Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression
Open accessAbstract
Objectives Either dysphoria (sadness) or anhedonia (loss of interest in usually pleasurable activities) is required for a diagnosis of major depression. Although major depression is a known risk factor for disability in older persons, few studies have examined the relationship between the two core symptoms of major depression and disability or mortality. Our objective was to examine the relationship between these two core symptoms and time to disability or death.Methods In a longitudinal cohort study, we used the nationally representative Health and Retirement Study to examine this relationship in 11,353 persons older than 62 years (mean: 73 years) followed for up to 13 years. Dysphoria and anhedonia were assessed with the Short Form Composite International Diagnostic Interview. Our outcome measure was time to either death or increased disability, defined as the new need for help in a basic activity of daily living. We adjusted for a validated disability risk index and other confounders.Results Compared with subjects without either dysphoria or anhedonia, the risk for disability or death was not elevated in elders with dysphoria without anhedonia (adjusted hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.91-1.36). The risk was elevated in those with anhedonia without dysphoria (HR: 1.30; 95% CI: 1.06-1.60) and those with both anhedonia and dysphoria (HR: 1.28; 95% CI: 1.13-1.46).Conclusion Our results highlight the need for clinicians to learn whether patients have lost interest in usually pleasurable activities, even if they deny sadness.
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Anhedonia and apathy confer risks for physical disability, functional impairment, and death independent of depression.
“anhedonia and apathy, common non-somatic symptoms of depression that are also prevalent in non-clinically depressed populations (Ishii, Weintraub, and Mervis 2009;Ritchie, Hearld, Gross, Allman, Sawyer, Sheppard, Salanitro, Locher, Brown, and Roth 2013) confer risks for physical disability, functional impairment, and death independent of depression (Covinsky, Cenzer, Yaffe, O'Brien, and Blazer 201”
From Successful aging: Advancing the science of physical independence in older adults (2015) · cites this paper as Covinsky et al. 2014
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- Authors
- Covinsky, K. E., Cenzer, I. S., Yaffe, K., O'Brien, S., & Blazer, D. G.
- Affiliations
- San Francisco VA Medical Center (US)
- Duke University (US)
- Corresponding author
- Covinsky, Kenneth E.
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 22
- Issue
- 6
- Pages
- 606-613
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC3766414
- OpenAlex
- W2077902030
- Cited by
- 43
- References
- 38
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 1 · 2023: 7 · 2022: 1 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 7 · 2014: 3
- FWCI
- 4.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (R01AG028481, K24AG029812, P30AG044281)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- dysphoria, anhedonia, geriatric depression, older adults, disability, mortality, activities of daily living, major depressive disorder, risk factors
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Depression, Female, Persons with Disabilities, Humans, Interview, Psychological, Longitudinal Studies, Male, Middle Aged, Mortality, Risk Factors, Anhedonia
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