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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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BackgroundPrimary Care Patients’ Involvement in Decision-Making Is Associated With Improvement in Depression
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“However, depressive syndromes not fulfilling rigorous diagnostic criteria are highly prevalent in older adults, while their consequences for well-being and disability have been shown to be similar to those of major depressive illness (Wells et al. 1989; Beekman et al. 1997b).”
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“This 20-item scale has been shown to have acceptable sensitivity and specificity as a screening tool for depression casefinding in non-clinical populations (23) and has demonstrated reliability and validity ( 24-26 ).”
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BackgroundDepressive Symptoms and Other Psychosocial Factors as Predictors of Stroke in the Elderly
Colantonio, A., Kasl, S. V., & Ostfeld, A. M. (1992) · American Journal of Epidemiology · doi:10.1093/aje/136.7.884 · Cited by 194
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“Studies have shown that compared to individuals with no chronic con- ditions, persons with depression report poorer HRQoL, including worse physical and social functioning, per- ceived health and more days in bed (Wells et al., 1989).”
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“Previous results from the study document that even subthreshold depressive symptoms are associated with substantial decrements in functioning (Wells et al., 1989) and an unfavorable clinical course (Wells et al.”
ResultFaris, R. F., Purcell, H., Henein, M. Y., & Coats, A. J. S. (2002) · European Journal of Heart Failure · doi:10.1016/s1388-9842(02)00101-0 · Cited by 192
Long‐term social functioning after depression treated by psychiatrists: a review
Kennedy, N., Foy, K. C., Sherazi, R., McDonough, M., & McKeon, P. (2007) · Bipolar Disorders · doi:10.1111/j.1399-5618.2007.00326.x · Cited by 202
Measuring the Impact of Organizational Behaviors on Work Disability Prevention and Management
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“(using a cutoff point of 52 on the mental health index of the SF-36 as recommended in (35), and by gender.”
MethodWell-Being and the Risk of Depression under Stress
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“Using data from a sample of adults seeking treatment for substance abuse disorders in the Massachusetts Managed Care Study, the objectives of this study were to (1) compare QOL assessments made by substance abusers to those for other chronic diseases, (2) to determine the factors influencing QOL ratings, and (3) to ex…”
BackgroundMethodSocioeconomic status, standard of living, and neurotic disorder
Lewis, G., Bebbington, P., Brugha, T. S., Farrell, M., Gill, B., Jenkins, R., & Meltzer, H. (1998) · The Lancet · doi:10.1016/s0140-6736(98)04494-8 · Cited by 185
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Stansfeld, S. A., Shipley, M. J., Head, J. A., & Fuhrer, R. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300589 · Cited by 191
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“This is consistent with the conclusions of others that the effects of depression and medical conditions are additive [4,63,64], as both can adversely affect symptom burden, functioning and QOL.”
BackgroundResultKeitner, G. I., Ryan, C. E., Miller, I. W., Kohn, R., & Epstein, N. B. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.3.345 · Cited by 182
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Boulware, L. E., Liu, Y., Fink, N. E., Coresh, J., Ford, D. E., Klag, M. J., & Powe, N. R. (2006) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.00030505 · Cited by 183
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“(44) have developed scales to rate the physical, social, and role functioning of depressed patients.”
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Brunello, N. (2002) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(02)00057-3 · Cited by 185
Restoring function in major depressive disorder: A systematic review
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“However, it should be noted that depressive syndromes not fulfilling rigorous diagnostic criteria are highly prevalent in older adults, while their consequences for well-being and disability have been shown to be very similar to those of major depressive illness [47, 48].”
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“The negative impact of MDD upon patient well-being and functioning is comparable to that of major chronic medical conditions such as diabetes, hypertension, coronary artery disease, and arthritis (Wells et al., 1989).”
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Eckhardt‐Henn, A., Breuer, P., Thomalske, C., Hoffmann, S. O., & Hopf, H. C. (2002) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(02)00226-8 · Cited by 187
“…periods of inability to work (Angst, 1996; Bailey, Sloane, Mitchell, & Preisser, 1993; Beitman, Kushner, & Basha, 1992; Candilis & Pollack, 1997; Chignon, Lepine, & Ades, 1993; Ettigi, Meyerhoff, Chirban, & Jacobs, 1997; Katon, 1996; Walker, Katon, Jemelka, & Byrne, 1992; Wells et al., 1989).”
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“” To be categorized as emotionally vital, participants had to fulfill all of the following criteria: (1) have high personal mastery (ie, disagree with “I often feel helpless in dealing with the problems of life’’ and agree with “I can do just about anything I really set my mind to”); (2) report a high level of happine…”
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BackgroundRelation of psychopathology in general medical inpatients to use and cost of services
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An overview of generic health-related quality of life measures for HIV research
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“Email: juruena@fmrp.usp.br Australian & New Zealand Journal of Psychiatry, 47(11) This disorder often leads to functional disability, causing significant social, work and family problems for the patient (Broadhead et al., 1990; Wells et al., 1989).”
BackgroundAssessment of the quality of life of patients with major depression
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Relationship between physical activity and general mental health
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“(5) found that functioning associated with depressive symptoms was worse than or comparable with that uniquely associated with several physical disorders.”
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“As with chronic anxiety, depression seems to increase the pain experience (Taenzer et al. 1986; Kremer 1981; Parmelee et al. 1991) and pain related behavior (Keefe et al. 1986; Wells et al. 1989).”
BackgroundHealth-Related Quality of Life in Depression: A Star*D Report
Daly, E., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Gaynes, B. N., Warden, D., Morris, D. W., Luther, J. F., Farabaugh, A. H., Cook, I. A., et al. (2010) · Annals of Clinical Psychiatry · doi:10.1177/104012371002200107 · Cited by 168
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The economic burden of depression in the US: societal and patient perspectives
Greenberg, P. E., & Birnbaum, H. G. (2005) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.6.3.369 · Cited by 166
“In research by Wells [6], only arthritis was associated with more chronic pain than depression was, whereas only advanced coronary artery disease was found to be more disabling.”
BackgroundBing, E. G., Hays, R. D., Jacobson, L. P., Chen, B., Gange, S. J., KASS, N. E., Chmiel, J. S., & Zucconi, S. L. (2000) · Quality of Life Research · doi:10.1023/a:1008919227665 · Cited by 164
“The factor structure of the SF-36 was found to be similar to that found previously in the general population and for other disease states [12, 30, 31], with physical health and mental health factors underlying the covariation among the eight SF-36 scale scores.”
Functional Status in Coronary Artery Disease
Sullivan, M. D., LaCroix, A. Z., Baum, C., Grothaus, L. C., & Katon, W. J. (1997) · The American Journal of Medicine · doi:10.1016/s0002-9343(97)00167-8 · Cited by 159
The lifelong course of social anxiety disorder: a clinical perspective
Keller, M. B. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.108.s417.6.x · Cited by 165
Amaya-Jackson, L. M., Davidson, J. R. T., Hughes, D. C., Swartz, M. S., Reynolds, V., George, L. K., & Blazer, D. G. (1999) · Journal of Traumatic Stress · doi:10.1023/a:1024781504756 · Cited by 165
Population-based care of depression: Effective disease management strategies to decrease prevalence
Katon, W. J., Korff, M. V., Lin, E. H. B., Unützer, J., Simon, G., Walker, E., Ludman, E. J., & Bush, T. M. (1997) · General Hospital Psychiatry · doi:10.1016/s0163-8343(97)00016-9 · Cited by 164
Chronic disease and mental disorder
Verhaak, P. F. M., Heijmans, M. J. W. M., Peters, L., & Rijken, M. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2004.06.012 · Cited by 164
Asthma and depression: a pragmatic review of the literature and recommendations for future research.
(2005) · Clinical Practice and Epidemiology in Mental Health · doi:10.1186/1745-0179-1-18 · Cited by 164
Depressive Symptoms and Indicators of Maternal Health Status during Pregnancy
Orr, S. T., Blazer, D. G., James, S. A., & Reiter, J. P. (2007) · Journal of Women s Health · doi:10.1089/jwh.2006.0116 · Cited by 166
Taragano, F. E., Lyketsos, C. G., Mangone, C. A., Allegri, R., & Díaz, E. C. (1997) · Psychosomatics · doi:10.1016/s0033-3182(97)71461-0 · Cited by 162
The impact of a pharmacist intervention on 6-month outcomes in depressed primary care patients
Adler, D. A., Bungay, K. M., Wilson, I. B., Pei, Y., Supran, S. E., Peckham, E., Cynn, D. J., & Rogers, W. H. (2004) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2003.08.005 · Cited by 163
“Despite recent advances in both screening and treatment protocols [1–15], policy makers report that the undertreatment of depression in primary care settings remains a serious public health problem [16–35].”
BackgroundResultOrganista, K. C., Muñoz, R. F., & Gonzalez, G. M. (1994) · Cognitive Therapy and Research · doi:10.1007/bf02357778 · Cited by 160
“Such comorbid patients are routinely excluded from treatment outcome research, yet they are more likely to have greater social dysfunction than patients with just depression, given the additive effect of depression and chronic medical conditions on dysfunction ( Wells et al., 1989 ).”
BackgroundInfluentialCorrelates of Early Postpartum Depressive Symptoms
Howell, E. A., Mora, P. A., & Leventhal, H. (2005) · Maternal and Child Health Journal · doi:10.1007/s10995-005-0048-9 · Cited by 161
“The association between symptoms of depression with limitations in multiple dimensions of patient well-being and functioning are well documented in the primary care literature (5).”
The burden of depression in patients with rheumatoid arthritis
Dickens, C. M. (2001) · British journal of rheumatology · doi:10.1093/rheumatology/40.12.1327 · Cited by 162
Spijker, J., de Graaf, R., Bijl, R. V., Beekman, A. T. F., Ormel, J., & Nolen, W. A. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00335.x · Cited by 158
“F P £3 (1) 3–6 (2) 6–12 (3) 12–24 (4) N 1⁄4 73 N 1⁄4 26 N 1⁄4 39 N 1⁄4 43”
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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