Chronic medical conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects

Abstract

Background. This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental health effects.Methods. Data were obtained from a population-based, cross-sectional survey of 5078 non-institutionalized, late middle-aged and older Dutch persons. The predictors were 16 types of CMCs, including all major chronic medical diseases as well as impairment of hearing, vision, and cognition. The outcomes were assessed in terms of psychological distress as measured by the Hospital Anxiety and Depression Scale. Two aspects of disability were measured (namely, physical and role functioning) and also three psychosocial resources (namely, mastery, self-efficacy and social support).Results. Level of psychological distress varied across type of CMC. Hearing impairment, neurological disease, vision impairment, and lung and heart disease had particularly strong associations with distress. The level of distress in patients with hearing impairment was 0·45 standard deviation higher than in those without hearing impairment (adjusted for demographics and all other CMCs). Roughly similar patterns of association were found between type of CMC and disability, and also, but to a lesser extent, mastery and self-efficacy. Stepwise multiple regression revealed that type of CMC accounted for 9%of the variance in distress initially, but this fell to 1% after the variance due to disability, mastery and self-efficacy was taken out. Social support was not a mediator. Disability and psychosocial resources accounted for 13% and 14% of the variance in distress, respectively.Conclusion. These results support the conventional wisdom that it is not the nature of the condition that determines psychological distress, but instead the severity of the disability and loss of psychological resources associated with the condition on the one hand and the psychological characteristics of the patient on the other.

Urinary Incontinence and Psychological Distress in Community‐Dwelling Older Adults

“…A more realistic mediation scenario posits a reciprocal relationship between depression and condition-specific functional impairment. Nevertheless, our findings support a general conceptual model, suggested for conditions other than UI such as low vision, 20 arthritis, 21 or other chronic medical conditions, 22 that conditionspecific functional impairment mediates the relationship between a chronic medical condition and psychological distress.…”

“…19 Withdrawal from activities, even if self-imposed, may lead to feelings of loss of control and diminished life satisfaction. Previous research has suggested that condition-specific functional loss accompanying low vision, 20 arthritis, 21 or other chronic medical conditions 22 was associated with depression. However, no previous research has examined whether persons with UI associated with condition-specific functional loss are more likely to have depressive symptoms than persons who do not report condition-specific functional loss due to UI.…”

Psychological problems following ICU treatment*

“…They warrant expert assessment for depression or anxiety as this score is above`disorder likely' threshold. In comparison, Ormel [15] found that 24.5% of a large sample of chronic medical patients scored above 12 on the HADS. In common with most psychological screening instruments, the sensitivity of the HADS is excellent (100% in one study of medical patients [16]) but the specificity is less impressive (ranging from 73% in one study [6] to 94% in another [17]).…”

The Relative Contribution of Domains of Quality of Life to Overall Quality of Life for Different Chronic Diseases

“…GLAS was a population-based prospective followup study of the psychological and social determinants of disease, functional disability, wellbeing and utilisation of care in older people [21,[23][24][25][26][27]. The primary objective of this study was to identify the psychosocial factors that influence the trajectory of QoL, independently or in interplay with diseaserelated factors.…”