Special Article
Depression and Disability in Late Life: Directions for Future Research

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The author reviews evidence from epidemiologic and clinical studies suggesting a reciprocal, potentially spiraling, relationship between depression and disability in older adults. The discussion outlines possible methodological and conceptual explanations for this evidence and poses avenues for future research. An underlying theme is the impact of how disability and depression are measured on the nature of empirical evidence and its interpretation. Measures and corresponding analytic strategies that capture the complexity of depression, disability, and their relationship are expected to lead to the most fruitful approaches to reducing the burden of depression and disability in the lives of older adults.

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

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    This work was supported by grants K02 MH01634 and R01 MH56482 from the National Institute of Mental Health.

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