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Trends in Depressive Symptom Burden Among Older Adults in the United States from 1998 to 2008

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ABSTRACT

CONTEXT

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.

OBJECTIVE

To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.

DESIGN

Serial cross-sectional analysis of six biennial assessments.

SETTING

Health and Retirement Study (HRS), a nationally-representative survey.

PATIENTS OR OTHER PARTICIPANTS

Adults aged 55 and older (N = 16,184 in 1998).

MAIN OUTCOME MEASURE

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.

RESULTS

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.

CONCLUSIONS

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.

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Acknowledgements

Funding Support

This study was funded by the National Institute on Aging (P01 AG031098) and the Department of Veterans Affairs, Health Services Research and Development (CD2 07-206-1 and VA IIR 10-176-3). The Health and Retirement Study is funded by the National Institute on Aging (U01 AG09740) and performed at the Institute for Social Research, University of Michigan.

Conflicts of Interest

The authors declare that they do not have any conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Veterans Affairs, National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA

    Kara Zivin PhD

  2. Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA

    Kara Zivin PhD, Kenneth M. Langa MD, PhD & Sandeep Vijan MD, MS

  3. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA

    Kara Zivin PhD

  4. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Kara Zivin PhD & Kenneth M. Langa MD, PhD

  5. Department of Veterans Affairs, Providence, RI, USA

    Paul A. Pirraglia MD

  6. Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA

    Paul A. Pirraglia MD

  7. Division of General Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    Ryan J. McCammon AB, Kenneth M. Langa MD, PhD & Sandeep Vijan MD, MS

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  1. Kara Zivin PhD
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  2. Paul A. Pirraglia MD
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Correspondence to Kara Zivin PhD.

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Zivin, K., Pirraglia, P.A., McCammon, R.J. et al. Trends in Depressive Symptom Burden Among Older Adults in the United States from 1998 to 2008. J GEN INTERN MED 28, 1611–1619 (2013). https://doi.org/10.1007/s11606-013-2533-y

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  • DOI: https://doi.org/10.1007/s11606-013-2533-y

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