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The Clinical Significance of Subsyndromal Depression in Older Primary Care Patients

https://doi.org/10.1097/01.JGP.0000235763.50230.83Get rights and content

Objective

Many seniors experience depressive symptoms not meeting standard diagnostic criteria. The authors sought to examine the clinical correlates of older primary care patients with “subsyndromal depression” (SSD), hypothesizing that SSD subjects have greater symptoms and functional impairment than nondepressed patients, but not as severe as those with major or minor depression, and to explore the characteristics of subjects captured by three different definitions of SSD used in prior published work.

Methods

The authors conducted a cross-sectional case comparison study that enrolled 662 primary care patients age ≥65 years. Outcomes were validated measures of psychopathology, medical illness burden, and functional status.

Results

All three SSD groups captured patients with greater symptoms and functional impairment than the nondepressed group. SSD subjects were as ill as those with minor or major depression on some measures (e.g., medical burden). Each SSD group definition captured some subjects unique to that group.

Conclusions

Subsyndromal depression is common and associated with symptoms or impairments of clinical importance. Sole reliance on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition definitions of major or minor depression omits a substantial proportion of seniors with clinically significant depressive symptoms. Longitudinal study is needed to help clinicians identify those at greatest risk for poor outcomes, while researchers testing mechanistic models should include patients with SSD to determine whether they share pathogenetic underpinnings with more severe mood disorders.

Section snippets

METHODS

The study methods have been described previously.15 In brief, we attempted to enroll all patients age 65 years or older who presented for care on selected days from primary care offices in internal medicine and family medicine, including private practice and hospital-based clinic settings. Potentially eligible subjects were asked for permission to approach them by telephone after their primary care appointment to ask about study participation; consenting patients were then called, in the order

RESULTS

Of 2,476 potentially eligible subjects appearing in the study practices on selected recruitment days, 1,322 were called for study enrollment; of these, 662 subjects (50.1%) were enrolled, a completion rate that is consistent with previous work using intensive, rigorous assessment methodologies such as the SCID in primary care settings.29 The enrolled subjects included 419 females (63.3%) and comprised 613 (92.6%) whites, 32 (4.8%) blacks, and 17 (2.6%) from other racial or ethnic groups.

CONCLUSIONS

The primary study hypothesis was partly confirmed. The variously defined subsyndromal depression groups had a greater proportion of females than the nondepressed group, similar to the major and minor depression groups. Compared with the nondepressed group, the SSD groups had greater overall depressive symptom severity, unsurprisingly given the group definitions. Importantly, the SSD groups also had greater functional disability, the latter particularly evident with the GAF rating of psychiatric

References (36)

  • JM Lyness et al.

    The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability

    J Am Geriatr Soc

    (1999)
  • CF Hybels et al.

    Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample

    Gerontologist

    (2001)
  • DC Steffens et al.

    Prevalence of depression and its treatment in an elderly population: the Cache County study

    Arch Gen Psychiatry

    (2000)
  • JM Lyness et al.

    Psychiatric disorders in older primary care patients

    J Gen Intern Med

    (1999)
  • B Geiselmann et al.

    Subthreshold depression in the elderly: qualitative or quantitative distinction?

    Compr Psychiatry

    (2000)
  • GJ McAvay et al.

    Depression in elderly homecare patients: patient versus informant reports

    Psychol Med

    (2004)
  • JJ Gallo et al.

    The challenge of depression in late life: bridging science and service in primary care

    JAMA

    (2000)
  • RL Spitzer et al.

    Structured Clinical Interview for Axis I DSM-IV Disorders.

    (1994)
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    This work was supported by grants NIMH R01 MH61429 and K24 MH71509.

    This work was presented in part at the International College of Geriatric Psychoneuropharmacology, Basel, Switzerland, October 16, 2004.

    The authors thank the patients, staff, and providers of the following primary care practices: University of Rochester Medical Center, Department of Medicine; Pulsifer Medical; East Ridge Family Medicine; Highland Family Medicine; Olsan Medical; Clinton Crossings Medical; Panorama Internal Medicine; Highland Geriatric Medicine; and Culver Medical. The authors also thank the following for technical assistance: Karen Gibson, M.S.Ed.; Constance Bowen, M.A.; James Evinger, M.Div.; Cameron Gardner, M.D.; Michael New; Andra Niculescu, M.D.; Jean Sauvain, B.S.; Jill Scheltz, B.A., L.M.T.; and Judy Woodhams, M.F.A.

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