The Association Between Chronic Disease and Psychological Distress: An Australian Twin Study

Abstract

There is a commonly observed association between chronic disease and psychological distress, but many potential factors could confound this association. This study investigated the association using a powerful twin study design that can control for unmeasured confounders that are shared between twins, including genetic and environmental factors. We used twin-paired cross-sectional data from the Adult Health and Lifestyle Questionnaire collected by Twins Research Australia from 2014 to 2017. Linear regression models fitted using maximum likelihood estimations (MLE) were used to test the association between self-reported chronic disease status and psychological distress, measured by the Kessler Psychological Distress Scale (K6). When comparing between twin pairs, having any chronic disease was associated with a 1.29 increase in K6 (95% CI: 0.91, 1.66; p < .001). When comparing twins within a pair, having any chronic disease was associated with a 0.36 increase in K6 (95% CI: 0.002, 0.71; p = .049). This within-pair estimate is of most interest as comparing twins within a pair naturally controls for shared factors such as genes, age and shared lived experiences. Whereas the between-pair estimate does not. The weaker effect found within pairs tells us that genetic and environmental factors shared between twins confounds the relationship between chronic disease and psychological distress. This suggests that associations found in unrelated samples may show exaggerated estimates.

Psychological distress in adolescents: prevalence and its relation to high-risk behaviors among secondary school students in Mbarara Municipality, Uganda

“…Students with the history of chronic health conditions were more likely to experience psychological distress compared to those who did not. This is in line with a research conducted among Ugandan adolescents living with HIV [ 53 ] and supported by other studies that examined the relationship between psychological distress and chronic health conditions [ 10 , 54 ]. This could (among other factors) be attributed to adverse social circumstances and financial strain, reduced ability to cope with routine daily activities, and aggravated physical consequences such as pain and discomfort [ 55 ].…”

“…Furthermore, this may be due to the fact that adolescents are curious and are more likely to engage in risky behaviors such as alcohol consumption and smoking. Also, coupled with easy accessibility and availability of these substances as well as weak regulatory policies and enforcements in Uganda, school-going adolescents are exposed to substance use in early age and may be psychologically distressed due to the negative consequences of substance use [10,11,[18][19][20][21]. Previous studies conducted in Tanzania [12], Ethiopia [20], Zambia [11], India [8], Norway [21] and Finland [49] have all shown similar results although a study in Canada reported that alcohol and cannabis use were not associated with psychological distress among adolescents [9].…”

“…Mental health conditions (including psychological distress) are a public health challenge that affects daily activities of adolescents including their school and work performance, relationships with family and friends, and involvement in the community [ 2 , 5 ]. Psychological distress has been associated with several negative consequences such as suicidal ideation and attempt [ 6 , 7 ], poor academic performance [ 8 ] and poor physical health [ 9 , 10 ] among adolescents.…”

Psychological distress among Brazilian workers during the initial stage of the COVID-19 pandemic: a descriptive study

“…It is important to note that, numerous studies have highlighted moderate associations between chronic diseases and psychological distress, irrespective of COVID-19. Nevertheless, findings from a twin-paired cross-sectional study indicate that the strength of the association between chronic diseases and psychological distress may be lower than previously presumed ( 75 ).…”

Association between oral health behavior and chronic diseases among middle-aged and older adults in Beijing, China

“…The outcome of interest was common chronic diseases in China, with chronic disease defined as a disease that is long-lasting with persistent effects [ 29 , 30 ]. Diseases were selected and grouped according to six major groups of commonly reported diseases in China [ 29 ].…”