ArticlePDF Available

Depression among older people in Europe: the EURODEP studies



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.
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.
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
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
Department of Psychiatry, University of Liverpool, UK;
Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands;
Department of Psychiatry,
University of Maastricht, The Netherlands;
INSERM U360, Hôpital de la Salpêtriere, Paris, France;
DOC-Team Oude Hoeverweg 10, 1816 BT Alkmaar, The
Department of Psychiatry of the Elderly, St. James’s Hospital, Dublin, Ireland;
Department of General Practice, University of Turku and Satakunta
Central Hospital, Turku and Pori, Finland;
Department of Psychiatry, University Hospital, Zaragoza, Spain;
Heilsugaeslustod Grundarfjardar, Iceland;
Sections of
Epidemiology and General Practice and Old Age Psychiatry, Institute of Psychiatry, London, UK;
Department of Psychiatry, University of Munich, Germany;
of Epidemiology, Institute of Psychiatry, London, UK;
Department of Psychiatry, Freie Universität, Berlin, Germany;
Department of Behaviour Therapy and
Counselling, University of Gent, Belgium;
Psykiatriska Kliniken, Sahlgrenska Sjukhuset, Goteborg, Sweden;
Clinica Psichiatrica, Ospedale Civile, Brescia, Italy
WPA4_09_Copeland 30-01-2004 15:32 Pagina 45 (Black/Process Black pellicola)
WWoorrlldd PPssyycchhiiaattrryy 33::11 --
February 2004
(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
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.
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).
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,
WPA4_09_Copeland 30-01-2004 15:32 Pagina 46 (Black/Process Black pellicola)
found around 10 % of case level depression received anti-
depressant medication.
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.
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.
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.
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.
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.
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.
The EURO-D Scale, it appeared, could be reduced to
two well characterised factors, ‘motivation’ and ‘affective
WPA4_09_Copeland 30-01-2004 15:32 Pagina 47 (Black/Process Black pellicola)
WWoorrlldd PPssyycchhiiaattrryy 33::11 --
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.
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.
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.
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 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.
1. Beekman ATF, Copeland JRM, Prince MJ. Review of community
prevalence of depression in later life. Br J Psychiatry 1999;174:
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
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)
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
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
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)
... Anxiety and depression are common psychiatric disorders in the older population (Baxter et al., 2013;Copeland et al., 2004). For example, a study of 13,808 adults aged ≥65 years from seven European countries showed that the prevalence of depression is around 12% (Copeland et al., 2004). ...
... Anxiety and depression are common psychiatric disorders in the older population (Baxter et al., 2013;Copeland et al., 2004). For example, a study of 13,808 adults aged ≥65 years from seven European countries showed that the prevalence of depression is around 12% (Copeland et al., 2004). With global population aging (Beard et al., 2016), the number of older people with psychiatric disorders is projected to increase (Andreas et al., 2017). ...
Background Little is known about the potential impact of falls on the onset of common mental disorders in older adults. Thus, we aimed to investigate the longitudinal association between falls and incident anxiety and depressive symptoms in adults aged ≥50 years living in Ireland. Methods Data from the Irish Longitudinal Study on Ageing were analyzed (Wave 1: 2009-2011; and Wave 2: 2012-2013). The presence of falls and injurious falls in the past 12 months was assessed at Wave 1. Anxiety and depressive symptoms were assessed at Wave 1 and Wave 2 using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and the 20-item Center for Epidemiologic Studies Depression (CES-D), respectively. Covariates included sex, age, education, marital status, disability, and the number of chronic physical conditions. The association of falls at baseline with incident anxiety and depressive symptoms at follow-up was estimated by multivariable logistic regression. Results This study included 6,862 individuals (51.5% women; mean [SD] age 63.1 [8.9] years). After adjusting for covariates, falls were significantly associated with anxiety (OR=1.58, 95%CI=1.06-2.35) and depressive symptoms (OR=1.43, 95%CI=1.06-1.92). These associations were no longer significant after including fear of falling in the models. Similar findings were obtained for injurious falls, although the relationship with anxiety symptoms was not statistically significant. Conclusions This prospective study of older adults from Ireland found significant associations between falls and incident anxiety and depressive symptoms. Future research may focus on whether interventions to reduce fear of falling could also alleviate anxiety and depressive symptoms.
... For example, higher depression rates were found among women, older populations, and those who were underweight or obese. [17][18][19][20] Similarly, socio economic status might be associated with depression. 21 Thus, it is important to consider the combined effects of multiple risk factors when comparing the prevalence of depression at a specific timepoint or over time. ...
... During the last decades, societies have improved their efforts to build sustainable societies where people could experience wellbeing and happiness. Nonetheless, people are experiencing increasing levels of sadness, worry and anxiety (Copeland et al., 2004;Davey et al., 2022). Depressive disorders are estimated to affect 300 million people worldwide (WHO, 2017). ...
Full-text available
BACKGROUND: Depression is characterized by affective symptoms and cognitive deficits. After psychological and medical treatment, affective symptoms frequently remit, but cognitive alterations may remain, affecting the academic and professional lives of people and having an impact on health, economy, and societies. The present publication refers to one experiment of a study entitled MUDGAME. The main purpose of the whole study is to analyze the changes derived from video games that include simultaneous cognitive and physical stimulation (exergames), in terms of cognitive functioning, psychomotor abilities and its neural substrate, in adults suffering from depression. In this protocol, we will analyze the methods, procedures, and equipment that we will use to specifically measure the effects of exergames on executive functions (EFs) under depression. EFs are complex functions that are essential for organizing information, planning an action, reasoning, decision-making, and problem-solving and they are compromised in depression, affecting daily life activities. METHODS: The experiment consists of a randomized three-arm controlled study. Middle-aged adults with depression will be randomly distributed into three experimental groups: an intervention group training with exergames, an active control group training only with cognitive video games, and a passive control group or wait-list. EFs are evaluated at three different time points: before the cognitive-behavioral intervention, after the intervention, and three months after finishing the training intervention, using the Wisconsin Card Sorting Test (WCST). We collect cognitive-behavioral and neural information (event-related potentials, ERPs). RESULTS: Performing analysis of variance (ANOVA) to compare the outcomes of the diverse groups at the three different time points, we will analyze the benefits of exergames in terms of EFs under depression. CONCLUSIONS: The study of effects of simultaneous multidomain interventions on executive functions under depression holds promise for the development of novel approaches to implement psychological and neuropsychological health. Trial Registration: Open Science Framework. No.10.17605/OSF.IO/Z4S9Q. Registered 17 October 2023. LICENSE: CC-By Attribution 4.0 International
... In a European study, the prevalence of mental ill-health among older adults was seen to vary between 7 to 40%, relevant to varying diagnosis criteria (Kujawska-Danecka et al., 2016). Common threats to mental health are symptoms of depression (Andreas et al., 2017;Copeland et al., 2004;Luijendijk et al., 2008;Skoog, 2011), anxiety disorders (Kujawska-Danecka et al., 2016) and mental problems related to dementia (Onyike, 2016;Wittchen et al., 2011). Mental ill-health among older adults may be challenging for health and social care professionals to recognize as the way the disorders are expressed can differ between younger and older age groups (Malkin et al., 2019;Skoog, 2011). ...
Full-text available
In this paper we sought to explore health and social care professionals’ self-rated confidence in helping older adults with mental ill-health in non-psychiatric care settings. A cross-sectional survey study was performed exploring the participants’ ( n = 480) confidence in helping. Confidence in helping was analyzed together with background characteristics and selected explanatory variables, such as the workplace and work experience of the participants, their personal experiences of and attitudes to mental ill-health, as well as their knowledge in mental ill-health among older adults, by means of descriptive statistics and logistic regression analysis. We found that approximately half (55%) of the participants were confident in helping older adults with mental ill-health. The odds ratios for being confident in helping were significantly associated to the workplace of the professionals, professionals’ attitude to and experience of mental ill-health, and knowledge of mental health among older adults. To increase confidence in helping older adults with mental ill-health, we recommend confidence-building interventions, for example, educational programs, through which knowledge of mental health among older adults is increased and negative attitudes are challenged, especially within the context of specialist somatic healthcare.
... A c c e p t e d M a n u s c r i p t Depressive symptoms were assessed through the EURO-D scale including 12 items: depressed mood, pessimism, wishing death, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment, and tearfulness (Copeland et al., 2004;Prince et al., 1999). With each item coded as 0 (symptom absent) and 1 (symptom present), a sum score was generated ranging from 0 to 12, with higher values indicating more depressive symptoms present in the respondent (Boisgontier et al., 2020). ...
Full-text available
Background and Objectives The ubiquity of multimorbidity makes it crucial to examine the intermediary factors linking it with quality of life (QoL). The objective was to examine to what extent the association between multimorbidity and QoL was mediated by functional and emotional/mental health and how these mediation pathways differed by sociodemographic factors (age, gender, education, financial strain). Research Design and Methods Data from waves 4 to 8 of 36,908 individuals from the Survey of Health, Aging and Retirement in Europe (SHARE) were included. Multimorbidity (exposure) was defined as having two or more chronic conditions. Mediators included limitations with (instrumental) activities of daily living (ADL and IADL), loneliness, and depressive symptoms. QoL (outcome) was assessed with the CASP-12 scale. Longitudinal model-based causal mediation analyses were performed to decompose the total association between multimorbidity and QoL into direct and indirect effects. Moderated mediation analyses tested for differences in mediation pathways by sociodemographic factors. Results Multimorbidity was significantly associated with lower QoL (direct effect: b = -0.66). This association was mediated by ADL limitations (percentage mediated 0.97%), IADL limitations (3.24%), and depressive symptoms (16.70%), but not by loneliness. The mediation pathways were moderated by age, education, financial strain, and gender. Discussion and Implications ADL, IADL, and depressive symptoms are crucial intermediary factors between multimorbidity and QoL in older European adults, with changing importance according to age, education, financial strain, and gender. The findings may help to increase the QoL of individuals with multimorbidity and redirect care efforts to these factors.
... Depressive symptoms were assessed using the Depression Symptoms Scale of the EURO-DEP consortium (EURO-D scale) (Copeland et al., 2004;Prince et al., 1999). The EURO-D scale consists of 12 items: Depressed mood, pessimism, death wish, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment, and tearfulness. ...
Objective: Why people with lower levels of educational attainment have poorer mental health than people with higher levels can partly be explained by financial circumstances. However, whether behavioral factors can further explain this association remains unclear. Here, we examined the extent to which physical activity mediates the effect of education on mental health trajectories in later life. Methods: Data from 54,818 adults 50 years of age or older (55 % women) included in the Survey of Health, Aging and Retirement in Europe (SHARE) were analyzed using longitudinal mediation and growth curve models to estimate the mediating role of physical activity (baseline and change) in the association between education and mental health trajectories. Education and physical activity were self-reported. Mental health was derived from depressive symptoms and well-being, which were measured by validated scales. Results: Lower education was associated with lower levels and steeper declines in physical activity over time, which predicted greater increases in depressive symptoms and greater decreases in well-being. In other words, education affected mental health through both levels and trajectories of physical activity. Physical activity explained 26.8 % of the variance in depressive symptoms and 24.4 % in well-being, controlling for the socioeconomic path (i.e., wealth and occupation). Conclusions: These results suggest that physical activity is an important factor in explaining the association between low educational attainment and poor mental health trajectories in adults aged 50 years and older.
... The problems of old age cause the elderly to become marginalized and turn them from having an active role to having a passive role, and cause dissatisfaction, loneliness, depression, and consequently, a decrease in their personal and social activities [40]. Depressed older adults make less effort to establish their social relationships due to the decrease in energy, motivation and change in their attitude towards issues; these changes gradually reduce their social interactions [20]. Planning by health care providers to optimally fill the time of the elderly, training the elderly to create and increase relationships with the people around them, as well as family-oriented training on how to interact with the elderly can reduce the feeling of loneliness in them and lead to reducing depression and improving social functioning. ...
Full-text available
Objectives: Due to the rapid growth of the elderly population, it is very important to pay attention to their mental health indicators including feeling of loneliness, social functions and depression. This study aims to determine the mediating role of depression in the relationship between feeling of loneliness and social functioning in the elderly. Methods & Materials: In this correlational cross-sectional study, 318 older adults covered by the comprehensive health centers in Bushehr, south of Iran in 2018 were selected using a simple random sampling method. To collect data, Russell’s UCLA loneliness scale (version 3), and Goldberg’s general health questionnaire (Depression and social dysfunction subscales) were used. We applied the partial least squares-structural equation modeling to analyze the data in PLS Graph version 3.00 software. The significance level was set at 0.05. Results: The mean age of the participants was 66.74±5.87 years; 55.3% were male and the rest were female. The results showed that feeling of loneliness directly (β=0.199, P
Background and aims: Depressive symptoms are common symptoms impairing the quality of life of older people. This population-based birth year cohort study investigated the prevalence of depressive symptoms and factors associated with them among home-dwelling older people. Study Design: A prospective, population-based 15-year follow-up study of the age cohort of 70-year-olds living in the city of Turku, Finland. Methods: The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920 (n=1530). Follow-ups using the same procedure were conducted in 2001 and 2006. All examinations included an identical study protocol; the participants’ self-reported health status/habits and depressive symptoms were investigated via a questionnaire. Afterwards, thorough clinical examinations including the Zung depression scale were conducted by a nurse and physician/geriatrician. Results: The mean of the Zung depression scale total score was 34 (SD 7.7) at the age of 70 and a significant increase was found in both re-examinations. At the age of 80 the mean of the Zung score was 35.8 (SD 7.5) while it was 37.6 (SD 8.9) at the age of 85 years. A similar increasing trend was found in the proportion of persons classified into the high Zung score group (≧45 points) indicating more depressive symptoms over the 15 year follow-up. Univariate and multivariate analyses showed that mostly functional and social factors were associated with subjectively reported depressive symptoms, while few associations were evidenced between depressive symptoms and medical conditions or poor health. Conclusions: Our findings revealed an increase in prevalence of depressive symptoms throughout the course of the investigation. Our findings suggest that even in the absence of a diagnosis of major depression, depressive symptoms assume importance in the evaluation of the health status and need for health care services among older people.
Objective: Concurrent polypharmacy and potentially-inappropriate-medication (PIMs) use with antidepressants in older adults is understudied. We investigated the prevalence and associated user characteristics of concurrent polypharmacy (≥5 drugs) and PIMs with antidepressants in all older adults (≥65 years) in Denmark based on prescriptions filled at community pharmacies during 2015-2019. Method: We applied a cross-sectional and cohort study design using socio-demographic and clinical data from Danish registers. Results: A total of 261,479 older adults (mean age 76 years, females 63%) redeemed at least one prescription of antidepressants during 2015-2019. The prevalence of polypharmacy was 73%, and PIMs was 56%, with over 80% using at least one other nervous system drug or cardiovascular system drug concomitantly with antidepressants. Characteristics associated with higher concurrent use of polypharmacy and PIM with antidepressants were older age, marital status as widow/widower/separated/single, place of residence predominantly in the rural regions, non-western origin, and having somatic diagnoses. Some characteristics showed opposite directions of the associations with the two outcomes, including previous antidepressant use and psychiatric diagnoses being associated with higher use of polypharmacy but lower use of PIM. Conclusion: High polypharmacy and PIM use with antidepressants underline the importance of regularly reviewing pharmacological treatments in older adults with depression.
Background and objective: Antidepressant use in older adults (≥ 65 years) is understudied in large population-based samples, particularly in recent years and regarding user characteristics. We aimed to describe the trends, patterns, and associated user characteristics of all antidepressant prescriptions redeemed by older adults at community pharmacies in Denmark during 2015-2019. Methods: This register-based study used a cross-sectional design to characterize antidepressant prescription trends and patterns, and a cohort design to describe user characteristics associated with antidepressant prescription initiation. We used descriptive statistics to characterize trends and patterns, and Poisson regression for analyzing user characteristics. Results: During the years 2015-2019, 17.9% of 1.2 million older adults redeemed 4.84 million antidepressant prescriptions, where 48.5% were selective serotonin reuptake inhibitors, followed by noradrenergic and specific serotonergic antidepressants (26.2%), serotonin-norepinephrine reuptake inhibitors (12.7%), tricyclic antidepressants (11.2%), and others (1.4%). Amitriptyline and nortriptyline, considered potentially inappropriate medications, were among the 10 most frequently redeemed antidepressants. Only 60.5% of prescriptions had a treatment indication of depression. Prescription-proportion trends by drug classes and individual antidepressants remained consistent. A higher incidence rate ratio (IRR) and 95% confidence interval (CI) of initiating antidepressants was associated with female sex (IRR 1.20, 95% CI 1.07-1.34), older age (e.g., 81-85 years vs. 65-70 years: IRR 1.74, 95% CI 1.44-2.11), living in rural areas (North Denmark vs. Capital Region: IRR 1.31, 95% CI 1.09-1.58), and having somatic and psychiatric diagnoses (e.g., per one psychiatric diagnosis: IRR 1.10, 95% CI 1.05-1.15), while a lower ratio was associated with being non-Western (vs. Danish: IRR 0.50, 95% CI 0.28-0.89) and having hospital contacts for psychiatric treatment (per each contact: IRR 0.96, 95% CI 0.93-1.00). Conclusion: SSRIs were the most commonly redeemed antidepressants, with consistent trends in Danish older adults. Besides clinical conditions, sociodemographics, e.g., sex, age, ethnicity, and place of residence, may influence antidepressant use.
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.
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.
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)
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.
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.
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.
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.
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.
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.
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.