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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“Our findings correspond to the studies implying that depressive disorders and symptoms significantly impair functioning in a number of areas, including work functioning, social functioning and HRQoL.(26,27) In addition, Goldstein et al.”
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Martinez, P., Andia, I., Emenyonu, N., Hahn, J. A., Hauff, E., Pepper, L., & Bangsberg, D. R. (2008) · AIDS and Behavior · doi:10.1007/s10461-007-9312-x · Cited by 68
“This may be due to a lower functional status that limits the ability to participate in long term health care (Wells et al. 1989), more chaotic health care use (Joyce et al. 2005), decreased motivation to accept therapy (Maisels et al. 2001), or provider concerns about decreased adherence (Fairfield…”
Background
Fibromyalgia, physical activity, and daily functioning: The importance of efficacy and health-related quality of life
Culos-Reed, S. N., & Brawley, L. R. (2000) · Arthritis & Rheumatism · doi:10.1002/1529-0131(200012)13:6 · Cited by 66
Mushroom intake and depression: A population-based study using data from the US National Health and Nutrition Examination Survey (NHANES), 2005–2016
Ba, D. M., Gao, X., Al‐Shaar, L., Muscat, J. E., Chinchilli, V. M., Beelman, R. B., & Richie, J. P. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.080 · Cited by 70
Persons with Depressive Symptoms and the Treatments They Receive: A Comparison of Primary Care Physicians and Psychiatrists
Pingitore, D. P., Snowden, L. R., Sansone, R. A., & Klinkman, M. S. (2001) · The International Journal of Psychiatry in Medicine · doi:10.2190/6bul-mwtq-0m18-30gl · Cited by 67
Prediction of childhood ADHD symptoms to quality of life in young adults: Adult ADHD and anxiety/depression as mediators
Yang, H.-N., Tai, Y.-M., Yang, L.-K., & Gau, S. S.-F. (2013) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2013.06.011 · Cited by 67
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Wu, D. Y., Muñoz, M., Espiritu, B., Zeladita-Huamán, J. A., Sánchez, E., Callacna, M., Rojas, C., Arévalo, J., Caldas, A., & Shin, S. S. (2008) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e31817dc3e9 · Cited by 66
Additive and Interactive Effects of Comorbid Physical and Mental Conditions on Functional Health
Fultz, N. H., Ofstedal, M. B., Herzog, A. R., et al. (2003) · Journal of Aging and Health · doi:10.1177/0898264303253502 · Cited by 68
“This finding con tributes to the growing body of research that documents the debilitat ing impact of mental health disorders on functional outcomes (e.g., Aguero-Torres et al., 1998; Oslin, Streim, Katz, Edell, & TenHave, 2000; Ostir et al., 2002; Wells et al., 1989).”
Background
Quality of life outcomes among patients with depression after 6 months of starting treatment: Results from FINDER
Reed, C. C., Monz, B. U., David, P., Gandhi, P., Bauer, M., Dantchev, N., Demyttenaere, K., Garcia-Cebrian, A., Grassi, L. G., Quail, D., et al. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.05.021 · Cited by 70
Measuring Antidepressant Prescribing Practice in a Health Care System Using Administrative Data: Implications for Quality Measurement and Improvement
Kerr, E. A., McGlynn, E. A., Vorst, K. A. V., & Wickstrom, S. L. (2000) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(00)26015-x · Cited by 67
Depression, use of medical services and cost-offset effects
Simon, G. E., & Katzelnick, D. J. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)00367-4 · Cited by 70
Factors which provoke post-infarction depression: Results from the post-infarction late potential study (PILP)
Ladwig, K., Lehmacher, W., Roth, R., BREITHARDT, G. E., Budde, T., & Borggrefe, M. (1992) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(92)90130-t · Cited by 68
The Quality Improvement for Depression Collaboration: general analytic strategies for a coordinated study of quality improvement in depression care
ROST, K. M., Duan, N., Rubenstein, L. V., Ford, D. E., Sherbourne, C. D., Meredith, L. S., & Wells, K. B. (2001) · General Hospital Psychiatry · doi:10.1016/s0163-8343(01)00157-8 · Cited by 68
Self-citation
Classification of Depression: Research and Diagnostic Criteria: DSM‐IV and ICD‐10
GRUENBERG, A. M., Goldstein, R. D., & Pincus, H. A. (2005) · doi:10.1002/9783527619672.ch1 · Cited by 68
Health-related quality of life following ECT in a large community sample
McCall, W. V., Prudic, J., Olfson, M., & Sackeïm, H. A. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2005.12.002 · Cited by 66
Deficits in Psychological Well‐Being and Quality‐of‐Life in Minor Depression: Implications for DSM‐V
Nierenberg, A. A., Rapaport, M. H., Schettler, P. J., Howland, R. H., Smith, J. A., Edwards, D., Schneider, T., & Mischoulon, D. (2010) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2009.00108.x · Cited by 75
“Follow-up studies suggest that Min D increases the likelihood of developing future MDD [1,3,11,33] and even in cases where Min D does not lead to MDD, patients have multiple recurrent disabling episodes [5].”
Background
Effectiveness of a psycho-educational group program for major depression in primary care: a randomized controlled trial
Casañas, R., Catalán, R., García, J. L. D. V., Real, J., Valero, S., & Casas, M. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-230 · Cited by 69
“The impact of depression on patients’ well-being and QoL has been shown to be equal to or greater than several other major chronic medical conditions such as diabetes mellitus, heart disease and arthritis [6-8].”
Background
The Argentine–Spanish SF-36 Health Survey was successfully validated for local outcome research
Augustovski, F., Lewin, G., García‐Elorrio, E., et al. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2008.05.004 · Cited by 67
Men's Adjustment to Prostate Cancer: The Role of Agency and Unmitigated Agency
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Acute Effects of Fluoxetine Versus
Heiligenstein, J. H., Ware, J. E., Beusterien, K. M., Roback, P., Andrejasich, C. M., & Tollefson, G. D. (1995) · International Psychogeriatrics · doi:10.1017/s1041610295002407 · Cited by 67
Major Depression in Primary Care Practice
Schulberg, H. C., Madonia, M. J., Block, M. R., Coulehan, J. L., Scott, C. P., Rodríguez, E., & Black, A. (1995) · Psychosomatics · doi:10.1016/s0033-3182(95)71682-6 · Cited by 67
Prevention of depression: The state of the science at the beginning of the 21st Century
Barrera, A. Z., Torres, L. D., & Muñoz, R. F. (2007) · International Review of Psychiatry · doi:10.1080/09540260701797894 · Cited by 65
“Subclinical depressive symptoms can have a substantial impact on functioning (Wells et al., 1989) and thus can be an important target for preventive interventions.”
Background
Impairments in Health Functioning and Sleep Quality in Older Adults with a History of Depression
Motivala, S. J., Levin, M. J., Oxman, M. N., & Irwin, M. R. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00819.x · Cited by 66
“Major depression leads to further impairments in health perceptions and physical performance in older people,(7) and such disability is comparable with the impairments found in patients with chronic medical disorders such as arthritis or diabetes mellitus.(8,9) Given evidence that poor physical functioning is reported…”
Depression as a determinant of quality of life in patients with chronic disease: data from Brazil
Cruz, L. N., Fleck, M. P. D. A., & Polanczyk, C. A. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0141-2 · Cited by 66
Incidence of Disability Among Preretirement Adults: The Impact of Depression
Dunlop, D. D., Manheim, L. M., Song, J., Lyons, J. S., & Chang, R. W. (2005) · American Journal of Public Health · doi:10.2105/ajph.2004.050948 · Cited by 66

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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