Evidence that medical illness is a risk factor for depression and depression is a risk factor for medical illness will be reviewed. The Baltimore Epidemiologic Catchment Area survey consisting of interviews in 1981 and 1994 provides an opportunity to assess whether depression at baseline interviews in 1981 was associated with the onset of specific physical disorders at follow-up interviews in 1994. Analyses from the Baltimore ECA employing such a strategy have shown strong relationships between Major Depression and the onset of diabetes (adjusted RR = 2.23, 95% CI {0.90, 5.55}), cardiovascular events (adjusted RR = 4.54, 95% CI {1.65, 12.44}), and some cancers (e.g., breast cancer adjusted RR = 3.8 95% CI {1.0, 14.2}), but not migraine headaches. Other analyses of the Baltimore ECA have revealed how depression and chronic illness interact in development of disability as assessed by self-report measures of ability to carry out ADLs. For example, compared to persons with a chronic disease (asthma, arthritis, heart disease, hypertension, or diabetes mellitus) without depression, persons with depression and a chronic disease were about 4 times as likely to report new ADL disability after a 13-year follow-up. In another analysis, psychological distress was associated with functional loss due to urinary incontinence (e.g., adjusted RR = 3.66 95% CI {1.61, 8.33}). Depression and medical co-morbidity are common and present an opportunity for treatment and prevention in medical contexts.
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