Functional impairment without depression diagnosis as an indicator of psychological distress in older adults

Psychological distress can occur even without a depression diagnosis. Many older adults have functional limitations that hinder daily activities, yet their emotional needs often go unrecognized. This study examined whether functional impairment is associated with psychological distress in older adults and whether this relationship varies by depression-diagnosis status. Data came from the 2023 Behavioral Risk Factor Surveillance System for U.S. adults aged 65 and older (N = 95,325). Functional impairment was defined as having 14 or more days in the past month when poor health limited usual activities. Psychological distress was measured by days of poor mental health and a binary indicator of high distress. Survey-weighted regression analyses tested main and interaction effects of functional impairment and depression diagnosis while adjusting for sociodemographic and behavioral factors. Functional impairment was linked to greater distress. Predicted estimates showed the highest distress among those with both impairment and a depression diagnosis (about 11 poor mental health days). Those with impairment only averaged about 6 days, those with a diagnosis only about 8, and those with neither condition about 3. Functional impairment may reveal hidden distress in older adults without diagnosed depression. Adding physical-function indicators to screening could help identify vulnerable individuals earlier.