BACKGROUND With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. METHODS We searched PubMed (1980–Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression. RESULTS In older adults subthreshold depression was generally at least 2–3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8–10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. LIMITATIONS Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. CONCLUSIONS The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.

Background There is growing public health interest in understanding and promoting successful aging. While there has been some exciting empirical work on objective measures of physical health, relatively little published research combines physical, cognitive, and psychological assessments in large, randomly selected, community-based samples to assess self-rated successful aging (SRSA). Methods In this Successful AGing Evaluation (SAGE) study, we used a structured multi-cohort design to assess successful aging in 1,006 community-dwelling adults in San Diego County, aged 50–99 years, with over-sampling of people over 80. A modified version of random digit dialing was used to recruit subjects. Evaluations included a 25-minute phone interview followed by a comprehensive mail-in survey of physical, cognitive, and psychological domains, including SRSA (scaled from 1 [lowest] to 10 [highest]) and positive psychological traits. Results In our sample with mean age of 77.3 years, the mean SRSA score was 8.2, and older age was associated with higher SRSA (R2 = 0.027), despite worsening physical and cognitive functioning. The best multiple regression model achieved, using all the potential correlates, accounted for 30% of variance in SRSA, and included resilience, depression, physical functioning, and age (entering the regression model in that order). Conclusions Resilience and depression had a significant association with SRSA with effect sizes comparable to that for physical health. While no causality can be inferred from cross-sectional data, increasing resilience and reducing depression might have as strong effects on successful aging as reducing physical disability, suggesting an important role for psychiatry in promoting successful aging.

As the coronavirus disease 2019 (COVID-19) began to spread in the US in early 2020, older adults experienced disproportionately greater adverse effects from the pandemic including more severe complications, higher mortality,concernsaboutdisruptionstotheirdailyroutinesand access to care, difficulty in adapting to technologies like telemedicine, and concerns that isolation would exacerbate existing mental health conditions. Older adults tend to have lower stress reactivity, and in general, better emotional regulation and well-being than younger adults, 1 but given the scale and magnitude of the pandemic, there was concern about a mental health crisis among older adults. The concern pertained to older adults both at home and in residential care facilities, where contact with friends, family, and caregivers became limited. The early data suggest a much more nuanced picture. This Viewpoint summarizes evidence suggesting that, counter to expectation, older adults as a group may be more resilient to the anxiety,depression,andstress-relatedmentalhealthdisorders characteristic of younger populations during the initial phase of the COVID-19 pandemic. Approximately 8 months into the pandemic, multiple studies have indicated that older adults may be less negatively affected by mental health outcomes than other age groups. In August 2020, the Centers for Disease Control and Prevention (CDC) published a survey, conducted June 24-30, 2020, of 5412 community-dwelling adults across the US, 2 noting that the 933 participants aged 65 years or older reported significantly lower percentages of anxiety disorder (6.2%), depressive disorder (5.8%), or trauma-or stress-related disorder (TSRD) (9.2%) than participants in younger age groups. According to the report, of the 731 participants aged 18 through 24 years, 49.1% reported anxiety disorder; 52.3%, depressive disorder; and 46%, TSRD. Of the 1911 participants aged 25 through 44 years, 35.3% reported anxiety disorder; 32.5%, depressive disorder; and 36% for TSRD. Of the 895 participants aged 45 through 64 years, 16.1% reported anxiety disorder; 14.4%, depressive disorder; and 17.2%, TSRD. Older adults, compared with other age groups, also reported lower rates of new or increased substance use and suicidal ideation in the preceding 30 days, with rates of 3% and 2%, respectively. These findings are similar to other reports from high-income countries. A cross-sectional study involving 3840 community-dwelling older adults aged 18 through 80 years from Spain noted that older age (60-80 years) compared with younger age (40-59 years) was associated with lower rates of anxiety, depression, and posttraumatic stress disorder (PTSD). 3 In this study, women had higher prevalence of anxiety, PTSD, and depressive symptoms than men. A study involving 776 community-dwelling US and Canadian adults who used a 7-day daily diary to track affect and stress found that older adults (>60 years; n = 193),