Examining Associations between Mental Health and Chronic Non-Communicable Diseases (C-NCDs) Among Older Adults in Wakiso in Uganda: A Population-Based Study

Background and Purpose: Prevalence of chronic non-communicable diseases (C-NCDs) and occurrence of multi-morbidity specifically, has been increasing and will continue to rise as life expectancy increases. The burden of mental health disorders has been rising globally. In sub-Saharan Africa (SSA), literature on these health issues, which are interrelated, is scarce. This study assesses the prevalence of C-NCDs, depressive and anxiety symptomology and examines the relationship between these issues among a sample of older adults in Uganda.

Methods: Between 2021- 2022, 604 consenting adults aged 35 years and older were surveyed on a broad range of health issues for the on-going AMBSO Population Health Surveillance (APHS) cohort study in Wakiso district. Descriptive analyses were performed to characterize the burden of C-NCDs (e.g. diabetes, hypertension), depression (PHQ-9), using a cutoff of <5 scores for minimal/no and 5 scores + for mild – severe symptomology) and anxiety (GAD-7), cutoff of 6+ scores for moderate-severe symptomology). Bivariate analysis and multivariable logistic regression models were built using stata software ver 16.0 to examine associations between having at least one C-NCD. Our exposure of interest was depressive and anxiety symptoms and our outcome of interest was presence of C-NCDs.

Results: Majority of participants were females (63.6%), median age was 46 (IQR: 39-54). Any C-NCDs prevalence was 18.7%, while 18.9% and 11.4%, had screening scores indicative of depressive and anxiety symptomology, respectively. 3.2% had PHQ-9 indicative of moderate to severe form of depression. In models adjusted for socio demographic characteristics, there was a 12% increased odds of suffering from C-NCDs for every unit increase in the experience of depressive symptoms (AOR=1.12, 95% CI: 1.10-1.20). For anxiety, there was a 13% increased odds of suffering from C-NCDs for every unit increase in experience of anxiety symptoms (AOR=1.13, 95% CI: 1.06-1.22).

Conclusion: C-NCDs were prevalent in older adults, particularly among those experiencing mental health symptoms. Screening for C-NCDs and MH symptoms should be integrated into routine health care for older adults in the country. Early screening and integration of these health issues through primary health care can significantly reduce mental health symptoms burden and the incidence of multi-morbidity in Uganda.