Who becomes depressed? The Islington community study of older people

Background: Depression in older people is common and debilitating and assoc iated with physical ill health. This is the first study of risk factors for depression in a representative sample of older people selected for high vu lnerability because of physical ill health. Method: Subjects identified in an epidemiological community survey of morbidity in people greater than or equal to 65 years old, who had activity limitation (ADL) but no psychiatric morbidity were reinterviewed after 3 years. Results: 79 (90%) of subjects were interviewed. Ten percent developed pervasive depression and 24% screen ed positive for depression. This latter group were more likely to consult d octors than others with similar levels of disability (P < 0.005) mainly bec ause of an acute physical illness. Frequent pain was associated with the de velopment of depression (P < 0.02). Conclusion: Older people who an ADL Lim ited are known to be at high risk for depression. For the majority who do n ot become depressed, chronicity of illness does not lead to depression. Tho se who become depressed an most likely to be those with an acute illness an d those who are in pain. They will usually increase their consultation rate with doctors but will not complain of depression. They may be undertreated for both pain and depression. Further studies are needed to confirm other risk factors. (C) 2000 Elsevier Science B.V. All rights reserved.