Cross-cultural comparison of depressive symptoms in Europe does not support stereotypes of ageing

Risk factors of major depression in the elderly

Background

Several risk factors of depression have been identified in retrospective as well as some prospective studies in the elderly. Confirmation in independent samples is needed. The present follow-up study prospectively investigated risk factors of depression in an elderly German sample.

Methods

One thousand four hundred and thirty-one subjects from a family study were re-investigated after 4.7 ± 2.5 years. Bivariate and multivariate forward logistic regression analyses were used to identify risk factors of the development of new depression in the elderly.

Results

Risk factors of a new depressive episode in 1408 elderly without current depression were age, female gender, a previous depression, subjective memory impairment, previous anxiety and somatoform disorders. The presence of dementia or mild cognitive impairment were significant risk factors in bivariate, but not multivariate analysis controlling for possible confounding. Risk factors of a first geriatric depressive episode were age, gender and subjective memory impairment; age remained the only significant risk factor in multivariate analysis.

Conclusions

This investigation confirms previous studies from other countries concerning the relevance of risk factors for depression in the elderly. The knowledge of risk factors might help identify subjects at increased risk of depression for early intervention approaches. Elderly with a history of previous depression carry the highest risk.

Depression in Chinese men undergoing different assisted reproductive technique treatments: prevalence and risk factors

PURPOSE

To explore the prevalence and risk factors for depression in men undergoing different assisted reproductive technique (ART) treatments in Chinese population.

METHOD

This was a prospective study of 844 men undergoing ART treatments. All men were distributed to four groups, according to they received treatments. The treatments included IUI (intrauterine insemination), IVF(in vitro fertilization), ICSI(intra cytoplasmatic sperm injection) and TESA/PESA (percutaneous epididymal sperm aspiration/testicular sperm aspiration). Their symptoms of depression were measured with use of the Center for Epidemiologic Studies of Depression scale(CES-D). Data were collected about age, BMI, education, duration of marriage, duration of infertility, smoking, type of infertility, infertility causes, history of ejaculation failure, and financial burden of the treatment. We estimated the prevalence of depressive symptom in men undergoing different ART and used logistic regression models to identify risk factors for depression in different groups.

RESULTS

The overall prevalence of depression was 13.3 % for men undergoing ART treatments: 14.5 % of IUI group, 12.4 % of IVF group, 19.2 % of ICSI group and 6.2 % of TESA/PESA group. Prevalence of depression among IUI group, IVF group and ICSI group were not significantly different. For IUI group, the factors were found to increase depression risk were treatment financial burden and duration of marriage, to decrease depression risk was age. For IVF group, the risk factors independently associated with depression were both male and female infertility, unexplained infertility, and history of ejaculation failure.

CONCLUSION

In a sample of Chinese men undergoing ART treatments, the prevalence of depression was higher than other country. The risk factors for depression varied in different ART treatments groups. when routine screening to identify the sub-group of vulnerable men which need counselling before ART treatments, we should also consider which pattern of ART treatments the man underwent.

Factors associated with a depressive disorder in Alzheimer's disease are different from those found for other dementia disorders

Background

This study explores factors associated with depression in Alzheimer's disease (AD) compared with mild cognitive impairment (MCI) and other dementia disorders.

Method

In a prospective study we included 195 patients: 31 with MCI, 112 with AD and 52 with other dementias.

Results

According to the ICD-10 and the DSM-IV criteria, 88 (44.1%) and 59 (30.3%), respectively, had a depressive disorder. An adjusted multiple regression analysis showed that previous depression (p < 0.05) was significantly associated with depression in AD patients. Severity of dementia (p < 0.05) was significantly associated with a depressive disorder in a group of patients with frontotemporal dementia, vascular dementia, or dementia due to Lewy Body disease or Parkinson's disease.

Conclusion

We found different factors associated with a depressive disorder in AD compared to those found for other dementia disorders.

Depression prevalence: is it really increasing?

OBJECTIVE

There is conflicting evidence as to whether depression prevalence is increasing or is stable. Although birth cohort analysis studies show increasing prevalence, longitudinal studies do not. To date there are no published Australian studies providing long-term estimates of depression prevalence. The aim of the present study was to examine the increasing depression prevalence hypothesis in an Australian context.

METHOD

Data from the 1998 and 2004 South Australian Health Omnibus Surveys were re-analysed. In each survey there were >3000 participants who were interviewed. The data were weighted to achieve representativeness prior to analysis. Depression status was classified by the Primary Care Evaluation of Mental Disorders scale (the PRIME-MD) into major, other and no depressions. Both univariate and multivariable analyses were used to examine depression trends over time and to adjust the data for significant background variables.

RESULTS

There was no significant increase in the cases of patients classified with major depression between 1998 and 2004; there was, however, a significant decrease in other depression. The overall unadjusted prevalence of major depression was 7.4% (6.8% in 1998 and 8.0% in 2004) and for other depression it was 9.5% (10.6% in 1998 and 8.4% in 2004). The highest levels of depression, both major and other, were observed among females aged 15-29 years, and the lowest levels among those aged > or =50 years. The strongest predictor of depression was poor overall health status.

CONCLUSION

It is time for the conventional wisdom that depression is increasing to be reconsidered, and for a more realistic perspective, developed from evidence-based analyses, to be accepted.

Children's impact on the mental health of their older mothers and fathers: findings from the Survey of Health, Ageing and Retirement in Europe

The relation between social support and mental health has been thoroughly researched and structural characteristics of the social network have been widely recognised as being an important component of social support. The aim of this paper is to clarify the association between children and depressive mood states of their older parents. Based on international comparative data from the Survey of Health, Ageing and Retirement in Europe we analysed how the number of children, their proximity and the frequency of contact between older parents and their children are associated with the mental health of older people, using the EURO-D index. Our results indicate a positive association of children and depressive mood since childless men and women report more depressive symptoms. Moreover, few contacts with children were associated with an increased number of depressive symptoms. The family status was related to mental health as well: older men and women living with a spouse or partner had the lowest levels of depression. Interestingly, the presence of a spouse or partner was more relevant for the mental health of older people than the presence of, or contact with, their children.

Universal features of personality traits from the observer's perspective: data from 50 cultures

To test hypotheses about the universality of personality traits, college students in 50 cultures identified an adult or college-aged man or woman whom they knew well and rated the 11,985 targets using the 3rd-person version of the Revised NEO Personality Inventory. Factor analyses within cultures showed that the normative American self-report structure was clearly replicated in most cultures and was recognizable in all. Sex differences replicated earlier self-report results, with the most pronounced differences in Western cultures. Cross-sectional age differences for 3 factors followed the pattern identified in self-reports, with moderate rates of change during college age and slower changes after age 40. With a few exceptions, these data support the hypothesis that features of personality traits are common to all human groups.

The Geriatric Mental State Examination in the 21st century

The Geriatric Mental State Examination (GMS) is now established as one of the most commonly used mental health assessments for older people. Its strengths lie in extensive validity studies, high inter-rater reliability, accessibility to trained raters, irrespective of professional background and its continual evolution and adaptation. Its computerisation, association with supplementary instruments and support by a diagnostic algorithm provides a comprehensive diagnostic system and syndrome profile for each subject. The instrument has been validated against most major diagnostic systems and has been used as outcome measures in intervention studies. It has been translated into numerous languages and validated as a diagnostic instrument in various cultures. Such studies have exposed weaknesses, including the over diagnoses of organic states in populations with poorly developed education. On-going studies continue to address these issues, providing a culture sensitive instrument enabling unique trans-cultural research in a relatively under-researched field.

Depression of older age. Origins of the study

BACKGROUND

The EURODEP collaboration was formed to take advantage of existing studies of random community samples of older people in Europe, using GMS-AGECAT for case identification and diagnosis. Later, other centres joined, and the EURO-D scale was developed to harmonise the different methods used with the GMS. Previous studies had revealed different levels of depression in Europe but had been confounded by the use of unreconcilable methods. These studies attempt to overcome this problem.

AIMS

To introduce the first set of publications from the EURODEP collaboration.

METHOD, RESULTS AND CONCLUSIONS

Presented in five accompanying papers (pp. 307-345, this issue).

Development of the EURO-D scale--a European, Union initiative to compare symptoms of depression in 14 European centres

BACKGROUND

In an 11-country European collaboration, 14 population-based surveys included 21,724 subjects aged > or = 65 years. Most participating centres used the Geriatric Mental State (GMS), but other measures were also used.

AIMS

To derive from these instruments a common depression symptoms scale, the EURO-D, to allow comparison of risk factor profiles between centres.

METHOD

Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile.

RESULTS

The EURO-D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation).

CONCLUSIONS

The EURO-D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.

Depression in Europe. Geographical distribution among older people

BACKGROUND

This is the first report of results from the EURODEP Programme.

AIMS

To assess the prevalence of depression judged suitable for intervention in randomised samples of those aged > or = 65 in nine European centres.

METHOD

The GMS-AGECAT package.

RESULTS

Differences in prevalence are apparent, 8.8% (Iceland) to 236% (Munich). When sub-cases and cases are added together, five high- and four low-scoring centres emerge. Women predominated over men. Proportions of sub-cases to cases revealed striking differences but did not explain prevalence. There was no constant association between prevalence and age. A meta-analysis (n = 13,808) gave an overall prevalence of 12.3%, 14.1% for women and 8.6% for men.

CONCLUSIONS

Considerable variation occurs in the levels of depression across Europe, the cause for which is not immediately obvious. Case and sub-case levels taken together show greater variability, suggesting that it is not a matter of case/sub-case selection criteria, which were standardised by computer. Substantial levels of depression are shown but 62-82% of persons had no depressive level. Opportunities for treatment exist.

Depression symptoms in late life assessed using the EURO-D scale. Effect of age, gender and marital status in 14 European centres

BACKGROUND

Data from surveys involving 21,724 subjects aged > or = 65 years were analysed using a harmonised depression symptom scale, the EURO-D.

AIMS

To describe and compare the effects of age, gender and mental status on depressive symptoms across Europe.

METHOD

We tested for the effects of centre, age, gender and marital status on EURO-D score. Between-centre variance was partitioned according to centre characteristics: region, religion and survey instrument used.

RESULTS

EURO-D scores tended to increase with age, women scored higher than men, and widowed and separated subjects scored higher than others. The EURO-D scale could be reduced into two factors: affective suffering, responsible for the gender difference, and motivation, accounting for the positive association with age.

CONCLUSIONS

Large between-centre differences in depression symptoms were not explained by demography or by the depression measure used in the survey. Consistent, small effects of age, gender and marital status were observed across Europe. Depression may be overdiagnosed in older persons because of an increase in lack of motivation that may be affectively neutral, and is possibly related to cognitive decline.