We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of enrollees in health maintenance organizations (N = 145) in the top decile of users of ambulatory health care who exceeded the 70th percentile of health maintenance organization population norms for depression. Improved depression was defined as a reduction of at least one third in depressive symptoms averaged across the two follow-up times. At the 12-month follow-up, persons with severe-improved depression experienced a 36% reduction in disability days (79 days per year to 51 days per year) and a 45% reduction in disability score. Persons with moderate-improved depression experienced a 72% reduction in disability days (62 days per year to 18 days per year) and a 40% reduction in disability score. In contrast, persons with severe-unimproved depression reported 134 disability days per year at baseline, while persons with moderate-unimproved depression reported 77 disability days per year at baseline. Neither group with unimproved depression showed improvement in either disability days or disability score during the 1-year follow-up period. High utilizers of health care with severe-unimproved depression were more likely to have current major depression and to be unemployed. Improved (relative to unimproved) depression was associated with borderline differences in the severity of physical disease and in the percent married. We conclude that depression and disability showed synchrony in change over time. However, depression and disability may show synchrony in change with disability because both depression and disability are controlled by some other factor that influences the chronicity of depression (eg, chronic disease or personality disorder). The finding of synchronous change of depression and disability provides a rationale for randomized controlled trials of depression treatments among depressed and disabled medical patients to determine whether psychiatric intervention might improve functional status in such patients. Such research is needed to determine whether there is a causal relationship between depression offset and reductions in functional disability.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=psych&articleId=495638&pdfFileName=archpsyc_49_2_002.pdf

Disability and depression among high utilizers of health-care - a longitudinal analysis

Based on a large and representative sample of physically disabled persons resident in the community, this paper considers the association between disability and risk for depression and examines the relevance of stress process variables in accounting for variations in depression. Using two waves of data spaced four years apart, we demonstrate that the disabled are at dramatically elevated risk for depressive symptoms and that this high level of depression characterizes both men and women of all ages. Longitudinal analyses show eventful stress, chronic strain, mastery, and social support to be significant determinants of depression in this population. Only the effects of mastery and social support, however, are clearly observable within all age groups.

https://www.jstor.org/stable/info/2137178

Physical disability and depression: a longitudinal analysis.

8 – Assessment of Chronic Pain

ContextCompensation, whether through workers’ compensation or through
litigation, has been associated with poor outcome after surgery; however,
this association has not been examined by meta-analysis.ObjectiveTo investigate the association between compensation status and outcome
after surgery.Data SourcesWe searched MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL, the Cochrane
Controlled Trials Register, and reference lists of retrieved articles and
textbooks, and we contacted experts in the field.Study SelectionThe review included any trial of surgical intervention in which compensation
status was reported and results were compared according to that status. No
restrictions were placed on study design, language, or publication date. Studies
were selected by 2 unblinded independent reviewers.Data ExtractionTwo reviewers independently extracted data on study type, study quality,
surgical procedure, outcome, country of origin, length and completeness of
follow-up, and compensation type.Data SynthesisTwo hundred eleven studies satisfied the inclusion criteria. Of these,
175 stated that the presence of compensation (workers’ compensation
with or without litigation) was associated with a worse outcome, 35 found
no difference or did not describe a difference, and 1 described a benefit
associated with compensation. A meta-analysis of 129 studies with available
data (n = 20 498 patients) revealed the summary odds ratio for an unsatisfactory
outcome in compensated patients to be 3.79 (95% confidence interval, 3.28-4.37
by random-effects model). Grouping studies by country, procedure, length of
follow-up, completeness of follow-up, study type, and type of compensation
showed the association to be consistent for all subgroups.ConclusionsCompensation status is associated with poor outcome after surgery. This
effect is significant, clinically important, and consistent. Because data
were obtained from observational studies and were not homogeneous, the summary
effect should be interpreted with caution. Compensation status should be considered
a potential confounder in all studies of surgical intervention. Determination
of the mechanism for this association requires further study.

Association between compensation status and outcome after surgery : A meta-analysis

Factors associated with injury proneness.

MMPI profiles from a random sample of 1,064 physical (nonpsychiatric) disability insurance claimants were compared with those of 14,306 general medical patients, matched for age and sex, seen at the Mayo Clinic. In contrast with the latter, the disability insurance claimants produced mean profiles in the clinically significant range. These results confirm earlier clinical findings that between 35 and 44 percent of the physical disability sample suffered from moderate to severe psychoneuroses or personality disorders.

John M. Little

Papers

MMPI Profiles of Disability Insurance Claimants