title: Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People.
abstract: OBJECTIVE
  The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help.
  
  
  METHODS
  Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata.
  
  
  RESULTS
  The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression.
  
  
  CONCLUSIONS
  The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.
authors.affiliation: Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden. mikael.ludvigsson@lio.se.
authors.forename: Mikael
authors.initials: M
authors.lastname: Ludvigsson
authors.affiliation: Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, LAH/Unit of Palliative Care, County Council of Östergötland, and Palliative Education and Research Centre in the County of Östergötland, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Milberg
authors.affiliation: Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Marcusson
authors.affiliation: Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden.
authors.forename: Ewa
authors.initials: E
authors.lastname: Wressle
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology* / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D012720:Severity of Illness Index
keywords: Coping; Frailty; Healthy aging; Subthreshold depression; Successful aging