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Major Depression and Disability in Older Primary Care Patients With Heart Failure

Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Department of Psychiatry University of Rochester School of Medicine and Dentistry, Rochester, New York, Bruce_Friedman{at}urmc.rochester.edu

Jeffrey M. Lyness, MD

Department of Psychiatry University of Rochester School of Medicine and Dentistry, Rochester, New York

Rachel L. Delavan, MS

Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry

Chunyu Li, MM

Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry

William H. Barker, MD

Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry

The purpose of this study was to examine the association between dependence in activities of daily living (ADL) and instrumental ADL (IADL) and major depression among 415 community-dwelling primary care patients age 65+ with heart failure and significant ADL or IADL dependence. Main findings include (1) a progressive increase in depression prevalence from 0% for no IADL dependence to about 40% for 6 IADL dependencies (P < .001), (2) a steady rise in depression prevalence to 40% for 6 ADL dependencies following a "floor effect" at about 10% for 0 to 2 ADL dependencies (P < .001), and (3) the association in a logistic regression model of major depression with number of IADL dependencies (P = .016) but not with number of ADL dependencies (P = .602). Our principal conclusion is that the progressively greater likelihood of major depression as the number of IADL dependencies increases has important clinical, personal, social, and public health relevance.

Key Words: heart failure • depression • activities of daily living • instrumental activities of daily living • primary care

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