Ian A. Davidson

Risk factors for depression in elderly people: a prospective study

In 1982‐1983 a random sample of 1486 people aged 65 years and above was generated from general practitioner lists; 1070 were interviewed in the community using the Geriatric Mental State and a Social History questionnaire. The cohort was followed up by interview 3 years later. At year 3 the diagnostic computer program AGECAT diagnosed 44 incident cases of depression. Information from the depressed groups initial and further interviews was compared with a control group (which excluded cases of affective or organic mental illness). Univariate analysis yielded three factors that were significantly associated with the development of depression 3 years later: a lack of satisfaction with life; feelings of loneliness; and smoking. Multivariate analysis confirmed their independent effects and revealed 2 further factors attaining significance: female gender and a trigger factor, bereavement of a close figure within 6 months of the third‐year diagnosis. Some other factors traditionally associated with depression, such as poor housing, marital status and living alone, failed to attain significance as risk factors.

Outcome of the depressed elderly living in the community in Liverpool: a 5-year follow-up

BACKGROUND Comparatively little is known about the long-term natural history of depressive disorders in the elderly living in the community. This is a follow-up of a subsample of the Continuing Health in the Community study random sample of the elderly population living in Liverpool. METHODS The investigators followed up 120 cases of depression identified by a semi-structured interview schedule (GMS) for a period of 5 years. A similar number of other subjects defined as subcases of depression, other cases of mental illness and a random selection of non-cases were also included. RESULTS The 5-year outcome for the cases of depression was worse than the outcome of the non-cases (relative mortality risk of 2.1, 95% confidence interval 1.1 to 3.9). Thirty-four per cent of the cases of depression died and 28% had dropped out during the follow-up. Of the 46 cases of depression who had a complete follow-up, 22% recovered from their symptoms, 30% were found to be AGECAT cases at one of the three follow-up waves, 24% were AGECAT cases at two of the three follow-up waves and the remaining 24% were AGECAT cases at each follow-up wave. Fifteen per cent of the surviving cases of depression were organic cases at the follow-up. Their anxiety comorbid state and depression score were identified as predictors of poor outcome. CONCLUSION The findings of this study indicate that depressive disorders (most of which were untreated) found in the elderly community have a poor prognosis.

Geriatric Mental State-AGECAT: Prevalence, Incidence and Long-Term Outcome of Dementia and Organic Disorders in the Liverpool Study of Continuing Health in the Community

The GMS-AGECAT package was used in the initial assessment and 3-year follow-up of a random sample of 1,070 elderly people living in the community. A prevalence of 4.3% is found for dementia after confirmation of diagnoses by outcome at year 3. The overall incidence of dementia was 9.2/1,000 per year after partial adjustments for outcome of year 6. Incidence per year for sub-types of dementia were AD 6.3/1,000, vascular 1.9/1,000, and alcohol-related 1.0/1,000.