Picture this experiment: A group of older adults living independently, most in their 70s and most female, are handed a couple of paragraphs to read. "You are 70," the first line says.
From there, the story heads in one of two directions. "You have been feeling unusually sad for the last few weeks," half of the study subjects read. But the others read this: "You don't seem to be able to enjoy things that you used to, like watching TV and reading the newspaper."
Both sets of paragraphs go on to describe additional and identical problems: trouble sleeping, feeling tired, losing appetite and weight, a lack of concentration. Neighbors have noticed a change.
When the participants finish reading, an interviewer asks them, "What would you say is wrong, if anything, with the person in the story?"
Fewer than half the participants correctly identified this unhappy 70-year-old as suffering from depression, reports a new study in The Journal of Applied Gerontology. That's not encouraging — perceiving the problem, of course, is an important factor in seeking or accepting help.
What's particularly interesting is that the study subjects were more apt to see this fictional person as depressed if he or she were said to suffer the most classic symptom: sadness. "If the person was sad, almost half the respondents knew that the person was depressed," said Amber Gum, a University of South Florida psychologist and the study's lead author. When the story instead referred only to a lack of interest in formerly pleasurable activities, only about a third of the participants described the 70-year-old as depressed.
"I've had older clients say, 'I'm not depressed — I'm not sad and crying all the time,' " Dr. Gum told me in an interview. But depression in old people can take an unusual form. Though depression with sadness (in psych-speak, dysphoria) remains the most common type, seniors are more likely than younger adults to suffer depression marked by loss of interest, also called anhedonia.
Because this form of depression is a bit unusual, even professionals may not recognize it in older people, Dr. Gum said. "If someone comes in and says, 'I'm sad,' you start thinking about depression. If someone says, 'I just don't feel like myself,' it's less obvious."
Two factors bolstered an older person's accuracy in spotting depression, the study revealed. Participants who had some earlier experience with mental health problems, affecting themselves or relatives or close friends, were more apt to grasp that weepy sadness is not the only criterion. And people with higher expectations for aging — those less likely, for instance, to see depression as normal in older people — also did better.
Still, fewer than half the total sample of 244 people, when asked what the hypothetical 70-year-old should do, suggested that he or she see a doctor or a mental health professional.
A pity. Aging will bring some conditions for which the medical and mental health pros can offer only limited options (dementia comes to mind). But depression isn't among them. Old people respond to the standard treatments — talk therapy and antidepressants — in roughly the same proportion as younger ones.
When they don't seek help, we tend to blame elders' unfamiliarity with psychotherapy, or the lack of mental health services in some areas, or the lingering stigma associated with "shrinks." We could also note, I suppose, that most people who just don't feel like themselves will turn first to their family doctors, who may not have much mental health training.
But what Dr. Gum and colleagues have pointed out is that depressed older people may not merely be stubborn or afraid. If they don't recognize the variety of symptoms, they may not see themselves as depressed at all. Public health educators, senior service directors and caregivers, take note.
