The Functioning and Well-being of Depressed Patients: Results From the Medical Outcomes Study

Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Ángeles, California, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/1989; 262(7):914-9. DOI: 10.1001/jama.1989.03430070062031
Source: PubMed

ABSTRACT We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.

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    • "3 Social well-being: The quality of interactions with others (Ryff and Singer, 1998). This overview indicates that well-being could be approached through its objective components, but it is also emphasized by the subjective assessment of both quality of life and health (Wells et al., 1989). For Diener et al. (1998), SWB is a person's evaluation of his/her life that involves between three and six dimensions. "
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    ABSTRACT: Purpose – The purpose of this paper is to examines the positive and negative impact of service provider experiences on the process of identity adjustment and how they can lead to subjective well-being (SWB). Due to increased life expectancies, people are experiencing major life events during aging (e.g. death of a spouse, serious disease and major health problems), events that lead to identity redefinition. Design/methodology/approach – To gain more insight into this issue, a qualitative study was carried out that involved 37 in-depth interviews conducted with aging individuals who had experienced a major life event such as retirement and/or death of spouse. To apprehend the diversity of consumption situations, the authors investigated daily consumption, hedonic consumption and imposed services (e.g. health and funeral services) due to life events. Findings – The findings suggest that service providers influence consumer’s SWB as regards relationships, growth and purpose in life, mastery and independence and self-acceptance. Originality/value – The contribution indicates that services play a role in maintaining and/or creating SWB. By segmentation through social roles and facilitating access to services, providers must take into account the processes of normalcy and abandonment (déprise) among aging consumers in life transitions. They must also ensure that they support consumers with the lowest human capital (skills, level of education, income and social class).
    Journal of Services Marketing 07/2015; 29(4):245-254. DOI:10.1108/JSM-05-2014-0154 · 0.62 Impact Factor
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    • "It is considered to be the major cause of years lived with disability (YLD) and by 2020 is expected to be among the two main causes of disability adjusted years (DALYs) together with ischemic heart disease [4]. The functional limitations caused by depression are equal to or even sometimes greater than the ones engendered by many other chronic medical conditions [5]. In spite of the great advances achieved in treatment of depression during the last decades, between 20 and 30% of cases are not adequately solved by first agent treatments (also known as treatment-resistant depression in literature) [6]. "
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    ABSTRACT: Despite all the knowledge on depression, it is still unclear whether current literature covers all the psychosocial difficulties (PSDs) important for depressed patients. The aim of the present study was to identify the gaps in the recent literature concerning PSDs and their related variables. Psychosocial difficulties were defined according to the World Health Organization International Classification of Functioning, Disability and Health (ICF). A comparative approach between a systematic literature review, a focus group, and individual interviews with depressed patients was used. Literature reported the main psychosocial difficulties almost fully, but not in the same degree of importance as patients' reports. Furthermore, the covered areas were very general and related to symptomatology. Regarding the related variables, literature focused on clinical variables and treatments above all but did not report that many psychosocial difficulties influence other PSDs. This study identified many existing research gaps in recent literature mainly in the area of related variables of PSDs. Future steps in this direction are needed. Moreover, we suggest that clinicians select interventions covering not only symptoms, but also PSDs and their modifiable related variables. Furthermore, identification of interventions for particular psychosocial difficulties and personalisation of therapies according to individuals' PSDs are necessary.
    BioMed Research International 06/2014; 2014:319634. DOI:10.1155/2014/319634 · 3.17 Impact Factor
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    • "The overall value ranges from 0 to 100, with improvement as scores increase. The psychometric properties of the SF-36 are well-characterized in a wide variety of patient populations [50,51]. "
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    ABSTRACT: Background: Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at 'training the brain' is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up.The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. Methods/design: The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web-based questionnaires will be completed at baseline, after the first 3 treatment sessions, post-treatment, and at 6 and 12-months follow-up. Discussion: Findings may provide empirical evidence on: (1) the effectiveness of a modern neuroscience approach to CSP for reducing pain and improving functioning, (2) the effectiveness of a modern neuroscience approach for normalizing brain gray matter in CSP patients, and (3) factors associated with therapy success. Hence, this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities' recommendations. Trial registration: Identifier: NCT02098005.
    BMC Musculoskeletal Disorders 04/2014; 15. DOI:10.1186/1471-2474-15-149 · 1.72 Impact Factor
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