<p>Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence</p>

Abstract

This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms "subthreshold depression," "prevalence," "treatment" and "older adults" in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.

Longitudinal Association between Late-Life Depression (LLD) and Frailty: Findings from a Prospective Cohort Study (MiMiCS-FRAIL)

“…Third, our analyses were based on DSM-5 criteria, in order to distinguish MDD from STD instead of considering only depressive symptoms. STD is generally also seen as an important depressive syndrome in late life (59). Most previous studies have only assessed self-report depressive symptoms in the association with frailty phenotype and this may be confounded with the presence of frailty (18,20).…”

Socio-Demographic and Coping Correlates and Predictors of Depressive Symptoms Among Low-Income and Ethnic Minority Mothers At-Risk

“…In published studies and national health surveys, low-income and ethnic minority mothers report levels of depressive symptoms in proportions (i.e., 16%-52%) (De Luca et al, 2018;Halgunseth et al, 2019;Marsiglia et al, 2011) more than double national averages for the rate of clinical depression in women (8.7%) (National Health Interview Survey, 2014;National Institute of Mental Health, 2019). These mothers may have clinical depression or subsyndromal depressive symptoms, depression that consists of depressed mood and other symptoms that have not reached diagnostic criteria for clinical depression (Biella et al, 2019;Conners-Burrow et al, 2016;Pietrzak et al, 2013). Depression, defined here as both subsyndromal and clinical depression, produce deleterious effects in the infants and young children of these mothers.…”

Design and protocol of the multimorbidity and mental health cohort study in frailty and aging (MiMiCS-FRAIL): unraveling the clinical and molecular associations between frailty, somatic disease burden and late life depression

“…The prevalence of major depression disorder ranges from 1 to 5% in community-based studies, showing a 2- to 5-fold increase among older adults with multimorbidity [ 17 ]. Clinically significant depressive symptoms (aka, minor, subthreshold or subsyndromal depression) is much more frequent among older adults, with a mean prevalence of 15% [ 18 ]. Late-life depression has a multifactorial origin in line with the definition of a geriatric syndrome, and is associated with a higher level of multimorbidity, worse prognosis of comorbid chronic somatic disorders, poor cognitive and social functioning, and higher level of self-neglect [ 16 ].…”

“…All three conditions are associated with similar adverse outcomes (i.e. falls, disability, hospitalization, death), share the same risk factors (e.g., older age, female sex, low income, ethnical background, undernutrition, obesity, functional disability), and partly overlap in their clinical presentation and/or diagnostic criteria [ 9 , 12 , 17 , 18 ]. Available prospective studies show bidirectional relations between each other.…”