How depression and mortality are associated in older community-dwelling populations has yet to be discovered. This study established the role of both major and minor depression in mortality and assessed the function of confounding and explanatory variables in the relationship. A cohort of 3056 Dutch men and women aged 55 to 85 years were followed for 4 years. DSM-III criteria were used to define major depression according to the Diagnostic Interview Schedule. Minor depression was defined as clinically relevant (a Center for Epidemiologie Studies Depression score of ≥ 16) without fulfilling diagnostic criteria for major depression. After accounting for sociodemographic and health status confounders, men with major depression had a risk of death that was 1.80 times higher (95% CI, 1.35 to 2.39) than that in nondepressed men during follow-up. The risk of mortality was not significantly increased in women with minor depression. Gender did not affect the higher association of major depression with mortality risk (95% CI, 1.09 to 3.10) when sociodemographics and health status had been adjusted for. The extra risk of mortality associated with depression was accounted for only in small part by health behviors such as smoking and physical inactivity. Minor depression in older men and major depression in both older men and women increase the risk of dying even after sociodemographics, health status, and health behaviors have been taken into account.

Minor and major depression and the risk of death in older persons

Background

Depression in late life is common and has serious consequences on function, medical co-morbidity, quality of life, and use of medical services.



Objective

To estimate the age- and gender-specific prevalence of depression among people over 60 years of age, and to examine correlates of depression, in particular the relationship between depression and cognitive impairment.



Method

From a total of 965 inhabitants, aged over 60 years, in Velestino, a rural town in central Greece, 608 were accessible and constituted the target population. During a five-month period in 2000, a trained health visitor interviewed all study participants. The interview covered socio-demographic characteristics, medical history, and administration of the 15-question Geriatric Depression Scale (GDS-15) and the Mini Mental Scale Examination instrument (MMSE).



Results

The prevalence of mild or more severe depression (GDS≥7) was 27%, while the prevalence of moderate to severe depression (GDS≥11) was 12%. Increasing age, female gender, lower education, and being currently unmarried were associated with higher risk of depression in univariate regression models, but these associations disappeared after controlling for cognitive function, except for the association with marital status. Cognitive impairment was strongly associated with increased risk for depression. The co-morbid presence of digestive, neurological and heart conditions was also associated with increased risk for depression, while cancer was not.



Conclusion

In a rural Greek area, the prevalence of depression in late life is high. Depression was more common among unmarried individuals, those with significant cognitive impairment, and in association with specific medical conditions. Copyright © 2005 John Wiley & Sons, Ltd.

Prevalence and correlates of depression in late life: a population based study from a rural Greek town.

Objective: To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care. Methods: A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up. Results: At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%). Conclusions: Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.

Outcome and impact of mental disorders in primary care at 5 years.

Dietary lipids and geriatric depression scale score among elders: the EPIC-Greece cohort.

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.

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The roles of social support and self-efficacy in physical health's impact on depressive and anxiety symptoms in older adults.

The general public heavily underrecognizes depression and depressive symptoms. This underrecognition is more pronounced among elderly people, and this study is an initial attempt to quantify the problem in a Greek elderly sample. Additionally the authors attempt to identify patient-related factors, which can assist a subject to recognize the depressive symptoms and the general practitioner to note their existence. Members of senior citizen centers (n = 682) participated in presentations about “depression in the elderly” and completed a questionnaire including the GDS-4 scale, four questions concerning depression risk factors and a question concerning a recent visit to a physician for depressive symptoms. Amongst those participating, 35.8% presented depressive symptoms (GDS-4 ≥ 2). The calculated rate for recognition of depression in the studied population was very low (17.3%). Patients with depressive symptoms were more often females and had a higher proportion of past history of depression and a lack of social support. Patients with a past history of depression and more severe forms of illness consulted a doctor more frequently. Finally, subjects suffering from depressive symptoms and comorbid medical illness were characterized by a higher proportion of past history, lack of support, and existence of multiple risk factors. The authors propose that the inclusion in public campaigns of activities with an experiential dimension, e.g., patient videos and the use of a very simple screening tool, such as the GDS-4 scale by general practitioners (GP), could be helpful in improving the recognition of depressive symptoms by the patient and his/her relatives and its diagnosis by the doctor. This proposition awaits formal proof in future studies. Depression and Anxiety 15:111–116, 2002. © 2002 Wiley-Liss, Inc.

Efi Rogakou

Papers

Recognition of depressive symptoms in the elderly: What can help the patient and the doctor