Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study finds lesser conditions a stepping stone to major depression

06.04.2006


An often undiagnosed source of suffering for elderly



Elderly patients with lesser versions of depression, a group many times larger than those with major depression, are more than five times as likely as healthy patients to descend into major depression within one year, according to a study published today in the Annals of Internal Medicine. The study’s authors believe that perhaps millions of elderly patients who do not meet the criteria for a diagnosis of major depression are indeed depressed, suffering and not being treated for it.

Researchers are focusing on depression in elderly patients because the number of persons aged 65 years or older (about 36 million) is expected to double in the next 25 years, with a third of them expected to struggle with a mental disorder at some point. While major depression among the elderly is an important problem, it has overshadowed related disorders that are less serious, but that leave many more people with suffering from painful emotions, disinterest in their surroundings, and thoughts of worthlessness. As a result, this group is more functionally disabled, less able to feed and groom themselves, or to go shopping.


The current study is the first to carefully reexamine the definitions of certain depression types in older patients seen in primary care settings, and to compare outcomes in different types of depression. According to the Diagnostic and Statistical Manual for Mental Disorders 4th Edition (DSM-IV), minor depression is officially defined using the exact same symptoms as major depression, but including fewer of them. To be precise, persons suffering from minor depression experience 2 to 4 symptoms of depression for most of the day nearly every day, while those with major depression experience five or more symptoms. Patients with the same symptoms, but experiencing them less frequently – perhaps only several days per week, or for only a few hours each day -- fall within the "subsyndromal" depression category.

Among patients in the current study, 20 percent were found to meet the criteria for minor or subsyndromal depression, compared to just five percent that met the definition of major depression. Projecting the percentages out to the U.S. population over aged 65, researchers estimate that about 7 million experience minor or subsyndromal depression, often undiagnosed and untreated, compared to 1.75 million senior citizens with major or so-called clinical depression.

"Our study makes the point that the lines drawn between major and minor depression, while useful in some ways, are arbitrary, and may need to be redrawn to put an end to a great deal of suffering in this country," said Jeffrey M. Lyness, M.D., director of the Program in Geriatrics and Neuropsychiatry at the University of Rochester Medical Center, and lead author of the article. "The less severe the depression, the less it has been studied, regardless of how significant its impact might be."

Study Details

The current study followed 622 patients who were at least 60 years of age and came in for treatment in primary care practices in greater New York City, Philadelphia and Pittsburgh. The current study sought to measure minor depression, not by studying patients that report to psychiatrist’s office, but instead by measuring depression among those who visited their primary care doctors’ offices. Most elderly persons never see mental a health specialist, but instead may tell their primary care physician about feeling down or nervous or otherwise unwell during a regular check-up.

Of the 441(70.9%) patients who completed one year of follow-up, 122 had major depression, 205 had minor or subsyndromal depression, and 114 did not have depression at the beginning of the study. One year after a baseline evaluation, data were collected using standard questionnaires and measurements of depression (e.g., Hamilton Depression Rating Scale).

The study found that patients with minor or subsyndromal depression were five and one-half times more likely to be diagnosed with major depression within a year than those who were not depressed at the start of the study. The group with minor and subsyndromal depression also suffered greater functional disability at one year than patients without depression, although not as severe as those with major depression. As shown in other studies, the level of a patient’s medical illness to start with (medical burden) and patients’ beliefs about their health and support from others such as families or friends were significant, independent predictors of depression outcome.

Beginnings of A Solution

Lyness has also co-authored a separate study, now in press in The American Journal of Psychiatry, which may hold part of the answer for these oft-neglected patients with minor and subsyndromal depression. In short, the second study, a statistical analysis of previously published clinical studies, found that patients with less severe forms of depression may on average experience 40 percent more improvement from psychotherapy (i.e., counseling) than from treatment with antidepressant drugs. In addition, a greater proportion of patients receiving psychotherapy improved than did those receiving drug treatment, Lyness said.

"There is an urgent need for all of us in the field to redraw the definitions and standards in minor and subsyndromal depression, but that will not happen until we prove what works for these patients in particular, as opposed to what works for patients with major depression," Lyness said. "In the near future we will seek to identify those patients most in need and most likely to respond to specific therapy or medications. To do so, my colleagues and I are currently analyzing information collected over the past five years from over 750 older persons in the Rochester area."

Greg Williams | EurekAlert!
Further information:
http://www.urmc.rochester.edu

More articles from Studies and Analyses:

nachricht Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University

nachricht New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Demonstration of a single molecule piezoelectric effect

Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale

Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...

Im Focus: Hybrid optics bring color imaging using ultrathin metalenses into focus

For photographers and scientists, lenses are lifesavers. They reflect and refract light, making possible the imaging systems that drive discovery through the microscope and preserve history through cameras.

But today's glass-based lenses are bulky and resist miniaturization. Next-generation technologies, such as ultrathin cameras or tiny microscopes, require...

Im Focus: Stem cell divisions in the adult brain seen for the first time

Scientists from the University of Zurich have succeeded for the first time in tracking individual stem cells and their neuronal progeny over months within the intact adult brain. This study sheds light on how new neurons are produced throughout life.

The generation of new nerve cells was once thought to taper off at the end of embryonic development. However, recent research has shown that the adult brain...

Im Focus: Interference as a new method for cooling quantum devices

Theoretical physicists propose to use negative interference to control heat flow in quantum devices. Study published in Physical Review Letters

Quantum computer parts are sensitive and need to be cooled to very low temperatures. Their tiny size makes them particularly susceptible to a temperature...

Im Focus: Autonomous 3D scanner supports individual manufacturing processes

Let’s say the armrest is broken in your vintage car. As things stand, you would need a lot of luck and persistence to find the right spare part. But in the world of Industrie 4.0 and production with batch sizes of one, you can simply scan the armrest and print it out. This is made possible by the first ever 3D scanner capable of working autonomously and in real time. The autonomous scanning system will be on display at the Hannover Messe Preview on February 6 and at the Hannover Messe proper from April 23 to 27, 2018 (Hall 6, Booth A30).

Part of the charm of vintage cars is that they stopped making them long ago, so it is special when you do see one out on the roads. If something breaks or...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

2nd International Conference on High Temperature Shape Memory Alloys (HTSMAs)

15.02.2018 | Event News

Aachen DC Grid Summit 2018

13.02.2018 | Event News

How Global Climate Policy Can Learn from the Energy Transition

12.02.2018 | Event News

 
Latest News

Fingerprints of quantum entanglement

16.02.2018 | Information Technology

'Living bandages': NUST MISIS scientists develop biocompatible anti-burn nanofibers

16.02.2018 | Health and Medicine

Hubble sees Neptune's mysterious shrinking storm

16.02.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>