Skip to main content

Antidepressant use and depressive symptomatology among older people from the Australian Longitudinal Study of Ageing

  • Ying Zhang (a1), Veronica Chow (a2), Agnes I. Vitry (a2), Philip Ryan (a1), Elizabeth E. Roughead (a2), Gillian E. Caughey (a2), Emmae N. Ramsay (a1), Andrew L. Gilbert (a2), Adrian Esterman (a3) and Mary A. Luszcz (a4)...

Background: Depression is one of the leading contributors to the burden of non-fatal diseases in Australia. Although there is an overall increasing trend in antidepressant use, the relationship between use of antidepressants and depressive symptomatology is not clear, particularly in the older population.

Methods: Data for this study were obtained from the Australian Longitudinal Study of Ageing (ALSA), a cohort of 2087 people aged over 65 years at baseline. Four waves of home interviews were conducted between 1992 and 2004 to collect information on sociodemographic and health status. Depressive symptoms were measured by the Center for Epidemiologic Studies – Depression Scale. Use of antidepressants was based on self-report, with the interviewer able to check packaging details if available. Longitudinal analysis was performed using logistic generalized estimating equations to detect if there was any trend in the use of antidepressants, adjusting for potential confounding factors.

Results: The prevalence of depressive symptoms was 15.2% in 1992 and 15.8% in 2004 (p > 0.05). The prevalence of antidepressant users increased from 6.5% to 10.9% (p < 0.01) over this period. Among people with depressive symptoms, less than 20% were taking antidepressants at any wave. Among people without depressive symptoms, the prevalence of antidepressant use was 5.2% in 1992 and 12.0% in 2004 (p < 0.01). Being female (OR = 1.67, 95%CI: 1.25–2.24), having poor self-perceived health status (OR = 1.17, 95%CI: 1.04–1.32), having physical impairment (OR = 1.48, 95%CI: 1.14–1.91) and having depressive symptoms (OR = 1.62, 95%CI: 1.24–2.13) significantly increased the use of antidepressants, while living in community (OR = 0.51, 95%CI: 0.37–0.71) reduced the risk of antidepressant use.

Conclusions: Use of antidepressants increased, while depressive symptoms remained stable, in the ALSA over a 12-year period. Use of antidepressants was low for people with depressive symptoms.

Corresponding author
Correspondence should be addressed to: Dr. Ying Zhang, Quality Use of Medicines and Pharmacy Research Centre, Reid Building, Frome Road, Adelaide, South Australia 5005, Australia. Phone: +61 8 83022763; Fax: +61 8 8302 1087. Email:
Hide All
Anstey, K. J. and Luszcz, M. A. (2002). Selective non-response to clinical assessment in the longitudinal study of ageing: Implications for estimating population levels of cognitive function and dementia. International Journal of Geriatric Psychiatry, 17, 704709.
Anstey, K. J., van Sanden, C., Sargent-Cox, K. and Luszcz, M. A. (2007). Prevalence and risk factors for depression in a longitudinal, population based study including individuals in the community and residential care. American Journal of Geriatric Psychiatry, 165, 497505.
Australian Government and Department of Health and Ageing (2008). Australian Statistics on Medicines 2006. Canberra: Australian Government and Department of Health and Ageing.
Ballinger, G. A. (2004). Using generalized estimating equations for longitudinal data analysis. Organizational Research Methods, 7, 127150.
Blazer, D. G., Hybels, C. F., Fillenbaum, G. G. and Pieper, C. F. (2005). Predictors of antidepressant use among older adults: have they changed over time? American Journal of Psychiatry, 162, 705710.
Charles, J., Britt, H., Fahridin, S. and Miller, G. (2007). Mental health in general practice. Australian Family Physician, 36, 200201.
Clarke, D. M., Cook, K., Smith, G. C. and Piterman, L. (2008). What do general practitioners think depression is? A taxonomy of distress and depression for general practice. Medical Journal of Australia, 188, S110113.
Esposito, D., Wahl, P., Daniel, G., Stoto, M. A., Erder, M. H. and Croghan, T. W. (2009). Results of a retrospective claims database analysis of differences in antidepressant treatment persistence associated with escitalopram and other selective serotonin reuptake inhibitors in the United States. Clinical Therapeutics, 31, 644656.
Esposito, E., Wang, J. L., Adair, C. E., Williams, J. V., Dobson, K. and Schopflocher, D. (2007). Frequency and adequacy of depression treatment in a Canadian population sample. Canadian Journal of Psychiatry, 52, 780789.
Folstein, M. F., Robins, L. N. and Helzer, J. E. (1983). The Mini-mental State Examination. Archives of General Psychiatry, 40, 812.
Folstein, M., Anthony, J. C. and Parhad, I. (1985). The meaning of cognitive impairment in the elderly. Journal of the American Geriatrics Society, 33, 228235.
Healy, D. and Aldred, G. (2005). Anti-depressant drug use and the risk of suicide. International Review of Psychiatry, 17, 163172.
Henderson, S., Andrews, G. and Hall, W. (2000). Australia's mental health: an overview of the general population survey. Australian and New Zealand Journal of Psychiatry, 34, 197205.
Jureidini, J. and Tonkin, A. (2006). Overuse of antidepressant drugs for the treatment of depression. CNS Drugs, 20, 623632.
Kendrick, T., Dowrick, C., McBride, A., Howe, A., Clarke, P. and Maisey, S. (2009). Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. BMJ, 338, b750.
Kerse, N., Flicker, L., Pfaff, J. J., Draper, B., Lautenschlager, N. T. and Sim, M. (2008). Falls, depression and antidepressants in later life: a large primary care appraisal. PLoS One, 3, e2423.
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J. and Johnson, B. T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med, 5, e45.
Krupinski, J. and Tiller, J. W. (2001). The identification and treatment of depression by general practitioners. Australian and New Zealand Journal of Psychiatry, 35, 827832.
Kwon, A., Bungay, K. M., Pei, Y., Rogers, W. H., Wilson, I. B. and Zhou, Q. (2003). Antidepressant use: concordance between self-report and claims records. Medical Care, 41, 368374.
Luszcz, M. A., Giles, L., Eckermann, S., Edwards, P., Browne-Yung, K. and Hayles, C. (2007). The Australian Longitudinal Study of Ageing: 15 Years of Ageing in South Australia. Adelaide: South Australian Department of Families and Communities.
Mamdani, M., Rapoport, M., Shulman, K. I., Herrmann, N. and Rochon, P. A. (2005). Mental health-related drug utilization among older adults: prevalence, trends, and costs. American Journal of Geriatric Psychiatry, 13, 892900.
Mant, A., Rendle, V. A., Hall, W. D., Mitchell, P. B., Montgomery, W. S. and McManus, P. R. (2004). Making new choices about antidepressants in Australia: the long view 1975–2002. Medical Journal of Australia, 181, S2124.
Mathers, C. D., Vos, E. T., Stevenson, C. E. and Begg, S. J. (2000). The Australian Burden of Disease Study: measuring the loss of health from diseases, injuries and risk factors. Medical Journal of Australia, 172, 592596.
McManus, P., Mant, A., Mitchell, P. B., Montgomery, W. S., Marley, J. and Auland, M. E. (2000). Recent trends in the use of antidepressant drugs in Australia, 1990–1998. Medical Journal of Australia, 173, 458461.
McManus, P., Mant, A., Mitchell, P., Britt, H. and Dudley, J. (2003). Use of antidepressants by general practitioners and psychiatrists in Australia. Australian and New Zealand Journal of Psychiatry, 37, 184189.
Montagnier, D., Barberger-Gateau, P., Jacqmin-Gadda, H., Dartigues, J.-F., Rainfray, M. and Peres, K. (2006). Evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large sample of older French people: results from the Personnes Agées Quid Study. Journal of the American Geriatrics Society, 54, 18391845.
Page, A. N., Swannell, S., Martin, G., Hollingworth, S., Hickie, I. B. and Hall, W. D. (2009). Sociodemographic correlates of antidepressant utilisation in Australia. Medical Journal of Australia, 190, 479483.
Pandya, R., Metz, L. and Patten, S. B. (2005). Predictive value of the CES-D in detecting depression among candidates for disease-modifying multiple sclerosis treatment. Psychosomatics, 46, 131134.
Parker, G. (2007). Is depression overdiagnosed? Yes. BMJ, 335, 328.
Pfaff, J. J., Draper, B. M., Pirkis, J. E., Stocks, N. P., Snowdon, J. A. and Sim, M. G. (2009). Medical morbidity and severity of depression in a large primary care sample of older Australians: the DEPS-GP project. Medical Journal of Australia, 190, S7580.
Radloff, L. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401.
Rubin, D. B. (1987). Multiple Imputation for Nonresponse in Surveys. New York: J. Wiley & Sons.
Sawada, N., Uchida, H., Suzuki, T., Watanabe, K., Kikuchi, T. and Handa, T. (2009). Persistence and compliance to antidepressant treatment in patients with depression: A chart review. BMC Psychiatry, 9:38doi:10.1186/1471-244X-9-38.
Schafer, J. L. and Graham, J. W. (2002). Missing data: our view of the state of the art Psychological Methods, 7, 147177.
Sonnenberg, C. M., Deeg, D. J., Comijs, H. C., van Tilburg, W. and Beekman, A. T. (2008). Trends in antidepressant use in the older population: results from the LASA-study over a period of 10 years. Journal of Affective Disorders, 111, 299305.
StataCorp (2001). Statistical Software: Release 9.0. College Station, TX: Stata Corporation.
Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A. and Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, 252260.
van Weel, C., van Weel-Baumgarten, E. and van Rijswijk, E. (2009). Treatment of depression in primary care. BMJ, 338, b934.
Whiteford, H. A. (2008). Depression in primary care: expanding the evidence base for diagnosis and treatment. Medical Journal of Australia, 188, S101102.
Zautra, A. J., Maxwell, B. M. and Reich, John W. (1989). Relationship among physical impairment, distress, and well-being in older adults. Journal of Behavioral Medicine, 12, 543557.
Zeger, S. L., Liang, K. and Albert, P. S. (1988). Models for longitudinal data: a generalized estimating equation approach. Biometrics, 44, 10491060.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed