How Does Functional Disability Affect Depressive Symptoms in Late Life

How Does Functional Disability Affect Depressive Symptoms in Late Life?
The Role of
Perceived Social Support and Psychological Resources
Author(s): Yang Yang
Source: Journal of Health and Social Behavior, Vol. 47, No. 4 (Dec., 2006), pp. 355-372
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/30040327
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How Does Functional Disability
Affect Depressive Symptoms in Late Life?
The Role of Perceived Social Support
and Psychological Resources*
YANG YANG
University of Chicago
Journal of Health and Social Behavior 2006, Vol 47 (December): 355-372
This study examines the process whereby functional disability amplifies depres-
sive symptoms through decreasing perceived social support and psychological
resources. The study analyzed two waves ofpanel data (1986 to 1992) of a large
sample of older adults from the National Institutes of Aging Established
Populations for Epidemiologic Studies of the Elderly. The results of longitudinal
change models and path analyses show that the perceived availability of a con-
fidant, satisfaction with support, sense of control, and self-esteem mediate the
effects of disability on increments in depressive symptoms in late life.
Psychological resources play a dominant role in mediating the effects of func-
tional impairment. Scales of sense of control and self-esteem account for 53
percent of the total effect of baseline disability and 43 percent of the total effect
of changes in disability on changes in the CES-D depression scale. Self-esteem
appears to be the strongest mediator.
Mortality reduction in the United States was dines in functioning during old age (Beckett et
more rapid in the twentieth century than in any al. 1996; Miller 2002). Although rates of diag-
previous period. The continuing increase of the nosed depression are lower in old age than in
aging population not only changes the coun- midlife, there is evidence that reported levels
try's demographic outlook, but also raises con- of depressive symptoms are generally high
cerns about the quality of life of the elderly. during
For old age (Blazer et al. 1991; George
many, prolonged life expectancy may be ac-1999; Mirowsky and Ross 1992; Zarit et al.
companied by increased morbidity and de- 1999). There has been considerable interest in
estimating the influence of functional disabili-
ty on depression in late life, but little research
* This research was supported in part by faculty re-
has explored how this influence operates.
search grant 5 P30 AG012857-12 from the Center on
Aging at NORC, the University of Chicago. An ear- Empirical evidence generally supports the hy-
lier version of the paper was presented at the 2004 pothesis that disability is associated with in-
annual meeting of the Gerontological Society of creased risk of depressive symptoms (Blazer et
America in Washington, DC. The statistical analyses al. 1991; Turner and Noh 1988). Still to be dis-
were performed using data collected via contract covered, however, is the pathway through
NO1 AG-12102 with the National Institute of Aging,which functional disability effects changes in
in support of the Established Populations for depressive symptoms over time.
Epidemiologic Studies of the Elderly (Duke
The central question pursued by the present
University). This paper has benefited from helpful
study is: How does disability amplify late-life
comments of Nan Lin, Linda George, and the anony-
depression? Specifically, this study explores
mous reviewers. I thank Bruce Burchett for assis-
tance with data preparation. Address correspon- the process whereby functional loss leads to in-
dence to Yang Yang, Department of Sociology, crements in depressive symptoms through de-
University of Chicago, 1126 E. 59th St., Chicago, creases
IL in social and psychological resources.
60637 (email: yangy@uchicago.edu). Drawing upon stress process theory (Pearlin et
355
356 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
al. 1981), I argue that functional disabilityhealth

is a (Thoits 1995). Relatively little is known
chronic stressful experience that can be disrup-regarding the potential significance of these
tive to perceived social support, sense of con- coping resources in ameliorating the effects on
trol over life, and perception of self-worth, depression of the specific type of stress
which in turn lead to elevated depressive symp- brought about by functional loss.
toms. The study then empirically examines the
intervening mechanisms that link functional Social Resources: Social Support
impairment with late-life depression. Using Functional impairment could lead to deficits
longitudinal data on older adults, the analyses in social support because restrictions in mobil-
attempt to elucidate the interrelationships ity and difficulty in managing independent dai-
among disability, mediating factors, and ly life impede engagement in social relation-
changes in depression over time and assess the ships and fulfillment of social roles. Studies
relative effectiveness of different mediators inshow that disabled elderly with poor physical
the disability stress process model. functioning experience restriction of valued
social activities (Williamson and Schulz 1992),
DISABILITY, SOCIAL SUPPORT, isolation from friends and family members,
PSYCHOLOGICAL RESOURCES,
withdrawal from social contact (Thompson and
AND DEPRESSIVE SYMPTOMS
Heller 1990), and reduced quality of social
Functional disability is defined as dimin- support (Steffens, Hays, and Frishnan 1999).
ished capacity or the inability to perform basic Social support is based on active social partic-
self-care tasks that are usually required for in- ipation with members of one's social network
dependent living in the community (Mendes de and reciprocal social obligations and mutual
Leon et al. 1999). Functional loss involves on- exchanges with confiding partners. This cre-
going challenges to managing necessary in- ates a sense of bonding (Lin 1986). The con-
strumental and social activities and presents a comitant ongoing need for instrumental assis-
considerable chronic strain. It has been con- tance and the restrictions in activities associat-
ceptualized as a chronic stressor that under- ed with functional disability prevent the for-
mines an individual's ability to interact with mation, maintenance, and strengthening of so-
the physical and social environment and con- cial ties, consequently weakening social bond
sequently increases the risk of depression All these factors have been shown to contribu
(Bruce 2001; Turner and Noh 1988; Verbruggeto significant increases in depression (Lin, Y
and Jette 1994). There is strong evidence fromand Ensel 1999). Therefore, functional disabil-
previous epidemiologic and gerontological re- ity acts as a support-disrupting stressor that
search that functional impairment may is related to impair mental health. People
consequently
increases in depressive symptoms in old age. with disabilities are likely to suffer from more
Cross-sectional studies universally support a depression, in part due to reductions in some
positive association between disability and de- forms of social support.
pressive symptoms (Blazer et al. 1991; Hays et Various conceptualizations and measures of
al. 1998; La Gory and Fitzpatrick 1992). social support fall into two general categories:
Findings from longitudinal studies also suggest objective support and subjective support
that disability onset leads to increased depres- (George 1996). Objective social support in-
sive symptoms over time (Kennedy, Kelman, cludes social network size, amount of social
and Thomas 1990; Roberts et al. 1997; Turner contact and interaction, and instrumental sup-
and Noh 1988; Yang and George 2005). port received. Subjective social support, also
Despite the well-established links between referred to as perceived social support, refers
functional disability and depressive symptoms, to perceptions of the availability and adequacy
there is a lack of understanding of how func- of support, especially from intimate relation-
tional impairment exerts its detrimental influ- ships, and satisfaction with the amount or qual-
ence on mental health. ity of support (Lin 1986; Landerman et al.
A myriad of studies have emerged from 1989). Previous research shows that objective
decades of stress research that emphasize the support is unrelated or much less related to de-
importance of social resources (such as social pressive symptoms than subjective or per-
support) and psychological resources (such as ceived support (Blazer 1982; George et al.
sense of control and self-esteem) in mediating 1989, 1996; Turner and Noh 1988; Wethington
or buffering the effects of life stress on mentaland Kessler 1986). This lack of a relation has
How DOES FUNCTIONAL DISABILITY AFFECT DEPRESSIVE SYMPTOMS? 357
implications for the relative potency of differ- may mediate the effects of disability on de-
ent aspects of social support as mediators of pression.
the effects of disability on depression. Sense of control, or mastery, refer

Perceived availability and quality of one's so-tent to which individuals see their
cial support may be more critical for older ing under their own control as opp
adults with chronic disability requiring long- ing ruled by external fatalistic for
term care. The study by Steffens et al. (1999) and Schooler 1978). There is eviden
used measures from the Duke Social Support er people experience reductions in personal
Index (DSSI) (Landerman et al. 1989) and control as a result of physical impairments
(Baltes, Wahl, and Schmid-Furstoss 1990;
found that functional deficit is not significant-
ly associated with social network size, isRodin mod-1986; Rowe and Kahn 1987; Mirowsky
erately associated with amount of social and inter-
Ross 1992). Turner and Noh (1988) found
action and instrumental support received, and
that it is particularly difficult for disabled indi-
is most strongly and significantly associated viduals to achieve a sense of control and mas-
with lower perceived support. In the face of tery because they are more likely to encounter
functional impairment that has slow (if any) difficulties that resist problem-solving efforts;
improvement, the perceived adequacy of sup- they also found that improvements in mastery
port and presence of confiding relationships can reduce the level of depressive symptoms.
provide emotional reassurance and have been Ensel (1991) found that sense of control medi-
shown to ease distress and ameliorate depres- ates the relationship between health events and
sive symptoms (Allen, Ciambrone, and Welch depressive symptoms.
2000; Thompson and Heller 1990). Disability may work simultaneously with
It is important to note that social support sense of control to amplify depression through
does not completely mediate the effects of dis-lowering self-esteem, or the positiveness of
ability on depression. For example, Taylor and one's judgments about one's self-worth.
Lynch (2004) found that after controlling for Research suggests that stressful events can dis-
the effects of perceived and received support rupt a person's identity, and interruptions of
and all other risk factors, the effect of baseline
identity increase feelings of distress (Burke
disability on subsequent increments of depres- 1991). In addition, the more salient an identity
sive symptoms remained significant. This sug- is, the more threatening the stressful experi-
gests the existence of other intervening mech- ence will be (Thoits 1996). From this perspec-
anisms. tive, functional loss is a stressful experience
that is linked to loss of personal identity as an
Psychological Resources: Sense of Control independent individual. Difficulties in manag-
and Self-Esteem ing basic daily activities are undesirable strains
Functional disability results in major alter- in an important identity domain; such difficul-
ations in lifestyle because of loss of autonomy ties will be appraised as major losses and as
and independence. Previous studies have sug- highly threatening and challenging to one's
gested that independence for older people is self-worth. The emotional response to the
socially and culturally valued in America meaning of disability, such as feeling worth-
(Krause 1987), and maintaining independence less, also increases the risk for depression
is considered integral to quality of life (Gignac(Bruce 2001). Empirical studies show that var-
et al. 2000). Functional incapacity and depen- ious forms of disability are linked to changes
dence, on the other hand, are associated with a in self-image, loss of self-validation (Allen et
sense of helplessness and incompetence al. 2000), and reduced feelings of self-worth
(Boerner 2004). There is evidence that where-
(Baltes 1996). Chronic strains such as disabil-
as appraisals of being dependent elicit negative
ity in functioning also create persistent diffi-
culties in maintaining independent living. As feelings in older adults (Gignac et al. 2000),
argued by Pearlin et al. (1981), two types of better functional status is related to higher lev-
psychological resources-sense of control and els of self-esteem (Duffy and MacDonald
self-esteem-are particularly vulnerable to 1990). There is also evidence that the onset of
loss brought about by persistent hardships, disability
andis a major stressor that leads to both
it is such loss that leads to depression. This loss of perceived control and lower self-esteem
suggests that sense of control and self-esteem (Schulz, Heckhausen, and O'Brien 1994).
In sum, both perceived social support and plore the intervening mechanisms of the dis-
psychological resources may be important me- ability-stress process by testing these hypothe-
ses using longitudinal data.
diators of the effects of disability on late-life
depression. I hypothesize that perceived social
support, sense of control, and self-esteem all DATA AND METHODS
have mediating effects. That is, theSample incorpora-
tion of these factors will reduce the direct ef-
Longitudinal data for this study are from the
fects of functional disability on depressive
North Carolina Established Populations for
symptoms. I expect that functional disability
Epidemiologic Studies of the Elderly (EPESE),
increases depressive symptoms through de-
supported by the National Institutes of Aging.
creasing perceived social support, reducing
The baseline survey was conducted in
sense of control and lowering self-esteem.
1986-1987 and consists of a multistage ran-
Most empirical research to date concerning the
dom sample of persons 65 and older residing in
effects of disability on perceived social sup-
households in Durham, Warren, Franklin,
port, psychological resources, and depression
Granville, and Vance counties in the central
is based on cross-sectional data. An important
Piedmont area of North Carolina. This site was
underexplored question is how these effects
the only EPESE site in the southeastern United
operate over time. Functional decline is typi-
States and included an oversample (54.3%) of
cally conceptualized as a chronic stressor
African American respondents, with the re-
(Verbugge and Jette 1994), which suggests
maining theprimarily white. Sample
46 percent
necessity of modeling the effects of functional
weights were developed to adjust sample dis-
impairment on changes in depression
tributions as
for a dy-
probability of selection within
namic process (Taylor and Lynch 2004).
households of It is, sizes, for differential
various
therefore, reasonable to examinenonresponse, the longitudi-and to match the demographic
nal effects of mediating factors in this disabil-
characteristics of the five-county area as esti-
ity-to-depression process. Whereas cross-sec- mated by the 1980 U.S. Census. All statistical
tional studies present a static view of correla- analyses employ sample weights to produce
tions between discrete statuses, a longitudinal unbiased estimates. Follow-up in-person inter-
analysis of changes in these statuses is better views were conducted in 1989, 1992, and
able to reveal how progressions of functional 1996. Due to the small sample size for the most
decline cause depletions in one's perceived lev- recent wave, the data used in these analyses are
els of social support and psychological re- from the baseline and 1992 surveys, covering a
sources and lead to increments in depressive six-year interval.
symptoms over time. The total sample size at the baseline survey
Life stress research suggests that the effec-
(Ti) was 4,162. A small number (162) of proxy
tiveness of any one coping resource may de- informants were excluded from the study sam-
pend on properties of a stressor and specific ple because depressive symptoms cannot be re-
types of stressful situations (Thoits 1995).
liably Few
reported by proxies. A few (26) individ-
studies on disability and depression have taken
uals of races other than white and African
advantage of this perspective. As American a result,were little
also excluded. Among the re-
is known about the relative importance maining of per-
respondents, 727 had missing data on
ceived social support and self-concept as me- one or more measures and were excluded. The
diators, as well as their interrelations. panel design reduced the sample size substan-
Psychological resources such as control and tially. The majority of attrition was due to death
self-esteem have been hypothesized to mediate or incapacity. By the six-year follow-up, 1,354
the effects of social support on mental health individuals had dropped out due to death or
(George 1996; Thoits 1995), but empirical ev- other reasons, and an additional 744 individu-
idence for these hypotheses is mixed. Some als had missing data on measures in 1992 (T2).
studies have found support for the hypothesis This leaves an effective sample size of 1,149.
(Krause 1987; Rowe and Kahn 1987), but one Two-sample t-tests were conducted to examine
does not (Mirowsky and Ross 1989). No evi- systematic differences between the final sam-
dence has been presented regarding whether ple and the three attrition types: attrition due to
social support and self-concepts have additive death, attrition due to other reasons, and miss-
mediating effects on the link between disabili- ing data.1 The results show that the final sam-
ty and depression in late life. In this study, I ex-ple was younger and healthier than those lost to
follow-up, but there were no significant differ-Fillenbaum 1985), and the Activities of Daily
ences between those with missing data and Living (ADL) scale that indicates more severe
those in the final sample. Therefore, the final functional impairment (Katz et al. 1963).
sample was not representative of the elderly Reliability and validity of these scales are
population in general, but only of those who widely accepted and reported elsewhere
survived and participated in both the baseline (Crimmins and Saito 1993; Kane and Kane
and follow-up surveys. 1981). Previous research in the demography of
aging (Manton and Gu 2001; Manton and
Measures Stallard 1997) and geriatric psychiatry (Blazer
Dependent variable. The dependent variable et al. 1991) show that old age disability ex-
is depressive symptoms as measured by the hibits complex patterns, and the four disability
Center for Epidemiologic Studies Depression scales above do not represent mutually exclu-
Scale (CES-D) at T2. Baseline CES-D (Ti) is sive states of functioning. Specifically, those
introduced as a lagged dependent variable to who have more severe forms of disability, such
as disabilities related to ADLs, also have less
control for prior depressive status in the change
models. The CES-D is a widely used short (20- severe forms of disability, such as IADLs,
item) screening scale designed to measure self- Nagi, and R-B. These studies suggest using hi-
reported current depressive symptoms in com- erarchical measures of disability to capture
munity populations. Reliability and validity overall functional status instead of individual
have been confirmed across ethnic groups, scales. The analysis adopted the measure of
gender, and educational levels (Radloff 1977). disability used by Blazer et al. (1991) and Yang
The original CES-D includes response cate- and George (2005), that is, a Guttman scale of
gories that range from 0 to 3, indicating in- functional disability status based on a hierar-
creasing frequency of depressive symptoms, chy of increasing levels of functional impair-
with a scale range of 0-60. The EPESE used a ment, with scores of 0 (no disability), 1 (dis-
modified CES-D, with dichotomous response ability on the Nagi or R-B scales only), 2 (dis-
categories, signifying the presence (1) or ab- ability also on the IADL scale but not on the
sence (0) of a symptom during the week pre- ADL scale), and 3 (disability also on the ADL
ceding the interview. The items were then scale).2
summed and ranged from 0 to 20. This modi- The measures of perceived social support
fied CES-D scale is highly comparable to the are from the Duke Social Support Index
traditional CES-D scale as a measure of de- (DSSI) (Landerman et al. 1989),3 a widely
pressive symptoms in community samples used set of multiple indicators of social sup-
(Blazer et al. 1991). port. Availability of at least one trusted confi-
Independent variables. Independent vari- dant (hereafter, "confidant") is a two-item
ables include baseline (T1) measures of func- scale (see footnote 3) that measures the degree
tional disability status, social support, sense to which respondents perceive that they have at
of control, and self-esteem and their changes least one confidant who will provide support in
from baseline (T1) to follow-up (T2). The difficult times and with whom they can discuss
change scores are created by taking the dif- their problems. Satisfaction with the amount of
ference between scores of TI and T2, that is,social interaction ("satisfaction") is a scale that
A Variable = Variable(T2) - Variable(TI). sums responses to two items (see footnote 3)
Larger absolute values of the change scores that measure the respondent's perceived satis-
indicate greater change experienced during faction with the amount of contact with friends
this period. Positive change scores represent and relatives. Responses to each constituent
increases and negative scores represent de- item include hardly ever (1), some of the time
creases. (2), and most of the time (3). The numbers of
Functional disability was measured using constituent items for both scales are small, and
items from four disability scales (see Appendix the items within each scale have low correla-
A): the Nagi Physical Performance Scale that tions,4 but because factor analyses showed
indicates strength disability (Nagi 1976), the each scale to be unidimensional, and they have
Rosow-Breslau (R-B) Health Scale for the higher reliabilities than any constituent item
Aged that indicates mobility disability (Rosow used individually, Landerman (1999) suggests
and Breslau 1966), the Instrumental Activities using the scales rather than their constituent
of Daily Living (IADL) scale (George and items. The DSSI also includes measures of
three dimensions of objective support: amount been found to be significantly related to de-
of social interaction, size of social network, pression: undesirable life events (Thoits 1995),
and instrumental support received from family chronic conditions (Beekman et al. 1995), and
and friends. Preliminary analyses showed that demographic and socioeconomic correlates
the magnitudes and directions of the effects of (Blazer et al. 1991). The life events scale in-
these dimensions of social support were con- cludes 20 events, such as deaths, divorce, and
sistent with findings from previous research. changes in financial status, that happened to
Because their effects were not statistically sig- the respondent during the year prior to the in-
nificant, either with or without controlling per- terview (Hays et al. 1998; Landerman et al.
ceived social support, they were excluded from
1989). Respondents rated the valence (positive,
the final analyses. neutral/mild, negative) of each event. The num-
Sense of control is measured by an eight- ber of negative events was summed. Chronic
item scale derived from an index constructed conditions are measured by an index of the re-
by Pearlin and colleagues (1981). Self-esteem spondent's current medical status based on the
is measured by the widely used 10-item presence of five physical health conditions:
Rosenberg self-esteem scale (Rosenberg heart problems, hypertension, diabetes, stroke,
1965). Both scales are summed measures and of di-
cancer.5 Demographic and socioeconomic
chotomous responses (yes/no) (included as correlates include gender (female = 1), race
Appendix B). (black = 1), age (65-105), marital status (mar-
Control variables. The analyses adjust for ried = 1), years of education achieved (0-17),
the effects of baseline characteristics that have and income in thousands of dollars (1.28-57).
TABLE 1. Sample Characteristics
Variables Mean SD Range

CES-D**
Tl 2.59 3.31 0-17
T2 2.65 3.48 0-17
Independent Variables
Functional disability***
Tl .73 .88 0-3
T2 1.10 1.03 0-3
A Disability .37 1.00 -3-3
Perceived social support
Confidant
Tl 5.60 .88 2-6
T2 5.64 .88 2-6
A Confidant .05 1.08 -4-4
Satisfaction
Tl 1.14 .75 0-2
T2 1.18 .77 0-2
A Satisfaction .04 .85 -2-2
Psychological resources
Sense of control***
Tl 5.50 2.01 0-8
T2 5.07 2.11 0-8
A Control -.44 2.06 -7-6
Self-esteem
Tl 8.09 1.21 2-10
T2 8.01 1.26 1-10
A Self-esteem -.08 1.31 -8-4
Control Variables (TI)
Number of negative life events .62 .92 0-7
Chronic conditions 32.74 26.70 0-158
Sex (% female) 61.70 .48 0-1
Race (% black) 35.60 .50 0-1
Age 71.11 5.27 65-92
Years of education 9.79 3.89 0-17
Income (in thousands) 18.49 14.16 1.28-57.00
Marital status (% married) 58.30 .50 0-1
** p <.01; *** p < .001 (two-tailed t-tests comparing the differences in means ofTI and T2 vari
Notes: N = 1,149. All descriptive statistics are weighted. CES-D = Center for Epidemiologic Stu
How DOES FUNCTIONAL DISABILITY AFFECT DEPRESSIVE SYMPTOMS? 36I
Table 1 presents the weighted sample char- time have also been found in previous studies
acteristics. Tests of difference between means and suggest that disability transitions are com-
(i.e., t-tests) were conducted to compare means mon in old age (Crimmins and Saito 1993;
of key variables from Tl to T2. On average, the Yang and George 2005).6 The standard devia-
elderly in the sample had a small number of de- tions for both the CES-D score and functional
pressive symptoms and were slightly disabled disability are large, which indicates large vari-
at baseline. There were significant increases in ations in the sample. The sample reported sub-
the average number of depressive symptoms (p stantial levels of perceived social support at
< .01) and disability status (p < .001) over the both baseline and follow-up. The lack of sig-
study period. Changes in functional status over nificant cross-time differences in the means of
TABLE 2. The Effects of Disability, Perceived Social Support, and Psychological Resources on
Depressive Symptoms in the Change Models
A. Zero-order Correlations among Key Model Variables
1 2 3 4 5 6 7 8 9 10 11 12
1. CES-D T2
2. CES-D Tl .451c
3. Disability TI .265c .262c
4. A Disability .105c .066a -.391c -
5. Confidant Tl -.155c -.195 -.057 .000 -
6. A Confidant -.098c .018 -.020 -.001 -.616
7. Satisfaction T1 -.095b -.139c -.095b -.008 -.001 .069a
8. A Satisfaction -.084b .007 -.020 -.031 .034 .044 -.549c
9. ControlTl -.340c -.367c -.271 -.103c .1430 -.031 .114c -.004
10. A Control -.136c -.018 -.034 -.092b .022 .014 -.031 .035 -.463c
11. EsteemTl -.359c -.329c -.221c -.122c .131C .096 .096b .008 .435c -.036
12. A Esteem -.195c -.042 -.003 -.054 -.013 .113c -.002 .052 -.054 .189c -.489c
B. Regression Analysis of Change in CES-D from Ti to T2 on Base
Model 1 Model 2 Model 3 Model 4
Metric Beta Metric Beta Metric Beta Metric Beta

Coef.e Coef. Coef. Coef. Coef. Coef. Coef. Coef.
CES-D T1 .384*** .352 .333*** .305 .226*** .207 .204*** .188
Disability Ti .885*** .225 .829*** .210 .346** .087 .344** .087
A Disability .619*** .176 .594*** .169 .132 .037 .149 .042
Perceived social support
Confidant Tl -.906*** -.216 -.585*** -.139
A Confidant -.766*** -.226 -.502*** -.148
Satisfaction Tl -.340* -.074 -.208 -.046
A Satisfaction -.474*** -.116 -.333** -.081
Psychological resources
Control Ti -.277*** -.160 -.274*** -.158
A Control -.257*** -.154 -.255*** -.152
Esteem T1 -1.093*** -.373 -.988*** -.338
A Esteem -.943*** -.343 -.841*** -.306
Control Variables Tld
Negative life events .278** .074 .304** .081 .192* .052 .218* .059
Sex (female = 1) .139 .020 .339 .047 .409* .058 .518** .073
Race (black = 1) -.130 -.018 -.233 -.032 .018 .003 -.069 -.010
Age -.039* -.057 -.047** -.069 -.048** -.071 -.053** -.078
Years of education -.045 -.050 -.043 -.047 .009 .010 .006 -.007
Constant 3.789 9.926 14.921 17.971

Adjusted R2 .261 .303 .406 .425
RMSE 8.163 7.896 7.293 7.176
a,* p < .05; b,** p < .01; c,*** p

Note: N = 1,149. RMSE = Root mean squared error.
d Chronic conditions, income, and marital status were excluded from the final analyses because their effects are not
significant with presence of other variables and the exclusion does not influence the coefficient estimates of other vari-
ables in the models.
e Standard errors not presented due to space considerations.
these measures suggest relative stability of the in depressive symptoms from baseline to fol-
quality of their support. On average, the elder- low-up (see George et al. 1989; Lin 1984).
ly in the sample had a moderate sense of con- I estimate nested regression models that en-
trol at baseline, but they experienced a signifi- ter one group of mediators at a time. I report
cant decrease in mastery by the follow-up (p < both unstandardardized metric coefficients,
.001). The average self-esteem scores were rel- which permit comparisons of magnitudes and
directions of the effects of regressors on the

atively high at both time points, with no signif-
icant changes over time. At baseline, 61.7 per-outcome, and standardized beta coefficients,
which can be used to compare the relative im-
cent of the respondents were female, 35.6 per-
cent were black, and 58.3 percent were mar- portance of the effects of different regressors in
ried. Sample members were, on average, 71 the same model. Based on the bivariate corre-
years old, had .6 negative events during the past lations and standardized beta coefficients, I
12 months, had a small number of chronic con- conduct path analyses (Land 1969; Retherford
ditions (32.6 out of 158 rated conditions), had and Choe 1993). The total effects of key vari-
9.8 years of education, and had an income of ables on changes in depression can be speci-
fied as the sums of direct effects and mediating
$18,490 per year.
effects (see Pearlin et al. 1981; Lin 1984; Lin
and Ensel 1989). The presence of a mediating
Analytic Method
effect reduces the direct effect of a regressor
Multivariate statistical analyses were ap-
variable on the outcome variable. Interaction
plied in order to investigate the effects terms
of base-
between perceived social support and
line and changes in disability status on changes
disability, and between psychological re-
in depression, and the mediating effects of sources and disability, are also created and in-
baseline and changes in social and psycholog- cluded in the regression equations to test the
ical coping resources over time. Specifically, I buffering effects hypothesis.
used longitudinal residual change models that
have frequently been used in finite-time-period
RESULTS
linear panel regression analyses. One common
Table 2 summarizes the results from the l
form of model specification based on two-
gitudinal regression analyses. Panel A reports
wave data distinguishes the effects of status
the zero-order correlation coefficients and sig-
and change in an independent variable as de-
nificance levels among key model variables.
terminants of the residual change in the out- Panel B presents the estimated effects of base-
come variable by regressing the outcome vari- line and change variables on changes in CES-
able measured at present time on the lagged D from T1 to T2. The effects of baseline con-
dependent variable measured at an earlier time trol variables are consistent with findings from
as well as the lagged independent variables and extant studies.
their change scores (Kessler and Greenberg
1981). Based on Coleman's (1968) derivation, Direct Effects
the change models in the present analyses can
Model 1 shows that, adjusting for the control
be written as
variables, more functional disability is strong-
ly related to increments in depressive symp-
Y2 = 13 + 3Y + 3X + 3Ax + 34Z + , toms over time.7 The standardized beta coeffi-
cients of disability at T1 and changes in dis-
where Y2 represents present levels of depres- ability are larger than those of all the control
sive symptoms (CES-D scores) at T2; Y1 is the variables. Therefore, they are the most impor-
lagged depressive symptoms at Ti; X1 repre- tant risk factors for increases in depression oth-
sents the vector of variables including baseline
er than prior levels of depression.
disability status, perceived social support, Model 2 is an additive model that includes
sense of control, and self-esteem; AX (i.e., baseline perceived social support variables and
equal to X2 - X1) represents their change their change variables, all of which show sig-
scores; Z represents baseline control variables; nificant negative effects on increases in CES-
and E is the error term. In these models, [3o rep- D. Baseline and changes in perceived avail-
resents the intercept, and the coefficients for ability of a confidant have larger and stronger
each regressor variable, 31, ... , [34, represent effects than other variables in the model. The
the effect of that variable on six-year changes proportional variance explained by this model
increases moderately from 26 percent in mod- .21). The adjusted R2 of this model increases to
el 1 to 30 percent. After adding perceived so- 41 percent, a 15 percent increase over model 1.
cial support to the model, the direct effects of Model 4 is the final model and shows the
both baseline and changes in disability de- joint effects of both perceived social support
crease slightly in magnitude and relative im- and psychological resources. Together they ac-
portance. Therefore, a small part of the effectscount for 16.5 percent of the variation in
of disability on changes in depression may be changes in depression (adjusted R2 increases to
mediated by perceived social support, but the 42.6%). Of the two, psychological resources
direct effects of disability remain significant. and their changes have greater direct effects
Model 3 includes the variables measuring than do perceived social support. Except for
psychological resources. The results show they satisfaction with support, the impacts of all
are strong risk factors for increased depression other mediating factors are statistically signif-
as well as mediators of the effects of disability icant and in the expected directions. Based on
on changes in depression. When baseline mea- the estimates of this final model, path analyses
sures of sense of control and self-esteem and are conducted to further quantify the mediating
their change scores are introduced to effects.
the Major
mod-results are illustrated in Figures
1 and
el, the metric coefficient of baseline 2.
disability
decreases by more than 50 percent and also de-
creases in significance level (from .885, p < Mediating Effects of Perceived Social
.001, to .346, p < .01). Furthermore, the effect Support and Psychological Resources
of changes in disability is no longer signifi- In both Figures 1 and 2, solid lines indicate
cant. In contrast, sense of control and self-es- effects that are statistically significant, where-
teem both show strong significant effects on as dashed lines indicate those that are not. The
changes in CES-D. A one-point increase in the diagonal line linking Disability (Ti) and CES-
self-esteem scale at baseline significantly re- D (T2) indicates the significant direct effect of
duces CES-D scores by more than one symp- baseline disability (.09, p < .001) on increases
tom (-1.093, p < .001). The effects of self-es- in CES-D from Ti to T2. The total effect of
teem and its changes are the largest of all vari-Disability (TI) on changes in CES-D is 0.22,8
ables, with the beta coefficients exceeding thatof which 40.7 percent is its direct effect
of the lagged dependent variable (e.g., -.37 vs. (.09/.22). This leaves about 60 percent of the
FIGURE 1. Path Analysis of the Mediating Effects of Perceived Social Support Estimated from
Model 4
confidant
disability ces-d
satisfaction
confidant
cse-d
disability
satisfaction
* p < .05; ** p < .01; *** p < .001 (two-tailed tests)

Note: A solid arrow indicates a significant effect; a dashed arrow indicates an insignificant effect.
FIGURE 2. Path Analysis of the Mediating Effects of Psychological Resources Estimated from
Model 4
Control
(T1) CES-D
Disability
(T1) (T1)
Esteem
(T1)
Control
CES-D
Disability
(T1)
Esteem
* p < .05; ** p < .01; *** p < .001 (two-tailed tests)

Note: A solid arrow indicates a significant effect; a dashed arrow indicates an insignificant effect.
total effect that is mediated by the two types of The insignificant paths from disability Ti and
coping resources. The dashed line linking change in disability to change in confidant and
change in disability (A Disability) and CES-D change in satisfaction suggest that changes in
(T2) indicates the direct effect of changes in perceived social support mediate little of the
disability that is not significant (.04) after con- effects of baseline disability and change in dis-
trolling for the effects of the mediators. The to- ability. Instead, they have strong direct effects
tal effect of change in disability is calculated to on change in CES-D. That is, decreases in the
be 0.07 in model 4.9 Therefore, 42.9 percent of perceived availability of a confidant and satis-
this effect can be attributed to mediating ef- faction with support are associated with in-
fects ([.07 - .04]/.07). Changes in disability are creases in CES-D (-.15, p < .001; -.08, p <
negatively affected by disability at T1 (-.39, p .001).
< .001). This result is statistically consistent Figure 2 shows that sense of control and
with the regression-toward-the-mean effect on self-esteem are strong mediators of the effects
the relation between a variable and its change of both baseline disability and changes in dis-
over time (Coleman 1969). ability on changes in CES-D from T1 to T2.
Figure 1 illustrates the mediating effects of The mediating effects of control (T1) and es-
perceived social support. As expected, baselineteem (TI) are 0.043 ([-.27] X [-.16]) and
disability (disability Ti) increases CES-D from0.075 ([-.22] x [-.34]), respectively. There-
Tl to T2 by decreasing baseline perceived so- fore, 19.5 percent of the effect of disability
cial support, that is, confidant (TI) and satis- (T1) is mediated by control (T1), and 33.9 per-
faction (Ti). The mediating effect of confidant cent of its effect is mediated by esteem (Ti).
(TI) is calculated as the product of two paths: Both effects are highly significant. The com-
-0.06 x -0.14 = 0.008. That of satisfaction bined effect of the two is nine times the mediat-
(T ) is similarly calculated as -0.10 x -0.05 = ing effect of perceived social support (.118 vs.
0.005. Together, they account for approximate-.013). Changes in perceived social support do
ly 5.9 percent (.013/.22) of the effect of base- not mediate the effect of changes in disability. In
line disability. Note that the effect coefficient contrast, change in control and change in esteem
of satisfaction (T1) (-.05) is not statistically largely mediate the effect of change in disabili-
significant after controlling for the effects ofty. The indirect effects of change in disability
psychological resources, so its mediating effect through change in control and change in esteem
is less significant than that of confidant (T1). are 0.014 and 0.016, and they account for 20
percent and 22.9 percent of the total effect of fect the effects of disability on changes in de-
change in disability, respectively. Note that pression by interacting with each other. None
baseline self-esteem and changes in self-esteem of these effects was statistically significant.
have larger mediating effects than baseline Nor did any of them increase the proportional
sense of control and changes in sense of control. variance explained in each model. The final
Results from path analyses of the interrela-model (model 4 in Table 2) that includes all the
tions among perceived social support, self-con- main effects has the best model fit.
cepts, and depressive symptoms (not shown) I examined the associations between disabil-
support the contention that perceived social ity and depression and the intervening effects
support reduces depression by boosting sense of social support and psychological resources
of control and self-esteem. That is, sense of in the reverse direction using the longi
control and self-esteem partially mediate the data. The results are consistent with pre
effect of perceived social support on depres- findings that depression is positively as
sion. Both confidant (TI) and satisfaction (TI)ed with increases in disability (Bruce 2001;
are strongly and positively related to control Cohen and Rodriguez 1995), but disability has
(TI) and esteem (Ti), which in turn are nega- a stronger effect on depressive symptoms than
tively related to increases in CES-D from vice T1 toversa (Aneshensel, Frerichs, and Huba
T2. Control (TI) and esteem (Ti) mediate 40.4 1984; Ormel et al. 2002).10 The mediating ef-
percent of the total effect of confidant (Ti) and fects of social support are not significant, and
59.7 percent of the total effect of satisfaction those of psychological resources are fairly
(T1). These effects are all significant. Com- small in the depression-to-disability models.
parisons of model 2 and model 4 suggest that Social support, mastery, self-esteem, and their
the effect of satisfaction (TI) is no longer sig- change scores together account for less than 5
nificant once psychological resources are con- percent of the variance in changes in disability.
trolled, so its effect is completely Thus, the mediating
mediated. Ofeffects in the two direc-
the two change variables, only change tions do not
in mirror
es- each other. The present
teem significantly mediates the effects of study did not attempt to completely determine
change in confidant and change in satisfaction the directions of causality between disability
on changes in CES-D, and these effects are and depression. The focus is on how a widely
rel-
atively small (18.5% and 16.7%) compared to observed relationship running from disability
the effects of the baseline measure. to depression is realized through the influences
The stress-buffering hypothesis suggests of psychosocial factors.
that social support and psychological resources
may have interaction effects with life stress; DISCUSSION AND CONCLUSION
that is, the simultaneous presence of stressPhysical and declines accompany aging. Loss of
absence of social support, sense of control, and independence in performing daily activities
self-esteem has a detrimental effect may on health
be depressing, but old-age depression is
(Kessler and McLeod 1985). However, the in- far from a certainty. The present study extends
consistency of findings regarding their buffer- previous research by conceptually explicating
ing effects precludes general conclusions about and empirically testing the mediating role of
the validity of this hypothesis (George 1996). social and psychological resources in the
In the case of disability and depression, it is process whereby functional disability ampli-
likely that in the face of functional impairment, fies depression in late life. It underscores the
those older people who have less perceived so- dynamic interplay among functional disability
cial support, a low sense of control, and low and social and psychological mediators, and
self-esteem are at increased risk for depression. their joint effects on changes in depressive
Empirical evidence for this hypothesis is scant: symptoms over a six-year interval. It identifies
The one study that reported interaction effects both social and psychological resources as sig-
of mastery and satisfaction with support on nificant mediators. Presence and levels of
disability is cross-sectional (Jang et al. 2002).
functional impairment alone do not necessari-
The present study tested interaction effects
ly lead of
to depression. Deficits in high-quality
perceived social support and disability, and social relationships, lack of control, and low
psychological resources and disability in mod- morale also contribute. Medical interventions
els 2 through 4. It also tested the possibility would be more effective if they also targeted
that the two sets of coping resources jointly af-preventing loss in these elements of coping re-
sources. The findings also highlight the rela-

and 43 percent of the total effect of changes in
tive importance of specific types of coping disability
re- on changes in CES-D score from
sources in reducing the types of stress associ-
baseline to follow-up, whereas perceived social
ated with functional declines. The results support
show mediates only 6 percent of the total ef-
that different forms of mediating are not equal-
fect of baseline disability and none of the effect
ly efficacious in explaining the effects ofof
dis-
changes in disability. This means that chron-
ability on depression. ic strains associated with functional loss erode
The study finds that only perceived social
and deplete key psychological coping re-
support, not objective measures of support, sources and result in reductions in feelings of
acts as a significant stress reducer and medi- autonomy and control over life, internalization
ates the detrimental effects of disability of a sense on in-
of incompetence, and negative eval-
crements in depressive symptoms. This cor- uations of self-worth, all of which lessen indi-
roborates the finding from life stress researchviduals' capacity to manage the psychological
that subjective support is the most potent di-distress evoked by disability and put them at
mension of social support. The analyses of all increased risk for depression. Because the ef-
four dimensions of social support using DSSI fects of disability on depression may be sub-
also confirmed the existence of increased in- stantially tempered through individual psycho-
strumental support received by those who had
logical strength and resilience, successful treat-
functional disability, an association reported in
ment of depressed mood in the disabled elder-
earlier studies (Mendes de Leon et al. 1999,
ly should focus on enhancing their sense of
2001; Seeman, Bruce, and McAvay 1996;
control and self-esteem. And self-esteem ap-
Steffens et al. 1999). Stoller and Pugliesi's
pears to be the most efficacious coping re-
study (1991) attributed this phenomenon to
source examined in this study, where depres-
support mobilization, i.e., declines in physical
sive symptom is the outcome of interest.
functioning in old age mobilize an increase in
Research on other psychiatric disorders is
the amount of instrumental assistance received
needed to fully assess the mental health conse-
from family and friends. Evidence on the ef-
quences of the disablement process and to de-
fects of received instrumental support, as well
termine how elements of coping resources vary
as evidence on other objective measures of so-
in their mediating effects.
cial support on depression, is inconsistent; but
Two interesting findings emerged from the
most studies reports no significant relationship
investigations of the interrelations among mul-
(George 1996; Krause 1997; Taylor and Lynch
tiple mediators. First, the mediating effects of
2004; Ulbrich and Bradsher 1993). This study
perceived social support and psychological re-
adds new weight to the conclusion that re-
sources are not entirely additive. The two not
ceived instrumental support does not mediate
only supplement each other's impact in affect-
the effects of disability on depressive symp-
toms. The finding also suggests that functional ing the relationship between disability and de-
pression, but they also are interrelated. Part of
disability limits involvement with one's social
environment, and, more importantly, reduces the effects of perceived social support on de-
pression, especially satisfaction with support,
the quality of support provided by social rela-
tionships by negatively affecting individuals' is further mediated or explained by indiv
psychological characteristics, suggesting that
appraisals and interpretation of social contact,
which are more protective against depression perceived social support functions by bolster-
than the amount of that contact. Improving the ing sense of control and feelings of self-es-
quality of social relationships, especially teem. Second, social support and psychological
strengthening intimate ties with confidants, resources do not seem to have issignificant in-
more effective in reducing risks for depression or with each
teraction effects with disability
in the disabled elderly than providing other other. The finding of no significant moderating
means of support. effects is not particularly surprising, given the
It is quite clear that psychological resources mixed results in previous empirical studies on
play a prominent role in mediating the effectsthe stress-buffering effects of social support
of functional impairment on increments in de- and psychological resources. A caveat is that
pression. Baseline and change scores of sense the results are based on data on older adults liv-
of control and self-esteem account for about 53ing in the southeastern United States. More
percent of the total effect of baseline disabilityanalyses using nationally representative data
are needed to draw inferences about these ef- by George and colleagues (1989), however,
fects in the general population. show that subjective support is measured ap-
Several methodological concerns related to propriately using multiple indicators, and the
the measurements of key variables in the study substantial time interval (6-32 months) be-
merit further comment. One concern is that the tween measurements provided by the prospec-
association found between disability and de- tive data argues against possible confounding
pressive symptom scales might be inflated due due to affective or mood states at the time of
to limitations of self-reported measures. the interview.
Although the data do not permit the study to di-
The potential confounding between de-
rectly address this possibility, previous re-
pressed mood and other self-reported measures
search on this problem provides convincing ev-
discussed above can be particularly perplexing
idence that this is not likely to be a major threat
and difficult to disentangle in cross-sectional
to the validity of the findings.
studies. The prospective research design used
First, the association between disability and
in this study facilitates the testing of con-
depression cannot simply be attributed to po-
founding effects of mood states and perception
tential shared variance between the instru-
of levels of disability or social support because
ments used to measure them. The CES-D scale
it allows the specification of analytic models in
includes the report of somatic symptoms (e.g.,
which the baseline statuses of disability or per-
"I felt everything I did was an effort"), which
may reflect problems more associated with
ceived support temporally precede changes in
functional disability than depression depression.
andThe mayresults show prior disability
thus raise symptom scores artificially. Based status as a significant determinant of CES-D
on item analysis and factor analysis of the scores at the six-year follow-up, net of the
CES-D scales, Berkman and colleagues (1986) baseline CES-D levels. The same holds true for
reported significantly increased symptoms for perceived social support. So any contamination
every one of the 20 CES-D items in elders with of affective states at the time of the baseline in-
greater functional disability-not just the so- terview should be largely reduced, if not elim-
matically oriented items-and concluded that inated, in the long term (George et al. 1989).
the overlapping of physical illness and somaticRecent panel studies using the same measures
symptoms indicative of depression accounted of perceived support and functional disability
for only a small part of the association between
from the Duke EPESE data reported similar re-
physical health and depression. Turner and sults regarding their relations (e.g., Taylor and
Noh (1988) also found that somatic symptoms Lynch 2004; Yang and George 2005) and fur-
contribute less to the higher CES-D scores ob- ther suggest that the presence of statistically
served for the disabled than nonsomatic symp-significant risk factors for old age depression
toms and confirmed that the positive relation-
is not simply artifactual. Nevertheless, future
ship between ADL disability and CES-D
research should consider supplementing self-
scores are real. Second, the association appears
reports with medical examinations or perfor-
not to be a result of inflated self-reports of de-
mance-based functional assessments for m
pression in disabled elders. Pessimism or neu-
definitive conclusions.
rosis that depressed individuals experience
Analyses of two-wave data are useful fo
could lead them to view themselves as more
tablishing the basic patterns of the intricat
disabled, but a substantial body of literature
lationships among disability, intervening
based on objective ratings of physical func-
tors, and depression, but they are only in
tioning such as strength, walking speed, and
other observer-rated instruments also shows mative of changes between two time poin
greater disability associated with depression natural extension in future research woul
(see a review by Lenze et al. 2001). to model changes over multiple time points.
Another concern is that subjective measures Further empirical investigations of how the
of social support can be contaminated with the long-term trajectories of physical and mental
depressed affect. There are studies that con- health outcomes are modified by changes in
clude that such measures are suspect because social and psychological coping resources may
depressed individuals may perceive their sup- shed new light on the dynamics of the path
port as less satisfying or adequate (Henderson ways linking stress and health over the life
1984; Henderson and Moran 1983). Analyses course.
APPENDIX A. FUNCTIONAL DISABILITIES SCALES

In the past 12 months:
Nagi Physical Activity-Have you had difficulty in moving large objects; stooping or kneelin
weights over 10 lbs.; reaching above shoulder; writing/handling small objects?
Rosow-Breslau Functional Performances-Have you been able to do heavy work; walk stairs; wa
Instrumental Activities of Daily Living (IADL)-Have you been able to use the telephone; drive car
el alone; do grocery shopping; do own housework; take own medicine; handle own money?
Activities of Daily Living (ADL)-Have you been able to walk across room; bathe; do personal gr
dress; eat; get in/out of bed/car; use/get to toilet?
APPENDIX B. PSYCHOLOGICAL RESOURCES SCALES
Sense of Control
Do you agree or disagree with these statements about yourself?
I have little control over things that happen to me.
I have little control over what happens to me in the future.
There is really no way I can solve problems.
There is little I can do to change important things in my life.
I can do about anything I set my mind to.
I often feel helpless in dealing with problems in my life.
Sometimes I feel I am being pushed around in life.
I wish I had more control over the things that happen to me.
Self-esteem
Do you agree or disagree with these statements?
I feel I am a person of worth.
I feel I have a number of good qualities.
I am inclined to feel that I am a failure.
I am able to do things as well as most other people.
I feel I do not have much to be proud of.
I take a positive attitude toward myself.
On the whole, I am satisfied with myself.
I wish I could have more respect for myself.
I certainly feel useless at times.
At times I think I am no good.
NOTES were significantly related to attrition, and

there
1. First, respondents who died prior to the fol-were no significant differences be-
low-up survey were compared with sur- tween those missing on one or more mea-
vivors. Those who died were, on average, sures in the analyses and the final sample
slightly more disabled (t = 5.68, p < .01), with complete data.
were more likely to be male (t = 2.45, p < 2. Few individuals exhibited disability on the
.05), and were older (t = 10.5, p < .01). IADLs but not on the Nagi/R-B scales, and
Second, comparisons were made between few had disability on the ADLs but not on
survivors. Analyses suggested that, com- the IADLs or Nagi/R-B scales.
3. Six items measuring perceived support were
pared to the remainder, those lost to follow-
up due to other reasons (including a small factor-analyzed using principal factoring
number of people who were administered with iterations. These items include those
proxy interviews in 1992, moved asking
out ofwhether
the the respondents: could
count on at least some family or friends in
interview area, refused interviews, or could
difficult
not be located) were slightly older times; had at least one confidant
(t = 10.7,
with whom
p < .01) and had slightly lower levels of ed- they could discuss their prob
lems;
ucation (t = 4.6, p < .01). No other wanted to see friends/relatives more
measures
or see them less; were satisfied with their 8. Total effect (disability Ti) = direct e
relationships; and wanted family/friends to (disability T1) + indirect effect (conf
give more help. Two factors with eigenval- Tl + satisfaction Ti + control T1 + est
ues greater than or equal to 1 emerged, with T1) = 0.09 + 0.008 + 0.005 + 0.043 + 0.075
the first two items loading on the first fac- = 0.22. Indirect effects through change
tor (> .60) and the next two items loading on variables of perceived social support and
the second factor (> .49). Loadings of other self-concepts are negligible.
indicators on these factors were less than or 9. Total effect (A Disability) = direct
equal to 0.25. While a promax rotation was (A Disability) + indirect effect (A Control
employed, the correlation between the fac- + A Esteem) = 0.04 + 0.014 + 0.016 = 0.07.
tors was near zero. Based on these results, Indirect effects through change in confi-
the EPESE constructed two scales summa- dant and change in satisfaction are negligi-
rized in the text. ble.
4. Cronbach's alpha was .55 for Confidant and 10. For instance, evaluations of the relative im-
.43 for Satisfaction (both lower than the pacts of the effects in two directions (dis-
rule-of-thumb minimum, .70). Especially ability on depression vs. depression on
for Confidant, the low reliability reflects the disability) in terms of the metric coeffi-
small number of constituent items, and a cients at mean levels of disability and de-
correlation of 0.38 reflects only modest as- pression show that the baseline disability
sociation. The scales' low reliabilities sug- effect on changes in depression is twice as
gest that their relations with other variables large as that of baseline depression on
will be attenuated due to measurement er- changes in disability; the effect of changes
ror, but this attenuation is less than for the in disability on changes in depression is 20
individual items (Landerman 1999). times larger than that of the reverse effect.
5. For each condition, 36 physicians provided
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Yang Yang is Assistant Professor of Sociology and faculty research associate at the Center o
Population Research Center at NORC, which is affiliated with the University of Chicago. Her c
stantive interests include demography of aging, social differentials in life course trajectories of
social stress and psychosocial coping resources. Her current methodological interests focus on
tical models and methods for cohort analysis and mathematical demography.

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How Does Functional Disability Affect Depressive Symptoms in Late Life?

Journal of Health and Social Behavior 2006, Vol 47 (December): 355-372

al. 1981), I argue that functional disabilityhealth

the effects of disability on depression. Sense of control, or mastery, refer

TABLE 1. Sample Characteristics

Variables Mean SD Range

B. Regression Analysis of Change in CES-D from Ti to T2 on Base

Model 1 Model 2 Model 3 Model 4

Metric Beta Metric Beta Metric Beta Metric Beta

Constant 3.789 9.926 14.921 17.971

a,* p < .05; b, p < .01; c,* p

directions of the effects of regressors on the

* p < .05; p < .01; * p < .001 (two-tailed tests)

* p < .05; p < .01; * p < .001 (two-tailed tests)

sources. The findings also highlight the rela-

APPENDIX A. FUNCTIONAL DISABILITIES SCALES

APPENDIX B. PSYCHOLOGICAL RESOURCES SCALES

NOTES were significantly related to attrition, and

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