Use of the late-life function and disability instrument to assess disability in major depression.
OBJECTIVE
To determine whether there was greater disability in subjects with depression than in those without, the correlation between disability and depression severity and quality of life, and whether improvement in disability after antidepressant pharmacotherapy was greater in those who responded to antidepressant treatment.


METHODS
Disability in subjects with and without depression from two different studies was compared for 22 weeks. Correlations were performed for the subjects with depression between disability and depression, anxiety, health-related quality of life (HRQOL), and medical comorbidity. T-tests were used to compare disability between subjects who did and did not respond to antidepressant treatment and change in disability after pharmacotherapy.


METHODS
Late-life depression research clinic.


METHODS
The 313 subjects were recruited from primary care and the community and were aged 60 and older; 244 subjects were participants in a depression treatment protocol, and 69 subjects without depression participated in a separate longitudinal observational study of the mental and cognitive health of depression-free older adults.


METHODS
The Late-Life Function and Disability Instrument (LL-FDI), a measure of instrumental activity of daily living, personal role, and social role functioning.


RESULTS
Subjects with depression scored lower than controls for domains measuring limitation (can do) and frequency (does do) of activities. Both disability domains correlated with depression severity, anxiety, HRQOL, and cognition. Disability improved with antidepressant treatment; for partial responders who continued to receive higher-dose antidepressant treatment out to 22 weeks, there was continued improvement, although not to the level of comparison subjects without depression.


CONCLUSIONS
The LL-FDI appears to discriminate subjects with depression from those without, correlates with depression severity, and demonstrates sensitivity to antidepressant treatment response. We recommend further investigation of the LL-FDI and similar disability instruments for assessing depression-related disability.
Karp
Jordan F
JF
Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Courier/Office: 100 North Bellefield Avenue, Room 766, Pittsburgh, PA 15213, USA. karpjf@upmc.edu
Skidmore
Elizabeth
E
Lotz
Meredith
M
Lenze
Eric
E
Dew
Mary Amanda
MA
Reynolds
Charles F
CF
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D015283:Citalopram / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D010353:Patient Education as Topic; D010555:Personality Inventory; D011613:Psychotherapy; D011788:Quality of Life / Q000523:psychology; D013223:Statistics as Topic
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram
Am J Geriatr Psychiatry. 2005 Mar;13(3):244-9
15728756
Am J Geriatr Psychiatry. 1996 Winter;4(1):1-16
28531050
J Am Geriatr Soc. 2007 Sep;55(9):1325-32
17767673
Int J Methods Psychiatr Res. 2004;13(2):69-92
15297905
Am J Psychiatry. 2001 Nov;158(11):1850-5
11691691
Am J Geriatr Psychiatry. 2007 Sep;15(9):807-14
17698601
Br J Med Psychol. 1959;32(1):50-5
13638508
Biol Psychiatry. 2006 Jun 1;59(11):990-6
16368078
J Am Geriatr Soc. 2007 Feb;55(2):202-11
17302656
Am J Geriatr Psychiatry. 2008 Jun;16(6):460-8
18515690
J Rehabil Med. 2003 May;35(3):145-9
12809198
J Psychiatr Res. 1975 Nov;12(3):189-98
1202204
Arch Gen Psychiatry. 1992 Feb;49(2):91-100
1550468
Am J Geriatr Psychiatry. 2001 Spring;9(2):102-12
11316615
J Gen Intern Med. 1995 Jan;10(1):7-12
7699487
Arch Gen Psychiatry. 2007 Oct;64(10):1180-8
17909130
Psychiatry Res. 1997 Jan 15;66(1):23-31
9061801
Am J Geriatr Psychiatry. 2005 Jan;13(1):77-80
15653943
J Am Geriatr Soc. 1968 May;16(5):622-6
5646906
Int J Geriatr Psychiatry. 2004 May;19(5):472-8
15156549
Arch Intern Med. 1989 Aug;149(8):1785-9
2788396
Am J Geriatr Psychiatry. 2001 Spring;9(2):113-35
11316616
Psychiatry Res. 1992 Mar;41(3):237-48
1594710
Int J Methods Psychiatr Res. 2007;16 Suppl 1:S8-S15
17623398
Clin Neuropsychol. 2000 May;14(2):187-95
10916193
Disabil Rehabil. 2006 Aug 30;28(16):1027-34
16882642
Acta Psychiatr Scand. 1983 Jun;67(6):361-70
6880820
Soc Psychiatry Psychiatr Epidemiol. 1994 Jul;29(4):165-71
7939965
J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
14399272
Arch Gen Psychiatry. 2004 Apr;61(4):387-92
15066897
Disabil Rehabil. 2004 Mar 18;26(6):362-70
15204488
Am J Occup Ther. 1994 Oct;48(10):914-8
7825707
Am J Public Health. 1993 Mar;83(3):385-90
8438977
Arch Gen Psychiatry. 1993 Oct;50(10):759-66
8215800
Int J Geriatr Psychiatry. 2007 Nov;22(11):1141-6
17486678
J Am Geriatr Soc. 2005 Apr;53(4):569-75
15817000
J Gerontol A Biol Sci Med Sci. 2002 Apr;57(4):M209-16
11909885
J Am Geriatr Soc. 2008 Oct;56(10):1926-31
18811613
JAMA. 1998 Jun 3;279(21):1720-6
9624025