Department of Veterans Affairs, National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA,
J Gen Intern Med. 2013 Dec;28(12):1611-9. doi: 10.1007/s11606-013-2533-y. Epub 2013 Jul 9.
Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown.
To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.
Serial cross-sectional analysis of six biennial assessments.
Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N = 16,184 in 1998).
The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics.
Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13-1.19), with significant increases in those aged ≥ 60 relative to those aged 55-59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60.
Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.
在过去的十年中，美国对抑郁症的诊断和治疗有所增加。目前尚不清楚老年人的自我报告抑郁症状是否同时有所下降。
在美国，在 1998 年至 2008 年间，调查老年人的抑郁症状趋势。
对六次两年一次的评估进行连续横断面分析。
健康与退休研究（HRS），一项全国性代表性调查。
年龄在 55 岁及以上的成年人（1998 年有 16184 人）。
使用八项流行病学研究中心抑郁量表（CES-D8）评估了三种抑郁症状水平（无症状= 0，轻度= 4+，重度= 6+），并对人口统计学和临床特征进行了调整。
在 10 年期间，无抑郁症状的人数从 40.9%增加到 47.4%（患病率比[PR]：1.16，95%置信区间：1.13-1.19），与≥60 岁的人群相比，55-59 岁的人群有显著增加。轻度抑郁症状的患病率从 15.5%下降到 14.2%（PR：0.93，95%置信区间：0.88-0.98），下降了 7%，其中 80-84 岁的轻度抑郁症状患病率从 14.3%下降到 9.6%，降幅最为明显。重度抑郁症状的患病率从 5.8%上升到 6.8%（PR：1.17，95%置信区间：1.06-1.28）；然而，这种增加仅限于 55-59 岁的人群，重度症状的概率从 8.7%上升到 11.8%。≥60 岁的人群中，严重症状没有明显变化。
从 1998 年到 2008 年，老年人的总体晚年抑郁症状负担显著下降。这种下降似乎主要是由最年长的老年人中抑郁症状的更大减少以及无症状者的增加所驱动的。这些症状负担的变化在很大程度上不受身体、功能、人口统计学和经济因素的影响。未来的研究应探讨这种抑郁症状的减少是否与治疗结果的改善有关，以及不同年龄组的治疗方法是否发生了变化。
