Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Subsyndromal Depression in Very Old Persons
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Subsyndromal depression hos äldre äldre personer (Swedish)
Abstract [en]

Background: Subsyndromal depression (SSD) or subthreshold depression is a common affective condition that can be described as depressiveness below the threshold of what is called a syndromal or a major depressive episode. The point prevalence for SSD has been reported to be about 10% in the community, or about two or three times higher than the prevalence for syndromal depression. In elderly persons, SSD compared to non-depression (ND) is associated with impaired activities of daily living, lower cognitive function, lower self-perceived health, worse psychiatric outcomes and higher mortality. However, most studies on SSD in elderly persons have been done in the young old age group (age 60-80 years), while few studies have investigated SSD in very old persons (age 80+). As many aspects (e.g. multimorbidity, frailty, functional decline and social dependence) change between the young old and the very old ages, there is a need for more knowledge about SSD in the very old. The overall aim of this doctoral thesis was to describe SSD, or the complex area between syndromal depression and normal aging, in very old persons.

Method: Paper 1 was based on qualitative interviews (n=27), while papers 2-4 were based largely on data from a prospective observational cohort study “Elderly in Linköping Screening Assessment” (ELSA85), with a population-based design following the participants from the age of 85 in three waves of follow-up. The 15-item Geriatric Depression Scale (GDS-15) was used for measuring depressiveness and to define SSD in the studies.

Results: The analysis of the qualitative interviews (paper 1) resulted in four themes (life curve and the body go down, to manage on one’s own, to keep up with life, and taking one day at a time), giving a comprehensive picture of SSD in very old age. In a comparison among SSD, ND and syndromal depression, SSD differed qualitatively from syndromal depression, but not clearly from ND. A cross-sectional analysis of data from baseline (paper 2) identified factors associated with SSD in very old persons, and according to analyses with multiple logistic and linear regressions, four domains (sociodemographic factors, declining physical functioning, neuropsychiatric factors, and existential factors) were significantly associated with SSD.

A five-year longitudinal follow-up (paper 3) showed that direct healthcare costs per month of survival for persons with SSD exceeded those of persons with ND by a ratio of 1.45 (€634 vs €436), a difference that was significant even after controlling for somatic multimorbidity.

An eight-year longitudinal follow-up (paper 4) showed that mortality was elevated (hazard ratio=1.33) for persons with SSD compared to ND, as were morbidity regarding basic ADL, IADL, loneliness, self-perceived health and depressiveness, whereas cognitive speed, executive functions and global cognitive function were not significantly impaired when adjusting for covariates.

Conclusion: SSD in very old persons has a different presentation in different persons, and healthcare personnel should be attentive to other depressive signs beside the classical ones in the diagnostic classification registries. SSD in the very old is associated with elevated direct healthcare costs, morbidity and mortality. Considering the high prevalence of SSD and the demographic development of increasing numbers of very old people, the findings highlight the need to develop clinical and societal strategies to prevent SSD and associated negative outcomes.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. , p. 94
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1633
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-149813DOI: 10.3384/diss.diva-149813ISBN: 9789176852538 (print)OAI: oai:DiVA.org:liu-149813DiVA, id: diva2:1235569
Public defence
2018-09-07, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-07-26 Created: 2018-07-26 Last updated: 2018-07-26Bibliographically approved
List of papers
1. Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People.
Open this publication in new window or tab >>Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People.
2015 (English)In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, no 5, p. 760-769Article in journal (Refereed) Published
Abstract [en]

Purpose of the Study: The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help.

DESIGN AND METHODS: Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata.

RESULTS: The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression.

IMPLICATIONS: The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.

Keywords
Coping, Frailty, Healthy aging, Subthreshold depression, Successful aging
National Category
Psychiatry Geriatrics
Identifiers
urn:nbn:se:liu:diva-120848 (URN)10.1093/geront/gnt162 (DOI)000362984500006 ()24398652 (PubMedID)
Funder
Östergötland County Council
Available from: 2015-08-27 Created: 2015-08-27 Last updated: 2018-07-26Bibliographically approved
2. Markers of subsyndromal depression in very old persons.
Open this publication in new window or tab >>Markers of subsyndromal depression in very old persons.
2016 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 31, no 6, p. 619-628Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate factors associated with subsyndromal depression (SSD) in very old persons, and to develop a model for prediction of SSD among very old persons.

METHODS: A cross-sectional, population-based study was undertaken on 85-year-old persons in Sweden. Data were collected from a postal questionnaire, assessments in the participants' homes and at reception visits. Depressiveness was screened with GDS-15 (Geriatric Depression Scale), and the results were classified into three outcome categories: non-depression (ND), SSD and syndromal depression. Data were analysed with binary logistic, ordinal logistic and linear regression.

RESULTS: With univariate logistic regression 20 factors associated with SSD were identified in very old persons, and the four hypothesized domains-sociodemographic factors, declining physical functioning, neuropsychiatric factors and existential factors-significantly related to SSD. The multivariate logistic model included seven independent factors that increase the likelihood of SSD instead of ND (lower self-perceived health, life not meaningful, problems with self-care, use of tranquilizing medication, no contact with neighbours, history of affective disorder and history of stroke). The ordinal logistic and the linear regression models resulted in seven partly different factors for predicting SSD and depressiveness, in the very old.

CONCLUSIONS: The identified markers may help clinicians with the detection, prevention and treatment of SSD in very old persons. The findings indicate the importance of a comprehensive functional approach to diagnosing and treating depressiveness in this population, and the findings might be interpreted as offering support for the coexistence of a dimensional and a categorical view on depressive disorders.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-127480 (URN)10.1002/gps.4369 (DOI)000374700000009 ()26489528 (PubMedID)
Note

Funding agencies: County Council of Ostergotland, Sweden

Available from: 2016-04-27 Created: 2016-04-27 Last updated: 2018-07-26
3. Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study
Open this publication in new window or tab >>Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study
Show others...
2018 (English)In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 26, no 7, p. 741-751Article in journal (Refereed) Published
Abstract [en]

Objectives

This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD.

Design and Setting

A prospective population-based study was undertaken on 85-year-old persons in Sweden.

Measurements

Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression.

Results

For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity.

Conclusions

SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Subthreshold depression; multimorbidity; oldest old; elderly; cost-of-illness; late-life depression
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-149695 (URN)10.1016/j.jagp.2018.03.007 (DOI)000436629200003 ()29673895 (PubMedID)2-s2.0-85045544057 (Scopus ID)
Note

Funding Agencies|County Council of Ostergotland, Sweden

Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2018-08-14Bibliographically approved

Open Access in DiVA

Subsyndromal Depression in Very Old Persons(1589 kB)16 downloads
File information
File name FULLTEXT02.pdfFile size 1589 kBChecksum SHA-512
4e6b86841e0357f031c096dbcbe5024658252fe3393d6c7e47effdf235fa3dd547810ab6b772a26f02361ccf31fade6993f30c0276f7c56f9b492301dd152445
Type fulltextMimetype application/pdf
omslag(103 kB)3 downloads
File information
File name COVER01.pdfFile size 103 kBChecksum SHA-512
a2d9e210e4bff0071a870c5cc6314addc4e81538fda8d4b1deda3578b1af310496554f826d57c039626af344e7670dd65f2a7fb3d5952dd2e93e054fde5a951d
Type coverMimetype application/pdf

Other links

Publisher's full textAvhandlingen på svenska

Search in DiVA

By author/editor
Ludvigsson, Mikael
By organisation
Division of Neuro and Inflammation ScienceFaculty of Medicine and Health SciencesDepartment of Acute Internal Medicine and Geriatrics
Gerontology, specialising in Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 21 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
isbn
urn-nbn

Altmetric score

doi
isbn
urn-nbn
Total: 108 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf