Depression in Later Life

Depression is the most pervasive mental health problem among older adults, but it is often unrecognized and untreated, representing a serious public health problem (Lebowitz et al., 1997). At the same time, and contrary to stereotypes, depression is far from ubiquitous among the elderly. It is important to remember that depression is a disease and not a normal part of the aging process nor a normal reaction to the losses experienced in old age.

Two primary methods are used in both clinical and research settings to assess depression in adult populations. The first involves the use of diagnostic interviews (structured and unstructured) to establish diagnoses of depressive disorders including major depression, minor depression, and dysthymia based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Criteria for a major depression include the experience of either depressed mood/sadness or loss of pleasure, along with at least four of seven other criteria symptoms persistently present for at least 2 weeks. The criteria for a minor depression are the same, but only one other symptom is required beyond depressed mood or loss of pleasure. Complicating appropriate identification and diagnosis, geriatric depression, in contrast to depression earlier in life, often presents without sadness or depressed mood, as elders often do not define their problems in psychological terms. Apathy and/or irritability as a result of loss of interest and pleasure in daily life are often the primary symptoms (Kennedy, 2000).

This classification approach (diagnosis of depression or not) is in contrast to the test approach, which assumes that depressive symptomatology among individuals can vary along a continuum of severity or intensity (Futterman, Thompson, Gallagher-Thompson, & Ferris, 1995). In this approach, depressive symptomatology is typically measured by standardized self-report instruments that have been normed against general community-based populations and have cut-scores established to indicate the existence of significant depressive symptomatology. The most widely [Page 335]used instruments with older adults in this category include the Center for Epidemiological Studies Depressive Scale and the Geriatric Depression Scale.