We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13-year follow-up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria.Population-based 13-year follow-up survey.Community-dwelling adults living in East Baltimore in 1981.Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981.The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression ("noncases"). The mortality and functional status of each group were compared after a 13-year follow-up interval.Compared with non-cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13-year follow-up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status.Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long-term outcomes.

Our prior psychometric work suggested that older adults interviewed in 1981 in a community survey were less likely than younger adults to report dysphoria. We hypothesized that this would also be true of older adults interviewed 13 years later.This study is a population-based 13-year follow-up survey of community-dwelling adults living in East Baltimore in 1981. Subjects were the continuing participants of the Baltimore Epidemiologic Catchment Area Program. After excluding 269 adults who were 65 years of age and older at initial interview in 1981, 1651 adults remained (347 aged 65 years and older and 1304 who were 30-64 years-old at follow-up). We applied structural equations with a measurement model for dichotomous data (the MIMIC -- multiple indicators, multiple causes -- model) to compare symptoms between adults who were 65 years and older at follow-up with younger adults, in relation to the nine symptom groups comprising the diagnostic criteria for major depression, adjusting for several potentially influential characteristics (namely, gender, self-reported ethnicity, educational attainment, cognitive impairment, marital status and employment).Older adults were less likely to endorse sadness as evidenced by a direct effect coefficient of -0.335 (95% Confidence Interval -0.643, -0.027). After adjusting for several potentially influential characteristics, the direct effect of age was substantially unchanged (-0.298 (95% CI -0.602, 0.006)).Older adults in 1994, like older adults in 1981, were less likely to endorse sadness than younger persons. This finding suggests, but does not prove, that the observed age difference in reporting depression does not reflect a cohort effect.

Researchers have posited a depletion syndrome among older adults that resembles "depression without sadness." Disengagement-related theories such as socio-emotional selectivity and gerotranscendence also describe an adaptive narrowing of the older person's social world and decreasing investment in activities and social relationships. This study has dual goals of confirming the existence of a "Withdrawal/Apathy/[Lack of] Vigor" (WAV) dimension of the Geriatric Depression Scale (GDS) and exploring its properties for evidence that it may be descriptive of either depletion or disengagement-related change in older adults.Data were obtained through a mailed survey of members 65 and older at a health maintenance organization. Respondents returned 327 completed surveys and 163 "decline" postcards. Principal-components analysis obtained a 6-item WAV factor for further analyses.High endorsement rates for the items in WAV and its bivariate correlations with age and health problems suggest WAV may be congruent with disengagement or depletion and may lead to over-identification of depression in older adults. Interpretation of the GDS and similar measures may be improved by use of subscale scores and consideration of age and health status of the respondent.

There is long-standing concern regarding poor recognition of depression in primary care, especially in older people.Studies that examined the unassisted (clinical) ability of general practitioners (GPs; primary care physicians) to identify depression were divided into those of older adults, younger adults and mixed populations. Data were extracted by 3 reviewers independently and pooled using a Bayesian meta-analysis.We identified 31 valid studies that examined both sensitivity and specificity (or rule-in and rule-out accuracy), involving 52,513 individuals. Twelve studies recruited older individuals, 12 recruited younger adults and 7 recruited both younger and older adults (mixed populations). In the most robust studies the point prevalence of depression in late life was 13.2% (95% CI = 7.9-19.6). GPs were able to correctly identify 47.3% of the late-life depressions and 78.6% of the non-cases (71.0% overall accuracy). In younger adults GPs were able to identify 39.7% of the mid-life depressions and 85.1% of the non-depressed (77.8% overall accuracy). In mixed aged groups GPs we able to correctly identify 46.6% of the depressed individuals and 86.2% of the non-depressed (79.6% overall accuracy). The overall fraction correctly identified was significantly lower in older compared with younger adults. Correcting for differences in prevalence showed a statistically lower rule-in performance for older compared with younger adults. There was no difference in ability to identify non-depressed (healthy) individuals by age.In clinical practice GPs appear to be less successful in identifying depression in older people than in younger adults, however there have been few head-to-head studies stratified by age from one centre.Copyright 2010 S. Karger AG, Basel.

Previous estimates of the prevalence of geriatric depression have varied. There are few large population-based studies; most of these focused on individuals younger than 80 years. No US studies have been published since the advent of the newer antidepressant agents.In 1995 through 1996, as part of a large population study, we examined the current and lifetime prevalence of depressive disorders in 4,559 nondemented individuals aged 65 to 100 years. This sample represented 90% of the elderly population of Cache County, Utah. Using a modified version of the Diagnostic Interview Schedule, we ascertained past and present DSM-IV major depression, dysthymia, and subclinical depressive disorders. Medication use was determined through a structured interview and a "medicine chest inventory."Point prevalence of major depression was estimated at 4.4% in women and 2.7% in men (P=.003). Other depressive syndromes were surprisingly uncommon (combined point prevalence, 1.6%). Among subjects with current major depression, 35.7% were taking an antidepressant (mostly selective serotonin reuptake inhibitors) and 27.4% a sedative/hypnotic. The current prevalence of major depression did not change appreciably with age. Estimated lifetime prevalence of major depression was 20.4% in women and 9.6% in men (P<.001), decreasing with age.These estimates for prevalence of major depression are higher than those reported previously in North American studies. Treatment with antidepressants was more common than reported previously, but was still lacking in most individuals with major depression. The prevalence of subsyndromal depressive symptoms was low, possibly because of unusual characteristics of the population.

Depression in elderly Canadians is an important but often unrecognized public health problem. Numerous studies have examined depression in the general community, but studies of depression in the elderly have generally been small and limited. The Canadian Study of Health and Aging (CSHA) includes a large and national representation of both the cognitively intact and the cognitively impaired elderly. The current analyses of 2,341 participants from the CSHA who completed a clinical rating scale for depression have two objectives: 1) to determine the prevalence of minor and major depression and 2) to examine the importance of several risk factors. The prevalences of major and minor depression were 2.6 percent and 4.0 percent, respectively, and were higher for females, specifically those in institutions, those who reported that their health problems limited activities, and those with chronic health conditions. Women were more likely to exhibit depression (OR = 3.5; 95% CI: 1.4-8.8) than men, and those with dementia more likely to exhibit depression than those without (OR = 2.4; 95% CI: 0.9-3.1). Depression is a significant mental health problem among elderly Canadians, particularly among women and those with physical limitations. More attention should be paid to the detection and treatment of depression in the elderly, particularly among those most at risk.

Depression in old age is an important public health problem. The aims of this study were to report the prevalence of depression in the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS), a community-based, cohort.Following screening of 13 004 people aged 65 and over from a population base, a stratified random subsample of 2640 participants received the Geriatric Mental State (GMS) examination and were diagnosed using the Automated Geriatric Examination for Computer-Assisted Taxonomy (AGECAT) algorithm.The prevalence of depression was 8.7% [95% confidence interval (CI) 7.3-10.2], increasing to 9.7% if subjects with concurrent dementia were included. Depression was more common in women (10.4%) than men (6.5%) and was associated with functional disability, co-morbid medical disorder, and social deprivation. Prevalence remained high into old age, but after adjustment for other associated factors, it was lower in the older age groups.The prevalence of depression in the elderly is high and remains high into old age, perhaps due to increased functional disability.

The China Mental Health Survey was set up in 2012 to do a nationally representative survey with consistent methodology to investigate the prevalence of mental disorders and service use, and to analyse their social and psychological risk factors or correlates in China. This paper reports the prevalence findings.We did a cross-sectional epidemiological survey of the prevalence of mental disorders (mood disorders, anxiety disorders, alcohol-use and drug-use disorders, schizophrenia and other psychotic disorders, eating disorder, impulse-control disorder, and dementia) in a multistage clustered-area probability sample of adults from 157 nationwide representative population-based disease surveillance points in 31 provinces across China. Face-to-face interviews were done with a two-stage design by trained lay interviewers and psychiatrists with the Composite International Diagnostic Interview, the Structured Clinical Interview for DSM-IV Axis I disorders, the Community Screening Instrument for Dementia from the 10/66 dementia diagnostic package, and the Geriatric Mental State Examination. Data-quality control procedures included logic check by computers, sequential recording check, and phone-call check by the quality controllers, and reinterview check by the psychiatrists. Data were weighted to adjust for differential probabilities of selection and differential response as well as to post-stratify the sample to match the population distribution.32 552 respondents completed the survey between July 22, 2013, and March 5, 2015. The weighted prevalence of any disorder (excluding dementia) was 9·3% (95% CI 5·4-13·3) during the 12 months before the interview and 16·6% (13·0-20·2) during the participants' entire lifetime before the interview. Anxiety disorders were the most common class of disorders both in the 12 months before the interview (weighted prevalence 5·0%, 4·2-5·8) and in lifetime (7·6%, 6·3-8·8). The weighted prevalence of dementia in people aged 65 years or older was 5·6% (3·5-7·6).The prevalence of most mental disorders in China in 2013 is higher than in 1982 (point prevalence 1·1% and lifetime prevalence 1·3%), 1993 (point prevalence 1·1% and lifetime prevalence 1·4%), and 2002 (12-month prevalence 7·0% and lifetime prevalence 13·2%), but lower than in 2009 (1-month prevalence 17·5%). The evidence from this survey poses serious challenges related to the high burdens of disease identified, but also offers valuable opportunities for policy makers and health-care professionals to explore and address the factors that affect mental health in China.National Health Commission of Health (Ministry of Health) and Ministry of Science and Technology of China.Copyright © 2019 Elsevier Ltd. All rights reserved.

Late-life depression may differ from early-life depression in its phenomenology.To investigate the effect of age on the phenomenology of major depression.A systematic search was conducted in PubMed, Embase and PsycINFO for all studies examining the relation between age and phenomenology of major depression according to RDC, DSM and ICD criteria. Studies were included only if the age groups were compared at the single-item level using the 17-, 21- or 24-item versions of the Hamilton Rating Scale for Depression; a meta-analysis was done for each item of the 17-item scale.Eleven papers met the inclusion criteria. Older depressed adults, compared with younger depressed adults, demonstrated more agitation, hypochondriasis and general as well as gastrointestinal somatic symptoms, but less guilt and loss of sexual interest.The phenomenology of late-life depression differs only in part from that of early-life depression. Major depression in older people may have a more somatic presentation, whereas feelings of guilt and loss of sexual function may be more prevalent in younger people.

Klotho, encoded by the KL gene, is a single-pass transmembrane protein and a circulating factor that plays a key role in cellular metabolism and body homeostasis and has been associated with age-related diseases. Alterations of this protein seem to influence the development of serotonergic neurons and could play a role in major depression in the elderly. Pretreatment of neurons with Klotho protein can avoid neuronal injury related to the toxic amyloid-β and glutamate, centrally related to the pathogenesis of Alzheimer's disease (AD), in order that Klotho protein could play a neuroprotective role in AD patients. Late-life depression, mild cognitive impairment, and dementia are different nosological entities but share common neurobiological facets and could represent a clinical continuum. Enhancement of Klotho levels in the early stages of the disease could represent a therapeutic strategy to prevent further deterioration and to ameliorate the outcome of elderly AD patients with or without major depression.

We examined reciprocal, time-ordered associations between age-related changes in fluid intelligence and depressive symptoms. Participants were 1,091 community-dwelling older adults from the Lothian Birth Cohort 1936 study who were assessed repeatedly at 3-year intervals between the ages of 70 and 79 years. On average, fluid intelligence and depressive symptoms worsened with age. There was also a dynamic-coupling effect, in which low fluid intelligence at a given age predicted increasing depressive symptoms across the following 3-year interval, whereas the converse did not hold. Model comparisons showed that this coupling parameter significantly improved overall fit and had a correspondingly moderately strong effect size, accounting on average for an accumulated 0.9 standard-deviation increase in depressive symptoms, following lower cognitive performance, across the observed age range. Adjustment for sociodemographic and health-related covariates did not significantly attenuate this association. This implies that monitoring for cognitive decrements in later life may expedite interventions to reduce related increases in depression risk.

Accurate assessment of the natural history of late-life depression requires frequent observation over time. In later life, depressive disorders fulfilling rigorous diagnostic criteria are relatively rare, while subthreshold disorders are common. The primary aim was to study the natural history of late-life depression, systematically comparing those who did with those who did not fulfill rigorous diagnostic criteria.Within the Longitudinal Aging Study Amsterdam, a large cohort of depressed elderly persons (n = 277) was identified and followed up for 6 years, using 14 observations. Depression was measured using self-reports (the Center for Epidemiological Studies Depression Scale) and diagnostic interviews (the Diagnostic Interview Schedule). The natural history was assessed for symptom severity (Center for Epidemiological Studies Depression Scale score), symptom duration, clinical course type, and stability of diagnoses.The average symptom severity remained above the 85th percentile of the population average for 6 years. Symptoms were short-lived in only 14%. There were remissions in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32% (percentages do not total 100 because of rounding). Comparing the outcome, there was a clear gradient in which those with subthreshold disorders had the best outcome, followed by those with major depressive disorder, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases, while this group was at high risk of developing DSM affective disorders.The natural history of late-life depression in the community is poor. DSM affective disorders are relatively rare among elderly persons, but do identify those with the worst prognosis. However, subthreshold depression is serious and chronic in many cases.

The relation between psychiatric disorders, defined by the Diagnostic Interview Schedule (DIS), and mortality over 15 months is compared in 3007 adults age 55 and over in the New Haven Epidemiologic Catchment Area (ECA) project. Our results indicate that the odds of dying are more than four times greater for individuals with affective disorders than for others in the sample, controlling for age, sex, and physical health. Cause of death is also examined. There were no suicides or deaths from external causes.

A new Geriatric Depression Scale (GDS) designed specifically for rating depression in the elderly was tested for reliability and validity and compared with the Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale (SDS). In constructing the GDS a 100-item questionnaire was administered to normal and severely depressed subjects. The 30 questions most highly correlated with the total scores were then selected and readministered to new groups of elderly subjects. These subjects were classified as normal, mildly depressed or severely depressed on the basis of Research Diagnostic Criteria (RDC) for depression. The GDS, HRS-D and SDS were all found to be internally consistent measures, and each of the scales was correlated with the subject's number of RDC symptoms. However, the GDS and the HRS-D were significantly better correlated with RDC symptoms than was the SDS. The authors suggest that the GDS represents a reliable and valid self-rating depression screening scale for elderly populations.

To determine the effect of a screening protocol using the Geriatric Depression Scale (GDS) on the frequency of primary care physicians' decisions to prescribe drug therapy or refer long-term care patients with possible depression to mental health care.Case-finding phase, followed by a randomized controlled trial of the effect of a physician-targeted intervention on antidepressant prescribing or referral to mental health services.Twenty-two nonacademic long-term care facilities.One hundred three of 1,602 patients aged 65 and older who met criteria for cognitive function and untreated symptoms of depression.The 77 physicians of these patients were randomized as clusters into an early notification (experimental) or a delayed notification (control) group.Frequency of physician response (mental health consult or antidepressant therapy) at 4 and 8 weeks from notification, physician follow-up, and factors associated with physician response.Frequency of physician response in the early group (25%) was greater than in the delayed group (2%) (P <.005) 4 weeks from baseline. Physician response rate when the groups were combined was 36% (95% confidence interval (CI) = 26%-46%) 8 weeks from notification. Overall, there was evidence of physician action after letters of notification in 69% (95% CI = 60%-78%) of cases. Univariate logistic regression suggested that physicians' decisions were primarily associated with physician-related characteristics.Screening of long-term care patients for depression can increase the frequency of treatment or referral by primary care physicians.

There is a lack of studies disentangling whether changes in frailty are associated with subsequent changes in depressive symptoms or vice versa among the oldest old. Consequently, we aimed to disentangle this link.Three waves [follow-up (FU) wave 7 to FU wave 9; n = 423 individuals in the analytical sample] were used from the multicenter prospective cohort study "Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)" (AgeQualiDe).Primary care patients aged 85 years and older.The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to quantify frailty, and the Geriatric Depression Scale was used to measure depressive symptoms. It was adjusted for several covariates (sociodemographic and health-related factors) in regression analysis.Multiple linear regressions with first differences showed that initial increases in depressive symptoms (from FU wave 7 to FU wave 8) were associated with subsequent increases in frailty (from FU wave 8 to FU wave 9; β = 0.06, P < .05), whereas initial increases in frailty (from FU wave 7 to FU wave 8) were not associated with subsequent increases in depressive symptoms (from FU wave 8 to FU wave 9).The study findings suggest the relevance of increases in depressive symptoms for subsequent increases in frailty. Treatment of depressive symptoms may also be beneficial to postpone frailty.Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.