title: Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression.
abstract: OBJECTIVE
  Either dysphoria (sadness) or anhedonia (loss of interest in usually pleasurable activities) is required for a diagnosis of major depression. Although major depression is a known risk factor for disability in older persons, few studies have examined the relationship between the two core symptoms of major depression and disability or mortality. Our objective was to examine the relationship between these two core symptoms and time to disability or death.
  
  
  METHODS
  In a longitudinal cohort study, we used the nationally representative Health and Retirement Study to examine this relationship in 11,353 persons older than 62 years (mean: 73 years) followed for up to 13 years. Dysphoria and anhedonia were assessed with the Short Form Composite International Diagnostic Interview. Our outcome measure was time to either death or increased disability, defined as the new need for help in a basic activity of daily living. We adjusted for a validated disability risk index and other confounders.
  
  
  RESULTS
  Compared with subjects without either dysphoria or anhedonia, the risk for disability or death was not elevated in elders with dysphoria without anhedonia (adjusted hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.91-1.36). The risk was elevated in those with anhedonia without dysphoria (HR: 1.30; 95% CI: 1.06-1.60) and those with both anhedonia and dysphoria (HR: 1.28; 95% CI: 1.13-1.46).
  
  
  CONCLUSIONS
  Our results highlight the need for clinicians to learn whether patients have lost interest in usually pleasurable activities, even if they deny sadness.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA; Division of Geriatrics, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA. Electronic address: ken.covinsky@ucsf.edu.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
authors.affiliation: Department of Medicine, University of California, San Francisco, CA; Division of Geriatrics, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Irena Stijacic
authors.initials: IS
authors.lastname: Cenzer
authors.affiliation: Departments of Psychiatry, Neurology, and Epidemiology, and Biostatistics, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Department of Medicine, University of California, San Francisco, CA; Division of Geriatrics, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Sarah
authors.initials: S
authors.lastname: O'Brien
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000367:Age Factors; D000368:Aged / Q000523:psychology / Q000706:statistics & numerical data; D000369:Aged, 80 and over; D059445:Anhedonia; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012307:Risk Factors
keywords: Depression; activities of daily living; anhedonia; health status; quality of life