Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study

Weyerer, Siegfried; Eifflaender-Gorfer, Sandra; Wiese, Birgitt; Luppa, Melanie; Pentzek, Michael; Bickel, Horst; Bachmann, Cadja; Scherer, Martin; Maier, Wolfgang; Riedel‐Heller, Steffi G.

doi:10.1093/ageing/afs184

Cited by 79 publications

(84 citation statements)

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“…However, our finding is consistent with a study examining psychiatric euthanasia and assisted suicide cases in the Netherlands [39]. Older people have an increased risk of having lost a partner, of experiencing social isolation or of the accumulation of chronic physical conditions associated with old age, which are in turn risk factors for depression and are associated with developing a wish to die [40–42]. However, research also showed that a majority of older respondents with a wish to die suffered from depressed mood without meeting the diagnostic criteria to qualify for a depressive disorder [40, 41].…”

Section: Discussionsupporting

confidence: 89%

Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases

et al. 2017

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BackgroundEuthanasia for people who are not terminally ill, such as those suffering from psychiatric disorders or dementia, is legal in Belgium under strict conditions but remains a controversial practice. As yet, the prevalence of euthanasia for people with psychiatric disorders or dementia has not been studied and little is known about the characteristics of the practice. This study aims to report on the trends in prevalence and number of euthanasia cases with a psychiatric disorder or dementia diagnosis in Belgium and demographic, clinical and decision-making characteristics of these cases.MethodsWe analysed the anonymous databases of euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia from the implementation of the euthanasia law in Belgium in 2002 until the end of 2013. The databases we received provided the information on all euthanasia cases as registered by the Committee from the official registration forms. Only those with one or more psychiatric disorders or dementia and no physical disease were included in the analysis.ResultsWe identified 179 reported euthanasia cases with a psychiatric disorder or dementia as the sole diagnosis. These consisted of mood disorders (N = 83), dementia (N = 62), other psychiatric disorders (N = 22) and mood disorders accompanied by another psychiatric disorder (N = 12). The proportion of euthanasia cases with a psychiatric disorder or dementia diagnosis was 0.5% of all cases reported in the period 2002–2007, increasing from 2008 onwards to 3.0% of all cases reported in 2013. The increase in the absolute number of cases is particularly evident in cases with a mood disorder diagnosis. The majority of cases concerned women (58.1% in dementia to 77.1% in mood disorders). All cases were judged to have met the legal requirements by the Committee.ConclusionsWhile euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder or dementia remains a comparatively limited practice in Belgium, its prevalence has risen since 2008. If, as this study suggests, people with psychiatric conditions or dementia are increasingly seeking access to euthanasia, the development of practice guidelines is all the more desirable if physicians are to respond adequately to these highly delicate requests.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1369-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases

et al. 2017

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“…First, several of our key findings (e.g., regarding physical/functional limitation, medical comorbidity and sleep) were consistent with prior reports (2, 3, 9, 33, 34). Similarly in keeping with prior work (4, 5, 8, 35–38), we observed that physical inactivity and smoking were independently related to LLD risk. Second, in an expansion upon the existing literature, we were able to demonstrate dosage effects for most exposures; prior studies typically lacked adequate sample sizes or exposure detail to do so (4, 8, 35, 37, 38).…”

Section: Discussionsupporting

confidence: 89%

“…Similarly in keeping with prior work (4, 5, 8, 35–38), we observed that physical inactivity and smoking were independently related to LLD risk. Second, in an expansion upon the existing literature, we were able to demonstrate dosage effects for most exposures; prior studies typically lacked adequate sample sizes or exposure detail to do so (4, 8, 35, 37, 38). Third, our findings regarding caregiving reinforced the importance of distinguishing types of caregiving activities: in our study, high volume of caregiving to disabled/ill persons was related to higher LLD risk, in line with a cross-sectional study (39), while decreased LLD risk was found for high volume of caregiving to children/grandchildren.…”

Section: Discussionsupporting

confidence: 89%

“…However, other potentially modifiable factors have been examined less comprehensively. In the literature in investigating LLD risk, potential limitations include: (1) risk factor information is often available once at baseline (4, 5); (2) association patterns (threshold/dose-response/plateau effects) are unclear due to lack of data (6); (3) since health and lifestyle behaviors are often correlated, studying one factor without adjustment for relevant confounders may bias results; and (4) although average daily alcohol intake has been examined in prospective studies (4, 7, 8), the specific relation of heavy or binge drinking to LLD risk has been relatively understudied.…”

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confidence: 99%

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Risk factors for late-life depression: A prospective cohort study among older women

Chang

Pan

Kawachi

et al. 2016

Preventive Medicine

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Depression prevention requires identifying key risk contributors. Prior studies have identified several factors related to late-life depression but have seldom addressed factors jointly or in dose-response fashion. This study aimed to examine a wide range of potential predisposing factors and to estimate individual and joint contributions to risk of late-life depression in women. A total of 21,728 women aged ≥65 years, without prior depression, in the Nurses’ Health Study conducted in the United States were followed from 2000–2010. Demographic, social, lifestyle/behavioral and health variables were selected a priori from the literature or previous findings in this cohort. Depression was defined as physician/clinician-diagnosed depression, regular antidepressant use, or the presence of severe depressive symptoms. During 10-year follow-up, 3,945 incident cases were identified. After simultaneous multivariable-adjustment, multiple factors in the domains of social stress (lower self-rated societal position and high volume of caregiving to disabled/ill relatives), unfavorable lifestyle (smoking, physical inactivity, heavy or binge drinking), and poor physical health (multiple comorbidity burden, excessive sleep, difficulty falling/staying asleep, bodily pain, and physical/functional limitation or disability) were significantly associated with higher depression risk; many featured dose-response relationships. Sensitivity analyses that excluded outcomes within 2 years yielded similar estimates. The total population attributable fraction for all factors was 55.5%. Physical/functional limitation accounted for one-quarter of population attributable fraction, followed by problematic sleep, inadequate exercise, and pain (combining for one-third of population attributable fraction). Efforts to remediate or prevent these factors may contribute to an efficient strategy for late-life depression prevention in women.

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“…15 A German study that followed an older adult (aged older than 65 years) primary care cohort using a depression screening tool estimated the incidence of screened depression to be 42.7 per 1,000 patients. 16 Cross-cultural studies indicate that women are more likely to develop depression than men. 17 In our study, we found the incidence of depressive symptoms was greater in women (6.30% in women vs 4.15% in men).…”

Section: Discussionmentioning

confidence: 99%

The 12-Month Incidence and Predictors of PHQ-9-Screened Depressive Symptoms in Chinese Primary Care Patients

Chin

Wan

Choi

et al. 2016

The Annals of Family Medicine

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PURPOSE Evidence regarding the onset of depressive symptoms in primary care is rarely available but can help inform policy development, service planning, and clinical decision making. The objective of this study was to estimate the 12-month cumulative incidence and predictors of a positive screen for depressive symptoms on the 9-item Patient Health Questionnare-9 (PHQ-9) among primary care patients with no history of physician-diagnosed depression. METHODSWe monitored a cohort of 2,929 adult primary care patients with no past history of physician-diagnosed depression and with baseline PHQ-9 scores of 9 or lower by telephone interview at 3, 6, and 12 months. A generalized linear mixed effects Poisson Model was used to explore factors associated with the incidence of PHQ-positive symptoms. RESULTSThe cumulative incidence of positive screening on the PHQ-9 over 12 months was 5.23% (95% CI, 3.83%-6.64%). Positive predictors included being female, coming from a lower-income household, being a smoker, having at least 2 comorbidities, having a family history of depression, and having consulted a physician at least twice in the past 4 weeks. Consulting a physician with qualifications in both family medicine and psychological medicine was a negative predictor. CONCLUSIONSThe cumulative incidence of PHQ-9-screened depressive symptoms in this study population was higher than those reported for depressive disorders in earlier systematic reviews. Groups who may warrant greater treatment attention include women, patients with multimorbidity, smokers, patients with recent high rates of medical consultations, and those who are from lower-income households or who have a family history of depression. Greater physician training may have a protective effect.

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Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study

Abstract: the incidence of depression increased significantly with age. In designing prevention programmes, it is important to call more attention on functional impairment, cognitive impairment and smoking.

Cited by 79 publications

References 26 publications

Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases

Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases

Risk factors for late-life depression: A prospective cohort study among older women

The 12-Month Incidence and Predictors of PHQ-9-Screened Depressive Symptoms in Chinese Primary Care Patients

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