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The Relationship of Medical Comorbidity and Depression in Older, Primary Care Patients

Received August 30, 2005; revised November 14, 2005; accepted November 30, 2005. From the Program in Geriatrics and Neuropsychiatry, Dept. of Psychiatry and Dept. of Biostatistics and Computational Biology, Univ. of Rochester Medical Center; and the Advanced Center in Interventions and Services Research for Late-Life Mood Disorders, Dept. of Psychiatry, Univ. of Pittsburgh School of Medicine, Pittsburgh, PA. Address correspondence and reprint requests to Dr. Lyness, Dept. of Psychiatry, Univ. of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642. e-mail: Jeffrey_Lyness{at}urmc.rochester.edu

Comorbid medical illnesses are a key feature of geriatric mood disorders, yet the specificity of such associations remains unclear. In a sample of 546 primary care patients age 65 years, pathology in several organ systems (respiratory, eye/ear/nose/throat, gastrointestinal, central nervous system, endocrine) and several chronic conditions (neurological disease, low vision, chronic obstructive pulmonary disease, diabetes) were associated with depression. However, notwithstanding these specific associations, global (overall) medical burden was most powerfully and independently associated with depression, largely independent of functional status. This generates the hypothesis that, in general primary care populations, the relationship of medical illness to depression may be multimodal and/or may involve shared pathobiological or psychosocial mechanisms.

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