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Original Investigation |

The Trajectory of Depressive Symptoms Across the Adult Life Span

Angelina R. Sutin, PhD1,3; Antonio Terracciano, PhD2,3; Yuri Milaneschi, PhD3,4; Yang An, MS3; Luigi Ferrucci, MD, PhD3; Alan B. Zonderman, PhD3
[+] Author Affiliations
1Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee
2Department of Geriatrics, Florida State University College of Medicine, Tallahassee
3National Institute on Aging, National Institutes of Health, Baltimore, Maryland
4VU University Medical Center, Amsterdam, the Netherlands
JAMA Psychiatry. 2013;70(8):803-811. doi:10.1001/jamapsychiatry.2013.193.
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Importance  Long-term longitudinal studies are needed to delineate the trajectory of depressive symptoms across adulthood and to individuate factors that may contribute to increases in depressive symptoms in older adulthood.

Objectives  To estimate the trajectory of depressive symptoms across the adult life span; to test whether this trajectory varies by demographic factors (sex, ethnicity, and educational level) and antidepressant medication use; and to test whether disease burden, functional limitations, and proximity to death explain the increase in depressive symptoms in old age.

Design  Longitudinal study.

Setting  Community.

Participants  The study included 2320 participants (47.0% female; mean [SD] age at baseline, 58.1 [17.0] years; range, 19-95 years) from the Baltimore Longitudinal Study of Aging.

Main Outcomes and Measures  Estimated trajectory of depressive symptoms modeled from 10 982 assessments (mean [SD] assessments per participant, 4.7 [3.6]; range, 1-21) based on the Center for Epidemiologic Studies Depression scale and 3 subscales (depressed affect, somatic complaints, and interpersonal problems).

Results  The linear (γ10 = 0.52; P < .01) and quadratic (γ20 = 0.43; P < .01) terms were significant, which indicated that depressive symptoms were highest in young adulthood, decreased across middle adulthood, and increased again in older adulthood. The subscales followed a similar pattern. Women reported more depressed affect at younger ages, but an interaction with age suggested that this gap disappeared in old age. Accounting for comorbidity, functional limitations, and impending death slightly reduced but did not eliminate the uptick in depressive symptoms in old age.

Conclusions and Relevance  Symptoms of depression follow a U-shaped pattern across adulthood. Older adults experience an increase in distress that is not due solely to declines in physical health or approaching death.

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Figure 1.
Scores for the Center for Epidemiologic Studies Depression Total Scale and 3 Subscales Across Adulthood

Estimated trajectory of scores for the Center for Epidemiologic Studies Depression (CES-D) total scale and 3 subscales across adulthood. Raw scored were z-transformed so that all scales could be plotted on the same axis. (eFigure 1 in the Supplement shows the estimated trajectories of each scale in the original metric.)

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Figure 2.
Depressed Affect Scores by Sex

Estimated trajectory of depressed affect scores by sex.

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Figure 3.
Somatic Complaint Scores in Old Age

Estimated trajectory of somatic complaint scores in old age in participants still living and participants who died.

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