Depression in adults with disabilities, in primary care.

Purpose: This research was design to answer the question: Does the prevalence of depression differ between adults with and without disability, in the same family medicine practice?

Method: A retrospective cohort design was used, to study depression among adults, with and without primary disabling conditions, receiving primary care in either a university based urban or rural family practice setting.

Results: When we compared individuals with disability to those without disability, and controlled for individual characteristics, the relative risk for depression was significantly lower for individuals with autism (Relative Risk (RR) 0.20: 95% Confidence Interval (CI) 0.05-0.55), cerebral palsy with mental retardation (RR 0.40: 95% CI: 0.24-0.65), and MR (RR 0.56: 95% CI: 0.39-0.77). The risk for depression was significantly higher for those with cerebral vascular accidents/stroke (RR 2.18: 95% CI: 1.72-3.76) and traumatic brain injury (RR 2.55: 95% CI: 1.72-2.77). The earliest onset of depression was among individuals with traumatic disabilities and milt mental retardation. Our estimate of depression prevalence for the non-disabled and disabled primary care patients was 22.8% and 24.9% respectively, when patients with disabilities were grouped together (p = 0.008).

Conclusion: It is important for physicians to recognize the higher prevalence of depression among patients with adult onset disabilities (e.g. stroke, traumatic brain injury). In addition, they should be aware of lower prevalence of depression among many individuals with lifelong disabilities, such as mental retardation, cerebral palsy, and autism.