Nitz NM, Garrard J, Rolnick SJ, Waller LA; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1998; 15: 190-1.
Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis 55455-0381, USA.
RESEARCH OBJECTIVE(S): We know less about the interpretation of the SF-36 health-transition question in the depressed elderly than in the general population. This paper examines whether depressive symptoms modify the association between self-reported health transition and one-year changes in health status. STUDY DESIGN: This is part of a longitudinal study examining patient outcomes associated with depressive symptoms, chronic disease, disability and antidepressant use among the enrollees of an HMO who were 65 years and older and living independently in the community. Sociodemographic data came from the computerized enrollement files. Enrollees were screened for depressive symptoms usign the Geriatric Depression Screeing (GDS) tool. We confirmed the presence of depressive symptoms with the telephone survey of the Diagnostic Interview Schedule (DIS), which was administered to a sample selected from the respondents to the GDS, with the sample stratified on GDS depressive symptoms and antidepressant use in the year before the GDS survey. The DIS respondents were grouped into categories of depressive-symptoms status: no symptoms, one to three symptoms (mild depression), and more than three symptoms (serious indication of depression). The 582 respondents to the DIS (78% response rate) received the Medical Outcomes Study (MOS) Short-Form 36 (SF-36) survey in March 1994. The 549 respondents to the first SF-36 survey received a follow-up SF-36 survey in March 1995 (460 responded). In addition to eight health-status subscales, the MOS SF-36 contains the question 'Compared to one year ago, how would you rate your health in general now', with 5 responses ranging from 'Much worse now' to 'Much better now'. For each of the eight SF-36 subscales, we regressed the response to the 2nd year health-transition question on the one-year change in SF-36 score, Baseline SF-36 score, DIS depression status, age, and gender. We also ran models with interaction terms for DIS depression status and one-year changes in SF-36 scale scores. PRINCIPAL FINDINGS: Self-reported health-transition was positively associatedwith changes in and baseline levels of each of the eight subscales (p<0.001 for each). In addition, in the regressions with pain, role limitations due to physical problems, and social-function, self-reported health-transition was negatively associated with level of depressive symptoms (p<.05) and positively associated with baseline levels and changes in these subscales (p<0.0001). Gender and Age were not significant in any of the models. The test for interaction between depressive symptom level and change in pain was significant, adjusted for gender, age, baseline pain level, and change in pain. With the non-depressed as the reference group, those with one to three depressive symptoms had a stronger association between changes in pain level and self-assessed health transition (B=0.217, C.I. 0.074, 0.360). Similar conclusions held true for the mental health and role limitations due to emotional health scales, but not for the other five scales. CONCLUSIONS: The level of depressive symptoms influences self-reported assessment of health transition. Mild depression plays an especially important role, both independently influencing self-reported health transition, and modifying the effect of actual changes in SF-36 health status scores on self-assessment of changes in general health. Changes in mental health, pain, and role limitations due to emotional problems had a greater impact on self-reported health transition for those who were mildly depressed than for those who were not depressed. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: Even mild depression affects how community-dwelling elderly assess their change in general health. The relationship between self-assessed transition in health and measured changes in health status depends on the initial level of depressive symptoms. Interpretations of the health transition question as a measure of health outcome for the elderly should account for the influence of low levels of depressive symptoms as well as more severe levels of depression. Mild depression may have a greater impact on the elderly than previously found in the literature.
Publication Types:
Keywords:
- Aged
- Data Collection
- Depression
- Depressive Disorder
- Health Status
- Health Transition
- Humans
- Longitudinal Studies
- Residence Characteristics
- Self Assessment (Psychology)
- hsrmtgs
Other ID:
UI: 102234356
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