background Depression, anxiety and physical disability often occur together. However, earlier research been cross-sectional, making it difficult to be certain about the direction of the associations reported.
aim To estimate the strength of the associations between depression, anxiety, and physical disability and to determine the direction of causality.
methods We used a prospective cohort study of general practice attendees (N = 4757) assessed at baseline, six, 12 and 24 months. The main outcome measures were dsm-iv major depressive disorder, anxiety and panic symptoms measured by the Patient Health Questionnaire, and physical disability measured by the Short Form 12 physical component summary scale. We performed complete case analyses using an(c) ova and logistic regression models to test for associations in both directions.
results Depression (β = -1.87; se = 2.61; P-value = 0.47) and anxiety (β = 0.43; se = 2.51; P-value = 0.89) did not lead to physical disability after two years, after adjustment baseline physical disability, age, sex, marital status and education level. Mild (or 1.6; 95% ci 1.2-2.3), moderate (or 2.1; 95% ci 1.5-2.9) and severe (or 3.0; 95% ci 2.1- 4.3) disability at baseline were associated with onset of depression or anxiety at follow-up, also after adjustment for age, sex, marital status and education level.
conclusion Physical disability predicts for onset of depression and anxiety, suggesting that this disability should be monitored in patients presenting with physical complaints as it can lead to psychiatric disorders in the future. Treatment of patients presenting with depressive or anxiety symptoms in primary care should focus on recovery from these symptoms rather than prevention of future physical disability.