Academic journal article Generations

Minor Depression and 'Subthreshold' Anxiety Symptoms in Older Adults: Psychosocial Therapies and Special Considerations

Academic journal article Generations

Minor Depression and 'Subthreshold' Anxiety Symptoms in Older Adults: Psychosocial Therapies and Special Considerations

Article excerpt


A new focus on these common causes of distress and impairment.

In recent years more attention has been given to identifying and treating mental disorders in older adults. By and large, these efforts have focused on disorders delineated in the American Psychiatric Association's Diagnostic and Sta/Manual of Mental Disorders (DSM-IV). However, another class of disorders is also beginning to receive attention: "subthreshold" mental disorders. Although these sets of symptoms do not meet the full criteria to be classified as specific mental disorders, they are nonetheless associated with clinically significant distress or impairment (Pincus, Davis, and McQueen,1999). In this article we will discuss two specific subthreshold conditions, "minor depression" and "subthreshold generalized anxiety disorder," and the evidence for the efficacy of psychosocial therapies for these conditions for older adults.


Minor depression is typically defined as the presence of at least two but fewer than five depressive symptoms, including depressed mood or loss of interest in normal daily activities, during the same two-week period with no history of major depressive episode or dysthymic disorder but with clinically significant impairment or distress (American Psychiatric Association, 1994). Minor depression is highly prevalent in older adults in the community (9.9 percent) (Hybels, Blazer, and Pieper, 2001) and in primary care (5.2 percent) (Lyness et al., 1999). In mixed-age samples minor depression has been shown to be associated with levels of functional impairment comparable to those caused by medical illnesses (Wells et al., 1992) and with increased expenditures on medical care (Johnson, Weissman, and Klerman, 1992). Morbidity has been less extensively studied in samples of older adults, but the morbidity rates of elders with minor depression may be assumed to be at least comparable to samples with medical illnesses given the higher prevalence of complicating medical conditions. A recent study has shown minor depression to be associated with an increased risk for mortality in older men (Penninx et al., 1999).

Although assessment of the prevalence of minor depression in racial and ethnic minority populations tends to be clouded by linguistic and cultural differences in expressing affective and somatic symptoms, recent research taking into account these measurement challenges indicates that minor depression is very common in older ethnic minorities in primary care. According to Arean and Alvidrez (2001), as many as io percent of older African Americans, 15 percent of older Latinos, and 12 percent of older Asians meet criteria for minor depression.


One of the most common instruments for screening and tracking depression in primary care is the Patient Health Questionnaire Nine-- Item Depression Module (PHQ-9). The patient fills out the questionnaire, and the information can yield a diagnosis of major or minor depression. While psychometric studies have yet to be done on the utility of the PHQ-9 with minority elders, the instrument is available in Spanish and Chinese.


Empirically derived treatment guidelines have been established for major depression. However, a paucity of studies, which have yielded conflicting findings, means that no specific guidelines are currently available for pharmacologic or psychosocial treatment of minor depression. Psychosocial therapies are particularly appealing for older adults because they often have medical conditions as well, leading to an increased possibility of adverse drug interactions. Since the research on treating minor depression in older adults is so limited, we will review the evidence for psychosocial treatments of minor depression in both younger and older adults together. The interventions examined include cognitive-behavioral, interpersonal, and problem-solving therapy, as well as physical exercise. …

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