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(Pope and Tarlov, 1991). Previously, most preventive research and policy efforts focused on prevention of the primary impairment, such as a spinal cord injury, cerebral palsy, or brain trauma. It is now recognized that it is just as important, if not more important, to address the inordinately high rate of secondary conditions that people with disabilities have.

An entire chapter of the recently published report Healthy People 2010 was related to disability and secondary conditions in people with disabilities (U.S. Department of Health and Human Services, 2001). Through this focused attention, the report sought to “promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities in the United States” (p. 3). Of the variety of secondary conditions that occur in people with primary impairments, depression was pointed out as being particularly important. Although there were relatively few data available at the time, that report highlighted the fact that people who have a disability reported having more days of pain, depression, and anxiety and fewer days of vitality during the previous month compared with the rates among people without a disability. That report also emphasized the need for more research, particularly applied research, on the problem of depression among people with disabilities.

A growing focus in the disability community today is the recently noted increase in life expectancy among people with impairments and chronic disabilities, including people with the most severe impairments. For example, life expectancy for a person with a spinal cord injury has increased more than 1,000 percent in the last 40 years (Sasma et al., 1993). Other groups with impairments such as cerebral palsy, polio, rheumatoid arthritis, and Down syndrome are showing similar increases in life expectancy. This aging of people with disabilities has resulted in what appears to be increased secondary conditions as people grow older. Recent research on these conditions (Kemp and Mosqueda, 2004) indicates that as people age with a disability they are at an even higher risk of secondary conditions than they were earlier in their lives. Changes such as a loss of function, increased pain, increased fatigue, and multiple medical problems present new challenges and new stresses to people with disabilities. These new challenges and stresses have a strong likelihood of resulting in difficulties adjusting and a possible increase in the likelihood of depression.

This paper describes what is known about the nature of depression in people with disabilities, its prevalence in groups of people with physical impairments, its possible causes and consequences, the assessment and treatment of depression in people with disabilities, and future research and practice needs. It is clear that better understanding, recognition, and treatment of depression for people with disabilities is an important avenue for improving a range of outcomes that are important to the people with disabilities. For example, it is hard to imagine that people who have a

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