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Depression and anxiety in medically unwell older adults: prevalence and short-term course

Published online by Cambridge University Press:  01 August 2009

Christina Bryant ,
Henry Jackson  and
David Ames
Christina Bryant*
Affiliation:
School of Behavioural Science, University of Melbourne, Victoria, Australia
Henry Jackson
Affiliation:
School of Behavioural Science, University of Melbourne, Victoria, Australia
David Ames
Affiliation:
University of Melbourne and National Ageing Research Institute, Royal Melbourne Hospital, Victoria, Australia
*
Correspondence should be addressed to: Dr Christina Bryant, Senior Lecturer in Clinical Psychology, School of Behavioural Science, Redmond Barry Building, University of Melbourne, Victoria 3010, Australia. Phone: +61 3 8344 6371; Fax: +61 3 9347 6618. Email: [email protected].
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Abstract

Background: The objective of this study was to examine the prevalence and short-term course of depression and anxiety in a sample of hospitalized, medically unwell older adults, using both a symptom measure and a diagnostic instrument.

Methods: One hundred participants were recruited from in-patients in a geriatric hospital in Melbourne, Australia. Anxiety and depression were assessed shortly after admission, and again two months later, using the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Mental Status Schedule/ AGECAT diagnostic system.

Results: At Time 1, 60% of the sample exhibited anxiety symptoms at a sub-case level, while 16% had anxiety symptoms at a syndrome case level, whereas 48% of the participants had depression at syndrome level. The HADS and AGECAT were concordant with respect to anxiety for 78% of participants, but agreement was lower for depression; AGECAT identified a further 36 syndrome cases of depression not deemed depressed by the HADS. There was a significant decrease in overall rates of both depression and anxiety symptoms and syndromes from Time 1 to Time 2.

Conclusion: This study confirms the findings of previous research with respect to the high prevalence of depression in physically unwell older adults, and extends knowledge about anxiety in this group. Symptoms of anxiety are even more common than symptoms of depression in this group, especially around the time of admission to hospital. Over a relatively short time period, there is a marked reduction in symptoms, but levels of anxiety and depression remain high.

Keywords

anxietydepressionprevalenceolder adultsphysical illness
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 4 , August 2009 , pp. 754 - 763
Copyright
Copyright © International Psychogeriatric Association 2009

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Ames, D., Flynn, E., Tuckwell, V. and Harrigan, S. (1994a). Diagnosis of psychiatric disorder in elderly general and geriatric hospital patients: AGECAT and DSM-III compared. International Journal of Geriatric Psychiatry, 9, 627–633.CrossRefGoogle Scholar
Ames, D., Flynn, E. and Harrigan, S. (1994b). Prevalence of psychiatric disorders among in-patients in an acute geriatric hospital. Australian Journal on Ageing, 13, 8–11.CrossRefGoogle Scholar
Astrom, M. (1996). Generalised Anxiety Disorder in stroke patients. Stroke, 27, 270–275.CrossRefGoogle ScholarPubMed
Australian Institute of Health and Welfare (2002). Older Australia at a Glance. Canberra: Australian Institute of Health and Welfare and Department of Ageing.Google Scholar
Beekman, A. et al. (1998). Anxiety disorders in later life: a report from the Longitudinal Aging Study, Amsterdam. International Journal of Geriatric Psychiatry, 13, 717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Blazer, D. (2003). Depression in late life: review and commentary. Journal of Gerontology, Medical Sciences, 58, 249–265.CrossRefGoogle Scholar
Bond, R., Gregson, B., Rousseau, N., Lecoutier, J. and Rodgers, H. (1998). Outcomes following acute hospital care for stroke or hip fracture: how useful is an assessment for anxiety? International Journal of Geriatric Psychiatry, 13, 601–610.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Bruce, M. (2001). Depression and disability in late life. American Journal of Geriatric Psychiatry, 9, 102–112.CrossRefGoogle ScholarPubMed
Bruce, M., Seeman, T., Merrill, S. and Blazer, D. (1994). The impact of depressive symptomatology on physical disability: MacArthur Studies of Successful Aging. American Journal of Public Health, 84, 1796–1799.CrossRefGoogle ScholarPubMed
Bryant, C., Jackson, H. and Ames, D. (2008). The prevalence of anxiety in older adults: methodological issues and a review of the literature. Journal of Affective Disorders, 109, 233–250.CrossRefGoogle Scholar
Copeland, J., Kelleher, M., Kellett, J., Gourlay, A., Gurland, B. and Fleiss, J. (1976). A semi-structured instrument for the assessment and diagnosis of mental state in the elderly: the Geriatric Mental State Schedule. Psychological Medicine, 6, 439–449.CrossRefGoogle Scholar
Copeland, J., Dewey, M., and Griffith-Jones, H. (1986). A computerised psychiatric diagnostic system and nomenclature for elderly subjects. Psychological Medicine, 16, 88–99.CrossRefGoogle ScholarPubMed
Davies, K., Burn, W., McKenzie, F. and Brothwell, J. (1993). Evaluation of the Hospital Anxiety and Depression Scale as a screening instrument in geriatric medical patients. International Journal of Geriatric Psychiatry, 8, 165–169.CrossRefGoogle Scholar
de Beurs, E., Beekman, A., van Balkom, A., Deeg, D., van Dyck, R. and van Tilburg, W. (1999). Anxiety in older persons: its effect on disability, well-being and use of health services. Psychological Medicine, 29, 303–316.CrossRefGoogle ScholarPubMed
Dorra, H. and Lenze, E. (2002). Clinically relevant factors in elderly hip fracture patients. International Journal of Psychiatry and Medicine, 32, 249–259.CrossRefGoogle Scholar
Hodkinson, M. (1972). Evaluation of a mental test score for the assessment of mental impairment in the elderly. Age and Ageing, 1, 233–238.CrossRefGoogle ScholarPubMed
Houston, D., McKee, K. and Wilson, J. (2000). Attributional style, efficacy and the enhancement of well-being among housebound older people. Basic and Applied Social Psychology, 22, 309–317.CrossRefGoogle Scholar
Koenig, H. and George, L. (1998). Depression and physical disabilitry outcomes in depressed medically ill hospitalised older adults. Gerontologist, 28, 308–310.Google Scholar
Koenig, H., Gittleman, D., Branski, S., Brown, S. and Stone, P. (1998). Depressive symptoms in elderly medical-surgical patients hospitalized in community settings. American Journal of Geriatric Psychiatry, 6, 14–23.CrossRefGoogle ScholarPubMed
Kroenke, K., Jackson, J. and Chamberlin, J. (1997). Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. American Journal of Medicine, 103, 339–347.CrossRefGoogle ScholarPubMed
Kvaal, K., Macijauskiene, J., Engedal, K. and Laake, E. (2001a). High prevalence of anxiety symptoms in hospitalised geriatric patients. International Journal of Geriatric Psychiatry, 16, 690–693.CrossRefGoogle Scholar
Kvaal, K., Laake, K. and Engedal, K. (2001b). Psychometric properties of the state part of the Spielberger State-Trait Anxiety Inventory (STAI) in geriatric patients. International Journal of Geriatric Psychiatry, 16, 980–986.CrossRefGoogle ScholarPubMed
Lenze, E. et al. (2001). The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. American Journal of Geriatric Psychiatry, 9, 113–135.CrossRefGoogle ScholarPubMed
Lichtenberg, P. and MacNeill, S. (2003). Streamlining assessments and treatments for geriatric mental health in medical rehabilitation. Rehabilitation Psychology, 48, 56–60.CrossRefGoogle Scholar
Lindesay, J. (1990). The Guy's /Age Concern survey: physical health and psychiatric disorder in an urban elderly sample. International Journal of Geriatric Psychiatry, 5, 171–178.CrossRefGoogle Scholar
Lindesay, J. (1994). Neurotic disorders. In Ames, D. and Chiu, E. (eds.), Functional Psychotic Disorders of the Elderly. Cambridge: Cambridge University Press.Google Scholar
Lloyd, G. and Cawley, R. (1983). Distress or illness? A study of psychological symptoms after myocardial infarction. British Journal of Psychiatry, 142, 120–125.CrossRefGoogle ScholarPubMed
Mahoney, R., Regan, C., Katona, C. and Livingston, G. (2005). Anxiety and depression in family caregivers of people with Alzheimer's disease. American Journal of Geriatric Psychiatry, 13, 795–801.CrossRefGoogle Scholar
Radloff, L. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–390.CrossRefGoogle Scholar
Shimoda, K. and Robinson, R. (1998). Effect of anxiety disorder on recovery from stroke. Journal of Neuropsychiatry and Clinical Neuroscience, 10, 34–40.CrossRefGoogle ScholarPubMed
Simon, G., Gater, R., Kisely, S. and Piccinelli, M. (1996). Somatic symptoms of distress: an international primary care study. Psychosomatic Medicine, 58, 481–488.CrossRefGoogle ScholarPubMed
Snaith, R. and Zigmond, A. (1994). The Hospital Anxiety and Depression Scale Manual. Windsor: NFER.Google Scholar
Spielberger, C., Gorusch, R., Lushene, P., Vagg, P. and Jacobs, A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting Psychologists’ Press Inc.Google Scholar
Sullivan, M., LaCroix, A., Baum, C. and Grothaus, L. (1997). Functional status in coronary artery disease: a one-year prospective study of the role of anxiety and depression. American Journal of Medicine, 103, 348–356.CrossRefGoogle ScholarPubMed
Tyrer, P. (1990). The division of neurosis: a failed classification. Journal of the Royal Society of Medicine, 83, 614–616.CrossRefGoogle ScholarPubMed
Wattis, J., Davies, K., Burn, W. and McKenzie, F. (1994). Correlation between Hospital Anxiety and Depression (HAD) Scale and other measures of anxiety and depression in geriatric inpatients. International Journal of Geriatric Psychiatry, 9, 61–63.CrossRefGoogle Scholar
Yohannes, A., Baldwin, R. and Connolly, M. (2000). Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. International Journal of Geriatric Psychiatry, 15, 1090–1096.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Zigmond, A. and Snaith, R. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed