title: Disentangling the complex relation of disability and depressive symptoms in old age - findings of a multicenter prospective cohort study in Germany.
abstract: Most of the previous studies attempted to disentangle the relationship between disability and depressive symptoms were limited to observation periods of only few years. Moreover, evidence is missing regarding the complex co-occurrence of disability and depressive symptoms in old age in Germany. In order to close the research gap, we aimed at disentangling the complex co-occurrence of disability and depressive symptoms in old age in Germany over a longer time frame.
  
  
  
  Based on data from a representative survey of the German general population aged 75 years and older, the course of disability as well as depressive symptoms was observed every 1.5 years over six waves. While disability was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale, the Geriatric Depression Scale was used to measure depressive symptoms. Taking into account the complex co-occurrence of depressive symptoms and disability, a panel vector autoregressive model was used. By taking the first differences, unobserved heterogeneity was taken into account.
  
  
  
  In the total sample and in both sexes, we revealed a robust positive association between an initial change in depressive symptoms and subsequent changes in disability. No robust association between an initial change in disability and a subsequent change in depressive symptoms was detected.
  
  
  
  Our findings highlight the importance of changes in depressive symptoms for future changes in disability in old age.
authors.affiliation: Department of Health Economics and Health Services Research,Hamburg Center for Health Economics,University Medical Center Hamburg-Eppendorf,Germany.
authors.forename: André
authors.identifier: 0000-0002-6886-2745
authors.initials: A
authors.lastname: Hajek
authors.affiliation: Department of Health Economics and Health Services Research,Hamburg Center for Health Economics,University Medical Center Hamburg-Eppendorf,Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.affiliation: Department of Primary Medical Care,Center for Psychosocial Medicine,University Medical Center Hamburg-Eppendorf,Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Eisele
authors.affiliation: Department of Primary Medical Care,Center for Psychosocial Medicine,University Medical Center Hamburg-Eppendorf,Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Lühmann
authors.affiliation: Institute of General Practice,Hannover Medical School,Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Mamone
authors.affiliation: Institute of General Practice,Hannover Medical School,Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Central Institute of Mental Health,Medical Faculty Mannheim/Heidelberg University,Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.affiliation: Central Institute of Mental Health,Medical Faculty Mannheim/Heidelberg University,Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Werle
authors.affiliation: Institute of General Practice,Medical Faculty,Heinrich-Heine-University Düsseldorf,Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: Institute of General Practice,Medical Faculty,Heinrich-Heine-University Düsseldorf,Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Pentzek
authors.affiliation: Institute of Social Medicine,Occupational Health and Public Health,University of Leipzig,Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Stein
authors.affiliation: Institute of Social Medicine,Occupational Health and Public Health,University of Leipzig,Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Luck
authors.affiliation: Department of Psychiatry,Technical University of Munich,Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.affiliation: Department of Psychiatry,Technical University of Munich,Germany.
authors.forename: Edelgard
authors.initials: E
authors.lastname: Mösch
authors.affiliation: Department of Psychiatry,University of Bonn,Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Heser
authors.affiliation: Department of Psychiatry,University of Bonn,Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Department of Psychiatry,University of Bonn,Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Primary Medical Care,Center for Psychosocial Medicine,University Medical Center Hamburg-Eppendorf,Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Institute of Social Medicine,Occupational Health and Public Health,University of Leipzig,Germany.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.affiliation: Department of Health Economics and Health Services Research,Hamburg Center for Health Economics,University Medical Center Hamburg-Eppendorf,Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D011795:Surveys and Questionnaires
keywords: activities of daily living (ADLs); depression; longitudinal studies