Physical health and depressive symptoms in older Europeans. Results from EURODEP

BACKGROUND

Associations between physical health and depression are consistent across cultures among adults up to 65 years of age. In later life, the impact of physical health on depression is much more substantial and may depend on sociocultural factors.

AIMS

To examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe.

METHOD

Fourteen community-based studies on depression in later life in nine western European countries contributed to a total study sample of 22 570 respondents aged 65 years and older. Measures were harmonized for depressive symptoms (EURO-D scale), functional limitations and chronic physical conditions.

RESULTS

In the majority of the participating samples, the association of depressive symptoms with functional disability was stronger than with chronic physical conditions. Associations were slightly more pronounced in the UK and Ireland.

CONCLUSIONS

The association between physical health and depressive symptoms in later life is consistent across western Europe.

Religion as a cross-cultural determinant of depression in elderly Europeans: results from the EURODEP collaboration

BACKGROUND

The protective effects of religion against late life depression may depend on the broader sociocultural environment. This paper examines whether the prevailing religious climate is related to cross-cultural differences of depression in elderly Europeans.

METHODS

Two approaches were employed, using data from the EURODEP collaboration. First, associations were studied between church-attendance, religious denomination and depression at the syndrome level for six EURODEP study centres (five countries, N = 8398). Secondly, ecological associations were computed by multi-level analysis between national estimates of religious climate, derived from the European Value Survey and depressive symptoms, for the pooled dataset of 13 EURODEP study centres (11 countries, N = 17,739).

RESULTS

In the first study, depression rates were lower among regular church-attenders, most prominently among Roman Catholics. In the second study, fewer depressive symptoms were found among the female elderly in countries, generally Roman Catholic, with high rates of regular church-attendance. Higher levels of depressive symptoms were found among the male elderly in Protestant countries.

CONCLUSIONS

Religious practice is associated with less depression in elderly Europeans, both on the individual and the national level. Religious practice, especially when it is embedded within a traditional value-orientation, may facilitate coping with adversity in later life.

Depressive disorders and personality variables in HIV positive and negative intravenous drug-users

BACKGROUND

Only a few reports investigated the prevalence of depression in intravenous drug-users with HIV infection, including both asymptomatic and symptomatic subjects. In the same group, the association of depression and personality diagnoses was also poorly researched.

METHODS

A consecutive sample of intravenous drug-users was collected from patients admitted to an infectious disease clinic, another random sample was taken from out-patients attending a methadone maintenance treatment program. Subjects were first screened with the Hospital Anxiety and Depression Scale, and then all positive subjects were evaluated with the Composite International Diagnostic Interview. Depression was diagnosed according to DSM-IIIR. In-patients were also given a structured personality inventory (Karolinska Psychodynamic Profile).

RESULTS

HIV-positive patients had a high rate of depression (major depression 36.2%, dysthymic disorder 7.1%) when compared to HIV-negatives (15.7 and 3.9%, respectively). In-patients had the highest rate of depression, irrespective of HIV clinical staging. A personality disorder was diagnosed in 36% of the sample, but these subjects were no more significantly depressed.

LIMITATIONS

Poor detection of depression by the admitting physician may have led to selective hospitalization of patients with both HIV and mood disorder. The composition of the sample may also be biased by the help-seeking behavior of HIV patients who are also depressed.

CONCLUSION

Physicians treating AIDS patients should be alerted to the high rate of depression in clinical HIV illness, in order to identify and properly treat depression.

Variables associated with the hospitalization of psychiatric emergencies evaluated in the community

We investigated hospitalization factors in acutely ill patients visited by psychiatrists at home. A series of 100 consecutive calls for psychiatric emergencies of a community mental health centre were investigated with a structured evaluation of psychiatric symptoms and aggressiveness (IEF, GAS, and VSAS). First order interactions were tested, and selected variables were tested with logistic regression analysis. Admission was significantly associated with GAS scores (low scores were found in 92.6% of admitted patients vs. 43.8% of patients not admitted), paranoid delusions (66.7 vs. 39.7%), and lack of social support (70.4 vs. 30.1%). Multivariate analysis confirmed a significant independent effect only for low GAS score and lack of social support. The study replicated some findings from research on hospitalization in emergency wards, while other factors, such as 'diagnosis' and 'suicide risk', were not significant.

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

BACKGROUND

Stereotypes of older people suggest that they are depressed.

AIMS

To examine depression symptoms among people aged > or = 65 in the general population and to ask the following questions. Are there high proportions of depressive symptoms among otherwise well people? Do these levels reflect the prevalence of depression? Do key symptoms vary with age and do they confirm stereotypes?

METHOD

Nine centres contributed data from community-based random samples, using standardised methods (GMS-AGECAT package).

RESULTS

Proportions of depressive symptoms varied between centres. Some often associated with ageing were rare. Many were more common in women. Low-prevalence centres tended to have fewer symptoms among 'well' people, but there were inconsistencies. Low levels of symptoms among the well population of a centre did not necessarily predict lower levels in the depressed.

CONCLUSIONS

Variations in the prevalence of depressive symptoms occurred between centres, not always related to levels of illness. There was no consistent relationship between proportions of symptoms in well persons and cases for all centres. Few symptoms were present in > 60% of the older population--stereotypes of old age were not upheld.

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.

Inter-observer and test-retest reliability of the Italian version of the Karolinska Psychodynamic Profile in two groups of psychiatric patients

A total of 64 psychiatric patients were tested with the Italian version of the Karolinska Psychodynamic Profile in order to investigate interobserver and test-retest reliability. The mean inter-observer agreement coefficients (rho) ranged from 0.75 to 0.80 with less experienced psychiatrists, while the mean rho value was higher (0.96) with more experienced raters. Test-retest values were good, ranging from 0.53 to 0.93. Overall, reliability was comparable with that reported in the original Swedish study.

Increase of aldosterone secretion following acute haloperidol administration: possible clinical implications

The present study was designed to investigate the effect of haloperidol on plasma corticosteroid levels in a small sample of unmediated psychiatric patients requiring acute care. Seven young male normotensive subjects in metabolic balance received a single dose of haloperidol (2 mg i.v.). Blood samples were collected for the radioimmunoassay of plasma renin activity, cortisol and aldosterone concentration at baseline and 3, 6, 12 and 24 h after injection. In five out of seven patients a significant, transient elevation of plasma aldosterone level was observed within 12 h from administration. In contrast, plasma renin activity and cortisol concentration were unchanged. Possible clinical implications of the neuroleptic-associated aldosterone elevations are discussed.

Affective disorders among elderly general practice patients. A two-phase survey in Brescia, Italy

BACKGROUND

We investigated the prevalence of depression among 255 elderly general practice patients and the practitioners' performance in identifying depression.

METHOD

Elderly patients attending 14 general practices entered a screening phase with GHQ-12 and MMSE. Those positive were then interviewed with GMS and HAS.

RESULTS

DSM-III-R major depression affected 22.4%, dysthymic disorder 6.3%, not otherwise specified (n.o.s.) depression 7.1%. General practitioners performed fairly well: identification index 88.4%, accuracy 0.49, bias 1.85.

CONCLUSIONS

Depression was markedly high. A selective progression of depressed elderly from the community to general practitioners is implied.

A community survey of psychotropic drug consumption in South Verona: prevalence and associated variables

A cross-sectional community survey was undertaken to investigate the pattern of psychotropic drug consumption in 453 community residents of South Verona. Overall, 15.0% of the subjects were taking psychotropics (benzodiazepines 13.5%, antidepressants 2.2%, neuroleptics 1.1%). Prevalence was higher in females (20.0%), in those over 45 years (25%), in high General Health Questionnaire (GHQ) scorers (26.2%), and in subjects with physical ill-health (27.0%), with social problems (20.0%), with distressing events (22.0%) and with alcohol abuse (32.3%). Logistic regression analysis showed that age, sex, GHQ score, physical ill-health and life events were all significantly and independently associated with psychotropic drug consumption.

Social support, adversities and emotional distress in an Italian community sample

The association of social support with emotional distress in relation to adversities such as social problems, physical health and undesirable life events was assessed in an Italian community sample of 222 men and 224 women. Univariate comparisons and logistic regression analyses showed that neither the quality of a confiding core relationship nor social support from kin confidants was related to adversities. In women only, social support from friend confidants exerted a statistically significant independent main effect together with social problems and undesirable life events in producing a greater probability of emotional distress. The implications of these findings are discussed considering the socio-cultural characteristics of Italian families and individual coping strategies.

[Psychiatric disorders in elderly patients with physical problems. Critical review of the recent literature]

The authors review some studies of the recent psychiatric literature on the elderly medically ill. The large variability in setting, screening instruments, and diagnostic criteria makes comparison of results somehow difficult and probably accounts for the differences in prevalence rates. We also outline methodological issues relating to the standardization of screening instruments and to special features ("pseudodementia", "masked" depression) of psychiatric disorders in old age.

Life events, social problems and physical health status as predictors of emotional distress in men and women in a community setting

The main aim of this study was to construct logistic models of emotional distress (defined as a GHQ-30 score of 6 or greater) in a community sample of 226 men and 225 women. The independent variables included were: sociodemographic characteristics, physical health status, social problems and undesirable life events. Univariate comparisons showed that in both sexes undesirable life events and social problems were associated with emotional distress; in men the presence of physical symptoms and widowed, separated or divorced status also showed such an association. Separate logistic regression models for men and women confirmed the importance of undesirable life events and social problems as predictors for emotional distress. In women there was also a significant interaction effect between the two variables on emotional distress. Sociodemographic characteristics and physical health status did not exert a statistically significant effect in these models.

[Pseudodementia. A critical review of the literature]

A review is made of the concept of "pseudodementia" through the main studies of the literature on clinical series. These can be divided in homogeneous and heterogeneous diagnostic series. Some of the main methodological flows of the research on the subject are pointed out and the difficult problem of differential diagnosis between depressive pseudodementia and recent onset organic dementia is discussed.