Study Ranks Depression With Chronic Medical Illnesses

Patients with depression are at least as impaired in their day-to-day activities--often more so--as patients with chronic medical conditions such as diabetes, according to a new study.

The findings are published in three articles in today’s issue of the Journal of the American Medical Assn.

The articles are the first reports from the “Medical Outcomes Study,” an ambitious $11.5-million research project designed to find ways to improve the care of patients with chronic medical conditions. The study involves 22,462 patients cared for by 523 physicians in Los Angeles, Boston and Chicago.

Depressed patients in the study were more likely to have problems with work, housework or school, or to spend days in bed than patients with diabetes, arthritis, back pain and gastrointestinal problems. They were more likely to report bodily pain than patients with diabetes, heart disease or lung problems.

Heart Conditions Cited

Current heart conditions were the only chronic illnesses likely to diminish overall functioning as much as depression.

The researchers at the New England Medical Center in Boston, the RAND Corp. in Santa Monica and other institutions also found that patients with heart disease and gastrointestinal disorders had greater impairment of daily functioning than patients with other chronic medical conditions.

Patients with high blood pressure had the least impairment. Patients with several chronic conditions had more impairment than those with a single condition.

Dr. Sheldon Greenfield, a former RAND researcher who is now at the New England Medical Center, said the study has developed “a paradigm” or model for judging the quality of care provided by physicians in their offices. It includes measures of patient well-being as well as data obtained from medical and financial records.

Purpose of Study

The aim is to enable doctors to measure patient well-being as accurately as they measure blood pressure or white-cell count.

Eventually, Greenfield said the new methods may be used to compare quality of care between different physicians and different health care systems as well as to monitor the performanceof individual physicians over time.

The study differs from many previous quality-of-care studies. It emphasizes patient-oriented factors in addition to medical and economic factors such as costs, deaths and complications. The patient-oriented factors include bodily pain and the extent to which health interferes with daily activities ranging from sports, dressing and going to work to visits with friends.

The life style factors are measured with a brief patient questionnaire, which has been standardized so that it can be used for many diseases.

For each disease, the researchers developed standardized profiles for different dimensions of daily functioning. Patients with arthritis, for example, tended to have more bodily pain that patients who had suffered heart attacks. But they had less overall physical or work impairment.

Good Care Important

After correcting for variations in the severity of illness, patients who receive good care for arthritis or heart disease would be likely to have substantially better standardized profiles than patients who received poor medical care, according to the study.

The researchers said the depression findings may counteract a tendency to downplay the significance of “the limitations associated with depression.”