Hello, We’re Hammad and Madiha, two 4th year medical students at the University of Glasgow. Over the last 5 weeks we worked on updating the multimorbidity literature database for the 1st of January to the 30th of June 2025 period. As we worked on this search, we both identified individual topics among the included multimorbidity articles that we found interesting, we then wrote a report on the whole process and our personal topics as part of our Student Selected component on Academic Research in General Practice.

We categorised the relevant articles into 6 categories:

  1. Epidemiology of multimorbidity – Predictors and Patterns
  2. Epidemiology of multimorbidity – Outcomes
  3. Polypharmacy
  4. Management of multimorbidity
  5. Qualitative work
  6. Multimorbidity policy and editorials

Our search syntax provided us with 1953 references which we double screened, and we excluded 1299 references. We were left with 654 references, which are included in the linked reference list, by category.

Hammad – The topic which interested me the most in this search was the impact of suicidal ideation and attempted suicide within individuals who have multimorbidity. As I reviewed various articles in this search it became more apparent to me that there is growing evidence that suggests that suicidal ideation is an overlooked outcome of individuals with multimorbidity. Articles that were included in this study outlined that suicide risk should not be viewed only with the background of mental illness but also a result of multiple chronic conditions.

Van Orden and his colleagues’ 5D model of suicide risk clearly highlighted the effect of multimorbidity on suicide (1). The article identified 5 key contributors to an individual’s risk of suicide attempts which were depression, disability, disconnection, access to means and disease burden (multimorbidity). It showed that even though those five contribute to suicide together, the biggest effect was from the trio of multimorbidity, disconnection and disability. This highlights that the effect of multimorbidity on suicide risk is clearly understudied.

Further evidence from a Canadian study of 6,915 people reported a direct link between morbidity and suicidal ideation/behaviour (2). This study showed that youth with even a single disease had an increased risk of suicide, however, those with multiple chronic conditions had an even higher risk of suicidal behaviour. The overall study highlights that suicidal behaviour isn’t limited to older populations with multimorbidity but can also start much earlier in life and potentially exposes a gap in the primary care sector where there is a lack of mental health services for the youth.

Both of these studies show that multimorbidity can be a factor in an individual's suicide risk. The association between these variables is critically understudied and deserves more recognition along with a greater need to develop programs and management regimes to improve mental health for people with multimorbidity.

Madiha - The topic I chose to focus on was the relationship between multimorbidity and functional outcomes. While reviewing the multimorbidity literature from our structured search, functional decline was consistently presented in the context of multimorbidity, highlighting how it is one of the key consequences of living with multiple chronic conditions. Outcomes such as difficulty in performing activities of daily living (ADLS) or loss of independence were particularly useful in capturing the real-life impact of multimorbidity.

I identified 5 papers from the search that directly examined the association between multimorbidity and functional outcomes. A large cross-national study by Ren et al across 31 countries found that childhood multimorbidity was associated with significantly higher rates of ADL and mobility limitations in later adulthood (3). This suggests that the functional impact of multimorbidity is observed across diverse populations and may have lasting consequences over time.

Further evidence from a meta-analysis by Lu et al. (2024) showed that increasing numbers of chronic conditions was associated with progressively higher levels of disability, measured using functional outcomes such as ADLS (4). This shows how functional disability becomes more prominent as multimorbidity increases reinforcing the relevance of functional outcomes in understanding the burden of multimorbidity.

Overall functional outcomes offer a meaningful way to understand the everyday impact of multimorbidity beyond just diagnoses. This highlights the importance of taking account of functional ability when assessing and managing multimorbidity for patients.

References

  1. Van KA, Buttaccio A, Conwell Y. The 5D indicators of suicide risk in older adults who are lonely. Annals of the New York Academy of Sciences. 2025 May 10;
  2. Fearon D, Luther A, Browne D, Colman I, Dubin JA, Duncan L, et al. Morbidity, Suicidal Ideation and Suicide Attempts Among Youth in Canada: A Nationally-Representative Study: Morbidité, idées suicidaires et tentatives de suicide chez les jeunes au Canada : Une étude représentative à l’échelle nationale. Canadian journal of psychiatry Revue canadienne de psychiatrie [Internet]. 2025 Dec;70(12):906–13. Available from: https://pubmed.ncbi.nlm.nih.gov/40400333/
  3. Ren Z, Sun Y, Nie L, Zhang X, Wang L, Li L, et al. Childhood multimorbidity and depressive symptoms and functional limitations among mid-to-old adults from 31 countries. Journal of Affective Disorders. 2025 Nov;388:119598.
  4. Lu J, Li Y, Cao L, Zhao H. Effect of Multimorbidity on Old‐Age Disability Among Adults Over 50 Years Old: Evidence From a Meta‐ Public Health Nursing. 2024 Oct 9;42(1):524–34.

 

First published: 19 December 2025

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