Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis.
OBJECTIVE
Many reports indicate that patients with combined chronic illness and depressive symptomatology have more disability than those with illness alone, which may influence physician visits. Studies suggest that these combined conditions are unevenly accommodated by the delivery system and nonpsychiatric physicians often fail to recognize or treat these symptoms. To address this need, this study aimed to provide further information on combined conditions and report on relations found among arthritis disease symptoms, depression, and disability.


METHODS
The data was derived from a series of statewide surveys assessing the influence of psychosocial factors on disease course and treatment in a community sample of 277 patients under the care of a rheumatologist. A multivariate model was developed to assess these interrelationships, using measures of symptom severity, depression (CESD), disability (activities of daily living, days of restrictive activities, days in bed), service utilizations, and a few personal and health variables.


RESULTS
Even after removing somatic items from the CESD to reduce the risk of inflation due to physical disease, evidence was found for additive impact of depression on one measure of disability, days of restrictive activities. Patients with comorbid conditions also were a high-service utilization group. Very few patients reported receiving help in dealing with emotional problems, suggesting presence of substantial unmet need.


CONCLUSIONS
Nonpsychiatric physicians need to be aware of the mental health status of chronically ill patients. Although the association between medication use and depression suggests some awareness of the need to treat depression, especially in physically compromised patients, there may be some need to dispense psychological and psychosocial support to those in need.
Health Research and Educational Trust of New Jersey, New Jersey Hospital Association, Princeton 08543, USA.
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D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000150:complications* / Q000503:physiopathology*; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology* / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010414:Pennsylvania / Q000453:epidemiology; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires