Direct and indirect effects of chronic physical conditions on depression: a preliminary investigation.

The study focuses on the relationship between chronic physical illness and depression in the general population. Based on a representative survey of 825 adult residents in the urban Reykjavik area of Iceland, the results suggest that chronic physical conditions affect depression directly, as well as indirectly by aggravating domestic, occupational, and economic strains, and by undermining personal resources (self-esteem and mastery). These relationships persisted when sociodemographic background and previous mental health status were controlled. A nonsignificant direct relationship between chronic physical conditions and social support suggests that chronic illness does not affect support independent of domestic and economic strains. Significant direct relationships between chronic physical illness and personal resources suggest that the experience of inescapable loss lowers self-esteem and the sense of mastery. The implications and limitations of the study are discussed.