeing (i.e. positive mood), rather than depressive symptoms, is associated with diabetes incidence and glycated hemoglobin trajectories over time. A further paper focussed on looking at how the interaction between depressive symptoms and C-reactive protein (CRP) is related to the incidence of multiple different physical illness, finding that a combination of elevated depressive symptoms and elevated CRP predicted incident heart disease, stroke, diabetes and pulmonary disease, but not cancer. With regards to my final research question, I have a paper published in BMJ Open, which uses thematic analysis of 42 face-to-face interviews undertaken as part of the qualitative work package of this grant. This addresses my third aim: 3. How does the experience of depression differ between people experiencing different physical illnesses? This paper explores the similarities and differences in the experience of depressive symptoms in patients with and without a physical illness comorbidity. Importantly it led to four key recommendations for future care practices of these patients: (1) Not all participants with depression and LTC view their mental and physical health as interconnected; there should be allowances in care plans for separate treatment pathways; (2) Key features of depression that affect LTC management are social withdrawal and lack of motivation to self-manage or access healthcare; (3) Key features of LTCs that worsen depression are pain, the unpredictability of future health and progressive disability; (4) Positive self-management of LTC could improve self-efficacy and therefore mood, and should be encouraged. Published papers are documented in the 'Publications' section. |
| Exploitation Route | I envisage the results of my work will help to advance knowledge of the field and highlight the importance of treating depression along with other somatic complaints such as insomnia. In addition, my work also highlights the risk depression holds not just for the risk of developing one chronic illness, but multiple chronic illnesses in the future. My work is demonstrating the association between mood and diabetes may be driven by positive, rather than negative, aspects of affect. |
| Sectors | Healthcare |
| Description | This project has led to a number of societal impacts. However, it should be noted that the routes to dissemination have been affected by the emergence of the COVID-19 pandemic. In 2019, I received an award from the ESRC Festival of Social Science to host a interactive event called 'The Mind-Body Connection: Bingo!'. This event aimed to disseminate the findings of my fellowship in an easy to understand and engaging format to members of the public. Feedback from this event was positive and to reach a wider audience the event was live tweeted by The Mental Elf to reach over 90,000 followers via Twitter. It also led to the production of a podcast, which is hosted online here: https://soundcloud.com/national-elf-service/lydia-poole-and-ruth-hackett I have continued my collaboration with The Mental Elf and have since produced two blogs published in 2021 on the topic of depression and multimorbidity and the treatment of depression in cardiac patients. These are available to read here: https://www.nationalelfservice.net/author/lydia-poole/ These blogs are freely available and help contribute to the evidence base for mental health research using easy to understand language, suitable for both clinical and non-clinical audiences. In 2021 I received a small grant from UCL Engagement for a 'Listen and Learn' award which involved talking to community engagement professionals working with the South Asian Health Foundation (SAHF) to discuss increasing diversity in health research. This led to the co-production of an infographic with our '10 Top Tips'. This is hosted online here: https://www.sahf.org.uk/news-blog/2021/12/15/top-10-tips-engaging-south-asian-communities-with-health-research. |
| First Year Of Impact | 2019 |
| Sector | Healthcare |
| Impact Types | Societal |
| Description | ESRC Festival of Social Science 2019 |
| Amount | £1,000 (GBP) |
| Organisation | York ESRC Festival of Social Sciences |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 11/2019 |
| End | 11/2019 |
| Description | Young Investigators Colloquium |
| Amount | $785 (USD) |
| Organisation | American Psychosomatic Society |
| Sector | Charity/Non Profit |
| Country | United States |
| Start | 03/2016 |
| End | 03/2016 |
| Description | Depression and sleep research |
| Organisation | Roehampton University |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Together with Dr Marta Jackowska, I have co-authored 3 research publications investigating the symptom overlap between depression and sleep, and their impact for future physical illness. |
| Collaborator Contribution | Dr Marta Jackowska has taken first authorship on one of our joint research papers and second authorship on our two other research papers. |
| Impact | 3 papers using data from the English Longitudinal Study of Ageing (ELSA). This collaboration is not multi-disciplinary. |
| Start Year | 2016 |
| Description | Georgia Black |
| Organisation | University College London |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | I sought out collaboration with Georgia Black from the Department of Applied Health Research at UCL, to help design the qualitative research project. |
| Collaborator Contribution | Georgia has provided training for myself and my Research Assistant, Hannah Rowlands, in qualitative research methods. She has advised on the design of the study and the content of the interview schedule. We are currently collaborating on a review paper which involves a meta synthesis of the qualitative literature in depression and long-term conditions. |
| Impact | No outputs yet. |
| Start Year | 2018 |
| Description | Noclor |
| Organisation | NOCLOR Research Support Service |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | The qualitative research project has been adopted by the NIHR portfolio and as such I have sought the support from North Thames CRN (aka Noclor). |
| Collaborator Contribution | Noclor are helping to oversee the establishment of the Patient Identification Centres in primary care in order for recruitment of patients to commence. |
| Impact | None as yet. |
| Start Year | 2018 |
| Description | APS conference, Denver |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | Lydia attended the APS conference in Denver and presented her work linking cortisol responses to depression onset as a poster presentation to other conference delegates. Her poster was well-received and she entered into useful discussions with other researchers in the field. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Department Away Day |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Other audiences |
| Results and Impact | I presented my work with my ERASMUS exchange student on caregiving and caregiving distress and the effects on neuroendocrine activity at the Department of Behavioural Science and Health's biannual away day. |
| Year(s) Of Engagement Activity | 2018 |
| Description | ELSA talk |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | A talk to disseminate my research findings to date with other users of the English Longitudinal Study of Ageing (ELSA) cohort. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Fellowship Talk - QMUL |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | I gave an invited talk to at Queen Mary's University of London at the William Harvey Research Institute to 2nd year medical students, PhD students and post-doctoral researchers on the impact of psychological factors on mental and physical illness. In this talk I discussed the findings of my fellowship. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Fellowship talk - Liverpool John Moore's University |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Other audiences |
| Results and Impact | I have been invited to present the findings of my fellowship to the School of Psychology at Liverpool John Moore's University. In this talk, I will give an overview of my main research questions, methods and findings. |
| Year(s) Of Engagement Activity | 2022 |
| Description | HBRC/Psychobiology away day 2016 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Other audiences |
| Results and Impact | I presented at the HBRC/Psychobiology away day which took place in July 2016 at City Hall, London. The audience were colleagues within UCL. I presented my preliminary findings from my fellowship to date, including work using the ELSA dataset. I received encouraging feedback and useful suggestions for further analysis. The day was a good opportunity to network. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Special Interest Group in Depression and Long Term Conditions |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Other audiences |
| Results and Impact | I set up a Special Interest Group for academics working across UCL to foster collaborations, share research news and to present ongoing work in the field of Depression and Long-term conditions. The group held a series of seminars across 2019, inviting attendees from across the whole of UCL. Speakers included Prof David Batty, Dr Marta Buszewicz, and Prof Jon Roiser. |
| Year(s) Of Engagement Activity | 2019 |
| Description | The Mind-Body Connection: Bingo! |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | This event was hosted as part of the ESRC Festival of Social Science to disseminate research relating to the mind-body connection. The event was held at UCL and we had an audience of around 60 members of the public who were invited to take part through adverts on social media, local charity organisations and through PPI channels. The event itself included a talk about my research, an interactive game of Bingo with science based clues, and a Q&A session. I also engaged with the Mental Elf, who live tweeted the event and created a podcast of the event, in order to reach as large an audience as possible. |
| Year(s) Of Engagement Activity | 2019 |
| URL | https://twitter.com/Mental_Elf/status/1192092257031208962 |
| Description | The Mood and Health Study Poster at APS |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | I have been invited to the US to present my findings from my qualitative study, The Mood and Health Study, as the American Psychosomatic Society's annual conference. |
| Year(s) Of Engagement Activity | 2022 |
| Description | The Mood and Health Study talk - University of Surrey |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | I have been invited to give a talk in the lunchtime seminar series in the School of Psychology at the University of Surrey. In this talk I will present my research project: 'The Mood and Health Study' which comprised the qualitative component of my fellowship. |
| Year(s) Of Engagement Activity | 2022 |
| Description | UCL Populations & Lifelong Health Domain Symposium |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Study participants or study members |
| Results and Impact | I was selected via an open competition to give an oral presentation at this symposium entitled: Depressive symptoms predict incident chronic disease burden 10 years later: findings from the English Longitudinal Study of Ageing. |
| Year(s) Of Engagement Activity | 2018 |