The role of depression in the association between self-rated physical health and clinically defined illness

We enrolled 543 elderly participants of a managed care organization in a cr oss-sectional study to test whether the association between self-rated phys ical health and clinically defined illness differs for persons who are not depressed compared with persons with minor or serious depression. Depressio n was measured with the Diagnostic Interview Schedule (DIS). Clinically def ined illness was measured with the Chronic Disease Score (CDS), a pharmacy- based measure. Additional variables included age, sex, and self-reported pa in and physical function. Self-rated physical health was associated with bo th minor and serious depression, independent of clinically defined illness; minor depression was no longer significant when self-reported pain and phy sical function were added to the model. A significant negative correlation between self-rated physical health and clinically defined illness was obser ved for minor and no depression, but no correlation was seen for serious de pression. These results confirm the association between depression and self -rated physical health and emphasize that, for persons with serious depress ion, self-rated health provides a less accurate picture of clinically defin ed illness at both ends of the spectrum. Also, a diagnosis of minor depress ion should not forestall investigation of inconsistencies between patient r eport and clinical evidence.