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A tune in "a minor" can "b major": a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults
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Background With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression.Methods We searched PubMed (1980-Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression.Results In older adults subthreshold depression was generally at least 2-3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8-10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation.Limitations Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis.Conclusions The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.
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“depression or depressive symptoms are common in clinical settings, potentially reaching a prevalence of over 40% for individuals with MCI”
From Evaluation of a Novel Psychological Intervention Tailored for Patients With Early Cognitive Impairment (PIPCI): Study Protocol of a Randomized Controlled Trial (2020) · cites this paper as Meeks et al., 2011
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“sub-clinical depressive symptoms are associated with the increased use of healthcare (Meeks et al., 2011)”
From Evaluation of a Novel Psychological Intervention Tailored for Patients With Early Cognitive Impairment (PIPCI): Study Protocol of a Randomized Controlled Trial (2020) · cites this paper as Meeks et al., 2011
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“Subthreshold depressive symptoms that do not meet criteria for a formal diagnosis of MDD (also known variously as subsyndromal, subclinical, or minor depression) are also associated with serious consequences in later life, including increased disability, greater healthcare utilization, and increased suicidal ideation (Meeks 2011)”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Meeks 2011
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Metadata
- Authors
- Meeks, T. W., Vahia, I. V., Lavretsky, H., Kulkarni, G., & Jeste, D. V.
- Affiliations
- University of California San Diego (US)
- University of California, Los Angeles (US)
- San Diego State University (US)
- Corresponding author
- Jeste, Dilip V.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 129
- Issue
- 1-3
- Pages
- 126-142
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC3036776
- OpenAlex
- W2014841928
- Cited by
- 569
- References
- 140
- Citations by year
- 2026: 15 · 2025: 36 · 2024: 24 · 2023: 28 · 2022: 49 · 2021: 77 · 2020: 51 · 2019: 39 · 2018: 36 · 2017: 38 · 2016: 38 · 2015: 36 · 2014: 35 · 2013: 37 · 2012: 19
- FWCI
- 29.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (T35 AG26757, T35AG026757)
- National Institute of Mental Health (P30MH080002, K24MH086481)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- subthreshold depression, minor depression, geriatric depression, older adults, prevalence, clinical course, remission, risk factors, disability, health care utilization, suicidal ideation, public health implications
- MeSH terms
- Age Factors, Aged, Cross-Sectional Studies, Major Depressive Disorder, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, Severity of Illness Index, Disease Progression
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