Depression, perceived family criticism, and functional status among older, primary-care patients

Relatively little research has examined the role of family factors in later-life depression, particularly in the broad range of depressive conditions seen in primary care. Authors tested the hypotheses that 1) perceived family criticism is independently associated with depression, 2) that family criticism and depression are independently associated with functional disability, and 3) that perceived family criticism moderates the association between depression and functional disability.

This cross-sectional study recruited 379 adults age > or =65 years from primary-care practices. Study measures included the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression, the Family Emotional Involvement and Criticism Scale, and several measures of functional disability. Multiple regression determined independent associations, and a multiplicative interaction term tested the moderator model of the third hypothesis.

Perceived family criticism was independently associated with depression diagnosis and depressive symptoms. Depression diagnosis, depressive symptoms, and perceived family criticism were each independently associated with functional status. Perceived family criticism did not moderate the association between depressive symptoms and functional status in the overall study group, although it did moderate the association between depression diagnosis and instrumental activities of daily living when only early-onset depressed patients were included.

Authors confirmed the first and second hypotheses; however data did not support the third hypothesis. These results provide support for clinicians to attend to quality of primary family relationships and perceived criticism in depressed older adults and for researchers to consider aspects of family functioning as covariates or potential targets for intervention studies.