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Coexisting medical comorbidity and depression: Multiplicative effects on health outcomes in older adults

Published online by Cambridge University Press:  15 April 2014

Cyrus SH Ho ,
Liang Feng ,
Johnson Fam ,
Rathi Mahendran ,
Ee Heok Kua  and
Tze Pin Ng
Cyrus SH Ho
Affiliation:
Gerontology Research Programme and Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Liang Feng
Affiliation:
Gerontology Research Programme and Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Johnson Fam
Affiliation:
Gerontology Research Programme and Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Rathi Mahendran
Affiliation:
Gerontology Research Programme and Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Ee Heok Kua
Affiliation:
Gerontology Research Programme and Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Tze Pin Ng*
Affiliation:
Gerontology Research Programme and Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
*
Correspondence should be addressed to: A/P Tze-Pin Ng, Gerontology Research Programme and Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228, Singapore. Phone: 65-67723478; Fax: 65-67772191. Email: [email protected].
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Abstract

Background:

Depression in the elderly is often associated with coexisting medical illnesses. We investigated the individual and combined impacts of depression and medical illnesses on disability and quality of life among community-living older persons.

Methods:

Cross-sectional and longitudinal analyses of data from 1,844 participants aged 55 and above of the Singapore Longitudinal Aging Study (SLAS-1). Baseline depressive symptoms (Geriatric Depressive Scale, GDS≥5) and chronic medical comorbidity (≥2) from self-reports were related to baseline and 2-year follow up instrumental and basic activities of daily living (IADL-BADL), and quality of life (Medical Outcomes Study 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) scores.

Results:

The prevalence of depressive symptoms was 11.4%. In main effect analyses of cross-sectional and longitudinal relationships, depression and medical comorbidity were individually associated with higher risk of IADL-BADL disability and lower PCS and MCS scores of quality of life, and only medical comorbidity was associated with increased risk of hospitalization. Significant interactive effects of depression and medical comorbidity were observed in longitudinal relationships with IADL-BADL disability (p = 0.03), PCS (p < 0.01), and MCS (p < 0.01) scores at follow up. The associations of medical comorbidity with increased odds of IADL-BADL disability and decreased SF-12 PCS and MCS scores were at least threefolds stronger among depressed than nondepressed individuals.

Conclusion:

Medical comorbidities and depression exert additive and multiplicative effects on functional disability and quality of life. The adverse impact and potential treatment benefits of coexisting mental and physical conditions should be seriously considered in clinical practice.

Keywords

Elderlydepressionmedical comorbidity outcomes
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 7 , July 2014 , pp. 1221 - 1229
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Buist-Bouwman, M. A., de Graaf, R., Vollebergh, W. A. and Ormel, J. (2005). Comorbidity of physical and mental disorders and the effect on work-loss days. Acta Psychiatrica Scandinavica, 111, 436–443.Google Scholar
Campbell, L. C., Clauw, D. J. and Keefe, F. J. (2003). Persistent pain and depression: a biopsychosocial perspective. Biological Psychiatry, 54, 399–409.Google Scholar
Centre for disease control and prevention. (2009). About the National Health Interview Survey. Available at http://www.cdc.gov/nchs/nhis/about.nhis.htm#content.Google Scholar
Chi, I. et al. (2005). Prevalence of depression and its correlates in Hong Kong's Chinese older adults. American Journal of Geriatric Psychiatry, 13, 409–416.CrossRefGoogle Scholar
Chiu, H. C., Chen, C. M., Huang, C. J. and Mau, L. W. (2005). Depressive symptoms, chronic medical conditions and functional status: a comparison of urban and rural elders in Taiwan. International Journal of Geriatric Psychiatry, J20, 635–644.CrossRefGoogle Scholar
Chrousos, G. P. and Kino, T. (2007). Glucocorticoid action networks and complex psychiatric and/or somatic disorders. Stress, 10, 213–219.Google Scholar
Cohen, S., Janicki-Deverts, D. and Miller, G. E. (2007). Psychological stress and disease. The Journal of the American Medical Association, 298, 1685–1687.Google Scholar
Coulehan, J. L., Schulberg, H. C., Block, M. R., Madonia, M. J. and Rodriguez, E. (1997). Treating depressed primary care patients improves their physical, mental, and social functioning. Archives of Internal Medicine, 157, 1113–1120.Google Scholar
Evans, A. S. and Frank, S. J. (2004). Adolescent depression and externalizing problems: testing two models of comorbidity in an inpatient sample. Adolescence. Spring, 39, 1–18.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189–198.Google Scholar
Golden, S. H. et al. (2008). Examining a bidirectional association between depressive symptoms and diabetes. The Journal of the American Medical Association, 299, 2751–2759.CrossRefGoogle ScholarPubMed
Goodyer, I. M. (2007). The hypothalamic-pituitary-adrenal axis: cortisol, DHEA and mental and behavioral function. In Steptoe, A. (ed.), Depression and Physical Illness (pp. 280–298). London: Cambridge University Press.Google Scholar
Harpole, L. H. et al. (2005). Improving depression outcomes in older adults with comorbid medical illness. General Hospital Psychiatry, 27, 4–12.Google Scholar
Hoffman, C., Rice, D. and Sung, H. (1996). Persons with chronic conditions: their prevalence and costs. The Journal of the American Medical Association, 276, 1473–1479.Google Scholar
Hunkeler, E. M., Spector, W. D., Fireman, B., Rice, D. P. and Weisner, C. (2003). Psychiatric symptoms, impaired function, and medical care costs in an HMO setting. General Hospital Psychiatry, 25, 178–184.Google Scholar
Katon, W. J. (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry, 54, 216–226.Google Scholar
Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F. and Glaser, R. (2002). Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annual Review of Psychology, 53, 83–107.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.Google Scholar
Lim, L., Jin, A. Z. and Ng, T. P. (2012). Anxiety and depression, chronic physical conditions, and quality of life in an urban population sample study. Social Psychiatry and Psychiatric Epidemiology, 47, 1047–1053.CrossRefGoogle Scholar
Lim, P. P. et al. (2000). Validation and comparison of three brief depression scales in an elderly Chinese population. International Journal of Geriatric Psychiatry, 15, 824–830.Google Scholar
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338, 171–9.Google Scholar
Murray, C. J. and Lopez, A. D. (1997). Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet, 349, 1498–1504.Google Scholar
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. (2006). Prevalence and correlates of functional disability in multiethnic elderly Singaporeans. Journal of American Geriatric Society, 54, 21–29.CrossRefGoogle ScholarPubMed
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. (2007). Ethnic differences in cognitive performance on Mini-Mental State Examination in Asians. American Journal of Geriatric Psychiatry, 15, 130–139.Google Scholar
Niti, M., Ng, T. P., Chiam, P. C. and Kua, E. H. (2007). Item response bias was present in instrumental activity of daily living scale in Asian older adults. Journal of Clinical Epidemiology, 60, 366–374.Google Scholar
Niti, M., Yap, K. B., Kua, E.H, Tan, C. H. and Ng, T. P. (2008). Physical, social and productive leisure activities, cognitive decline and interaction with APOE-epsilon4 genotype in Chinese older adults. International Psychogeriatrics, 11, 1–15.Google Scholar
Nyunt, M. S. Z., Jin, A. Z., Fones, C. S. L. and Ng, T. P. (2009). Criterion-based validity and reliability of the Geriatric Depression Screening Scale (GDS-15) in a large validation sample of community-living Asian older adults. Ageing and Mental Health, 13, 376–382.Google Scholar
Ormel, J. et al. (1994). Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. The Journal of the American Medical Association, 272, 1741–1748.Google Scholar
Ormel, J. et al (1999). Onset of disability in depressed and non-depressed primary care patients. Psychological Medicine, 29, 847–53.CrossRefGoogle ScholarPubMed
Ormel, J. and VonKorff, M. (2000). Synchrony of change in depression and disability: what next? Archives of General Psychiatry, 57, 381–382.CrossRefGoogle ScholarPubMed
Ortega, A. N., Feldman, J. M., Canino, G., Steinman, K. and Alegría, M. (2006). Co-occurrence of mental and physical illness in US Latinos. Social Psychiatry and Psychiatric Epidemiology, 41, 927–934.Google Scholar
Patten, S. B. et al. (2005). Long-term medical conditions and major depression: strength of association for specific conditions in the general population. Canadian Journal of Psychiatry, 50, 195–202.Google Scholar
Penninx, B. W., Leveille, S., Ferrucci, L., van Eijk, J. T. and Guralnik, J. M. (1999). Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. American Journal of Public Health, 89, 1346–1352.CrossRefGoogle ScholarPubMed
Pyne, J. M. (1997). Assessment of the quality of life of patients with major depression. Psychiatric Services, 48, 224–230.Google Scholar
Scott, KM. et al. (2009). Mental-physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys. Psychological Medicine, 39, 33–43. doi: 10.1017/S0033291708003188.Google Scholar
Sharpe, L. and Curran, L. (2006). Understanding the process of adjustment to illness. Social Science and Medicine, 62, 1153–66.Google Scholar
Sprangers, M. A. et al. (2000) Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology, 53, 895–907.Google Scholar
Stewart, A. et al. (1989). Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. The Journal of the American Medical Association, 262, 907–913.CrossRefGoogle ScholarPubMed
Taft, C., Karlsson, J. and Sullivan, M. (2001). Do SF-36 summary component scores accurately summarize subscale scores? Quality of Life Research, 10, 395–404.Google Scholar
Tiemens, B. G. et al. (1999). Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes? Psychological Medicine, 29, 833–845.CrossRefGoogle ScholarPubMed
Unützer, J. et al. (2000). Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. International Psychogeriatrics, 12, 15–33.Google Scholar
Ustün, T. B., Ayuso-Mateos, J. L., Chatterji, S., Mathers, C. and Murray, C. J. (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry, 184, 386–392.Google Scholar
VonKorff, M. (1999). Disability and psychological illness in primary care. In Tansella, M. and Thomicroft, G. (Eds.), Common Mental Disorders in Primary Care (pp 52–65). London: Routledge.Google Scholar
Ware, J. E., Kosinski, M. and Keller, S. D. (1996). A 12-item short form health survey. Medical Care, 34, 220–223.Google Scholar
Wells, KB. et al. (1989). The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. The Journal of the American Medical Association, 262, 914–919.Google Scholar
Wells, K. B., Strom, R., Sherbourne, C. D. and Meredith, L. S. (1996). Caring for Depression: a RAND Study. Cambridge: Cambridge Harvard University Press.Google Scholar
Whooley, M. A. and Browner, W. S. (1998). Association between depressive symptoms and mortality in older women. Study of Osteoporotic Fractures Research Group. Achieves of Internal Medicine, 158, 2129–2135.CrossRefGoogle ScholarPubMed
Williams, J. W. Jr. et al (1999). Primary care physicians’ approach to depressive disorders. Effects of physician specialty and practice structure. Achieves of Family Medicine, 8, 58–67.CrossRefGoogle ScholarPubMed
Yesavage, J. (1988). Geriatric depression scale. Psychopharmacology Bulletin, 24, 709–711.Google Scholar