Oct 30, 2012
Severe and increasing depressive symptoms in older women are associated with unhealthy old age, with high rates of disability, comorbid physical illness, and unhealthy lifestyles, new research shows.
A large, ongoing prospective cohort study looking at the trajectory of depression among older women showed that about 20% experienced persistently high or increasing depressive symptoms as they aged.
Furthermore, women with severe depression were more likely than those with minimal depressive symptoms to have diabetes, obesity, myocardial infarction, and physical disabilities. In addition, they were more likely to smoke and to be physically inactive and socially isolated.
"These associations support the need for intervention and prevention strategies to reduce depressive symptoms into the oldest-old years," the authors, led by Amy L. Byers, PhD, MPH, University of California, San Francisco, Veterans Affairs Medical Clinic, write.
The study was published in the October issue of Archives of General Psychiatry.
Improve Recognition, Treatment
According to the investigators, although evidence suggests that rates of depression are high in older individuals, little is known about the long-term course of late-life depression.
"Few studies have assessed trajectories of depressive symptoms in older participants, and these have been limited by short follow-up periods," they write.
They also note that because individuals aged 80 years and older are "the fastest growing age group in the United States and because a high incidence of depressive symptoms has been found among the oldest old, long-term investigation of depressive symptoms is needed in this age group."
The goal of the study was to characterize the natural course of depressive symptoms among "young" older women by providing follow-up into the ninth and tenth decades of life.
The study included 7240 community-dwelling women aged 65 years and older from clinic sites in 4 US centers from 1988 to 2009. The women were assessed at years 2, 6, 10, 16, and 20 using the Geriatric Depression Scale short form (GDS).
Lifestyle factors, including smoking status, alcohol use, physical activity, and social networks, were assessed at baseline.
In addition, all participants underwent a baseline medical history and assessment of global cognitive function using the Mini–Mental State Examination.
The mean number of GDS measurements was 3.4, and the median duration of follow-up was 12.2 years.
The researchers identified 4 distinct trajectories of depressive symptoms.
These included minimal depressive symptoms (27.8%), persistently low depressive symptoms (54.0%), increasing depressive symptoms (14.8%), and persistently high depressive symptoms (3.4%).
The results revealed that current antidepressant use was low for all groups but did increase with depression severity. Yet current antidepressant use was still only 7.1% among women with persistently high depressive symptoms.
The investigators report that compared to women with minimal symptoms, those with persistently high symptoms and those with increasing symptoms, respectively, had odds ratios (ORs) that were "substantially and significantly elevated" for baseline smoking (ORs, 4.69 and 7.97), physical inactivity (ORs, 2.11 and 2.78), small social network (ORs, 3.24 and 6.75), physical impairment (ORs, 8.11 and 16.43), myocardial infarction (ORs, 2.09 and 2.41), diabetes mellitus (ORs, 2.98 and 3.03), and obesity (ORs, 1.86 and 2.90).
"Given the increased life expectancy, the health and economic costs of depression, and the projected expansion of the older populations, the potential public health burdens of late-life depressive disorders implicated by our study are concerning.
"These findings emphasize the importance of improving the recognition, monitoring, and treatment of depressive symptoms during the long term and of developing better interventions to forestall their development," the investigators write.
The authors have disclosed no relevant financial relationships.
Arch Gen Psych. 2012;69:1073-1079. Abstract