THE SYMPTOMATOLOGY OF DEPRESSION IN THE ELDERLY

Older people may have a different pattern of depressive symptoms to th at found earlier in life, in particular having more somatic symptoms a nd less overt low mood symptoms. Few attempts have been made to relate such differences to more general aspects of cognitive or emotional pr ocessing, such as the presence of dysfunctional attitudes or of alexit hymia. Symptom differences within depression in old age have also rece ived relatively little study, as has the ability of individual symptom s to distinguish between depressed and non-depressed elderly populatio ns. These issues have been examined in two studies. In the first, a ra ndom sample of 700 subjects aged 65 years and over were identified thr ough door-knocking in randomized enumeration districts in Islington, a socially deprived region of inner city London, and evaluated using a shortened version of the Comprehensive Assessment and Referral Evaluat ion (Short-CARE), which incorporates a depression subscale (DPDS). All 18 DPDS items distinguished significantly between depressed and non-d epressed subjects (P < 0.0001). Depressed men were significantly more pessimistic than depressed women (63 versus 40%; P < 0.05); non-signif icant trends suggested that depressed women are more worried (39 versu s 22%) and more restless (50 versus 31%), and depressed men more likel y to be `not very happy' or `not happy at all' (53 versus 36%). There were no significant differences between older (age > 74 years) and you nger subjects. Several other Short-CARE items, predominantly addressin g subjective memory and disability, also distinguished significantly b etween the depressed and non-depressed groups. Logistic regression ana lysis identified eight items of the DPDS contributing significantly to the predictive ability of the total scale. In the second study, the T oronto Alexithymia Scale (TAS) and the Dysfunctional Attitudes Scale ( DAS;3) were administered to primary-care attenders aged > 64 years, an d those with significant depressive symptoms were matched by age and s ex to a depression-free control group. Depressed subjects had higher s cores on both the TAS (Mann-Whitney U-test z = -4.71, P < 0.0001) and on the DAS (z = -2.49, P < 0.02).