title: Comparison of major depressive disorder and subthreshold depression among older adults in community long-term care.
abstract: OBJECTIVE
  This study extends existing knowledge regarding the continuum between major depression (MD) and subthreshold depression (SD) by examining differences in symptomology and associative factors for a subpopulation of older adults with functional disability.
  
  
  METHODS
  Our sample consisted of clients age 60 and above entering public community long term care derived from the baseline survey of a longitudinal study (315 non-depressed, 74 MD, and 221 SD). We used the Diagnostic Interview Schedule to establish diagnoses of MD, the Center for Epidemiological Studies Depression Scale (CES-D) to assess SD, and other self-report measures to explore potential associative factors of demographics, comorbidity, social support, and stressors.
  
  
  RESULTS
  No differences in CES-D identified symptoms occurred between the two groups. MD and SD were both associated with lower education, poorer social support, more severe medical conditions, and higher stress when compared to non-depressed older adults. Younger age and being female were associated solely with MD; whereas, worse perceived health and more trouble affording food were associated solely with SD. The only associative factor significantly different between MD and SD was age. Those with MD were more likely to be younger than those with SD.
  
  
  CONCLUSIONS
  Our findings of symptom profiles and associative factors lend support to the continuum notion of depression. Identification of only older adults within the community long-term care service system who meet criteria for MD would leave many older adults, who also face multiple comorbidities, high levels of stress and social isolation, and substantial depressive symptoms undiagnosed and untreated.
authors.affiliation: Department of Social Welfare, Konkuk University, Danwol-dong, Chungju-si, South Korea. mleegwb@kku.ac.kr
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Lee
authors.forename: Leslie K
authors.initials: LK
authors.lastname: Hasche
authors.forename: Sunha
authors.initials: S
authors.lastname: Choi
authors.forename: Enola K
authors.initials: EK
authors.lastname: Proctor
authors.forename: Nancy
authors.initials: N
authors.lastname: Morrow-Howell
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012112:Residential Facilities; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D014481:United States / Q000453:epidemiology