Depression and Comorbid Illness in Elderly Primary Care Patients: Impact on Multiple Domains of Health Status and Well-being

Polly Hitchcock Noël; John W. Williams; Jürgen Unützer; Jason Worchel; Shuko Lee; John Cornell; Wayne Katon; Linda H. Harpole; Enid Hunkeler

doi:10.1370/afm.143

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Figure 1.
IMPACT participant flow. SCID = The Structured Clinical Interview for DSM-IV Axis I Disorders. ^*Most (90%–95%) did not meet screening or research diagnostic criteria for depression.

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Table 1.

Sample Characteristics (N = 1,801)

Sample Characteristics	Mean	SE	%
PCS-12 = physical component score of the Short Form-12; MCS-12 = mental component score of the Short Form-12); QOL = quality of life; SDI = Sheehan Disability Index.
Sociodemographic characteristics
Age
≤64 y			23.2
65–69 y			22.5
70v74 y			19.5
5–79 y			20.1
≥80 y			14.7
Sex, female			64.9
Race or ethnicity
White			77.0
African American			12.3
Hispanic			7.6
Other			3.1
Education
Less than high school graduate			19.2
High school graduate or general equivalency diploma			22.7
Some college			35.3
College graduate or graduate degree			22.8
Marital status
Married or living with partner			46.3
Divorced, separated, or never married			28.9
Widowed			24.8
Psychiatric illnesses
Depression severity (0–4), ↑ scores indicate ↑ depression	1.68	0.014
Chronic depression			83.0
Positive screening test for posttraumatic stress disorder			10.6
Positive screening test for panic disorder			21.7
Anxiety-neuroticism, ↑ scores indicate ↑ neuroticism	19.62	0.126
Positive screening test for mild cognitive impairment			35.4
Medical Illnesses
Chronic lung disease			23.3
Hypertension			57.9
Diabetes			23.2
Arthritis			55.6
Sensory deficit			55.2
Cancer (excluding skin cancer)			10.9
Neurological disease			8.4
Heart disease			27.6
Chronic pain			56.8
Gastrointestinal disease			20.9
Urinary/prostate disease			38.7
Sum of all chronic diseases (0–11)	3.79	0.046
General health indicators
PCS-12 (0–100), ↑ scores indicate better functioning	40.26	0.150
MCS-12 (0–100), ↑ scores indicate better functioning	36.68	0.235
QOL (0–10), ↑ scores indicate better QOL	5.35	0.047
SDI (0–10), ↑ scores indicate greater disability	4.63	0.061

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Table 2.

Bivariate Correlations Between Outcomes (N = 1,801)

	MCS-12 (PValue)	QOL (PValue)	SDI (PValue)
PCS-12 = physicial component of the Short Form-12; MCS-12 = mental component of the Short Form-12; QOL = quality of life.
PCS-12	−0.18 (<.001)	0.17 (.397)	−0.41 (<.001)
MCS-12		0.26 (<.001)	−0.24 (<.001)
QOL			−0.30 (<.001)

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Table 3.

Final Models Predicting Physical Functioning (PCS-12), Mental Functioning (MCS-12), Disability (SDI), and Quality of Life (QOL) (N = 1,801)

	PCS-12 ↑Scores Indicate Better Physical Functioning		MCS-12 ↑Scores Indicate Better Mental Health Functioning		SDI ↑Scores Indicate More Disability		QOL ↑Scores Indicate Better Quality of Life
Characteristics	Coeff	95% CL	Coeff	95% CL	Coeff	95% CL	Coeff	95% CL
Coeff = coefficient; CL = confidence limits; PTSD = posttraumatic stress disorder.
* Indicates standardized regression coefficients with P ≤.001.
† Indicates standardized regression coefficients with P <.05 .
‡ Indicates joint test for categorical variables with more than 2 levels, collapsed across levels for presentation in table.
§ Indicates standardized regression coefficients with P <.01.
\|\| Indicates significance of difference of likelihood ratio χ².
Intercept	48.23^*	45.29, 51.17	49.85^*	46.80, 52.89	1.17^†	0.15, 2.19	7.99^*	7.18, 8.80
Demographics, P value	<.001		<.001		<.001		<.001
Age^‡	0.28		1.04		0.07		0.26
Male	0.86^†	0.10, 1.67	−0.17	−0.98, 0.63	0.04	−0.23, 0.32	−0.41^*	−0.62, −0.20
Education^‡	3.04^†		0.38		0.30		2.29
Ethnic group^‡	3.00^†		2.59		0.38		1.52
Marital status^‡	0.46		1.09		0.64		3.54^†
Organization^‡	3.79^§		8.02^*		3.65^§		2.71^§
Psychological, P value	<.016^\|\|		<.001^\|\|		<.001^\|\|		<.001^\|\|
Depression severity, ↑scores indicate ↑ severity	−0.26^*	−1.90, −0.63	−3.96^*	−4.62, −3.29	1.43^*	1.21, 1.66	−1.24^*	−1.44, −1.05
Chronic depression	0.14	−0.73, 1.00	−0.40	−1.32, 0.51	−0.07	−0.37, 0.23	−0.01	−0.24, 0.23
Positive screening test for PTSD	0.06	−0.95, 1.07	−0.04	−1.02, 1.09	0.20	−0.16, 0.56	−0.01	−0.29, 0.26
Positive screening test for panic	0.05	−0.75, 0.84	−0.23	−1.06, 0.60	0.05	−0.23, 0.33	−0.03	−0.25, 0.18
Neuroticism, ↑ scores indicate ↑ neuroticism	−0.07^†	−0.14, − 0.001	−0.01	−0.08, 0.06	0.003	−0.02, 0.03	0.01	−0.01, 0.03
Positive screening test for mild cognitive Impairment	−1.13^§	−1.82, −0.44	0.14	−0.58, 0.87	0.44^§	0.20, 0.68	0.07	−0.12, 0.25
Medical illness, P value	<.001^\|\|		.447^\|\|		<.001^\|\|		.071^\|\|
Chronic lung disease	−1.63^*	−2.37, −0.89	0.11	−0.66, 0.89	0.42^§	0.16, 0.69	−0.05	−0.26, 0.15
Hypertension	−0.99^§	−1.64, −0.34	−0.28	−0.96, 0.39	0.10	−0.13, 0.32	−0.02	−0.20, 0.16
Diabetes	−1.56^*	−2.33, −0.78	−0.27	−1.09, 0.54	0.38^§	0.11, 0.66	−0.04	−0.25, 0.17
Arthritis	−2.09^*	−2.77, −1.41	0.73^†	0.02,1.45	0.24	−0.003, 0.48	−0.13	−0.32, 0.06
Sensory deficit	−0.43	−1.09, 0.24	0.04	−0.65, 0.74	0.14	−0.10, 0.37	−0.11	−0.29, 0.07
Cancer excluding skin Cancer	−0.92	−1.91, 0.08	−0.35	−1.39, 0.69	0.13	−0.23, 0.48	−0.06	−0.33, 0.22
Neurological disease	−1.80^§	−2.91, −0.69	0.25	−0.93, 1.42	0.86^*	0.47, 1.25	−0.21	−0.52, 0.10
Heart disease	−0.99^§	−1.71, −0.27	−0.61	−1.36, 0.14	0.32^†	0.06, 0.57	−0.80^§	−1.39, −0.21
Chronic pain	−3.08^*	−3.78, −2.39	−0.01	−0.72, 0.71	0.56^*	0.32, 0.81	−0.02	−0.20, 0.17
Gastrointestinal disease	−1.08^§	−1.86, −0.29	−0.11	−0.92, 0.71	0.12	−0.16, 0.39	−0.03	−0.24, 0.18
Urinary tract or prostate disease	−0.48	−1.15, 0.19	0.38	−0.31, 1.08	0.0001	0.24, 0.24	−0.14	−0.32, 0.05
Interactions, P value			.021^\|\|				<.041^\|\|
Depression chronicity X ethnic group^‡			3.26^†
Depression severity X heart disease							0.35^†	0.01, 0.68

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The Article in Brief

Treatment of depression may lead to more dramatic improvements in the health of elderly patients than treatment for other chronic illnesses. Researchers found that patients' mental functioning, disability and quality of life are affected more by the severity of a patient's depression than by other chronic medical conditions like diabetes, lung disease, hypertension, cancer, chronic pain and heart disease. Patients with more severe depression experience lower quality of life, lower physical and mental functioning, and more disability. Late-life depression can be treated, and improved recognition and treatment of this condition could significantly improve patients' lives, in spite of other medical illnesses.