{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:52:05Z","timestamp":1792086725838,"version":"4.4.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR202632"],"award-info":[{"award-number":["NIHR202632"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Multimorbidity, the co-occurrence of two or more chronic conditions, is a pressing global health challenge. However, research capturing the dynamic, longitudinal nature of health trajectories, particularly the intersection of physical and mental domains, remains scarce compared to traditional cross-sectional \u201csnapshots.\u201d Leveraging up to 21 years of electronic health records data from 858,789 Scottish patients in the University of Dundee Health Informatics Centre, we used multistate modelling to explore how individuals transition from a disease-free baseline into multimorbidity, evaluating how age, sex, and socioeconomic status shape these pathways. Overall transition estimates were driven by the younger demographic of our baseline disease-free cohort. The findings highlight the critical role of severe, hospital-contacting mental health conditions in driving early-onset multimorbidity, particularly in young men and socioeconomically disadvantaged groups. These findings underscore the urgent need to prioritise integrated physical-mental care and address upstream structural determinants of health. This temporal approach identifies high-risk populations for targeted early interventions and informs policy initiatives aimed at reducing health disparities.<\/jats:p>","DOI":"10.1371\/journal.pone.0359871","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:35:49Z","timestamp":1792085749000},"page":"e0359871","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal physical-mental multimorbidity trajectories by sociodemographic factors: a cohort study using electronic health records in Scotland (2000\u20132021)"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7092-5221","authenticated-orcid":true,"given":"Thu","family":"Nguyen","sequence":"first","affiliation":[{"name":"University of St Andrews","place":["St Andrews, United Kingdom"],"department":["School of Computer Science"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Keenan","sequence":"additional","affiliation":[{"name":"University of St Andrews","place":["St Andrews, United Kingdom"],"department":["School of Geography and Sustainable Development"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9466-833X","authenticated-orcid":true,"given":"Colin","family":"McCowan","sequence":"additional","affiliation":[{"name":"School of Medicine, University of St Andrews","place":["St Andrews, United Kingdom"],"department":["Division of Population and Behavioural Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Papathomas","sequence":"additional","affiliation":[{"name":"University of St Andrews","place":["St Andrews, United Kingdom"],"department":["School of Mathematics and Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-8535","authenticated-orcid":true,"given":"Areti","family":"Manataki","sequence":"additional","affiliation":[{"name":"University of St Andrews","place":["St Andrews, United Kingdom"],"department":["School of Computer Science"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"pone.0359871.ref001","unstructured":"WHO. Multimorbidity. 2016."},{"issue":"12","key":"pone.0359871.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(19)30222-1","article-title":"Multimorbidity-a defining challenge for health systems","volume":"4","author":"J Pearson-Stuttard","year":"2019","journal-title":"Lancet Public Health"},{"key":"pone.0359871.ref003","volume-title":"Understanding the health care needs of people with multiple health conditions","author":"M Stafford","year":"2018"},{"key":"pone.0359871.ref004","unstructured":"GOV.UK. Major conditions strategy: case for change and our strategic framework. 2023. Available from: https:\/\/www.gov.uk\/government\/publications\/major-conditions-strategy-case-for-change-and-our-strategic-framework\/major-conditions-strategy-case-for-change-and-our-strategic-framework\u20132"},{"key":"pone.0359871.ref005","doi-asserted-by":"crossref","DOI":"10.1177\/2235042X19870934","article-title":"Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies","volume":"9","author":"H Nguyen","year":"2019","journal-title":"J Comorb"},{"issue":"1","key":"pone.0359871.ref006","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"ST Skou","year":"2022","journal-title":"Nat Rev Dis Prim"},{"issue":"7","key":"pone.0359871.ref007","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/S0895-4356(00)00368-1","article-title":"Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly)","volume":"54","author":"A Menotti","year":"2001","journal-title":"J Clin Epidemiol"},{"key":"pone.0359871.ref008","volume-title":"Multimorbidity: a priority for global health research","author":"Academy of Medical Sciences","year":"2018"},{"issue":"5","key":"pone.0359871.ref009","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1370\/afm.528","article-title":"Psychological distress and multimorbidity in primary care","volume":"4","author":"M Fortin","year":"2006","journal-title":"Ann Fam Med"},{"key":"pone.0359871.ref010","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/1477-7525-2-51","article-title":"Multimorbidity and quality of life in primary care: a systematic review","volume":"2","author":"M Fortin","year":"2004","journal-title":"Health Qual Life Outcomes"},{"issue":"2","key":"pone.0359871.ref011","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1161\/HYPERTENSIONAHA.120.15324","article-title":"Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension","volume":"76","author":"G Iaccarino","year":"2020","journal-title":"Hypertension"},{"issue":"1","key":"pone.0359871.ref012","article-title":"Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis","volume":"8","author":"A Emami","year":"2020","journal-title":"Arch Acad Emerg Med"},{"issue":"4","key":"pone.0359871.ref013","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1177\/1077558711399580","article-title":"Review: health care utilization and costs of elderly persons with multiple chronic conditions","volume":"68","author":"T Lehnert","year":"2011","journal-title":"Med Care Res Rev"},{"issue":"9","key":"pone.0359871.ref014","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1377\/hlthaff.2015.0791","article-title":"Integrating Mental Health In Care For Noncommunicable Diseases: An Imperative For Person-Centered Care","volume":"34","author":"V Patel","year":"2015","journal-title":"Health Aff (Millwood)"},{"issue":"9590","key":"pone.0359871.ref015","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/S0140-6736(07)61238-0","article-title":"No health without mental health","volume":"370","author":"M Prince","year":"2007","journal-title":"Lancet"},{"issue":"4","key":"pone.0359871.ref016","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1007\/s11606-015-3524-y","article-title":"Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk","volume":"31","author":"JJ Gallo","year":"2016","journal-title":"J Gen Intern Med"},{"issue":"9590","key":"pone.0359871.ref017","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S0140-6736(07)61415-9","article-title":"Depression, chronic diseases, and decrements in health: results from the World Health Surveys","volume":"370","author":"S Moussavi","year":"2007","journal-title":"Lancet"},{"issue":"4","key":"pone.0359871.ref018","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s11136-014-0820-7","article-title":"Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey","volume":"24","author":"RE Mujica-Mota","year":"2015","journal-title":"Qual Life Res"},{"issue":"8","key":"pone.0359871.ref019","article-title":"Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies","volume":"6","author":"IS-S Ho","year":"2021","journal-title":"Lancet Public Health"},{"issue":"11","key":"pone.0359871.ref020","doi-asserted-by":"crossref","first-page":"100790","DOI":"10.1016\/j.lanhl.2025.100790","article-title":"Understanding changes in complex care needs over time: key research insights into multimorbidity trajectories","volume":"6","author":"A Calder\u00f3n-Larra\u00f1aga","year":"2025","journal-title":"Lancet Healthy Longev"},{"key":"pone.0359871.ref021","unstructured":"Public Health Scotland. Data management in secondary care: hospital activity. 2025. Available from: https:\/\/publichealthscotland.scot\/resources-and-tools\/health-intelligence-and-data-management\/data-management-in-secondary-care-hospital-activity\/scottish-morbidity-records-smr\/definitions-and-change-control\/"},{"issue":"1","key":"pone.0359871.ref022","article-title":"Measuring multimorbidity in research: Delphi consensus study","volume":"1","author":"ISS Ho","year":"2022","journal-title":"BMJ Med"},{"key":"pone.0359871.ref023","unstructured":"Scottish Government. Scottish Index of Multiple Deprivation 2020. 2020. Available from: https:\/\/www.gov.scot\/collections\/scottish-index-of-multiple-deprivation-2020\/"},{"key":"pone.0359871.ref024","article-title":"Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005\u20132019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals","volume":"32","author":"J Lyons","year":"2023","journal-title":"Lancet Reg Health - Eur"},{"key":"pone.0359871.ref025","first-page":"1","volume-title":"Multi-state modelling with R: the msm package","author":"C Jackson","year":"2007"},{"issue":"582","key":"pone.0359871.ref026","doi-asserted-by":"crossref","DOI":"10.3399\/bjgp11X548929","article-title":"Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study","volume":"61","author":"C Salisbury","year":"2011","journal-title":"Br J Gen Pract"},{"issue":"9836","key":"pone.0359871.ref027","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study","volume":"380","author":"K Barnett","year":"2012","journal-title":"Lancet"},{"issue":"624","key":"pone.0359871.ref028","doi-asserted-by":"crossref","DOI":"10.3399\/bjgp14X680545","article-title":"The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study","volume":"64","author":"G McLean","year":"2014","journal-title":"Br J Gen Pract"},{"issue":"6","key":"pone.0359871.ref029","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S2215-0366(24)00091-9","article-title":"Prevalence of multimorbidity in people with and without severe mental illness: a systematic review and meta-analysis","volume":"11","author":"S Halstead","year":"2024","journal-title":"Lancet Psychiatry"},{"issue":"8","key":"pone.0359871.ref030","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/S2215-0366(19)30132-4","article-title":"The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness","volume":"6","author":"J Firth","year":"2019","journal-title":"Lancet Psychiatry"},{"issue":"12","key":"pone.0359871.ref031","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1017\/S0033291717000551","article-title":"Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries","volume":"47","author":"B Stubbs","year":"2017","journal-title":"Psychol Med"},{"issue":"2","key":"pone.0359871.ref032","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/BF03324754","article-title":"Men: good health and high mortality. Sex differences in health and aging","volume":"20","author":"A Oksuzyan","year":"2008","journal-title":"Aging Clin Exp Res"},{"key":"pone.0359871.ref033","first-page":"277","article-title":"Gender and Mental Health","volume-title":"Handbooks of Sociology and Social Research","author":"S Rosenfield","year":"2012"},{"issue":"7","key":"pone.0359871.ref034","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1001\/archgenpsychiatry.2009.36","article-title":"Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys","volume":"66","author":"S Seedat","year":"2009","journal-title":"Arch Gen Psychiatry"},{"key":"pone.0359871.ref035","doi-asserted-by":"crossref","DOI":"10.1017\/SJP.2024.29","article-title":"Gender matters: a critical piece in mental health","volume":"27","author":"RM Ba\u00f1os","year":"2024","journal-title":"Spanish J Psychol"},{"issue":"3","key":"pone.0359871.ref036","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/1359105302007003215","article-title":"Issues for a Psychology of Men\u2019s Health","volume":"7","author":"C Lee","year":"2002","journal-title":"J Health Psychol"},{"issue":"3","key":"pone.0359871.ref037","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.socscimed.2004.12.008","article-title":"\u201cIt\u2019s caveman stuff, but that is to a certain extent how guys still operate\u201d: men\u2019s accounts of masculinity and help seeking","volume":"61","author":"R O\u2019Brien","year":"2005","journal-title":"Soc Sci Med"},{"issue":"3","key":"pone.0359871.ref038","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1136\/jech-2020-214691","article-title":"Household and area-level social determinants of multimorbidity: a systematic review","volume":"75","author":"E Ingram","year":"2021","journal-title":"J Epidemiol Commun Health"},{"issue":"1","key":"pone.0359871.ref039","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1186\/s12916-023-02970-z","article-title":"Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service","volume":"21","author":"C MacRae","year":"2023","journal-title":"BMC Med"},{"issue":"5","key":"pone.0359871.ref040","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/0022-3999(90)90027-2","article-title":"Sex differences in general practice attendance and help seeking for minor illness","volume":"34","author":"RH Corney","year":"1990","journal-title":"J Psychosom Res"},{"issue":"511","key":"pone.0359871.ref041","first-page":"108","article-title":"Primary care consultation predictors in men and women: a cohort study","volume":"55","author":"N Kapur","year":"2005","journal-title":"Br J Gen Pract"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359871","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:35:59Z","timestamp":1792085759000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359871"}},"subtitle":[],"editor":[{"given":"Bruno Pereira","family":"Nunes","sequence":"first","affiliation":[{"name":"University of Illinois Urbana-Champaign","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0359871","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]}}}