Pain, activity restriction, and symptoms of depression among community-residing elderly adults.

Relations among physical illness, functional disability, pain, and symptoms of depression were investigated in a sample of community-residing elderly outpatients. As expected, physical illness, functional disability, and pain were correlated with depressive symptomatology. It was further hypothesized that functional disability (but not physical illness per se) would attenuate the relation between depressed affect and pain. The data supported these predictions by showing that functional disability (but not physical illness) accounted for differences in reported pain between nondepressed subjects and those at risk for developing clinical depression. Additional analyses revealed that functional disability mediated relations between pain and depressed affect and also between illness and depressed affect. These results indicate that both pain and illness are important contributors to functional disability, which in turn contributes to symptoms of depression. Secondary analyses revealed that restriction of certain activities associated with physical mobility and independence were strong individual factors in attenuating the relation between pain and depressed affect. An important implication of this research is that neither pain nor activity restriction should be treated in isolation. Maximal effects are likely to be achieved when both are targeted simultaneously.