W. van Tilburg

Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subject in the Netherlands

The Center for Epidemiologic Studies Depression scale (CES-D) has been widely used in studies of late-life depression. Psychometric properties are generally favourable, but data on the criterion validity of the CES-D in elderly community-based samples are lacking. In a sample of older (55-85 years) inhabitants of the Netherlands, 487 subjects were selected to study criterion validity of the CES-D. Using the 1-month prevalence of major depression derived from the Diagnostic Interview Schedule (DIS) as criterion, the weighted sensitivity of the CES-D was 100%; specificity 88%; and positive predictive value 13.2%. False positives were not more likely among elderly with physical illness, cognitive decline or anxiety. We conclude that the criterion validity of the CES-D for major depression was very satisfactory in this sample of older adults.

Consequences of anxiety in older persons: its effect on disability, well-being and use of health services

BACKGROUND Although anxiety is quite prevalent in late life, its impact on disability, well-being, and health care utilization of older persons has not been studied. Older persons are a highly relevant age group for studying the consequences of anxiety, since their increasing numbers put an extra strain on already limited health care resources. METHODS Data of a large community-based random probability sample (N = 659) of older subjects (55-85 year) in the Netherlands were used to select three groups: subjects with a diagnosed anxiety disorder, subjects with merely anxiety symptoms and a reference group without anxiety. These groups were compared with regard to their functioning, subjective well-being, and use of health care services, while controlling for potentially confounding variables. RESULTS Anxiety was associated with increased disability and diminished well-being. Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms. Although use of health services was increased in anxiety sufferers, their use of appropriate care was generally low. CONCLUSIONS Anxiety has a clear negative impact on the functioning and well-being of older subjects. The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking. Finally, in spite of its grave consequences for the quality of life, appropriate care for anxiety is seldom received. Efforts to improve recognition, disseminate effective treatments in primary care, and referring to specialized care may have positive effects on the management of anxiety in late life.

Risk factors for depression in later life; results of a prospective community based study (AMSTEL).

BACKGROUND Depression in the elderly was found to be associated with a variety of risk-factors in cross sectional designs. Based on the vulnerability-stress model, etiologic pathways for depression have been suggested, with vulnerability modifying the effect of stress factors. The current prospective study tests an etiologic model for depression incidence, by assessing modifying effects of three types of vulnerability: genetic/familial vulnerability, organic vulnerability, and environmental vulnerability. METHODS 1940 non-depressed community-living elderly were interviewed at baseline, and at follow-up three years later. Bivariate and multivariate relationships between risk factors and incident depression (GMS-AGECAT) were studied. RESULTS Higher age, personal history of depression, death of spouse, health related factors and comorbid organic or anxiety syndrome showed significant bivariate associations with depression incidence. In multivariate analysis, the effect of stress factors on incident depression was not modified by a genetic/familial vulnerability, nor by an organic vulnerability. Effect modification by environmental factors was however evident; having a marital partner, and if unmarried having social support, significantly reduced the impact of functional disabilities on the incidence of depression. LIMITATIONS The study consisted of two measurements with a three years interval, depressive episodes with a short duration may be under-represented. CONCLUSIONS In the elderly, the effect of stress on incident depression is modified by environmental vulnerability. No evidence was found of effect modification by either genetic/familial or organic vulnerability. The results have implications for both recognition and treatment of late-life depression.

Physical health and the onset and persistence of depression in older adults: an eight-wave prospective community-based study

BACKGROUND Poor physical health has long been recognized to be one of the most important risk factors for depression in older adults. Since many aspects of physical health can be targeted for improvement in primary care, it is important to know whether physical health problems predict the onset and/or the persistence of depression. METHODS The study is based on a sample which at the outset consisted of 327 depressed and 325 non-depressed older adults (55-85) drawn from a larger random community-based sample in the Netherlands. Depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves. RESULTS From all incident episodes, the majority (57%) was short-lived. These short episodes could generally not be predicted by physical health problems. The remaining incident episodes (43%) were not short-lived and could be predicted by poor physical health. Chronicity (34%) was also predicted by physical health problems. CONCLUSIONS The study design with its frequent measurements recognized more incident cases than previous studies; these cases however did have a better prognosis than is often assumed. The prognosis of prevalent cases was rather poor. Physical health problems were demonstrated to be a predictor of both the onset and the persistence of depression. This may well have implications for prevention and intervention.

Depression and physical health in later life: results from the Longitudinal Aging Study Amsterdam (LASA)

BACKGROUND In later life, declining physical health is often thought to be one of the most important risk factors for depression. Major depressive disorders are relatively rare, while depressive syndromes which do not fulfill diagnostic criteria (minor depression) are common. METHODS Community-based sample of older adults (55-85) in the Netherlands: baseline sample n = 3056; study sample in two stage screening procedure n = 646. Both relative (odds ratios) and absolute (population attributable risks) measures of associations reported. RESULTS In multivariate analyses minor depression was related to physical health, while major depression was not. General aspects of physical health had stronger associations with depression than specific disease categories. Significant interactions between ill health and social support were found only for minor depression. Major depression was associated with variables reflecting long-standing vulnerability. CONCLUSION Major and minor depression differ in their association with physical health. LIMITATION Cross-sectional study relying largely on self-reported data. CLINICAL RELEVANCE In major depression, with or without somatic co-morbidity, primary treatment of the affective disorder should not be delayed. In minor depression associated with declining physical health, intervention may be aimed at either or both conditions.

Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study

BACKGROUND Various studies support the notion that the clinical picture of depression in the oldest old differs from that in younger elderly. Moreover, withstanding the serious negative effects of depression on well being and functioning, the detection rate of depression in several medical settings is low. METHODS Prevalence of depression, correlates and the rate of recognition by general practitioners were assessed in an 85-year-old community-based population. The GDS-S was applied in 500 participants with a MMSE >18, from a representative sample of 599 community based 85-year-old subjects. Demographic data, daily functioning, health correlates, use of medication and recognition of depression were recorded in home visits and from the general practitioner and pharmacists registers. RESULTS The prevalence of depression, as measured with a GDS-S score of 5 points or more, was 15.4%, which is comparable to previous studies. No demographic factors were correlated with depression. Perceived health, loneliness, impaired mobility, cognitive decline and functional disability were major correlates of depression. From the participants who were seen by their general practitioner, 25% were recognised as depressed. Antidepressive pharmacotherapy was almost nonexistent. LIMITATIONS Formal diagnosis of depression was not available. The data were collected cross-sectionally. CONCLUSIONS Depression is highly prevalent in the oldest old and strongly associated with functional disability and cognitive impairment. It is important to enhance recognition of depression in community based oldest old as a first step to possible interventions.

Religiosity as a protective or prognostic factor of depression in later life; results from a community survey in The Netherlands

This study examines the impact of religiosity on the incidence and course of depressive syndromes in a community‐based sample of elderly people in The Netherlands (n= 177). The course of depression was assessed in five waves of measurements, covering a period of 1 year. Religiosity was defined as salience of religion compared to the salience of other aspects of life. Religious salience was not associated with incidence of depression, but showed a relatively strong association with improvement of depression among the respondents who were depressed at the first measurement. This association was most prominent among subjects with poor physical health.

Sex differences in late-life depression.

Sonnenberg CM, Beekman ATF, Deeg DJH, van Tilburg W. Sex differences in late‐life depression.

The association of physical health and depressive symptoms in the older population: age and sex differences

Physical health and depression are closely related in the elderly. This has been found in both cross-sectional and longitudinal studies. In this study the relation between four aspects of physical health and depressive symptom levels were studied in a community-based sample of older inhabitants of a small town in the Netherlands (n=224). Results indicated that depression as measured with the CES-D is sufficiently different from physical health to be distinguished from it, and that it is sufficiently related to physical health to be relevant for further study. The more subjective measures of physical health used in this study (pain and subjective health) appeared to have a much stronger relation with depression than the more objective health measures (chronic diseases and functional limitations). Physical health and aspects of the social environment such as marital status appeared to have independent effects on mood. In this study these effects were moderated by age and sex. In women and the young-old (55–64) none of the associations between physical health and depression were significant. In men and the old-old (75+) all associations were highly significant.

Differences in prevalence of dementia based on community survey and general practitioner recognition

A study was conducted, which simultaneously used GPs and epidemiological assessment procedures (MMSE, CAMDEX), to identify individuals with DSM-III-R dementia in the same population. In addition, a 1-year follow-up assessment was conducted in patients with a CAMDEX-diagnosis of dementia. In the non-institutionalized group, which was assessed both by the GP and with the epidemiological test battery, the prevalence of dementia according to the GP was 2.2%, whereas the prevalence based on the epidemiological approach amounted to 5.2%. In general CAMDEX-diagnoses of dementia were confirmed at 1-year follow-up, and thus the discrepancy between the two prevalence estimates must be attributed to the low sensitivity of the GPs. Sensitivity of the GP was related to help-seeking behaviour, with low sensitivity in patients with a low contact rate. It was also related to the use of less specific diagnostic labels by the GP (cognitive impairment), and to poor recognition of cognitive impairment in patients who visited their GP.