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Profile of Depressive Symptoms in Younger and Older Medical Inpatients with Major Depression
Author(s) -
Koenig Harold G.,
Cohen Harvey J.,
Blazer Dan G.,
Krishnan K. Ranga Rama,
Sibert Thomas E.
Publication year - 1993
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1993.tb07298.x
Subject(s) - medicine , depression (economics) , psychiatry , mood , anxiety , major depressive disorder , geriatric depression scale , clinical psychology , depressive symptoms , economics , macroeconomics
Objective : To examine and compare the profile of cognitive symptoms, somatic symptoms, and somatic complaints in younger and older medical inpatients diagnosed with major depressive disorder (MDD) Design : Cross‐sectional cohort. Patients and Setting : Male patients aged 20–39 years ( n = 116) and aged 70–102 years ( n = 332), consecutively admitted to the medical and neurological services of a VA medical center, underwent psychiatric evaluations for depression. Measurements : Depressive symptoms were measured using the observer‐rated Hamilton Depression Scale and the self‐rated Geriatric Depression Scale using an “inclusive” approach (symptoms rated regardless of etiology). Data on 12 common somatic complaints were also collected. Clinical diagnoses of MDD were made by a psychiatrist based on the Diagnostic Interview Schedule and other psychiatric and physical health data. Results : After controlling for severity of medical illness, functional status, and alcohol use, symptoms that discriminated MDD best among younger men were loss of interest, feelings of guilt or of being a burden, suicidal thoughts, and depressed mood (primarily cognitive and affective symptoms). Among older men, loss of interest, insomnia, suicidal thoughts, and hypochondriasis most strongly differentiated depressed from non‐depressed patients (mixture of cognitive and somatic symptoms); fatigue, weight loss, genital symptoms, and somatic anxiety were weakly related or unrelated to MDD. Number of somatic complaints (headache, dizziness, palpitations, etc.) helped differentiate patients with MDD; although equally common among depressed young and older patients, a distinct pattern of complaints emerged in each age group. Conclusions : Cognitive symptoms of depression can help to distinguish medical inpatients with and without MDD. In older adults, however, somatic symptoms cannot be ignored and may be more important for diagnosing MDD than previously realized. These findings will help clinicians identify patients with MDD and differentiate them from non‐depressed patients with medical illness.