COGNITIVE IMPAIRMENT AND SOCIAL DISTRESS AS DIFFERENT PATHWAYS TO DEPRESSION IN THE ELDERLY - A CROSS-SECTIONAL STUDY

Background. This study investigates the recent suggestion that some pu tative aetiological factors for depression, such as cerebral deteriora tion and social distress, may act differentially in the aetiology of d epression in old age. Method. In a cross-sectional study, a community sample of 654 elderly subjects were interviewed with Short-CARE to ass ess the prevalence of depression and cognitive impairment. Information was collected for a variety of potential risk factors for depression such as exposure to social support deficit, threatening life events, i mpairment, disability and handicap. Results. The prevalence of depress ion was 17% and that of a broad concept of cognitive impairment 23.9%, This analysis found associations between depression and exposure to s ocial support deficits and threatening life events in the year prior t o interview. These associations were considerably stronger for those s ubjects with no cognitive impairment than for those with cognitive imp airment. We also found a progressive lowering in the strength of these associations the higher the chance of cognitive impairment measured a s a longitudinal variable using both the Dementia Diagnostic Scale (DD S) and the Organic Brain Syndrome Scale (OBS) included in Short-CARE. Conclusions. The results of this theory-driven analysis lend some supp ort to the notion of at least two differential pathways to depression in the elderly, one via social distress factors and another mediated b y cerebral deterioration clinically expressed as cognitive impairment. (C) 1997 John Wiley & Sons, Ltd.