Hostname: page-component-669899f699-b58lm Total loading time: 0 Render date: 2025-04-25T16:56:42.777Z Has data issue: false hasContentIssue false
  • English
  • Français

Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R)

Published online by Cambridge University Press:  17 June 2009

R. C. Kessler ,
H. Birnbaum ,
E. Bromet ,
I. Hwang ,
N. Sampson  and
V. Shahly
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
H. Birnbaum
Affiliation:
The Analysis Group, Boston, MA, USA
E. Bromet
Affiliation:
Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, Stony Brook, NY, USA
I. Hwang
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
N. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
V. Shahly
Affiliation:
Boston Psychoanalytic Society and Institute, Boston, MA, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life.

Method

We studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0.

Results

Lifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged ⩾65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly.

Conclusions

Given that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.

Keywords

Chronic conditionsco-morbiditydepressionelderlyepidemiology
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 2 , February 2010 , pp. 225 - 237
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Alexopoulos, GS, Buckwalter, K, Olin, J, Martinez, R, Wainscott, C, Krishnan, KR (2002). Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biological Psychiatry 52, 543–558.CrossRefGoogle ScholarPubMed
Baker, M, Stabile, M, Deri, C (2001). What do self-reported, objective measures of health measure? NBER Working Paper 8419. National Bureau of Economic Research: Cambridge, MA.CrossRefGoogle Scholar
Blazer, D, Hughes, DC, George, LK (1987). The epidemiology of depression in an elderly community population. Gerontologist 27, 281–287.CrossRefGoogle Scholar
Blazer, DG 2nd, Hybels, CF (2005). Origins of depression in later life. Psychological Medicine 35, 1241–1252.CrossRefGoogle ScholarPubMed
Bremmer, MA, Beekman, AT, Deeg, DJ, Penninx, BW, Dik, MG, Hack, CE, Hoogendijk, WJ (2008). Inflammatory markers in late-life depression: results from a population-based study. Journal of Affective Disorders 106, 249–255.CrossRefGoogle ScholarPubMed
Bremmer, MA, Deeg, DJ, Beekman, AT, Penninx, BW, Lips, P, Hoogendijk, WJ (2007). Major depression in late life is associated with both hypo- and hypercortisolemia. Biological Psychiatry 62, 479–486.CrossRefGoogle ScholarPubMed
Charles, ST, Carstensen, LL (2008). Unpleasant situations elicit different emotional responses in younger and older adults. Psychology and Aging 23, 495–504.CrossRefGoogle ScholarPubMed
Diehl, M, Coyle, N, Labouvie-Vief, G (1996). Age and sex differences in strategies of coping and defense across the life span. Psychology and Aging 11, 127–139.CrossRefGoogle ScholarPubMed
Drayer, RA, Mulsant, BH, Lenze, EJ, Rollman, BL, Dew, MA, Kelleher, K, Karp, JF, Begley, A, Schulberg, HC, Reynolds, CF 3rd (2005). Somatic symptoms of depression in elderly patients with medical comorbidities. International Journal of Geriatric Psychiatry 20, 973–982.CrossRefGoogle ScholarPubMed
Edwards, WS, Winn, DM, Kurlantzick, V, Sheridan, S, Berk, ML, Retchin, S, Collins, JG (1994). Evaluation of National Health Interview Survey Diagnostic Reporting. National Center for Health Statistics. Vital and Health Statistics 2, 120.Google Scholar
Ernst, C, Angst, J (1995). Depression in old age. Is there a real decrease in prevalence? A review. European Archives of Psychiatry and Clinical Neuroscience 245, 272–287.CrossRefGoogle Scholar
Felton, BJ, Revenson, TA (1987). Age differences in coping with chronic illness. Psychology and Aging 2, 164–170.CrossRefGoogle ScholarPubMed
Fiske, A, Gatz, M, Pedersen, NL (2003). Depressive symptoms and aging: the effects of illness and non-health-related events. Journal of Gerontology Series B: Psychological Sciences and Social Sciences 58, 320–328.CrossRefGoogle ScholarPubMed
Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, de Girolamo, G, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA, Kessler, RC (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research 15, 167–180.CrossRefGoogle ScholarPubMed
Hosmer, DW, Lemeshow, S (2001). Applied Logistic Regression, 2nd edn. Wiley & Son: New York.Google Scholar
Jorm, AF (2000). Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychological Medicine 30, 11–22.CrossRefGoogle ScholarPubMed
Kennedy, GJ, Kelman, HR, Thomas, C (1990). The emergence of depressive symptoms in late life: the importance of declining health and increasing disability. Journal of Community Health 15, 93–104.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Chiu, WT, Demler, O, Heeringa, S, Hiripi, E, Jin, R, Pennell, BE, Walters, EE, Zaslavsky, A, Zheng, H (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 69–92.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 3095–3105.CrossRefGoogle ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kessler, RC, Merikangas, KR (2004). The National Comorbidity Survey Replication (NCS-R): background and aims. International Journal of Methods in Psychiatric Research 13, 60–68.CrossRefGoogle ScholarPubMed
Kessler, RC, Üstün, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Knäuper, B, Cannell, CF, Schwarz, N, Bruce, ML, Kessler, RC (1999). Improving accuracy of major depression age-of-onset reports in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research 8, 39–48.CrossRefGoogle Scholar
Knight, M, Stewart-Brown, S, Fletcher, L (2001). Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys. Journal of Public Health Medicine 23, 179–186.CrossRefGoogle ScholarPubMed
Koenig, HG, Meador, KG, Shelp, F, Goli, V, Cohen, HJ, Blazer, DG (1991). Major depressive disorder in hospitalized medically ill patients: an examination of young and elderly male veterans. Journal of the American Geriatric Society 39, 881–890.CrossRefGoogle Scholar
Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehan, DV (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93–105.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Subramaniam, H (2005). Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. American Journal of Psychiatry 162, 1588–1601.CrossRefGoogle ScholarPubMed
Petronijevic, M, Petronijevic, N, Ivkovic, M, Stefanovic, D, Radonjic, N, Glisic, B, Ristic, G, Damjanovic, A, Paunovic, V (2008). Low bone mineral density and high bone metabolism turnover in premenopausal women with unipolar depression. Bone 42, 582–590.CrossRefGoogle ScholarPubMed
Research Triangle Institute (2002). SUDAAN: Professional Software for Survey Data Analysis [computer program]. Research Triangle Institute: Research Triangle Park, NC.Google Scholar
Revicki, DA, Rentz, AM, Dubois, D, Kahrilas, P, Stanghellini, V, Talley, NJ, Tack, J (2004). Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Quality of Life Research 13, 833–844.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowitz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573–583.CrossRefGoogle ScholarPubMed
Salaycik, KJ, Kelly-Hayes, M, Beiser, A, Nguyen, AH, Brady, SM, Kase, CS, Wolf, PA (2007). Depressive symptoms and risk of stroke: the Framingham Study. Stroke 38, 16–21.CrossRefGoogle ScholarPubMed
Sargeant, JK, Bruce, ML, Florio, LP, Weissman, MM (1990). Factors associated with 1-year outcome of major depression in the community. Archives of General Psychiatry 47, 519–526.CrossRefGoogle ScholarPubMed
Schoenborn, CA, Adams, PF, Schiller, JS (2003). Summary health statistics for the U.S. population: National Health Interview Survey, 2000. Vital and Health Statistics 10, 1–83.Google Scholar
Schoevers, RA, Geerlings, MI, Deeg, DJ, Holwerda, TJ, Jonker, C, Beekman, AT (2009). Depression and excess mortality: evidence for a dose response relation in community living elderly. International Journal of Geriatric Psychiatry 24, 169–176.CrossRefGoogle ScholarPubMed
Simon, GE, Von Korff, M (1992). Reevaluation of secular trends in depression rates. American Journal of Epidemiology 135, 1411–1422.CrossRefGoogle ScholarPubMed
Snowdon, J (1997). Depression in old age: questions concerning prevalence studies. International Journal of Geriatric Psychiatry 12, 1043–1045.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Taylor, WD, McQuoid, DR, Krishnan, KR (2004). Medical comorbidity in late-life depression. International Journal of Geriatric Psychiatry 19, 935–943.CrossRefGoogle ScholarPubMed
Weissman, MM, Bruce, ML, Leaf, PJ, Florio, LP, Holzer, C (1991). Affective disorders. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (ed. Robins, L. N. and Regier, D. A.), pp. 53–80. Free Press: New York.Google Scholar
Wolter, KM (1985). Introduction to Variance Estimation. Springer-Verlag: New York.Google Scholar