Article

Explaining heterogeneity in disability associated with current major depressive disorder: effects of illness characteristics and comorbid mental disorders.

Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Journal of Affective Disorders (Impact Factor: 3.71). 12/2010; 127(1-3):203-10. DOI: 10.1016/j.jad.2010.05.024
Source: PubMed

ABSTRACT Although major depressive disorder (MDD) is associated with disability, some persons do function well despite their illness. Aim of the present study was to examine the effect of illness characteristics and comorbid mental disorders on various aspects of disability among persons with a current MDD episode.
Data were derived from 607 participants with a current MDD based on the Composite International Diagnostic Interview (CIDI). Severity was assessed via the Inventory of Depressive Symptoms self-report (IDS-SR). For disability three outcome measures were used: World Health Organization Disability Assessment Schedule II (WHODAS) disability and its 7 dimensions, days out of role, and work absence. Using multiple regression analysis the effects of MDD characteristics and comorbid mental disorders were estimated.
The IDS-SR score was the best predictor of all disability outcomes. Of the comorbid mental disorders, agoraphobia was significantly associated with overall disability. Collectively, all illness characteristics accounted for 43% of variance in WHODAS disability, 13% in days out of role and 10% in work absence, suggesting substantial unexplained variance.
Only self-report measures of disability were used. There were no assessments of other diagnoses than depressive, anxiety and alcohol use disorders.
Although heterogeneity in disability of persons with current MDD is partially explained by illness characteristics of MDD (especially symptom severity) and comorbid mental disorders, most of the variance is not accounted for.

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    ABSTRACT: Objective: Depression among older adults is associated with both disability and somatic disease. We aimed to further understand this complicated relationship and to study the possible modifying effect of increasing age. Design: Cross sectional survey. Setting: Outpatient and inpatient clinics of regional facilities for mental health care and primary care. Participants: Elderly people, 60 years and older, 378 persons meeting DSM-IV criteria for a depressive disorder and 132 non-depressed comparisons. Measurements: Depression diagnoses were assessed with the CIDI version 21 Disability was assessed with the WHO Disability Assessment Schedule (WHODAS). Social-demographic information and somatic diseases were assessed by self-report measurements. Results: Disability, in general and on all its subscales, was strongly related to depression. Presence of somatic disease did not contribute independently to variance in depression. The relationship was stronger for people of 60-69 years old than for those older than 70 years. Important aspects of disability that contributed to depression were disability in participation, self-care and social activities. Limitations: Results are based on cross sectional data. No inferences about causal relationships can be drawn. Conclusion: Disability, especially disability regarding participation, self-care, or social activities is strongly related to late-life depression. Somatic diseases in itself are less of a risk for depression, except that somatic diseases are related to disability.
    Journal of Affective Disorders 06/2014; 167C:187-191. DOI:10.1016/j.jad.2014.05.057 · 3.71 Impact Factor
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    ABSTRACT: Objective Depression among older adults is associated with both disability and somatic disease. We aimed to further understand this complicated relationship and to study the possible modifying effect of increasing age. Design Cross sectional survey. Setting Outpatient and inpatient clinics of regional facilities for mental health care and primary care. Participants Elderly people, 60 years and older, 378 persons meeting DSM-IV criteria for a depressive disorder and 132 non-depressed comparisons. Measurements Depression diagnoses were assessed with the CIDI version 2.1. Disability was assessed with the WHO Disability Assessment Schedule (WHODAS). Social-demographic information and somatic diseases were assessed by self-report measurements. Results Disability, in general and on all its subscales, was strongly related to depression. Presence of somatic disease did not contribute independently to variance in depression. The relationship was stronger for people of 60–69 years old than for those older than 70 years. Important aspects of disability that contributed to depression were disability in participation, self-care and social activities. Limitations Results are based on cross sectional data. No inferences about causal relationships can be drawn. Conclusion Disability, especially disability regarding participation, self-care, or social activities is strongly related to late-life depression. Somatic diseases in itself are less of a risk for depression, except that somatic diseases are related to disability.

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