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Depression Without Sadness: Functional Outcomes of Nondysphoric Depression in Later Life
Author(s) -
Gallo Joseph J.,
Rabins Peter V.,
Lyketsos Constantine G.,
Tien Allen Y.,
Anthony James C.
Publication year - 1997
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.1532-5415.1997.tb03089.x
Subject(s) - medicine , dysphoria , depression (economics) , sadness , relative risk , distress , confidence interval , activities of daily living , population , late life depression , psychiatry , gerontology , demography , clinical psychology , cognition , anxiety , environmental health , anger , sociology , economics , macroeconomics
OBJECTIVES: We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13‐year follow‐up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria. DESIGN: Population‐based 13‐year follow‐up survey. SETTING: Community‐dwelling adults living in East Baltimore in 1981. PARTICIPANTS: Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981. MEASUREMENTS: The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression (“non‐cases”). The mortality and functional status of each group were compared after a 13‐year follow‐up interval. RESULTS: Compared with non‐cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13‐year follow‐up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status. CONCLUSION: Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long‐term outcomes.