Physical health and depressive symptoms in older Europeans. Results from EURODEP.

BACKGROUND: Associations between physical health and depression are consistent across cultures among adults up to 65 years of age. In later life, the impact of physical health on depression is much more substantial and may depend on sociocultural factors. AIMS: To examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe. METHOD: Fourteen community-based studies on depression in later life in nine western European countries contributed to a total study sample of 22 570 respondents aged 65 years and older. Measures were harmonized for depressive symptoms (EURO-D scale), functional limitations and chronic physical conditions. RESULTS: In the majority of the participating samples, the association of depressive symptoms with functional disability was stronger than with chronic physical conditions. Associations were slightly more pronounced in the UK and Ireland. CONCLUSIONS: The association between physical health and depressive symptoms in later life is consistent across western Europe.

Religion as a cross-cultural determinant of depression in elderly Europeans: results from the EURODEP collaboration.

BACKGROUND: The protective effects of religion against late life depression may depend on the broader sociocultural environment. This paper examines whether the prevailing religious climate is related to cross-cultural differences of depression in elderly Europeans. METHODS: Two approaches were employed, using data from the EURODEP collaboration. First, associations were studied between church-attendance, religious denomination and depression at the syndrome level for six EURODEP study centres (five countries, N = 8398). Secondly, ecological associations were computed by multi-level analysis between national estimates of religious climate, derived from the European Value Survey and depressive symptoms, for the pooled dataset of 13 EURODEP study centres (11 countries, N = 17,739). RESULTS: In the first study, depression rates were lower among regular church-attenders, most prominently among Roman Catholics. In the second study, fewer depressive symptoms were found among the female elderly in countries, generally Roman Catholic, with high rates of regular church-attendance. Higher levels of depressive symptoms were found among the male elderly in Protestant countries. CONCLUSIONS: Religious practice is associated with less depression in elderly Europeans, both on the individual and the national level. Religious practice, especially when it is embedded within a traditional value-orientation, may facilitate coping with adversity in later life.

Development of the EURO-D scale--a European, Union initiative to compare symptoms of depression in 14 European centres.

BACKGROUND: In an 11-country European collaboration, 14 population-based surveys included 21,724 subjects aged > or = 65 years. Most participating centres used the Geriatric Mental State (GMS), but other measures were also used. AIMS: To derive from these instruments a common depression symptoms scale, the EURO-D, to allow comparison of risk factor profiles between centres. METHOD: Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile. RESULTS: The EURO-D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation). CONCLUSIONS: The EURO-D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.

Depression symptoms in late life assessed using the EURO-D scale. Effect of age, gender and marital status in 14 European centres.

BACKGROUND: Data from surveys involving 21,724 subjects aged > or = 65 years were analysed using a harmonised depression symptom scale, the EURO-D. AIMS: To describe and compare the effects of age, gender and mental status on depressive symptoms across Europe. METHOD: We tested for the effects of centre, age, gender and marital status on EURO-D score. Between-centre variance was partitioned according to centre characteristics: region, religion and survey instrument used. RESULTS: EURO-D scores tended to increase with age, women scored higher than men, and widowed and separated subjects scored higher than others. The EURO-D scale could be reduced into two factors: affective suffering, responsible for the gender difference, and motivation, accounting for the positive association with age. CONCLUSIONS: Large between-centre differences in depression symptoms were not explained by demography or by the depression measure used in the survey. Consistent, small effects of age, gender and marital status were observed across Europe. Depression may be overdiagnosed in older persons because of an increase in lack of motivation that may be affectively neutral, and is possibly related to cognitive decline.

Regional inequities in health expectancy in Belgium.

Mortality differs substantially between the Flemish and Walloon regions is Belgium. The question remains as to whether the health status of both populations varies in a similar way. The difference in healthy life expectancy, an indicator of population health, between the Flemish and Walloon regions was therefore assessed. In 1989-1990 a cross-sectional survey in the general population was performed in which 2640 persons were selected by a multistage random process. Perceived health status was determined through a validated question: "On the whole, how would you describe your health for the moment? Would you say it is very good/good/fair/rather bad/bad?" The prevalence of "being in good health (very good to fair)" was combined with mortality data (Sullivan method) to estimate the healthy life expectancy (HLE), and the following results were found. Among males, life expectancy (LE) and HLE at age 15 was 58.9 years and 56.5 years in the Flemish region, compared with 56.6 and 50.2 years in the Walloon region. At age 65, LE and HLE in the Flemish region was 14.3 and 13.3 years, and only 13.2 and 9.2 years in the Walloon region. Women at age 15 had an LE and HLE in the Flemish region of 65.2 years and 61.3 years, compared to 63.9 and 58.1 years in the Walloon region. At age 65, both the LE and the HLE in the Flemish region were higher, with LE at 18.5 versus 17.7 years, and HLE at 16.0 versus 14.3 years. Similar results were obtained when the criteria of "being in good health" were restricted to those indicating their health to be very good or good. In conclusion, the data indicate that the population in the Walloon region not only has a shorter life but apparently also has a shorter healthy life. Research is needed to explain what proportion of these differences can be attributed to differences in the prevalence of diseases, cultural differences and socio-economic differences.

The prevalence of dementia in Belgium: a population-based door-to-door survey in a rural community.

The project Epidemiology Research on Dementia in Antwerp (ERDA) estimated the prevalence of dementia in a random, population-based sample, stratified for age and sex. The sample of 1,736 elderly was screened at home with the Mini-Mental State Examination. All elderly under the cutoff of 23-24/30 got a diagnostic examination with the Cambridge Mental Disorders of the Elderly Examination and the DSM-IIIR criteria. The prevalence of dementia in the population above 65 years was estimated at 9%. The following age-specific prevalences of dementia (included mild dementia) were found in the age-groups 65-69, 70-74, 75-79, 80-84, 85+: 0.6, 5.1, 7.6, 16.2 and 33.6%. The prevalence of at least moderate dementia was 0.3, 3.9, 4.0, 11.2 and 25.0%, respectively. The prevalence of dementia, vascular dementia and dementia of the Alzheimer type was markedly higher in women than in men.

Epidemiology research on dementia in Antwerp, Belgium.

Epidemiological research on dementia in Belgium started in 1990 with a prevalence study. In the first phase of the MMSE was used for screening a random sample, stratified by age, of 1,800 aged people. In the second phase the diagnostic work was done by a psychiatrist using the CAMDEX. An incidence study will start after 2 years. Potential risk factors will be examined in a case-control study.