Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study

Abstract

Background: Few studies have examined the prevalence and correlates of subsyndromal and syndromal depressive symptoms (SSSD) among older adults with schizophrenia spectrum disorder. In this report, we examined the prevalence of SSSD and their associations with sociodemographic characteristics, clinical characteristics of schizophrenia, comorbidity, psychotropic medications, quality of life, functioning and mental health care utilization in a large, multicenter sample of older adults with schizophrenia spectrum disorder. Methods: Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of SSSD, defined using the Center of Epidemiologic Studies Depression (CESD) scale. Clinical characteristics associated with SSSD were explored. Results: Among 343 older adults with schizophrenia spectrum disorder, 78.1% had either subsyndromal (30.6%) or syndromal (47.5%) depressive symptoms. SSSD were independently associated with positive and negative symptoms, lower quality of life, non-late-onset psychosis, benzodiazepine use and urbanicity. There were no significant associations of SSSD with other sociodemographic characteristics and psychotropic medications, or with general medical conditions. We found no significant differences in the proportion of participants who were treated with antidepressants between those with syndromal depressive symptoms and those without depression (22.1% vs. 20.0%, p = 0.89). SSSD were not associated with higher mental health care utilization. Limitations: Data were cross-sectional and depression was not evaluated with a semi-structured interview. Conclusion: SSSD may be highly prevalent and under-assessed and/or undertreated among older adults with schizophrenia spectrum disorder. Our findings should alert clinicians about the need to assess systematically and regularly depression in this vulnerable population.

Benzodiazepine use among older adults with schizophrenia spectrum disorder: prevalence and associated factors in a multicenter study

“…Cross-sectional data was drawn from the CSA study, a cohort of 353 inpatients (34.1%, mean duration of hospitalization = 134.7 days [SD = 133.0]) or outpatients (65.9%) aged 55 years or more with schizophrenia spectrum disorder, which included people with an International Classification of Diseases, tenth edition (ICD-10) diagnosis of schizophrenia (82.4%) or schizoaffective disorder (17.6%) (Hoertel et al, 2019;Abou Kassm et al, 2019). In France, state hospitalization services are organized into "sectors."…”

Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

“…Within this group, the largest body of data concerns schizophrenia. Estimates of the prevalence of depressive episodes in schizophrenia have ranged from 27 to 48% [65-67], while in one study 31% of patients aged >55 years with schizophrenia spectrum disorders had subsyndromal depressive symptoms [67]. Comorbid depression in schizophrenia is associated with more positive and negative symptoms and greater suicidality [67, 68].…”

“…Estimates of the prevalence of depressive episodes in schizophrenia have ranged from 27 to 48% [65][66][67], while in one study 31% of patients aged > 55 years with schizophrenia spectrum disorders had subsyndromal depressive symptoms [67]. Comorbid depression in schizophrenia is associated with more positive and negative symptoms and greater suicidality [67,68]. Despite substantial overlap between depressive and negative symptoms, low mood, pessimism, and suicidality are more specific to depression, while alogia and blunted affect are more reliably linked to negative symp-toms [69].…”

Metformin Enhances Antidepressant/Antipsychotic Combination Therapy of Schizophrenia With Comorbid Depression in a Murine Model

“…Depression frequently complicates schizophrenia, with a prevalence of 20% to 60% depending on the disease stage (Conley et al, 2007;Upthegrove et al, 2017). Depression is the most common mood disorder across all phases of schizophrenia, and is also prevalent among persons at high risk for schizophrenia (Fusar-Poli et al, 2013;Hoertel et al, 2019). Coexistent depression confounds the therapy of schizophrenic patients, as only minor benefits are obtained by the addition of antidepressants to antipsychotics (Helfer et al, 2016).…”