Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes

doi:10.1176/ajp.154.10.1376

Cited by 279 publications

(38 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Others have suggested that traditional symptoms scales or diagnostic assessments may under-represent depression in older adults who may more often present with somatic symptoms or cognitive complaints (29). Alternatively, older adults' more frequent contact with health care may result in a higher likelihood that less severe depression will be recognized and treated.…”

Section: Discussionmentioning

confidence: 99%

Antidepressants Are Not Overprescribed for Mild Depression

Simon

Rossom

Beck

et al. 2015

J. Clin. Psychiatry

View full text Add to dashboard Cite

Objective Evaluate over-prescribing of antidepressant medication for minimal or mild depression. Method Electronic records data from four large healthcare systems identified outpatients aged 18 or older starting a new episode of antidepressant treatment with an ICD9 diagnosis of depressive disorder (296.2, 296.3, 311, or 300.4). PHQ9 depression severity scores at time of treatment initiation were used to examine the distribution of baseline severity and the association between baseline severity and patients' demographic and clinical characteristics. Results Of 19,751 adults beginning treatment in 2011, baseline PHQ9 scores were available for 7051. In those with a baseline score, 85% reported moderate or severe symptoms (PHQ9 score 10 or more), 12% reported mild symptoms (PHQ score 5 to 9), and 3% reported minimal symptoms (PHQ9 score less than 5). The proportion reporting minimal or mild symptoms when starting treatment increased with age, ranging from 11% in those under age 30 to 26% in those aged 65 and older. The proportion with minimal or mild symptoms was also moderately higher among patients living in wealthier neighborhoods and those treated by psychiatrists. Nevertheless, across all subgroups defined by sex, race/ethnicity, prescriber specialty, and treatment history, the proportions with minimal or mild symptoms did not exceed 18%. Secondary analyses, including weighting and subgroup analyses, found no evidence that estimates of baseline severity were biased by missing PHQ9 scores. Conclusions In these health systems, prescribing of antidepressant medication for minimal or mild depression is much less common than suggested by previous reports. Given that this practice may sometimes be clinically appropriate, our findings indicate that over-prescribing of antidepressants for mild depression is not a significant public health concern.

show abstract

Section: Discussionmentioning

confidence: 99%

Antidepressants Are Not Overprescribed for Mild Depression

Simon

Rossom

Beck

et al. 2015

J. Clin. Psychiatry

View full text Add to dashboard Cite

show abstract

“…Another possibility came from our diagnostic approach in consultation. As depressive symptoms and medical illness interact bidirectionally, we adopted the inclusive approach, which was to include those depressive symptoms even when physical illness might be related to the symptoms [47]. Thus, in the diagnosis of major depression, especially for the current episode, this inclusive approach tended to over-diagnose and might possibly include those of adjustment disorder or demoralization [48].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

et al. 2014

View full text Add to dashboard Cite

BackgroundParaquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated.MethodsWe included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates.ResultsThe consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13–27.69; p<0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure.ConclusionsAwareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.

show abstract

“…These data seem to suggest that a simplified list of symptoms may be considered, at least for use in people with comorbid physical illness. However, an investigation conducted in medically ill hospitalized elders [32] found that a diagnostic approach omitting somatic symptoms led to the exclusion of a large proportion of patients who continued to experience persistent symptoms of depression many weeks after discharge.…”

Section: Validation Of the Concept Of Major Depressionmentioning

confidence: 99%

Development and Validation of the Current Concept of Major Depression

Maj¹

2012

Psychopathology

View full text Add to dashboard Cite

The operational diagnostic criteria for major depression have remained more or less the same in the past 40 years. However, the threshold for the diagnosis fixed by operational definitions has been criticized for either being too high, excluding many depressive states which do not differ from currently defined major depression on several variables, or too low, so that the milder cases receiving the diagnosis do not respond to antidepressants better than to placebo. Furthermore, it has been stated that current operational criteria do not convey anymore the gestalt of the depressive syndrome, and that they lead to the inclusion under the heading of depression of several homeostatic responses to adverse life events. This paper reviews the development and validation of the current concept of major depression and identifies priorities for future research.

show abstract

Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes

Cited by 279 publications

References 21 publications

Antidepressants Are Not Overprescribed for Mild Depression

Antidepressants Are Not Overprescribed for Mild Depression

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

Development and Validation of the Current Concept of Major Depression

Contact Info

Product

Resources

About