Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-18T15:01:22.610Z Has data issue: false hasContentIssue false

Age-related variability in the presentation of symptoms of major depressive disorder

Published online by Cambridge University Press:  27 October 2016

R. Schaakxs*
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
H. C. Comijs
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
F. Lamers
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
A. T. F. Beekman
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
B. W. J. H. Penninx
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
*Address for correspondence: R. Schaakxs, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Arent Janszoon Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands. (Email:



The heterogeneous aetiology of major depressive disorder (MDD) might affect the presentation of depressive symptoms across the lifespan. We examined to what extent a range of mood, cognitive, and somatic/vegetative depressive symptoms were differentially present depending on patient's age.


Data came from 1404 participants with current MDD (aged 18–88 years) from two cohort studies: the Netherlands Study of Depression and Anxiety (NESDA) and the Netherlands Study of Depression in Older Persons (NESDO). Associations between age (per 10 years) and 30 depressive symptoms as well as three symptom clusters (mood, cognitive, somatic/vegetative) were assessed using logistic and linear regression analyses.


Depression severity was found to be stable with increasing age. Nevertheless, 20 (67%) out of 30 symptoms were associated with age. Most clearly, with ageing there was more often early morning awakening [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.36–1.60], reduced interest in sex (OR 1.42, 95% CI 1.31–1.53), and problems sleeping during the night (OR 1.33, 95% CI 1.24–1.43), whereas symptoms most strongly associated with younger age were interpersonal sensitivity (OR 0.72, 95% CI 0.66–0.79), feeling irritable (OR 0.73, 95% CI 0.67–0.79), and sleeping too much (OR 0.75, 95% CI 0.68–0.83). The sum score of somatic/vegetative symptoms was associated with older age (B = 0.23, p < 0.001), whereas the mood and cognitive sum scores were associated with younger age (B = −0.20, p < 0.001; B = −0.04, p = 0.004).


Depression severity was found to be stable across the lifespan, yet depressive symptoms tend to shift with age from being predominantly mood-related to being more somatic/vegetative. Due to the increasing somatic presentation of depression with age, diagnoses may be missed.

Original Articles
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Bagby, RM, Ryder, AG, Schuller, DR, Marshall, MB (2004). The Hamilton depression rating scale: has the gold standard become a lead weight? American Journal of Psychiatry 161, 21632177.CrossRefGoogle ScholarPubMed
Barry, LC, Abou, JJ, Simen, AA, Gill, TM (2012). Under-treatment of depression in older persons. Journal of Affective Disorders 136, 789796.Google Scholar
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.CrossRefGoogle ScholarPubMed
Brodaty, H, Altendorf, A, Withall, A, Sachdev, P (2010). Do people become more apathetic as they grow older? A longitudinal study in healthy individuals. International Psychogeriatrics 22, 426436.CrossRefGoogle Scholar
Buysse, DJ, Germain, A, Moul, DE, Franzen, PL, Brar, LK, Fletcher, ME, Begley, A, Houck, PR, Mazumdar, S, Reynolds, CF III, Monk, TH (2011). Efficacy of brief behavioral treatment for chronic insomnia in older adults. Archives of Internal Medicine 171, 887895.CrossRefGoogle ScholarPubMed
Ciechanowski, PS, Katon, WJ, Russo, JE (2000). Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Archives of Internal Medicine 160, 32783285.CrossRefGoogle ScholarPubMed
Comijs, HC, van Marwijk, HW, van der Mast, RC, Naarding, P, Oude Voshaar, RC, Beekman, AT, Boshuisen, M, Dekker, J, Kok, R, de Waal, MW, Penninx, BW, Stek, ML, Smit, JH (2011). The Netherlands study of depression in older persons (NESDO); a prospective cohort study. BMC Research Notes 4, 524.Google Scholar
De Graaf, R, ten Have, M, van Gool, C, van Dorsselaer, S (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social Psychiatry and Psychiatric Epidemiology 47, 203213.Google Scholar
De Miranda Azevedo, R, Roest, AM, Hoen, PW, de Jonge, P (2014). Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis. Psychological Medicine 44, 26892703.Google Scholar
Doraiswamy, PM, Bernstein, IH, Rush, AJ, Kyutoku, Y, Carmody, TJ, Macleod, L, Venkatraman, S, Burks, M, Stegman, D, Witte, B, Trivedi, MH (2010). Diagnostic utility of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) in the elderly. Acta Psychiatrica Scandinavica 122, 226234.CrossRefGoogle ScholarPubMed
Fiske, A, Wetherell, JL, Gatz, M (2009). Depression in older adults. Annual Review of Clinical Psychology 5, 363389.Google Scholar
Folstein, MF, Folstein, SE, McHugh, PR (1975). ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.CrossRefGoogle Scholar
Gallo, JJ, Rabins, PV, Anthony, JC (1999). Sadness in older persons: 13-year follow-up of a community sample in Baltimore, Maryland. Psychological Medicine 29, 341350.CrossRefGoogle ScholarPubMed
Grace, J, O'Brien, JT (2003). Association of life events and psychosocial factors with early but not late onset depression in the elderly: implications for possible differences in aetiology. International Journal of Geriatric Psychiatry 18, 473478.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 5662.Google Scholar
Hegeman, JM, de Waal, MWM, Comijs, HC, Kok, RM, van der Mast, RC (2015). Depression in later life: a more somatic presentation? Journal of Affective Disorders 170, 196202.CrossRefGoogle ScholarPubMed
Hegeman, JM, Kok, RM, van der Mast, RC, Giltay, EJ (2012 a). Phenomenology of depression in older compared with younger adults: meta-analysis. British Journal of Psychiatry 200, 275281.Google Scholar
Hegeman, JM, Wardenaar, KJ, Comijs, HC, de Waal, MW, Kok, RM, van der Mast, RC (2012 b). The subscale structure of the Inventory of Depressive Symptomatology Self Report (IDS-SR) in older persons. Journal of Psychiatric Research 46, 13831388.Google Scholar
Khan, AY, Carrithers, J, Preskorn, SH, Lear, R, Wisniewski, SR, John Rush, A, Stegman, D, Kelley, C, Kreiner, K, Nierenberg, AA, Fava, M (2006). Clinical and demographic factors associated with DSM-IV melancholic depression. Annals of Clinical Psychiatry 18, 9198.CrossRefGoogle ScholarPubMed
Korten, NC, Comijs, HC, Lamers, F, Penninx, BW (2012). Early and late onset depression in young and middle aged adults: differential symptomatology, characteristics and risk factors? Journal of Affective Disorders 138, 259267.Google Scholar
Lyness, JM, Niculescu, A, Tu, X, Reynolds, CF III, Caine, ED (2006). The relationship of medical comorbidity and depression in older, primary care patients. Psychosomatics 47, 435439.Google Scholar
Penninx, BWJH, Beekman, ATF, Smit, JH, Zitman, FG, Nolen, WA, Spinhoven, P, Cuijpers, P, de Jong, PJ, van Marwijk, HW, Assendelft, WJ, van der Meer, K, Verhaak, P, Wensing, M, de Graaf, R, Hoogendijk, WJ, Ormel, J, van Dyck, R, NESDA Research Consortium (2008). The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods. International Journal of Methods in Psychiatric Research 17, 121140.CrossRefGoogle ScholarPubMed
Roest, AM, Thombs, BD, Grace, SL, Stewart, DE, Abbey, SE, de Jonge, P (2011). Somatic/affective symptoms, but not cognitive/affective symptoms, of depression after acute coronary syndrome are associated with 12-month all-cause mortality. Journal of Affective Disorders 131, 158163.Google Scholar
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477486.Google Scholar
Small, GW (2009). Differential diagnoses and assessment of depression in elderly patients. Journal of Clinical Psychiatry 70, e47.Google Scholar
Sneed, JR, Kasen, S, Cohen, P (2007). Early-life risk factors for late-onset depression. International Journal of Geriatric Psychiatry 22, 663667.Google Scholar
Troxel, WM, Kupfer, DJ, Reynolds, CF 3rd, Frank, E, Thase, ME, Miewald, JM, Buysse, DJ (2012). Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations. Journal of Clinical Psychiatry 73, 478485.Google Scholar
Van den Berg, MD, Oldehinkel, AJ, Bouhuys, AL, Brilman, EI, Beekman, AT, Ormel, J (2001). Depression in later life: three etiologically different subgroups. Journal of Affective Disorders 65, 1926.CrossRefGoogle ScholarPubMed
Volkert, J, Schulz, H, Härter, M, Wlodarczyk, O, Andreas, S (2013). The prevalence of mental disorders in older people in Western countries – a meta-analysis. Ageing Research Reviews 12, 339353.CrossRefGoogle ScholarPubMed
Wardenaar, KJ, van Veen, T, Giltay, EJ, den Hollander-Gijsman, M, Penninx, BW, Zitman, FG (2010). The structure and dimensionality of the Inventory of Depressive Symptomatology Self Report (IDS-SR) in patients with depressive disorders and healthy controls. Journal of Affective Disorders 125, 146154.Google Scholar
Weisenbach, SL, Kumar, A (2014). Current understanding of the neurobiology and longitudinal course of geriatric depression. Current Psychiatry Reports 16, 463.Google Scholar
Wetherell, JL, Petkus, AJ, McChesney, K, Stein, MB, Judd, PH, Rockwell, E, Sewell, DD, Patterson, TL (2009). Older adults are less accurate than younger adults at identifying symptoms of anxiety and depression. Journal of Nervous and Mental Disease 197, 623626.Google Scholar
WHO (2008). The global burden of disease. 2004 update. World Health Organization ( Accessed 24 September 2013.Google Scholar
Wiltink, J, Michal, M, Wild, PS, Zwiener, I, Blettner, M, Münzel, T, Schulz, A, Kirschner, Y, Beutel, ME (2013). Associations between depression and different measures of obesity (BMI, WC, WHtR, WHR). BMC Psychiatry 13, 223.Google Scholar
Wittchen, HU (1994). Reliability and validity studies of the WHO – Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 5784.CrossRefGoogle ScholarPubMed