Late-life depression from a primary care perspective

Research output: ThesisDoctoral Thesis (compilation)

Abstract

Studies have found that depressive states in old age that do not fulfil the criteria for major depression are clinically important depressive states. These depressive states are common in primary care patients. Therefore, studies of late-life depression from a primary care perspective are needed. A depressive rating scale, Hopkins Symptom Checklist-25 (HSCL-25), was used in a community survey in 1993. The prevalence of high depressive score was 10.2%. In a medical record review, the high score group and an age- and sex-matched low score group were compared in order to identify clinical characteristics. The high score group often had many contacts with health care, recognised mental health problems and/or prescribed psychotropic medication. However, these characteristics did not have the discriminatory power for case-finding. In a 6-year outcome study in 1999 the risk of dying were nearly twice as high for the high score group as for the low score group. The overall outcome was poor in the high score group: 72% were either dead, had moved to long-term accommodation or were depressed. HSCL-25 was compared with Montgomery-Åsberg Depression Rating Scale (MADRS) and with the diagnostic criteria for depressive disorders in an interview study. HSCL-25, with cut-off > 1.75, was found to be a sensitive case finder for clinically important depressive states. The data from the interview study were also used for identifying the most characteristic symptoms of clinically important late-life depression. We found that the symptoms “hopelessness”, “everything is an effort” and “lassitude” were in good agreement with depression, of which “hopelessness” could be useful as a key symptom.

Details

Authors
  • Karin Fröjdh
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology

Keywords

  • Gerontologi, Gerontology, HSCL-25, outcome, Late-life depression, primary care
Original languageEnglish
QualificationDoctor
Awarding Institution
Supervisors/Assistant supervisor
  • [unknown], [unknown], Supervisor, External person
Award date2004 May 27
Publisher
  • Karin Fröjdh, Lövsjövägen 14, SE-653 46 Karlstad,
Print ISBNs91-628-6092-5
Publication statusPublished - 2004
Publication categoryResearch

Bibliographic note

Defence details Date: 2004-05-27 Time: 10:15 Place: Jubileumsaulan, MAS, Malmö External reviewer(s) Name: Wimo, Anders Title: [unknown] Affiliation: [unknown] --- Article: I. Fröjdh K, Håkansson A, Janson S. Are there any clinical characteristics of depression in elderly people that could be useful for case finding in general practice? Scand J Prim Health Care 2003;21:214–8.II. Fröjdh K, Håkansson A, Karlsson I, Molarius A. Deceased, disabled or depressed − a population-based 6-year follow-up study of elderly people with depression. Soc Psychiatry Psychiatr Epidemiol 2003;38:557–562.III. Fröjdh K, Håkansson A, Karlsson I. The Hopkins Symptom Checklist-25 is a sensitive case-finder of clinically important depressive states in elderly people in primary care. Int J Geriatr Psychiatry 2004;19:386–90IV. Fröjdh K, Håkansson A, Karlsson I. Hopelessness − a key symptom of depression (submitted)