nach oben

Social Psychiatry and Psychiatric Epidemiology

Erschienen in:

01.01.2013 | Original Paper

Social inequalities in depression and suicidal ideation among older primary care patients

verfasst von: Stephen E. Gilman, Martha L. Bruce, Thomas Ten Have, George S. Alexopoulos, Benoit H. Mulsant, Charles F. Reynolds III, Alex Cohen

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 1/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Depression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults.

Methods

Data come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period.

Results

Mean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67–2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34–3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38–3.98).

Conclusions

There exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations.

Cairney J, Krause N (2005) The social distribution of psychological distress and depression in older adults. J Aging Health 17(6):807–835. doi:10.1177/0898264305280985 PubMedCrossRef

Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157(2):98–112PubMedCrossRef

Gilman SE, Kawachi I, Fitzmaurice GM, Buka SL (2002) Socioeconomic status in childhood and the lifetime risk of major depression. Int J Epidemiol 31:359–367PubMedCrossRef

Mulsant BH, Ganguli M (1999) Epidemiology and diagnosis of depression in late life. J Clin Psychiatr 60(Suppl 20):9–15

Alexopoulos GS (2005) Depression in the elderly. Lancet 365(9475):1961–1970. doi:10.1016/s0140-6736(05)66665-2 PubMedCrossRef

Bruce ML (2002) Psychosocial risk factors for depressive disorders in late life. Biol Psychiatr 52(3):175–184CrossRef

Gilman SE, Carliner H, Cohen A (2012) The social determinants of depression in older adulthood. In: Reynolds CF, H. L, M. S (eds) Late-life mood disorders. Oxford University Press, New York (in press)

Kraaij V, Arensman E, Spinhoven P (2002) Negative life events and depression in elderly persons: a meta-analysis. J Gerontol Ser B Psychol Sci Soc Sci 57(1):P87–P94CrossRef

Butterworth P, Rodgers B, Windsor TD (2009) Financial hardship, socio-economic position and depression: results from the PATH through life survey. Soc Sci Med 69(2):229–237. doi:10.1016/j.socscimed.2009.05.008 PubMedCrossRef

10.

Ferraro KF, Su Y (1999) Financial strain, social relations, and psychological distress among older people: a cross-cultural analysis. J Gerontol B Psychol Sci Soc Sci 54(1):S3–15PubMedCrossRef

11.

Kahn JR, Pearlin LI (2006) Financial strain over the life course and health among older adults. J Health Soc Behav 47(1):17–31PubMedCrossRef

12.

Zimmerman FJ, Katon W (2005) Socioeconomic status, depression disparities, and financial strain: what lies behind the income-depression relationship? Health Econ 14(12):1197–1215. doi:10.1002/hec.1011 PubMedCrossRef

13.

Szanton SL, Thorpe RJ, Whitfield K (2010) Life-course financial strain and health in African–Americans. Soc Sci Med 71(2):259–265. doi:10.1016/j.socscimed.2010.04.001 PubMedCrossRef

14.

Price RH, Choi JN, Vinokur AD (2002) Links in the chain of adversity following job loss: how financial strain and loss of personal control lead to depression, impaired functioning, and poor health. J Occup Health Psychol 7(4):302–312PubMedCrossRef

15.

Friedman B, Conwell Y, Delavan RL (2007) Correlates of late-life major depression: a comparison of urban and rural primary care patients. Am J Geriatr Psychiatr 15(1):28–41. doi:10.1097/01.JGP.0000224732.74767.ad CrossRef

16.

Cohen A, Chapman BP, Gilman SE, Delmerico AM, Wieczorek W, Duberstein PR, Lyness JM (2010) Social inequalities in the occurrence of suicidal ideation among older primary care patients. Am J Geriatr Psychiatr 18(12):1146–1154. doi:10.1097/JGP.0b013e3181dd1e55 CrossRef

17.

Cohen A, Gilman SE, Houck PR, Szanto K, Reynolds CF 3rd (2009) Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults. Soc Psychiatr Psychiatr Epidemiol 44(4):272–277. doi:10.1007/s00127-008-0436-8 CrossRef

18.

Cohen A, Houck PR, Szanto K, Dew MA, Gilman SE, Reynolds CF 3rd (2006) Social inequalities in response to antidepressant treatment in older adults. Arch Gen Psychiatr 63(1):50–56. doi:10.1001/archpsyc.63.1.50 PubMedCrossRef

19.

Friedman ES, Wisniewski SR, Gilmer W, Nierenberg AA, Rush AJ, Fava M, Zisook S, Balasubramani GK, Trivedi MH (2009) Sociodemographic, clinical, and treatment characteristics associated with worsened depression during treatment with citalopram: results of the NIMH STAR(*)D trial. Depress Anxiety 26(7):612–621. doi:10.1002/da.20568 PubMedCrossRef

20.

Stafford RS, Ausiello JC, Misra B, Saglam D (2000) National patterns of depression treatment in primary care. Prim Care Companion J Clin Psychiatr 2(6):211–216CrossRef

21.

Zung WW, Broadhead WE, Roth ME (1993) Prevalence of depressive symptoms in primary care. J Fam Pract 37(4):337–344PubMed

22.

Cuijpers P, Smit F (2002) Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 72(3):227–236PubMedCrossRef

23.

Ryan J, Carriere I, Ritchie K, Stewart R, Toulemonde G, Dartigues JF, Tzourio C, Ancelin ML (2008) Late-life depression and mortality: influence of gender and antidepressant use. Br J Psychiatr 192(1):12–18. doi:10.1192/bjp.bp.107.039164 CrossRef

24.

Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289(23):3095–3105PubMedCrossRef

25.

Strothers HS 3rd, Rust G, Minor P, Fresh E, Druss B, Satcher D (2005) Disparities in antidepressant treatment in medicaid elderly diagnosed with depression. J Am Geriatr Soc 53(3):456–461. doi:10.1111/j.1532-5415.2005.53164.x PubMedCrossRef

26.

Park M, Unutzer J (2011) Geriatric depression in primary care. Psychiatr Clin N Am 34(2):469–487. doi:10.1016/j.psc.2011.02.009 CrossRef

27.

Lyness JM, Heo M, Datto CJ, Ten Have TR, Katz IR, Drayer R, Reynolds CF 3rd, Alexopoulos GS, Bruce ML (2006) Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Ann Intern Med 144(7):496–504PubMed

28.

Dew MA, Whyte EM, Lenze EJ, Houck PR, Mulsant BH, Pollock BG, Stack JA, Bensasi S, Reynolds CF 3rd (2007) Recovery from major depression in older adults receiving augmentation of antidepressant pharmacotherapy. Am J Psychiatr 164(6):892–899PubMedCrossRef

29.

Lyness JM, Niculescu A, Tu X, Reynolds CF 3rd, Caine ED (2006) The relationship of medical comorbidity and depression in older, primary care patients. Psychosomatics 47(5):435–439. doi:10.1176/appi.psy.47.5.435 PubMedCrossRef

30.

George LK, Blazer DG, Hughes DC, Fowler N (1989) Social support and the outcome of major depression. Br J Psychiatr 154:478–485CrossRef

31.

Oxman TE, Berkman LF, Kasl S, Freeman DH Jr, Barrett J (1992) Social support and depressive symptoms in the elderly. Am J Epidemiol 135(4):356–368PubMed

32.

Rowe JL, Conwell Y, Schulberg HC, Bruce ML (2006) Social support and suicidal ideation in older adults using home healthcare services. Am J Geriatr Psychiatr 14(9):758–766. doi:10.1097/01.JGP.0000218324.78202.25 CrossRef

33.

Taylor MG, Lynch SM (2004) Trajectories of impairment, social support, and depressive symptoms in later life. J Gerontol B Psychol Sci Soc Sci 59(4):S238–S246PubMedCrossRef

34.

Bruce ML, Ten Have TR, Reynolds CF 3rd, Katz II, Schulberg HC, Mulsant BH, Brown GK, McAvay GJ, Pearson JL, Alexopoulos GS (2004) Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA 291(9):1081–1091. doi:10.1001/jama.291.9.1081 PubMedCrossRef

35.

Alexopoulos GS, Katz IR, Bruce ML, Heo M, Ten Have T, Raue P, Bogner HR, Schulberg HC, Mulsant BH, Reynolds CF 3rd (2005) Remission in depressed geriatric primary care patients: a report from the PROSPECT study. Am J Psychiatr 162(4):718–724. doi:10.1176/appi.ajp.162.4.718 PubMedCrossRef

36.

Bogner HR, Cary MS, Bruce ML, Reynolds CF 3rd, Mulsant B, Ten Have T, Alexopoulos GS (2005) The role of medical comorbidity in outcome of major depression in primary care: the PROSPECT study. Am J Geriatr Psychiatr 13(10):861–868. doi:10.1176/appi.ajgp.13.10.861

37.

Alexopoulos GS, Reynolds CF 3rd, Bruce ML, Katz IR, Raue PJ, Mulsant BH, Oslin DW, Ten Have T (2009) Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatr 166(8):882–890. doi:10.1176/appi.ajp.2009.08121779 PubMedCrossRef

38.

Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatr 23:56–62PubMedCrossRef

39.

Beck AT, Brown GK, Steer RA (1997) Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients. Behav Res Ther 35(11):1039–1046PubMedCrossRef

40.

Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH (1988) The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients. Med Care 26(7):709–723PubMedCrossRef

41.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef

42.

Harel O, Hofer SM, Hoffman L, Pedersen NL, Johansson B (2007) Population inference with mortality and attrition in longitudinal studies on aging: a two-stage multiple imputation method. Exp Aging Res 33(2):187–203. doi:10.1080/03610730701239004 PubMedCrossRef

43.

Raghunathan TE, Lepkowski JM, Van Hoewyk J, Solenberger P (2001) A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv Methodol 27(1):85–95

44.

Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S (2005) Socioeconomic status in health research: one size does not fit all. JAMA 294(22):2879–2888PubMedCrossRef

45.

Cohen CI, Goh KH, Gustave M (2010) A prospective study of outcome and predictors of subclinical and clinical depression in an older biracial sample of psychiatric outpatients. J Affect Disord 121(3):204–211. doi:10.1016/j.jad.2009.05.021 PubMedCrossRef

46.

Umberson D, Wortman CB, Kessler RC (1992) Widowhood and depression: explaining long-term gender differences in vulnerability. J Health Soc Behav 33(1):10–24PubMedCrossRef

47.

Cooper C, Bebbington PE, Meltzer H, Bhugra D, Brugha T, Jenkins R, Farrell M, King M (2008) Depression and common mental disorders in lone parents: results of the 2000 National Psychiatric Morbidity Survey. Psychol Med 38(3):335–342. doi:10.1017/S0033291707001493 PubMedCrossRef

48.

von Ammon Cavanaugh S, Furlanetto LM, Creech SD, Powell LH (2001) Medical illness, past depression, and present depression: a predictive triad for in-hospital mortality. Am J Psychiatr 158(1):43–48CrossRef

49.

Callahan CM, Wolinsky FD, Stump TE, Nienaber NA, Hui SL, Tierney WM (1998) Mortality, symptoms, and functional impairment in late-life depression. J Gen Intern Med 13(11):746–752PubMedCrossRef

50.

Lynch TR, Mendelson T, Robins CJ, Krishnan KR, George LK, Johnson CS, Blazer DG (1999) Perceived social support among depressed elderly, middle-aged, and young-adult samples: cross-sectional and longitudinal analyses. J Affect Disord 55(2–3):159–170PubMedCrossRef

51.

Huurre T, Eerola M, Rahkonen O, Aro H (2007) Does social support affect the relationship between socioeconomic status and depression? A longitudinal study from adolescence to adulthood. J Affect Disord 100(1–3):55–64. doi:10.1016/j.jad.2006.09.019 PubMedCrossRef

52.

Schulz AJ, Israel BA, Zenk SN, Parker EA, Lichtenstein R, Shellman-Weir S, Klem AB (2006) Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit’s eastside. Soc Sci Med 62(2):510–522. doi:10.1016/j.socscimed.2005.06.028 PubMedCrossRef

53.

Harris T, Brown GW, Robinson R (1999) Befriending as an intervention for chronic depression among women in an inner city. 1: randomised controlled trial. Br J Psychiatr 174:219–224CrossRef

54.

Hertzman C, Power C (2003) Health and human development: understandings from life-course research. Dev Neuropsychol 24(2–3):719–744. doi:10.1080/87565641.2003.9651917 PubMed

55.

Pearlin LI (2010) The life course and the stress process: some conceptual comparisons. J Gerontol B Psychol Sci Soc Sci 65B(2):207–215. doi:10.1093/geronb/gbp106 PubMedCrossRef

56.

Leon AC, Olfson M, Broadhead WE, Barrett JE, Blacklow RS, Keller MB, Higgins ES, Weissman MM (1995) Prevalence of mental disorders in primary care. Implications for screening. Arch Fam Med 4(10):857–861PubMedCrossRef

57.

Beekman AT, Geerlings SW, Deeg DJ, Smit JH, Schoevers RS, de Beurs E, Braam AW, Penninx BW, van Tilburg W (2002) The natural history of late-life depression: a 6-year prospective study in the community. Arch Gen Psychiatr 59(7):605–611PubMedCrossRef

58.

Schoevers RA, Beekman AT, Deeg DJ, Hooijer C, Jonker C, van Tilburg W (2003) The natural history of late-life depression: results from the Amsterdam Study of the Elderly (AMSTEL). J Affect Disord 76(1–3):5–14PubMedCrossRef

59.

Reynolds CF 3rd (2009) Prevention of depressive disorders: a brave new world. Depress Anxiety 26(12):1062–1065. doi:10.1002/da.20644 PubMedCrossRef

60.

Reynolds CF 3rd, Dew MA, Lenze EJ, Whyte EM (2007) Preventing depression in medical illness: a new lead? Arch Gen Psychiatr 64(8):884–885PubMedCrossRef

61.

Miranda J, Chung JY, Green BL, Krupnick J, Siddique J, Revicki DA, Belin T (2003) Treating depression in predominantly low-income young minority women: a randomized controlled trial. JAMA 290(1):57–65PubMedCrossRef

Titel: Social inequalities in depression and suicidal ideation among older primary care patients
verfasst von: Stephen E. Gilman
Martha L. Bruce
Thomas Ten Have
George S. Alexopoulos
Benoit H. Mulsant
Charles F. Reynolds III
Alex Cohen
Publikationsdatum: 01.01.2013
Verlag: Springer-Verlag
Erschienen in: Social Psychiatry and Psychiatric Epidemiology / Ausgabe 1/2013
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-012-0575-9

Neu im Fachgebiet Psychiatrie

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

23.04.2024 Depression antepartal oder postpartal Nachrichten

Bislang gibt es kein Medikament zur Prävention von Wochenbettdepressionen. Das Injektionsanästhetikum Esketamin könnte womöglich diese Lücke füllen.

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

22.04.2024 DGIM 2024 Kongressbericht

Die Kombination aus Medikamenten und Psychotherapie gilt als effektivster Ansatz bei Depressionen. Das ist bei betagten Menschen nicht anders, trotz Besonderheiten.

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

22.04.2024 DGIM 2024 Nachrichten

Um Menschen nach der Flucht aus einem Krisengebiet bestmöglich medizinisch betreuen zu können, ist es gut zu wissen, welche Erkrankungen im jeweiligen Herkunftsland häufig sind. Dabei hilft eine Internetseite der CDC (Centers for Disease Control and Prevention).

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2013

Cognitive deficits and ethnicity: a cohort study of early psychosis patients in The Netherlands

Patterns of lifetime female victimisation and psychotic experiences: a study based on the UK Adult Psychiatric Morbidity Survey 2007

Burden of caregiving amongst family caregivers of patients with eating disorders

Passing the baton: a new chief editor for social psychiatry and psychiatric epidemiology