Beyond Comorbidity: A Critical Perspective of Syndemic Depression and Diabetes in Cross‐cultural Contexts

Abstract

This article examines the comorbidity concept in medical anthropology. I argue that the dearth of articles on comorbidity in medical anthropology may result from the rise of syndemic theory. Syndemics recognize how social realities shape individual illness experiences as well as distribution of diseases across populations. I discuss synergistic interactions foundational to the syndemics construct through my research of depression and diabetes comorbidity in vulnerable populations from urban United States, India, and South Africa. I argue that social and economic factors that cluster with depression and diabetes alone and together exemplify the biosocial processes that are at the heart of syndemics. In doing so, I illustrate how social, cultural, and economic factors shape individual-level experiences of co-occurring diseases despite similar population-level trends. Finally, I discuss the relevance of syndemics for the fields of medicine and public health while cautioning what must not be lost in translation across disciplines.

Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations

“…106107 Anthropological research on syndemics reveals that diabetes interacts differently with one or two diseases of poverty across contexts. 8108 Although depression commonly occurs with diabetes, 109 social experiences vary based on social, cultural, and economic variance within and between populations. 848 For example, the legacy of the HIV/AIDS epidemic has had a profound impact on how people experience living with diabetes; research from Kenya and South Africa underscores the social consequences of caring for AIDS-orphaned grandchildren in the lives of middle-aged patients with diabetes.…”

“…8108 Although depression commonly occurs with diabetes, 109 social experiences vary based on social, cultural, and economic variance within and between populations. 848 For example, the legacy of the HIV/AIDS epidemic has had a profound impact on how people experience living with diabetes; research from Kenya and South Africa underscores the social consequences of caring for AIDS-orphaned grandchildren in the lives of middle-aged patients with diabetes. 11110 In these contexts, the social cost of the epidemic (as opposed to the biological effect) mediates their ability to dedicate social and financial resources to managing their chronic illness.…”

“…112 Depression also increases risk for morbidity and mortality in those with diabetes 113 and this is common among socially and economically disadvantaged populations. 49114 Therefore, there is substantial evidence that the interactions and outcomes of depression and diabetes are mediated by social contexts, 8115 and therefore are particularly devastating among low-income populations in HICs 116 and LMICs. 49 …”

“…By recognising how these mutually interacting factors promote adverse health outcomes, the syndemic framework moves beyond disease-specific or multimorbidity models to evaluate how social and economic conditions foster and exacerbate disease clusters. 78 Syndemics provide a tool for empirically evaluating how health statuses of multi-morbidity arise in a population, and what health interventions might be most effective for mitigating them.…”

“…7 This mental stress differs from women residing in the same communities with different ethnic and legal statuses, such as Puerto Ricans and African Americans. 8 A syndemic approach can then be applied to design integrated chronic care that can be locally relevant and most effective at mitigating the root causes of co-occurring conditions in public health and medicine. 13 …”