Depressive symptomology across adult age groups: differences in PHQ-9 symptom endorsement in a US sample

Longstanding clinical wisdom in geriatrics asserts that depressive symptom presentation varies between older and younger adults. However, these observations are based on data from one to two decades ago. The shifting demography across different birth cohorts necessitates an updated examination.

This retrospective cross-sectional study analyzed interview data from the 2017 to 2020 waves of the National Health and Nutrition Examination Survey. Depressive symptoms were assessed from 8325 participants aged 18 and older via the 9-item Patient Health Questionnaire (PHQ-9). PHQ-9 scores were used to classify a subset of participants with symptoms of a major and/or minor depressive episode based on DSM-5-TR criteria. Participants were categorized into four age groups (youngest, young/middle-aged, older, and oldest old adults) to test associations of age with depressive symptom endorsement.

Membership in the oldest age group (age 76 and older) was associated with lower endorsement of depressed mood relative to the youngest and young/middle-aged adults among those reporting symptoms of a major depressive episode. We did not find any age group differences in somatic or other symptom endorsement for those with either major or minor depressive symptoms.

Analyses of more recently collected data are required to maintain a dynamic life course perspective in the geriatric mental health literature. These analyses are one such attempt at updating the literature on depressive disorder phenomenology among adults in the United States.