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A practical approach to assess depression risk and to guide risk reduction strategies in later life

Published online by Cambridge University Press:  30 September 2010

Osvaldo P. Almeida ,
Helman Alfonso ,
Jane Pirkis ,
Ngaire Kerse ,
Moira Sim ,
Leon Flicker ,
John Snowdon ,
Brian Draper ,
Gerard Byrne  and
Robert Goldney
...Show all authors
Osvaldo P. Almeida*
Affiliation:
Western Australian Centre for Health & Ageing, Centre for Medical Research of the University of Western Australia, Perth, Australia School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia Department of Psychiatry, Royal Perth Hospital, Perth, Australia
Helman Alfonso
Affiliation:
Western Australian Centre for Health & Ageing, Centre for Medical Research of the University of Western Australia, Perth, Australia School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
Jane Pirkis
Affiliation:
School of Population Health, University of Melbourne, Melbourne, Australia
Ngaire Kerse
Affiliation:
School of Population Health, University of Auckland, Auckland, New Zealand
Moira Sim
Affiliation:
School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Perth, Australia
Leon Flicker
Affiliation:
Western Australian Centre for Health & Ageing, Centre for Medical Research of the University of Western Australia, Perth, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
John Snowdon
Affiliation:
Department of Psychological Medicine, University of Sydney, Sydney, Australia
Brian Draper
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia
Gerard Byrne
Affiliation:
School of Medicine, University of Queensland, Brisbane, Australia
Robert Goldney
Affiliation:
Department of Psychiatry, University of Adelaide, Adelaide, Australia
Nicola T. Lautenschlager
Affiliation:
Western Australian Centre for Health & Ageing, Centre for Medical Research of the University of Western Australia, Perth, Australia School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia Academic Unit for Psychiatry of Old Age, St Vincent's Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
Nigel Stocks
Affiliation:
Unit of General Practice, University of Adelaide, Adelaide, Australia
Marcia Scazufca
Affiliation:
Institute and Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
Martijn Huisman
Affiliation:
EMGO Institute for Health and Care Research, Department of Psychiatry, VU University Medical Center; Department of Sociology, VU University Amsterdam, Amsterdam, The Netherlands
Ricardo Araya
Affiliation:
Department of Psychiatry, University of Bristol, Bristol, U.K.
Jon Pfaff
Affiliation:
Western Australian Centre for Health & Ageing, Centre for Medical Research of the University of Western Australia, Perth, Australia School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
*
Correspondence should be addressed to: Professor Osvaldo P. Almeida, WA Centre for Health & Ageing (M573), University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia. Phone: +61 8 9224 2720; Fax: +61 8 9224 8009. Email: [email protected].
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Abstract

Background: Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies.

Methods: A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer.

Results: The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors.

Conclusions: Our probabilistic matrix can be used to estimate depression risk and to guide the introduction of risk reduction strategies. Future studies should now aim to clarify whether interventions designed to mitigate the impact of risk factors can change the prevalence and incidence of depression in later life.

Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 2 , March 2011 , pp. 280 - 291
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Alexopoulos, G. S., Meyers, B. S., Young, R. C., Campbell, S., Silbersweig, D. and Charlson, M. (1997). Vascular depression hypothesis. Archives of General Psychiatry, 54, 915–922.CrossRefGoogle ScholarPubMed
Almeida, O. P. and Pfaff, J. J. (2005). Depression and smoking amongst older general practice patients. Journal of Affective Disorders, 86, 317–321.CrossRefGoogle ScholarPubMed
Almeida, O. P., Burton, E. J., Ferrier, N., McKeith, I. G. and O'Brien, J. T. (2003). Depression with late onset is associated with right frontal lobe atrophy. Psychological Medicine, 33, 675–681.CrossRefGoogle ScholarPubMed
Almeida, O. P., Norman, P., Hankey, G., Jamrozik, K. and Flicker, L. (2006). Successful mental health aging: results from a longitudinal study of older Australian men. American Journal of Geriatric Psychiatry, 14, 27–35.CrossRefGoogle ScholarPubMed
Almeida, O. P. et al. (2007). Association of cardiovascular risk factors and disease with depression in later life. American Journal of Geriatric Psychiatry, 15, 506–513.CrossRefGoogle ScholarPubMed
Almeida, O. P., McCaul, K., Hankey, G. J., Norman, P., Jamrozik, K. and Flicker, L. (2008a). Homocysteine and depression in later life. Arch Gen Psychiatry, 65, 1286–1294.CrossRefGoogle ScholarPubMed
Almeida, O. P., Yeap, B. B., Hankey, G. J., Jamrozik, K. and Flicker, L. (2008b). Low free testosterone concentration as a potentially treatable cause of depressive symptoms in older men. Archives of General Psychiatry, 65, 283–289.CrossRefGoogle ScholarPubMed
Almeida, O. P., Calver, J., Jamrozik, K., Hankey, G. J. and Flicker, L. (2009a). Obesity and metabolic syndrome increase the risk of incident depression in older men: the Health In Men Study. American Journal of Geriatric Psychiatry, 17, 889–898.CrossRefGoogle ScholarPubMed
Almeida, O. P. et al. (2009b). Polymorphisms of the CRP gene inhibit inflammatory response and increase susceptibility to depression: the Health in Men Study. International Journal of Epidemiology, 38, 1049–1059.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Arroll, B., Khin, N. and Kerse, N. (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ, 327, 1144–1146.CrossRefGoogle ScholarPubMed
Baas, K. D. et al. (2009). Screening for depression in high-risk groups: prospective cohort study in general practice. British Journal of Psychiatry, 194, 399–403.CrossRefGoogle ScholarPubMed
Barkow, K., Maier, W., Ustun, T. B., Gansicke, M., Wittchen, H. U. and Heun, R. (2003). Risk factors for depression at 12-month follow-up in adult primary health care patients with major depression: an international prospective study. Journal of Affective Disorders, 76, 157–169.CrossRefGoogle ScholarPubMed
Beard, J. R., Tracy, M., Vlahov, D. and Galea, S. (2008). Trajectory and socioeconomic predictors of depression in a prospective study of residents of New York City. Annals of Epidemiology, 18, 235–243.CrossRefGoogle Scholar
Beekman, A. T., Copeland, J. R. and Prince, M. J. (1999). Review of community prevalence of depression in later life. British Journal of Psychiatry, 174, 307–311.CrossRefGoogle ScholarPubMed
Bolton, J. M., Robinson, J. and Sareen, J. (2009). Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders, 115, 367–375.CrossRefGoogle ScholarPubMed
Bradley, R. G. et al. (2008). Influence of child abuse on adult depression: moderation by the corticotropin-releasing hormone receptor gene. Archives of General Psychiatry, 65, 190–200.CrossRefGoogle ScholarPubMed
Brilman, E. I. and Ormel, J. (2001). Life events, difficulties and onset of depressive episodes in later life. Psychological Medicine, 31, 859–869.CrossRefGoogle ScholarPubMed
Bruce, M. L. (2002). Psychosocial risk factors for depressive disorders in late life. Biological Psychiatry, 52, 175–184.CrossRefGoogle ScholarPubMed
Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B. and Bruce, M. L. (2010). High occurrence of mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Archives of General Psychiatry, 67, 489–496.CrossRefGoogle ScholarPubMed
Chi, I. et al. (2005). Prevalence of depression and its correlates in Hong Kong's Chinese older adults. American Journal of Geriatric Psychiatry, 13, 409–416.CrossRefGoogle Scholar
Cohen, G. D. (2000). Loneliness in later life. American Journal of Geriatric Psychiatry, 8, 273–275.CrossRefGoogle ScholarPubMed
Cole, M. G. and Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160, 1147–1156.CrossRefGoogle ScholarPubMed
Cuijpers, P., van Straten, A. and Smit, F. (2006). Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials. International Journal of Geriatric Psychiatry, 21, 1139–1149.CrossRefGoogle ScholarPubMed
D'Agostino, R. B. Sr. et al. (2008). General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation, 117, 743–753.CrossRefGoogle ScholarPubMed
Draper, B. et al. (2008). Long-term effects of childhood abuse on the quality of life and health of older people: results from the Depression and Early Prevention of Suicide in General Practice Project. Journal of the American Geriatrics Society, 56, 262–271.CrossRefGoogle ScholarPubMed
El Hage, W., Powell, J. F. and Surguladze, S. A. (2009). Vulnerability to depression: what is the role of stress genes in gene × environment interaction? Psychological Medicine, 39, 1407–1411.CrossRefGoogle Scholar
Elley, C. R., Kerse, N. M. and Arroll, B. (2003). Why target sedentary adults in primary health care? Baseline results from the Waikato Heart, Health, and Activity Study. Preventive Medicine, 37, 342–348.CrossRefGoogle ScholarPubMed
Gallo, J. J., Rabins, P. V., Lyketsos, C. G., Tien, A. Y. and Anthony, J. C. (1997). Depression without sadness: functional outcomes of nondysphoric depression in later life. Journal of the American Geriatrics Society, 45, 570–578.CrossRefGoogle ScholarPubMed
Goldberg, D., Privett, M., Ustun, B., Simon, G. and Linden, M. (1998). The effects of detection and treatment on the outcome of major depression in primary care: a naturalistic study in 15 cities. British Journal of General Practice, 48, 1840–1844.Google ScholarPubMed
Gunn, J. M. et al. (2008). Who is identified when screening for depression is undertaken in general practice? Baseline findings from the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) longitudinal study. Medical Journal of Australia, 188, S119–125.CrossRefGoogle ScholarPubMed
Hamalainen, J. et al. (2001). Cigarette smoking, alcohol intoxication and major depressive episode in a representative population sample. Journal of Epidemiology and Community Health, 55, 573–576.CrossRefGoogle Scholar
Heo, M., Murphy, C. F., Fontaine, K. R., Bruce, M. L. and Alexopoulos, G. S. (2008). Population projection of US adults with lifetime experience of depressive disorder by age and sex from year 2005 to 2050. International Journal of Geriatric Psychiatry, 23, 1266–1270.CrossRefGoogle ScholarPubMed
Holley, C., Murrell, S. A. and Mast, B. T. (2006). Psychosocial and vascular risk factors for depression in the elderly. American Journal of Geriatric Psychiatry, 14, 84–90.CrossRefGoogle ScholarPubMed
Kessler, R. C. et al. (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289, 3095–3105.CrossRefGoogle ScholarPubMed
King, M. et al. (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study. Archives of General Psychiatry, 65, 1368–1376.CrossRefGoogle ScholarPubMed
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J. and Johnson, B. T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine, 5, e45.CrossRefGoogle ScholarPubMed
Klungsoyr, O., Nygard, J. F., Sorensen, T. and Sandanger, I. (2006). Cigarette smoking and incidence of first depressive episode: an 11-year, population-based follow-up study. American Journal of Epidemiology, 163, 421–432.CrossRefGoogle ScholarPubMed
Koenig, H. G., Westlund, R. E., George, L. K., Hughes, D. C., Blazer, D. G. and Hybels, C. (1993). Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics, 34, 61–69.CrossRefGoogle ScholarPubMed
Koster, A. et al. (2006). Socioeconomic differences in incident depression in older adults: the role of psychosocial factors, physical health status, and behavioral factors. Journal of Psychosomatic Research, 61, 619–627.CrossRefGoogle ScholarPubMed
Kritz-Silverstein, D., Barrett-Connor, E. and Corbeau, C. (2001). Cross-sectional and prospective study of exercise and depressed mood in the elderly: the Rancho Bernardo study. American Journal of Epidemiology, 153, 596–603.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Ladin, K. (2008). Risk of late-life depression across 10 European Union countries: deconstructing the education effect. Journal of Aging and Health, 20, 653–670.CrossRefGoogle ScholarPubMed
Lenze, E. J. et al. (2000). Comorbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry, 157, 722–728.CrossRefGoogle ScholarPubMed
Lorant, V., Croux, C., Weich, S., Deliege, D., Mackenbach, J. and Ansseau, M. (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. British Journal of Psychiatry, 190, 293–298.CrossRefGoogle ScholarPubMed
McDougall, F. A. et al. (2007). Prevalence of depression in older people in England and Wales: the MRC CFA Study. Psychological Medicine, 37, 1787–1795.CrossRefGoogle ScholarPubMed
Mottram, P., Wilson, K. and Strobl, J. (2006). Antidepressants for depressed elderly. Cochrane Database of Systematic Reviews, CD003491.CrossRefGoogle Scholar
NHMRC (2001). Australian Alcohol Guidelines: Health Risks and Benefits. Canberra: Commonwealth of Australia.Google Scholar
NZGG (2003). The Assessment and Management of Cardiovascular Risk. Wellington: New Zealand Guidelines Group.Google Scholar
Pasco, J. A. et al. (2008). Tobacco smoking as a risk factor for major depressive disorder: population-based study. British Journal of Psychiatry, 193, 322–326.CrossRefGoogle ScholarPubMed
Pearson, T. A. et al. (2002). AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke, 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation, 106, 388–391.CrossRefGoogle ScholarPubMed
Pfaff, J. J. and Almeida, O. P. (2005). A cross-sectional analysis of factors that influence the detection of depression in older primary care patients. Australian and New Zealand Journal of Psychiatry, 39, 262–265.CrossRefGoogle ScholarPubMed
Pirkis, J. et al. (2009). The community prevalence of depression in older Australians. Journal of Affective Disorders, 115, 54–61.CrossRefGoogle ScholarPubMed
Prince, M. et al. (2007). No health without mental health. Lancet, 370, 859–877.CrossRefGoogle ScholarPubMed
Roberts, R. E., Deleger, S., Strawbridge, W. J. and Kaplan, G. A. (2003). Prospective association between obesity and depression: evidence from the Alameda County Study. International Journal of Obesity and Related Metabolic Disorders, 27, 514–521.CrossRefGoogle ScholarPubMed
Samuelsson, G., McCamish-Svensson, C., Hagberg, B., Sundstrom, G. and Dehlin, O. (2005). Incidence and risk factors for depression and anxiety disorders: results from a 34-year longitudinal Swedish cohort study. Aging and Mental Health, 9, 571–575.CrossRefGoogle ScholarPubMed
Schoevers, R. A., Beekman, A. T., Deeg, D. J., Geerlings, M. I., Jonker, C. and Van Tilburg, W. (2000). Risk factors for depression in later life; results of a prospective community based study (AMSTEL). Journal of Affective Disorders, 59, 127–137.CrossRefGoogle ScholarPubMed
Schoevers, R. A. et al. (2006). Prevention of late-life depression in primary care: do we know where to begin? American Journal of Psychiatry, 163, 1611–1621.CrossRefGoogle ScholarPubMed
Smit, F., Ederveen, A., Cuijpers, P., Deeg, D. and Beekman, A. (2006). Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Archives of General Psychiatry, 63, 290–296.CrossRefGoogle ScholarPubMed
Smit, F., Smits, N., Schoevers, R., Deeg, D., Beekman, A. and Cuijpers, P. (2008). An epidemiological approach to depression prevention in old age. American Journal of Geriatric Psychiatry, 16, 444–453.CrossRefGoogle Scholar
Soares, C. N., Almeida, O. P., Joffe, H. and Cohen, L. S. (2001). Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Archives of General Psychiatry, 58, 529–534.CrossRefGoogle ScholarPubMed
Sriwattanakomen, R. et al. (2008). Preventing depression in later life: translation from concept to experimental design and implementation. American Journal of Geriatric Psychiatry, 16, 460–468.CrossRefGoogle ScholarPubMed
Stek, M. L., Vinkers, D. J., Gussekloo, J., Beekman, A. T., Van Der Mast, R. C. and Westendorp, R. G. (2005). Is depression in old age fatal only when people feel lonely? American Journal of Psychiatry, 162, 178–180.CrossRefGoogle ScholarPubMed
Steyerberg, E. W., Harrell, F. E., Jr., Borsboom, G. J., Eijkemans, M. J., Vergouwe, Y. and Habbema, J. D. (2001). Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. Journal of Clinical Epidemiology, 54, 774–781.CrossRefGoogle ScholarPubMed
Strawbridge, W. J., Deleger, S., Roberts, R. E. and Kaplan, G. A. (2002). Physical activity reduces the risk of subsequent depression for older adults. American Journal of Epidemiology, 156, 328–334.CrossRefGoogle ScholarPubMed
Thombs, B. D. et al. (2008). Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA, 300, 2161–2171.CrossRefGoogle ScholarPubMed
Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A. and Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, 252–260.CrossRefGoogle ScholarPubMed
van't Veer-Tazelaar, P. J. et al. (2009). Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Archives of General Psychiatry, 66, 297–304.CrossRefGoogle ScholarPubMed
Williamson, M. K. et al. (2007). Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study. BMC Medical Research Methodology, 7, 42.CrossRefGoogle ScholarPubMed