OLDER AGE AND THE UNDERREPORTING OF DEPRESSIVE SYMPTOMS

OBJECTIVE: To determine whether older age is associated with a decreas e in self-reported depressive symptoms, independent of examiner-rated symptoms, in inpatients with major depression. DESIGN: Survey study. S ETTING: Inpatient psychiatric units at a university medical center. PA TIENTS: Eligible subjects were those over 20 years of age with a prima ry diagnosis of DSM-III-R major depression. Participation was sought f rom all subjects over 60 years of age and from every second or every t hird younger subject, depending on rater availability. Of 137 eligible subjects, 97 completed all study measures. MEASUREMENTS: The Beck Dep ression Inventory (BDI), as a measure of self-reported depressive symp toms, was the dependent variable. The Hamilton Rating Scale for Depres sion (Ham-D) was used to assess examiner-rated symptoms. MAIN RESULTS: Older age (P = .03) was associated negatively and examiner-rated depr essive symptoms (P = .0001) were associated positively with BDI score. Other variables, including gender, education, age of depression onset , and medical illness burden, were not independently associated with B DI. Examination of depressive symptom subtotals (psychologic/affective vs. somatic/neurovegetative) revealed that only the self-reported psy chologic/affective subtotal was significantly associated with age (P = .0018). CONCLUSIONS: Some older patients with clinically significant depression underreport their symptoms. When asking older patients abou t depressive symptoms, clinicians should view negative responses only within larger clinical contexts and should obtain information from oth er sources as needed. Similar concerns must temper interpretation of r esearch that relies on subject self-report to study depression in late life.