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Depression in old age. Is there a real decrease in prevalence? A review

C Ernst1, J Angst

  • 1Psychiatric University Hospital, Zürich, Switzerland.

European Archives of Psychiatry and Clinical Neuroscience
|January 1, 1995
PubMed
Summary
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Depressive symptoms remain common in older adults, but formal diagnoses decrease. This may be due to higher mortality, milder depression courses, and somatic symptom interpretation in the elderly.

Area of Science:

  • Geriatrics
  • Psychiatry
  • Epidemiology

Background:

  • Depressive symptoms and dysphoria are prevalent in old age.
  • However, diagnoses of major depression and dysthymia (DSM-III) decrease in this demographic.

Purpose of the Study:

  • To discuss the discrepancy between symptom prevalence and formal diagnoses of depression in the elderly.
  • To explore common hypotheses explaining this phenomenon.

Main Methods:

  • Review of existing literature and explanatory hypotheses.
  • Analysis of factors such as memory deficits, somatic symptom interpretation, institutionalization, and mortality.
  • Consideration of depression course and late-onset depression.

Main Results:

Related Experiment Videos

  • Higher mortality rates, a milder course of depression, and rarity of true late-onset depression contribute to a decline in diagnosed prevalence.
  • Depressive states in old age are increasingly linked to somatic illnesses.
  • Clinically significant depressive states not meeting DSM-III criteria may be characteristic of late-life psychopathology.

Conclusions:

  • A real decline in diagnosed depression in old age is supported by factors like mortality and milder disease courses.
  • The association between depressive states and somatic illness strengthens with age.
  • Subthreshold depressive conditions are likely common in elderly populations.