Mind Matters - April 2007
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

Depression Kills
by Ron Sterling, M.D. -- April 2007

    Dear Dr. Ron:

      I read a very recent article about depression among older adults in the United Kingdom. It reported a study that showed that depression was tragically under-diagnosed by 17 percent. Many of that 17 percent died within two years of leaving the hospital where the study took place. Is this also true in the United States? What can be done about it? Signed: Concerned About Depression.

    Dear Concerned:

      Thank you for writing! I have read the original research article which was published in the International Journal of Geriatric Psychiatry in February 2007 -- "Survival in the community of the very old depressed, discharged from medical inpatient care." I am thankful that the results were widely publicized because, although the alarm bells have been ringing for quite some time, not many people have woken up. Hopefully, this study will help get our eyes wide open.

      However, the study was not so much about the under-diagnosis of depression as it was to discover the rate of post-hospitalization depression and whether it was a risk factor. The researchers were trying to find out if depression, by itself, could cause increased readmissions to the hospital, increased further illnesses, or increased death rates.

      The data that was collected included demographic details (race, gender, age, etc.), handicaps, pain levels, forced expiratory volume (breathing) and social network. These are potential risk factors associated in some earlier studies with poorer post-hospitalization survival statistics. It was found that the prevalence of depression in the 311 research participants was 17.4 percent. It was found that depression was the only baseline variable that was associated with reduced survival in the community.

      This is very dramatic evidence that mind (brain) often trumps other physical matters in post-hospitalization outcomes. That is why this article is entitled "Depression Kills." Most of us know that depression often kills by leading to suicidal behavior. Now it is clear from this and many other studies that depression kills in other ways by shortening people's lives.

      You asked if depression in older adults in the United States is under-diagnosed and, if so, what can be done about it? Professor Ken Wilson, one of the author's of the 2007 UK study has stated "depression is often undiagnosed and both patients and doctors confuse it with other illnesses or general signs of aging." The same is true in the United States. Many studies have confirmed that depression among all populations in the United States is under-diagnosed, but especially in older adults. I don't report this just because I am a psychiatrist. I report this because the studies are clear.

      Answering your question "What can be done about it?" will require a much longer discussion than I can offer in this short column. To answer that question, you have to ask, "why is depression under-diagnosed?" Some of the reasons for under-diagnosis are (1) the myth that depression is a normal part of aging (it is not!); (2) the relative lack of mental health care due to "cost-cutting" efforts of hospitals and insurance providers; and, (3) a huge misplaced burden of diagnosis and treatment -- primary care physicians are the sole contact for more than 50% of patients with diagnosable mental conditions and clinical depression is 2 to 3 times more prevalent in primary care patients than in the overall population.

      For now, what can be done about doing a better job of diagnosing depression is primarily a consumer burden, since it is not likely that health care systems will change rapidly in the near future to provide better mental health care. Families and friends must be diligent in learning about the symptoms of depression and about getting their loved ones the follow-up and help they need and deserve. In my opinion, over-concern about a life-threatening illness is preferable to under-concern.

      Please visit All About Depression web page to get more information about depression. I hope that helps. -- Best wishes, Dr. Ron.

        Author Bio:

        Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement

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