Prevalence of Depressive Disorders

Recent community longitudinal studies have provided the opportunity to examine the prevalence and outcomes associated with depressive disorders in older adults. The Established Populations for Epidemiologic Studies of the Elderly (EPESE) in the United States is one such study. The EPESE program was a set of longitudinal studies sponsored by the National Institute on Aging to identify risk factors associated with mortality, morbidity and health services utilization in individuals 65 or older (Cornoni-Huntley et al., 1986). EPESE surveys were conducted in four sites and depression was measured using the Center for Epidemiologic Studies—Depression scale (CES-D) (Radloff, 1977). The prevalence of significant depressive symptomatology was 9.0% in the North Carolina sample (Blazer et al., 1991) and 15.1% in the New Haven sample (Cornoni-Huntley et al., 1986). In controlled analyses of the North Carolina data, depression was not associated with age. Specifically, the oldest old suffered fewer depressive symptoms when factors known to be associated with depression were simultaneously controlled (Blazer et al., 1991). A similar prevalence of 11.3% of depressive illness in adults over 65 was found in Liverpool (Copeland et al., 1987).

The prevalence of major depression as identified by the DIS was 1.2% among adults 65 or older in Edmonton (Bland et al., 1988). In the Longitudinal Aging Study Amsterdam (LASA), a study of adults 55-85 years of age conducted in the Netherlands, the prevalence of DIS defined major depression was 2.02%. The prevalence increased with age, from 1.3% in those subjects ages 55-59 to 2.7% in those 80-85. Among the LASA participants, the prevalence of clinically relevant depression was 14.9% (Beekman et al., 1995b). Henderson et al. reported from Australia the point prevalence of depressive episodes as defined by draft ICD-10 criteria in persons 70 or older was 3.3%. The prevalence of DSM-III-R major depression was 1.0%. The number of depressive symptoms did not increase with age (Henderson et al., 1993). Steffens et al. recently reported the prevalence of DSM-IV major depression in older adults was 4.4% in women and 2.7% in men (Steffens et al., 2000). Higher levels of DSM depression were also reported from the Hobart, Tasmania study. The prevalence was 6.3% in those 70-79 and 15.5% in those 80 or older (Kay et al., 1985). In summary, there is a range in the reported prevalence of depression depending on the criteria used. In addition, studies have provided mixed results concerning the relationship between depression and age.

The prevalence of depression in clinical settings is higher than that reported from community studies. In a review of the epidemiology of depression in primary care, Katon and Schulberg (1992) concluded that the prevalence of major depression increases linearly as studies move from the community to the primary care clinic to the inpatient medical ward. In a sample of primary care patients 60 years of age or older, the prevalence of major depression was 6.5%, while the prevalence of minor depression was 5.2% (Lyness et al., 1999a). In a study of HMO patients 65 or older, 14% met criteria for CES-D depression (Unutzer et al., 2000).

The prevalence of major depression in male veterans hospitalized with medical illness was 11.5%-13.3%, while the prevalence of minor depression was 23.0%-29.2% (Koenig et al., 1988, 1991). The prevalence of major depression was lower than that in veterans under 40, but the prevalence of minor depression was higher (Koenig et al., 1991). In another study, Koenig et al. reported the prevalence of major depression in male and female hospitalized adults 60 or older was 10% to 21%, depending on the diagnostic scheme used. The prevalence of minor depression varied from 14% to 25% (Koenig et al., 1997).

Among 708 aged nursing home and congregate apartment residents, the prevalence of possible major depression was 12.4%. Another 30.5% reported less severe depressive symptoms. Possible major depression was more prevalent among newly admitted residents, while long-term residents were more likely to report minor depression (Parmelee et al., 1989).

The incidence, or onset, of depression in late life, though important, has been less studied. In a study of 875 nondepressed older adults with a mean age of 85, the incidence of depression was 4.1%. The incidence of first onset depression was 1.4% per person year (0.8% for males and 1.5% for females). Characteristics at baseline associated with incidence of depression were having a dementia, insufficient social network, and having more than two depressive symptoms at baseline (Forsell and Winblad, 1999). A lower incidence of 133.49 per 1000 person years at risk was reported in another study of adults 85 or older in Munich (Meller et al., 1996). A similar incidence was reported from Australia in a sample of community dwelling elders 70 or older followed for three to six years. Of those nondepressed, 2.5% had become cases of major depression during the follow up period (Henderson et al., 1997). In a sample of adults 55 or older in The Netherlands followed for one year, the incidence was much higher. A total of 16% suffered an incident depression (Beekman et al., 1995a).

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