Depression and chronic medical illnesses in Asian older adults: the role of subjective health and functional status Matthew Niti 1,2 * , Tze-Pin Ng 1,2 , Ee Heok Kua 1,2 , Roger Chun Man Ho 1,3 and Chay Hoon Tan 1,2 1 Gerontological Research Programme, Yong Loo Lin School of Medicine, National University of Singapore 2 Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore 3 Department of Psychological Medicine, National University Hospital, Singapore SUMMARY Objective Depression in elderly is reportedly associated with a number of specific chronic illnesses. Whether each of these co-morbid associations results uniquely from disease-specific psychobiological responses or is mediated by non-specific factors like subjective health and functional status is unclear. Method Analysis of data of 2,611 community-dwelling Chinese aged 55 and older, including depressive symptoms defined by Geriatric Depression Scale score  5 and self-reports of specific chronic illnesses. Results The prevalence of depressive symptoms was 13.3%, lower in those without chronic illness (7.5%), and higher in those with illnesses (13.2–24.2%). Crude Odds Ratios (OR) were significantly elevated for hypertension, eye disorders, diabetes, arthritis, ischemic heart disease, asthma/COPD, stroke, osteoporosis, heart failure, thyroid problem, and gastric problem. In multivariable analyses, only asthma/COPD [OR:2.85, 95% Confidence Intervals (CI): 1.36, 5.98], gastric problem (OR:2.64, 95% CI: 1.11, 6.29), arthritis (OR:1.87, 95% CI: 1.02, 3.42) and heart failure (OR:2.11, 95% CI: 0.98, 4.58) remained independently associated with depressive symptoms, after adjusting for comorbidities, subjective health and functional status, cognitive functioning, smoking, alcohol, psychosocial and demographic variables. Conclusion Most comorbid associations of depressive symptoms with specific chronic illnesses are explained by accompanying poor self-reported health and functional status, but some illnesses probably have a direct psychobiological basis. Copyright # 2007 John Wiley & Sons, Ltd. key words — depression; chronic medical illness; Chinese elderly; population-based study INTRODUCTION Late life depression is a major public health problem and is associated with various specific chronic illnesses (Lebowitz et al., 1997). Underlying mech- anisms, by which a particular illness causes or contributes to depression, have been posited, however, they remain elusive (Lyness et al., 1996). The mediating role of functional status is still unclear and may differ by type of illnesses (Williamson and Schulz, 1992). Lewinsohn et al. (1985) argued that medical illness does not predict depression, except when the illness and functional incapacitation co-occur. On the other hand, it has been found that the associations of certain illnesses, in particular, arthritis and heart diseases, with depression remain significant even after accounting for functional status (Dunlop et al., 2004). The present study aimed to determine the extent to which the associations of chronic medical illness and depression in a commu- nity-dwelling Chinese elderly population were inde- pendent of subjective health and functional status. METHOD The study was conducted with data collected in the Singapore Longitudinal Ageing Study (SLAS), a prospective cohort study of ageing and health of community-dwelling elderly. Older adults aged 55 or older, who were residents in five adjoining districts in INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int. J. Geriatr. Psychiatry (in press) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.1789 *Correspondence to: Dr M. Niti, National University of Singapore, Department of Psychological Medicine. National University Hos- pital, 5 Lower Kent Ridge Road, Singapore 119074. E-mail: pcmnmm@nus.edu.sg Copyright # 2007 John Wiley & Sons, Ltd. Received 6 November 2006 Accepted 29 January 2007