Research report
Emergence and persistence of late life depression: a 3-year follow-up of the Longitudinal Aging Study Amsterdam

https://doi.org/10.1016/S0165-0327(00)00243-3Get rights and content

Abstract

Background: The present study was designed to assess onset and persistence of late-life depression, systematically comparing the factors associated with prevalence, onset and prognosis. Methods: The data were derived from a large (n=2200), random, age and sex stratified sample of the elderly (55–85 years) in The Netherlands. Using a 3-year, prospective longitudinal design, both the onset and the persistence of depression were assessed. Depression was measured using the Center for Epidemiologic Studies Depression Scale. Risk factors associated with prevalence, onset and persistence were compared using both bivariate and multivariate analyses. Results: In those not depressed at index assessment, the onset of depression was 9.7%. Among those depressed at baseline, persistence occurred in 50.4%. Risk factors predicting onset were almost identical to those associated with prevalence. Persistence was predicted by very few factors (external locus of control and chronic physical illness). Conclusions: The data suggest that cross-sectional studies are biased due to their overrepresenting chronic depressive episodes. However, the risk factors derived from cross-sectional studies do seem to adequately reflect factors associated with onset. The prognosis is not adequately predicted by variables usually included in epidemiological studies of late life depression. It is speculated that including more biological correlates of depression and data concerning positive life-changes may improve our understanding of the prognosis of late life depression.

Introduction

There is accumulating evidence confirming the clinical and public health significance of late life depression (Copeland et al., 1992; Gurland, 1992; Blazer, 1994; Burvill and Hall, 1994; Beekman et al., 1995a, Beekman et al., 1997a). Nevertheless, little is known about the natural history of late life depression and about the factors determining both onset and prognosis. Studies of risk factors associated with onset are of importance to disentangle the aetiology and pathogenesis of late life depression, and to identify high risk groups or key processes that may be targeted for preventative measures. Studies of the factors determining the course of late life depression are important because they may help to identify subjects at risk to develop chronic depression and to design more effective treatment strategies. However, most of the evidence pertaining to riskfactors has been derived from cross-sectional studies. Cross-sectional data are prone to various biases. Both report and recall bias may cause depressed elderly subjects to selectively report exposure to important risk factors, when asked retrospectively in a survey-type study design (Raphael and Cloitre, 1994). A second disadvantage of cross-sectional designs is that the temporal ordering of events cannot be reliably ascertained, biasing associations between disease and risk factors. A third important concern is that, in cross-sectional studies, chronic cases are overrepresented. Especially in a disorder with a highly variable natural course, such as depression, this may seriously bias the associations found with important risk factors. A fourth, related issue, is that prevalence is the outcome of both incidence and prognosis. This means that the risk factors associated with prevalence represent a mix of both aetiology and prognosis. Cross-sectional data therefore cannot be used to distinguish whether risk factors are relevant to the aetiology or to the prognosis of depression.

As there is no reason to assume that emergence and outcome are determined by the same factors, and as distinction may facilitate both prevention and treatment, prospective data are important. The primary aim of the present paper was to systematically compare risk factors associated with the prevalence, emergence and persistence of late life depression in a large, community-based study of elderly. It was hypothesised that factors associated with persistence would be different from factors associated with the emergence of depression, the combination of both reflecting the factors associated with prevalence.

Section snippets

Sampling and procedures

The Longitudinal Aging Study Amsterdam (LASA) is a 10-year longitudinal study on predictors and consequences of changes in well-being and autonomy in the older population (Deeg et al., 1993). The sampling and procedures adopted to achieve the baseline sample were described in detail in previous papers (Beekman et al., 1995a, Beekman et al., 1997a, Beekman et al., 1997b). At the baseline measurement, which took place in 1992/1993, data on both depression and a comprehensive set of risk factors

Description of the sample

The characteristics of the sample reflect the stratified sampling design, which was aimed to result in even numbers of males and females in all age groups (Table 1). Due to the fact that the older old (especially males) were oversampled, the sample includes a relatively large number of not or no longer married subjects, with chronic illnesses, functional limitations and with cognitive decline. This shows that, although these factors predicted attrition to follow-up, all relevant variables are

Discussion

Emergence of depression occurred in nearly 10% of those not depressed at baseline. Five previous studies, carried out among elderly in the community have reported onset rates between 5 and 26%. Three of these used similar 1-year follow-ups and yielded very similar rates of onset (Kennedy et al., 1990, 9% onset; Gachaw et al., 1991, 10% onset; Prince et al., 1998, 12% onset). Lower rates of incidence were found in studies using both a shorter (6 months, Phifer and Murrell, 1986) and a longer (3

Acknowledgements

This study is based on data collected in the context of the Longitudinal Aging Study Amsterdam (LASA), which is funded largely by the Ministry of Welfare, Health and Sports of The Netherlands.

References (37)

  • L.F. Berkman et al.

    Depressive symptoms in relation to physical health and functioning in the elderly

    Am. J. Epidemiol.

    (1986)
  • D.G. Blazer

    Epidemiology of late-life depression

  • G.W. Brown et al.
  • P.W. Burvill et al.

    Predictors of increased mortality in elderly depressed patients

    Int. J. Geriatr. Psychiatry

    (1994)
  • Central Bureau of Statistics, 1989. Health Interview Questionnaire. CBS,...
  • J.R.M. Copeland et al.

    Alzheimer’s disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool

    Br. J. Psychiatry

    (1992)
  • D.J.H. Deeg et al.
  • J. de Jong-Gierveld et al.

    The development of a Rasch-type loneliness scale

    Appl. Psych. Meas.

    (1985)
  • Cited by (80)

    • Course of depressive symptoms and associated factors in people aged 65+ in Europe: A two-year follow-up

      2019, Journal of Affective Disorders
      Citation Excerpt :

      Our finding that female gender is an important predictor of depressive symptoms is also consistent with a number of previous studies (Beekman et al., 2001; Djernes et al.; 2006; Zunzunegui et al., 2007). The relevance of chronic diseases and of all aspects of physical health has also been widely reported (Beekman et al., 2001; Hegeman et al., 2017; Ylli et al., 2016). Although our analysis suggested that financial difficulties was also an important factor in relation to depression, this variable has been less often cited in previous research (Blazer, 2003; Portellano-Ortiz et al., 2017; Ylli et al., 2016).

    View all citing articles on Scopus
    View full text