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1 VERDICT, an HSR&D Center of Excellence, South Texas Veterans Health Care System, San Antonio, Tex
2 University of Texas Health Science Center, San Antonio, Tex
3 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
4 Duke University Medical Center, Durham, NC
5 University of California Los Angeles, Los Angeles, Calif
6 Central Texas Veterans Health Care System, Austin, Tex
7 University of Washington School of Medicine, Seattle, Wash
8 Group Health Cooperative of Puget Sound, Seattle, Wash
9 Kaiser Permanente of Northern California, Oakland, Calif
CORRESPONDING AUTHOR: Polly Hitchcock Noël, PhD, VERDICT, an HSR&D Center of Excellence, South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11C6), San Antonio, TX 78229-4404, pollyh{at}verdict.uthscsa.edu.
PURPOSE Our objective was to examine the relative association of depression severity and chronicity, other comorbid psychiatric conditions, and coexisting medical illnesses with multiple domains of health status among primary care patients with clinical depression.
METHODS We collected cross-sectional data as part of a treatment effectiveness trial that was conducted in 8 diverse health care organizations. Patients aged 60 years and older (N = 1,801) who met diagnostic criteria for major depression or dysthymia participated in a baseline survey. A survey instrument included questions on sociodemographic characteristics, depression severity and chronicity, neuroticism, and the presence of 11 common chronic medical illnesses, as well as questions screening for panic disorder and posttraumatic stress disorder. Measures of 4 general health indicators (physical and mental component scales of the SF-12, Sheehan Disability Index, and global quality of life) were included. We conducted separate mixed-effect regression linear models predicting each of the 4 general health indicators.
RESULTS Depression severity was significantly associated with all 4 indicators of general health after controlling for sociodemographic differences, other psychological dysfunction, and the presence of 11 chronic medical conditions. Although study participants had an average of 3.8 chronic medical illnesses, depression severity made larger independent contributions to 3 of the 4 general health indicators (mental functional status, disability, and quality of life) than the medical comorbidities.
CONCLUSIONS Recognition and treatment of depression has the potential to improve functioning and quality of life in spite of the presence of other medical comorbidities.
Key Words: Depression • primary health care • quality of life • health status
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