The Variability of Depression in Old Age

Narrative as an Integrative Construct
  • Keith G. Meador
  • Dan G. Blazer
Chapter
Part of the The Springer Series in Adult Development and Aging book series (SSAD)

Abstract

Although there have been attempts throughout the ages to understand, describe, and treat depression (Jackson, 1986), the word depression continues to be used variably according to context and the predisposing biases of the speaker. Our discussion in this chapter embodies a fluid understanding of depression. Inherent to our constructive position is an appreciation for the heterogeneity of depressive disorders in the elderly. While acknowledging the considerable strides made during the last 20 years in delineating major depression using the categorical methods of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) and subsequent editions of the DSM, we suggest limits to that framework for the optimal understanding of the vicissitudes of depression in old age. We propose that an optimal understanding of depression in general, but particularly in the elderly, requires a biopsychosocial formulation that is derived and interpreted in the context of a particular, contextually and historically contingent, narrative.

Keywords

Depressive Symptom Late Life Mental Health Practitioner Subsequent Edition Hopelessness Depression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington DC: Author.Google Scholar
  2. Andersson, L., & Stevens, N. (1993). Associations between early experiences with parents and well-being in old age. Journal of Gerontology: Psychological Sciences, 48, P109–P116.Google Scholar
  3. Baltes, P. B., & Staudinger, U. M. (1993). The search for a psychology of wisdom. Current Directions in Psychological Science, 2, 75–80.CrossRefGoogle Scholar
  4. Beekman, A. T. F., Kriegsman D. M. W., Deeg, D. J. H., & Van Tilburg, W. (1995). The association of physical health and depressive symptoms in the older population: Age and sex differences. Social Psychiatry Psychiatric Epidemiology, 30, 32–38.CrossRefGoogle Scholar
  5. Blazer, D. G., & Williams, C. D. (1980). Epidemiology of depression and dysphoria in an elderly population. American Journal of Psychiatry, 137, 439–443.PubMedGoogle Scholar
  6. Blazer, D. G. (1993). Depression in late life. (2nd ed). St. Louis: Mosby.Google Scholar
  7. Bowlby, J. (1979). The making and breaking of affectional bonds. London: Tavistock.Google Scholar
  8. Broadhead, W. E., Blazer, D. G., George, L. K., & Tse, C. K. (1990).Depression, disability days and days lost from work in a prospective epidemiologic survey. Journal of the American Medical Association, 264, 2524–2528.PubMedCrossRefGoogle Scholar
  9. Brown, G. W, & Harris, T. O. (1978). Social origins of depression. London: Tavistock.Google Scholar
  10. Calasanti, T. M. (1996). Incorporating diversity: Meaning, levels of research, and implications for theory. Gerontologist, 36, 147–156.PubMedCrossRefGoogle Scholar
  11. Callahan C. M., & Wolinsky, F. D. (1994). The effect of gender and race on the measurement properties of the CES-D in older adults. Medical Care, 32, 341–356.PubMedCrossRefGoogle Scholar
  12. Caserta. M. S., & Lund D. A. (1993). Intrapersonal resources and the effectiveness of self-help groups for bereaved older adults. Gerontologist, 33, 619–629.PubMedCrossRefGoogle Scholar
  13. De Leon C.F., Kasl, S. V., & Jacobs, S. (1994). A prospective study of widowhood and changes in symptoms of depression in a community sample of the elderly. Psychological Medicine, 24, 613–624.CrossRefGoogle Scholar
  14. De Vellis, B. M., & Blalock, S. J. (1992). Illness attributions and hopelessness depression: The role of hopelessness expectancy. Journal of Abnormal Psychology, 101, 257–264.CrossRefGoogle Scholar
  15. Erikson E. H., Erikson, J. M., & Kivnick H. Q. (1986). Vital involvement in old age. New York: Norton.Google Scholar
  16. Finch, J. F., & Zautra A. U. J. (1992). Testing latent longitudinal models of social ties and depression among the elderly: A comparison of distribution-free and maximum likelihood estimates with nonnormal data. Psychology and Aging, 7, 107–118.PubMedCrossRefGoogle Scholar
  17. Frank, A. W. (1995). The wounded storyteller. Chicago: University of Chicago Press.CrossRefGoogle Scholar
  18. Frankl, V. (1965). The doctor and the soul. New York: Knopf.Google Scholar
  19. Gallo, J. J., Anthony, J. C., & Muthen, B. O. (1994). Age differences in the symptoms of depression: A latent trait analysis. Journal of Gerontology: Psychological Sciences, 49, P251–P264.Google Scholar
  20. George, L. K. (1996). Missing links: The case for a social psychology of the life course. Gerontologist, 36, 248–255.PubMedCrossRefGoogle Scholar
  21. Gurland, B. J., Copeland, J., & Curiawsky, J. (1983). The mind and mood of aging. New York: Haworth Press.Google Scholar
  22. Hauerwas, S., & Burrell, D. (1970). From system to story: An alternative pattern for rationality in ethics. In S. Hauerwas, (Ed.), Truthfulness and tragedy (pp. 15–39). Notre Dame, IN: University of Notre Dame Press.Google Scholar
  23. Hayslip G., Galt, C. P., Lopez F. G., Nation P. C. (1994). Irrational beliefs and depressive symptoms among younger and older adults: A cross-sectional comparison. International Journal of Aging and Human Development, 38, 307–326.PubMedCrossRefGoogle Scholar
  24. Heithoff, K. (1995). Does the ECA underestimate the prevalence of late life depression?. Journal of the American Geriatrics Society, 43, 2–6.PubMedGoogle Scholar
  25. Horwath, E. W, Johnson, J., Klerman, G. L., & Weissman, M. M. (1992). Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry, 49, 817–823.PubMedCrossRefGoogle Scholar
  26. Horwath, E. W., Johnson, J., Klerman, G. L., & Weissman, M. M. (1994). What are the public health implications of subclinical depressive symptoms?. Psychiatric Quarterly, 65, 323–337.PubMedCrossRefGoogle Scholar
  27. Hunter, K. M. (1991). Doctor’s stories: The narrative structure of medical knowledge. Princeton, NJ: Princeton University Press.Google Scholar
  28. Jackson, S. (1986). Melancholia and depression: From Hippocratic times to modern times. New Haven, CT: Yale University Press.Google Scholar
  29. Jones-Webb, R. J., & Snowden, L. R. (1993). Symptoms of depression among blacks and whites. American Journal of Public Health, 83, 240–244.PubMedCrossRefGoogle Scholar
  30. Judd L. L., Rapaport, M. D., Paulus, M. P., & Brown, J. L. (1994). Subsyndromal symptomatic depression: A new mood disorder?. Journal of Clinical Psychiatry, 55, 18–28.PubMedGoogle Scholar
  31. Kendler, K. S., Walters E. E., Truett, K. R., Heath, A. C., Neale, M. C., Martin, N. G., & Eaves, L. J. (1994). Sources of individual differences in depressive symptoms: Analysis of two samples of twins and their families. American Journal of Psychiatry, 151, 1605–1614.PubMedGoogle Scholar
  32. Koenig, H. G., Meador, K. G., Goli, V., Shelp, F., Cohen, H. J., & Blazer D. G. (1992). Self-rated depressive symptoms in medical patients: Age and racial differences. International Journal Psychiatry in Medicine, 22, 11–31.CrossRefGoogle Scholar
  33. Krause, N. (1995). Stress, alcohol use, and depressive symptoms in later life. Gerontologist, 35, 296–307.PubMedCrossRefGoogle Scholar
  34. Krause, N., Herzog, A. R., & Baker, E. (1992). Providing support to others and well-being in later life. Journal of Gerontology: Psychological Sciences, 47, 300–311.Google Scholar
  35. Krishnan, K. R. R., & McDonald, W. M. (1993). Ateriosclerotic depression. Medical Hypotheses, 44, 111–115.CrossRefGoogle Scholar
  36. Krishnan, K. R. R., Hays, J. C., Tupler, L. A., George, L. K., & Blazer, D. G. (1995). Clinical and phenomenological comparisons of late-onset and early-onset depression. American Journal of Psychiatry, 152, 785–789.PubMedGoogle Scholar
  37. Labouvie-Vief, G., Chiodo, L. M., Goguen L. A., Diehl, M., & Orwoll, L. (1995). Representations of Self across the life span. Psychology and Aging, 10, 404–415.PubMedCrossRefGoogle Scholar
  38. Light, J. M., Grigsby, J. S., & Bligh, M. C. (1996). Aging and heterogeniety: Genetics, social structure and personality. Gerontologist, 36, 165–173.PubMedCrossRefGoogle Scholar
  39. Limentani, A. (1995). Creativity and the Third Age. International Journal of Psycho-Analysis, 76, 825–833.PubMedGoogle Scholar
  40. Lyness, J. M., Cox, C., Curry, J., Conwell, Y., King, D. A., & Caine, E. D. (1995). Older age and underreporting of depressive symptoms. Journal of the American Geriatrics Society, 43, 216–221.PubMedGoogle Scholar
  41. MacIntyre, A. (1977). Epistemological crisis, dramatic narrative, and the philosophy of science. Monist, 60, 453–472.CrossRefGoogle Scholar
  42. MacIntyre, A. (1981). After virtue, Notre Dame, IN: University of Notre Dame Press.Google Scholar
  43. Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33, 187–205.PubMedCrossRefGoogle Scholar
  44. Oxman, T. E., Berkman, L. R, Kasl, S., Freeman, D. H., & Barrett, J. (1992). Social support and depressive symptoms in the elderly. American Journal of Epidemiology, 135, 356–368.PubMedGoogle Scholar
  45. Parmelee, P. A., Katz, I. R., & Lawton, M. P. (1992). Incidence of depression in long-term care settings. Journal of Geriatrics: Medical Sciences, 47, M189–M196.Google Scholar
  46. Pearlin, L. I., & Skaff, M. M. (1996). Stress and the life course: A paradigmatic alliance. Gerontologist, 36, 239–247.PubMedCrossRefGoogle Scholar
  47. Reichman, W. E., & Coyne A. C. (1994). Depressive symptoms in Alzheimer’s disease and multi-infarct dementia. Journal of Geriatric Psychiatry and Neurology, 8, 96–99.Google Scholar
  48. Reynolds, C. F., Hoch, C. C., Buysse, D. J., Houck, P. R., Schlernitzauer, M., Frank, E., Mazumdar, S., & Kupfer, D. J. (1992). Electroencephalographic sleep in spousal bereavement and bereavement-related depression of late life. Biological Psychiatry, 31, 69–82.PubMedCrossRefGoogle Scholar
  49. Robins, L. N., Heizer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institutes of Mental Health Diagnostic Interview Schedule: History, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.PubMedCrossRefGoogle Scholar
  50. Robins, L. N., & Regier, D. A. (1990). Psychiatric disorders in America. New York: Free Press.Google Scholar
  51. Rovner, B. W. (1993). Depression and increased risk of morality in the nursing home patient. American Journal of Medicine, 94(5A), 195–225.Google Scholar
  52. Santor, D. A., & Zuroff, D. C. (1994). Depressive symptoms: Effects of negative affectivity and failing to accept the past. Journal of Personality Assessment, 63, 294–312.PubMedCrossRefGoogle Scholar
  53. Schank, R. C. (1990). Tell me a story: A new look at real and artificial memory. New York: Scribner’s.Google Scholar
  54. Wells, K. B., Stewart A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., Berry, S., Greenfield, S., & Ware, J. (1989). The functioning and well-being of depressed patients. Journal of the American Medical Association, 262(7), 914–919.PubMedCrossRefGoogle Scholar
  55. Williamson, G. W, & Schulz, R. (1992). Physical illness and symptoms of depression among elderly outpatients. Psychology and Aging, 3, 343–351.CrossRefGoogle Scholar
  56. Yalom, I. (1980). Existential psychotherapy. New York: Basic Books.Google Scholar
  57. Zisook S., Shuchter, S. R., Sledge, P., & Mulvihill M. (1993). Aging and bereavement. Journal of Geriatric Psychiatry and Neurology, 6, 137–143.PubMedGoogle Scholar
  58. Zung, W. W. K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63–70.PubMedCrossRefGoogle Scholar
  59. Zung, W. W. K., Broadhead, W. E., & Roth M. E. (1993). Prevalence of depressive symptoms in primary care. Journal of Family Practice, 37, 337–344.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Keith G. Meador
    • 1
  • Dan G. Blazer
    • 1
  1. 1.School of Medicine and Divinity SchoolDuke UniversityDurhamUSA

Personalised recommendations