Elsevier

Biological Psychiatry

Volume 52, Issue 3, 1 August 2002, Pages 175-184
Biological Psychiatry

Review article
Psychosocial risk factors for depressive disorders in late life

https://doi.org/10.1016/S0006-3223(02)01410-5Get rights and content

Abstract

This article summarizes research findings on psychosocial risk factors for late life depressive disorders. The article draws heavily on longitudinal cohort studies of well-defined, population-based samples with diagnostic measures that assess the risk of incident or new-onset depressive episodes. These studies have identified a number of significant psychosocial risk factors for late life depressive disorders, including life events and ongoing difficulties; death of a spouse or other loved one; medical illness and injuries; disability and functional decline; and lack of social contact. Additional evidence suggests that the impact of these psychosocial risk factors on depression can be enhanced or buffered by personal or environmental factors. Although many of these psychosocial risk factors are more prevalent among older than younger adults, it is not clear that their impact on the risk of depression differs by age. Methodological challenges to advancing research on psychosocial risk factors for late life depression are reviewed, including problems related to study designs, sample selection, and measurement.

Introduction

This article reviews the research evidence concerning the contribution of psychosocial factors to the risk of depression in late life. Psychosocial factors are loosely defined as factors related to the psychological or social environment and processes (Kelsey et al 1996). Psychosocial factors encompass many of life experiences as well as the environmental context in which individuals pursue their lives. Understanding the role of psychosocial factors in the risk of disease is important, as psychosocial factors may offer innovative avenues for prevention and treatment.

This review begins by first describing criteria for evaluating studies that investigate the contribution of psychosocial factors to the risk of late life depression. The next section reports the results of these studies, organized by type of risk factor. The third section briefly reports evidence on factors that modify the impact of psychosocial factors on the risk of depression, and the next section discusses the extent to which psychosocial risk factors vary across age groups. The final section summarizes the findings and concludes with a discussion of challenges faced by the next set of investigations.

Section snippets

Criteria for weighing the evidence

Although numerous studies have reported correlational associations between various psychosocial factors and depressive diagnoses or symptoms in late life, only a few provide relatively unambiguous evidence that psychosocial factors contribute to the risk of depression. The criteria for ā€œrelatively unambiguousā€ draw on the basic principles of observational epidemiology, the science of the occurrence and distribution of disease and other health-related conditions in populations. Epidemiology

Negative life events and ongoing difficulties

Many specific psychosocial risk factors for depression fall under the general category of life stressors. The impact of life stressors, especially life events, on the risk of depression has received a great deal of study for a long time. As summarized by McLean and Link (1994), the two major conceptualizations of how life events affect mental health include: 1) life events as disruptive experiences that necessitate changes and readjustment Dohrenwend et al 1978, Holmes and Rahe 1967; and 2)

Modifying factors

Despite the strong evidence that psychosocial factors contribute longitudinally to the risk of depression, the majority of individuals who experience specific psychosocial risk factors do not become depressed. One possible explanation for this observation is that our measures of psychosocial risk factors do not adequately specify the aspect of the factor that increases risk. This explanation is being addressed in an ongoing fashion by efforts to improve measures or further specificity.

Another

Age differences

The focus of this review has been the contribution of psychosocial factors to the risk of depressive disorders in late life. A final question is the extent to which psychosocial risk factors for depression are differentā€”either in terms of exposure or impactā€”in older compared to younger adults.

Psychosocial risk factors: summary and challenges for future research

The research summarized here has identified a number of significant psychosocial risk factors for late life depressive disorders, including life events and ongoing difficulties; death of a spouse or other loved one; medical illness and injuries; disability and functional decline; and lack of social contact. The effects of these psychosocial factors have been demonstrated in well-designed, longitudinal studies. For the most part, the effects have persisted while controlling for at least some

Acknowledgements

This work was supported by grant no. KO2MH01634.

Aspects of this work were presented at the conference, ā€œUnmet Needs in Diagnosis and Treatment of Mood Disorders in Late Life,ā€ October 9ā€“10, 2001 in Washington, DC. The conference was sponsored by the National Depressive and Manic-Depressive Association (National DMDA) through unrestricted educational grants provided by Abbott Laboratories, AstraZeneca, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Eli Lilly and Company, Merck &

References (53)

  • M. Beiser

    Extreme situations

  • E.I. Brilman et al.

    Life events, difficulties and onset of depressive episodes in late life

    Psychol Med

    (2001)

  • Life events and measurement

  • G.W. Brown et al.

    Social Origins of Depression

    (1978)
  • M.L. Bruce et al.

    Social and physical health risk factors for first onset major depressive disorder in a community sample

    Soc Psychiatry Psychiatr Epidemiol

    (1994)
  • M.L. Bruce et al.

    Differences in the effects of divorce on major depression in men and women

    Am J Psychiatry

    (1992)
  • M.L. Bruce et al.

    Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample

    Am J Psychiatry

    (1990)
  • J.A. Cervilla et al.

    Cognitive impairment and social distress as different pathways to depression in the elderlyA cross-sectional study

    Int J Geriatr Psychiatry

    (1997)
  • L.S. Chen et al.

    Empirical examination of current depression categories in a population-based studySymptoms, course, and risk factors

    Am J Psychiatry

    (2000)
  • J.R.M. Copeland et al.

    A computerized psychiatric diagnostic system and case nomenclature for elderly subjectsGMS and AGECAT

    Psychol Med

    (1986)
  • M.A. Dew

    Psychiatric disorder in the context of physical illness

  • B.S. Dohrenwend et al.

    Exemplification of a method for scaling life eventsThe PERI life events scale

    J Health Soc Behav

    (1978)
  • Y. Forsell

    Predictors of depression, anxiety, and psychotic symptoms in a very elderly populationData from a 3 year follow-up study

    Soc Psychiatry Psychiatr Epidemiol

    (2000)
  • A. Frances

    Problems in defining clinical significance in epidemiologic studies

    Arch Gen Psychiatry

    (2000)
  • D.E. Gallagher et al.

    Psychosocial factors affecting adaptation to bereavement in the elderly

    Inter J Aging Hum Dev

    (1981ā€“1982)
  • S.W. Geerlings et al.

    Physical health and the onset and persistence of depression in older adultsAn eight-wave prospective community-based study

    Psychol Med

    (2000)

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