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

Background. The importance of stressful life events and long-term difficulties in the onset of episodes of unipolar depression is well established for young and middle-aged persons, but less so for older people.Method. A prospective case-control study was nested in a large community survey of older people. We recruited 83 onset casts during a 2-year period starting 21/2 years after the survey, via screening (N = 59) and GP monitoring (N = 24), and 83 controls, a random sample from the same survey population. We assessed depression with the PSE-10 and life stress exposure with the LEDS.Results. Risk of onset was increased 22-fold by severe events and three-fold by ongoing difficulties of at least moderate severity. Severe events accounted for 21 % of all episodes but ongoing difficulties for 45 %. The association of onset with life stress, often health-related such as death, major disability and hospitalization of subject or someone close, was most pronounced in the cases identified by screening. While a clear risk threshold for events was found between threat 2 and 3 (on a scale of 1-4), the risk associated with difficulties increased more gradually with severity of difficulty. Compared with controls, severe events involved a larger risk for cases without a prior history of depression (OR = 39(.)48) than for cases with (OR = 8(.)86). The opposite was found for mild events (OR = 2(.)94 in recurrent episodes; OR = 1(.)09 in first episodes). The impact of ongoing difficulties was independent of severity of episode and history of depression.Conclusion. Although the nature of life stress in later life, in particular health-related disability and loss of (close) social contacts. is rather different from that in younger persons, it is a potent risk factor for onset of a depressive episode in old age. Severe events show the largest relative risk, but ongoing difficulties account for most episodes. The association of severe events with onset tends to be stronger in first than in recurrent episodes. Mild events can trigger a recurrent episode but not a first one

Personality does not predict stressful event occurrence in elderly persons

This study investigates associations between personality characteristics and event occurrence in old age. The sample included 83 individuals (mean age 71.9, SD = 7.1; 55.4% females), randomly selected from the participants of a community survey among elderly persons. Several personality measures, obtained during the survey, were used to predict the occurrence of stressful life events a few years later. None of the personality characteristics was significantly associated with later event occurrence, neither with respect to the overall number of negative or positive events, nor with respect to only interpersonal events. The results indicate lack of event production in old age, which may indicate that, compared to younger age groups, elderly persons are less actively involved in shaping their own experiences

The interplay and etiological continuity of neuroticism, difficulties, and life events in the etiology of major and subsyndromal, first and recurrent depressive episodes in later life

Objective: Stressful life events, long-term difficulties, and high neuroticism are established risk factors for depression. Less is known about their role in late-life depression, how they modify or mediate one another's effects, and whether this differs between major and subsyndromal, first and recurrent episodes. Method: The authors used a prospective case-control design nested in a community survey of elderly subjects that included a measure of neuroticism. They compared 83 survey participants who subsequently developed a depressive episode with 83 randomly selected comparison participants. The authors determined dates of onset, history, and severity of episodes and dates of occurrence and severity of stressful life events and difficulties. Results: Stressful life events did not mediate the effects of high neuroticism and difficulties at onset, possibly because of the uncontrollable nature of common stressful life events in later life. Without both high neuroticism and difficulties, stressful life events did not increase risk. High neuroticism and difficulties increased risk, even without a stressful life event. In the presence of high neuroticism and/or difficulties, the depressogenic effect of stressful life events was substantial, suggesting effect modification. The authors found no evidence to suggest etiological discontinuity between major and subsyndromal episodes. First and recurrent episodes showed a discontinuous pattern of associations. Severe stressful life events had weaker associations, but high neuroticism and mild stressful life events had stronger associations with recurrent than with first episodes. Conclusions: This study demonstrated the usefulness of a dynamic stress-vulnerability model for understanding late-life depression. Evidence was found suggesting etiological discontinuity between first and recurrent but not between major and subsyndromal episodes