title: A mixed-methods approach to understanding loneliness and depression in older adults.
abstract: OBJECTIVE
  Depression in late life may be difficult to identify, and older adults often do not accept depression treatment offered. This article describes the methods by which we combined an investigator-defined definition of depression with a person-derived definition of depression in order to understand how older adults and their primary care providers overlapped and diverged in their ideas about depression.
  
  
  METHODS
  We recruited a purposive sample of 102 persons aged 65 years and older with and without significant depressive symptoms on a standardized assessment scale (Center for Epidemiologic Studies-Depression scale) from primary care practices and interviewed them in their homes. We applied methods derived from anthropology and epidemiology (consensus analysis, semi-structured interviews, and standardized assessments) in order to understand the experience and expression of late-life depression.
  
  
  RESULTS
  Loneliness was highly salient to older adults whom we asked to describe a depressed person or themselves when depressed. Older adults viewed loneliness as a precursor to depression, as self-imposed withdrawal, or as an expectation of aging. In structured interviews, loneliness in the week prior to interview was highly associated with depressive symptoms, anxiety, and hopelessness.
  
  
  CONCLUSIONS
  An improved understanding of how older adults view loneliness in relation to depression, derived from multiple methods, may inform clinical practice.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, 2 Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. bargf@uphs.upenn.edu
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
authors.forename: Rebecca
authors.initials: R
authors.lastname: Huss-Ashmore
authors.forename: Marsha N
authors.initials: MN
authors.lastname: Wittink
authors.forename: Genevra F
authors.initials: GF
authors.lastname: Murray
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
mesh_terms: D000368:Aged; D001290:Attitude; D003710:Demography; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008132:Loneliness / Q000523:psychology*; D008297:Male; D012054:Reinforcement, Psychology; D011795:Surveys and Questionnaires