title: Depression without sadness: functional outcomes of nondysphoric depression in later life.
abstract: OBJECTIVE
  We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13-year follow-up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria.
  
  
  METHODS
  Population-based 13-year follow-up survey.
  
  
  METHODS
  Community-dwelling adults living in East Baltimore in 1981.
  
  
  METHODS
  Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981.
  
  
  METHODS
  The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression ("noncases"). The mortality and functional status of each group were compared after a 13-year follow-up interval.
  
  
  RESULTS
  Compared with non-cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13-year follow-up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status.
  
  
  CONCLUSIONS
  Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long-term outcomes.
authors.affiliation: Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: P V
authors.initials: PV
authors.lastname: Rabins
authors.forename: C G
authors.initials: CG
authors.lastname: Lyketsos
authors.forename: A Y
authors.initials: AY
authors.lastname: Tien
authors.forename: J C
authors.initials: JC
authors.lastname: Anthony
mesh_terms: D000203:Activities of Daily Living; D015142:Baltimore; D002391:Catchment Area, Health; D003863:Depression / Q000145:classification* / Q000401:mortality / Q000523:psychology; D003866:Depressive Disorder / Q000145:classification / Q000401:mortality; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors