Depression in Older Adults With Schizophrenia Spectrum Disorders: Prevalence and Associated Factors

SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.
American Journal of Geriatric Psychiatry (Impact Factor: 4.24). 12/2007; 15(12):991-8. DOI: 10.1097/JGP.0b013e31815ae34b
Source: PubMed


Although depression is common in older adults with schizophrenia, it has not been well studied. The authors examine those factors that are related to depression in a multiracial urban sample of older persons with schizophrenia.
The schizophrenia group consisted of 198 persons aged 55 or older who lived in the community and developed schizophrenia before age 45. Persons with substantial cognitive impairment were excluded from the study. A community comparison group (N = 113) was recruited using randomly selected census tract data. The authors adapted George's Social Antecedent Model of Depression, which consists of six categories comprising 16 independent variables, and used a dichotomous dependent variable based on a Center for Epidemiologic Studies Depression Scale cutoff score of > or = 16.
The schizophrenia group had significantly more persons with clinical depression than the community comparison group (32% versus 11%, respectively; chi(2) = 28.23, df = 1, p = 0.001). Bivariate analysis revealed that eight of the 16 variables were significantly related to clinical depression in the schizophrenia group. In logistic regression, six variables retained significance: physical illness (odds ratio [OR] = 1.60, 95% confidence interval [CI], 1.17-2.18), quality of life (OR = 0.84, 95% CI, 0.76-0.93), presence of positive symptoms (OR = 1.12, 95% CI, 1.02-1.21), proportion of confidants (OR = 0.03, 95% CI, 0.01-0.39), copes by using medications (OR = 2.12, 95% CI, 1.08-4.13), and copes with conflicts by keeping calm (OR = 1.34, 95% CI, 1.03-1.74).
Consistent with earlier studies of schizophrenia in older persons, the authors found physical health, positive symptoms, and several nonclinical variables to be associated with depression. Potential points for intervention include strengthening social supports, improving physical well-being, more aggressive treatment of positive symptoms, and increasing the recognition and treatment of depression.

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    • "It also appears to improve motor retardation. We noted that the effect of citalopram on negative symptoms was partly mediated by improvements in symptoms of depression, even though depression and negative symptoms have been demonstrated as distinct clinical dimensions of schizophrenia.[26] This finding is consistent with observations of a degree of overlap between negative and depressive symptom domains,[14] and is encouraging in suggesting that improvement in both domains may be seen with citalopram treatment. "
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    ABSTRACT: It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant augmentation on positive and negative symptoms. Participants in this study conducted at the University of California, San Diego and the University of Cincinnati, were persons with schizophrenia or schizoaffective disorder aged 40 or older and who met study criteria for SSD. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current anti-psychotic medication. Analysis of covariance was used to compare changes in positive and negative syndrome scale (PANSS) scores between treatment groups. We also assessed mediating effects of improvement in depression and moderating effects of multiple factors on positive and negative symptoms. There was significant improvement in PANSS negative symptoms scores in the citalopram group, which was partially mediated by improvement in depressive symptoms. There was no effect on PANSS positive scores. In patients with schizophrenia/schizoaffective disorder, treating depressive symptoms with citalopram appears to carry the added benefit of improving negative symptoms.
    Indian Journal of Psychiatry 04/2013; 55(2):144-8. DOI:10.4103/0019-5545.111452
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    • "Existing studies suggest that SubD is associated with both threshold and subthreshold anxiety disorders (Kvaal et al., 2008; Palmer et al., 1997) in older adults—Geisselmann et al. (2001) reported that 32% of older adults with SSD experienced significant anxiety symptoms (though not specifically DSM disorders). SubD is also prevalent among older persons with schizophrenia (Zisook et al., 2007; Diwan et al., 2007). While.a "
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    • "Methods for this study are described elsewhere (Diwan et al. 2007). Briefly, we recruited subjects aged 55 and over living in community who developed schizophrenia before the age of 45 using a stratified sampling method in which we attempted to interview approximately half the subjects from outpatient clinics and day programs and the other half from supported community residences in New York City. "
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