title: Older age and the underreporting of depressive symptoms.
abstract: OBJECTIVE
  To determine whether older age is associated with a decrease in self-reported depressive symptoms, independent of examiner-rated symptoms, in inpatients with major depression.
  
  
  METHODS
  Survey study.
  
  
  METHODS
  Inpatient psychiatric units at a university medical center.
  
  
  METHODS
  Eligible subjects were those over 20 years of age with a primary diagnosis of DSM-III-R major depression. Participation was sought from all subjects over 60 years of age and from every second or every third younger subject, depending on rater availability. Of 137 eligible subjects, 97 completed all study measures.
  
  
  METHODS
  The Beck Depression Inventory (BDI), as a measure of self-reported depressive symptoms, was the dependent variable. The Hamilton Rating Scale for Depression (Ham-D) was used to assess examiner-rated symptoms.
  
  
  RESULTS
  Older age (P = .03) was associated negatively and examiner-rated depressive symptoms (P = .0001) were associated positively with BDI score. Other variables, including gender, education, age of depression onset, and medical illness burden, were not independently associated with BDI. Examination of depressive symptom subtotals (psychologic/affective vs. somatic/neurovegetative) revealed that only the self-reported psychologic/affective subtotal was significantly associated with age (P = .0018).
  
  
  CONCLUSIONS
  Some older patients with clinically significant depression underreport their symptoms. When asking older patients about depressive symptoms, clinicians should view negative responses only within larger clinical contexts and should obtain information from other sources as needed. Similar concerns must temper interpretation of research that relies on subject self-report to study depression in late life.
authors.affiliation: Department of Psychiatry, University of Rochester Medical Center, NY 14642.
authors.forename: J M
authors.initials: JM
authors.lastname: Lyness
authors.forename: C
authors.initials: C
authors.lastname: Cox
authors.forename: J
authors.initials: J
authors.lastname: Curry
authors.forename: Y
authors.initials: Y
authors.lastname: Conwell
authors.forename: D A
authors.initials: DA
authors.lastname: King
authors.forename: E D
authors.initials: ED
authors.lastname: Caine
mesh_terms: D000367:Age Factors; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D003866:Depressive Disorder / Q000175:diagnosis; D004194:Disease / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011581:Psychological Tests; D014342:Truth Disclosure