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Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R)

Published online by Cambridge University Press:  17 June 2009

R. C. Kessler ,
H. Birnbaum ,
E. Bromet ,
I. Hwang ,
N. Sampson  and
V. Shahly
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
H. Birnbaum
Affiliation:
The Analysis Group, Boston, MA, USA
E. Bromet
Affiliation:
Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, Stony Brook, NY, USA
I. Hwang
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
N. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
V. Shahly
Affiliation:
Boston Psychoanalytic Society and Institute, Boston, MA, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: kessler@hcp.med.harvard.edu)
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Abstract

Background

Although depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life.

Method

We studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0.

Results

Lifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged ⩾65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly.

Conclusions

Given that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.

Keywords

Chronic conditionsco-morbiditydepressionelderlyepidemiology
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 2 , February 2010 , pp. 225 - 237
Copyright
Copyright © Cambridge University Press 2009

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