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Comparative Study
. 2010 Jul;124(1-2):38-44.
doi: 10.1016/j.jad.2009.10.026. Epub 2009 Nov 24.

Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode

Mariken E Stegmann  1 , Johan Ormel, Ron de Graaf, Josep-Maria Haro, Giovanni de Girolamo, Koen Demyttenaere, Vivianne Kovess, Herbert Matschinger, Gemma Vilagut, Jordi Alonso, Huibert Burger; ESEMED/MHEDEA Investigators
Collaborators, Affiliations
Comparative Study

Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode

Mariken E Stegmann et al. J Affect Disord. 2010 Jul.

Abstract

Background: The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor.

Methods: Data was analyzed from a subsample (N=8796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression.

Results: All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease.

Limitations: Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation cannot simply be interpreted as the amount of mediation.

Conclusions: Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions.

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Conflict of interest statement

Conflict of interest

All authors declare that have no conflicts of interest in submitting this paper.

Figures

Figure 1
Figure 1
Prevalence of chronic physical conditions in persons with a 12-month major depressive episode (N=905) and without (N=5,809) a major depressive episode lifetime N’s are unweighted. Prevalences are weighted to obtain representativeness of the figures for the European populations. Weights take into account the different probabilities of selection, the two-stage design and restore the age and gender distribution of the population within each country and the relative dimension of the population across countries.
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