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Peer-reviewedCC BY 4.0Alpha Psychiatry

Prevalence and Influencing Factors of Comorbid Major Depressive Disorder in Elderly Schizophrenia: A Multicenter Cross-Sectional Study

  • Peng Cui1
  • Guoshuai Luo1
  • Xiangyang Zhang1,2
  1. 1Institute of Mental Health, Tianjin Anding Hospital, Psychiatric Medical Center of Tianjin University, Mental Health Center of Tianjin Medical University, 300222 Tianjin, China
  2. 2Hefei Fourth People’s Hospital, Anhui Mental Health Center, Affiliated Mental Health Center, Anhui Medical University, 230022 Hefei, Anhui, China
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Abstract

Background:: This multicenter cross-sectional study aimed to determine the prevalence, clinical correlates, and determinants of comorbid major depressive disorder (MDD) in elderly patients with schizophrenia (SZ), addressing a critical gap in understanding late-life dual diagnosis.

Methods:: We recruited 274 elderly SZ patients (≥60 years) from nine psychiatric centers across China. Diagnoses of schizophrenia and concurrent MDD were confirmed using the Structured Clinical Interview for DSM-5 (SCID-5). Depressive severity was assessed with the Hamilton Depression Rating Scale (HAMD-17), and psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS). Multivariate analyses (binary/ordinal logistic regression, partial correlations), adjusted for age, sex, education, and antipsychotic dosage (chlorpromazine equivalents), identified factors associated with MDD comorbidity and severity.

Results:: The prevalence of comorbid MDD was 29.2% (80/274). PANSS General Psychopathology subscale scores (odds ratio [OR] = 1.064, 95% confidence interval [CI]: 1.013–1.118, p = 0.012) and PANSS Total Score (OR = 1.062, 95% CI: 1.008–1.152, p = 0.002) were significantly associated with MDD comorbidity. HAMD-17 scores exhibited strong positive correlations with PANSS General Psychopathology (r = 0.402, p < 0.001) and PANSS Total Score (r = 0.310, p < 0.001) after adjustment for covariates. No significant association was found between HAMD-17 and the PANSS Negative subscale (r = 0.606, p > 0.05).

Conclusions:: In this multicenter sample of elderly Chinese inpatients with schizophrenia, nearly one-third of participants had comorbid MDD. The robust association between overall psychopathology severity, as measured by the PANSS Total Score and General Psychopathology subscale, and comorbid MDD supports the presence of transdiagnostic mechanisms in late-life schizophrenia. PANSS assessment, particularly the General Psychopathology subscale, may serve as a clinically informative adjunct to routine evaluation for identifying elderly patients with schizophrenia who are at increased risk of comorbid depression. However, its modest discriminative performance (area under the curve [AUC] ≈ 0.60) precludes its use as a standalone screening tool.

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Cite

BibTeXRIS
BibTeX
@article{cui2026prevalence,
  title = {{Prevalence and Influencing Factors of Comorbid Major Depressive Disorder in Elderly Schizophrenia: A Multicenter Cross-Sectional Study}},
  author = {Peng Cui and Guoshuai Luo and Xiangyang Zhang},
  journal = {Alpha Psychiatry},
  year = {2026},
  month = sep,
  doi = {10.31083/ap52709},
  url = {https://doi.org/10.31083/ap52709},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Prevalence and Influencing Factors of Comorbid Major Depressive Disorder in Elderly Schizophrenia: A Multicenter Cross-Sectional Study
AU  - Peng Cui
AU  - Guoshuai Luo
AU  - Xiangyang Zhang
PY  - 2026
DA  - 2026/09/07
JO  - Alpha Psychiatry
DO  - 10.31083/ap52709
UR  - https://doi.org/10.31083/ap52709
AB  - Background:: This multicenter cross-sectional study aimed to determine the prevalence, clinical correlates, and determinants of comorbid major depressive disorder (MDD) in elderly patients with schizophrenia (SZ), addressing a critical gap in understanding late-life dual diagnosis.  Methods:: We recruited 274 elderly SZ patients (≥60 years) from nine psychiatric centers across China. Diagnoses of schizophrenia and concurrent MDD were confirmed using the Structured Clinical Interview for DSM-5 (SCID-5). Depressive severity was assessed with the Hamilton Depression Rating Scale (HAMD-17), and psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS). Multivariate analyses (binary/ordinal logistic regression, partial correlations), adjusted for age, sex, education, and antipsychotic dosage (chlorpromazine equivalents), identified factors associated with MDD comorbidity and severity.  Results:: The prevalence of comorbid MDD was 29.2% (80/274). PANSS General Psychopathology subscale scores (odds ratio [OR] = 1.064, 95% confidence interval [CI]: 1.013–1.118, p = 0.012) and PANSS Total Score (OR = 1.062, 95% CI: 1.008–1.152, p = 0.002) were significantly associated with MDD comorbidity. HAMD-17 scores exhibited strong positive correlations with PANSS General Psychopathology (r = 0.402, p < 0.001) and PANSS Total Score (r = 0.310, p < 0.001) after adjustment for covariates. No significant association was found between HAMD-17 and the PANSS Negative subscale (r = 0.606, p > 0.05).  Conclusions:: In this multicenter sample of elderly Chinese inpatients with schizophrenia, nearly one-third of participants had comorbid MDD. The robust association between overall psychopathology severity, as measured by the PANSS Total Score and General Psychopathology subscale, and comorbid MDD supports the presence of transdiagnostic mechanisms in late-life schizophrenia. PANSS assessment, particularly the General Psychopathology subscale, may serve as a clinically informative adjunct to routine evaluation for identifying elderly patients with schizophrenia who are at increased risk of comorbid depression. However, its modest discriminative performance (area under the curve [AUC] ≈ 0.60) precludes its use as a standalone screening tool.
SN  - 2757-8038
ER  -