Demonstrating the disability of depression.

Demonstrating the disability of depression

Depression -- or even a few symptoms of depression that do not rate a psychiatric diagnosis -- physically disables some people just as badly as high blood pressure, diabetes, athritis and many other ailments treated by primary care physicians, according to preliminary results of a long-term study.

"Depression may be more like major medical conditions in its disabling effects than has previously been appreciated," says psychiatrist Kenneth B. Wells of the University of California, Los Angeles, who directed the study.

Many psychiatrists and psychologists have long recognized that depression can physically disable their patients, "but this is the first study to clearly demonstrate this scientifically," comments psychiatrist Martin B. Keller of Harvard Medical School in Boston.

Primary care physicians provide most mental health care, and studies indicate they often misdiagnose depression and its symptoms.

The new study, described in the Aug. 18 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, is based on data from 11,242 medical outpatients being treated in Boston, Chicago and Los Angeles. During office visits in 1986, patients filled out a questionnaire developed by the researchers, which asks about physical, social and work-related functioning as well as perceptions of current health and well-being.

About half the people in the sample had depressive symptoms, full-fledged depression or one of eight chronic medical conditions: high blood pressure, diabetes, advanced coronary artery disease, chest pain due to angina, arthritis, back ailments, lung problems or a gastrointestinal disorder. Researchers telephone-interviewed more than half the 2,467 patients with depression or some of its symptoms.

Depressive symptoms include feeling down in the dumps, having crying spells or expressing intense guilt. Depressive disorder involves a number of symptoms associated with recurring sadness and loss of interest or pleasure in all activities for at least two weeks.

Compared with patients suffering depression or depressive symptoms, only patients with angina or coronary artery disease were more limited in routine daily activities, such as climbing stairs, walking, dressing and going to work. In addition, only arthritis patients reported more bodily pain than the depressed group, and only coronary artery disease patients reported more days in bed.

Day-to-day functioning proved most disturbed among patients with both depressive symptoms and a chronic medical condition, the researchers say.

Somewhat surprising, Keller notes, is the researchers' conclusion that people with depressive symptoms function nearly as poorly as those with depressive disorder. The significance of depressive symptoms will not emerge without a long-term study, he says. Wells and his co-workers are completing a two-year follow-up of all subjects.

In a five-year study in Boston and Chicago, Keller is using the same questionnaire to measure general functioning and well-being among patients with anxiety disorders. Since symptoms of anxiety often accompany depression, Keller says, future research must examine the functioning of depressed patients with and without anxiety.