Skip to main content
    • Aa
    • Aa

Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R)

  • R. C. Kessler (a1), H. Birnbaum (a2), E. Bromet (a3), I. Hwang (a1), N. Sampson (a1) and V. Shahly (a4)...

Although depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life.


We studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0.


Lifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged ⩾65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly.


Given that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.

Corresponding author
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email:
Hide All
Alexopoulos GS, Buckwalter K, Olin J, Martinez R, Wainscott C, Krishnan KR (2002). Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biological Psychiatry 52, 543558.
Baker M, Stabile M, Deri C (2001). What do self-reported, objective measures of health measure? NBER Working Paper 8419. National Bureau of Economic Research: Cambridge, MA.
Blazer D, Hughes DC, George LK (1987). The epidemiology of depression in an elderly community population. Gerontologist 27, 281287.
Blazer DG 2nd, Hybels CF (2005). Origins of depression in later life. Psychological Medicine 35, 12411252.
Bremmer MA, Beekman AT, Deeg DJ, Penninx BW, Dik MG, Hack CE, Hoogendijk WJ (2008). Inflammatory markers in late-life depression: results from a population-based study. Journal of Affective Disorders 106, 249255.
Bremmer MA, Deeg DJ, Beekman AT, Penninx BW, Lips P, Hoogendijk WJ (2007). Major depression in late life is associated with both hypo- and hypercortisolemia. Biological Psychiatry 62, 479486.
Charles ST, Carstensen LL (2008). Unpleasant situations elicit different emotional responses in younger and older adults. Psychology and Aging 23, 495504.
Diehl M, Coyle N, Labouvie-Vief G (1996). Age and sex differences in strategies of coping and defense across the life span. Psychology and Aging 11, 127139.
Drayer RA, Mulsant BH, Lenze EJ, Rollman BL, Dew MA, Kelleher K, Karp JF, Begley A, Schulberg HC, Reynolds CF 3rd (2005). Somatic symptoms of depression in elderly patients with medical comorbidities. International Journal of Geriatric Psychiatry 20, 973982.
Edwards WS, Winn DM, Kurlantzick V, Sheridan S, Berk ML, Retchin S, Collins JG (1994). Evaluation of National Health Interview Survey Diagnostic Reporting. National Center for Health Statistics. Vital and Health Statistics 2, 120.
Ernst C, Angst J (1995). Depression in old age. Is there a real decrease in prevalence? A review. European Archives of Psychiatry and Clinical Neuroscience 245, 272287.
Felton BJ, Revenson TA (1987). Age differences in coping with chronic illness. Psychology and Aging 2, 164170.
Fiske A, Gatz M, Pedersen NL (2003). Depressive symptoms and aging: the effects of illness and non-health-related events. Journal of Gerontology Series B: Psychological Sciences and Social Sciences 58, 320328.
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research 15, 167180.
Hosmer DW, Lemeshow S (2001). Applied Logistic Regression, 2nd edn. Wiley & Son: New York.
Jorm AF (2000). Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychological Medicine 30, 1122.
Kennedy GJ, Kelman HR, Thomas C (1990). The emergence of depressive symptoms in late life: the importance of declining health and increasing disability. Journal of Community Health 15, 93–104.
Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E, Jin R, Pennell BE, Walters EE, Zaslavsky A, Zheng H (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 6992.
Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 30953105.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.
Kessler RC, Merikangas KR (2004). The National Comorbidity Survey Replication (NCS-R): background and aims. International Journal of Methods in Psychiatric Research 13, 6068.
Kessler RC, Üstün TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.
Knäuper B, Cannell CF, Schwarz N, Bruce ML, Kessler RC (1999). Improving accuracy of major depression age-of-onset reports in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research 8, 3948.
Knight M, Stewart-Brown S, Fletcher L (2001). Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys. Journal of Public Health Medicine 23, 179186.
Koenig HG, Meador KG, Shelp F, Goli V, Cohen HJ, Blazer DG (1991). Major depressive disorder in hospitalized medically ill patients: an examination of young and elderly male veterans. Journal of the American Geriatric Society 39, 881890.
Leon AC, Olfson M, Portera L, Farber L, Sheehan DV (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93–105.
Mitchell AJ, Subramaniam H (2005). Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. American Journal of Psychiatry 162, 15881601.
Petronijevic M, Petronijevic N, Ivkovic M, Stefanovic D, Radonjic N, Glisic B, Ristic G, Damjanovic A, Paunovic V (2008). Low bone mineral density and high bone metabolism turnover in premenopausal women with unipolar depression. Bone 42, 582590.
Research Triangle Institute (2002). SUDAAN: Professional Software for Survey Data Analysis [computer program]. Research Triangle Institute: Research Triangle Park, NC.
Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J (2004). Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Quality of Life Research 13, 833844.
Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R, Thase ME, Kocsis JH, Keller MB (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573583.
Salaycik KJ, Kelly-Hayes M, Beiser A, Nguyen AH, Brady SM, Kase CS, Wolf PA (2007). Depressive symptoms and risk of stroke: the Framingham Study. Stroke 38, 1621.
Sargeant JK, Bruce ML, Florio LP, Weissman MM (1990). Factors associated with 1-year outcome of major depression in the community. Archives of General Psychiatry 47, 519526.
Schoenborn CA, Adams PF, Schiller JS (2003). Summary health statistics for the U.S. population: National Health Interview Survey, 2000. Vital and Health Statistics 10, 183.
Schoevers RA, Geerlings MI, Deeg DJ, Holwerda TJ, Jonker C, Beekman AT (2009). Depression and excess mortality: evidence for a dose response relation in community living elderly. International Journal of Geriatric Psychiatry 24, 169176.
Simon GE, Von Korff M (1992). Reevaluation of secular trends in depression rates. American Journal of Epidemiology 135, 14111422.
Snowdon J (1997). Depression in old age: questions concerning prevalence studies. International Journal of Geriatric Psychiatry 12, 10431045.
Taylor WD, McQuoid DR, Krishnan KR (2004). Medical comorbidity in late-life depression. International Journal of Geriatric Psychiatry 19, 935943.
Weissman MM, Bruce ML, Leaf PJ, Florio LP, Holzer C (1991). Affective disorders. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (ed. Robins L. N. and Regier D. A.), pp. 5380. Free Press: New York.
Wolter KM (1985). Introduction to Variance Estimation. Springer-Verlag: New York.
Recommend this journal

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

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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: 23
Total number of PDF views: 183 *
Loading metrics...

Abstract views

Total abstract views: 880 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th October 2017. This data will be updated every 24 hours.