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Importance of Subsyndromal Symptoms of Depression in Elderly Patients

Received December 3, 2003; revised April 28, June 1, 2004; accepted June 8, 2004. From the Section on Geriatric Psychiatry, Dept. of Psychiatry, Univ. of Pennsylvania, Philadelphia, PA (MPC,KK,DWO), the Center for Clinical Epidemiology and Biostatistics, Univ. of Pennsylvania, Philadelphia, PA (TTH), the Center for Mental Health Care Policy and Services Research, Dept. of Psychiatry, Univ. of Pennsylvania (CZ,TH), the Dept. of Psychiatry, Univ. of Pennsylvania (JCC), the Center for the Study of Addictions, Dept. of Psychiatry, Univ. of Pennsylvania (DWO), and VISN 4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center (DWO). Send correspondence and reprint requests to David W. Oslin, M.D., Univ. of Pennsylvania Health System, 3535 Market Street, Room 3002, Philadelphia, PA 19104. e-mail: oslin{at}mail.med.upenn.edu
© 2005 American Association for Geriatric Psychiatry

Objective: There is a debate about the importance of subsyndromal symptoms of depression (SSD). The current study examined the cross-sectional and longitudinal significance of SSD in geriatric subjects both with and without a past history of major depression. Methods: Elderly primary-care subjects with SSD, both with (SSD+; N=54) and without (SSD–; N=204) a history of major depression, were compared with subjects with major depression (MDD; N=111), minor depression (MinD; N=74), and symptom-free comparison subjects (N=59). Assessment domains included physical and psychological disability, health-care utilization, hopelessness, death and suicidal ideation, and a diagnostic evaluation at a 3-month follow-up. Results: Both subjects with SSD+ and SSD– differed from the symptom-free comparison subjects on measures of psychological disability, hopelessness, and death ideation, with SSD+ subjects being more severely psychologically disabled than SSD– subjects. There were few differences between SSD+ and MinD subjects or those with MDD, except on measures of psychological disability. Finally, more than 24% of SSD+ subjects progressed to meet criteria of MDD, MinD, or dysthymia over a 3-month period. Utilization of outpatient services did not differ among any of the depression groups or comparison subjects. Conclusions: SSD (with or without a past history of MDD) is associated with significant disability. Moreover, the risk of developing a diagnosis of MDD, MinD, or dysthymia is substantially elevated in subjects with a past history of MDD.

Key Words: Primary Care • Mood • Depression

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