Special ArticleDepression and Disability in Late Life: Directions for Future Research
Section snippets
Disability
Disability research has been guided by several conceptual models of disability.6., 7., 8., 9., 10., 11. In general, they all differentiate disease and trauma (e.g., heart disease, fall) from the impairment caused by disease or trauma (e.g., shortness of breath, broken hip) from the limitations or difficulties these impairments place on performing activities. Such activities might encompass everything from basic physical actions (e.g., ambulation, climbing stairs) to fundamental tasks of
Cross-Sectional Studies
Empirical evidence of a cross-sectional association between depression and disability is found in various types of samples. Particularly important are population-based samples, usually defined by geographic parameters, because this kind of sample is less likely to be biased by the presence of either disability or depression. Numerous population-based studies support the association between depression and physical disability. The relationship has been reported in studies assessing depressive
POTENTIAL EXPLANATIONS
Why do the data suggest that depression and disability each contribute to mutual risk over time? This section will pose several methodological explanations and review some of the hypothesized substantive reasons.
FUTURE DIRECTIONS
Generally speaking, research to date has demonstrated the existence of a relationship between depression and disability without telling us much about the mechanism driving this relationship. In several respects, the data lack enough detail to test the hypotheses offered by the theoretical literature. The next section suggests several strategies that could be useful: 1) studies that further specify the components or aspects of disability and depression that are related; 2) analytic approaches to
CONCLUDING COMMENTS
Although the connection between depression and disability may seem intuitively obvious, empirical data on the nature of this relationship suggest that the links between the two are surprisingly subtle and complex. This article has recommended a number of analytic strategies that could be useful to clarifying these relationships. Each shares a common need to increase the specificity of our investigations of the relationships between depression and disability in terms of both measurement and
References (93)
- et al.
The disablement process
Soc Sci Med
(1994) - et al.
Physical disability in older adults: a physiological approach
J Clin Epidemiol
(1994) - et al.
Depression, illness perception, and coping in rheumatoid arthritis
J Psychosom Res
(1999) - et al.
Risk factors for functional status decline in community-dwelling elderly people: a systematic literature review
Social Science and Medicine
(1999) - et al.
Major depression and physical illness: special considerations in diagnosis and biological treatment
Psychiatr Clin North Am
(1987) - et al.
Perspectives on depressive realism: implications for cognitive theory of depression
Behav Res Ther
(1995) - et al.
Recommendations for scientific reports on depression in late life
Am J Geriatr Psychiatry
(1993) - et al.
Quality of life in elderly patients with recurrent major depression: factor analysis of the General Life Functioning Scale
Psychiatry Res
(1996) - et al.
Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease
Psychosomatics
(1992) Diagnosis and treatment of depression in late life
JAMA
(1992)
Social and physical health risk factors for first-onset major depressive disorder in a community sample
Soc Psychiatry Psychiatr Epidemiol
Depression and disability in the elderly: reciprocal relations and changes with age
Int J Geriatr Psychiatry
On the inseparability of mental and physical health in aged persons: lessons from depression and medical comorbidity
Am J Geriatric Psychiatry
An epidemiology of disability among adults in the United States
Milbank Q
International Classification of Impairments, Disabilities, and Handicaps
International Classification of Functioning and Disability. Beta-2 draft, Short Version
The structure of health status among older adults: disease, disability, functional limitation, and perceived health
J Health Soc Behav
Functional disability scales
Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function
JAMA
Performance profiles of the Functional Independence Measure
Arch Phys Rehabil
Measuring change over time: assessing the usefulness of evaluative instruments
Journal of Chronic Disease
Identifying mobility dysfunctions in elderly patients: standard neuromuscular examination or direct assessment?
JAMA
Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality-of-life outcomes in older adults
J Gerontol
Relationship between physical performance and self-perceived physical function
J Am Geriatr Soc
Functional performance measures: are they superior to self-assessments?
J Gerontol
The relationship between physical performance measures and independence in instrumental activities of daily living
J Am Geriatr Soc
Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact of depressive symptoms
J Gerontol Psychol Sci
Measuring physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures
J Am Geriatr Soc
Psychiatric diagnosis as reified measurement
J Health Soc Behav
Comment to Mirowsky and Ross
J Health Soc Behav
A comparison of self-report and clinical diagnostic interviews for depression
Arch Gen Psychiatry
A comparison of diagnostic interviews for depression in the Stirling County Study
Arch Gen Psychiatry
Limitations of diagnostic criteria and assessment instruments for mental disorders
Arch Gen Psychiatry
Problems in defining clinical significance in epidemiologic studies
Arch Gen Psychiatry
Diagnosis and need for treatment are not the same
Arch Gen Psychiatry
Disability and depressive symptoms in two communities
Am J Psychiatry
Depressive symptoms in relation to physical health and functioning in the elderly
Am J Epidemiol
Hierarchy of characteristics associated with depressive symptoms in an urban elderly sample
Am J Psychiatry
Chronic medical conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects
Psychol Med
The course of depression in the elderly: a longitudinal community-based study in Australia
Psychol Med
Association of age, sex, cognitive dysfunction, and disability with major depressive symptoms in an elderly sample
Am J Psychiatry
Impairment, disability and handicap as risk factors for depression in old age: The Gospel Oak Project, V
Psychol Med
Consequences of major and minor depression in later life: a study of disability, well-being, and service utilization
Psychol Med
The risk of nursing home admission in three communities
Journal of Aging and Health
Cited by (0)
This work was supported by grants K02 MH01634 and R01 MH56482 from the National Institute of Mental Health.