title: Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being.
abstract: OBJECTIVE
  Our objective was to examine the relative association of depression severity and chronicity, other comorbid psychiatric conditions, and coexisting medical illnesses with multiple domains of health status among primary care patients with clinical depression.
  
  
  METHODS
  We collected cross-sectional data as part of a treatment effectiveness trial that was conducted in 8 diverse health care organizations. Patients aged 60 years and older (N = 1,801) who met diagnostic criteria for major depression or dysthymia participated in a baseline survey. A survey instrument included questions on sociodemographic characteristics, depression severity and chronicity, neuroticism, and the presence of 11 common chronic medical illnesses, as well as questions screening for panic disorder and posttraumatic stress disorder. Measures of 4 general health indicators (physical and mental component scales of the SF-12, Sheehan Disability Index, and global quality of life) were included. We conducted separate mixed-effect regression linear models predicting each of the 4 general health indicators.
  
  
  RESULTS
  Depression severity was significantly associated with all 4 indicators of general health after controlling for sociodemographic differences, other psychological dysfunction, and the presence of 11 chronic medical conditions. Although study participants had an average of 3.8 chronic medical illnesses, depression severity made larger independent contributions to 3 of the 4 general health indicators (mental functional status, disability, and quality of life) than the medical comorbidities.
  
  
  CONCLUSIONS
  Recognition and treatment of depression has the potential to improve functioning and quality of life in spite of the presence of other medical comorbidities.
authors.affiliation: VERDICT, an HSR&D Center of Excellence, South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11C6), San Antonio, TX 78229-4404, USA. pollyh@verdict.uthscsa.edu
authors.forename: Polly Hitchcock
authors.initials: PH
authors.lastname: Noël
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Jason
authors.initials: J
authors.lastname: Worchel
authors.forename: Shuko
authors.initials: S
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Cornell
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Linda H
authors.initials: LH
authors.lastname: Harpole
authors.forename: Enid
authors.initials: E
authors.lastname: Hunkeler
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011788:Quality of Life; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires