A Biobehavioral Framework to Address the Emerging Challenge of Multimorbidity

Abstract

Multi-morbidity, the co-occurrence of multiple physical or psychological illnesses, is prevalent particularly among older adults. The number of Americans with multiple chronic diseases is projected to increase from 57 million in 2000 to 81 million in 2020. However, behavioral medicine and health psychology, while focusing on the co-occurrence of psychological/psychiatric disorders with primary medical morbidities, have historically tended to ignore the co-occurrence of primary medical comorbidities, such as diabetes and cancer, and their biopsychosocial implications. This approach may hinder our ecologically valid understanding of the etiology, prevention, and treatment of individual patients with multi-morbidity. In this selective review, we propose a heuristic biobehavioral framework for the etiology of multi-morbidity. More acknowledgment and systematic research on multiple, co-existing disorders in behavioral medicine is consistent with the biopsychosocial model’s emphasis on treating the “whole person,” which means not considering any single illness, its symptoms, risk factors, or mechanisms, in isolation. As systems analytics, big data, machine learning, and mixed model trajectory analyses, among others, come on-line and become more widely available, we may be able to tackle multi-morbidity more holistically, efficiently and satisfactorily.

Future Directions in the Study of Early-Life Stress and Physical and Emotional Health: Implications of the Neuroimmune Network Hypothesis

“…Another implication of the neuroimmune network hypothesis is that identifying common etiological pathways for chronic diseases (e.g., low-grade inflammation) may help explain multimorbidity, which has been defined as “the co-occurrence of multiple physical or psychological illnesses” (Suls, Green, & Davidson, 2016). Epidemiological studies reveal that multimorbidity is increasingly becoming the norm rather than the exception, especially given the growing proportion of the elderly population in the U.S.(Vogeli et al, 2007; Ward, Schiller, & Goodman, 2014).…”

Current Psychosomatic Practice

“…There have been major transformations in health care needs [66,203,204]. The traditional medical specialties, based mostly on organ systems (e.g.…”

Informal Care Networks in the Context of Multimorbidity: Size, Composition, and Associations With Recipient Psychological Well-Being

“…Upwards of 80 million individuals in the US are expected to have multiple health conditions by 2020, and approximately two-thirds of health care dollars in the US are spent on these patients (Suls et al 2016). Accordingly, multimorbidity is shaping the delivery of health care and services now more than ever, presenting clinicians with a variety of challenges in providing optimal patient care geared toward combinations of patient health conditions (Tinetti and Studenski 2011).…”

“…Accordingly, multimorbidity is shaping the delivery of health care and services now more than ever, presenting clinicians with a variety of challenges in providing optimal patient care geared toward combinations of patient health conditions (Tinetti and Studenski 2011). Meanwhile, epidemiologists increasingly are moving toward examining multimorbidity rather than singular conditions, in order to more accurately delineate and understand the complex sources of health vulnerability and risk in the population (Suls et al 2016). …”