Clinical, demographic and social characteristics of psychotic depression

The goal of this study was to compare the clinical, demographic and social characteristics of psychotic and non-psychotic depression in the elderly and younger age groups. Depressed patients (n = 674) meeting DSM-III-R criteria for major depressive episode were classified into two groups, psychotic and non-psychotic, based on the presence of delusions or hallucinations. The patients with psychotic and non-psychotic depression were compared on clinical, demographic, and social characteristics. Bivariate analyses revealed that younger age, psychomotor retardation, guilt, feelings of worthlessness, history of delusions in the past, and increased suicidal ideation and intent were found more commonly in psychotic as compared to non-psychotic depression. A fully adjusted logistic regression model also confirmed younger age, history of past delusions, and increased feelings of worthlessness to be associated more with psychotic than with non-psychotic depression. Trends were observed for psychotic depression to be associated with poor subjective social support and with bipolar illness. Cerebrovascular risk factors and gender composition did not differ significantly in the psychotic vs. non-psychotic groups. The study confirms previously described findings such as increased guilt, increased psychomotor retardation and increased suicidality in psychotic depression in a large sample of depressed patients. The study also introduces the concept of age as an important variable influencing psychotic depression. The limitation of this finding is that it is applicable to tertiary care samples. Further studies are needed to confirm this finding in other subgroups.