DEPRESSION IN PHYSICAL DISABILITY: PARKINSONISM, STROKE, AND AMPUTATION (NEUROLOGICAL)

Abstract

Depression is often observed to occur in physically disabled persons. In this study, the nature of depression was studied in three disabled groups. Two groups were neurologically-impaired (Parkinsonism and right-hemisphere stroke), and one group was not (lower limb amputation, secondary to diabetes/vascular disease). All 104 subjects included were screened to ensure normal mental status. Duration of illness/disability varied; Parkinson subjects were ill an average of 9 years, whereas 12 weeks was the average duration in the other two groups.;Two self-report depression measures were administered: the Beck Depression Inventory (modified) and the Multiple Affect Adjective Check List (MAACL). In addition, MAACL self-reports of anxiety and hostility were obtained. Other major variables included ratings of severity of functional disability (self- and observer-rated), demographic data, neurological indices, and relevant amputee variables.;As for the depression manifested, subjects on the average were mildly depressed. There was, however, wide variability. Approximately one-half the subjects showed no depression beyond normal expectancy. Roughly 25% of all subjects showed moderate to severe depression. There were no significant differences among the groups in either severity of or mean depression scores.;An attempt was made to predict the occurrence of depression. Diability rated by observers correlated inconsistently with depression. Self-ratings of disability correlated more strongly with depression measures in stroke and amputee groups, but not in Parkinsonism subjects.;Indices of neurological involvement did not relate to depression, except for sensory loss in stroke subjects, nor did demographic variables (duration of illness/disability, sex, age, and others), except for education (variable direction of effects). For amputees, presence of prosthesis, but not extent of amputation, was related to greater depression.;Although single variables tended not to predict depression, a varying group-specific combination of psychological, demographic, and medical variables predicted depression successfully in multiple regression analyses.;It is suggested that factors other than those investigated in this study, especially psychological and situational, may predict more successfully whether disabled persons will become depressed. Depression does not automatically result from physical disability, nor does severity of disability alone predict depression.