Depression and Anxiety in Patients With Multimorbidity in Primary Care

Multimorbidity is increasingly common in primary care and frequently coexists with depression and anxiety, creating a complex interaction between physical and mental health. The likelihood of psychological symptoms rises with increasing chronic disease burden, while socioeconomic deprivation, functional limitation, persistent pain, reduced social support, and treatment burden may further increase vulnerability. Depression and anxiety can alter the experience and management of chronic illness by affecting motivation, concentration, self-care, medication adherence, physical activity, and engagement with healthcare services. Their symptoms may also overlap with those of chronic physical conditions, particularly fatigue, sleep disturbance, appetite changes, and impaired concentration, which can complicate recognition during routine consultations. Patients with combined mental and physical multimorbidity often experience poorer quality of life, greater disability, more severe symptom burden, and higher healthcare utilization than those with physical conditions alone. Repeated consultations, polypharmacy, fragmented treatment plans, and competing clinical priorities can further increase the burden faced by both patients and clinicians. Primary care is well positioned to address these challenges because it provides continuity, long-term monitoring, and coordination across different conditions and specialties. Effective management requires attention to psychological symptoms alongside physical disease control, supported by regular assessment, medication review, shared decision-making, and appropriate psychological interventions. Collaborative care approaches can strengthen communication between primary care and mental health professionals and may improve depressive symptoms, treatment adherence, and selected chronic disease outcomes. Person-centred management is particularly important in multimorbidity because treatment priorities differ according to symptom severity, functional status, social circumstances, and individual preferences. Integrating mental health assessment into routine multimorbidity care may support earlier recognition of depression and anxiety while reducing fragmented disease-specific management and helping clinicians respond more effectively to the combined physical, psychological, and social needs of patients.