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What is the prevalence of untreated depression and death ideation in older people? Data from the Irish Longitudinal Study on Aging

Published online by Cambridge University Press:  16 January 2018

Robert Briggs ,
Katy Tobin ,
Rose Anne Kenny  and
Sean P. Kennelly
Robert Briggs*
Affiliation:
The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
Katy Tobin
Affiliation:
The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
Rose Anne Kenny
Affiliation:
The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
Sean P. Kennelly
Affiliation:
Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
*
Correspondence should be addressed to: Robert Briggs, The Irish Longitudinal Study on Ageing (TILDA), Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland. Phone: +353-1-8962509. Email: briggsr@tcd.ie.
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Abstract

Objective:

Late life depression (LLD) confers significant morbidity and mortality but is well recognized that it often goes undetected or untreated. The objective of this study is to quantify the burden of untreated depression and death ideation (DI) at a population level.

Design:

Cross-sectional study ascertaining the prevalence of, and factors associated with, untreated depression and DI.

Setting:

This study, embedded within the Irish Longitudinal Study on Ageing, involves over 7,000 community-dwelling people aged ≥50 years.

Measurements:

Depression was defined as Centre for Epidemiological Studies Depression scale ≥16 indicating current clinically relevant depressive symptoms or Composite International Diagnostic Interview indicative of major depressive episode within the last year. Participants not prescribed antidepressants/antipsychotics were defined as untreated. To define DI, participants were asked “In the last month, have you felt like you would rather be dead?”

Results:

In total, 12% (839/7,055) met criteria for depression with 29% (241/839) on pharmacological therapy. Those with untreated depression were less likely to endorse symptoms of persistent low mood or worthlessness, but there was no difference in age or general practitioner (GP) visits compared to those on treatment. Over 3% (223/7,055) of participants had DI and less than one-third had visited their GP within the last year.

Conclusions:

This study demonstrates that two-thirds of depressed older people are not prescribed antidepressant/antipsychotic therapy. It is important to raise awareness of depression among older people and healthcare professionals, with particular focus on the fact that LLD is not an inevitable consequence of ageing and effective treatment is available.

Keywords

late life depressionmooddeath ideationundiagnoseduntreated
Type
Original Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 9: Issue Theme: Quality of Care for Frail Older Adults , September 2018 , pp. 1393 - 1401
Copyright
Copyright © International Psychogeriatric Association 2018 

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References

Alexopoulos, G. S. (2011). Pharmacotherapy for late-life depression. The Journal of Clinical Psychiatry, 72, e04. doi:10.4088/JCP.7085tx2cj.Google Scholar
Ayalon, L. and Litwin, H. (2009). What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community dwelling Israelis. International Journal of Geriatric Psychiatry, 24, 472–478. Available at:http://doi.org/10.1002/gps.2140.Google Scholar
Baca-Garcia, E. et al. (2011). Estimating risk for suicide attempt: are we asking the right questions? Passive suicidal ideation as a marker for suicidal behaviour. Journal of Affective Disorders, 134, 327–332. doi:10.1016/j.jad.2011.06.026.Google Scholar
Baldwin, R. C., Gallagley, A., Gourlay, M., Jackson, A. and Burns, A. (2006). Prognosis of late life depression: a three-year cohort study of outcome and potential predictors. International Journal of Geriatric Psychiatry, 21, 57–63. doi:10.1002/gps.1424.Google Scholar
Birrer, R. B. and Vemuri, S. P. (2004). Depression in later life: a diagnostic and therapeutic challenge. American Family Physician, 69, 2375–2382.Google Scholar
Burroughs, H., Lovell, K., Morley, M., Baldwin, R., Burns, A. and Chew-Graham, C. (2006). ‘Justifiable depression’: how primary care professionals and patients view late-life depression? A qualitative study. Family Practice, 23, 369–377. doi:10.1093/fampra/cmi115.Google Scholar
Charles, S. T. and Carstensen, L. L. (2010). Social and emotional aging. Annual Review of Psychology, 61, 383–409. doi:10.1146/annurev.psych.093008.100448.Google Scholar
Chew-Graham, C. et al. (2012). Why may older people with depression not present to primary care? Messages from secondary analysis of qualitative data. Health & Social Care in the Community, 20, 52–60. doi:10.1111/j.1365-2524.2011.01015.x.Google Scholar
Conner, K. O. et al. (2010). Mental health treatment seeking among older adults with depression: the impact of stigma and race. The American Journal of Geriatric Psychiatry, 18, 531–543. doi:10.1097/JGP.0b013e3181cc0366.Google Scholar
Crumpacker, D. W. (2008). Suicidality and antidepressants in the elderly. Baylor University Medical Center Proceedings, 21, 373–377.Google Scholar
Fiske, A., Wetherell, J. L. and Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363–389. doi: 10.1146/annurev.clinpsy.032408.153621.Google Scholar
Fitch, K., Molnar, F. J., Power, B., Wilkins, D. and Man-Son-Hing, M. (2005). Antidepressant use in older people: family physicians’ knowledge, attitudes, and practices. Canadian Family Physician, 51, 80–81.Google Scholar
Gelenberg, A. J. (2010). The prevalence and impact of depression. The Journal of Clinical Psychiatry, 71, e06. doi:10.4088/JCP.8001tx17c.Google Scholar
Ghio, L. et al. (2015). Duration of untreated depression influences clinical outcomes and disability. Journal of Affective Disorders, 175, 224–228. doi:10.1016/j.jad.2015.01.014.Google Scholar
Hirsch, J. K., Duberstein, P. R., Chapman, B. and Lyness, J. M. (2007). Positive affect and suicide ideation in older adult primary care patients. Psychology and Aging, 22, 380–385. doi:10.1037/0882-7974.22.2.380.Google Scholar
Kessler, R. C. and Ustün, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121. doi:10.1002/mpr.168.Google Scholar
Kim, Y. A., Bogner, H. R., Brown, G. K. and Gallo, J. J. (2006). Chronic medical conditions and wishes to die among older primary care patients. International Journal of Psychiatry in Medicine, 36, 183–198.Google Scholar
Kiosses, D. N., Szanto, K. and Alexopoulos, G. S. (2014). Suicide in older adults: the role of emotions and cognition. Current Psychiatry Reports, 16, 495. doi: 10.1007/s11920-014-0495-3.Google Scholar
Lenze, E. J. et al. (2005). The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the Cardiovascular Health Study. Journal of the American Geriatrics Society, 53, 569–575. doi:10.1111/j.1532-5415.2005.53202.x.Google Scholar
Lewinsohn, P. M., Seeley, J. R., Roberts, R. E. and Allen, N. B. (1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12, 277–287. doi: 10.1037/0882-7974.12.2.277.Google Scholar
Li, C., Ford, E. S., Zhao, G., Ahluwalia, I. B., Pearson, W. S. and Mokdad, A. H. (2009). Prevalence and correlates of undiagnosed depression among U.S. adults with diabetes: the behavioral risk factor surveillance system, 2006. Diabetes Research and Clinical Practice, 83, 268–279. doi: 10.1016/j.diabres. 2008.11.006.Google Scholar
Licht-Strunk, E., Beekman, A. T., de Haan, M. and van Marwijk, H. W. (2009). The prognosis of undetected depression in older general practice patients. A one year follow-up study. Journal of Affective Disorders, 114, 310–315. doi:10.1016/j.jad.2008.06.006.Google Scholar
Lotfi, L., Flyckt, L., Krakau, I., Mårtensson, B. and Nilsson, G. H. (2010). Undetected depression in primary healthcare: occurrence, severity and co-morbidity in a two-stage procedure of opportunistic screening. Nordic Journal of Psychiatry, 64, 421–427. doi:10.3109/08039481003786378.Google Scholar
Mitchell, A. J., Rao, S. and Vaze, A. (2010). Do primary care physicians have particular difficulty identifying late-life depression? A meta-analysis stratified by age. Psychotherapy and Psychosomatics, 79, 285–294. doi:10.1159/000318295.Google Scholar
Mitchell, A. J., Vaze, A. and Rao, S. (2009). Clinical diagnosis of depression in primary care: a meta-analysis. Lancet, 374, 609–619. doi:10.1016/S0140-6736(09)60879-5.Google Scholar
Murray, J., Banerjee, S., Byng, R., Tylee, A., Bhugra, D. and Macdonald, A. (2006). Primary care professionals’ perceptions of depression in older people: a qualitative study. Social Science & Medicine, 63, 1363–1373. doi:10.1016/j.socscimed.2006.03.037.Google Scholar
Nuyen, J., Volkers, A. C., Verhaak, P. F., Schellevis, F. G., Groenewegen, P. P. and Van den Bos, G. A. (2005). Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity. Psychological Medicine, 35, 1185–1195. doi:10.1017/S0033291705004812.Google Scholar
Olfson, M., Blanco, C. and Marcus, S. C. (2016). Treatment of adult depression in the United States. JAMA Internal Medicine, 176, 1482–1491. doi:10.1001/jamainternmed.2016.5057.Google Scholar
Oslin, D. W., Streim, J., Katz, I. R., Edell, W. S. and TenHave, T. (2000). Change in disability follows inpatient treatment for late life depression. Journal of the American Geriatrics Society, 48, 357–362. doi:10.1111/j.1532-5415.2000.tb04690.x.Google Scholar
Rajji, T. K., Mulsant, B. H., Lotrich, F. E., Lokker, C. and Reynolds, C. F. 3rd. (2008). Use of antidepressants in late-life depression. Drugs & Aging, 25, 841–853. doi:10.2165/00002512-200825100-00003.Google Scholar
Regan, C. O., Kearney, P. M., Savva, G. M., Cronin, H. and Kenny, R. A. (2013). Age and sex differences in prevalence and clinical correlates of depression: first results from the Irish Longitudinal study on ageing. International Journal of Geriatric Psychiatry, 28, 1280–1287. doi:10.1002/gps.3955.Google Scholar
Rothschild, A. J. (1996). The diagnosis and treatment of late-life depression. The Journal of Clinical Psychiatry, 57, 5–11.Google Scholar
Shah, A., Bhat, R., Zarate-Escudero, S., DeLeo, D. and Erlangsen, A. (2016). Suicide rates in five-year age-bands after the age of 60 years: the international landscape. Aging & Mental Health, 20, 131–138. doi: 10.1080/13607863.2015.1055552.Google Scholar
Sheline, Y. I., Gado, M. H. and Kraemer, H. C. (2003). Untreated depression and hippocampal volume loss. The American Journal of Psychiatry, 160, 1516–1518. doi: 10.1176/appi.ajp.160.8.1516.Google Scholar
Sirey, J. A. et al. (2008). Depressive symptoms and suicidal ideation among older adults receiving home delivered meals. International Journal of Geriatric Psychiatry, 23, 1306–1311. doi:10.1002/gps.2070.Google Scholar
Steffens, D. C., Fisher, G. G., Langa, K. M., Potter, G. G. and Plassman, B. L. (2009). Prevalence of depression among older Americans: the aging, demographics and memory study. International Pychogeriatrics, 21, 879–888. doi:10.1017/S1041610209990044.Google Scholar
Stone, M. et al. (2009). Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US food and drug administration. BMJ, 339, b2880. doi: 10.1136/bmj.b2880.Google Scholar
Van Orden, K. and Conwell, Y. (2011). Suicides in late life. Current Psychiatry Reports, 13, 234–241. doi:10.1007/s11920-011-0193-3.Google Scholar
Varnik, P. (2012). Suicide in the world. International Journal of Environmental Research and Public Health, 9, 760–771. doi:10.3390/ijerph9030760.Google Scholar
Villagut, G., Forero, C. G., Barbaglia, G. and Alonso, J. (2016). Screening for depression in the general population with the center for epidemiologic studies depression (CES-D): a systematic review with meta-analysis. PLoS One, 11, e0155431. doi:10.1371/journal.pone. 0155431.Google Scholar
Volkers, A. C., Nuyen, J., Verhaak, P. F. and Schellevis, F. G. (2004). The problem of diagnosing major depression in elderly primary care patients. Journal of Affective Disorders, 82, 259–263. doi:10.1016/j.jad.2003.11.003.Google Scholar
Whelan, B. J. and Savva, G. M. (2013). Design and methodology of the Irish Longitudinal study on ageing. Journal of the American Geriatrics Society, 61 (Suppl. 2), S265–8. doi:10.1111/jgs.12199.Google Scholar