Association between Depression and Health Perception Asymmetry Type in Chronic Disease Multimorbidity : A Multinomial Logistic Regression Analysis Using 2024 KNHANES Data

This study used data from the 2024 Korea National Health and Nutrition Examination Survey to examine the association between depressive symptoms and health perception asymmetry types in 1,556 adults with chronic disease multimorbidity. Multinomial logistic regression analysis accounting for the complex sampling design showed that 41.7% of participants were classified as the good-health concordant type, 27.5% as the optimistic asymmetry type, 16.4% as the poor-health concordant type, and 14.4% as the pessimistic asymmetry type. PHQ-9 depression scores significantly increased the likelihood of belonging to the poor-health concordant type (OR=1.15, 95% CI=1.09–1.22) and the pessimistic asymmetry type (OR=1.17, 95% CI=1.10–1.25), but were not significantly associated with the optimistic asymmetry type. In addition, the absence of activity limitations was associated with a lower likelihood of belonging to the poor-health concordant and pessimistic asymmetry types, while increasing age was associated with an increased likelihood of belonging to the poor-health concordant and optimistic asymmetry types and a decreased likelihood of belonging to the pessimistic asymmetry type. Body mass index was significantly associated with the poor-health concordant and optimistic asymmetry types, and experience of unmet healthcare needs was significantly associated with the pessimistic asymmetry type. Depressive symptoms were more closely associated with perceiving one's own health negatively than with the direction of distortion in health perception. Therefore, management of patients with multimorbidity should combine treatment of physical diseases with screening and interventions for depressive symptoms and support to improve access to healthcare.