title: Does psychological distress vary between younger and older adults in health and disease?
abstract: OBJECTIVE
  The effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made.
  
  
  METHODS
  In 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (<65, N=1040) and older (≥65, N=428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models.
  
  
  RESULTS
  Among the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p=.026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p=.016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis.
  
  
  CONCLUSIONS
  Medical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.
authors.affiliation: Department of Psychiatry, Medical School, University of Ioannina, Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Goulia
authors.forename: Ilias
authors.initials: I
authors.lastname: Papadimitriou
authors.forename: Myrela O
authors.initials: MO
authors.lastname: Machado
authors.forename: Christos
authors.initials: C
authors.lastname: Mantas
authors.forename: Chrisavgi
authors.initials: C
authors.lastname: Pappa
authors.forename: Epameinondas
authors.initials: E
authors.lastname: Tsianos
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pavlidis
authors.forename: Alexandros A
authors.initials: AA
authors.lastname: Drosos
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
authors.forename: Thomas
authors.initials: T
authors.lastname: Hyphantis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires