Importance of Subsyndromal Symptoms of Depression in Elderly Patients

• Published in: The American journal of geriatric psychiatry 2005-07, Vol.13 (7), p.597-606
• Main Authors: Chopra, Mohit P., Zubritsky, Cynthia, Knott, Kathryn, Have, Thomas Ten, Hadley, Trevor, Coyne, James C., Oslin, David W.
• Format: Article
• Language: English
• Subjects: Aged; Cross-Sectional Studies; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - psychology; Disability Evaluation; Dysthymic Disorder - diagnosis; Dysthymic Disorder - epidemiology; Dysthymic Disorder - psychology; Female; Follow-Up Studies; Humans; Male; Mental Health Services - utilization; Primary Health Care; Severity of Illness Index
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1097/00019442-200507000-00008

There is a debate about the importance of subsyndromal symptoms of depression (SSD). The current study examined the cross-sectional and longitudinal significance of SSD in geriatric subjects both with and without a past history of major depression. Elderly primary-care subjects with SSD, both with (SSD+; N = 54) and without (SSD–; N = 204) a history of major depression, were compared with subjects with major depression (MDD; N = 111), minor depression (MinD; N = 74), and symptom-free comparison subjects (N = 59). Assessment domains included physical and psychological disability, health-care utilization, hopelessness, death and suicidal ideation, and a diagnostic evaluation at a 3-month follow-up. Both subjects with SSD+ and SSD− differed from the symptom-free comparison subjects on measures of psychological disability, hopelessness, and death ideation, with SSD+ subjects being more severely psychologically disabled than SSD− subjects. There were few differences between SSD+ and MinD subjects or those with MDD, except on measures of psychological disability. Finally, more than 24% of SSD+ subjects progressed to meet criteria of MDD, MinD, or dysthymia over a 3-month period. Utilization of outpatient services did not differ among any of the depression groups or comparison subjects. SSD (with or without a past history of MDD) is associated with significant disability. Moreover, the risk of developing a diagnosis of MDD, MinD, or dysthymia is substantially elevated in subjects with a past history of MDD.