CONCLUSIONSDecrements in mental hea

CONCLUSIONS
Decrements in mental health powerfully relate to physical illness, with depressive or anxious symptoms influencing physical, social and role impairment to the same degree as 8 common chronic conditions investigated in the Medical Outcomes Study. In other studies, depressive symptoms also have been associated with increased risk of incident ischemic heart disease, poorer outcomes among people with existing cardiovascular disease, and elevated risk of all-cause mortality in medical inpatients.27,28 The adverse health effects associated with caregiving are likely to disproportionately affect women, because 70% of informal care is provided by women and most US women will provide informal care at some point during their lives.5 Therefore, if our findings are replicated and can be generalized to all women in this society, it could be predicted that a large proportion of the US population is exposed to the risks described in this article. We must establish structures to support not only the elderly and infirm but also their caregivers.