Cited by 2,130Mental Health Treatment and AccessTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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The Functioning and Well-being of Depressed Patients: Results From the Medical Outcomes Study

Wells, Kenneth B.·1989·JAMA

DOI 10.1001/jama.1989.03430070062031

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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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Background
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Background
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Background
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Background
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Self-citation
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“Moreover, functional limitations due to depression are additive to the limitations from the medical conditions [45].”
Background
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“These cut-offs are now almost universally used to present K10 and K6 results [26].”
BackgroundMethod
Development and Validation of a Discriminative Quality of Life Questionnaire for Osteoporosis (The OPTQoL)
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Background
Are SSRIs a Cost-Effective Alternative to Tricyclics?
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“This finding provides further evidence, in a new setting, of the well-established relationship of QOL with mood and anxiety disorders (Wells et al., 1989; Mendlowicz and Stein, 2000).”
Background
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Assessment depression in primary care practice with the Beck Depression Inventory and the Hamilton Rating Scale for Depression.
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“There were multiple significant sleep effects favoring ESZ, but not every difference was statistically significant; this is not surprising given that (1) this investigation was not powered to detect differences for the sleep outcomes, and (2) we did not have any PSG or actigraphy severity criteria for inclusion into t…”
Result
Mood disorders: rural/urban differences in prevalence, health care utilization, and disability in Ontario
Parikh, S. V., WASYLENKI, D. A., Goering, P. N., & Wong, J. (1996) · Journal of Affective Disorders · doi:10.1016/0165-0327(95)00096-8 · Cited by 102
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Hagen, E. H. (2003) · The MIT Press eBooks · doi:10.7551/mitpress/3232.003.0008 · Cited by 108
Physical health, depression and cognitive function as correlates of disability in an older Korean population
Kim, J., Stewart, R. J., Glozier, N., Prince, M. J., Kim, S., Yang, S., Shin, I., & Yoon, J. (2005) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1266 · Cited by 101
“Disability has also been found to be strongly associated with depression both in community populations (Berkman et al., 1986; Wells et al., 1989; Beekman et al., 1997; Prince et al., 1998; Sinclair et al., 2001) and in Copyright # 2005 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2005; 20:…”
BackgroundInfluential
Long-term work disability and absenteeism in anxiety and depressive disorders
Hendriks, S. M., Spijker, J., Licht, C. M. M., Hardeveld, F., de Graaf, R., Batelaan, N. M., Penninx, B. W. J. H., & Beekman, A. T. F. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.03.004 · Cited by 101
Quality of Life in Social Anxiety Disorder Compared With Panic Disorder and the General Population
Simon, N. M., Otto, M. W., Korbly, N. B., Peters, P., Nicolaou, D. C., & Pollack, M. H. (2002) · Psychiatric Services · doi:10.1176/appi.ps.53.6.714 · Cited by 100
Depression and low bone mineral density: a meta-analysis of epidemiologic studies
Wu, Q., Magnus, J. H., Liu, J., Bencaz, A. F., & Hentz, J. G. (2009) · Osteoporosis International · doi:10.1007/s00198-009-0918-x · Cited by 102
Implementation of Primary Care-Mental Health Integration Services in the Veterans Health Administration: Program Activity and Associations with Engagement in Specialty Mental Health Services
Wray, L. O., Szymanski, B. R., Kearney, L. K., & McCarthy, J. F. (2012) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-011-9285-9 · Cited by 99
“…medical costs (Insel, 2008; Murray & Lopez, 1996; Regier et al., 1993; Simon, Ormel, Von Korff, & Barlow, 1995), increased complications in the care of comorbid medical illness (Institute of Medicine, Institute of Medicine 2001; Wells et al., 1989), and reduced quality of life (Bush et al., 2005).”
Background
Management of depression in rheumatoid arthritis: A combined pharmacologic and cognitive‐behavioral approach
Parker, J. C., Smarr, K. L., Slaughter, J. R., Johnston, S. K., Priesmeyer, M. L., Hanson, K. D., Johnson, G. E., Hewett, J. E., Hewett, J. E., Irvin, W. S., et al. (2003) · Arthritis Care & Research · doi:10.1002/art.11459 · Cited by 97
The prevalence and correlates of workplace depression in the national comorbidity survey replication
Kessler, R. C., Merikangas, K. R., & Wang, P. S. (2008) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0b013e31816ba9b8 · Cited by 96
“Second, depression appears to have substantial adverse effects on workplace functioning.(11,12) A number of excellent reviews of recent research document the evidence on this point.”
Background
Levels of disability in Major Depression
Kruijshaar, M. E., Hoeymans, N., Bijl, R. V., Spijker, J., & Essink‐Bot, M. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00099-x · Cited by 101
Self‐reported life satisfaction and treatment factors in patients with schizophrenia, major depression and anxiety disorder
Koivumaa-Honkanen, H. T., Honkanen, R., Antikainen, R., Hintikka, J., & Viinamäki, H. T. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb07244.x · Cited by 96
Mood disorders in elderly patients with chronic obstructive pulmonary disease
Yohannes, A. M., Baldwin, R., & Connolly, M. J. (2000) · Reviews in Clinical Gerontology · doi:10.1017/s0959259800002100 · Cited by 99
Outcomes research in mental health
Gilbody, S. M., House, A. O., & Sheldon, T. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.181.1.8 · Cited by 103
“Studies that recruited subjects prospectively, such as the MOS (Wells et al, 1989), achieved smaller sample sizes (n¼1772) than those selecting subjects retrospectively from large, existing data-sets (Croghan et al, 1999; Rosenheck et al, 1999a) (median n¼4052).”
BackgroundMethodInfluential
Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care
Duran, B., Sanders, M., SKIPPER, B. J., Waitzkin, H. B., Malcoe, L. H., Paine, S., & Yager, J. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.1.71 · Cited by 99
Predicting sexual and psychologic morbidity and improving the quality of life for women with gynecologic cancer
Andersen, B. L. (1993) · Cancer · doi:10.1002/cncr.2820710437 · Cited by 99
Physical Symptoms and Depressive Symptoms Among Individuals With HIV Infection
Belkin, G. S., Fleishman, J. A., Stein, M. D., Piette, J. D., & Mor, V. (1992) · Psychosomatics · doi:10.1016/s0033-3182(92)71946-x · Cited by 97
Depressive symptoms associated with scleroderma
Roca, R. P., Wigley, F. M., & White, B. (1996) · Arthritis & Rheumatism · doi:10.1002/art.1780390623 · Cited by 98
Outcome of depression in later life in primary care: longitudinal cohort study with three years' follow-up
Licht-Strunk, E., van Marwijk, H., Hoekstra, T., Twisk, J. W. R., Haan, M. D., & Beekman, A. T. F. (2009) · BMJ · doi:10.1136/bmj.a3079 · Cited by 100
An Efficient Method of Identifying Major Depression and Panic Disorder in Primary Care
Means‐Christensen, A. J., Arnau, R. C., Tonidandel, A., Bramson, R., & Meagher, M. W. (2005) · Journal of Behavioral Medicine · doi:10.1007/s10865-005-9023-6 · Cited by 100
“This is particularly troubling in light of data indicating that mental health problems like depression are associated with impairments in functioning comparable to or greater than those demonstrated by people with chronic medical conditions (McQuaid et al., 1999 ;O rmelet al., 1998; Schonfeld et al., 1997; Wells et al…”
Result
The Clinical and Public Health Relevance of Current Research on Subthreshold Depressive Symptoms to Elderly Patients
Judd, L. L., & Akiskal, H. S. (2002) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200205000-00002 · Cited by 98
Psychometric properties of the short Warwick Edinburgh mental well-being scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders
Vaingankar, J. A., Abdin, E., Chong, S. A., Sambasivam, R., Seow, E., Jeyagurunathan, A., Picco, L., Stewart-Brown, S. L., & Subramaniam, M. (2017) · Health and Quality of Life Outcomes · doi:10.1186/s12955-017-0728-3 · Cited by 96
“It is well established that apart from psychological and emotional well-being, mental illnesses have a significant negative impact on the functioning and social well-being of those affected [4].”
Background
DSM-IV and new diagnostic categories: holding the line on proliferation
(1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.1.112 · Cited by 96
Revisão das diretrizes da Associação Médica Brasileira para o tratamento da depressão (Versão integral)
Fleck, M. P. D. A., Berlim, M. T., Lafer, B., Sougey, É. B., Porto, J. A. D., Brasil, M. A. A., Juruena, M. F., & Hetem, L. A. (2009) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462009000500003 · Cited by 101
Barriers to the provision of evidence-based psychosocial care in oncology
Schofield, P. E., Carey, M. L., Bonevski, B., & Sanson‐Fisher, R. (2005) · Psycho-Oncology · doi:10.1002/pon.1017 · Cited by 99
“Untreated psychological conditions can result in greater pain (Wells et al., 1989) poorer physical functioning (Wells et al., 1989), higher medical costs, and longer hospital stays (Fulop et al., 1987; Levenson et al., 1990; Simon et al., 1995) and therefore place an added burden on the health…”
BackgroundInfluential
Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events
MILANI, R. V., & Lavie, C. J. (1996) · The American Journal of Medicine · doi:10.1016/s0002-9343(96)00020-4 · Cited by 97
Assessment of quality of life before and after surgery for severe obesity
Kral, J., Sjöström, L., & Sullivan, M. (1992) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/55.2.611s · Cited by 97
A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions
McKinnon, M. C., Boyd, J. E., Frewen, P. A., Lanius, U. F., Jetly, R., Richardson, J. D., & Lanius, R. A. (2016) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.07.017 · Cited by 94
“…psychiatric disorders, including PTSD (Charuvastra and Cloitre, 2008; Lanius et al., 2011; Olatunji et al., 2007), mood disorders (Romera et al., 2010; Wells et al., 1989), and schizophrenia (Couture, 2006; Fett et al., 2011) and is associated with reduced treatment efficacy (Sotsky et al., 1991).”
Clinician Screening and Treatment of Alcohol, Drug, and Mental Problems in Primary Care
Edlund, M. J., Un??tzer, J., & Wells, K. B. (2004) · Medical Care · doi:10.1097/00005650-200412000-00002 · Cited by 94
Self-citation
Gender differences in depression detection: A comparison of clinician diagnosis and standardized assessment.
Potts, M. K., Burnam, M. A., & Wells, K. B. (1991) · Psychological Assessment · doi:10.1037/1040-3590.3.4.609 · Cited by 101
Self-citation
Predictors of women's physical health problems after childbirth
Ansara, D. L., Cohen, M. M., Gallop, R., Kung, R., & Schei, B. (2005) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/01443610400023064 · Cited by 96
“Depressed individuals have also been found to have more functional disability [ 19 ] and to have more frequent use of the health care system [20] than nondepressed individuals.”
Background

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
DOI: 10.1001/jama.1989.03430070062031
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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The Functioning and Well-being of Depressed Patients: Results From the Medical Outcomes Study

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