Late-life depression from a primary care perspective

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.