A tune in “a minor” can “b major”: A review of epidemiology, illness course, and public health implications of subthreshold depression in older adults

Abstract

BACKGROUND With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. METHODS We searched PubMed (1980–Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression. RESULTS In older adults subthreshold depression was generally at least 2–3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8–10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. LIMITATIONS Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. CONCLUSIONS The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.

Ageism in Mental Health Assessment and Treatment of Older Adults

“…The mixed results in the literature have not helped to decrease clinician bias and confusion in this domain. Adding to this is the mounting evidence that subthreshold mental disorders are more prevalent than diagnosed disorders in late life and are associated with significant disability and comorbidity (e.g., Meeks et al 2011). Together, these factors make the diagnosis of mental disorders in old age more difficult.…”

“…This inconsistency might be accounted for in several ways; one main factor might be problems in the diagnosis of depression in older adults. For example, evidence shows that compared to younger populations, a smaller percentage of older adults suffers from a major depressive disorder but a higher percentage experiences subsyndromal depressive symptoms (Meeks et al 2011). Furthermore, in many cases, it can be difficult to distinguish between diagnosable depression, subsyndromal depressive states, and normal ageing among older adults (Fiske et al 2009).…”

Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients

“…We also investigated the modification of age on the PAP response and PRO relationships given literature suggesting that EDS in SDB is associated with younger age group 27 and some data suggesting increased depressive symptoms and fatigue symptoms in older adults. 28,29 We therefore postulated that the treatment of SDB with PAP will result in improvement of PRO measures ranging from sleepiness, depressive symptoms and fatigue and hypothesize that race and age will serve as effect modifiers of these relationships.…”

Depresión como predictor de discapacidad en adultos mayores

“…En la población de AM, la depresión es una de las alteraciones de salud mental más frecuentes, se reporta que 9.8% de AM presentan síntomas depresivos y que de estos el 8-10% desarrollarán depresión mayor 9 ; lo que implica un factor de riesgo independiente para el desarrollo de discapacidad en AM; aun controlando características sociodemográficas y condiciones generales de salud 10,11 , esta pérdida de funcionalidad atribuida a trastornos mentales o neuropsiquiátricos puede ser igual o incluso más incapacitante que la provocada por condiciones médicas generales 12,13 ; El objetivo del presente trabajo es describir el papel de la depresión como predictor de discapacidad en AM proveniente de la comunidad según lo reportado en la literatura.…”