The association between chronic diseases and depressive symptomatology in older Mexican Americans

Background. Among the elderly population, the risk for psychological distress increases with the number of chronic diseases and accompanying functional disability. The prevalence of chronic medical conditions and functional disability varies substantially across ethnocultural groups, however. Using data from the Hispanic EPESE, we previously reported that among older Mexican Americans, the total number of chronic medical conditions and the presence of functional impairment are strong predictors of depressive symptoms. Methods. Using multiple regression, we examined the association between specific chronic diseases, individual functional disabilities, and depressive symptoms in this group of ethnic elders. Results. Multiple regression models indicated that diabetes (OR = 1.25, 95% CI = 1.03-1.56), arthritis (OR = 1.42, 95% CI = 1.17-1.72), urinary incontinence (OR = 1.94, 95% CI = 1.46-2.59), bowel incontinence (OR = 2.28, 95% CI = 1.15-4.55), kidney disease (OR = 3.11, 95% CI = 1.13-8.58), and ulcers (OR = 2.56, 95% CI = 1.23-5.29) were predictive of high levels of depressive symptoms. Hip fracture, although recognized as having a substantial impact on functional status, was not found to be associated with depressive symptoms. History of stroke was not significantly associated with depressive symptoms in bivariate or multivariate analyses, but history of stroke with residual speech problems was predictive (OR = 2.16, 95% CI = 1.01-4.79). Among specific activities of daily living, only impaired ability to walk across a room (OR = 1.65, 95% CI = 1.04-2.73) or to baths oneself (OR = 1.87, 95% CI = 1.12-3.12) proved to be predictive in multivariate analyses. Conclusions. This constellation of chronic medical conditions and functional disabilities is very different from those reported to be associated with depressive symptoms in older non-Hispanic White and African Americans, and appears to comprise those conditions most associated with substantial physical impairment, pain, and discomfort.