Does age make a difference in the effects of physical health and social support on the outcome of a major depressive episode?

OBJECTIVE: The authors examined the effects of physical health and social support on 6-month outcome of a major depressive episode in 67 patients who were less than 60 years old and 46 patients who were 60 years old or older. They hypothesized that despite their higher rate of troublesome health problems, older patients would have fewer depressive symptoms at follow-up than would younger patients. METHOD: The Center for Epidemiologic Studies Depression Scale (CES-D Scale) and a modified version of the National Institute of Mental Health Diagnostic Interview Schedule were used to gather data from inpatients and outpatients treated at Duke University Medical Center during a face-to-face interview at baseline and over the telephone at 6-month follow-up. At baseline, all patients met DSM-III-R criteria for a major depressive episode. Data analyses included bivariate and multivariate procedures. RESULTS: At baseline, the mean CES-D Scale scores of the two age groups were similar. As expected, the mean illness index score of the older patients was significantly higher and their mean impaired subjective social support score was slightly lower than those of the younger patients. At 6-month follow-up, the mean CES-D Scale score of the younger patients was above the depressive threshold, but the mean CES-D Scale score of the older patients was below the depressive threshold. The illness index and impaired subjective support measures were significant predictors of depressive symptoms at 6 months for the younger patients but not for the older patients. CONCLUSIONS: The authors conclude that older depressed patients have a more favorable prognosis than younger depressed patients. Predictors of outcome vary by age.

Alcohol abuse and dependence: consistency in reporting of symptoms over ten years.

The present study assesses the stability of the diagnosis of alcoholism among a sample of St Louis, USA Epidemiological Catchment Area Study participants. The Diagnostic Interview Schedule was used at Time 1 and the Composite International Diagnostic Interview--Substance Abuse Module was used at 10-year follow-up. Alcohol abuse and dependence were diagnosed using DSM-III criteria. Kappa values and Yule's statistics for agreement in diagnoses, criterion groups and individual symptoms are reported. Fair to good measurement of agreement was shown for any diagnosis of alcohol abuse or dependence versus no diagnosis. The criterion group for "impairment in social or occupational functioning" showed the highest agreement of the three criterion groups studied. Agreement was lower for individual symptoms of alcoholism. Incident cases accounted for some of the inconsistency in responses over 10 years. Other types of inconsistency found were changing response from yes to no, changing response from no to yes but not meeting the definition of an incident case, and misstating age of onset of symptoms. Mean per cent inconsistency across all symptoms was 11.4%. Further research regarding reasons for inconsistencies is needed.

Psychiatric disorders among the homeless: a comparison of older and younger groups.

The purpose of this study is to identify differences between older and younger homeless subgroups. Nine hundred homeless persons were interviewed using the National Institute of Mental Health Diagnostic Interview Schedule, and DSM-III-R diagnoses were made. Results showed that 79 (13%) of the 600 men and 10 (3%) of the 300 women were in the older (age > or = 50 years) group. Compared with their younger counterparts, older subjects were more likely to be male and white, to report lower incomes and poorer health, and to meet criteria for lifetime alcohol-use disorder. Fewer older than younger subjects met criteria for lifetime drug use disorder and post-traumatic stress disorder. These findings suggest that older and younger individuals have different vulnerabilities to homelessness.