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Six-Year Effect of Depressive Symptoms on the Course of Physical Disability in Community-Living Older Adults
Diane Cronin-Stubbs, PhD, RN, FAAN;
Carlos F. Mendes de Leon, PhD;
Laurel A. Beckett, PhD;
Terry S. Field, ScD;
Robert J. Glynn, PhD;
Denis A. Evans, MD
Arch Intern Med. 2000;160:3074-3080.
Background Late-life depression affects physical health and impedes recovery from physical disability. But whether milder symptoms that occur frequently in the general population increase the risk of developing a disability or decrease the likelihood of recovery remains unclear.
Objective To examine the effect of mild symptoms of depression, assessed by a reduced version (10 items, ranging from 0-10) of the Center for Epidemiological Studies–Depression Scale, on the course of physical disability, assessed by items from the Katz Activities of Daily Living Scale, the Rosow-Breslau Functional Health Scale, and the Nagi Index.
Methods A population-based longitudinal study was conducted, with 6 follow-up interviews of 3434 community-dwelling persons aged 65 years and older in East Boston, Mass.
Results The likelihood of becoming disabled increased with each additional symptom of depression (for the Katz measure: odds ratio, 1.16 per symptom; 95% confidence interval, 1.13-1.19; for the Rosow-Breslau measure: odds ratio, 1.14; 95% confidence interval, 1.11-1.16; and for the Nagi measure: odds ratio, 1.17; 95% confidence interval, 1.14-1.19). As the number of depressive symptoms increased, the likelihood of recovering from a physical disability decreased (for the Katz measure: odds ratio, 0.96; 95% confidence interval, 0.93-0.99; for the Rosow-Breslau measure: odds ratio, 0.86; 95% confidence interval, 0.84-0.89; and for the Nagi measure: odds ratio, 0.89; 95% confidence interval, 0.87-0.91). This effect was not accounted for by age, sex, level of educational attainment, body mass index, or chronic health conditions.
Conclusion Mild depressive symptoms in older persons (those aged  65 years) are associated with an increased likelihood of becoming disabled and a decreased chance of recovery, regardless of age, sex, and other factors that contribute to physical disability.
From the Rush Institute for Healthy Aging and the Department of Medicine, Rush University College of Medicine (Drs Cronin-Stubbs, Mendes de Leon, Beckett, and Evans), Rush–Presbyterian–St Luke's Medical Center, Chicago, Ill; Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester (Dr Field); and the Department of Medicine (Biostatistics), Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Dr Glynn). Dr Cronin-Stubbs is now affiliated with the Rehabilitation Institute of Chicago.
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