Differentiating Depression and Anxiety from Physical Health Problems

Self-report inventories of depression typically include many somatic complaints, such as fatigue, headaches, back and neck pain, constipation, and sleep distur

Assessment of Mental Health in Older Adults bances. While in younger individuals these types of complaints may be indicative of depression, such symptoms are very common among the elderly. Thus, this inclusion of physical health symptoms in psychological assessment instruments may lead to Type I errors. On the other hand, there is some indication that depression in the elderly may be presented in terms of physical symptoms, and a relatively high proportion of medical visits to general practitioners by the elderly may be due to depression manifesting in physical complaints. Thus, screening for recent life events and/or changes in living conditions (see below) may be an important way for clinicians to determine whether bereavement or social isolation may be important factors underlying such visits.

On the other hand, many illnesses common to the elderly, as well as prescribed medications, may have concomitant symptoms of depression and anxiety. For example, elders are at increased risk for hypothyroid-ism, cardiovascular disease, and chronic obstructive pulmonary disorder, which may cause fatigue, sleep disturbances, and negative affect. Other disorders, such as myocardial infarctions, vitamin deficiencies, anemia, pneumonia, and hyper- and hypothyroidism, may present with symptoms of anxiety. Further, many medications commonly prescribed in the elderly, such as antihypertensives, may also create symptoms of depression. Thus, physical, mental, and social health are often tightly intertwined in the elderly, and multi-pronged assessment techniques may be necessary to adequately establish the etiology of symptoms of depression and anxiety in the elderly.

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