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Potentially Modifiable Factors Associated With Disability Among People With Diabetes

Von Korff, Michael ScD; Katon, Wayne MD; Lin, Elizabeth H. B. MD, MPH; Simon, Gregory MD, MPH; Ludman, Evette PhD; Oliver, Malia; Ciechanowski, Paul MD, MPH; Rutter, Carolyn PhD; Bush, Terry PhD

doi: 10.1097/01.psy.0000155662.82621.50
Original Articles

Objective: This article seeks to identify potentially modifiable factors associated with disability among people with diabetes.

Study Design and Setting: Among people with diabetes (N = 4357) in a large health maintenance organization, disease severity, psychologic and behavioral risk factors for disability were assessed. Disability was evaluated by the WHO Disability Assessment Scale (WHO-DAS-II), the SF-36 Social Functioning scale, and days of reduced household work.

Results: Depression was associated with a tenfold increase in elevated WHO-DAS-II and low SF-36 Social Functioning scores, and a fourfold increase in 20+ days of reduced household work. Minor depression and the presence of three or more diabetic complications were associated with approximately a twofold increase in disability risk. Diabetic symptoms, chronic disease comorbidity, and reduced exercise were also associated with disability.

Conclusion: Among people with diabetes, depression, diabetic complications, and exercise are potentially modifiable factors associated with disability. This suggests that integrated, biopsychosocial approaches may be needed to understand and to ameliorate disability among people with diabetes.

BMI = body mass index; GHC = Group Health Cooperative; DSM-IV = Diagnostic and Statistical Manual, 4th Edition; PHQ-9 = Patient Health Questionnaire; ICD-9 = International Classification of Diseases, 9th Revision; HbA1c = glycosylated hemoglobin; WHO-DAS-II = World Health Organization Disability Assessment Schedule II.

From the Center for Health Studies (M.v.K., E.H.B.L., G.S., M.O., C.R., T.B.), Group Health Cooperative, Seattle, WA; and the Department of Psychiatry & Behavioral Sciences (W.K., E.L., P.C.), University of Washington School of Medicine, Seattle, WA.

Supported by grant #MH 4–1739 from the National Institute of Mental Health Services Division, Bethesda, MD.

Address correspondence and reprint requests to Michael Von Korff, ScD, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave. Suite 1600, Seattle, WA 98101. E-mail:

Received for publication March 24, 2004; revision received October 4, 2004.

Copyright © 2005 by American Psychosomatic Society
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