The trajectory of negative mood and depressive symptoms over two decades
Introduction
The core feature of depressive disorder, and one of the two prerequisite symptoms to receive a formal diagnosis, is the presence of negative mood [1]. Research examining negative mood as a facet of personality has consistently shown a link between mood state and psychopathology [2], and negative mood has been shown to be a consistent risk factor for developing a Major Depressive Disorder (MDD) across the life-span [2], [3]. While most standardised assessments of depressive symptoms include a single item related to negative mood, examination of negative mood using a specific measure with several components specific to assessing affect provides a more comprehensive measure. An examination of the longitudinal characteristics of depressive symptoms, including a separate assessment of negative mood as an independent factor is lacking.
Studies specifically examining negative mood have shown that adults report a decline in negative mood as they age [4], [5]. In a longitudinal analysis exploring mood characteristics in both sexes, negative mood scores were found to decrease steadily to the age of 60, where they continued to decrease at a much slower rate [5]. Studies that have examined the incidence of depressive symptoms across the life span have provided inconclusive results, with some showing an increase across age groups and others a decrease [4], [6], [7], [8], [9], [10]. Cross-sectional studies generally report either a decline with age, or a curvilinear relationship with higher rates reported in old age or very old age [10], [11], [12]. When assessing depressive symptoms, standardised measures include a range of physiological and somatic symptoms in addition to negative mood [13], [14]. These measures can be impacted by cohort characteristics, such as age, or cultural background [14]. Measures used to assess younger adult populations may not be appropriate for older adults who are likely to be diagnosed with comorbid physical illness which may inflate scores of somatic items on depressive symptom scales [15], making the assessment of negative mood as an independent factor particularly important.
Prevalence rates of depression have consistently been demonstrated to be higher in women, with gender differences in lifetime prevalence for a female to male ratio ranging from 2:1 [16], [17] to 4:1 [18].This gender difference is consistently reported when considering hospital admissions, population studies, suicide attempts or the prescription of anti-depressant medication [19], [20]. Given the consistent finding of gender differences between men and women, a separate assessment of the characteristics of depressive symptoms in these populations is warranted.
In order to examine the temporal characteristics of negative mood and depressive symptoms over time, a longitudinal analysis comparing these factors in a cohort of female participants is needed. In the current analysis mood scores for women transitioning from mid-life to late-life were examined. It was hypothesised that both negative mood and depressive symptoms would reduce over time. The specific goals of the study were to 1) examine the course of negative mood across the twenty year span of the study and, 2) to compare depressive symptom prevalence across the latter ten years of the study.
Section snippets
Method
Data for this study was drawn from the Women’s Healthy Ageing Project, an ongoing, longitudinal epidemiological study examining women’s healthy ageing [21]. The study, which commenced in 1991 as the Melbourne Women’s Midlife Health Project, spans twenty years and examines biological, lifestyle and health factors. Measures specific to the assessment of depressive symptoms were introduced in 2002 and were readministered in 2004 and 2012. Analysis of baseline statistics for those who remained in
Negative mood from mid-life to late-life
At baseline 438 women participated, with 88% retention at eight year follow up and 58% (n = 252) retention in 2012. The 1992 baseline characteristics for the women who remained in the study, and provided data on the mood measures, were compared to those who had dropped out of the study by 2012. Those who continued to participate had no statistically significant differences between those who dropped out with regards to age, years of education, BMI, use of anti-depressant medication, number of
Discussion
To our knowledge this is the first study to include both depressive symptoms and a separate assessment of negative mood when considering changes of occurrence over time in a longitudinal sample with data spanning twenty years. The major finding of the present study was that negative mood score decreased significantly between mid-life and late-life. Similarly, depressive symptom scores also demonstrated a significant reduction in depressive symptoms across the ten years of the study, as women
Conclusion
In a sample of community dwelling Australian women negative mood significantly declined across twenty years, as women transitioned from mid-life (50 years) to late-life (70 years). Depressive symptoms also significantly reduced for women between the ages of 60 years and 70 years. When the mean age of the women was 60 years 22.6% reported mild or moderate symptoms of depression compared to 15.5% of women with an average age of 70 years.
Contributors
KEC participated in the study design, data collection and interpretation, and created the initial draft of the manuscript.
LD contributed to the study design and data collection, and was involved in revising the manuscript.
CES participated in the study design and data collection, and assisted in revising the manuscript.
MT contributed to the data analysis and was involved in revising the manuscript.
All authors saw and approved the final version.
Conflict of interest
KEC, LD and MT have no conflicts of interest.
CES has provided clinical consultancy and been on scientific advisory committees for the Australian Commonwealth Scientific and Industrial Research Organisation, Alzheimer's Australia, University of Melbourne and other relationships which are subject to confidentiality clauses. She has been a named Chief Investigator on investigator-driven collaborative research projects in partnership with Pfizer, Merck, Bayer and GE. She has been an investigator on
Funding
Funding for the Healthy Ageing Program (HAP) has been provided by the National Health and Medical Research Council (NHMRC Grants 547500, 1032350, 1062133), Ramaciotti Foundation, Australian Healthy Ageing Organisation, the Brain Foundation, the Alzheimer’s Association (NIA320312), Australian Menopausal Society, Bayer Healthcare, Shepherd Foundation, Scobie and Claire Mackinnon Foundation, Collier Trust Fund, J.O. & J.R. Wicking Trust, Mason Foundation and the Alzheimer’s Association of
Ethical approval
At each point of contact the study has been approved by the Human Research Ethics Committee of the University of Melbourne (1034765; 1339373). All procedures and ethical standards are in accordance with those outlined by the National Health and Medical Research Council. All women have provided informed written consent for each time point at which they have participated.
Provenance and peer review
This article has undergone peer review.
Acknowledgements
We would like to acknowledge the contribution of the participants and their supporters for their time and commitment for over 20 years to the University.
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