Age differences in symptom expression in patients with major depression

Abstract

Objective: The aim of the study was to compare symptom expression in primarily middle-aged (<60) and older (60+) patients who were depressed and determine if symptom profiles differed by age.

Methods: Patients diagnosed with major depression (N = 664) were screened using the Center for Epidemiologic Studies--Depression scale and sections of the Diagnostic Interview Schedule. Patients were separated into homogeneous clusters based on symptom endorsement using latent class analysis.

Results: Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die, and thinking about suicide. In two latent class models with depressive symptoms as indicators, three-class models best fit the data. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health, and social variables were controlled but did not support age-specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have ever received electroconvulsive therapy (ECT), and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations but had higher levels of subjective social support and had experienced fewer stressful life events.

Conclusions: There are age differences in symptom endorsement between younger/middle-aged and older patients with major depression. The data, however, did not identify a symptom profile unique to late-life depression.

Figure 1. Latent class symptom profiles based on endorsement of CES-D and DIS symptoms (n=664)

CES-D:1=Bothered by things; 2=Appetite poor; 3=Couldn't shake off blues; 4=Felt just as good as others (reverse coded); 5=Trouble concentrating; 6=Felt depressed; 7=felt everything effort; 8=Felt hopeful about future (reverse coded); 9=Thought life a failure; 10=Felt fearful; 11=Restless sleep; 12=Was happy (reverse coded); 13=Talked less than usual; 14=Felt lonely; 15=People were unfriendly; 16=Enjoyed life (reverse coded); 17=Crying spells; 18=Felt sad; 19=Felt people disliked me; 20=Could not get going; DIS:1=Felt tired, sad, blue or depressed; 2=Two years feeling depressed or sad; 3=Lost appetite; 4=Lost weight without trying to; 5=Gained weight; 6=Trouble falling asleep, staying asleep or waking up too early; 7=Sleeping too much; 8=Felt tired out all the time; 9=Talked or moved more slowly than normal; 10=Had to be moving all the time; 11=Interest in sex lot less than usual; 12=Felt worthless, sinful or guilty; 13=Trouble concentrating; 14=Thoughts came much slower or seemed mixed up; 15=Thought a lot about death; 16=Felt like wanted to die; 17=Thought about committing suicide; 18=Attempted suicide;