Joint Effect of Depression and Chronic Conditions on Disability: Results From a Population-Based Study
To estimate and compare the prevalence of functional disability in individuals with both chronic medical conditions and comorbid major depression and individuals with either chronic medical conditions or major depression alone and to determine the joint effect of depression and chronic conditions on functional disability. Evidence exists that major depression interacts with physical illness to amplify the functional disability associated with many medical conditions. We used data from the Canadian Community and Health Survey Cycle 2.1 (n = 46,262), a nationally representative survey conducted in 2003 by Statistics Canada. Depression, chronic conditions, and functional disability were assessed by personal/telephone interview. Prevalence of functional disability was higher in subjects with chronic conditions and comorbid major depression (46.3%) than in individuals with either chronic conditions (20.9%) or major depression (27.8%) alone. With no chronic conditions and no major depression as reference and after adjusting for relevant covariates, the odds ratio of functional disability was 2.49 (95% confidence interval (CI), 1.91-3.26) for major depression, 2.12 (95% CI, 1.93-2.32) for chronic conditions, and 6.34 (95% CI, 5.35-7.51) for chronic conditions and comorbid major depression. The results suggest that there is a joint effect of depression and chronic conditions on functional disability. Research and social policies should focus on the treatment of depression in chronic conditions.
[Show abstract] [Hide abstract] ABSTRACT: Background: The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP). Method: All 4 823 069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005]. Results: HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70). Conclusions: Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.0Comments 0Citations
- "Other differences were that they only included people in paid work, that only people aged >30 years were included and that their cohort was followed for more years. In other studies, a joint effect of mental and various somatic conditions towards disability, as limitations in performing activities of daily living, have been shown (Schmitz et al. 2007; Scott et al. 2009), but not on DP. The importance of our findings is additionally strengthened by previous studies suggesting a worsened prognosis of patients with both pain and depression , such as prolonged recovery and reduced response to treatment (Bair et al. 2003Bair et al. , 2004). "
- "In terms of effects on functioning, the authors review data suggesting that, when occupational performance was compared, " depressed workers had significantly greater performance deficits than control workers (who had rheumatoid arthritis) with regard to performing mental interpersonal tasks, time management, output tasks and physical tasks… clinical improvement did not result in full recovery of job performance " (Patten et al. 2009, p. S9). We also note the observation that there is a joint effect on disability when depression is combined with chronic physical diseases (Schmitz et al. 2007). Cost of Psychological Impairments—PTSD Similarly, Deykin et al. (2001) found that patients with higher medical utilization rates were almost twice as likely as low users (27.5% vs. 14.8%) to have PTSD. "
[Show abstract] [Hide abstract] ABSTRACT: Background: Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends. Methods: Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females. Results: All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: -18.10 (-20.95,-15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. Conclusions: Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.0Comments 8Citations
- "These results expand and complement the evidence since most studies have focused on the impact of individual conditions, specific pairs of conditions or organ domain classifi- cations. [10,15,22,28,29,34,53,55,57,69,70,79,80]. Our results support the descriptive analysis made by Lawson et al. (2013) in which participants reporting longstanding conditions presented reductions in preference-weighted health-related quality of life. "