Ageing and trajectories of depressive symptoms in community-dwelling men and women.

OBJECTIVE: The aim of this study was to investigate age-related patterns of depressive symptoms in older men and women and to identify their determinants. METHODS: The Center for Epidemiological Studies Depression Scale was used to prospectively assess depressive symptoms in 1059 men and 1531 women, enrolled in a French representative population-based cohort (PAQUID study) and followed over a period of 20 years. Using a group-based trajectory method with an accelerated longitudinal design, we modelled the course of depressive symptoms between 65 and 104 years of age and examined associations between trajectory patterns and baseline socio-demographic and health variables. RESULTS: In men, we identified three rising trajectories: 'never depressed' including 65% of the sample, 'emerging depression' (28%) and 'increasing depression' (7%). Compared with the membership of the never-depressed trajectory, that of the two higher trajectories was significantly associated with a history of depression and dyspnoea. In women, we identified two slightly rising trajectories (never depressed, 56%, and 'rising subclinical', 33%) and one stable high trajectory ('persistent depression', 11%). Membership of the two higher trajectories was significantly associated with the use of benzodiazepine, polymedication and dyspnoea. A history of nondepressive psychiatric disorder was a risk factor for membership of the persistent-depression group, whereas being widowed seemed to be a protective factor for membership of this group. CONCLUSION: High-risk groups for later-life depression should be targeted differently in older men and women in order to implement appropriate interventions to prevent chronicity and disability.

Plasma eicosapentaenoic acid is inversely associated with severity of depressive symptomatology in the elderly: data from the Bordeaux sample of the Three-City Study.

BACKGROUND: Depressive symptoms are commonly observed in elderly people, and nutritional factors such as polyunsaturated fatty acids (PUFAs) have been proposed as potential protective determinants of depressive disorders. OBJECTIVE: The objective was to analyze the relation between plasma fatty acids and severity of depressive symptomatology (DS) in French elderly community dwellers. DESIGN: The study population (mean age: 74.6 y) consisted of 1390 subjects from Bordeaux (France) included in the Three-City Study cohort. DS was evaluated by using the Center for Epidemiologic Studies Depression scale. The use of antidepressant drugs was recorded. The proportion of each plasma fatty acid was determined. Cross-sectional analysis of the association between plasma fatty acids and severity of DS was performed by multilinear regression. RESULTS: Compared with control subjects, subjects with DS were older, were more often women, were more often widowed or single, were of lower income, were receiving antidepressant treatment more frequently, had a lower incidence of hypercholesterolemia, and had lower Mini-Mental State Examination scores (mean: -1.1 point; P < 0.0001). Plasma eicosapentaenoic acid (EPA) was lower in the subjects with DS than in the control subjects (0.85% compared with 1.01%; P = 0.001). There were no significant differences in any other fatty acid. When adjusted for potential confounders, such as sociodemographic characteristics and health indicators, plasma EPA was inversely associated with the severity of DS (beta = -0.170, P = 0.040) in subjects taking antidepressants. CONCLUSION: Higher plasma EPA was associated with a lower severity of DS in elderly subjects, especially those taking antidepressants.

Evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large sample of older French people: Results from the personnes agées quid study.

OBJECTIVES: To describe the evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large representative sample of older community-dwelling French people. DESIGN: Prospective cohort designed in 1988/89 to study cerebral and functional aging. SETTING: Urban and rural communities in southwestern France. PARTICIPANTS: Three thousand six hundred thirty-seven adults aged 65 and older living in noninstitutional settings at baseline. MEASUREMENTS: Participants were interviewed 3, 5, 8, and 10 years after the initial data collection. Depressive symptomatology was evaluated using a French version of the Center for Epidemiological Studies Depression Scale. Longitudinal analysis of the prevalence of depressive symptomatology was performed using a logistic mixed model adjusted for antidepressant use, sex, age, education level, living conditions, psychiatric antecedents, drug consumption, and diagnosis of dementia. RESULTS: Over the 10 years of follow-up, the prevalence of depressive symptomatology decreased from 13.8% to 8.3%. This decrease was statistically significant even after adjustment (odds ratio = 0.88 per increased year, 95% confidence interval = 0.85-0.90) and was more pronounced in subjects having reported previous depression at baseline. During the same period, antidepressant use rose from 5.2% to 11.9%, mainly due to increased use of selective serotonin reuptake inhibitors. Furthermore, the proportion of subjects who had depressive symptoms and did not use antidepressants decreased from 11.8% to 6.2%. CONCLUSION: This study suggests better management of late-life depression in the last decade and illustrates the heterogeneity of depression disorder in late life.

[Descriptive epidemiology and risk factors of depression in the elderly]. / Epidémiologie descriptive, facteurs de risque, étiologie de la dépression du sujet âgé.

Depressive symptoms are frequent among the elderly, and seriously impair their quality of life. The prevalence of depressive symptoms is difficult to evaluate on account of several epidemiological problems, such as the various definitions of "depression", which often prevent comparisons between studies. The second major difficulty is related to the selection bias due to differences in populations studied, and to the high risk of refusal to participate among the depressed subjects. Nevertheless, the prevalence has been estimated, in general population, from 1 to 4% for major depression according to the DSM-IV criteria, and from 8 to 16% for depressive symptoms which may require treatment. The heterogeneity of the symptomatology of depression in the elderly, with atypical clinical feature, leads to underestimate its diagnosis and lack of proper medical care. However, effective treatments exist and most cases of depression among elderly are treatable. In the literature, many risk factors of depression among the elderly have been identified : female sex, low socio-economical level, bereavement, prior depression, co-morbidities, disability, cognitive deterioration and vascular factors. To decrease the consequences of depression and to improve the quality of life of the elderly, the screening and treatment of depression should be strengthened in the general elderly population.