DEPRESSION IN MEDICALLY ILL HOSPITALIZED OLDER ADULTS - PREVALENCE, CHARACTERISTICS, AND COURSE OF SYMPTOMS ACCORDING TO 6 DIAGNOSTIC SCHEMES

Objective: The purpose of this study was to examine and compare rates of depression, correlates, and course of symptoms in medically ill hos pitalized elders through use of six diagnostic schemes (inclusive, eti ologic, exclusive-inclusive, exclusive-etiologic, substitutive-inclusi ve, and substitutive-etiologic). Method: A consecutive series of 460 c ognitively unimpaired patients aged 60 or over who were admitted to th e medical inpatient services of Duke Hospital underwent a structured p sychiatric evaluation administered by a psychiatrist. Patients with de pression u,ere contacted by telephone at 12-week intervals after disch arge to assess weekly change in depressive symptoms (median follow-up time=47 weeks). Results: The prevalence of major depression varied fro m 10% to 21% depending on diagnostic scheme; similarly, minor depressi on varied from 14% to 25%. Diagnostic strategy made little difference in known psychological and health characteristics of patients with dep ression (predictive validity) or severity of depressive symptoms (conv ergent validity). The diagnostic strategy that best distinguished a se vere and persistent major depression was the exclusive-etiologic appro ach; however, this strategy missed 49% of patients with major depressi on identified by the inclusive approach, almost 60% of whom continued to experience persistent symptoms of depression many weeks after disch arge. Conclusions: Diagnostic strategy affects rates of major and mino r depression, with about a twofold difference between the extremes. Th ere is little reason, however, to choose one diagnostic scheme over an other in all cases. Diagnostic strategy should be chosen on the basis of the specific goals and purposes of the examiner. While the exclusiv e-etiologic approach identifies the most severe and Persistent depress ions, the inclusive approach is the most sensitive arm reliable approa ch and is an intermediate predictor of persistent depression.