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Depression, comorbidities linked in older adults.


LOS ANGELES--Strong associations exist between depression and chronic medical comorbidities in older adults, in an analysis of 2009-2010 data from the National Health and Nutrition Examination Survey.

The findings have important implications for treating the aging ill, Dr. Margaret A. Ege noted in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Among the 2,063 adults aged 60 years and older in the analysis, 5% had major depression and 72.9% had at least one chronic medical comorbidity: osteoporosis, arthritis, coronary artery disease, gout, diabetes, stroke, asthma, chronic obstructive pulmonary disease (COPD), or heart failure. The prevalence of depression was 1.2% in those with no medical comorbidities, compared with 5.9% in those with at least one comorbidity, said Dr. Ege of the University of Arkansas, Little Rock.

After adjustment for age, race, and gender, the odds ratio for depression in those with one or more comorbidities was 3.4. Prevalence of depression by medical comorbidity was 7.4% for osteoporosis, 7.1% for arthritis, 7.5% 0, for coronary artery disease, 6.7% for gout, 9.3% for diabetes, 8.9% for stroke, 10% for asthma, 11.9% for COPD, and 11.7% for heart failure.

NHANES subjects were screened with questions from the nine-item Patient Health Questionnaire, and 4 additional questions about multiple medical comorbidities.

"When using a conservative cut-off to make a diagnosis of depression, individuals with arthritis, congestive heart failure, COPD, asthma, and diabetes were all significantly more likely to be depressed. When using a less stringent cut-off, individuals post stroke were also significantly more likely to be depressed," Dr. Ege said, noting that, in general, higher numbers of chronic medical illnesses were associated with a higher prevalence of comorbid depression.

By some estimates, more than 10% of adults over age 60 years and nearly a third of older adults in residential care meet DSM-IV criteria for major depressive disorder. Higher rates have F; been reported among those in nursing homes. "Many patients and care providers assume that depression is a normal part of aging or a normal consequence of chronic medical illness, leading to less emphasis placed on the diagnosis and treatment of depression in older adults," Dr. Ege wrote.

Depression has been shown to increase mortality in COPD, end-stage renal disease, and coronary artery disease, she added.


Major finding: The adjusted odds ratio for depression in older adults with one or more comorbidities was 3.4.

Data source: NHANES 2009-2010.

Disclosures: Dr. Ege had no disclosures.
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Title Annotation:MENTAL HEALTH
Author:Worcester, Sharon
Publication:Internal Medicine News
Date:May 1, 2013
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