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Am J Psychiatry 1993; 150:910-915
Copyright © 1993 by American Psychiatric Association
Depressive symptoms, medical illness, and functional status in depressed psychiatric inpatients
JM Lyness, ED Caine, Y Conwell, DA King and C Cox
Department of Psychiatry, University of Rochester Medical Center, NY 14642.
OBJECTIVE: There is evidence that both psychiatric (especially affective)
and medical illnesses contribute to physical disability. However, the
differential contributions of specific psychiatric disorders and of medical
pathology to functional status in psychiatric populations have not been
studied. The authors therefore examined the contributions of depressive
symptoms and medical illness to functional disability in depressed
inpatients. METHOD: This prospective investigation included 109 psychiatric
inpatients with DSM-III-R major depression. Regression techniques were used
to examine the contribution of demographic variables (age, sex, education),
depressive symptom severity (Hamilton Rating Scale for Depression score),
psychiatric function (Global Assessment of Functioning Scale score), organ
system pathology (Cumulative Illness Rating Scale score), and medical
disability (Karnofsky Performance Status Scale score) to overall functional
status (Instrumental Activities of Daily Living and Physical
Self-Maintenance scores). These relationships were also examined in older
and younger subgroups. RESULTS: Greater age, female sex, and illness
factors all contributed to poorer functional status. Of the illness
factors, psychiatric pathology contributed more to low functional status
than did medical illness. The predictive power came specifically from the
functionally based measures of psychiatric and medical illness; a
quantitative measure of symptoms (Hamilton depression scale) or organ
pathology (Cumulative Illness Rating Scale) did not significantly predict
overall functional status. CONCLUSIONS: Clinicians and researchers should
recognize that symptomatic and functional assessments tap related but
different domains and that both psychiatric and medical illnesses
contribute to overall disability.
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