Determinants of Depression in Older Adults in Europe: An Investigation into Demographic and Psychosocial Risk Factors

Abstract

Summary Ageing is becoming a significant public health concern, particularly in Europe, where the undergoing a dramatic shift. It is estimated that by 2050, 25% of the European population will be 65 years of age and older (WHO, 2012). This unprecedented fluctuation in the population will create a significant imbalance in the population structure, which is predicted to have a substantial impact on the existing social setting by putting additional strains on future health care systems, social security and pension systems, international economies, and on the overall health and wellbeing of society. This calls for action from international governments to create policies that will support this unprecedented population growth; therefore provisions need to be put in place in order to cater for these contingencies. Coupled with this is the inevitable increase in mental disorders which will develop in parallel with an ageing population and will add layers of complexity to the public health issue of ageing. Depressive and anxiety disorders are prolific in older adults, and constitute the majority of late-life mental disorders (Byers et al., 2010). The impact of these disorders on older adults is significant and debilitating, where depressive disorders has been invariably associated with negative health outcomes, such as cognitive decline, increased disability, self-neglect, heart disease, diabetes, morbidity and mortality (suicide). Moreover, depression produces the greatest decrement in health compared with other chronic diseases, such as angina, arthritis, asthma and diabetes (Moussavi et al., 2007). Simultaneously, anxiety disorders, which are even more prolific in older adults, have been associated with comorbidity,reduced cognitive ability, disability, increased healthcare utilization and poor quality of life. For the purpose of this dissertation, depression will be the main focus of the papers, however, anxiety is also addressed in one of the papers with a view to provide a broader context and to provide a more comprehensive assessment of mental disorders in the elderly, since both disorders often occur co-morbidly. Depression transcends culture, country and boarders, and its prevalence has caused a significant public health concern across Europe. Although the prevalence of depression varies considerably across countries, it is important to understand the various contextual factors that contribute to depression within and between countries. Additionally, there are many important determinants associated with depression in older adults, (which differ to those determinants in younger cohorts) and comprise of physical disability, bereavement, cognitive decline, and other psychosocial factors such as loneliness and isolation. Considering that depressive disorders consist of distinct differences in the aetiology of depression in older adults, it is important to give late-life depression the same attention that the disorder receives in younger populations, and since the population of older adults in Europe is growing at a staggering rate, understanding the aetiology of depression in this cohort is of clinical, public and economic significance. Therefore, the main aim of the current research was to epidemiologically investigate the role of demographic and psychological variables on mental disorders, specifically depression, in the older European population, and to contribute to findings that can inform public policy measures.:1. Introduction 1.1 No Health without Mental Health 1.2 Ageing as a Public Health Concern 1.3 Mental Disorders in the Older European Population 1.3.1 Prevalence 1.3.2 Depression in the Elderly 1.4 Socioeconomic Status and Depression 1.4.1 Education 1.4.2 Income and Wealth 1.5 The Role of Ageing Perceptions on Depression 1.6 Impact of Depression on Health Status 1.7 Rationale of Research and Introduction to Articles 2. Publications 2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 2.2 Paper 2: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging survey in Europe) 3. Dissertation Summary (Zusammenfassung der Arbeit) 3.1 Thematic Context 3.2 Rationale for Research 3.3 Publications 3.4 Research Findings and Implications 4. Bibliography 5. Appendices 5.1 Declaration of Independent work for Dissertation (Erklärung über die eigenständige Abfassung der Arbeit) 5.2 Statement of own Contribution (Darstellung des eigenen Beitrags) 5.2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 5.2.2 Paper 1: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging Survey in Europe) 5.3 Curriculum Vitae (Lebenlauf) 5.4 Publications and Presentations 5.4.1 Publications. 5.4.2 Presentations 5.5 Acknowledgement