title: Physical limitations and depressive symptoms: exploring the nature of the association.
abstract: OBJECTIVE
  Although evidence suggests that physical disability and depression may be reciprocally related, questions of causality versus spuriousness and the direction of causality remain to be confidently answered. This study considered the hypothesis of reciprocal influence; the possibility of spuriousness in relation to pain, stress, and lifetime major depression; and the possible mediating effects of pain and social stress.
  
  
  METHODS
  We analyzed data from a two-wave panel study of Miami-Dade County residents (n = 1,455) that included a substantial oversampling of individuals reporting a physical disability.
  
  
  RESULTS
  Results indicated that, although prior levels of physical limitations predicted changes in depressive symptoms, there was no evidence of the reverse association. Results also indicated that part of the association between prior physical limitations and changes in depressive symptoms was explained by intervening level of pain and, to a lesser extent, by the day-to-day experience of discrimination.
  
  
  CONCLUSIONS
  Much of whatever causation may be involved in the linkage between physical limitations and depressive symptomatology flows from limitations to depression rather than in the reverse direction. Results also make clear that this linkage is not an artifact of shared associations with pain, social stress, or lifetime major depression.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Boulevard, CB#7590, Chapel Hill, NC 27599-7590, USA. mgayman@schsr.unc.edu
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Gayman
authors.forename: R Jay
authors.initials: RJ
authors.lastname: Turner
authors.forename: Ming
authors.initials: M
authors.lastname: Cui
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D011287:Prejudice; D012307:Risk Factors