Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study

Nicolas Hoertel; Claire Jaffré; Rachel Pascal de Raykeer; Kibby McMahon; Sarah Barrière; Yvonne Blumenstock; Christophe Portefaix; Delphine Raucher-Chéné; Céline Béra-Potelle; Christine Cuervo-Lombard; Astrid Chevance; Christophe Guerin-Langlois; Cédric Lemogne; Guillaume Airagnes; Hugo Peyre; Arthur Kaladjian; Frédéric Limosin; CSA Study group.

doi:10.1016/j.jad.2019.03.007

Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study

J Affect Disord. 2019 May 15:251:60-70. doi: 10.1016/j.jad.2019.03.007. Epub 2019 Mar 6.

Authors

Nicolas Hoertel¹, Claire Jaffré², Rachel Pascal de Raykeer³, Kibby McMahon⁴, Sarah Barrière⁵, Yvonne Blumenstock², Christophe Portefaix⁶, Delphine Raucher-Chéné⁷, Céline Béra-Potelle⁵, Christine Cuervo-Lombard⁸, Astrid Chevance², Christophe Guerin-Langlois⁹, Cédric Lemogne¹⁰, Guillaume Airagnes¹¹, Hugo Peyre¹², Arthur Kaladjian⁷, Frédéric Limosin¹⁰; CSA Study group.

Affiliations

¹ AP-HP, Western Paris University Hospitals, Department of Psychiatry, Issy-les-Moulineaux 92130, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France. Electronic address: nico.hoertel@yahoo.fr.
² AP-HP, Western Paris University Hospitals, Department of Psychiatry, Issy-les-Moulineaux 92130, France.
³ AP-HP, Western Paris University Hospitals, Department of Psychiatry, Issy-les-Moulineaux 92130, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.
⁴ Department of Psychology & Neuroscience, Duke University, 2213 Elba Street, Durham, NC 27710, United States.
⁵ Department of Psychiatry, Robert Debré Hospital, Reims University Hospital, Reims, France.
⁶ Department of Medical Imaging, Maison Blanche Hospital, Reims University Hospital, Reims, France; CReSTIC Laboratory (EA 3804), University of Reims Champagne-Ardenne, Reims, France.
⁷ Department of Psychiatry, Robert Debré Hospital, Reims University Hospital, Reims, France; Cognition, Health and Socialization Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France.
⁸ Department of Psychiatry, Robert Debré Hospital, Reims University Hospital, Reims, France; Toulouse 2 Jean Jaurès University, Department of Psychology, CERPPS laboratory, Toulouse EA 7411, France.
⁹ AP-HP, Western Paris University Hospitals, Department of Psychiatry, Issy-les-Moulineaux 92130, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
¹⁰ AP-HP, Western Paris University Hospitals, Department of Psychiatry, Issy-les-Moulineaux 92130, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
¹¹ AP-HP, Western Paris University Hospitals, Department of Psychiatry, Issy-les-Moulineaux 92130, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, UMS 011, Population-based Epidemiological Cohorts, VIMA, Villejuif UMR 1168, France.
¹² Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France.

PMID: 30904777
DOI: 10.1016/j.jad.2019.03.007

Abstract

Background: Few studies have examined the prevalence and correlates of subsyndromal and syndromal depressive symptoms (SSSD) among older adults with schizophrenia spectrum disorder. In this report, we examined the prevalence of SSSD and their associations with sociodemographic characteristics, clinical characteristics of schizophrenia, comorbidity, psychotropic medications, quality of life, functioning and mental health care utilization in a large, multicenter sample of older adults with schizophrenia spectrum disorder.

Methods: Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of SSSD, defined using the Center of Epidemiologic Studies Depression (CESD) scale. Clinical characteristics associated with SSSD were explored.

Results: Among 343 older adults with schizophrenia spectrum disorder, 78.1% had either subsyndromal (30.6%) or syndromal (47.5%) depressive symptoms. SSSD were independently associated with positive and negative symptoms, lower quality of life, non-late-onset psychosis, benzodiazepine use and urbanicity. There were no significant associations of SSSD with other sociodemographic characteristics and psychotropic medications, or with general medical conditions. We found no significant differences in the proportion of participants who were treated with antidepressants between those with syndromal depressive symptoms and those without depression (22.1% vs. 20.0%, p = 0.89). SSSD were not associated with higher mental health care utilization.

Limitations: Data were cross-sectional and depression was not evaluated with a semi-structured interview.

Conclusion: SSSD may be highly prevalent and under-assessed and/or undertreated among older adults with schizophrenia spectrum disorder. Our findings should alert clinicians about the need to assess systematically and regularly depression in this vulnerable population.

Keywords: Antidepressants; Antipsychotic; Depression; Depressive symptoms; Elderly; Older; Prevalence; Risk factors; Schizophrenia; Treatment.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Antidepressive Agents / therapeutic use
Benzodiazepines / therapeutic use
Cohort Studies
Comorbidity
Cross-Sectional Studies
Depressive Disorder / drug therapy
Depressive Disorder / epidemiology*
Depressive Disorder / psychology
Female
Humans
Male
Middle Aged
Prevalence
Psychiatric Status Rating Scales
Psychotic Disorders / psychology
Quality of Life / psychology
Risk Factors
Schizophrenia / drug therapy
Schizophrenia / epidemiology*

Substances

Antidepressive Agents
Benzodiazepines