Marks has expertise in several areas: Rheumatology; orthopedics; rehabilitation; health promotion and prevention. She has served as the Director (2005 - present) of the Center for Health Promotion, School of Health and Behavioral Sciences, City University of New York, York College - a non-profit Public Health Education Center with a 20 year history of serving the local community. She is Founding Director of the Osteoarthritis Research Center, Canada.


Background: Although significant symptoms of depression are common among older community dwelling adults, and the severely disabled, very few studies have specifically examined the magnitude and extent of depressive symptoms,and their interrelationships with other common cognitive, functional, and health status variables among adults with mild to moderate, as opposed to more advanced or severe knee osteoarthritis disability.
Objective: Given that early identification of depression may be helpful in preventing or retarding the onset of severely disabling disease problems, the present cross sectional study strove to examine the degree to which self-reported comorbid depressive symptoms might occur among a sample of moderately affected individuals. Also of interest was the nature of the relationship between the extent of these symptoms and pain, function, disease impact, body mass index, medication history, and self efficacy for managing pain, and other symptoms.
Methods: Data previously collected on 71 women and 15 men mean age 72.47±7.15 years with either unilateral or bilateral knee osteoarthritis using validated tools, were analyzed.
Results: Analyses revealed: 1) More than 20% of the present cohort could be categorized as having clinical depression using a more stringent cut-off point than the standard, even though none were being treated for this condition; 2) Cases categorized as exhibiting depressive symptoms indicative of depressed mood tended to have more pain, worse mobility, and lower self-efficacy perceptions than those not exhibiting such symptoms; 3) Self-efficacy for managing their condition was the only predictor of depressive symptomology; and those with low self-efficacy for managing their condition were more likely to have depressive symptoms than those with high self-efficacy (p<0.01); 4) Factors such as gender, extent of osteoarthritis, and body mass had no relationship with depressive symptom prevalence.
Conclusion: A high percentage of older individuals with mild to moderate knee osteoarthritis may be experiencing depressive symptoms at rates greater than expected in the general population. The degree of depression experienced appears related to perceptions of the impact of the disease, and walking ability in a dose dependent manner. Moreover, those with less confidence to meet disease-related challenges report depressive symptoms more frequently those who are more confident.

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