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The Cache County Study

David C. Steffens, MD; Ingmar Skoog, MD, PhD; Maria C. Norton, MS; Andrea D. Hart, MS; JoAnn T. Tschanz, PhD; Brenda L. Plassman, PhD; Bonita W. Wyse, PhD; Kathleen A. Welsh-Bohmer, PhD; John C. S. Breitner, MD, MPH

Arch Gen Psychiatry. 2000;57:601-607.

Background  Previous estimates of the prevalence of geriatric depression have varied. There are few large population-based studies; most of these focused on individuals younger than 80 years. No US studies have been published since the advent of the newer antidepressant agents.

Methods  In 1995 through 1996, as part of a large population study, we examined the current and lifetime prevalence of depressive disorders in 4559 nondemented individuals aged 65 to 100 years. This sample represented 90% of the elderly population of Cache County, Utah. Using a modified version of the Diagnostic Interview Schedule, we ascertained past and present DSM-IV major depression, dysthymia, and subclinical depressive disorders. Medication use was determined through a structured interview and a "medicine chest inventory."

Results  Point prevalence of major depression was estimated at 4.4% in women and 2.7% in men (P=.003). Other depressive syndromes were surprisingly uncommon (combined point prevalence, 1.6%). Among subjects with current major depression, 35.7% were taking an antidepressant (mostly selective serotonin reuptake inhibitors) and 27.4% a sedative/hypnotic. The current prevalence of major depression did not change appreciably with age. Estimated lifetime prevalence of major depression was 20.4% in women and 9.6% in men (P<.001), decreasing with age.

Conclusions  These estimates for prevalence of major depression are higher than those reported previously in North American studies. Treatment with antidepressants was more common than reported previously, but was still lacking in most individuals with major depression. The prevalence of subsyndromal depressive symptoms was low, possibly because of unusual characteristics of the population.

From the Department of Psychiatry and Behavioral Sciences (Drs Steffens, Plassman, Welsh-Bohmer, and Breitner), and the Joseph and Kathleen Bryan Alzheimer's Disease Research Center (Dr Welsh-Bohmer), Duke University Medical Center, Durham, NC; Institute of Clinical Neurosciences, Section of Psychiatry, Göteborg University, Göteborg, Sweden (Dr Skoog); the College of Family Life (Drs Tschanz and Wyse and Mss Norton and Hart) and Department of Psychology (Dr Tschanz and Ms Norton), Utah State University, Logan; and the Department of Mental Hygiene, Johns Hopkins University, Baltimore, Md (Dr Breitner).

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