A landmark international study has revealed that living with combinations of chronic physical illnesses—such as heart disease, diabetes, lung conditions, or liver problems—more than doubles the risk of developing depression, underscoring the urgent need for Thailand’s healthcare system to integrate physical and mental health care. The research, published in Nature Communications Medicine and based on health data from over 142,000 adults, highlights a concerning link between certain multimorbidity profiles and future depression diagnoses, particularly when illnesses like heart disease and diabetes occur together (Neuroscience News).
For Thailand, where the burden of non-communicable diseases like diabetes and cardiovascular illnesses is rising year after year, these findings signal a call to action for both healthcare policymakers and individual practitioners. The study, conducted by experts at the University of Edinburgh using the extensive UK Biobank cohort, found that about one in twelve individuals with multiple chronic illnesses developed depression within 10 years, compared to just one in twenty-five with no long-term conditions. “Healthcare often treats physical and mental health as completely different things, but this study shows that we need to get better at anticipating and managing depression in people with physical illness,” stated a professor of general practice at the University of Edinburgh’s Advanced Care Research Centre. This sentiment aligns with ongoing debates in Thailand’s health system about better care models for complex, long-term diseases.
Why does this matter so much in Thailand? According to Thailand’s National Statistical Office, over 8 million Thais are currently living with diabetes, with hypertension and cardiovascular disease widely prevalent, particularly among the elderly (NSO 2022. As chronic diseases become more widespread, so do mental health challenges. Depression is one of the top causes of lost productivity and diminished quality of life nationwide, yet it remains significantly underdiagnosed—an issue compounded by social stigma and limited access to psychological services in many provinces.
The new findings underscore that multimorbidity—having two or more chronic health conditions—amplifies the risk, creating a compounding effect on sufferers’ mental wellbeing. The study’s analysis identified several high-risk combinations. Cardiometabolic illnesses, such as the co-occurrence of diabetes and heart disease, represented the most distinct risk cluster, but adults with joint or bone problems and those suffering from chronic lung, bowel, or liver diseases were also much more likely to be diagnosed with depression. Findings showed that women with arthritis or other musculoskeletal problems faced a particularly heightened risk, highlighting the need for gender-sensitive screening and support.
These insights are especially significant given Thailand’s ageing society, where older adults commonly live with a mix of non-communicable diseases (NCDs). A director at the Department of Mental Health, Ministry of Public Health, emphasises, “Thailand is already witnessing the challenges of multimorbidity and mental illness, especially among elders. Integrating depression screening and support into chronic illness management could transform care and improve lives.” Current Thai clinical guidelines, however, often focus on each disease in isolation, missing opportunities for holistic risk assessment.
From a historical perspective, mental illness and chronic disease have long been siloed both in Thai medicine and cultural attitudes. The traditional view in many communities is that physical and mental maladies are separate, sometimes resulting in reluctance to seek help for psychological distress linked to chronic health problems. Yet Buddhist philosophy, often evoked in Thai public health discourse, acknowledges the interconnectedness of body and mind (kāya-citta). Recognising this could provide cultural leverage for more integrated health education and intervention campaigns going forward.
The study’s methodology brings further authority to these conclusions. Researchers used advanced statistical clustering and survival analysis to examine depression outcomes among 142,000 adults aged 37-73 with at least one pre-existing chronic condition but no history of depression at baseline. Notably, they found that people with the most complex mixture of physical illnesses—without a single dominant diagnosis—faced the highest risk of developing depression. This suggests it is not merely the type but the complexity and number of conditions that matter.
While the biological burden—such as chronic inflammation, hormonal changes, or medication side effects—may contribute to these risks, social and systemic factors also likely play a major role. Patients juggling several illnesses may experience social isolation, loss of independence, or unemployment, each intensifying depressive symptoms. In Thailand, family networks traditionally provide support, but urbanisation, migration, and changing demographics are weakening this safety net, potentially heightening vulnerability to mental health crises.
Expert voices in the research community are urging policymakers to overhaul care models. “NIHR’s research in this area is helping to paint a full picture of what patients are dealing with, rather than just focusing on one health condition at a time,” said the Scientific Director of Innovation at the National Institute for Health and Care Research. Implementing truly integrated care—where doctors screen for depression in chronic illness clinics and where psychological support is embedded in NCD care pathways—remains rare, but pilot projects in Bangkok and Chiang Mai are showing early promise. For example, some hospitals have initiated routine mental health screenings in diabetes and hypertension clinics, and NGOs are piloting “psychoeducation” workshops for family caregivers.
The economic impact of underdiagnosed depression alongside chronic physical illness is enormous. A World Health Organization report estimates that depression and anxiety cost the global economy US$1 trillion each year in lost productivity. For Thailand, this translates to billions of baht annually, especially as the workforce ages and multimorbidity becomes more common. Untreated depression in chronic patients leads to poorer disease control, longer hospital stays, and higher rates of complications—from heart attacks to kidney failure.
Future trends suggest the problem could worsen unless addressed. Thailand’s “super-aged” society is projected to reach more than 20% aged over 65 by 2030 (UN ESCAP statistics), with an expected corresponding surge in multimorbidity and, now proven, depression. Telemedicine and e-health platforms, which expanded rapidly during the COVID-19 years, offer one possible solution, bringing mental health check-ups alongside chronic disease management to remote districts. However, digital equity remains a challenge, especially for older and low-income patients.
Given the clear evidence, what should Thai patients, families, and healthcare providers do? Experts urge those living with two or more chronic illnesses to be vigilant for signs of depression, such as persistent sadness, sleep disturbances, loss of interest in activities, or difficulty concentrating. Family members can play a vital role in encouraging open dialogue about emotional health. For healthcare professionals, the study recommends routinely screening for depression symptoms in all patients with multiple chronic illnesses, especially those with heart disease and diabetes, and among older women with joint or bone ailments.
Public health authorities have an essential role to play by integrating mental health services within primary care settings and chronic-disease clinics, including training village health volunteers (อสม.) to identify at-risk individuals. Community-focused health campaigns—aligned with well-known Buddhist teaching on harm reduction and self-compassion, which are already part of Thailand’s health education strategy—could help destigmatise depression and encourage earlier help-seeking across all age groups.
Thailand’s health system is at a crossroads. This new research demonstrates the scale of the challenge, but also provides a pathway to better care, stronger communities, and healthier futures. By bridging the gap between body and mind, the nation can address one of its fastest-growing public health crises with compassion, science, and cultural understanding.
For more information and practical depression screening tools (in Thai), see resources provided by the Department of Mental Health, Ministry of Public Health.