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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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Depression and coronary heart disease: A review for cardiologists
Carney, R. M., Freedland, K. E., Sheline, Y. I., & Weiss, E. S. (1997) · Clinical Cardiology · doi:10.1002/clc.4960200304 · Cited by 159
Psychoneuroimmunology of depression: clinical implications
Irwin, M. (2002) · Brain, Behavior, and Immunity · doi:10.1006/brbi.2001.0654 · Cited by 160
“Second, limitations in functioning of depressed persons across physical domains are equal to or greater than those found in many major chronic medical conditions (Wells et al., 1989).”
BackgroundFleishman, J. A., & Zuvekas, S. H. (2007) · Medical Care · doi:10.1097/mlr.0b013e31803bb4b0 · Cited by 159
“SRMH also predicted activity and role limitations, consistent with prior studies of associations between depression and functioning.(13,20) SRMH was more strongly associated with emotional role limitations than with physical role limitations, providing evidence for discriminant validity.”
ResultDo Pediatricians Recognize Mothers With Depressive Symptoms?
Heneghan, A. M., Silver, E. J., Bauman, L. J., & Stein, R. E. K. (2000) · PEDIATRICS · doi:10.1542/peds.106.6.1367 · Cited by 160
Wells, K. B., Rogers, W. H., Burnam, A., Greenfield, S., & Ware, J. E. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.12.1688 · Cited by 156
Self-citationBoomsma, D. I., Willemsen, G. A. H. M., Sullivan, P. F., Heutink, P., Meijer, P., Sondervan, D., Kluft, C., Smit, G., Nolen, W. A., Zitman, F. G., et al. (2008) · European Journal of Human Genetics · doi:10.1038/sj.ejhg.5201979 · Cited by 155
“3 MDD is associated with large morbidity (greater than chronic medical conditions such as diabetes and arthritis)”
BackgroundSelf-report disability in an international primary care study of psychological illness
Korff, M. V., Üstün, T. B., Ormel, J., Kaplan, I., & Simon, G. E. (1996) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(95)00512-9 · Cited by 161
Health care for homeless women: Unmet needs and barriers to care
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“Similar results were described in other studies [4,20-22].”
ResultComorbidity and survival in HIV-Infected men in the San Francisco Men's Health Survey
Page, K. A., DeLorenze, G. N., Satariano, W. A., & Winkelstein, W. (1996) · Annals of Epidemiology · doi:10.1016/s1047-2797(96)00064-6 · Cited by 157
Predictors of the onset of depressive symptoms in patients with heart failure
Havranek, E. P., Spertus, J. A., Masoudi, F. A., Jones, P. G., & Rumsfeld, J. S. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.09.034 · Cited by 158
“S C a c epression is a chronic disease that is associated with imitations in physical and social functioning equal to or reater than those of other common chronic diseases (1) and s associated with increased mortality (2).”
BackgroundPatients' perspectives on the management of emotional distress in primary care settings
Brody, D. S., Khaliq, A. A., & Thompson, T. L. (1997) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1997.00070.x · Cited by 156
Plaisier, I., Beekman, A. T. F., de Graaf, R., Smit, J. H., van Dyck, R., & Penninx, B. W. J. H. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.01.072 · Cited by 168
“In previous studies, psychosocial (Coryell et al., 1993; Wells et al., 1989) and cognitive (Nakano et al.”
BackgroundMykletun, A. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.8.1412 · Cited by 237
Jongenelis, K., Pot, A. M., Eisses, A. M. H., Gerritsen, D. L., Derksen, M. T., Beekman, A. T. F., Kluiter, H., & Ribbe, M. W. (2005) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1398 · Cited by 156
“Depression is one of the most common psychiatric disorders in older persons, and it has been associated with negative outcomes such as diminished functioning and well-being, and increased mortality (Wells et al., 1989; Rovner, 1993; Beekman et al., 2002).”
BackgroundA randomized trial of psychiatric consultation with distressed high utilizers
Katon, W. J., Korff, M. V., Lin, E., Bush, T. M., Russo, J. E., Lipscomb, P. A., & Wagner, E. H. (1992) · General Hospital Psychiatry · doi:10.1016/0163-8343(92)90033-7 · Cited by 155
Depression and Quality of Life: Results of a Follow-Up Study
Angermeyer, M. C., Holzinger, A., Matschinger, H., & Stengler‐Wenzke, K. (2002) · International Journal of Social Psychiatry · doi:10.1177/002076402128783235 · Cited by 155
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The Effect of Disease Prevention and Health Promotion on Workplace Productivity: A Literature Review
Riedel, J. E., Lynch, W., Baase, C. M., Hymel, P. A., & Peterson, K. W. (2001) · American Journal of Health Promotion · doi:10.4278/0890-1171-15.3.167 · Cited by 156
Psychological attributes of preoperative total joint replacement patients
Ayers, D. C., Franklin, P. D., Trief, P. M., Ploutz-Snyder, R. J., & Freund, D. A. (2004) · The Journal of Arthroplasty · doi:10.1016/j.arth.2004.06.019 · Cited by 152
Katz, I. R. (1996) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-199624410-00001 · Cited by 160
Therapeutic Exercise and Depressive Symptoms After Stroke
Lai, S., Studenski, S. A., Richards, L. G., Perera, S., Reker, D. M., Rigler, S. K., & Duncan, P. W. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00573.x · Cited by 151
“Mood is thought to heavily influence self-perceived quality of life.(48) Exercise could directly affect depressive symptoms, and improved depressive symptoms might be a powerful influence on improved quality of life.”
BackgroundThe many faces of depression following spousal bereavement
Zisook, S., Paulus, M. P., Shuchter, S. R., & Judd, L. L. (1997) · Journal of Affective Disorders · doi:10.1016/s0165-0327(97)00062-1 · Cited by 151
WHOQOL-BREF as a measure of quality of life in older patients with depression
Naumann, V. J., & Byrne, G. J. (2004) · International Psychogeriatrics · doi:10.1017/s1041610204000109 · Cited by 151
“In the Medical Outcomes Study (Wells et al., 1989), depressed patients rated their QOL as worse than a group of chronically medically ill patients.”
BackgroundStiefel, F., Trill, M. D., Berney, A., Núñez-Olarte, J. M., & Razavi, D. (2001) · Supportive Care in Cancer · doi:10.1007/s005200100244 · Cited by 149
“Two major paradigms exist in current clinical practice for defining depression: (1) the general phenomenon of depressive symptoms and (2) specific depressive disorders defined by diagnostic criteria [ 104 ].”
BackgroundPsychological comorbidity and length of stay in the general hospital
Saravay, S. M., Steinberg, M. D., Weinschel, B., et al. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.3.324 · Cited by 150
Improving patient quality of life with feedback to physicians about functional status
Rubenstein, L. V., McCoy, J. M., Cope, D., Barrett, P. A., Hirsch, S. H., Messer, K. S., & Young, R. T. (1995) · Journal of General Internal Medicine · doi:10.1007/bf02602744 · Cited by 152
Flynn, H. A., Davis, M. M., Marcus, S. M., Cunningham, R. M., & Blow, F. C. (2004) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2004.03.009 · Cited by 148
“[3] Wells KB, Stewart A, Hays RD, et al.”
BackgroundKim, W. K., Lim, S.-H., Chung, E.-J., & Woo, J. (2009) · Psychiatry Investigation · doi:10.4306/pi.2009.6.4.245 · Cited by 158
Assessing the validity of the SF-36 General Health Survey
Stansfeld, S. A., Roberts, R., & Foot, S. P. (1997) · Quality of Life Research · doi:10.1023/a:1026406620756 · Cited by 147
Machado, M., Iskedjian, M., Ruiz, I., & Einarson, T. R. (2006) · Current Medical Research and Opinion · doi:10.1185/030079906x132415 · Cited by 144
Traumatic life events in primary care patients: a study in an ethnically diverse sample.
Holman, E., Silver, R., & Waitzkin, H. (2000) · Archives of Family Medicine · doi:10.1001/archfami.9.9.802 · Cited by 156
“These findings are consistent with prior studies that have linked psychiatric disorders with impaired physical functioning and unexplained physical symptoms.(5,20,22,32,33,56-59) To the extent that traumatic experiences increase the risk of developing a psychiatric disorder, our data suggest that they may contribute i…”
BackgroundResultLoss of Work Productivity due to Illness and Medical Treatment
Cockburn, I., Bailit, H. L., Berndt, E. R., & Finkelstein, S. N. (1999) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-199911000-00005 · Cited by 143
The relationship of presenting physical complaints to depressive symptoms in primary care patients
Gerber, P. D., Barrett, J. E., Barrett, J. A., Oxman, T. E., Manheimer, E., Smith, R., & Whiting, R. D. (1992) · Journal of General Internal Medicine · doi:10.1007/bf02598007 · Cited by 143
Physical Functioning: Self-Report and Performance Measures Are Related but Distinct
Wittink, H. M., Rogers, W. H., Sukiennik, A., & Carr, D. B. (2003) · Spine · doi:10.1097/01.brs.0000085304.01483.17 · Cited by 147
“Similar findings have been reported by others.(3,6,74,75,70) In the present study, patients with low MH reported lower PF and BP scores (i.”
ResultGender differences in depression in primary care
Williams, J. B. W., Spitzer, R. L., Linzer, M., Kroenke, K., Hahn, S. R., deGruy, F. V., & Lazev, A. B. (1995) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(95)90298-8 · Cited by 144
Efficacy of vitamin D supplementation in depression in adults: a systematic review
Li, G., Mbuagbaw, L., Samaan, Z., Falavigna, M., Zhang, S., Adachi, J. D., Cheng, J., Papaioannou, A., & Thabane, L. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3450 · Cited by 144
The Impact of Partner Psychological Abuse on Health Behaviors and Health Status in College Women
Straight, E. S., Harper, F. W. K., & Arias, I. (2003) · Journal of Interpersonal Violence · doi:10.1177/0886260503254512 · Cited by 143
Psychological Impact of HIV Disease and Implications for Intervention
Chesney, M. A., & Folkman, S. (1994) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(18)30136-9 · Cited by 143
A Review of Randomized Trials of Psychiatric Consultation-Liaison Studies in Primary Care
Katon, W. J., & Gonzales, J. J. (1994) · Psychosomatics · doi:10.1016/s0033-3182(94)71775-8 · Cited by 142
“Zung SDS 'u 96 N/A Linn and Yager (1984)+”
BackgroundAssessing outcomes for sufferers of severe mental disorder: A conceptual framework and review
Rosenblatt, A., & Attkisson, C. C. (1993) · Evaluation and Program Planning · doi:10.1016/0149-7189(93)90049-e · Cited by 142
“You Don't Want to Burden Them”
Cahill, E., Lewis, L. M., Barg, F. K., & Bogner, H. R. (2009) · Journal of Family Nursing · doi:10.1177/1074840709337247 · Cited by 153
“The Medical Outcomes Study Short Form (SF-36) has been employed in studies of outcomes of patient care (Gallo, Bogner, Straton, et al., 2005; McHorney, 1996; Stewart et al., 1989; Stewart, Hays, & Ware, 1988; Stewart & Ware, 1993; Wells et al., 1989) and appears to be reliable and valid in older adults (Stadnyk, Calde…”
MethodClinically Significant Non-Major Depression: Old Concepts, New Insights
Lavretsky, H., & Kumar, A. (2002) · The American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200205000-00003 · Cited by 147
“Most patients with mental illness are seen exclusively in primary care medicine.(5,11,12) Primary care settings have therefore been the recent focus of studies of minor depression.”
Labordé-Lahoz, P. M., El-Gabalawy, R. M., Kinley, J., Kirwin, P. D., Sareen, J., & Pietrzak, R. H. (2014) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4204 · Cited by 140
“In 1989, for example, Wells and colleagues found that depressive symptoms that did not meet criteria for MDD resulted in greater disability than many chronic medical illnesses (Wells et al., 1989).”
BackgroundNature and Prevalence of Mental Illness in the Workplace
Dewa, C. S., LESAGE, A. D., Goering, P. N., & Caveen, M. (2004) · A Nudge Too Far? A Nudge at All? On Paying People to Be Healthy · doi:10.12927/hcpap..16820 · Cited by 146
“It has also been observed that there is an association between these chronic disorders and depression (Patten 1999; Wells et al. 1989).”
BackgroundThe effect of depression on quality of life of patients with type II diabetes mellitus
Eren, İ., Erdi, Ö., & Şahin, M. (2007) · Depression and Anxiety · doi:10.1002/da.20288 · Cited by 143
“Subsyndromal depressive symptoms have also been found to be associated with additive disability in patients with chronic medical illness [Wells et al., 1989].”
BackgroundResultInfluentialSubjective measurement of insomnia and quality of life in depressed inpatients
McCall, W. V., Reboussin, B. A., & Cohen, W. (2000) · Journal of Sleep Research · doi:10.1046/j.1365-2869.2000.00186.x · Cited by 138
“…of insomnia (Nelson and Charney 1980), and MDE has been shown in cross-sectional studies to be associated with clinically signi®cant QOL de®cits (Wells et al. 1989; Ormel et al. 1994; Alexopoulos et al. 1996; Dunham and Correspondence: W. Vaughn McCall, MD, MS, Department of Psychiatry and…”
BackgroundPrimary care patients' personal illness models for depression: a preliminary investigation
Brown, C., Dunbar‐Jacob, J. M., Palenchar, D. R., Kelleher, K. J., Bruehlman, R., Sereika, S., & Thase, M. E. (2001) · Family Practice · doi:10.1093/fampra/18.3.314 · Cited by 138
Correlates of life satisfaction among psychiatric patients
Koivumaa-Honkanen, H., Viinamäki, H. T., Honkanen, R., Tanskanen, A. J., Antikainen, R., NISKANEN, L. K., Jääskeläinen, J. E., & Lehtonen, J. (1996) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1996.tb09875.x · Cited by 138
“Depression (17, 18) and attributing one's problems to a mental illness (19) are associated with a reduced subjective quality of life in psychiatric patients.”
Backgroundde Groot, M. H., de Keijser, J., & Neeleman, J. (2006) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2006.36.4.418 · Cited by 139
TRIVEDI, R. B., Ayotte, B. J., Edelman, D. E., & Bosworth, H. B. (2008) · Journal of Behavioral Medicine · doi:10.1007/s10865-008-9173-4 · Cited by 138
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THE PSYCHOLOGICAL SYMPTOMS OF CONJUGAL BEREAVEMENT IN ELDERLY MEN OVER THE FIRST 13 MONTHS
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Valuck, R. J., Libby, A. M., Orton, H. D., Morrato, E. H., Allen, R. R., & Baldessarini, R. J. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07010007 · Cited by 137
Bortolotti, B., Menchetti, M., Bellini, F., Montaguti, M. B., & Berardi, D. (2008) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2008.04.001 · Cited by 136
Food insecurity and cognitive function in Puerto Rican adults
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Chronic Sorrow in the HIV-Positive Patient: Issues of Race, Gender, and Social Support
Lichtenstein, B., Laska, M. K., & Clair, J. M. (2002) · AIDS Patient Care and STDs · doi:10.1089/108729102753429370 · Cited by 137
“11,12 It is unclear how much of the depression in HIV-positive persons can be attributed to the effects of diagnosis itself, to medical factors such as illness and the effects of antiviral medications, or to changes in self-perception and social context.”
Hostility and pain are related to inflammation in older adults
Graham‐Engeland, J. E., Robles, T. F., Kiecolt‐Glaser, J. K., Malarkey, W. B., Bissell, M. G., & Glaser, R. (2006) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2005.11.002 · Cited by 145
Functioning and well-being of patients with panic disorder
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Self-citationPharmacotherapy of Depression in Older Patients: A Summary of the Expert Consensus Guidelines
Alexopoulos, G. S., Katz, I. R., Reynolds, C. F., Carpenter, D. P., Docherty, J. P., & ROSS, R. W. (2001) · Journal of Psychiatric Practice · doi:10.1097/00131746-200111000-00003 · Cited by 135
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Depression among high utilizers of medical care
Pearson, S. D., Katzelnick, D. J., Simon, G. E., Manning, W. G., Helstad, C. P., & Henk, H. J. (1999) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1999.06278.x · Cited by 131
“In this report, we use data from the screening phase of the study to examine the following among this group of patients: (1) the prevalence of unrecognized or unsuccessfully treated depression; (2) the association between depression and general medical illness; and (3) the relation of depression to resource utilizatio…”
MethodSubsyndromal symptomatic depression: A new concept
Sadek, N., & Bona, J. R. (2000) · Depression and Anxiety · doi:10.1002/1520-6394(2000)12:1 · Cited by 132
Quality of life in depression: Daily life determinants and variability
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“Its usefulness as a general outcome tool has been tested on a wide variety of mental health and general medical patients (e.g. Brazier et al., 1992; McHorney, Ware, & Raczek, 1993; Wells et al., 1989).”
MethodOkello, E. S., & Neema, S. (2006) · Qualitative Health Research · doi:10.1177/1049732306296433 · Cited by 130
Chelminski, P. R., Ives, T. J., Felix, K., Prakken, S., Miller, T. M., Perhac, J. S., Malone, R. M., Bryant, M. E., DeWalt, D. A., & Pignone, M. P. (2005) · BMC Health Services Research · doi:10.1186/1472-6963-5-3 · Cited by 132
“How to identify chronic pain patients at risk for drug misuse and to treat their pain remains a challenge [ 83-89 ].”
BackgroundResultPanic disorder and quality of life: variables predictive of functional impairment
Hollifield, M. A., Katon, W. J., SKIPPER, B. J., Chapman, T., Ballenger, J. C., Mannuzza, S., & Fyer, A. J. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.6.766 · Cited by 130
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The Need for Mental Health Promotion
Herrman, H. (2001) · Australian & New Zealand Journal of Psychiatry · doi:10.1046/j.1440-1614.2001.00947.x · Cited by 129
“Depression in older people is linked with social isolation, alcohol and drug abuse and smoking [28], and poor physical and role functioning [29].”
BackgroundRavindran, A. V., Anisman, H., Merali, Z., Charbonneau, Y., Telner, J. I., Bialik, R. J., Wiens, A., Ellis, J., & Griffiths, J. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.10.1608 · Cited by 130
Interventions to improve occupational health in depressed people
Nieuwenhuijsen, K., Bültmann, U., Neumeyer-Gromen, A., Verhoeven, A. C., Verbeek, J. H., & Feltz-Cornelis, C. M. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006237.pub2 · Cited by 129
Current Considerations in the Treatment of Generalized Anxiety Disorder
Katzman, M. A. (2009) · CNS Drugs · doi:10.2165/00023210-200923020-00002 · Cited by 128
Craighead, W. E., & Dunlop, B. W. (2011) · Annual Review of Psychology · doi:10.1146/annurev.psych.121208.131653 · Cited by 130
Rollman, B. L., Hanusa, B. H., Lowe, H., Gilbert, T., Kapoor, W. N., & Schulberg, H. C. (2002) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2002.10421.x · Cited by 125
Is The Prevalence Of Mental Disorders A Good Measure Of The Need For Services?
Mechanic, D. (2003) · Health Affairs · doi:10.1377/hlthaff.22.5.8 · Cited by 126
Quality of life in tuberculosis: Patient and provider perspectives
Hansel, N. N., Wu, A. W., Chang, B. W., & Diette, G. B. (2004) · Quality of Life Research · doi:10.1023/b:qure.0000021317.12945.f0 · Cited by 129
THE EPIDEMIOLOGY OF PSYCHIATRIC DISORDERS AND THE DE FACTO MENTAL HEALTH CARE SYSTEM
NORQUIST, G. S., & Regier, D. A. (1996) · Annual Review of Medicine · doi:10.1146/annurev.med.47.1.473 · Cited by 127
Health Status among Women with Menstrual Symptoms
Barnard, K., Frayne, S. M., Skinner, K. M., & SULLIVAN, L. M. (2003) · Journal of Women s Health · doi:10.1089/154099903770948140 · Cited by 129
Depression in a Primary Care Clinic: the Prevalence and Impact of an Unrecognized Disorder
McQuaid, J. R., Stein, M. B., Laffaye, C., & McCahill, M. E. (1999) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00191-8 · Cited by 121
Cooke, R. G. (1996) · Journal of Affective Disorders · doi:10.1016/0165-0327(96)00016-x · Cited by 129
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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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