Skip to main content
    • Aa
    • Aa

A practical approach to assess depression risk and to guide risk reduction strategies in later life

  • Osvaldo P. Almeida (a1) (a2) (a3), Helman Alfonso (a1) (a2), Jane Pirkis (a4), Ngaire Kerse (a5), Moira Sim (a6), Leon Flicker (a1) (a7) (a8), John Snowdon (a9), Brian Draper (a10), Gerard Byrne (a11), Robert Goldney (a12), Nicola T. Lautenschlager (a1) (a2) (a13), Nigel Stocks (a14), Marcia Scazufca (a15), Martijn Huisman (a16), Ricardo Araya (a17) and Jon Pfaff (a1) (a2)...

Background: Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies.

Methods: A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer.

Results: The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors.

Conclusions: Our probabilistic matrix can be used to estimate depression risk and to guide the introduction of risk reduction strategies. Future studies should now aim to clarify whether interventions designed to mitigate the impact of risk factors can change the prevalence and incidence of depression in later life.

Corresponding author
Correspondence should be addressed to: Professor Osvaldo P. Almeida, WA Centre for Health & Ageing (M573), University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia. Phone: +61 8 9224 2720; Fax: +61 8 9224 8009. Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G. S. Alexopoulos , B. S. Meyers , R. C. Young , S. Campbell , D. Silbersweig and M. Charlson (1997). Vascular depression hypothesis. Archives of General Psychiatry, 54, 915922.

O. P. Almeida and J. J. Pfaff (2005). Depression and smoking amongst older general practice patients. Journal of Affective Disorders, 86, 317321.

O. P. Almeida , E. J. Burton , N. Ferrier , I. G. McKeith and J. T. O'Brien (2003). Depression with late onset is associated with right frontal lobe atrophy. Psychological Medicine, 33, 675681.

O. P. Almeida , P. Norman , G. Hankey , K. Jamrozik and L. Flicker (2006). Successful mental health aging: results from a longitudinal study of older Australian men. American Journal of Geriatric Psychiatry, 14, 2735.

O. P. Almeida (2007). Association of cardiovascular risk factors and disease with depression in later life. American Journal of Geriatric Psychiatry, 15, 506513.

O. P. Almeida , K. McCaul , G. J. Hankey , P. Norman , K. Jamrozik and L. Flicker (2008a). Homocysteine and depression in later life. Arch Gen Psychiatry, 65, 12861294.

O. P. Almeida , B. B. Yeap , G. J. Hankey , K. Jamrozik and L. Flicker (2008b). Low free testosterone concentration as a potentially treatable cause of depressive symptoms in older men. Archives of General Psychiatry, 65, 283289.

O. P. Almeida , J. Calver , K. Jamrozik , G. J. Hankey and L. Flicker (2009a). Obesity and metabolic syndrome increase the risk of incident depression in older men: the Health In Men Study. American Journal of Geriatric Psychiatry, 17, 889898.

O. P. Almeida (2009b). Polymorphisms of the CRP gene inhibit inflammatory response and increase susceptibility to depression: the Health in Men Study. International Journal of Epidemiology, 38, 10491059.

B. Arroll , N. Khin and N. Kerse (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ, 327, 11441146.

K. D. Baas (2009). Screening for depression in high-risk groups: prospective cohort study in general practice. British Journal of Psychiatry, 194, 399403.

K. Barkow , W. Maier , T. B. Ustun , M. Gansicke , H. U. Wittchen and R. Heun (2003). Risk factors for depression at 12-month follow-up in adult primary health care patients with major depression: an international prospective study. Journal of Affective Disorders, 76, 157169.

J. R. Beard , M. Tracy , D. Vlahov and S. Galea (2008). Trajectory and socioeconomic predictors of depression in a prospective study of residents of New York City. Annals of Epidemiology, 18, 235243.

A. T. Beekman , J. R. Copeland and M. J. Prince (1999). Review of community prevalence of depression in later life. British Journal of Psychiatry, 174, 307311.

J. M. Bolton , J. Robinson and J. Sareen (2009). Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders, 115, 367375.

R. G. Bradley (2008). Influence of child abuse on adult depression: moderation by the corticotropin-releasing hormone receptor gene. Archives of General Psychiatry, 65, 190200.

M. L. Bruce (2002). Psychosocial risk factors for depressive disorders in late life. Biological Psychiatry, 52, 175184.

A. L. Byers , K. Yaffe , K. E. Covinsky , M. B. Friedman and M. L. Bruce (2010). High occurrence of mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Archives of General Psychiatry, 67, 489496.

I. Chi (2005). Prevalence of depression and its correlates in Hong Kong's Chinese older adults. American Journal of Geriatric Psychiatry, 13, 409416.

G. D. Cohen (2000). Loneliness in later life. American Journal of Geriatric Psychiatry, 8, 273275.

M. G. Cole and N. Dendukuri (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160, 11471156.

P. Cuijpers , A. van Straten and F. Smit (2006). Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials. International Journal of Geriatric Psychiatry, 21, 11391149.

R. B. D'Agostino Sr. (2008). General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation, 117, 743753.

B. Draper (2008). Long-term effects of childhood abuse on the quality of life and health of older people: results from the Depression and Early Prevention of Suicide in General Practice Project. Journal of the American Geriatrics Society, 56, 262271.

C. R. Elley , N. M. Kerse and B. Arroll (2003). Why target sedentary adults in primary health care? Baseline results from the Waikato Heart, Health, and Activity Study. Preventive Medicine, 37, 342348.

J. J. Gallo , P. V. Rabins , C. G. Lyketsos , A. Y. Tien and J. C. Anthony (1997). Depression without sadness: functional outcomes of nondysphoric depression in later life. Journal of the American Geriatrics Society, 45, 570578.

J. Hamalainen (2001). Cigarette smoking, alcohol intoxication and major depressive episode in a representative population sample. Journal of Epidemiology and Community Health, 55, 573576.

M. Heo , C. F. Murphy , K. R. Fontaine , M. L. Bruce and G. S. Alexopoulos (2008). Population projection of US adults with lifetime experience of depressive disorder by age and sex from year 2005 to 2050. International Journal of Geriatric Psychiatry, 23, 12661270.

C. Holley , S. A. Murrell and B. T. Mast (2006). Psychosocial and vascular risk factors for depression in the elderly. American Journal of Geriatric Psychiatry, 14, 8490.

R. C. Kessler (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289, 30953105.

M. King (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study. Archives of General Psychiatry, 65, 13681376.

I. Kirsch , B. J. Deacon , T. B. Huedo-Medina , A. Scoboria , T. J. Moore and B. T. Johnson (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine, 5, e45.

O. Klungsoyr , J. F. Nygard , T. Sorensen and I. Sandanger (2006). Cigarette smoking and incidence of first depressive episode: an 11-year, population-based follow-up study. American Journal of Epidemiology, 163, 421432.

H. G. Koenig , R. E. Westlund , L. K. George , D. C. Hughes , D. G. Blazer and C. Hybels (1993). Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics, 34, 6169.

A. Koster (2006). Socioeconomic differences in incident depression in older adults: the role of psychosocial factors, physical health status, and behavioral factors. Journal of Psychosomatic Research, 61, 619627.

D. Kritz-Silverstein , E. Barrett-Connor and C. Corbeau (2001). Cross-sectional and prospective study of exercise and depressed mood in the elderly: the Rancho Bernardo study. American Journal of Epidemiology, 153, 596603.

K. Kroenke , R. L. Spitzer and J. B. Williams (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.

K. Ladin (2008). Risk of late-life depression across 10 European Union countries: deconstructing the education effect. Journal of Aging and Health, 20, 653670.

E. J. Lenze (2000). Comorbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry, 157, 722728.

V. Lorant , C. Croux , S. Weich , D. Deliege , J. Mackenbach and M. Ansseau (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. British Journal of Psychiatry, 190, 293298.

F. A. McDougall (2007). Prevalence of depression in older people in England and Wales: the MRC CFA Study. Psychological Medicine, 37, 17871795.

P. Mottram , K. Wilson and J. Strobl (2006). Antidepressants for depressed elderly. Cochrane Database of Systematic Reviews, CD003491.

J. A. Pasco (2008). Tobacco smoking as a risk factor for major depressive disorder: population-based study. British Journal of Psychiatry, 193, 322326.

T. A. Pearson (2002). AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke, 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation, 106, 388391.

J. J. Pfaff and O. P. Almeida (2005). A cross-sectional analysis of factors that influence the detection of depression in older primary care patients. Australian and New Zealand Journal of Psychiatry, 39, 262265.

J. Pirkis (2009). The community prevalence of depression in older Australians. Journal of Affective Disorders, 115, 5461.

M. Prince (2007). No health without mental health. Lancet, 370, 859877.

R. E. Roberts , S. Deleger , W. J. Strawbridge and G. A. Kaplan (2003). Prospective association between obesity and depression: evidence from the Alameda County Study. International Journal of Obesity and Related Metabolic Disorders, 27, 514521.

G. Samuelsson , C. McCamish-Svensson , B. Hagberg , G. Sundstrom and O. Dehlin (2005). Incidence and risk factors for depression and anxiety disorders: results from a 34-year longitudinal Swedish cohort study. Aging and Mental Health, 9, 571575.

R. A. Schoevers , A. T. Beekman , D. J. Deeg , M. I. Geerlings , C. Jonker and W. Van Tilburg (2000). Risk factors for depression in later life; results of a prospective community based study (AMSTEL). Journal of Affective Disorders, 59, 127137.

R. A. Schoevers (2006). Prevention of late-life depression in primary care: do we know where to begin? American Journal of Psychiatry, 163, 16111621.

F. Smit , A. Ederveen , P. Cuijpers , D. Deeg and A. Beekman (2006). Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Archives of General Psychiatry, 63, 290296.

F. Smit , N. Smits , R. Schoevers , D. Deeg , A. Beekman and P. Cuijpers (2008). An epidemiological approach to depression prevention in old age. American Journal of Geriatric Psychiatry, 16, 444453.

C. N. Soares , O. P. Almeida , H. Joffe and L. S. Cohen (2001). Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Archives of General Psychiatry, 58, 529534.

R. Sriwattanakomen (2008). Preventing depression in later life: translation from concept to experimental design and implementation. American Journal of Geriatric Psychiatry, 16, 460468.

M. L. Stek , D. J. Vinkers , J. Gussekloo , A. T. Beekman , R. C. Van Der Mast and R. G. Westendorp (2005). Is depression in old age fatal only when people feel lonely? American Journal of Psychiatry, 162, 178180.

E. W. Steyerberg , F. E. Harrell , Jr., G. J. Borsboom , M. J. Eijkemans , Y. Vergouwe and J. D. Habbema (2001). Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. Journal of Clinical Epidemiology, 54, 774781.

W. J. Strawbridge , S. Deleger , R. E. Roberts and G. A. Kaplan (2002). Physical activity reduces the risk of subsequent depression for older adults. American Journal of Epidemiology, 156, 328334.

B. D. Thombs (2008). Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA, 300, 21612171.

E. H. Turner , A. M. Matthews , E. Linardatos , R. A. Tell and R. Rosenthal (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, 252260.

P. J. van't Veer-Tazelaar (2009). Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Archives of General Psychiatry, 66, 297304.

M. K. Williamson (2007). Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study. BMC Medical Research Methodology, 7, 42.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *