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Research ArticleOriginal Research

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 and Enid Hunkeler
The Annals of Family Medicine November 2004, 2 (6) 555-562; DOI: https://doi.org/10.1370/afm.143
Polly Hitchcock Noël
PhD
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John W. Williams Jr
MD, MHS
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Jürgen Unützer
MD, MPH
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Jason Worchel
MD
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Shuko Lee
MS
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John Cornell
PhD
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Wayne Katon
MD
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Linda H. Harpole
MD, MPH
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Enid Hunkeler
MA
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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 CharacteristicsMeanSE%
    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 y23.2
        65–69 y22.5
        70v74 y19.5
        5–79 y20.1
        ≥80 y14.7
    Sex, female64.9
    Race or ethnicity
        White77.0
        African American12.3
        Hispanic7.6
        Other3.1
    Education
        Less than high school graduate19.2
        High school graduate or general equivalency diploma22.7
        Some college35.3
        College graduate or graduate degree22.8
    Marital status
        Married or living with partner46.3
        Divorced, separated, or never married28.9
        Widowed24.8
    Psychiatric illnesses
    Depression severity (0–4), ↑ scores indicate ↑ depression1.680.014
    Chronic depression83.0
    Positive screening test for posttraumatic stress disorder10.6
    Positive screening test for panic disorder21.7
    Anxiety-neuroticism, ↑ scores indicate ↑ neuroticism19.620.126
    Positive screening test for mild cognitive impairment35.4
    Medical Illnesses
    Chronic lung disease23.3
    Hypertension57.9
    Diabetes23.2
    Arthritis55.6
    Sensory deficit55.2
    Cancer (excluding skin cancer)10.9
    Neurological disease8.4
    Heart disease27.6
    Chronic pain56.8
    Gastrointestinal disease20.9
    Urinary/prostate disease38.7
    Sum of all chronic diseases (0–11)3.790.046
    General health indicators
    PCS-12 (0–100), ↑ scores indicate better functioning40.260.150
    MCS-12 (0–100), ↑ scores indicate better functioning36.680.235
    QOL (0–10), ↑ scores indicate better QOL5.350.047
    SDI (0–10), ↑ scores indicate greater disability4.630.061
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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-120.26 (<.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 FunctioningMCS-12 ↑Scores Indicate Better Mental Health FunctioningSDI ↑Scores Indicate More DisabilityQOL ↑Scores Indicate Better Quality of Life
    CharacteristicsCoeff95% CLCoeff95% CLCoeff95% CLCoeff95% 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.
    Intercept48.23*45.29, 51.1749.85*46.80, 52.891.17†0.15, 2.197.99*7.18, 8.80
    Demographics, P value<.001<.001<.001<.001
        Age‡0.281.040.070.26
        Male0.86†0.10, 1.67−0.17−0.98, 0.630.04−0.23, 0.32−0.41*−0.62, −0.20
        Education‡3.04†0.380.302.29
        Ethnic group‡3.00†2.590.381.52
        Marital status‡0.461.090.643.54†
        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, −3.291.43*1.21, 1.66−1.24*−1.44, −1.05
        Chronic depression0.14−0.73, 1.00−0.40−1.32, 0.51−0.07−0.37, 0.23−0.01−0.24, 0.23
        Positive screening test for PTSD0.06−0.95, 1.07−0.04−1.02, 1.090.20−0.16, 0.56−0.01−0.29, 0.26
        Positive screening test for panic0.05−0.75, 0.84−0.23−1.06, 0.600.05−0.23, 0.33−0.03−0.25, 0.18
        Neuroticism, ↑ scores indicate ↑ neuroticism−0.07†−0.14, − 0.001−0.01−0.08, 0.060.003−0.02, 0.030.01−0.01, 0.03
        Positive screening test for mild cognitive Impairment−1.13§−1.82, −0.440.14−0.58, 0.870.44§0.20, 0.680.07−0.12, 0.25
    Medical illness, P value<.001||.447||<.001||.071||
        Chronic lung disease−1.63*−2.37, −0.890.11−0.66, 0.890.42§0.16, 0.69−0.05−0.26, 0.15
        Hypertension−0.99§−1.64, −0.34−0.28−0.96, 0.390.10−0.13, 0.32−0.02−0.20, 0.16
        Diabetes−1.56*−2.33, −0.78−0.27−1.09, 0.540.38§0.11, 0.66−0.04−0.25, 0.17
        Arthritis−2.09*−2.77, −1.410.73†0.02,1.450.24−0.003, 0.48−0.13−0.32, 0.06
        Sensory deficit−0.43−1.09, 0.240.04−0.65, 0.740.14−0.10, 0.37−0.11−0.29, 0.07
        Cancer excluding skin Cancer−0.92−1.91, 0.08−0.35−1.39, 0.690.13−0.23, 0.48−0.06−0.33, 0.22
        Neurological disease−1.80§−2.91, −0.690.25−0.93, 1.420.86*0.47, 1.25−0.21−0.52, 0.10
        Heart disease−0.99§−1.71, −0.27−0.61−1.36, 0.140.32†0.06, 0.57−0.80§−1.39, −0.21
        Chronic pain−3.08*−3.78, −2.39−0.01−0.72, 0.710.56*0.32, 0.81−0.02−0.20, 0.17
        Gastrointestinal disease−1.08§−1.86, −0.29−0.11−0.92, 0.710.12−0.16, 0.39−0.03−0.24, 0.18
        Urinary tract or prostate disease−0.48−1.15, 0.190.38−0.31, 1.080.00010.24, 0.24−0.14−0.32, 0.05
    Interactions, P value.021||<.041||
    Depression chronicity X ethnic group‡3.26†
    Depression severity X heart disease0.35†0.01, 0.68

Additional Files

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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.

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The Annals of Family Medicine: 2 (6)
The Annals of Family Medicine: 2 (6)
Vol. 2, Issue 6
1 Nov 2004
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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
The Annals of Family Medicine Nov 2004, 2 (6) 555-562; DOI: 10.1370/afm.143

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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
The Annals of Family Medicine Nov 2004, 2 (6) 555-562; DOI: 10.1370/afm.143
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Subjects

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    • Chronic illness
    • Mental health
  • Person groups:
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  • Methods:
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  • Other topics:
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