Gender, Depressive Symptoms, Chronic Medical Conditions, and Time to First Psychiatric Diagnosis among American Older Adults

Abstract

Background: To test whether gender moderates the effects of baseline depressive symptoms and
chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among
older adults.

Methods: Data came from ten waves of the Health and Retirement Study, a nationally
representative longitudinal study. We followed 9794 individuals older than 52 years without any
diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and
CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline
demographics and socioeconomics were controls, and gender was the moderator. We used Cox
proportional hazards models for data analysis.

Results: In the pooled sample, female gender
increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence
interval [CI], 1.26–2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63–0.97)
on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36;
95% CI, 1.87–2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69–0.95) decreased time
to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI,
1.21–1.83) but not CMC (HR, 1.06; 95% CI, 0.91–1.23) were associated with time to receiving a
psychiatric diagnosis over time.

Conclusions: Men and women differ in how depressive symptoms
and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms
are more salient promotor for men than women while CMC is only a barrier for men.

Keywords: Chronic medical conditions, depressive symptoms, gender