Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-03T07:01:42.952Z Has data issue: false hasContentIssue false
  • English
  • Français

Subsyndromal depression in old age: clinical significance and impact in a multi-ethnic community sample of elderly Singaporeans

Published online by Cambridge University Press:  01 February 2008

Soh Keng Chuan ,
Rajeev Kumar ,
Niti Matthew ,
Kua Ee Heok  and
Ng Tze Pin
Soh Keng Chuan
Affiliation:
Department of Psychological Medicine, National University of Singapore
Rajeev Kumar*
Affiliation:
Department of Psychological Medicine, National University of Singapore
Niti Matthew
Affiliation:
Department of Psychological Medicine, National University of Singapore
Kua Ee Heok
Affiliation:
Department of Psychological Medicine, National University of Singapore
Ng Tze Pin
Affiliation:
Department of Psychological Medicine, National University of Singapore
*
Correspondence should be addressed to: Dr. Rajeev Kumar, National University of Singapore, Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. Phone: +65 67724524; Fax: +65 67724524. Email: pcmrk@nus.edu.sg.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: This cross-sectional study examined the clinical significance and impact of subsyndromal depression in a sample of elderly people living in the community in Singapore.

Method: Data were analyzed from a population survey (the Singapore National Mental Health Survey of the Elderly). A total of 1092 respondents from a nationally representative multi-ethnic (Chinese, Malay and Indian) stratified random sample of older adults aged 60 and above were examined for depression using the Geriatric Mental State Examination (GMS). Diagnostic confidence levels of 3–5 indicated a DSM-IV diagnosis of syndromal depression, and 1–2 indicated subsyndromal depression. Other variables included sociodemographic characteristics, psychiatric and medical comorbidities, MMSE, health awareness, health and functional status.

Results: Subjects with subsyndromal depression were more likely to have poor socioeconomic status, cognitive impairment, anxiety, and measures of poor mental, physical and functional status compared with non-depressed subjects, and were similar to or worse than syndromal cases. In multivariate analyses that controlled for age, gender, ethnicity, education and several other sociodemographic factors, both subsyndromal and syndromal depression were significantly associated with higher numbers of medical comorbidities, diagnoses of comorbid dementia and anxiety, lower MMSE scores, self-reported mental health problem, functional disability and poor health status.

Conclusion: In this Asian population, subsydromal depression had the same clinical significance and health impact as syndromal depression, similar to findings in the West.

Keywords

depressionminorsubsyndromalAsian
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 1 , February 2008 , pp. 188 - 200
Copyright
Copyright © International Psychogeriatric Association 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Altshuler, L. L. et al. . 2006. Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: results of a large, multisite study. Journal of Clinical Psychiatry, 67, 1551–1560.CrossRefGoogle ScholarPubMed
American Psychiatric Association 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Blazer, D., Swartz, M., Woodbury, M., Manton, K. G., Hughes, D. and George, L. K. 1988. Depressive symptoms and depressive diagnoses in a community population. Archives of General Psychiatry, 45, 1078–1084.CrossRefGoogle Scholar
Boockvar, K. and Lachs, M. 2002. Hospitalization risk following admission to an academic nursing home. Journal of the American Medical Directors Association, 3, 130–135.CrossRefGoogle Scholar
Broadhead, W. E., Blazer, D. G., George, L. K. and Tse, C. K. 1990. Depression, disability days, and days lost from work in a prospective epidemiological survey. JAMA, 264, 2524–2528.CrossRefGoogle Scholar
Copeland, J. R. et al. . 1976. A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. I. Development and reliability. Psychological Medicine, 6, 439–449.CrossRefGoogle Scholar
Copeland, J. R., Dewey, M. E. and Griffiths-Jones, H. M. 1986. Computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychological Medicine, 16, 89–99.CrossRefGoogle ScholarPubMed
Cuijpers, P., De Graaf, R. and Van Dorsselaer, S. 2004. Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. Journal of Affective Disorders, 79, 71–79.CrossRefGoogle ScholarPubMed
Folstein, M., Folstein, S. and McHugh, P. 1975. “Mini-mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Horwarth, E., Johnson, J., Klerman, G. L. and Weissman, M. M. 1992. Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry, 49, 817–823.CrossRefGoogle Scholar
Huang, B. Y., Cornoni-Huntley, T., Hays, J. C., Huntley, R. R., Galanos, A. N. and Blazer, D. G. 2000. Impact of depressive symptoms on hospitalization risk in community-dwelling older persons. Journal of the American Geriatrics Society, 48, 1279–1284.CrossRefGoogle ScholarPubMed
Judd, L. L., Rapaport, M. H., Paulus, M. P. and Brown, J. L. 1994. Subsyndromal symptomatic depression: a new mood disorder? Journal of Clinical Psychiatry, 55 (Suppl.), 18–28.Google ScholarPubMed
Lavretsky, H. and Kumar, A. 2003. Practical geriatrics: clinically significant nonmajor geriatric depression. Psychiatric Services, 54, 297–299.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. 1969. Assessment of older people: self maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Lyness, J. M. et al. . 2006. Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Annals of Internal Medicine, 144, 496–504.CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. W. 1965. Functional evaluation: the Barthel Index. The Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Mulsant, B. H. and Ganguli, M. 1999. Epidemiology and diagnosis of depression in late life. Journal of Clinical Psychiatry, 60 (Suppl.), 9–15.Google ScholarPubMed
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. 2006. Prevalence and correlates of functional disability in multiethnic elderly Singaporeans. Journal of the American Geriatrics Society; 54, 21–29.CrossRefGoogle ScholarPubMed
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. 2007. Ethnic differences in cognitive performance on Mini-mental State Examination in Asians. American Journal of Geriatric Psychiatry, 15, 130–139.CrossRefGoogle ScholarPubMed
Preisig, M., Merikangas, K. R. and Angst, J. 2001. Clinical significance and comorbidity of subthreshold depression and anxiety in the community. Acta Psychiatrica Scandinavica, 104, 96–103.CrossRefGoogle ScholarPubMed
Rapaport, M. H. and Judd, L. L. 1998. Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. Journal of Affective Disorders, 48, 227–232.CrossRefGoogle ScholarPubMed
Sadek, N. and Bona, J. 2000. Subsyndromal symptomatic depression: a new concept. Depression and Anxiety, 12, 30–39.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Schaub, R. T., Linden, M. and Copeland, J. R. 2003. A comparison of GMS-A/AGECAT, DSM-III-R for dementia and depression, including subthreshold depression (SD) – results from the Berlin Aging Study (BASE). International Journal of Geriatric Psychiatry, 18, 109–117.CrossRefGoogle ScholarPubMed
Schoevers, R. A. et al. . 2006. Prevention of late-life depression in primary care: do we know where to begin? American Journal of Psychiatry, 163, 1611–1621.CrossRefGoogle ScholarPubMed
Tannock, C. and Katona, C. 1995. Minor depression in the aged: Concepts, prevalence, and optimal management. Drugs and Aging, 6, 278–292.CrossRefGoogle ScholarPubMed
VanItallie, T. B. 2005. Subsyndromal depression in the elderly: underdiagnosed and undertreated. Metabolism – Clinical and Experimental, 54, 39–44.CrossRefGoogle ScholarPubMed
Wagner, H. R., Burns, B. J., Broadhead, W. E., Yarnall, K. S. H., Sigmon, A. and Gaynes, B. N. 2000. Minor depression in family practice: functional morbidity, co-morbidity, service utilization and outcomes. Psychological Medicine, 30, 1377–1390.CrossRefGoogle Scholar
Ware, J. E., Kosinski, M. and Keller, S. D. 1996. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.CrossRefGoogle ScholarPubMed
Wragg, R. E. and Jeste, D. V. 1989. Overview of depression and psychosis in Alzheimer's disease. American Journal of Psychiatry, 146, 577–87.Google ScholarPubMed