Depression and disability from chronic medical illness

Abstract

Demographic data concerning ageing, the prevalence of chronic medical illnesses and the prevalence of depression, provide the context within which the Interaction of depression and chronic medical illness can assume considerable public health importance. Depression may lead to a worsening of medical illness by direct and indirect routes. First, it may decrease compliance with self-care and other medical regimens. Second, it may alter the perception of somatic symptoms so that they become more aversive and disabling. Third, depression may have negative physiological effects upon the concurrent medical illness through the neuroendocrine and autonomic alterations known to accompany major depression. In the past few years numerous epidemiologic studies in the United States have documented the functional disability that accompanies major depressive disorder and depressive symptoms. Depression and disability vary together in medical out-patients, each exacerbating the other. Psychosocial factors, including depression, may mediate between physiological capacity and functional performance in those with chronic medical illness of mild to moderate severity. These findings suggest that depressive symptoms may have a particularly potent effect upon functional status among the medically ill elderly.