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Identification Of Risk Factors In Depression In The Elderly Could Improve Public Health

Five factors - bereavement, sleep disturbance, disability, prior depression and female gender - have been identified as risk factors for depression in people aged fifty years or more, by a qualitative analysis of previously published studies. The selected studies involved more than 20,000 subjects, of which 1,694 had incident depression. Forty-three risk factors were analysed.

The researchers, led by Martin Cole, MD, of St Mary's Hospital, Montreal Canada, searched the literature for relevant articles published between January 1966 and June 2001, and abstracted data from 20 studies meeting their inclusion criteria. These criteria were that: the studies were original research published in English or French; study groups consisted of community residents; the studies were of prospective design that excluded patients who were depressed at baseline; at least 1 risk factor for depression was studied; and an acceptable definition of depression was used in the study.

In addition to the 5 significant risk factors listed above, the qualitative analysis identified poor health, cognitive impairment, living alone, and a new medical illness as "uncertain risk factors". Higher age; lower educational level, being unmarried and poor social care, did not appear to be risk factors. Both multivariate and univariate qualitative analyses found disability, female gender, new medical illness, poor health status, prior depression, sleep disturbance, poor self-perceived health and bereavement to be risk factors for depression in 2 or more studies each.

Of note among the results was the identification of bereavement as a risk factor for depression. This contradicted an earlier study (see related link below), which found low rates of bereavement-related depression in the elderly. The authors of the study reviewed here suggested that the contradiction arose because the earlier study possibly failed to diagnose low-level symptomatic depression.

Although the researchers noted that their analyses had several limitations, mainly in relation to the differences in definitions and other factors between the various studies analysed, they said that information about the risk factors they had identified could serve several purposes. Whole populations at risk of depression could be identified and treatment could be focused on the most important potentially contributory factors. "Elderly populations could be screened to identify individuals at high risk of depression ... Subsequently, these individuals could be targeted for interventions to abate the 3 potentially modifiable risk factors [bereavement, sleep disturbance and disability] and reduce the risk of depression," the researchers said, concluding that this could be expected to have a positive impact on public health.
Am J Psychiatry 2003;160:6:1147-56. "Risk factors for depression among elderly community subjects: a systematic review and meta-analysis"

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