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Depression among older people in Europe: the EURODEP studies

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Abstract

The data from nine centres in Europe which had used the Geriatric Mental Scale (GMS) AGECAT were analysed to compare prevalence of diagnoses in subjects aged 65 years and over living in the community. Levels of depressive illness were: Iceland 8.8%, Liverpool 10.0%; Zaragoza 10.7%; Dublin 11.9%; Amsterdam 12.0%; Berlin 16.5%; London 17.3%; Verona 18.3% and Munich 23.6%. Taking all levels of depression, five high (Amsterdam, Berlin, Munich, London and Verona) and four low (Dublin, Iceland, Liverpool, Zaragoza) scoring centres were identified. Meta-analysis of all 13,808 subjects yielded a mean level of depression of 12.3% (95% CI 11.8-12.9), 14.1% for women (95% CI 13.5-14.8) and 8.6% for men (95% CI 7.9-9.3). Symptom levels varied between centres: 40% of the total study population in Amsterdam reported depressive mood against only 26% in Zaragoza. To incorporate studies from other centres using other methods for depression identification, the EURO-D scale was developed from 12 items of the GMS and validated against other scales and expert diagnosis. A two factor solution emerged, an 'affective suffering factor' and a 'motivation factor'. The EURO-D scale was applied to 14 population based surveys. Depression score tended to increase with age unlike levels of prevalence of depression. Large between centre differences were evident in levels of depression unexplained by age, gender or marital status. These data show that depressive illness defined as suitable for intervention is common among older people in Europe. Opportunities for effective treatment are almost certainly being lost. Levels of depressive symptoms vary significantly between high and low scoring centres, prompting the next phase of this study, an examination of risk factors in Europe.
45
The EURODEP consortium consists of a number of
independent community based studies of depression
among older people, conducted in centres in Europe
which have been brought together to form a Concerted
Action Programme under the European Community BIO-
MED I initiative. In the first studies, EURODEP is trying
to answer the questions: how much depression exists
among older people in Europe? Does its level vary from
place to place? Does the clinical picture differ between
populations? Is the level of depression consistent with
suicide levels? Is it treated and what are its risk factors?
The increasing proportions of older people in the pop-
ulations of Europe lent urgency to the need to know their
levels of mental illness, of which one of the most prevalent
is depression. First, a systematic review of the world liter-
ature on community-based studies of the prevalence of
depression in later life (aged 55+) was undertaken (1).
Thirty-four studies were eligible for inclusion, with a range
of prevalence rates for depression of 0.4-35%. They
revealed a weighted average for major depression of 1.8%
and for minor depression of 9.8%, while all depressive
syndromes considered clinically relevant reached 13.5%.
A higher rate of prevalence of depression was a consistent
finding for women and among older people in poor socio-
economic circumstances. Because of the diversity of meas-
ures used, it was not possible in such a survey to make
comparisons between individual studies in order to iden-
tify areas of high and low depression prevalence. The need
for a uniform standardised method was clear.
The aims of the first studies were: a) to study the varia-
tion in the prevalence of diagnosable depression among
people aged 65 and over living in the community in dif-
ferent centres in Europe using a standardised method; b)
to examine core symptoms and clinical profiles across
centres: how do they differ? c) to interpret them in rela-
tion to existing socio-economic and risk factor variables;
and d) the harmonisation of scales of depression to allow
other centres to join the consortium for comparing levels
of depressed mood by scale score.
METHOD
Formation of the consortium
The original members of the consortium (Study 1) had
used the Geriatric Mental State (GMS) AGECAT as the
principal case finding and diagnostic instrument for their
studies: Amsterdam (2); Berlin (3); Dublin (4); Iceland
(5); Liverpool (6); London (7); Munich (8); Verona, Italy
Depression among older people in Europe:
the EURODEP studies
RESEARCH REPORT
The data from nine centres in Europe which had used the Geriatric Mental Scale (GMS) AGECAT were analysed to compare prevalence
of diagnoses in subjects aged 65 years and over living in the community. Levels of depressive illness were: Iceland 8.8%, Liverpool 10.0%;
Zaragoza 10.7%; Dublin 11.9%; Amsterdam 12.0%; Berlin 16.5%; London 17.3%; Verona 18.3% and Munich 23.6%. Taking all levels
of depression, five high (Amsterdam, Berlin, Munich, London and Verona) and four low (Dublin, Iceland, Liverpool, Zaragoza) scor-
ing centres were identified. Meta-analysis of all 13,808 subjects yielded a mean level of depression of 12.3% (95% CI 11.8-12.9), 14.1%
for women (95% CI 13.5-14.8) and 8.6% for men (95% CI 7.9-9.3). Symptom levels varied between centres: 40% of the total study pop-
ulation in Amsterdam reported depressive mood against only 26% in Zaragoza. To incorporate studies from other centres using other
methods for depression identification, the EURO-D scale was developed from 12 items of the GMS and validated against other scales
and expert diagnosis. A two factor solution emerged, an ‘affective suffering factor’ and a ‘motivation factor’. The EURO-D scale was
applied to 14 population based surveys. Depression score tended to increase with age unlike levels of prevalence of depression. Large
between centre differences were evident in levels of depression unexplained by age, gender or marital status. These data show that depres-
sive illness defined as suitable for intervention is common among older people in Europe. Opportunities for effective treatment are
almost certainly being lost. Levels of depressive symptoms vary significantly between high and low scoring centres, prompting the next
phase of this study, an examination of risk factors in Europe.
Key words: EURODEP, depression, old age, GMS-AGECAT, EURO-D
JOHN R.M. COPELAND
1
, AARTJAN T.F. BEEKMAN
2
, ARJAN W. BRAAM
2
, MICHAEL E. DEWEY
1
, PHILIPPE DELESPAUL
3
,
R
EBECCA FUHRER
4
, CHRISTOPHER HOOIJER
5
, BRIAN A. LAWLOR
6
, SIRKKA-LIISA KIVELA
7
, ANTHONY LOBO
8
, HALGRIMUR
MAGNUSSON
9
, ANTHONY H. MANN
10
, INGEBORG MELLER
11
, MARTIN J. PRINCE
12
, FRIEDEL REISCHIES
13
, MARC ROE-
LANDS
14
, INGMAR SKOOG
15
, CESARE TURRINA
16
, MARTEN W. DEVRIES
3
, KENNETH C.M. WILSON
1
1
Department of Psychiatry, University of Liverpool, UK;
2
Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands;
3
Department of Psychiatry,
University of Maastricht, The Netherlands;
4
INSERM U360, Hôpital de la Salpêtriere, Paris, France;
5
DOC-Team Oude Hoeverweg 10, 1816 BT Alkmaar, The
Netherlands;
6
Department of Psychiatry of the Elderly, St. James’s Hospital, Dublin, Ireland;
7
Department of General Practice, University of Turku and Satakunta
Central Hospital, Turku and Pori, Finland;
8
Department of Psychiatry, University Hospital, Zaragoza, Spain;
9
Heilsugaeslustod Grundarfjardar, Iceland;
10
Sections of
Epidemiology and General Practice and Old Age Psychiatry, Institute of Psychiatry, London, UK;
11
Department of Psychiatry, University of Munich, Germany;
12
Section
of Epidemiology, Institute of Psychiatry, London, UK;
13
Department of Psychiatry, Freie Universität, Berlin, Germany;
14
Department of Behaviour Therapy and
Counselling, University of Gent, Belgium;
15
Psykiatriska Kliniken, Sahlgrenska Sjukhuset, Goteborg, Sweden;
16
Clinica Psichiatrica, Ospedale Civile, Brescia, Italy
WPA4_09_Copeland 30-01-2004 15:32 Pagina 45 (Black/Process Black pellicola)
46
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(9); Zaragoza, Spain (10). The centres decided to come
together and form a Concerted Action, pool their data and
thus give added strength to their analyses of risk factors
and generate new hypotheses for further studies.
To the original nine GMS AGECAT centres, another
centre was added with expertise in the technique of ‘Expe-
rience Sampling’ (Maastricht). Five further centres (Study
2) applied to join - Gothenburg, Sweden (11); Antwerp,
Belgium (12); Bordeaux, France (13); Oulu, Finland (14);
and Amsterdam (15) - which had used other measures. It
was decided to try to harmonise their measures of depres-
sion with those of the other centres. Under the European
Community PECO initiative, an East European centre was
added: Tirana, Albania (not reported here).
Characteristics of the centres
Details on the individual centres for Study 1 are report-
ed elsewhere (16). All the centres took random communi-
ty samples collected between 1990 and 1996, except for
Iceland which had a total population birth cohort born
1895-1897 and interviewed in 1983, and Dublin which
used a general practitioner complete register. The age
range was from 65 upwards for most samples, except Ams-
terdam (65-84), Berlin (70+), Munich (85+) and Iceland
(88-89). Only one centre excluded nursing homes entirely
(Verona). Most samples were urban, except Iceland which
was mixed rural/urban. Their size varied between 202 in
Verona and 5222 in Liverpool. The two samples in Italy
and Spain were predominantly catholic. The samples in
the UK (London and Liverpool), in Germany (Berlin and
Munich), in the Netherlands and in Iceland were predom-
inantly protestant, while the sample in Dublin was
catholic.
Measures
The studies were undertaken using the GMS (17,18)
community version in approved translation. AGECAT
(19,20) is a computerised diagnostic algorithm which uses
scores on GMS items in stage one for each subject to pro-
duce a level of confidence of diagnosis on a scale of 0-4 or
0-5 for each of eight diagnostic syndrome clusters: organ-
ic brain syndrome, schizophrenia, mania, depression (psy-
chotic and neurotic), and obsessional, hypochondriacal,
phobic and anxiety neuroses. Stage 2 reaches a final dif-
ferential diagnosis by comparing level for level, recorded
as either a diagnostic subcase (confidence levels 1 and 2)
or a diagnostic case (confidence levels 3,4 and 5). Thus it
allows the identification of comorbid states. Level 3 and
above on any diagnostic cluster accords with what psychi-
atrists would usually recognise as a case for treatment or
intervention, if available. Good agreement has been
shown between AGECAT cases of depression and DSM-
III major depressive episode and dysthymia taken togeth-
er (21,22). In addition to the GMS, most centres collected
risk factor information and seven undertook follow-up of
their samples.
Data analysis for the pooled data took place in Liver-
pool. The Liverpool and Berlin samples were gender and
age stratified. The overall prevalence figures for these cen-
tres are therefore adjusted using the appropriate weights
to take this into account.
STUDY 1A: PREVALENCE OF DEPRESSION
IN EUROPEAN CENTRES
Results
Substantial differences in the prevalence of depression
were found, with Iceland having the lowest level at 8.8%,
followed by Liverpool 10.0%; Zaragoza 10.7%; Dublin
11.9%; Amsterdam 12.0%; Berlin 16.5%; London 17.3%;
Verona 18.3% and Munich 23.6%. When all five AGE-
CAT depression levels, including both subcases of depres-
sion and cases, were added together, five high scoring cen-
tres emerged (Amsterdam, Berlin, Munich, London and
Verona) with a prevalence of all levels of depression of
30.4 to 37.9%, and four low scoring centres (Dublin, Ice-
land, Liverpool, Zaragoza) with prevalence levels between
17.7 to 21.4%. Women almost invariably dominated over
men. The examination of the proportions of subcases to
cases, and psychotic to neurotic depression, although
revealing some striking differences between centres, pro-
vided no obvious explanation for the difference in preva-
lence (see also 16).
Although age-specific prevalence rates varied between
centres, there was no constant association between preva-
lence and age.
The meta-analysis of the pooled data on the nine Euro-
pean centres yielded 13,808 subjects, with an overall
prevalence of depression of 12.3% (95% CI 11.8-12.9);
14.1% for women (95% CI 13.5-14.8) and 8.6% for men
(95% CI 7.9-9.3).
Discussion
It was concluded that considerable variation existed in
the levels of depression across Europe, although the
cause was not immediately obvious. Cases and subcases
taken together showed even greater variability, particular-
ly for women, suggesting that it was not simply a matter
of variation in case/subcase criteria, which were in any
event standardised by computer. It is possible that risk
factors for well/subcase and subcase/case transitions in
both directions vary, although this was not true for Liver-
pool (23), where subcases shared similar risk factors to
cases. Although there were substantial levels of depres-
sion in all centres, it can also be said that between 62 and
82 percent of older persons had no depressive level on
the AGECAT system. It was finally concluded that sub-
stantial opportunities for treatment existed. Not all stud-
ies assessed treatment. Those that did, e.g. Liverpool,
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47
found around 10 % of case level depression received anti-
depressant medication.
STUDY 1B: PRESENTATION OF DEPRESSION
AND DEPRESSIVE SYMPTOMS IN EUROPE
Results
The proportions of depressive symptoms were found to
vary between centres. In Amsterdam, for example, 40% of the
general population of older people reported depressive mood
compared to 26% in Zaragoza. Symptoms such as ‘future
bleak’, ‘hopelessness’, ‘wish to be dead’ were generally rare,
but the last reached higher levels in Berlin, Munich and
Verona. Sleep disturbance was admitted by only 15% of the
population in Dublin, but 54% and 60% in Munich and
Berlin. Large differences for some symptoms were found with-
in the very old populations in Iceland, Berlin and Munich: in
men aged 85 and over, the prevalence of ‘depressed mood’,
‘crying’, ‘cannot cry’, ‘life not worth living’ and ‘wish to be
dead’ was 9%, 3%, 4%, 2% and 3%, respectively, in Iceland,
whereas it was 50%, 33%, 26%, 30% and 29% in Munich,
and 41%, 21%, 15%, 16% and 25% in Berlin, whereas there
was no difference for ‘guilt’ and ‘energy loss’. These differ-
ences were also evident for women (see also 24).
As expected from the prevalence levels of depression,
many symptoms were more common among women. Cen-
tres where the prevalence of depression was low tended to
have fewer symptoms among the well (i.e., those with no
depressive level), but there were inconsistencies, so that a
low level of symptoms in the ‘well’ did not necessarily pre-
dict a lower level in the depressed.
Discussion
We conclude that surprising variations in prevalence of
depressive symptoms occurred between centres, and were
not always consistent with levels of depressive illness. The
high level of serious symptoms of depression in populations
aged 85 and over in the German centres compared to others,
and particularly to Iceland, may have been due to the linger-
ing aftermath of the Second World War in this generation.
Less variation with age occurred than expected and was
inconsistent between centres. There was no consistent
relationship between proportions of symptoms in well
persons and cases for all centres. In all, it can be said that
the levels of depressive symptoms among over 60% of the
older general population of Europe were low, so that pejo-
rative stereotypes of old age in Europe as naturally
depressed were not upheld.
STUDY 2A: HARMONISATION OF MEASURES
OF DEPRESSION IN OLDER PEOPLE
Method
Because new centres had entered the consortium,
which had not used the GMS AGECAT, attempts were
made to harmonise the depression measures which they
had used with the GMS items, so that a common scale
could be derived (the EURO-D, 25). Most of the non-
GMS AGECAT centres had used the Short Care, the
Center for Epidemiological Studies - Depressive Scale
(CES-D), the Comprehensive Psychopathological Rating
Scale (CPRS) and the Zung Self Rating Depression Scale
(ZSDS). Common items were identified by scrutiny of
these instruments, and algorithms for fitting items from
other instruments to the GMS were derived. This was
undertaken by direct observation of item correspon-
dence or by expert opinion. The resulting twelve item
scale was checked in each centre for internal consisten-
cy, criterion validity and uniformity of factor and analyt-
ic profiles.
Results
It was concluded that the EURO-D Scale, from whichev-
er scale it had been derived, was entirely consistent and
seemed to capture the essence of its parent instrument. It
was also judged to have a comparable factor structure what-
ever its origin, but a two factor solution was optimal.
‘Depression’, ‘tearfulness’, and ‘wishing to die’ loaded on
the first factor, which we called ‘affective suffering’, while
‘loss of interest’, ‘poor concentration’ and ‘lack of enjoy-
ment’ loaded on the second, called the ‘motivation factor’.
It was concluded that the diverse depression measures cov-
ered common conceptual domains, and often had similarly
worded items. Even differences in modes of administration
(for example, self report versus semi-structured clinical
interview) did not seem to prevent the extraction of broad-
ly comparable data with common scaling properties.
STUDY 2B: APPLICATION OF THE EURO-D SCALE
Method
Subjects from the 14 population based surveys were
used to test the EURO-D with respect to the main inter-
active effects of centre, age, gender and marital status (see
also 26). Between centre variance was partitioned accord-
ing to centre sub-characteristics, geographical region,
prominent religion and survey instrument used.
Results
It was noted that EURO-D scores tended to increase
with increasing age, unlike the levels of prevalence of
depression. Women had generally higher scores than men,
and widowed and separated subjects higher scores than
those who were currently or never married.
Discussion
The EURO-D Scale, it appeared, could be reduced to
two well characterised factors, ‘motivation’ and ‘affective
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48
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February 2004
suffering’. The motivation factor seemed to account for
the positive association with age, while the affective suf-
fering factor was responsible for the gender difference.
The gender difference was modified by marital status,
being negligible among those who had never married,
and equally evident among the currently married, the
widowed and the separated. There was no evidence for a
continuation of the gender difference with increasing
age. The effects of age, gender and marital status
accounted for less than 1% of the variance in the EURO-
D Scale.
It was concluded that there were large between centre
differences, which could be explained neither by the age,
gender or marital status characteristics of the population,
nor by the instruments used to survey them.
Reasonably consistent, but small effects of age, gender
and marital status on depression symptoms have been
observed across the 14 European centres. It is concluded
that while symptoms of depression increase with age,
depression may be over-diagnosed in older persons
because of an increase in complaints of lack of interest
and motivation which may be affectively neutral and pos-
sibly related to cognitive decline.
STUDY 3: RELIGIOUS BEHAVIOUR AND DEPRESSIVE
SYMPTOMS IN EUROPE
Method
We examined the influence of religion on the level of
both depressive symptoms and illness across the Euro-
pean centres. The EURO-D Scale was used in this analy-
sis to allow all the centres, original and additional, to
participate. The influence of religion is of interest to the
collaboration because of the split between North and
South Europe and between protestant and roman
catholic groups, with some catholic centres (Ireland, Bel-
gium, and in part Liverpool) being in the more northerly
parts of the continent, and Spain, Italy and France in the
more southerly. The addition of Albania had the advan-
tage of introducing a largely Muslim religious group (see
also 27).
The protective effects of being a religious person were
examined using data from 13 community based studies in
11 centres.
Results
Fewer depressive symptoms were found in those
catholic countries with high rates of regular church
attendance, while in protestant countries high levels of
depressive symptoms were associated with lower levels
of attendance. It was concluded that religious practice,
especially when it is embedded within a traditional
value-orientation, may facilitate coping with adversity in
later life.
Interactive effects showed the results to be more pro-
nounced among older women. It was concluded that older
Europeans appear to benefit from religious practice.
CONCLUSIONS
However interpreted, these results make it plain that
depression as an illness is common among older people in
Europe. Although it was not possible to assess the size of
the population receiving treatment, it is known that in the
London and Liverpool centres it falls often well below
15% of depressed persons judged as likely to benefit.
There is no reason to suppose these figures are better in
other European countries. Opportunities for effective
treatment are almost certainly being lost.
THE FUTURE
The consortium is now addressing the risk factors for
depression in this age group, and prognosis. We shall
also be examining comorbidity with organic states, espe-
cially dementia. Issues such as daily life, handicap and
depression, the validity of social measures of depression
and the concept of handicap and the daily life of older
people in Europe are being explored by the use of the
Experience Sampling Method developed at the Maas-
tricht Centre.
The consortium looks to extend its work into ran-
domised controlled treatment trials of depression between
centres and to study better methods for service delivery.
The EURODEP consortium gave rise to the ASIADEP
consortium, consisting of nine similar centres distributed
in Asian countries (Japan, China, South Korea, Taiwan,
Singapore, Malaysia and India) which will shortly be
reporting their results.
References
1. Beekman ATF, Copeland JRM, Prince MJ. Review of community
prevalence of depression in later life. Br J Psychiatry 1999;174:
307-11.
2. Van Ojen R, Hooijer C, Jonker C et al. Late-life depressive disor-
der in the community, early onset and the increase of vulnerabil-
ity with increasing age. J Affect Disord 1995;33:159-66.
3. Helmchen H, Linden M, Wernicke T. Psychiatrische Morbidität
bei Hochbetagten: Ergebnisse aus der Berliner Altersstudie. Ner-
venarzt 1996;67;739-50.
4. Lawlor BA, Bruce I, Swanwick GRJ et al. Prevalence of mental
illness in an elderly community dwelling population using AGE-
CAT. Irish J Psychol Med 1994;11:157-9.
5. Magnusson H. Mental health of octogenarians in Iceland. An epi-
demiological study. Acta Psychiatr Scand 1989;79 (Suppl. 349).
6. Saunders PA, Copeland JRM, Dewey ME et al. The prevalence of
dementia, depression and neurosis in later life: the Liverpool
MRC-ALPHA study. Int J Epidemiol 1993;22:838-47.
7. Livingston G, Hawkins A, Graham N et al. The Gospel Oak
Study: prevalence rates of dementia, depression and activity lim-
itation among elderly residents in inner London. Psychol Med
1990;20:137-46.
8. Meller I, Fichter M, Schroppel H et al. Mental and somatic health
and needs for care in octo- and nonogenerians: an epidemiologi-
WPA4_09_Copeland 30-01-2004 15:32 Pagina 48 (Black/Process Black pellicola)
49
cal study. Eur Arch Psychiatry Clin Neurosci 1993;242:286-92.
9. Turrina C, Perdona G, Bianchi L et al. Disturbi psichici (DSM-
III-R) nella popolazione anziana del quartiere di Verona-Sud.
Dati preliminari. Riv Sper Fren 1991;64:1006-13.
10. Lobo A, Dewey M, Copeland JRM et al. The prevalence of
dementia among elderly people living in Zaragoza and Liverpool.
Psychol Med 1992;22:239-43.
11. Skoog I, Nilsson L, Landahl S et al. Mental disorders and the use
of psychotropic drugs in an 85 year old urban population. Int
Psychogeriatrics 1993;5:33-48.
12. Roelands M, Wostyn P, Dom H et al. The prevalence of dementia
in Belgium: the population-based door-to-door survey in a rural
community. Neuroepidemiology 1994;13:155-61.
13. Barberger Gateau P, Chaslerie A, Dartigues JF et al. Health meas-
ures correlates in the French elderly community population: the
PAQUID study. J Gerontol 1992;47:S88-S95.
14. Kivela S-L, Pahkala K, Laipala P. Prevalence of depression in an
elderly Finnish population. Acta Psychiatr Scand 1988;78: 401-13.
15. Beekman ATF, Deeg DJH, van Tilberg T et al. Major and minor
depression in later life: a study of prevalence and associated fac-
tors. J Affect Disord 1995;36:65-75.
16. Copeland JRM, Beekman ATF, Dewey ME et al.. Depression in
Europe. Geographical distribution among older people. Br J Psy-
chiatry 1999;174:312-21.
17. Copeland JRM, Kelleher MJ, Kellett JM et al. A semi-structured
clinical interview for the assessment of diagnosis and mental state
in the elderly. The Geriatric Mental State Schedule. l. Develop-
ment and reliability. Psychol Med 1976;6:439-49.
18. Gurland BJ, Fleiss JL, Goldberg K et al. A semi-structured clini-
cal interview for the assessment of diagnosis and mental state in
the elderly. The Geriatric Mental State Schedule 2. A factor
analysis. Psychol Med 1976;6:451-9.
19. Copeland JRM, Dewey ME, Griffiths-Jones HM. Computerised
psychiatric diagnostic system and case nomenclature for elderly
subjects: GMS and AGECAT. Psychol Med 1986;16:89-99.
20. Dewey ME, Copeland JRM. Computerised psychiatric diagnosis
in the elderly: AGECAT. J Microcomputer Appl 1986;9:135-40.
21. Copeland JRM, Dewey ME, Griffiths-Jones HM. Dementia and
depression in elderly persons: AGECAT compared with DSM III
and pervasive illness. Int J Geriatr Psychiatry 1990;5:47-51.
22. Ames D, Flynn E, Tuckwell V et al. Diagnosis of psychiatric dis-
order in elderly, general and geriatric hospital patients: AGECAT
and DSM-III-R compared. Int J Geriatr Psychiatry 1994;9:627-33.
23. Copeland JRM, Chen R, Dewey ME et al. Community-based case-
control study of depression in older people. Cases and subcases
from the MRC-ALPHA study. Br J Psychiatry 1999;175:340-7.
24. Copeland JRM, Beekman ATF, Dewey ME et al. Cross-cultural
comparison of depressive symptoms in Europe does not support
stereotypes of ageing. Br J Psychiatry 1999;174:322-9.
25. Prince MJ, Reischies F, Beekman ATF et al. Development of the
EURO-D Scale - A European union initiative to compare symp-
toms of depression in 14 European centres. Br J Psychiatry
1999;174:330-8.
26. Prince MJ, Beekman ATF, Deeg DJH et al. Depression symptoms
in late life assessed using the EURO-D Scale. The effect of age,
gender and marital status in 14 European centres. Br J Psychiatry
1999;174:339-45.
27. Braam A, van den Eeden P, Prince MJ et al. Religion as a cross
cultural determinant of depression in elderly Europeans: results
from the EURODEP collaboration. Psychol Med 2001;31:803-14.
WPA4_09_Copeland 30-01-2004 15:32 Pagina 49 (Black/Process Black pellicola)
... Additionally, this group had the highest proportion of members residing in areas constituting the bottom two quintiles of deprivation indices. The cognitive function of this group, as measured by the RBANS metric (mean 75.1), was also lower compared to the other groups, except for Group 1. Interestingly, this group had the highest proportion of female members (74.1%), aligning with findings in recent meta-analyses and reviews indicating that women experience depressive symptoms more frequently than men[53][54][55].Group 4 participants displayed several symptoms of anxiety, particularly those related to feelings of tension and restlessness. No members of this group met the threshold level for clinical diagnosis of depression, yet symptoms of anxiety were the second highest, on average, among the groups considered (median HADS 5). ...
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Understanding patterns of mental health in older people, how it is measured, and how it is affected by associated risk factors is of growing importance as life expectancy increases worldwide. Here, we aimed to explore typologies of mental health using a clustering method and determine how the identified clusters differ in terms of the prominence and severity of depression and anxiety. Our analysis hinged on the Trinity Ulster Department of Agriculture study dataset, encompassing 5186 participants with a mean age of 74.0. This dataset comprises five distinct feature sets, encompassing mental health (Center for Epidemiologic Studies Depression Scale [CES-D] and Hospital Anxiety and Depression Scale [HADS]), cognitive and neuro-psychological function, illness diagnoses and medical prescription history, lifestyle and nutritional attainment, as well as physical well-being. We perform cluster analysis on each feature set independently and subsequently elucidate the interrelations among the clusterings across the various feature sets. We uncovered a five-group typology: Group 1, mild depressive symptoms and no symptoms of anxiety; Group 2, acute depression and anxiety; Group 3, less severe but persistent depression and anxiety symptoms; Group 4, symptoms of anxiety with no depressive symptoms; and Group 5, no symptoms of either depression or anxiety. Each group is associated with distinct socio-demographic, physical, and cognitive characteristics, allowing a deeper understanding of the risk factors associated with each syndrome profile. The characteristics of the groups were explored using descriptive statistics and confirmatory analysis. Analysis of a follow-up study performed at a median of 5.4 years finds that the identified typology is robust longitudinally. The co-clustering methodology also provides partitions of the questions in the CES-D and HADS scales. Our results suggest that data-driven techniques can discern different mental health typologies in older adults, distinguished by the number and severity of issues they experience.
... Depression is one of the leading causes of disease worldwide (Richards, 2011) and the fourth leading cause of disease burden worldwide (Üstün et al., 2004). It affects 8% of individuals in the United States (Brody et al., 2018) and 12% of individuals in Europe (Copeland et al., 2004) and accounts for 4.4% of total disability-adjusted life years worldwide (Üstün et al., 2004). It affects a substantial proportion of caregivers of individuals with disabilities (Ebrahimi et al., 2021). ...
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Aims This study examined whether reserve-building activities are associated with attenuated reported depression among people who were disabled from work due to a medical condition as compared to employed, retired, and unemployed participants. Methods This secondary analysis included 771 individuals who provided data at three time points: baseline (late Spring 2020), follow-up 1 (Spring 2021), and follow-up 2 (Fall 2021). The DeltaQuest Reserve-Building Measure assessed current activities related to brain health. An analysis of variance and Pearson correlation coefficients assessed group differences in reserve-building activity scores. Classification and regression tree (CART) modeling investigated factors associated with higher and lower reported depression by employment group. The random effects (RE) models tested two buffering hypotheses: (1) comparing all groups to the employed group and (2) examining within-group effects. Results Engaging in outdoor activities, exercise, and religious/spiritual activities was associated with reduced depression over time in the overall sample. While disabled participants endorsed lower levels of being Active in the World, Outdoor activities, and Exercise and higher levels of Inner Life and Passive Media Consumption than the other employment groups, more reserve-building activities distinguished depression levels in the disabled group's CART models compared to the others. Among the disabled, unemployed, and retired participants, engaging in any reserve-building activities was also associated with lower depression scores, which was distinct from the employed participants. In the RE models that used the employed group as the reference category, only the disabled group's level of depression was buffered by engaging in creative activities. In the within-group RE models, the disabled group's engagement in Religious/Spiritual, Outdoors, and Games was associated with substantially reduced within-group depression, which was different from the other employment groups. In contrast, reserve-building activities were not implicated at all as buffers for employed participants. Conclusion This study revealed a beneficial effect of reserve-building activities on buffering depression over time during the COVID-19 pandemic, particularly for disabled people. It documented that even if such individuals engaged in lesser amounts of such activities as compared to other employment groups, the buffering effect was substantial. Given the low-cost and accessible nature of reserve-building activities, it would be worthwhile to encourage such activities for disabled individuals.
... 33 According to a study comparing depression levels across different regions in Europe, unmarried, widowed, or divorced adults were found to report more symptoms of depression compared to married adults. 41 The study conducted in the Sylhet District found that elderly individuals in urban areas who were not engaged in any work, such as housewives or unemployed individuals, reported a higher prevalence of geriatric depression compared to those who were engaged in work or service. Other studies 37,42 have also found that the amount of depression is higher among those who do not work and inconsistent with another study. ...
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Background and Aims The prevalence of depression among the elderly is a growing concern, and this study examines the differences between urban and rural areas in terms of geriatric depression. Methods Using a two‐stage random sampling approach in urban areas and a multistage random sampling approach in rural areas, the study surveyed 944 elderly individuals of both sexes. Results The results indicate that the prevalence of depression was high, with 52.5% of the elderly population experiencing mild to severe depression. The study found that increasing age, female gender, nuclear family structure, and involvement of housewives or others were significant factors affecting depression in urban areas, while increasing age and elderly people without spouses were significant factors in rural areas. Additionally, the study identified hearing impairment, asthma, and arthritis as risk factors for depression in rural areas, and bronchitis, heart disease, and thyroid illness as significant factors in urban areas. Conclusion These findings highlight the need for policymakers to focus on addressing the mental health needs of older people, particularly women and those without spouses.
... According to the literature [4], the prevalence of depression in older adults is significant, at approximately 35.1%. Also, in Europe depression in the geriatric population is one of the most common mental disorders [5,6] with the highest prevalence rates in France, Italy, and Spain [7]. However, late-life depression is still under-diagnosed, due to the exclusion of the elderly (over 85 years of age) from epidemiological studies [8], atypical symptoms, characterized by somatization, anxiety, suicidal ideation, apathy and emotional coercion [9,10] and social stigma, especially in the male population, who tend to be less inclined to ask for help [11,12]. ...
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Background: Currently, the global demographic landscape is undergoing a transformative shift towards an increasingly aging population. This leads to an increase in chronic pathologies, including depression and cognitive impairment. This study aimed to evaluate the association between depressive mood, whether in treatment or not, and cognitive capacities, assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Methods: This study included 259 subjects, aged 65 years or older, evaluated at the Geriatric Outpatient Service of the University Hospital of Monserrato, Cagliari, between July 2018 and May 2022, who experienced subjective depressive mood and/or cognitive deficits. Results: Only 25.1% of the sample showed no cognitive impairment on the RBANS. Education was a significant regressor of the RBANS Total Scale scores (p < 0.0001) and was negatively associated with mood deflection (r = −0.15, p = 0.0161). Subjects with depressive mood had more impaired attention and visuospatial/constructional abilities compared to untreated euthymic patients. Post-hoc analysis, conducted with the Conover test, showed that untreated euthymic patients (GDS-15 ≤ 5, group 2) had a higher score on the RBANS total scale than patients with mood deflection (GDS-15 > 5, group 1), and treated euthymic patients (GDS-15 ≤ 5, group 3). Finally, different logistic regression analyses revealed a significant negative coefficient for GDS as a regressor of the RBANS total scale (coefficient: −0.04, p = 0.0089), visuospatial/constructional abilities (coefficient: −0.03, p = 0.0009), language (coefficient: −0.05, p = 0.0140), and attention (coefficient: −0.05, p < 0.0001). Conclusions: Our analysis demonstrated that “naturally” euthymic people show better cognitive performances than people with depressive mood and subjects with acceptable mood due to antidepressants. Furthermore, the gender-based difference observed in the language domain suggests the potential utility of incorporating an alternative category for male patients in the Semantic Fluency test.
... The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 2024, Vol. 79, No. 4 symptoms across countries (Copeland et al., 2004). The EURO-D consists of 12 items evaluating the presence of 12 depressive symptoms in the last month, including depression, pessimism, death wishes, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment, and tearfulness. ...
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Objectives While many studies have explored the benefits of support giving or receiving for older people, little is known about how the balance between giving and receiving instrumental support in non-relative relationships affects home-dwelling older people. This study examines the relation between long-term support balance and subjective well-being in relationships with non-relatives among older people across 11 European countries. Method 4,650 Participants aged 60 years and above from three waves of the Survey of Health and Retirement in Europe (SHARE) were included. Support balance was calculated as the intensity difference between support received and support given across three waves. Multiple auto-regressive analyses were conducted to test the relationship between support balance and subjective well-being, as indicated by quality of life, depression, and life satisfaction. Results The impact of balanced versus imbalanced support on all subjective well-being measurements was not significantly different. Compared to balanced support, imbalanced receiving was negatively related to subjective well-being and imbalanced giving was not related to better subjective well-being. Compared to imbalanced receiving, imbalanced giving showed to be the more beneficial for all subjective well-being measures. Discussion Our results highlight the beneficial role of imbalanced giving and balanced support for older people compared to imbalanced receiving. Policies and practices should prioritize creating an age-friendly environment that promotes active participation and mutual support among older people, as this may be effective to enhance their well-being.
... the present study sheds light on the prevalence of depressive symptoms in older adults with and without neurocognitive disorders in Greece and on demographic and clinical factors that are related to these symptoms. the prevalence of depressive symptoms in the total sample was 19.5%. in line with the lack of general consensus possibly due to differences in sample socioeconomic and cultural characteristics, in employed diagnostic instruments, and/or variation in the representativeness of study samples, the here detected prevalence of depressive symptoms is compatible with that of observations in the Mediterranean cities of Verona, italy and Narlıdere, turkey, but not in Zaragoza, spain (copeland et al., 2004;Yaka et al., 2014). interestingly, the findings of the employed regression model point to an impact of the urban or rural character of the population on the severity of depressive symptoms. ...
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Objectives: To study (i) the prevalence of mild and moderate-to-severe depressive symptoms in the entire spectrum of cognitive ageing in Greece and (ii) the relationship between these symptoms and demographic and clinical data. Methods: The study was based on the randomly selected cohort of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Depressive symptoms were assessed with the 15-item version of the Geriatric Depression Scale. Participants also received a comprehensive neuropsychological assessment, while the clinical diagnoses of dementia and mild cognitive impairment were established according to international diagnostic criteria. Statistical analyses relied on comparison tests and a logistic (proportional odds) ordinal regression model. Results: Depressive symptoms were detected in 19.5% of the 1936 study participants, while 11.3% of both people with MCI and dementia had moderate-to-severe depressive symptoms. The regression model revealed that older adults with more severe depressive symptoms were more likely female, cognitively impaired, less educated, were treated with psychotropic medication and lived in Attica versus Thessaly. Conclusions: Since depressive symptoms were detected in almost one in five older adults, healthcare professionals in Greece should safeguard the timely detection and effective treatment of such symptoms and the post-diagnostic care of older adults with depression.
Article
According to a survey published by the National Center for Health Statistics, depression can affect people of any age, but the prevalence of the condition was shown to be second greatest among people aged 65 and older. The most significant repercussion of late-life depressed syndrome is an increase in the overall death rate, which can be attributed to either suicide or other illnesses. The primary objective of this research is to evaluate the impacts of depression caused by biological factors, interpersonal variables, and other socially linked factors on Vietnamese senior people. The Geriatric Depression Scale (GDS-15) was used to evaluate and screen the elderly for signs of geriatric depression in the final data set, which included 630 males (40.1% of the total) and 942 females (59.9% of the total). The participants ranged in age from 60 to 80 years and were all older than that. The most important findings revealed that aspects of this study, such as gender and the amount of time spent sleeping each day, had the potential to operate as predictors of elderly depression.
Article
INTRODUCTION: The presented literature review is devoted to neurochemical, immunological and genetic aspects of the formation of anxiety and depression. The aim of the review was integration of the available knowledge on the topic to present it in a more systematized form and evaluate the existing scientific data on the topic. The review is non-systematic. It included the international and domestic literature sources, databases, the results of studies posted on the PubMed portal on the Internet, in the scientific electronic library e-Library. The search depth was 30 years (from 1993 to 2023). The review incorporated sources that satisfied the topic of the work. A deeper studying of anxiety and depression showed involvement of a number of systems in their formation: serotoninergic, noradrenergic, dopaminergic and other neurotransmitter systems, which leads to formation of neuroinflammation. There is also data on the interrelation between the immune and psychopathological statuses. The infectious component of the pathology cannot be excluded either. On the other hand, there is evidence of the involvement of AB (0) blood system in the occurrence of the above condition. Of special attention are publications showing a mediated influence of genetic factors on the course of anxiety and depression. CONCLUSION: There are a number of hypotheses confirming a close link between the functioning of the regulatory systems (endocrine, immune, central nervous system) and disorders that entail anxiety and depressive disorders. In result, the existing knowledge on the topic was presented in a more systematized form.
Article
Objective: The purpose of this study was to determine the prevalence of a range of mental disorders in an elderly community dwelling population in Dublin using AGECAT, a reliable and standardised computerised diagnostic system that has been previously validated in community epidemiological surveys. Methods: A total of 451 individuals over the age of 65 in a GP group practice were interviewed using AGECAT. Results: Approximately one in five subjects had a mental illness according to AGECAT criteria. The prevalence of depression was 13.1% and did not change appreciably with age. 5.5% of subjects met organic ‘case’ criteria, and the frequency of organic cases increased with age, approximating 15% in the over 80 year age group. Neurotic disorders occurred with very low frequency, representing 1.1% of the subjects tested. Conclusions: These findings have implications for mentalhealth services planning at a local level, and underscore the utility of AGECAT as a tool for comparative crosscultural epidemiological surveys.
Article
Synopsis A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.
Article
Compared diagnoses made (1) by the computer diagnosis system AGECAT, (2) according to the criteria of "pervasive illness" (B. J. Gurland et al, 1983), and (3) by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Data were drawn from a community study by J. R. Copeland et al (1986) and the Gurland et al study. Findings show that AGECAT selected more borderline cases of depression than the other methods and designated 2 levels of subcases for both depression and dementia. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Physically ill elderly patients (N= 236) in a geriatric and a general hospital were interviewed with the Geriatric Mental State (GMS) schedule. Psychiatric diagnoses made by the computer programme ‘AGECAT’ were compared with those made by a psychiatrist who applied DSM-III-R diagnostic criteria to the GMS data. Overall kappa for all diagnostic groups was 0.78. Agreement was excellent for organic diagnoses and good for depression. GMS-AGECAT can be used with confidence to detect common psychiatric disorders in physically ill elderly general and geriatric hospital patients.
Article
Zusammenfassung Aufgrund der Zunahme der allgemeinen Lebenserwartung steigt die Zahl Hochbetagter (70–84 Jahre) und v. a. der Hchstbetagten (85 Jahre und lter). Ungeklrt ist, inwieweit es in diesen hohen Altersgruppen zu Vernderungen in der Hufigkeit oder im Spektrum psychiatrischer Morbiditt kommt. Im Rahmen der Berliner Altersstudie (BASE) wurde eine nach Alter und Geschlecht geschichtete reprsentative Stichprobe (n = 516) der 70- bis 100 jhrigen Westberliner Bevlkerung interdisziplinr psychologisch, soziologisch, internistisch sowie psychiatrisch intensiv untersucht. Erfat wurden u. a. subjektive Beschwerden („Beschwerdenliste, BL“), beobachtbare psychopathologische Symptomatik („Brief Psychiatric Rating Scale, BPRS“) und psychiatrische Diagnosen nach DSM-III-R (auf der Basis des „Geriatric Mental State Interviews (GMS-A)“). Auf der Selbstbeurteilungsskala BL gaben 10 % ausgeprgte bzw. 32 % zumindest deutliche subjektive Beschwerden an. Bei syndromaler psychiatrischer Befundung waren unter Zugrundelegung der BPRS 17 % deutlich oder 75 % zumindest leicht psychopathologisch auffllig. Diagnostisch fanden sich nach DSM-III-R bei 4,2 % schwer ausgeprgte bzw. bei insgesamt 23,5 % psychische Strungen; nach dem klinischen Urteil der untersuchenden Psychiater lagen sogar bei 40,4 % psychische Strungen mit Krankheitswert vor, berwiegend mit leichtem Ausprgungsgrad. Im Vordergrund des Erkrankungsspektrums standen Strungen wie Insomnien (18,8 %) oder unspezifische depressive Strungen (17,8 %) sowie Demenzerkrankungen (13,8 %). Die Demenzerkrankungen zeigen den bekannten Anstieg mit zunehmendem Alter. Fr die sonstige psychiatrische Morbiditt findet sich kein Altersgang. Hchstbetagte unterscheiden sich somit in den hier untersuchten psychiatrischen Variablen bis auf die hhere Demenzhufigkeit nicht von Hochbetagten.
Article
This paper describes a computerized diagnostic system, AGECAT (Automated Geriatric Examination for Computer Assisted Taxonomy), designed for use with the Geriatric Mental State Schedule (GMS).AGECAT can be divided into three main parts. In the first part symptoms are aggregated to form symptom components. In the second part these components are grouped and compared, using a logical decision tree approach, to reach levels of confidence on eight syndrome clusters. In the third part these levels are compared, cluster by cluster and if the level of confidence is sufficiently high a decision is reached on the diagnosis. In addition the program provides a variety of other information on alternative diagnoses and any unusual features detected.Developing a portable program for this type of work presents an interesting computing task involving various programming tools. One of the benefits of computer methods is the way in which they enforce a precise statement of the theory involved. This advantage is lost if, as is usual, the version which humans read is a hand translation of the computerized version. The implementation of AGECAT has been designed to access a single master text which is used to produce all the target versions automatically, and the paper considers some of the advantages of this approach.
Article
Synopsis One hundred geriatric psychiatric patients were examined with the Geriatric Mental State Schedule in New York and London, and a correlation procedure involving both clinical and statistical operations was carried out on the psychopathological data thus collected. Twenty-one factors were produced, including three dealing with cognitive impairment. Although it was found that elderly depressives show a profile of psychopathology quite different from that shown by patients with organic disorder, it was also found that patients with an apparently functional disorder may sometimes be diagnosed as an organic disorder, that subjective complaints of intellectual impairment are not good indicators of organic disorders and may be associated with a depressive factor, and that complaints that could be dismissed as attributes of ageing may actually be indicative of a depressive disorder in the elderly. The methodological implications, as well as the limitations of the sample size, are discussed.
Article
PAQUID is an epidemiologic prospective study of mental and functional aging. A sample of 4,050 community-dwelling individuals, aged 65 and over, was randomly selected from electoral lists of 37 parishes of Gironde after stratification by age, sex, and size of urban unit; 68.9 percent agreed to participate. Baseline information was obtained from a one-hour home interview. Health measures included ADL, IADL, mobility, Rosow scale, and two subjective health assessments. Depressive symptomatology was assessed by the CES-D scale and cognitive functioning by Folstein's MMS. Dependence rates vary from 9.7 percent to 71.9 percent according to the indicator under consideration. Cross-sectional correlations with dependence are significant for age, sex, education, rural setting, joint pain, dyspnea, hearing and visual impairment, MMS score, and depression. In logistic regressions, only dyspnea, MMS score, and depression are always significantly correlated with dependence, whichever the indicator.
Article
SYNOPSIS The prevalence of dementia in elderly people living in the community was compared using data from Zaragoza (Spain) and Liverpool (UK). A standardized interview, the Geriatric Mental State (GMS), was administered to a random sample of 1070 persons in Liverpool and 1080 in Zaragoza. Using diagnoses derived from the GMS-AGECAT package we found no significant difference between the prevalence of dementia in Zaragoza (7·4%) and Liverpool (5·0%). The expected increase in prevalence with age was found, but the two cities did not appear to differ in the relationship between age and prevalence. No sex difference was apparent, and the two cities do not differ in the relationship between sex and prevalence.
Article
SYNOPSIS The steps to setting up a population register of elderly residents are described. Based upon this, 87·2% of the elderly residents of an inner-city electoral area were screened for memory disorder, depression and activity limitation using the Short CARE. Contact with medical and social agencies was also recorded; 4·7% were classed as cases by the dementia diagnostic scale, sufferers being older and not living alone. Of the residents 15·9% were classed as depressed, this state being more prevalent in those not currently married. The depresse were, in contrast to the demented residents, likely to be in recent contact with hospital and general practitioner. Thirty-two per cent of the population showed impairment in daily activity, these individuals were usually older, not married and receiving hospital care. Sleep disorder and compliant of many somatic symptoms were associated with a diagnosis of depression. In contrast, most respondents with a subjective complaint of memory disorder, which was common in this population, were neither suffering from depression nor dementia. With this accurate sampling frame and a good response rate, the prevalence rate of clinical depression must be seen as disturbingly high. The prevalence rate of dementia approximated to that of other surveys. This study also indicated that general practitioners' lists may be inaccurate and that non-responders to first approaches for interview, although similar in demographic features to those responding, may contain among them many suffering from dementia.