The 12-month outcome of 103 elderly depressed patients treated by psychiatrists in Perth, Western Australia, was good in 32-47% of cases, depending upon the stringency of the outcome criteria used. A higher than expected mortality was found, especially in men. No clear association was found between 12-month outcome and a variety of clinical variables at index admission, including chronic physical illness, severity of depression, and severe life events during follow-up. As the statistical power of this and other studies is small, it would be unwise at present to draw definite conclusions about the role of possible risk factors in the prognosis of depressed elderly. Vigorous treatment of the depressive illness and adequate after-care are important.

Routine outcome assessment using reliable and valid instruments is practical, and could lead to improvements in the quality of care for psychiatric patients.

Elderly patients with early-onset and late-onset depressive illness presenting to psychiatrists for treatment were compared for social, demographic, and clinical measures. For most factors measured no statistically significant differences were found. In the early-onset cases, patients were significantly more severely depressed. There was some evidence for the hypotheses that family history is less important and biological factors more important in late-onset depression. It is suggested that the latter hypothesis should be tested by a range of the newer neuroanatomical and neurophysiological laboratory investigations. The findings indicate that neuroticism is an important underlying factor in both early-onset and late-onset depression in the elderly.

A total of 101 elderly depressed patients and 85 community residents (matched for age and sex) were interviewed about life events, difficulties, and confiding relationships. Significantly more of the depressed sample reported at least one severe event in the three months before the onset of their illness. Lack of a good confiding relationship was associated with depression in men but not in women. In this relatively affluent Australian sample, life difficulties were rare and, probably as a result, were not significantly associated with depression.

Elderly patients with early-onset and late-onset depressive illness presenting to psychiatrists for treatment were compared for social, demographic, and clinical measures. For most factors measured no statistically significant differences were found. In the early-onset cases, patients were significantly more severely depressed. There was some evidence for the hypotheses that family history is less important and biological factors more important in late-onset depression. It is suggested that the latter hypothesis should be tested by a range of the newer neuroanatomical and neurophysiological laboratory investigations. The findings indicate that neuroticism is an important underlying factor in both early-onset and late-onset depression in the elderly.