A tune in "a minor" can "b major": A review of epidemiology, illness course, and public health implications of subthreshold depression in older adults

Department of Psychiatry, University of California, San Diego, UCSD, United States.
Journal of Affective Disorders (Impact Factor: 3.71). 10/2010; 129(1-3):126-42. DOI: 10.1016/j.jad.2010.09.015
Source: PubMed

ABSTRACT With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression.
We searched PubMed (1980-Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression.
In older adults subthreshold depression was generally at least 2-3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8-10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation.
Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis.
The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.

  • [Show abstract] [Hide abstract]
    ABSTRACT: A model community-based outreach program overcomes barriers to screening and case identification of vulnerable older adults in psychiatric distress.
    Generations (San Francisco, Calif.) 09/2014; 38(3):68-74. · 0.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Population-based data are lacking on the prevalence and comorbidity of subsyndromal depression (SSD) and its associated risk for incident psychiatric disorders in older adults. Methods Using nationally representative data from 10,409 US adults aged 55 years and older who participated in the National Epidemiologic Survey on Alcohol and Related Conditions, we evaluated associations between lifetime SSD at Wave 1, and lifetime and incident mood, anxiety, and substance use disorders over a 3-year period. Results Some 13.8% of older adults met criteria for SSD, and 13.7% met criteria for major depressive disorder (MDD). After adjustment for sociodemographic characteristics, older adults with SSD at Wave 1 had significantly increased odds of lifetime mood (adjusted odds ratios (AORs) = 3.65–10.55), anxiety (AORs = 1.61–2.50), and any personality (AOR = 1.62) disorders. After adjustment for sociodemographic characteristics and comorbid psychiatric disorders, older adults with SSD at Wave 1 had significantly increased odds of developing new-onset MDD (AOR = 1.44, 95% confidence interval (CI) = 1.01–2.05), as well as an anxiety disorder (AOR = 1.52, 95% CI = 1.04–2.20) at Wave 2. Conclusion In addition to the 13.7% of US older adults with lifetime MDD, an additional 13.8% have lifetime SSD, which is not a formally recognized diagnosis. In addition to its high prevalence, SSD is associated with elevated rates of comorbid mood, anxiety, and personality disorders, as well as the development of a new-onset MDD and anxiety disorder. These results underscore the importance of dimensional approaches to assessing depressive symptoms in older persons, as diagnostic approaches that rely on rigorous categorical classifications may fail to identify a substantial proportion of at-risk individuals.
    International Journal of Geriatric Psychiatry 10/2014; DOI:10.1002/gps.4204 · 3.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Several systematic reviews and meta-analyses demonstrated the association between depression and the risk of coronary heart disease (CHD), but the previous reviews had some limitations. Moreover, a number of additional studies have been published since the publication of these reviews. We conducted an updated meta-analysis of prospective studies to assess the association between depression and the risk of CHD.Methods Relevant prospective studies investigating the association between depression and CHD were retrieved from the PubMed, Embase, Web of Science search (up to April 2014) and from reviewing reference lists of obtained articles. Either a random-effects model or fixed-effects model was used to compute the pooled risk estimates when appropriate.ResultsThirty prospective cohort studies with 40 independent reports met the inclusion criteria. These groups included 893,850 participants (59,062 CHD cases) during a follow-up duration ranging from 2 to 37 years. The pooled relative risks (RRs) were 1.30 (95% CI, 1.22-1.40) for CHD and 1.30 (95% CI, 1.18-1.44) for myocardial infarction (MI). In the subgroup analysis by follow-up duration, the RR of CHD was 1.36 (95%CI, 1.24-1.49) for less than 15 years follow-up, and 1.09 (95%CI, 0.96-1.23) for equal to or more than 15 years follow-up. Potential publication bias may exist, but correction for this bias using trim-and-fill method did not alter the combined risk estimate substantially.Conclusions The results of our meta-analysis suggest that depression is independently associated with a significantly increased risk of CHD and MI, which may have implications for CHD etiological research and psychological medicine.
    BMC Psychiatry 12/2014; 14(1):7. DOI:10.1186/s12888-014-0371-z · 2.24 Impact Factor

Full-text (2 Sources)

Available from
Jun 5, 2014

Similar Publications