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Depression in Older Patients in Residential Care

Significance of Dysphoria and Dimensional Assessment

From the Section on Geriatric Psychiatry, University of Pennsylvania, Philadelphia, PA. Address correspondence to Ira R. Katz, M.D., Ph.D., Department of Psychiatry, University of Pennsylvania, 3600 Market St., Room 812, Philadelphia, PA 19104.

To investigate the significance of subsyndromal depressive states in geriatric patients, the authors used data from ongoing studies of depression in older patients in residential care to evaluate the clinical correlates of dysphoria. They find that dysphoria is, in general, a persistent state associated with increased medical illness, pain, self-care deficits, and mortality relative to euthymic subjects; thus it is clinically significant. Differences between dysphoria and major depression in the extent of associated disability and mortality, but not in measures of medical illness, pain, or persistence, remain significant after controlling for self-ratings of depression from the Geriatric Depression Scale. This finding suggests that dimensional assessments can account for some of the correlates of depression, but that categorical diagnoses are required for others.