P346
ORMEL ET AL.
and functioning in the elderly. American Journal of Epidemiology, 124,
372–388.
increased and premature mortality (e.g., Penninx et al., 1999).
Second, those who experience a significant deterioration in
health are more likely to obtain medical care and rehabilita-
tion than are those with stable health, which may in part
neutralize the deterioration. In addition, developmental pro-
cesses in elderly adults may make them less prone to de-
pression when disability has become an expected part of
aging (Sullivan, 1997).
Brilman, E. I., & Ormel, J. (2001). Life events, difficulties, and onset of de-
pressive episodes in later life. Psychological Medicine, 31, 859–869.
Bruce, M. L., Seeman, T. E., Merrill, S. S., & Blazer, D. G. (1994). The im-
pact of depressive symptomatology on physical disability: MacArthur
Studies of Successful Aging. American Journal of Public Health, 84,
1796–1799.
Coulehan, J. L., Schulberg, H. C., Block, M. R., Madonia, M. J., & Rod-
riguez, E. (1997). Treating depressed primary care patients improves
their physical, mental, and social functioning. Archives of Internal
Medicine, 157, 1113–1120.
Policy Significance
Duncan-Jones, P., Fergusson, D., Ormel, J., & Horwood, L. (1990). A
model of stability and change in minor psychiatric symptoms: Results
from three longitudinal studies. Psychological Medicine (Monograph
Suppl. No. 18). Cambridge, England: Cambridge University Press.
Eid, M., Notz, P., Steyer, R., & Schwenkmezger, P. (1994). Validating
scales for the assessment of mood level and variability by latent state–
trait analyses. Personal and Individual Differences, 16, 63–76.
Kempen, G. I. J. M., Miedema, I., Ormel, J., & Molenaar, W. (1996). The
assessment of disability with the Groningen Activity Restriction Scale:
Conceptual framework and psychometric properties. Social Science
and Medicine, 43, 1601–1610.
Kempen, G. I. J. M., Ormel, J., Brilman, E. I., & Relyveld, J. (1997). Adap-
tive responses among Dutch elderly: The impact of eight chronic condi-
tions on health-related quality of life. American Journal of Public
Health, 87, 38–44.
Kempen, G. I. J. M., Steverink, N., Ormel, J., & Deeg, D. J. H. (1996). The
assessment of ADL among frail elderly in an interview survey: Self-
report versus performance-based tests and determinants of discrepan-
cies. Journal Gerontology: Psychological Sciences, 51B, P254–P260.
Kennedy, G. L., Klerman, H. R., & Thomas, C. (1990). The emergence
of depressive symptoms in late life: The importance of declining
health and increasing disability. Journal of Community Health, 15,
93–104.
The existence of this feedback cycle suggests mutual re-
inforcement over time of depression and disability for dis-
abled elderly adults. Our findings suggest that the most im-
mediate and strongest benefit to this population will be
obtained by reducing IADL/ADL disability, because the ef-
fect of IADL/ADL disability on depression is faster and
stronger than the 1-year lagged effect of depression on IADL/
ADL status. Efforts to minimize depressive symptoms and
improve mental health are also likely to be cost-effective
compared with other interventions, because depression may
be more reversible than the disability associated with chronic
and degenerative disease. As reported by Tinetti, Inouye, Gill,
& Doucette (1995), reduction of risk factors that are shared
by a variety of geriatric syndromes, among which is depres-
sion, may help to restore functional independence. Interven-
tions to reduce disability and depression in elders may be
among the most cost-effective means to increase the quality
of life in the aging population. What appears particularly
important is to watch for depression when disability is new,
and to watch for disability when depression is persistent.
Kenny, D. A., & Campbell, D. T. (1989). On the measurement of stability
in over-time data. Journal of Personality, 57, 445–481.
Krishnan, K. R., & Gadde, K. M. (1996). The pathophysiologic basis for
later-life depression: Imaging studies of the aging brain. American
Journal of Geriatic Psychiatry, 4, S22–S33.
Mintz, J., Mintz, L. I., Arruda, M. J., & Hwang, S. S. (1992). Treatments of
depression and the functional capacity to work. Archives of General
Psychiatry, 49, 761–768.
Mynors-Wallis, L., Gath, D. H., Lloyd-Thomas, A. R., & Tomlinson, D.
(1995). Randomised controlled trial comparing problem solving treat-
ment with amitriptyline and placebo for major depression in primary
care. British Medical Journal, 310, 441–445.
Neale, M.C. (1995). Mx: Statistical modeling. Available from M. C. Neale,
Box 710, Department of Psychiatry, MCV, Richmond, VA 23298.
Ormel, J., Kempen, G. I. J. M., Deeg, D. J. H., Brilman, E. I., van Son-
deren, E., & Relyveld, J. (1998). Functioning, well-being, and health
perception in late middle-aged and older people: Comparing the effects
of depressive symptoms and chronic medical conditions. Journal of the
American Geriatrics Society, 46, 39–48.
Acknowledgments
Mark Sullivan was supported by National Institute of Mental Health
Grant K01 MH-1351. This research is part of the Groningen Longitudinal
Aging Study (GLAS). GLAS is conducted by the Northern Centre for
Healthcare Research (NCH) and various Departments of the University of
Groningen in The Netherlands. The primary departments involved are Pub-
lic Health and Health Psychology, Family Medicine, Psychiatry, Sociology,
and Human Movement Sciences. GLAS and its substudies are financially
supported by the Dutch government (through NESTOR), the University of
Groningen, the Faculty of Medical Sciences, the Dutch Cancer Foundation,
and The Netherlands Organization for Scientific Research (NWO). Prepara-
tion of this article was supported by NWO grants 905-59-104 and 904-
57-068. The central office of GLAS is located at the NCH, A. Deusinglaan
Address correspondence to Johan Ormel, Department of Psychiatry,
P.O. Box 30.001, 9700 RB Groningen, The Netherlands. E-mail:
Ormel, J., Kempen, G. I. J. M., Penninx, B. W. J. H., Brilman, E. I., Beek-
man, A. T. F., & van Sonderen, E. (1997). Chronic medical conditions
and mental health in older people: Disability and psychosocial re-
sources mediate specific mental health effects. Psychological Medicine,
27, 1065–1077.
References
Ormel, J., & Schaufeli, W. (1991). Stability and change of psychological
distress and their relationship with self-esteem and locus of control.
Journal of Personality and Social Psychology, 60, 288–299.
Ormel, J., & VonKorff, M. (2000). Synchrony of change in depression and
disability. What next? Archives of General Psychiatry, 57, 381–382.
Ormel, J., VonKorff, M., Oldehinkel, A. J., Simon, G., Tiemens, B. G., &
Üstün, T. B. (1999). Onset of disability in depressed and non-depressed
primary care patients. Psychological Medicine, 29, 847–853.
Ormel, J., VonKorff, M., Üstün, T. B., Pini, S., Korten, A., & Oldehinkel,
A. J. (1994). Common mental disorders and disability across cultures:
Results from the WHO collaborative primary care study. Journal of
American Medical Association, 272, 1741–1748.
Alexopoulos, G. S., Meyers, B. S., Young, R. C., Kakuma, T., Silbersweig,
D., & Charlson, M. (1997). Clinically defined vascular depression.
American Journal of Psychiatry, 154, 562–565.
Aneshensel, C. S., Frerichs, R. R., & Huba, G. J. (1984). Depression and
physical illness: A multiwave, nonrecursive causal model. Journal of
Health and Social Behavior, 25, 350–371.
Armenian, H. K., Pratt, L. A., Gallo, J., & Eaton, W. W. (1998). Psychopathol-
ogy as a predictor of disability: A population-based follow-up study in
Baltimore, Maryland. American Journal of Epidemiology, 148, 269–275.
Baldwin, R. C., & Tomenson, B. (1995). Depression in later life. A com-
parison of symptoms and risk factors in early and late onset cases. Brit-
ish Journal of Psychiatry, 167, 649–652.
Penninx, B. W. J. H., Geerlings, S. W., Deeg, D. J., van Eijk, J. T. M. van
Tilburg, W., & Beekman, A. T. F. (1999). Do minor and major depres-
Berkman, L. F., Berkman, C. S., Kasl, S., Freeman, D. H., Leo, L., Ostfeld,
A. M., et al. (1986). Depressive symptoms in relation to physical health