Review of community prevalence of depression in later life.
01 Apr 1999-British Journal of Psychiatry (Royal College of Psychiatrists)-Vol. 174, Iss: 4, pp 307-311
TL;DR: A systematic review of community-based studies of the prevalence of depression in later life (55+) found consistent evidence for higher prevalence rates for women and among older people living under adverse socio-economic circumstances.
Abstract: BACKGROUND Despite considerable interest, there is no consensus regarding the prevalence of depression in later life.
AIMS To assess the prevalence of late-life depression in the community.
METHOD A systematic review of community-based studies of the prevalence of depression in later life (55+). Literature was analysed by level of caseness at which depression was defined and measured.
RESULTS Thirty-four studies eligible for inclusion were found. The reported prevalence rates vary enormously (0.4-35%). Arranged according to level of caseness, major depression is relatively rare among the elderly (weighted average prevalence 1.8%), minor depression is more common (weighted average prevalence 9.8%), while all depressive syndromes deemed clinically relevant yield an average prevalence of 13.5%. There is consistent evidence for higher prevalence rates for women and among older people living under adverse socio-economic circumstances.
CONCLUSIONS Depression is common in later life. Methodological differences between studies preclude firm conclusions about cross-cultural and geographical variation. Improving the comparability of epidemiological research constitutes an important step forward.
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TL;DR: The aim of this Review was to summarise the evidence regarding seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, mid life obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity.
Abstract: At present, about 33·9 million people worldwide have Alzheimer's disease (AD), and prevalence is expected to triple over the next 40 years. The aim of this Review was to summarise the evidence regarding seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity. Additionally, we projected the effect of risk factor reduction on AD prevalence by calculating population attributable risks (the percent of cases attributable to a given factor) and the number of AD cases that might be prevented by risk factor reductions of 10% and 25% worldwide and in the USA. Together, up to half of AD cases worldwide (17·2 million) and in the USA (2·9 million) are potentially attributable to these factors. A 10-25% reduction in all seven risk factors could potentially prevent as many as 1·1-3·0 million AD cases worldwide and 184,000-492,000 cases in the USA.
2,269 citations
TL;DR: The extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective is presented and the current therapies prescribed for depressed elders, ranging from medications to group therapy are presented.
Abstract: Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. In recent years, the literature on late-life depression has exploded. Many gaps in our understanding of the outcome of late-life depression have been filled. Intriguing findings have emerged regarding the etiology of late-onset depression. The number of studies documenting the evidence base for therapy has increased dramatically. Here, I first address case definition, and then I review the current community- and clinic-based epidemiological studies. Next I address the outcome of late-life depression, including morbidity and mortality studies. Then I present the extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective. Finally, I present evidence for the current therapies prescribed for depressed elders, ranging from medications to group therapy.
2,034 citations
Cites background or methods from "Review of community prevalence of d..."
...agonist in the living brain: PET study with [carbonyl-(11)C]WAY100635 in conscious monkeys....
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...ranging from 1% to 4% overall, with higher prevalence among women yet with no significant racial or ethnic differences (3,9,11,12)....
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TL;DR: A systematic review of all published nonexperimental studies (to June 2004) with prospective consecutive patient recruitment and quantification of depressive symptoms/illness after stroke was conducted in this article.
Abstract: Background and Purpose— Although depression is an important sequelae of stroke, there is uncertainty regarding its frequency and outcome Methods— We undertook a systematic review of all published nonexperimental studies (to June 2004) with prospective consecutive patient recruitment and quantification of depressive symptoms/illness after stroke Results— Data were available from 51 studies (reported in 96 publications) conducted between 1977 and 2002 Although frequencies varied considerably across studies, the pooled estimate was 33% (95% confidence interval, 29% to 36%) of all stroke survivors experiencing depression Differences in case mix and method of mood assessment could explain some of the variation in estimates across studies The data also suggest that depression resolves spontaneously within several months of onset in the majority of stroke survivors, with few receiving any specific antidepressant therapy or active management Conclusions— Depression is common among stroke patients, with the
1,315 citations
TL;DR: An update on prevalence and predictors of old age depression in populations of elderly Caucasians is offered to offer an update on practices to treat and prevent depression in older people.
Abstract: Objective: To offer an update on prevalence and predictors of old age depression in populations of elderly Caucasians.
Method: The databases MEDLINE and Psychinfo were searched and relevant literature from 1993 onwards was reviewed.
Results: The prevalence of major depression ranges from 0.9% to 9.4% in private households, from 14% to 42% in institutional living, and from 1% to 16% among elderly living in private households or in institutions; and clinically relevant depressive symptom ‘cases’ in similar settings vary between 7.2% and 49%. The main predictors of depressive disorders and depressive symptom cases are: female gender, somatic illness, cognitive impairment, functional impairment, lack or loss of close social contacts, and a history of depression.
Conclusion: Depression is frequent in populations of elderly. Methodological differences between the studies hinder consistent conclusions about geographical and cross-cultural variations in prevalence and predictors of depression. Improved comparability will provide a basis for consistent conclusions.
1,009 citations
Cites background or result from "Review of community prevalence of d..."
...This review also found consistent evidence of higher prevalence rates for women and people living under adverse socioeconomic circumstances (118)....
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...The prevalence of depressive disorders and depressive symptom cases of community and nursing home living elderly individuals included in this review (Tables 1 and 2) is in reasonable agreement with the corresponding figures of the reviews dating back to before 1993 (118, 119)....
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...Two comprehensive papers were selected among previous reviews to cover the period before 1993 (118, 119)....
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...A systematic review of community prevalence of late life depression dating back to 1956 (118) stated weighted average prevalences (range in parentheses): major depression 1....
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TL;DR: Depression increases the risk for cardiac mortality in subjects with and without cardiac disease at baseline, and the excess cardiac mortality risk was more than twice as high for major depression as for minor depression.
Abstract: Background Depression may be a potential risk factor for subsequent cardiac death. The impact of depression on cardiac mortality has been suggested to depend on cardiac disease status, and to be stronger among cardiac patients. This study examined and compared the effect of depression on cardiac mortality in community-dwelling persons with and without cardiac disease. Methods A cohort of 2847 men and women aged 55 to 85 years was evaluated for 4 years. Major depression was defined according to psychiatric DSM-III criteria. Minor depression was defined by Center for Epidemiologic Studies-Depression Scale scores of 16 or higher. Effects of minor and major depression on cardiac mortality were examined separately in 450 subjects with a diagnosis of cardiac disease and in 2397 subjects without cardiac disease after adjusting for demographics, smoking, alcohol use, blood pressure, body mass index, and comorbidity. Results Compared with nondepressed cardiac patients, the relative risk of subsequent cardiac mortality was 1.6 (95% confidence interval [CI], 1.0-2.7) for cardiac patients with minor depression and 3.0 (95% CI, 1.1-7.8) for cardiac patients with major depression, after adjustment for confounding variables. Among subjects without cardiac disease at baseline, similar increased cardiac mortality risks were found for minor depression (1.5 [95% CI, 0.9-2.6]) and major depression (3.9 [95% CI, 1.4-10.9]). Conclusion Depression increases the risk for cardiac mortality in subjects with and without cardiac disease at baseline. The excess cardiac mortality risk was more than twice as high for major depression as for minor depression.
938 citations
Cites result from "Review of community prevalence of d..."
...These prevalences are in line with other community-based studies.(36) Despite its high prevalence, depression often goes unrecognized....
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References
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TL;DR: In this article, a new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria.
Abstract: • A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).
4,884 citations
01 Jan 1989
TL;DR: Depressed patients tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions.
2,921 citations
"Review of community prevalence of d..." refers background in this paper
...It is associated with a decline in both well-being and daily functioning (Wells et al, 1989; Gurland, 1992; Ormel et al, 1994) and with higher risks of functional impairment, mortality and service utilisation (Gurland et al, 1983; Burvill & Hall, 1994; Beekman et al, 1997~)....
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TL;DR: For example, patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions.
Abstract: We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11 242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning. ( JAMA . 1989;262:914-919)
2,759 citations
TL;DR: The evidence for differing rates of depression between the sexes in the United States and elsewhere during the last 40 years is reviewed, and the various explanations offered are critically analyzed.
Abstract: • This article reviews the evidence for differing rates of depression between the sexes in the United States and elsewhere during the last 40 years, and then critically analyzes the various explanations offered. These explanations include the possibility that the trends are spurious because of artifacts produced by methods of reporting symptoms, or that they are real because of biological susceptibility (possibly genetic or female endocrine), psychosocial factors such as social discrimination, or female-learned helplessness.
1,811 citations
"Review of community prevalence of d..." refers background in this paper
...In an extensive review for all depressive syndromes in Hong Kong. by Weissman & Klerman (1977), the effect This variation may be attributed largely to of gender was explained in terms of methodology (report bias - women being more apt to report symptoms), psychopathology (women being more…...
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TL;DR: The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures and suggests the importance of impairments of higher-order human capacities as determinants of functional disability.
Abstract: Objective. —To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. Design. —A cross-sectional sample selected by two-stage sampling. Setting. —Primary health care facilities in 14 countries covering most major cultures and languages. Patients. —A total of 25916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). Main Outcome Measures. —Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. Results. —After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. Conclusions. —The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability. (JAMA. 1994;272:1741-1748)
859 citations
"Review of community prevalence of d..." refers background in this paper
...It is associated with a decline in both well-being and daily functioning (Wells et al, 1989; Gurland, 1992; Ormel et al, 1994) and with higher risks of functional impairment, mortality and service utilisation (Gurland et al, 1983; Burvill & Hall, 1994; Beekman et al, 1997~)....
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