Disability status and health restrictions are differently associated with depressiveness in older German adults: a cross-sectional study

Disability indicators are commonly associated with poorer mental health, yet this is partly contradicted by the "disability paradox." A research gap persists in utilizing both the objective operationalization of officially recognized disability status and the subjective operationalization of self-reported health-related restrictions to assess their associations with depressiveness. Investigating the impact of varying degrees of disability severity is also needed.  Objective: Assessing and comparing the association of subjective and objective measures of disability regarding depressiveness. Methods: This cross-sectional study analysed the data set of the German Ageing Survey (DEAS) 2023 including 4012 participants. Analysis of covariance (ANCOVA) and post-estimated adjusted contrasts were employed to investigate the association between disability measures (objective status and subjective health restrictions, both scaled categorically) and a depression score while controlling for the covariates gender, education, employment status (each categorically scaled) and age (continuously scaled). To examine the interaction between disability status and health restrictions on depressiveness, the interaction term disability status*health restrictions was added along the covariates in their association with depressiveness. Results: Both recognized disability status and greater subjective health restrictions were significantly associated with increased depressiveness (p<.05). Keeping all other covariates constant, the model using health restrictions as independent variable accounted for a larger proportion of variance of depressiveness (13.21%) than using degree of disability (9.61%). No clear gradient effect was observed in 10% increments of disability degree; however, participants with a degree of over 50% reported lower depressiveness than those with a degree under 50%. Individuals with both acknowledged disability and strong subjective restrictions showed the highest depressiveness, the interaction term was not statistically significant. Conclusions: A comprehensive understanding of depressiveness in disability necessitates the consideration of both officially recognized status and subjective health restrictions.