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