title: Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: results from the EURODEP concerted action.
abstract: BACKGROUND
  In the epidemiology of late life depression, few insights are available on the co-occurrence of subthreshold depression and comorbid symptoms of anxiety. The current study aims to describe prevalence patterns of comorbid anxiety symptoms across different levels of depression in old age, and to describe the burden of depressive symptoms and functional disability across patterns of comorbidity.
  
  
  METHODS
  Respondents were older adults in the community, age 65-104 (N=14,200), from seven European countries, with in total nine study centres, collaborating in the EURODEP concerted action. Depression and anxiety were assessed using the Geriatric Mental State examination (GMS-AGECAT package), providing subthreshold level and case-level diagnoses. Presence of anxiety symptoms was defined as at least three distinct symptoms of anxiety. Number of depressive symptoms was assessed with the EURO-D scale.
  
  
  RESULTS
  The prevalence of anxiety symptoms amounts to 32% for respondents without depression, 67% for those with subthreshold depression, and 87% for those with case-level depression. The number of depressive symptoms is similar for those with subthreshold-level depression with comorbid anxiety, compared to case-level depression without symptoms of anxiety. In turn, at case level, comorbid symptoms of anxiety are associated with higher levels of depressive symptoms and more functional disability.
  
  
  CONCLUSIONS
  GMS-AGECAT is insufficiently equipped with diagnostic procedures to identify specific types of anxiety disorders.
  
  
  CONCLUSIONS
  Anxiety symptoms in late life depression are highly prevalent, and are likely to contribute to the burden of symptoms of the depression, even at subthreshold level.
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Care Research; Department of Epidemiology and Biostatistics, Longitudinal Aging Study Amsterdam, Amsterdam, The Netherlands; Altrecht Mental Health Care, Department of Emergency Psychiatry and Department of Specialist Training, Utrecht, The Netherlands. Electronic address: a.braam@vumc.nl.
authors.forename: Arjan W
authors.initials: AW
authors.lastname: Braam
authors.affiliation: Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, UK.
authors.forename: John R M
authors.initials: JR
authors.lastname: Copeland
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University, and Mondriaan Regional Care System, The Netherlands.
authors.forename: Philippe A E G
authors.initials: PA
authors.lastname: Delespaul
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Care Research; Department of Epidemiology and Biostatistics, Longitudinal Aging Study Amsterdam, Amsterdam, The Netherlands.
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: Child and Adolescent Psychiatry Service, Tirana University School of Medicine, Tirana, Albania.
authors.forename: Ariel
authors.initials: A
authors.lastname: Como
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.affiliation: Department of Psychiatry, Ludwig Maximilians Universität, München, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Fichter
authors.affiliation: VU University Medical Centre, EMGO+ Institute for Health and Care Research; Department of Epidemiology and Biostatistics, Longitudinal Aging Study Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Tjalling J
authors.initials: TJ
authors.lastname: Holwerda
authors.affiliation: Department of Psychiatry, Jonathan Swift Clinic, St. James' Hospital, Dublin, Republic of Ireland.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Lawlor
authors.affiliation: Department of Psychiatry, University of Zaragoza; Instituto de Investigacion Sanitaria de Aragon (IIS) and Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lobo
authors.affiliation: Heilsugæslustöð, Grundarfirði, Iceland.
authors.forename: Hallgrímur
authors.initials: H
authors.lastname: Magnússon
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Prince
authors.affiliation: Psychiatrische Klinik und Poliklinik, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Friedel
authors.initials: F
authors.lastname: Reischies
authors.affiliation: Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, UK.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Wilson
authors.affiliation: Institute of Clinical Neurosciences, Sahlgrenska University Hospital, Göteborg University, Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Skoog
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index
keywords: Anxiety; Comorbidity; Depression; Epidemiology; Old age