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The Functioning and Well-being of Depressed Patients: Results From the Medical Outcomes Study
Abstract
We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11 242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning. (JAMA. 1989;262:914-919)
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“When present alone, depression was found to be as debilitating an illness as a chronic somatic illness [28].”
From Treatment of somatization in primary care (1997) · cites this paper as [28]
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Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., & Wang, P. S. (2003) · JAMA · doi:10.1001/jama.289.23.3095 · Cited by 7,988
“At least part of this growth in depression awareness and treatment has occurred as a resultof agrowing realization thatdepression is a very common and very serious illness.(21,22) Indeed, the World Health Organization (WHO) now ranks major depressionasoneofthemostburdensome diseases in the world.”
Kessler, R. C., & Üstün, T. B. (2004) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.168 · Cited by 4,771
“…add important information to the growing body of data that physical disorders often cause substantial role impairments (Zeiss and Lewinsohn, 1988; Wells et al., 1989; Wells, Stewart, Hays, Burnam, Rogers, Daniels, Berry, Greenfield and Ware, 1989; Stewart, Greenfield and Hays, 1989; Ormel, Von…”
BackgroundThe PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002) · Psychosomatic Medicine · doi:10.1097/00006842-200203000-00008 · Cited by 3,415
“Many physical disorders (eg, hypertension, well-controlled diabetes, and stable coronary artery disease) are minimally symptomatic and thus produce less impairment than mental disorders or symptomatic physical disorders (47, 48).”
BackgroundRates and risk of postpartum depression – a meta-analysis
O'hara, M. W., & Swain, A. M. (1996) · International Review of Psychiatry · doi:10.3109/09540269609037816 · Cited by 3,116
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“[26] have shown in the Medical Outcome Study that not only patients with major depression but also those with subsyndromal depressive symptoms have additive disability in patients with chronic medical illnesses.”
BackgroundRevising axis V for DSM-IV: a review of measures of social functioning
Goldman, H. H., Skodol, A. E., & Lave, T. R. (1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.9.1148 · Cited by 1,408
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“Depression is associated with personal suffering and decrements in quality of life and functioning.(3) Patients with unrecognized depression consult with their physician more frequently, and consume greater health care resources.”
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“Wells et al (1988) in the Epidemiologic Catchment Area Study found that people suffering from one of eight medical disorders had a 41% increase in the risk of having any recent psychiatric disorder (anxiety, affective, substance abuse disorders) compared with people without chronic medical disorders.”
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BackgroundSequenced treatment alternatives to relieve depression (STAR*D): Rationale and design
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“…on subsequent life adversity, that evidence for a socioeconomic gradient in MDE is less clear in the ICPE surveys than in previous epidemiological studies (Canino et al., 1987; Bland et al., 1988a; Hwu et al., 1989; Lépine et al., 1989; Wells et al., 1989; Lee et al., 1990; Wittchen et al., 1992).”
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“…are associated with high levels of personal suffering, increased disability days, and elevated risk of cardiovascular mortality and suicide (Wells et al., 1989; Broadhead et al., 1990; Ormel et al., 1994; Simon et al., 1995; Frasure-Smith et al., 2000; Penninx et al., 2001; Posternak and…”
BackgroundAssessing Psychiatric Impairment in Primary Care with the Sheehan Disability Scale
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Development and Testing of a Five‐Item Version of the Geriatric Depression Scale
Trinidad Hoyl, M., Alessi, C., Harker, J. O., Josephson, K. R., Pietruszka, F. M., Koelfgen, M., Mervis, J. R., Fitten, L. J., & Rubenstein, L. Z. (1999) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1999.tb03848.x · Cited by 838
Epidemiology and treatment of depression in patients with chronic medical illness
J. Katon, W. (2011) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2011.13.1/wkaton · Cited by 820
“This large study showed that patients with depression were at least as functionally impaired as patients with chronic medical illnesses such as diabetes, CHD, and arthritis.(22) Moreover, when depression was comorbid with chronic physical illness, there was additive functional impairment.”
InfluentialPromoting Health: Intervention Strategies From Social and Behavioral Research
(2000) · PsycEXTRA Dataset · doi:10.1037/e720012007-001 · Cited by 791
Excess mortality in depression: a meta-analysis of community studies
Cuijpers, P. J., & Smit, F. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(01)00413-x · Cited by 798
Relapse and impairment in bipolar disorder
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.11.1635 · Cited by 762
New Evidence Regarding Racial And Ethnic Disparities In Mental Health: Policy Implications
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Prevalence, burden, and treatment of insomnia in primary care
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.10.1417 · Cited by 694
“This figure is comparable to the excess disability associated with lung disease or diabetes seen in the Medical Outcomes Study (23).”
ResultPsychometric evaluation of the Beck Depression Inventory-II with primary care medical patients.
Arnau, R. C., Meagher, M. W., Norris, M. P., & Bramson, R. (2001) · Health Psychology · doi:10.1037/0278-6133.20.2.112 · Cited by 694
Büchner, D. M., & Wagner, E. H. (1992) · Clinics in Geriatric Medicine · doi:10.1016/s0749-0690(18)30494-4 · Cited by 667
Epidemiology of depression in primary care
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The enduring psychosocial consequences of mania and depression
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Which chronic conditions are associated with better or poorer quality of life?
Sprangers, M. A. G., de Regt, E. B., Andries, F., van Agt, H. M. E., Bijl, R. V., de Boer, J. B., Foets, M., Hoeymans, N., Jacobs, A., Kempen, G. I. J. M., et al. (2000) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00204-3 · Cited by 641
Prevalence and clinical course of depression: a review
Richards, D. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.07.004 · Cited by 623
Bauer, M., Pfennig, A., Severus, E., Whybrow, P. C., Angst, J., Möller, H.-J., & Šon behalf of the Task Force on Unipolar Depressive Disorders (2013) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2013.804195 · Cited by 632
“…on society (Brunello et al. 1995; Thase 2001; Fava et al. 2003b; Greenberg et al. 2003; McIntyre and O ’ Donovan 2004; Sartorius et al. 2007), even more so when not properly diagnosed or undertreated (Wells et al. 1989; Ü st ü n and Sartorius 1995; Unutzer et al. 2000; Young et al. 2001).”
BackgroundJudd, L. L., Akiskal, H. S., Maser, J. D., Zeller, P. J., Endicott, J., Coryell, W., Paulus, M. P., Kunovac, J. L., Leon, A. C., Mueller, T. I., et al. (1998) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00138-4 · Cited by 590
“ence and increased psychosocial impairment associated with threshold depressive symptoms (SSD) Studies in community samples report high preval(Wells et al., 1989; Broadhead et al., 1990; Johnson et al., 1992; Judd et al., 1994, 1996, 1997), which beneath the diagnostic threshold for minor, 1979),…”
BackgroundLenze, E. J., Rogers, J. C., Martire, L. M., Mulsant, B. H., Rollman, B. L., Dew, M. A., Schulz, R., & Reynolds, C. F. (2001) · The American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200105000-00004 · Cited by 593
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The ESEMeD/MHEDEA 2000 investigators, Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., de Girolamo, G., de Graaf, R., Demyttenaere, K., et al. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0047.2004.00329.x · Cited by 581
“This is in line with studies amongst patients and community samples, which also report in general more functional disability for mental disorders (6, 21, 22).”
ResultPenninx, B. W., Leveille, S., Ferrucci, L., van Eijk, J. T., & Guralnik, J. M. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.9.1346 · Cited by 570
Meeks, T. W., Vahia, I. V., Lavretsky, H., Kulkarni, G., & Jeste, D. V. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.09.015 · Cited by 569
“In 1992, Wells et al. (1989) reported that depressive symptoms not qualifying as MDD were associated with more social disability than many medical illnesses.”
BackgroundHealth care costs associated with depressive and anxiety disorders in primary care
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.3.352 · Cited by 555
BRUCE, M. L., Seeman, T. E., Merrill, S. S., & Blazer, D. G. (1994) · American Journal of Public Health · doi:10.2105/ajph.84.11.1796 · Cited by 554
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Self-citationComorbid Depression, Chronic Pain, and Disability in Primary Care
Arnow, B. A., Hunkeler, E. M., Blasey, C. M., Lee, J., Constantino, M. J., FIREMAN, B. H., KRAEMER, H. C., Dea, R., Robinson, R., & Hayward, C. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000204851.15499.fc · Cited by 542
“Although both depression (12) and chronic pain (13) are known to be independently associated with decrements in quality of life and increased somatic preoccupation (10), the impact of the presence of both conditions on these outcomes has rarely been investigated.”
BackgroundResultDisability and Depression Among High Utilizers of Health Care: A Longitudinal Analysis
Von Korff, M. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820020011002 · Cited by 523
D, M. F. M., Rush, A. J., Trivedi, M. H., Nierenberg, A. A., Thase, M. E., Sackeïm, H. A., Quitkin, F. M., Wisniewski, S. R., Lavori, P. W., Rosenbaum, J. F., et al. (2003) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(02)00107-7 · Cited by 528
“The Medical Outcomes Study [13] showed that patients who meet criteria for MDD function more poorly than other primary care outpatients in three domains: (1) limitations in physical activities, (2) limitations in occupational or role responsibilities, and (3) limitations in social activities because of health problems.”
MethodAdequacy and Duration of Antidepressant Treatment in Primary Care
Katon, W. J., Korff, M. V., Lin, E. H. B., Bush, T. M., & Ormel, J. (1992) · Medical Care · doi:10.1097/00005650-199201000-00007 · Cited by 519
Treatment and prevention of depression
Hollon, S. D., Thase, M. E., & Markowitz, J. C. (2002) · Psychological Science in the Public Interest · doi:10.1111/1529-1006.00008 · Cited by 511
“Their impact on quality of life and economic productivity matches that of heart disease and surpasses the burdens associated with peptic ulcer, arthritis, hypertension, or diabetes (Wells et al., 1989).”
BackgroundWhat Does Research Tell Us About Depression, Job Performance, and Work Productivity?
Lerner, D., & Henke, R. M. (2008) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e31816bae50 · Cited by 525
Exercise and the Treatment of Clinical Depression in Adults: Recent Findings and Future Directions
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“[30] In the MOS,[24] the effects of depressive symptoms and”
BackgroundMethodInfluentialTreatment preferences among depressed primary care patients
Dwight-Johnson, M., Sherbourne, C. D., Liao, D., & Wells, K. B. (2000) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2000.08035.x · Cited by 478
“Patients were asked, “If you were depressed and you could choose between 5 treatments that might cure your depression, which ONE would you chose? (1) Free medication daily for 6 months, often causes nausea and headaches, 75% chance of cure (representing older antidepressants which have greater side effects, but low co…”
BackgroundInfluentialSelf-citationImpact of major depression on chronic medical illness
Katon, W., & Ciechanowski, P. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00313-6 · Cited by 485
“Subsyndromal depressive symptoms have also been found to be associated with additive disability in patients with chronic medical illness [30].”
BackgroundInfluentialQuality of life in multiple sclerosis: the impact of depression, fatigue and disability
Amato, M. P., Ponziani, G., Rossi, F., Liedl, C. L., Stefanile, C., & Rossi, L. (2001) · Multiple Sclerosis Journal · doi:10.1177/135245850100700511 · Cited by 506
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“…also subject to under-detection and under-reporting, although those with the greatest severity are the most likely to be detected (Cleary et al., 1988; Wells et al., 1989; Buchsbaum et al., 1992; Callahan et al., 1994; Mathias et al., 1994; Simon and Von Korff, 1995; Spitzer et al., 1999; Lefevre…”
BackgroundMigraine, quality of life, and depression
Lipton, R. B., Hamelsky, S. W., Kolodner, K., Steiner, T., & Stewart, W. F. (2000) · Neurology · doi:10.1212/wnl.55.5.629 · Cited by 478
Bauer, M., Bschor, T., Pfennig, A., Whybrow, P. C., Angst, J., Versiani, M., Möller, H., & WFSBP Task Force on Unipolar Depres (2007) · The World Journal of Biological Psychiatry · doi:10.1080/15622970701227829 · Cited by 483
“…imposes significant costs on society (Brunello et al. 1995; Thase 2001; Fava et al. 2003a; Greenberg et al. 2003; McIntyre and O’Donovan 2004), even more so when not properly diagnosed or undertreated (Wells et al. 1989a; Üstün and Sartorius 1995; Unützer et al. 2000b, Young et al. 2001).”
BackgroundAwareness, diagnosis, and treatment of depression
the Council on Scientific Affairs, A. M. A., Goldman, L. S., Nielsen, N. H., & Champion, H. C. (1999) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1999.03478.x · Cited by 466
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“Patients with major depression, for example, are known to have increased rates of impaired occupational functioning, marital problems, and social isolation (Wells et al., 1989; Broadhead et al., 1990; Olfson et al., 1997).”
BackgroundNegative Consequences of Hearing Impairment in Old Age
Strawbridge, W. J., Wallhagen, M. I., Shema, S. J., & Kaplan, G. A. (2000) · The Gerontologist · doi:10.1093/geront/40.3.320 · Cited by 465
“Depression is a serious problem in old age that is also associated with negative sequellae (Wells et al., 1989).”
BackgroundWho is at risk of nondetection of mental health problems in primary care?
Borowsky, S. J., Rubenstein, L. V., Meredith, L. S., Camp, P., Jackson‐Triche, M., & Wells, K. B. (2000) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2000.12088.x · Cited by 470
Self-citationPromoting Health: Intervention Strategies from Social and Behavioral Research
Smedley, B. D., & Syme, S. L. (2001) · American Journal of Health Promotion · doi:10.4278/0890-1171-15.3.149 · Cited by 475
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“In general, depression and anxiety may substantially reduce a person’s quality of life and that of his or her family (26, 27).”
BackgroundJudd, L. L., Akiskal, H. S., & Paulus, M. P. (1997) · Journal of Affective Disorders · doi:10.1016/s0165-0327(97)00055-4 · Cited by 444
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Pain modulation: expectation, opioid analgesia and virtual pain
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Treating Major Depression in Primary Care Practice
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Social and economic burden of mood disorders
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“HRQL measured by SF-36 was equally low or lower than scores obtained in patients having severe cardiopulmonary diseases or major depression (Stewart et al., 1989; Wells et al., 1989; Ware et al., 1994).”
MethodObesity–depression associations in the population
Faith, M. S., Matz, P. E., & Jorge, M. A. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00308-2 · Cited by 446
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The economic burden of depression and the cost-effectiveness of treatment
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“A large body of literature has documented that depression imposes a substantial burden on society (Zeiss and Lewinsohn, 1988; Wells et al., 1989; Broadhead et al., 1990; Rohde et al., 1990; Coryell et al., 1993; Tweed, 1993).”
BackgroundHermann, B. P., Seidenberg, M., & Bell, B. D. (2000) · Epilepsia · doi:10.1111/j.1528-1157.2000.tb01522.x · Cited by 407
Community-Integrated Home-Based Depression Treatment in Older Adults: A Randomized Controlled Trial
Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P., Kulzer, J., Gray, S., Collier, C., & LoGerfo, J. (2004) · JAMA · doi:10.1001/jama.291.13.1569 · Cited by 406
The Impact of Psychiatric Disorders on Labor Market Outcomes
Ettner, S. L., Frank, R. G., & Kessler, R. C. (1997) · Industrial and Labor Relations Review · doi:10.1177/001979399705100105 · Cited by 404
Effects of Nortriptyline on Depression and Glycemic Control in Diabetes
Lustman, P. J., Griffith, L. S., Clouse, R. E., Freedland, K. E., Eisen, S. A., Rubin, E. H., Carney, R. M., & McGill, J. B. (1997) · Psychosomatic Medicine · doi:10.1097/00006842-199705000-00007 · Cited by 405
“Depression is known to have a profound adverse influence on quality of life and overall functioning (3-5).”
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“It is associated with considerable morbidity (7-9), excess mortality from suicide and other causes (10-13), and substantial direct and indirect costs (14).”
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“…depression, anxiety, pain) produce so much disability and loss of well-being (Ormel et al., 1993; Ormel et al., 1994; Von Korff et al., 1992; Wells et al., 1989) may be because those impairments cause decrements in higher-order mental capacities such as energy, self-regulation of affect,…”
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“These scores were then compared with published scores from a general outpatient clinic sample (6) and with scores from ambulatory patients with chronic medical conditions (12, 13).”
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Five years later: a cross‐sectional comparison of breast cancer survivors with healthy women
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“This instrument has excellent reliability and validity and has been used to evaluate functional status in depressed, chronically ill, and healthy populations (Wells et al., 1989).”
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“detect a diagnosed disorder but also sub-threshold depression, since even the latter may have adverse health consequences [3, 32].”
Background
Metadata
- Authors
- Wells, K. B.
- Corresponding author
- Wells, Kenneth B.
- ORCID
- Wells, Kenneth B.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1989-08-18
- Volume
- 262
- Issue
- 7
- Pages
- 914
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1539382539
- Cited by
- 2,130
- References
- 0
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 18 · 2023: 18 · 2022: 21 · 2021: 39 · 2020: 30 · 2019: 33 · 2018: 31 · 2017: 30 · 2016: 25 · 2015: 44 · 2014: 44 · 2013: 61 · 2012: 49
- FWCI
- 66.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Funders
- National Institute of Mental Health (MH 42229-03S1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, depressive symptoms, chronic disease, functional status, well-being, physical function, social functioning, role functioning, health perception, bodily pain, outpatients, comorbidities
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