title: Depression Affects the Scores of All Facets of the WHOQOL-BREF and May Mediate the Effects of Physical Disability among Community-Dwelling Older Adults.
abstract: BACKGROUND
  Geriatric depression is associated with the overall quality of life (QOL). However, how depressive symptoms affect the different domains and facets of QOL in older adults, and whether depressive symptoms mediate the relationship between physical disability and QOL in older adults are unclear.
  
  
  METHODS
  A total of 490 ambulatory community-dwelling older adults aged 65 years or above were interviewed using the brief version of the World Health Organisation Quality of Life instrument (WHOQOL-BREF), the Modified Barthel Index (MBI), the 15-item Geriatric Depression Scale (GDS-15), and the Mini-Mental State Examination (MMSE). Sequential models for multiple linear regressions were analysed to determine if the MBI, GDS-15 and MMSE scores predict the WHOQOL-BREF scores. The potential mediation effects of depression (as determined by the GDS-15) on the relationship between MBI and WHOQOL-BREF were also analysed.
  
  
  RESULTS
  The GDS-15 score was predictive of the scores of the four domains and all 26 facets of the WHOQOL-BREF. The significant predictive effects of the MBI score on 15 of the 26 facets of the WHOQOL-BREF were reduced to three after the adjustment for the GDS-15 score. Depression (as assessed by the GDS-15) is a mediator of the relationship between MBI and the physical, psychological and environmental domains of the WHOQOL-BREF.
  
  
  CONCLUSIONS
  Depression (assessed by the GDS-15) may affect the scores of every domain and all facets of the WHOQOL-BREF in the elderly. Furthermore, it may mediate the relationship between the MBI and on QOL scores. We recommend taking depressive symptoms into consideration when measuring community-dwelling older adults' QOL and providing active ageing programs.
authors.affiliation: Department of Community Health, Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Division of Geriatrics, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Psychology, National Taiwan University, Taipei, Taiwan.
authors.forename: Grace
authors.initials: G
authors.lastname: Yao
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Hu
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Departments of Internal Medicine and Occuptional and Environmental Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003863:Depression / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires