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Depression, anxiety and physical function: exploring the strength of causality
  1. Bauke T Stegenga1,
  2. Irwin Nazareth2,3,
  3. Francisco Torres-González4,
  4. Miguel Xavier5,
  5. Igor Švab6,
  6. Mirjam I Geerlings1,
  7. Christian Bottomley7,
  8. Louise Marston3,
  9. Michael King8
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Medical Research Council General Practice Research Framework, London, UK
  3. 3Department of Primary Care and Population Health, UCL, London, UK
  4. 4Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Granada, Spain
  5. 5Faculdade Ciências Médicas, University of Lisbon, Lisbon, Portugal
  6. 6Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
  7. 7Infectious Diseases Epidemiology Unit, LSHTM, London, UK
  8. 8Department of Mental Health Sciences, UCL, London, UK
  1. Correspondence to Mirjam I Geerlings, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; m.geerlings{at}


Background Depression, anxiety and physical function may be bi-directionally related. We aim to estimate the strength of the longitudinal associations between depression, anxiety and physical function.

Methods Prospective cohort study of general practice attendees across Europe (N=4757) assessed at baseline, 6, 12 and 24 months. Main outcome measures were Diagnostic and Statistical Manual of Mental Disorders-IV major depression, Patient Health Questionnaire anxiety and Short Form 12 physical function. Complete-case analyses using random coefficient models and logistic regression models were performed.

Results Those with depression (β=−1.90, 95% CI −3.42 to −0.39), anxiety (β=−4.12, 95% CI −5.39 to −2.86) or depression and anxiety (β=−5.74, 95% CI −7.38 to −4.10) had lower levels of physical function at baseline and over time compared with no diagnosis after adjustment for potential confounders. Physical function increased over time, but the rate of increase was not different between the groups. When compared with depression, those with anxiety (β=−2.22, 95% CI −4.08 to −0.36) or depression and anxiety (β=−3.83, 95% CI −5.95 to −1.71) had significantly lower levels of physical function at baseline. Lower levels of physical function at baseline were associated with onset of depression (OR 1.83, 95% CI 1.08 to 3.10) but even stronger with anxiety (OR 2.79, 95% CI 1.52 to 5.12) or depression and anxiety (OR 5.05, 95% CI 2.55 to 9.99) during 24 months compared with no dysfunction, after adjustment for potential confounders.

Conclusion It is essential to prevent lower levels of physical function as this is likely to lead to onset of depression and anxiety over time.

  • Depressive
  • anxious
  • disability
  • epidemiology
  • cohort
  • depression
  • disability SI
  • psychosocial epidemiology

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  • Funding The study was funded by European Commission's Fifth Framework (grant number PREDICT-QL4-CT2002-00683) and a VIDI grant from the Netherlands Organization for Scientific Research (NWO project number 917-66-311). Partial support in Europe was the Slovenian Ministry for Research (grant 4369-1027), the Spanish Ministry of Health (grant field-initiated studies program references PI041980, PI041771 and PI042450), the Spanish Network of Primary Care Research (redIAPP) (ISCIII-RETIC RD06/0018) and SAMSERAP group. The UK National Health Service Research and Development office provided service support costs in the UK. The funding sources had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the paper for publication.

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the local ethical committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.