depression in elderly essay

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• Published: 18 December 2021

Prevalence and determinants of depression among old age: a systematic review and meta-analysis

• Yosef Zenebe   ORCID: orcid.org/0000-0002-0138-6588 1 ,
• Baye Akele 2 ,
• Mulugeta W/Selassie 3 &
• Mogesie Necho 1  

Annals of General Psychiatry volume  20 , Article number:  55 ( 2021 ) Cite this article

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Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It is also one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in elderly patients. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in half of the cases. Several studies showed different and inconsistent prevalence rates in the world. Hence, this study aimed to fill the above gap by producing an average prevalence of depression and associated factors in old age.

This study aims to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression and its determinants among old age.

A comprehensive search of PubMed, Scopus, Web of sciences, Google Scholar, and Psych-info from database inception to January 2020. Moreover, the reference list of selected articles was looked at manually to have further eligible articles. The random-effects model was employed during the analysis. Stata-11 was used to determine the average prevalence of depression among old age. A sub-group analysis and sensitivity analysis were also run. A graphical inspection of the funnel plots and Egger’s publication bias plot test were checked for the occurrence of publication bias.

A search of the electronic and manual system resulted in 1263 articles. Nevertheless, after the huge screening, 42 relevant studies were identified, including, for this meta-analysis, n  = 57,486 elderly populations. The average expected prevalence of depression among old age was 31.74% (95% CI 27.90, 35.59). In the sub-group analysis, the pooled prevalence was higher among developing countries; 40.78% than developed countries; 17.05%), studies utilized Geriatrics Depression Scale-30(GDS-30); 40.60% than studies that used GMS; 18.85%, study instrument, and studies having a lower sample size (40.12%) than studies with the higher sample; 20.19%.

A high prevalence rate of depression among the old population in the world was unraveled. This study can be considered as an early warning and advised health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic care for the elderly population.

The elderly people are matured and experienced persons of any community. Their experience, wisdom, and foresight can be useful for development and progress; they are a valuable asset for any nation [ 1 ]. Despite their invaluable wisdom and insight, the aging of the world's population is causing extensive economic and social consequences globally [ 2 ]. The aging population has increased rapidly over the last decades owing to two significant factors, namely, the reduction in mortality and fertility rates and improved quality of life, leading to an increase in life expectancy worldwide [ 3 , 4 , 5 ]. Globally, the number and proportion of people aged 60 years and older in the population are increasing. In 2019, the number of people aged 60 years and older was 1 billion. This number will increase to 1.4 billion by 2030 and 2.1 billion by 2050. By 2050, 80% of all older people will live in low- and middle-income countries [ 6 , 7 , 8 ].

A high geriatric population leads to high geriatric psychiatric problems [ 9 ]. The elderly, in general, face various challenges that are associated with physical and psychological changes commonly associated with the aging process [ 10 ]. The incidence of mental health problems is expected to increase among adults in general as well as in older populations in particular [ 11 ].

Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease [ 12 ]. It is also one of the most common geriatric psychiatric disorders [ 13 ] and a major risk factor for disability and mortality in older patients [ 14 ]. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in about 50% of cases. The estimates for the prevalence of depression in the aging differ greatly [ 15 , 16 , 17 ]. WHO estimated that the global depressive disorder among older adults ranged between 10 and 20% [ 18 , 19 , 20 , 21 ]. Among all mentally ill individuals, 40% were diagnosed to have a depressive disorder [ 22 ]. People with depressive disorder have a 40% greater chance of premature death than their counterparts [ 20 ].

Most of the time, the clinical picture of depression in old age is masked by memory difficulties with distress and anxiety symptoms; however, these problems are secondary to depression [ 23 , 24 , 25 ]. Numerous community-based studies showed that older adults experienced depression-related complications [ 26 , 27 , 28 , 29 , 30 ]. Depression amplifies the functional disabilities caused by physical illness, interferes with treatment and rehabilitation, and further contributes to a decline in the physical functioning of a person [ 31 , 32 ]. It also has an economic impact on older adults due to its significant contribution to the rise of direct annual livelihood costs [ 33 ]. Hence, improvement of mental health among people in late life is considered to be medically urgent to prevent an increase in suicides in a progressively aging society.

Although real causes of depression remain not clear, psychological, social, and biological processes are thought to determine the etiology of depression and comorbid psychiatric diagnoses (e.g., anxiety and various personality disorders) [ 34 ]. Social scientists, postulating the psychosocial theory, posited that depression could be caused by a lack of interpersonal and communication skills, social support, and coping mechanisms [ 35 ]. Old biological theories stated depression is caused by a lack of monoamines in the brain. However, recent theories underscore the role of Brain-derived neurotrophic factor (BDNF) in the pathogenesis of depression [ 36 ]. In general, depression in the elderly is the result of a complex interaction of social, psychological, and biological factors [ 37 , 38 ].

Different factors associated with geriatric depression, such as female sex [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ], increasing age [ 37 , 40 , 41 , 44 , 46 , 47 , 48 , 49 ], being single or divorced [ 42 ], religion [ 50 ], lower educational attainment [ 39 , 40 , 41 , 42 , 44 ], unemployment [ 38 , 42 ], low income [ 37 , 39 , 40 , 42 , 44 , 46 , 51 , 52 ], low self-esteem [ 53 ], childhood traumatic experiences [ 54 ], loneliness or living alone [ 40 , 50 , 51 , 55 ], social deprivation [ 45 , 46 , 56 ], bereavement [ 39 , 43 , 57 , 58 ], presence of chronic illness or poor health status [ 37 , 39 , 43 , 44 , 45 , 46 , 49 , 50 , 56 , 59 , 60 , 61 , 62 , 63 , 64 ], lack of health insurance [ 42 ], smoking habit [ 48 ], cognitive impairment [ 39 , 43 , 44 , 45 , 46 , 47 , 61 ] and a history of depression [ 43 , 44 , 47 ].

Compared with other health services, evidence of depressive disorders tends to be relatively poor. Therefore, the level of its burden among older adults is not well addressed in the world. Lack of adequate evidence about depression in older adults may be a factor that contributes to poor or inconsistent mental health care at the community level [ 21 , 65 ]. In addition to the poor setting for mental health care services, there are no up-to-date systematic reviews and meta-analysis studies conducted that could vividly show the global prevalence and determinants of depression among old age. Several studies also revealed different and inconsistent prevalence rates in the world. Therefore, this systematic review and meta-analysis aimed to summarize the existing evidence on the prevalence of depression among old age and to formulate possible suggestions for clinicians, the research community, and policymakers.

Search process

A systematic search of the literature in September 2020 using both international [PubMed, Scopus, Web of sciences, Google Scholar, Psych-info, and national scientific databases] was conducted to identify English language studies, published between August 1994 and January 2020, that examined the prevalence of depression among old age. We searched English keywords of “epidemiology” OR “prevalence” OR “magnitude” OR “incidence” AND “factor” OR “associated factor” OR “risk” OR “risk factor” OR “determinant”, “depression”, “depressive disorder” OR “major depressive disorder” AND “old age” OR “elderly” OR “geriatrics”, “community”, “hospital” and “global”. In addition, the reference lists of the studies were manually checked to obtain further studies.

Inclusion and exclusion criteria

Original quantitative studies that examined the prevalence and determinants of depression among old age were included. The included studies were randomized controlled trials, cohort, case–control, cross-sectional, articles written in English, full-text articles, and published between August 1994 and January 2020. The exclusion criteria were studies which published as review articles, qualitative studies, brief reports, letter to the editor or editorial comments, working papers articles published in a language other than English, researches conducted in non-human subjects, and studies having duplicate data with other studies. The literature search was conducted based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guideline [ 66 ]. All articles were independently reviewed by four researchers against inclusion and exclusion criteria. Any initial disagreement was resolved.

Data extraction and appraisal of study quality

After eliminating the duplicates, four investigators reviewed study titles and abstracts for eligibility. If at least one of them considered an article as potentially eligible, the full texts were assessed by the same reviewers. Any disagreements were resolved by discussion. Detailed information on the country, data source, study population, and results were extracted from each included study into a standardized spreadsheet by two authors and checked by the other two authors. EndNote X7.3.1 was used to organize the identified articles. Two investigators independently assessed the risk of bias of each of the included studies. The quality of studies included in the final analysis was evaluated with the Newcastle Ottawa quality assessment checklist [ 67 ]. The components of the quality assessment checklist include study participants and setting, research design, recruitment strategy, response rate, representativeness of the sample, the convention of valid measurement, reliability of measurement, and appropriate statistical analyses.

Statistical analysis

The data were analyzed with STATA 12.0 [ 68 ]. Prevalence standard errors were calculated using the standard formula for proportions: sqrt [ p *(1 – p )/ n ]; The heterogeneity across the studies in proportion of depression in the elderly population and the contribution of studies attributing to total heterogeneity was estimated by the I 2 statistic. The point estimates from each study were combined using a random-effects meta-analysis model to obtain the overall estimate with the DerSimonian–Laird method. Sources of heterogeneity across studies were examined with meta-regression. Publication bias and small study effects were assessed with the Egger test.

Search result

The search procedure primarily obtained n  = 1263 results, which after reading the title and abstract, full-text, and the application of the inclusion and exclusion criteria were reduced to n  = 42. The selection process is shown in Fig.  1 .

Articles search flow diagram

Characteristics of the study subjects

A total of 42 studies [ 38 , 42 , 50 , 57 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ] studied our outcome of interest; A total sample size of fifty-seven thousand four hundred and eighty-six (57,486) elderly populations were included in the present study. The geographical province of studies was assessed. We found: Six studies in India [ 72 , 86 , 94 , 95 , 98 , 102 ], five studies in China [ 50 , 77 , 84 , 89 ], three studies in Turkey [ 71 , 82 , 105 ], three studies in Nepal [ 76 , 90 , 97 ], three studies in Thailand [ 70 , 75 , 83 ], two studies in the USA [ 91 , 100 ], two studies in Australia [ 57 , 99 ], two studies in Malaysia [ 42 , 96 ], two studies in Ethiopia [ 81 , 93 ], one study in German [ 103 ], one study in the UK [ 104 ], one study in Norway [ 85 ], one study in Italy [ 79 ], one study in Japan [ 87 ], one study in Mexico [ 78 ], one study in Brazil [ 92 ], one study in Finland [ 74 ], one study in Singapore [ 101 ], one study in Saudi Arabia [ 69 ], one study in the United Arab Emirates [ 80 ], one study in Ghana [ 88 ], one study in Sudan [ 73 ] and one study in Egypt [ 38 ]. Most of the studies in the present analysis were cross-sectional [ 38 , 42 , 50 , 57 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 81 , 82 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 92 , 93 , 95 , 96 , 97 , 98 , 101 , 102 , 103 , 105 ] and four studies were Cohort [ 85 , 94 , 99 , 104 ].

Sixteen studies [ 70 , 73 , 74 , 81 , 86 , 88 , 90 , 92 , 93 , 94 , 97 , 98 , 102 , 103 , 104 , 105 ] used Geriatric Depression Scale-15 (GDS-15), 12 studies [ 38 , 69 , 71 , 72 , 75 , 76 , 77 , 82 , 84 , 89 , 96 ] used Geriatric Depression Scale-30 (GDS-30), four studies [ 50 , 80 , 83 , 101 ] used Geriatric Mental State Schedule (GMS) and ten studies [ 42 , 57 , 78 , 79 , 85 , 87 , 91 , 95 , 99 , 100 ] used others (ICD-10, CIDI, DASS-21, KICA, CES-D, Euro-D, DSM-III, MCS and HADS) tools to measure depression in old age (Table 1 ).

Quality of included studies

The quality of 42 studies [ 38 , 42 , 50 , 57 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ] was assessed with the modified Newcastle Ottawa quality assessment scale. This scale divides the total quality score into 3 ranges; a score of 7 to 10 as very good/good, a score of 5 to 6 as having satisfactory quality, and a quality score less than 5 as unsatisfactory. The majority (28 from the 42 studies) had scored good quality, nine had a satisfactory quality, and four of the studies had unsatisfactory quality .

The prevalence of depression among old age

The reported prevalence of elderly depression among 42 studies [ 38 , 42 , 50 , 57 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ] included in this study ranges from 7.7% in a study from Malaysia and Australia [ 57 , 96 ] to 81.1% in India [ 72 ]. The average prevalence of depression among old age using the random effect model was found to be 31.74% (95% CI 27.90, 35.59). This average prevalence of depression was with the heterogeneity of ( I 2  = 100%, p value = 0.000) from the difference between the 42 studies (Fig.  2 ).

Forest plot for the prevalence of depression

Subgroup analysis of the prevalence of depression among old age

A subgroup analysis was done considering the economic status of countries, the study instrument and the sample size of each study. The cumulative prevalence of depression in elderly population among developing countries; 40.78% [ 38 , 42 , 69 , 70 , 71 , 72 , 73 , 75 , 76 , 78 , 81 , 82 , 83 , 86 , 88 , 90 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 101 , 102 , 105 ] was higher than the prevalence in developed countries; 17.05% [ 50 , 57 , 74 , 77 , 79 , 80 , 84 , 85 , 87 , 89 , 91 , 99 , 100 , 103 , 104 ] (Fig.  3 ). The average prevalence of depression was 40.60% in studies that used GDS-30 [ 38 , 69 , 71 , 72 , 75 , 76 , 77 , 82 , 84 , 89 , 96 ] which is higher than the prevalence in studies that utilized GDS-15;35.72% [ 70 , 73 , 74 , 81 , 86 , 88 , 90 , 92 , 93 , 94 , 97 , 98 , 102 , 103 , 104 , 105 ], GMS;18.85% [ 50 , 80 , 83 , 101 ] and other tools;19.91% [ 42 , 57 , 78 , 79 , 85 , 87 , 91 , 95 , 99 , 100 ] (Fig.  4 ). Moreover, studies which had a sample size of below 450 [ 38 , 42 , 57 , 70 , 71 , 72 , 73 , 75 , 76 , 79 , 81 , 86 , 88 , 90 , 92 , 94 , 96 , 97 , 98 , 99 , 102 , 104 ] provided higher prevalence of depression; 40.12% than those who had a sample size ranges from 450 to 999 [ 74 , 80 , 82 , 84 , 85 , 91 , 93 , 95 , 100 , 105 ]; 25.38% and above 1000 [ 50 , 69 , 74 , 77 , 78 , 83 , 87 , 89 , 101 , 103 ]; 20.19% (Fig.  5 ).

Sub-group analysis of depression based on economic status of countries

Sub-group analysis of depression based on study instruments

Sub-group analysis of depression based on sample size of studies

Sensitivity analysis

The sensitivity analysis was performed to identify whether one or more of the 42 studies had out-weighted the average prevalence of depression among old age. However, the result showed that there was no single influential study, since the 95% CI interval result was obtained when each of the 42 studies was excluded at a time (Fig.  6 ).

Sensitivity analysis for the prevalence of depression among old age

Publication bias

There was no significant publication bias detected and Egger's test p value was ( p  = 0.644) showing the absence of publication bias for the prevalence of depression among old age. This was also supported by asymmetrical distribution on the funnel plot for a Logit event rate of prevalence of depression among old age against its standard error (Fig.  7 ).

Funnel plot for publication bias for depression

Factors associated with depression among old age

Among 42 studies [ 38 , 42 , 50 , 57 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ] included in the present meta-analysis, only 32 [ 38 , 42 , 50 , 57 , 69 , 72 , 73 , 75 , 77 , 78 , 79 , 80 , 81 , 83 , 84 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 101 , 102 , 103 , 104 , 105 ] reported about the associated factors for depression among old age. Our qualitative synthesis for the sociodemographic factors associated with depression in elderly populations showed that female gender [ 38 , 69 , 72 , 75 , 80 , 86 , 89 , 93 , 98 , 102 , 105 ], age older than 75 years [ 38 , 69 , 101 , 102 ], being single, divorced or widowed [ 38 , 42 , 69 , 80 , 81 , 87 , 89 , 98 , 105 ], being unemployed [ 69 , 86 , 96 , 105 ], retired [ 95 ], no educational background [ 75 , 81 , 86 , 89 , 90 , 97 , 102 ] OR low level of education [ 69 , 81 , 84 , 91 , 92 , 105 ], low level of income [ 69 , 72 , 78 , 80 , 94 , 95 , 105 ], substance use [ 75 , 81 , 103 ], poverty [ 95 , 102 ], cognitive impairment [ 81 , 103 ], presence of physical illness, such as diabetes, heart diseases, stroke and head injury [ 42 , 50 , 57 , 72 , 77 , 81 , 83 , 84 , 86 , 87 , 88 , 89 , 95 , 97 , 106 ], living alone [ 88 , 102 , 104 ], disturbed sleep [ 77 , 89 ], lack of social support [ 73 , 77 , 87 ], dependent totally for the activities of daily living [ 50 , 79 , 91 , 92 , 97 , 102 , 103 ], living with family [ 42 , 93 ], history of a serious life events, such as death in family members, conflict in family, chronic illness in family members and those who had 3 or more serious life events [ 72 , 83 , 96 ], poor daily physical exercise [ 89 ] and exposure to verbal and/or physical abuse were strongly and positively associated with depression [ 90 ] (Table 2 ).

As to the researcher’s knowledge, this review and meta-analysis on the prevalence and determinants of depression among old age are the first of their kind in the world. Therefore, the knowledge generated from this meta-analysis on the pooled prevalence and associated factors for depression among old age could be important evidence to different stakeholders aiming to plan policy in the area. The average prevalence of depression among old age using the random effect model was found to be 31.74%. A subgroup analysis was done considering the economic status of countries, the study instrument, and the sample size of each study.

In the present systematic review and meta-analysis, the existing available information varies by the region, where the study was conducted, data collection tools used to screen depression, and the sample size assimilated in the study. Sixty-two percent ( n  = 26) of the studies were found in developing countries. About 38% ( n  = 16) of the incorporated studies utilized GDS-15 to screen depression, around 28% ( n  = 12) studies used GDS-30 to screen depression, ten percent ( n  = 4) studies used GMS to screen depression, whereas the rest utilized other tools. More than half ( n  = 22) of the included studies utilized a sample size of below 450.

The result of this meta-analysis revealed that depression in the elderly populations in the world was high (31.74%). This pooled prevalence of depression among old age in the world (31.74%; 95% CI 27.90 to 35.59%) was higher than a global systematic review and meta-analysis study on 95,073 elderly populations aged > 75 years and 24 articles in which a pooled prevalence of depression was 17.1% (95% CI 9.7 to 26.1%) [ 107 ], a global systematic review and meta-analysis study on 41 344 outpatients and 83 articles in which a pooled prevalence of depression was 27.0% (95% CI: 24.0% to 29.0%) [ 108 ], WHO reports on mental health of older adults over 60 years old with 7% prevalence of depression in the general older population [ 106 ], a Brazilian systematic review and meta-analysis study on 15,491 community-dwelling elderly people average age 66.5 to 84.0 years and 17 articles with a pooled prevalence rates of 7.0% for major depression, 26.0% for CSDS (clinically significant depressive symptoms), and 3.3% for dysthymia [ 109 ] and an Iranian meta-analysis study on 3948 individuals aged 50 to 90 years and 13 articles with a pooled prevalence of severe depression was 8.2% (95% CI 4.14 to 6.3%) [ 110 ]. The reason for such a high prevalence of depression in the globe would be due to the difference in sample size, study subjects, the severity of depression, study area, study instruments, and the means of administration of the tools employed in the studies [ 111 ].

In contrast to our current systematic review and meta-analysis study, the pooled prevalence of depression was lower than a Chinese Meta-Analysis of Observational Studies on 36,791 subjects and 46 articles with a pooled prevalence of depression was 38.6% (95% CI 31.5–46.3%) [ 112 ], and an Indian systematic review and meta-analysis study on 22,005 study subjects aged 60 years and above, and 51 articles with a pooled prevalence of depression was 34.4% (95% CI 29.3 to 39.6) [ 113 ]. The reason for the discrepancy might be due to the wide coverage of the study and the higher sample size utilized in the present study. Furthermore, differences could be due to the poor health care coverage and significant population makes a destitute life both in China and India. In addition, both China and India have a rapidly aging population. Old age causes enforced retirement which may lead to marginalizing older people. Elders are regarded as incompetent and less valuable by potential employers. This attitude serves as a social stratification between the young and old and can prevent older men and women from fully participating in social, political, economic, cultural, spiritual, civic, and other activities [ 114 , 115 , 116 ].

A significant regional variation on the pooled prevalence of depression in the elder population was observed in this review and meta-analysis study. The aggregate prevalence of depression in elderly population among developing countries; 40.78% [ 38 , 42 , 69 , 70 , 71 , 72 , 73 , 75 , 76 , 78 , 81 , 82 , 83 , 86 , 88 , 90 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 101 , 102 , 105 ] was higher than the prevalence in developed countries; 17.05% [ 50 , 57 , 74 , 77 , 79 , 80 , 84 , 85 , 87 , 89 , 91 , 99 , 100 , 103 , 104 ]. The huge variation might be due to absolute poverty, economic reform programs, limited public health services, civil unrest, and sex inequality are very common in developing countries [ 117 ].

Likewise, the greater pooled prevalence of depression in elderly population was observed in studies using a sample size below 450 study subjects (40.12%) [ 38 , 42 , 57 , 70 , 71 , 72 , 73 , 75 , 76 , 79 , 81 , 86 , 88 , 90 , 92 , 94 , 96 , 97 , 98 , 99 , 102 , 104 ] than the pooled prevalence of depression in elders that used a sample size of 450–999 (25.38%) [ 74 , 80 , 82 , 84 , 85 , 91 , 93 , 95 , 100 , 105 ], and above 1000 (20.19%) [ 50 , 69 , 74 , 77 , 78 , 83 , 87 , 89 , 101 , 103 ]. The reason could be a smaller sample size increases the probability of a standard error thus providing a less precise and reliable result with weak power.

Regarding the associated factors; being female, age older than 75 years, being single, divorced or widowed, being unemployed, retired, no educational background, low level of education, low level of income, lack of social support, living with family, current smoker, presence of physical illness, such as diabetes, heart diseases, stroke, and head injury, poor sleep quality, physical immobility and a history of serious life events, such as a death in family members, conflict in the family, chronic illness in family members and those who had 3 or more serious life events were found to have a strong and positive association with depression among old age.

Difference between included studies in the meta-analysis

This meta-analysis study was obtained to have a high degree of heterogeneity between the studies incorporated in pooling the prevalence of depression in the elderly population of the world. The analysis of subgroups for detection of sources of heterogeneity was done and the economic status of the country, where the study was done, data collection instruments, and sample size were identified to contribute to the existing variation between the studies incorporated in the analysis. Besides, a sensitivity analysis was performed using the random-effects model to identify the effect of individual studies on the pooled estimate. No significant changes in the pooled prevalence were found on the removal of a single study.

Limitations should be considered when interpreting the results of this study. Screening tools cannot take the place of a comprehensive clinical interview for confirmatory diagnosis of depression. Nevertheless, it is a useful tool for public health programs. Screening provides optimum results when linked with confirmation by mental health experts, treatment, and follow-up. As this meta-analysis included studies done using screening tools, a further meta-analysis done with diagnostic tools will help to assess the true burden of depression and to determine the need for pharmacological and non-pharmacological interventions. Furthermore, because of the lack of access to the full text of some studies, the researchers failed to include these research findings.

This review and meta-analysis study obtained a pooled prevalence of depression in the elderly population in the world to be very high, 31.74% (95% CI 27.90, 35.59). This pooled effect size of depression in the elderly population in the world obtained is very important as it showed aggregated evidence of the burden of depression in the targeted population. Since the high prevalence of depression among the old population in the world, this study can be considered as an early warning and advice to health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic assessment for the elderly population.

Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Activities of daily living

Adjusted odds ratio

Community-dwelling elderly people

Center for Epidemiologic Studies Depression Scale

Confidence interval

Composite International Diagnostic Interview Short Form

Clinically significant depressive symptoms

Cross-sectional

Depression, Anxiety, and Stress Scale

Diagnostic and Statistical Manual of Mental Disorders

Elderly medical inpatients

Geriatrics depression

Geriatric Depression Scale

Geriatric Mental State Schedule

Hospital Anxiety and Depression Scale

Kimberley Indigenous Cognitive Assessment of Depression

Mental Component Summary

Not reported

Preferred Reporting Items for Systematic Reviews and Meta-analysis

United Kingdom

United States of America

World Health Organization

Singh C, Mathur J, Mishra V, Singh J, Singh R, Garg B, et al. Social Problems of Aged in a rural population. Indian J Community Med. 1995;20(2):24.

Google Scholar  

Tan S. Mental Health and Ageing. Speech by the Minister of Community Development and Consumer Affairs at “The Proclamation of the World Health Mental Day with the Theme Mental Health and Ageing”, Malaysia. 1999.

Organization WH. Global health observatory (GHO) data. Life expectancy. World Health Organization, Geneva. http://www.whoint/gho/mortality_burden_disease/life_tables/situation_trends_text/en/ Accessed. 2016;20.

Osman C. Physical and psychiatry diseases of aged people in Malaysia: an evaluation in Ampang, Selangor, Malaysia. Sch J App Med Sci. 2015;3(1C):159–66.

Bujang MA, Hamid AMA, Zolkepali NA, Mustaâ N, Lazim SSM, Haniff J. Mortality rates by specific age group and gender in Malaysia: Trend of 16 years, 1995 –2010. Journal of Health Informatics in Developing Countries. 2012;6(2).

Organization WH. The Global Network for Age-friendly Cities and Communities: Looking back over the last decade, looking forward to the next. World Health Organization, 2018.

Rudnicka E, Napierała P, Podfigurna A, Męczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020.

Organization WH. Multisectoral action for a life course approach to healthy aging: draft global strategy and plan of action on aging and health. World Health Organization: Geneva, Switzerland. 2016:1–37.

Tiple P, Sharma S, Srivastava A. Psychiatric morbidity in geriatric people. Indian J Psychiatry. 2006;48(2):88.

Article   PubMed   PubMed Central   Google Scholar  

Blazer DG, Hybels CF. Origins of depression in later life. Psychol Med. 2005;35(9):1241–52.

Article   PubMed   Google Scholar  

Flood M, Buckwalter KC. Recommendations for mental health care of older adults: Part 1—an overview of depression and anxiety. J Gerontol Nurs. 2009;35(2):26–34.

James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789–858.

Article   Google Scholar  

Moss K, Scogin F, Di Napoli E, Presnell A. A self-help behavioral activation treatment for geriatric depressive symptoms. Aging Ment Health. 2012;16(5):625–35.

Blazer DG, Hybels CF, Pieper CF. The association of depression and mortality in elderly persons: a case for multiple, independent pathways. J Gerontol A Biol Sci Med Sci. 2001;56(8):M505–9.

Article   CAS   PubMed   Google Scholar  

Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004;291(21):2581–90.

Gallo JJ, Lebowitz BD. The epidemiology of common late-life mental disorders in the community: themes for the new century. Psychiatr Serv. 1999;50(9):1158–66.

Charney DS, Reynolds CF, Lewis L, Lebowitz BD, Sunderland T, Alexopoulos GS, et al. Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life. Arch Gen Psychiatry. 2003;60(7):664–72.

Raviola G, Eustache E, Oswald C, Belkin GS. Mental health response in Haiti in the aftermath of the 2010 earthquake: a case study for building long-term solutions. Harv Rev Psychiatry. 2012;20(1):68–77.

Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. Am J Psychiatry. 2005;162(9):1588–601.

Organization WH. The mental health of older adults: fact Sheet. World Health Organization Media Centre http://www.who.int/mediacenter/factsheets/fs381/en/ Published December. 2017;12.

Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. 2014;43(2):476–93.

Patel V, Saxena S. Transforming lives, enhancing communities—innovations in global mental health. N Engl J Med. 2014;370(6):498–501.

Mirkena Y, Reta MM, Haile K, Nassir Z, Sisay MM. Prevalence of depression and associated factors among older adults at ambo town, Oromia region, Ethiopia. BMC Psychiatry. 2018;18(1):338.

Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097–106.

Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):M249–65.

Saxena S, Funk M, Chisholm D. World health assembly adopts comprehensive mental health action plan 2013–2020. Lancet. 2013;381(9882):1970–1.

Organization WH. Global health risks: mortality and burden of disease attributable to selected major risks: World Health Organization; 2009.

Andreasen P, Lönnroos E, von Euler-Chelpin MC. Prevalence of depression among older adults with dementia living in low-and middle-income countries: a cross-sectional study. Eur J Public Health. 2014;24(1):40–4.

Padayachey U, Ramlall S, Chipps J. Depression in older adults: prevalence and risk factors in a primary health care sample. S Afr Fam Pract. 2017;59(2):61–6.

Ferrari A, Somerville A, Baxter A, Norman R, Patten S, Vos T, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med. 2013;43(3):471.

Nicholson IR. New technology, old issues: Demonstrating the relevance of the Canadian Code of Ethics for Psychologists to the ever-sharper cutting edge of technology. Can Psychol. 2011;52(3):215.

Souci M, Prince M, Atalay A, Derege K, Stewart R, Nick G, et al. Outcome of major depression in Ethiopia. Br J Psychiatry. 2006;189(3):241–6.

Luppa M, Heinrich S, Matschinger H, Sandholzer H, Angermeyer MC, König H-H, et al. Direct costs associated with depression in old age in Germany. J Affect Disord. 2008;105(1–3):195–204.

Lemma A, Target M, Fonagy P. The development of a brief psychodynamic protocol for depression: Dynamic Interpersonal Therapy (DIT). Psychoanal Psychother. 2010;24(4):329–46.

Gonzalez VM, Goeppinger J, Lorig K. Four psychosocial theories and their application to patient education and clinical practice. Arthritis Rheum. 1990;3(3):132–43.

Article   CAS   Google Scholar  

Dwivedi Y. Brain-derived neurotrophic factor: role in depression and suicide. Neuropsychiatric Dis Treat. 2009;5:433–49.

Munsawaengsub C. Factors influencing the mental health of the elderly in Songkhla, Thailand. J Med Assoc Thai. 2012;95(6):S8–15.

PubMed   Google Scholar  

Sidik SM, Rampal L, Afifi M. Physical and mental health problems of the elderly in a rural community of Sepang, Selangor. Malays J Med Sci. 2004;11(1):52.

PubMed   PubMed Central   Google Scholar  

Cole MG, Dendukuri N. Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Am J Psychiatry. 2003;160(6):1147–56.

Sengupta P, Benjamin AI. Prevalence of depression and associated risk factors among the elderly in urban and rural field practice areas of a tertiary care institution in Ludhiana. İndian J Public Health. 2015;59(1):3.

Velázquez-Brizuela IE, Ortiz GG, Ventura-Castro L, Árias-Merino ED, Pacheco-Moisés FP, Macías-Islas MA. Prevalence of dementia, emotional state and physical performance among older adults in the metropolitan area of Guadalajara, Jalisco, Mexico. Curr Gerontol Geriatr Res. 2014;2014:387528.

Yaka E, Keskinoglu P, Ucku R, Yener GG, Tunca Z. Prevalence and risk factors of depression among community-dwelling elderly. Arch Gerontol Geriatr. 2014;59(1):150–4.

Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand. 2006;113(5):372–87.

Akbaş E, Yiğitoğlu GT, Çunkuş N. Yaşlılıkta Sosyal İzolasyon ve Yalnızlık. OPUS Uluslararası Toplum Araştırmaları Dergisi. 15(26):4540–62.

Roberts RE, Kaplan GA, Shema SJ, Strawbridge WJ. Does growing old increase the risk for depression. 1997.

Blazer D, Burchett B, Service C, George LK. The association of age and depression among the elderly: an epidemiologic exploration. J Gerontol. 1991;46(6):M210–5.

Heun R, Hein S. Risk factors of major depression in the elderly. Eur Psychiatry. 2005;20(3):199–204.

Weyerer S, Eifflaender-Gorfer S, Wiese B, Luppa M, Pentzek M, Bickel H, et al. Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study. Age Aging. 2013;42(2):173–80.

Koenig HG, Meador KG, Cohen HJ, Blazer DG. Depression in elderly hospitalized patients with medical illness. Arch Intern Med. 1988;148(9):1929–36.

Kugbey N, Nortu TA, Akpalu B, Ayanore MA, Zotor FB. Prevalence of geriatric depression in a community sample in Ghana: analysis of associated risk and protective factors. Arch Gerontol Geriatr. 2018;78:171–6.

VYas J, MNAMS D. NIraj Ahuja MD: Textbook of Postgraduate Psychiatry, Jaypee Brothers Medical Publishers (P) Ltd. New Delhi Second edtion. 1999.

Veras RP, Coutinho ED. Estudo de prevalência de depressão e síndrome cerebral orgânica na população de idosos, Brasil. Rev Saude Publica. 1991;25:209–17.

Donald M. Psychiatric illnesses in elderly. J Gerontol. 1992;47:142–50.

Abbasian M, Pourshahbaz A, Taremian F, Poursharifi H. The role of psychological factors in non-suicidal self-injury of female adolescents. Iran J Psychiatry and Behav Sci. 2021;15(1).

Lin J-H, Huang M-W, Wang D-W, Chen Y-M, Lin C-S, Tang Y-J, et al. Late-life depression and quality of life in a geriatric evaluation and management unit: an exploratory study. BMC Geriatr. 2014;14(1):1–7.

McDOUGALL FA, Kvaal K, Matthews FE, Paykel E, Jones PB, Dewey ME, et al. Prevalence of depression in older people in England and Wales: the MRC CFA Study. Psychol Med. 2007;37(12):1787.

Choulagai P, Sharma C, Choulagai B. Prevalence and associated factors of depression among elderly population living in geriatric homes in Kathmandu Valley. J Inst Med Nepal. 2013;35(1):39–44.

Wilson K, Taylor S, Copeland J, Chen R, McCracken C. Socio-economic deprivation and the prevalence and prediction of depression in older community residents. Br J Psychiatry. 1999;175(6):549–53.

Valvanne J, Juva K, Erkinjuntti T, Tilvis R. Major depression in the elderly: a population study in Helsinki. Int Psychogeriatr. 1996;8(3):437–43.

Byers AL, Yaffe K. Depression, and risk of developing dementia. Nat Rev Neurol. 2011;7(6):323.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet. 2007;370(9590):851–8.

Sartorius N, Üstün TB, Silva J-AC, Goldberg D, Lecrubier Y, Ormel J, et al. An international study of psychological problems in primary care: a preliminary report from the World Health Organization Collaborative Project Psychological Problems in General Health Care. Arch Gen Psychiatry. 1993;50(10):819–24.

Beekman AT, Deeg DJ, van Tilburg T, Smit JH, Hooijer C, van Tilburg W. Major and minor depression in later life: a study of prevalence and risk factors. J Affect Disord. 1995;36(1–2):65–75.

Blazer DG, Sachs-Ericsson N, Hybels CF. Perception of unmet basic needs as a predictor of depressive symptoms among community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2007;62(2):191–5.

Bitew T. Prevalence and risk factors of depression in Ethiopia: a review. Ethiop J Health Sci. 2014;24(2):161–9.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009;89(9):873–80.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

StataCorp LLCataCorp L. Stata Statistical Software: Release 12. StataCorp; 2011.

Boman E, Gustafson Y, Häggblom A, Santamäki Fischer R, Nygren B. Inner strength–associated with reduced prevalence of depression among older women. Aging Ment Health. 2015;19(12):1078–83.

Güzel A, Kara F. Determining the prevalence of depression among older adults living in Burdur, Turkey, and their associated factors. Psychogeriatrics. 2020;20(4):370–6.

Swarnalatha N. The prevalence of depression among the rural elderly in Chittoor District, Andhra Pradesh. J Clin Diagn Res. 2013;7(7):1356.

Ashe S, Routray D. Prevalence, associated risk factors of depression and mental health needs among the geriatric population of an urban slum, Cuttack, Odisha. Int J Geriatr Psychiatry. 2019;34(12):1799–807.

Girma M, Hailu M, Wakwoya A, Yohannis Z, Ebrahim J. Geriatric depression in Ethiopia: prevalence and associated factors. J Psychiatry. 2016;20(400): 1000400

Mirkena Y, Reta MM, Haile K, Nassir Z, Sisay MM. Prevalence of depression and associated factors among older adults at ambo town, Oromia region, Ethiopia. BMC Psychiatry. 2018;18(1):1–7.

He G, Xie J, Zhou J, Zhong Z, Qin C, Ding S. Depression in left‐behind elderly in rural China: prevalence and associated factors. Geriatr Gerontol Int. 2016;16(5):638–43.

Cong L, Dou P, Chen D, Cai L. Depression and associated factors in the elderly cadres in Fuzhou, China: a community-based study. Int J Gerontol. 2015;9(1):29–33.

Feng L, Li P, Lu C, Tang W, Mahapatra T, Wang Y, et al. Burden and correlates of geriatric depression in the Uyghur elderly population, observation from Xinjiang, China. PLoS ONE. 2014;9(12):e114139.

Rajkumar A, Thangadurai P, Senthilkumar P, Gayathri K, Prince M, Jacob K. Nature, prevalence and factors associated with depression among the elderly in a rural south Indian community. Int Psychogeriatr. 2009;21(2):372–8.

Simkhada R, Wasti SP, Gc VS, Lee AC. Prevalence of depressive symptoms and its associated factors in older adults: a cross-sectional study in Kathmandu, Nepal. Aging Ment Health. 2018;22(6):802–7.

Manandhar K, Risal A, Shrestha O, Manandhar N, Kunwar D, Koju R, et al. Prevalence of geriatric depression in the Kavre district, Nepal: Findings from a cross-sectional community survey. BMC Psychiatry. 2019;19(1):1–9.

Arslantas D, Ünsal A, Ozbabalık D. Prevalence of depression and associated risk factors among the elderly in Middle A natolia, turkey. Geriatr Gerontol Int. 2014;14(1):100–8.

Charoensakulchai S, Usawachoke S, Kongbangpor W, Thanavirun P, Mitsiriswat A, Pinijnai O, et al. Prevalence and associated factors influencing depression in older adults living in rural Thailand: a cross-sectional study. Geriatr Gerontol Int. 2019;19(12):1248–53.

Forlani C, Morri M, Ferrari B, Dalmonte E, Menchetti M, De Ronchi D, et al. Prevalence and gender differences in late-life depression: a population-based study. Am J Geriatr Psychiatry. 2014;22(4):370–80.

Wilson K, Mottram P, Sixsmith A. Depressive symptoms in the very old living alone: prevalence, incidence and risk factors. Int J Geriatr Psychiatry. 2007;22(4):361–6.

Steffens DC, Fisher GG, Langa KM, Potter GG, Plassman BL. Prevalence of depression among older Americans: the Aging, Demographics and Memory Study. Int Psychogeriatr. 2009;21(5):879.

Abdul Manaf MR, Mustafa M, Abdul Rahman MR, Yusof KH, Abd Aziz NA. Factors influencing the prevalence of mental health problems among Malay elderly residing in a rural community: a cross-sectional study. PLoS ONE. 2016;11(6):e0156937.

Almeida OP, Flicker L, Fenner S, Smith K, Hyde Z, Atkinson D, et al. The Kimberley assessment of depression of older Indigenous Australians: prevalence of depressive disorders, risk factors and validation of the KICA-dep scale. PLoS ONE. 2014;9(4):e94983.

Weyerer S, Eifflaender-Gorfer S, Köhler L, Jessen F, Maier W, Fuchs A, et al. Prevalence and risk factors for depression in non-demented primary care attenders aged 75 years and older. J Affect Disord. 2008;111(2–3):153–63.

Jadav P, Patel MV. Prevalence of depression and factors associated with it in geriatric population in the rural area of Vadodara, Gujarat. 2017.

Sinha SP, Shrivastava SR, Ramasamy J. Depression in an older adult rural population in India. MEDICC Rev. 2013;15:41–4.

Kaji T, Mishima K, Kitamura S, Enomoto M, Nagase Y, Li L, et al. Relationship between late-life depression and life stressors: large-scale cross-sectional study of a representative sample of the Japanese general population. Psychiatry Clin Neurosci. 2010;64(4):426–34.

Fernández-Niño JA, Manrique-Espinoza BS, Bojorquez-Chapela I, Salinas-Rodríguez A. Income inequality, socioeconomic deprivation and depressive symptoms among older adults in Mexico. PLoS ONE. 2014;9(9):e108127.

Al-Shammari SA, Al-Subaie A. Prevalence and correlates of depression among Saudi elderly. Int J Geriatr Psychiatry. 1999;14(9):739–47.

Subramaniam M, Abdin E, Sambasivam R, Vaingankar JA, Picco L, Pang S, et al. Prevalence of depression among older adults-results from well-being of the Singapore elderly study. Ann Acad Med Singapore. 2016;45(4):123–33.

Assil S, Zeidan Z. Prevalence of depression and associated factors among elderly Sudanese: a household survey in Khartoum State. EMHJ-Eastern Mediterr Health J. 2013;19(5):435–40.

Haseen F, Prasartkul P. Predictors of depression among older people living in rural areas of Thailand. Bangladesh Med Res Counc Bull. 2011;37(2):51–6.

Ghubash R, El-Rufaie O, Zoubeidi T, Al-Shboul QM, Sabri SM. Profile of mental disorders among the elderly United Arab Emirates population: sociodemographic correlates. Int J Geriatr Psychiatry. 2004;19(4):344–51.

Abdo NM, Eassa S, Abdalla AM. Prevalence of depression among elderly and evaluation of interventional counseling session in Zagazig district-Egypt. J Am Sci. 2011;7(6).

Snowdon J, Lane F. The Botany survey: a longitudinal study of depression and cognitive impairment in an elderly population. Int J Geriatr Psychiatry. 1995;10(5):349–58.

McCall NT, Parks P, Smith K, Pope G, Griggs M. The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries. Int J Geriatr Psychiatry. 2002;17(6):557–65.

Li N, Chen G, Zeng P, Pang J, Gong H, Han Y, et al. Prevalence of depression and its associated factors among Chinese elderly people: A comparison study between community-based population and hospitalized population. Psychiatry Res. 2016;243:87–91.

Mendes-Chiloff CL, Ramos-Cerqueira ATA, Lima MCP, Torres AR. Depressive symptoms among elderly inpatients of a Brazilian university hospital: prevalence and associated factors. Int Psychogeriatr. 2008;20(5):1028.

Prashanth A, Rakesh MPK, Praveena V, Preethi A, Prithvi S, Priyadharshini R, et al. Prevalence of depression and factors influencing it among geriatric population attending the outpatient department of a tertiary care hospital. Adv Med Sci. 2015;2:1–5.

Helvik AS, Skancke RH, Selbæk G. Screening for depression in elderly medical inpatients from the rural area of Norway: prevalence and associated factors. Int J Geriatr Psychiatry. 2010;25(2):150–9.

Anantapong K, Pitanupong J, Werachattawan N, Aunjitsakul W. Depression and associated factors among elderly outpatients in Songklanagarind Hospital, Thailand: a cross-sectional study. Songklanagarind Med J. 2017;35(2):139–48.

Organization WH. The mental health of older adults, 12 December 2017. 2019

Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, et al. Age-and gender-specific prevalence of depression in latest-life–systematic review and meta-analysis. J Affect Disord. 2012;136(3):212–21.

Wang J, Wu X, Lai W, Long E, Zhang X, Li W, et al. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open. 2017;7(8):e017173.

Barcelos-Ferreira R, Izbicki R, Steffens DC, Bottino CM. Depressive morbidity and gender in community-dwelling Brazilian elderly: systematic review and meta-analysis. Int Psychogeriatr. 2010;22(5):712.

Salari N, Mohammadi M, Vaisi-Raygani A, Abdi A, Shohaimi S, Khaledipaveh B, et al. The prevalence of severe depression in Iranian older adults: a meta-analysis and meta-regression. BMC Geriatr. 2020;20(1):39.

de Waal MW, van der Weele GM, van der Mast RC, Assendelft WJ, Gussekloo J. The influence of the administration method on scores of the 15-item Geriatric Depression Scale in old age. Psychiatry Res. 2012;197(3):280–4.

Zhang H-H, Jiang Y-Y, Rao W-W, Zhang Q-E, Qin M-Z, Ng CH, et al. Prevalence of depression among empty-nest elderly in China: a meta-analysis of observational studies. Front Psych. 2020;11:608.

Pilania M, Yadav V, Bairwa M, Behera P, Gupta SD, Khurana H, et al. Prevalence of depression among the elderly (60 years and above) population in India, 1997–2016: a systematic review and meta-analysis. BMC Public Health. 2019;19(1):1–18.

Pilania M, Bairwa M, Kumar N, Khanna P, Kurana H. Elderly depression in India: An emerging public health challenge. Australas Med J. 2013;6(3):107.

Organization WH. World Health Day 2012: aging and health: a toolkit for event organizers. World Health Organization, 2012.

Mao G, Lu F, Fan X, Wu D. China's aging population: The present situation and prospects. Population change and impacts in Asia and the Pacific: Springer; 2020. p. 269–87.

Patel V, Abas M, Broadhead J, Todd C, Reeler A. Depression in developing countries: lessons from Zimbabwe. BMJ. 2001;322(7284):482–4.

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Zenebe, Y., Akele, B., W/Selassie, M. et al. Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Ann Gen Psychiatry 20 , 55 (2021). https://doi.org/10.1186/s12991-021-00375-x

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Summary points

Depression in older adults is associated with an increased risk of death and disability

Cognitive and functional impairment and anxiety are more common in older than in younger adults with depression

Older adults with depression are at increased risk of suicide and are more likely than younger adults to complete suicide

Depression is associated with cognitive impairment and an increased risk of dementia

A selective serotonin reuptake inhibitor should be the first line pharmacological treatment for depression for most older adults, including those with chronic physical illness

Psychological and drug treatment is as effective in older as in younger adults

Subthreshold depressive symptoms that substantially affect older patients’ lives are common and management with psychosocial and drug strategies may be effective and prevent further deterioration

Depression is a major contributor to healthcare costs and is projected to be the leading cause of disease burden in middle and higher income countries by the year 2030. w1 Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes from physical illness. Most clinicians will encounter older patients with depression in their day to day practice, but although treatment is as effective for older patients as for younger adults, the condition is often under-recognised and under-treated. According to WHO data, proportionately more people aged over 65 commit suicide than any other age group, and most have major depression. Older people who attempt suicide are more likely to die than younger people, while in those who survive, prognosis is worse for older adults. 1

With a progressively ageing population worldwide, identification and treatment of depression in older adults becomes increasingly important, especially as older patients may have different presentations and needs than younger ones. We consider recent systematic reviews, meta-analyses, and randomised controlled trials to provide generalists with an understanding of current approaches to the diagnosis and management of patients who develop late life depression.

Sources and selection criteria

We based the review on searches of PubMed, EMBASE, and the Cochrane Database of Systematic Reviews using the search terms “depression”, “elderly”, “aged”, and “old age” published between 2006 and 2011 and limited to English language. We focused on well conducted systematic reviews, meta-analyses, and randomised controlled trials.

What is late life depression and who gets it?

Traditionally, the age of 65 has been used to differentiate between “older” and “younger” adults, although there is no set point at which an individual becomes “older” and assessment and care must be based on individual need. Arbitrary definitions of “late life” and differences between studies in terms of diagnostic criteria and populations sampled have produced varying reports of prevalence. Individuals with late life depression represent a heterogeneous group with symptoms that may fall anywhere on a spectrum ranging from sub-threshold mood disorder to major depression. A recent comprehensive meta-analysis using studies with moderate to high methodological quality showed that the point prevalence of major depression in over 75s ranged from 4.6% to 9.3% 2 whereas rates for sub-threshold depressive symptoms (those failing to reach diagnostic criteria) ranged from 4.5% to 37.4%. A related meta-analysis in people aged over 55 found that sub-threshold depressive symptomatology was two to three times more prevalent than major depression. 2 Most depressive episodes in late life will be a recurrence rather than a first ever episode w2 and the increased female to male ratio is in line with that in younger adults.

Prevalence rates of depression are increased in brain disorders including dementia, Parkinson’s disease, and stroke, and also in systemic disease, for example diabetes mellitus and cardiovascular disease (box 1). Prevalence estimates for depression in Alzheimer’s disease cluster around 30% but range from 0% to 86%, w3 reflecting the difficulty associated with definition and diagnosis of depression in dementia.

Box 1 Risk factors for depression in elderly people 30

Physical factors.

Chronic disease, such as diabetes, ischaemic heart disease, heart failure, chronic obstructive pulmonary disease

Acute myocardial infarction

Organic brain disease: dementia, stroke, Parkinson’s disease, cerebrovascular disease

Endocrine/metabolic disorders: thyroid disease, hypercalcaemia, B12 and folate deficiency

Chronic pain and disability

Psychosocial factors

Social isolation

Change in financial circumstances

Being a carer

Change of role and loss of social status

Bereavement and loss

Difficulty in adapting to illness/pain/disability

Poor defences against anxiety about death

History of depression

Being in institutional care

How is depression diagnosed in older patients?

Box 2 lists the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for diagnosis of a major depressive episode. Ideally diagnosis is based on clinical interview, observation of the patient’s behaviour, and a collateral history from relatives and care givers. When taking a background history it is important to identify factors that may precipitate and maintain depression. The main risk factors for late life depression are comorbid physical illness, cognitive impairment, functional impairment, lack or loss of close social contacts, and a previous history of depression (box 1), according to the findings of large community based studies.

Box 2 DSM-IV criteria for major depressive episode

Nearly every day for the preceding two weeks the patient has experienced five or more of:

Depressed mood for most of the day*

Decreased interest or pleasure in nearly all activities for most of the day*

Marked loss or gain of weight or markedly increased or decreased appetite

Excessive sleep or not enough sleep

Observable psychomotor agitation or retardation

Tiredness or loss of energy

Feelings of guilt or worthlessness

Poor concentration or indecisiveness

Thoughts of dying or suicide, suicide attempt

*One of these features must be present. Depressed mood for ≥2 weeks not meeting these criteria is defined as a minor depressive episode. Diagnostic and statistical manual of mental disorders (DSMIV), American Psychiatric Association, 1994

The risk assessment is important in any psychiatric presentation, and in patients with depression the main area of risk is suicide. Methodologically sound controlled studies have identified some key risk factors for suicide, listed in box 3.

Box 3 Risk factors for suicide in older people 1

Older age, male sex

Bereavement

History of attempts

Evidence of planning

Chronic painful illness or disability

Drug or alcohol use

Sleep disorders

Older patients often have symptoms of depression that do not meet the criteria for a major depressive episode (box 2) but are nonetheless clinically important. Identification of the psychological and functional effects of these symptoms determines whether or not treatment is indicated and who may benefit from interventions.

Current guidance for the assessment and management of depression from the UK National Institute for Health and Clinical Excellence (NICE) ( http://guidance.nice.org.uk/CG90/QuickRefGuide/pdf/English ) recommends the use of rating scales to determine severity, although many are weighted towards the presence of somatic symptoms and may therefore overestimate depression in older people, in whom such symptoms are common.

A recent comparison of several assessment scales (patient health questionnaire, Beck depression inventory, hospital anxiety and depression scale) in a primary care population found that treatment and referral rates were identical even though each tool identified differing numbers of patients with moderate to severe depression. However, regardless of the tool used, rates for treatment in older people still remained lower than for younger adults. w4 Many rating scales are in common use to assess depression but few are well validated in older people, with the exception of the patient health questionnaire, geriatric depression scale, hospital anxiety and depression scale, and the Cornell scale for depression in dementia (box 4).

Box 4 Useful scales for depression

Geriatric depression scale (gds-15)*.

Specifically developed for use in geriatric patients; contains fewer somatic items; suitable only for patients with no, mild, or moderate cognitive impairment (>15/30 on mini-mental state examination)

Well validated in older people. Cut-off score in population over 60 of ≥5 indicates a case of depression: sensitivity 92%, specificity 54% w12 w13

Cornell scale for depression in dementia (CSDD)*

Suitable for patients with cognitive deficit, not diagnostic for depression but higher scores indicate greater need for further evaluation w14

Patient health questionnaire (PHQ-9)*

Self reported depression assessment tool scoring each of the nine DSM-IV criteria as 0 (not at all) to 3 (nearly every day)

Validated in adults over 60 in primary care in the United States and Netherlands. With cut-off score of >9 has sensitivity 88%, specificity 80% w15 w16

Beck depression inventory (BDI)

Self reported seven item scale

Not recommended for use in older people owing to focus on somatic symptoms w17

Hospital anxiety and depression scale (HADS)*

Self-rating scale containing two subscales measuring symptoms of depression (HADS-D) and anxiety (HADS-A) during previous week. Scores >8 for both HADS-A and HADS-D have sensitivity and specificity of 80% and predictive validity of 70%

HADS identifies equal numbers of patients with depression regardless of age w18

Montgomery and Åsberg depression rating scale (MADRS)

Clinician rated 10 item scale, measures severity of depressive symptoms; sensitive to change; mainly used to assess response to treatment but no agreement on cut-off score for remission (between ≤4 and ≤10), popular in Europe

*Validated in older adults

Is depression more difficult to diagnose in older adults?

Several studies have shown that older adults are significantly less likely than younger ones to recognise depressive symptoms, which they attribute to normal ageing or physical illness, and that both patients and their doctors tend to view depression as a problem that can be explained away, rather than as an objective illness that warrants treatment. w5 These findings suggest that older adults might be less able to identify, and therefore seek appropriate treatment for, common depressive symptoms.

In our clinical experience, late life depression differs qualitatively from depression in early life. Somatisation, hypochondriasis, psychomotor retardation or agitation, and psychosis more commonly form part of the clinical picture, although this tendency has not been uniformly demonstrated. 3 Furthermore, late life depression has been associated with cognitive impairment, physical disability, and anxiety, with a large community naturalistic study suggesting that clinically important anxiety coexists in around 50% of patients aged 55-85. 4

Does depression increase the risk of dementia?

Most studies find that depression in late life is accompanied by measurable cognitive impairment, mediated by memory deficits, diminished executive function, and slowed information processing, which may resolve on remission of symptoms, or may persist even after effective treatment of mood. In the past, the term “depressive pseudodementia” was used to describe reversible dementia in depression, but this oversimplifies the complex spectrum of cognitive impairment.

Two systematic meta-analyses of high quality studies 5 6 report that late onset depression (after age 65) increases the risk of dementia twofold, but as yet no research has ascertained whether depression is a risk factor for dementia or represents a prodromal condition. 7

Several mechanisms have been proposed to explain the relation between depression and dementia, including hypercortisolaemia, loss of hippocampal volume, neuroinflammatory processes, increased Alzheimer-type pathology, reduced cognitive reserve, and vascular disease. None has yet been conclusively demonstrated, but the link is probably multifactorial and the mechanisms not mutually exclusive.

Of these potential mechanisms, vascular changes in the brain have attracted most attention. The key hypothesis is that disruption of prefrontal-striatal circuitry by cerebrovascular pathology produces a syndrome of mood disorder and executive dysfunction. This syndrome is variously described as “vascular depression” or “depression executive dysfunction syndrome”, 8 reflecting fundamental nosological differences. However, the concept is controversial, and a prospective population based postmortem study of over 65s found no association between depression and cerebrovascular pathology. 9 Randomised controlled trials have shown that presence of “vascular depression”/“depression executive dysfunction syndrome” may predict a worse response to antidepressant drug treatment 10 and is associated with increased mortality 11 There is currently no evidence to suggest that treating depression in early or late life reduces the incidence of dementia.

How is late life depression managed?

Given the association between medical morbidity and depression, exclusion of underlying causative or exacerbating factors is an important first step in the management of late life depression (box 1). Baseline investigations, for example routine blood tests, may be indicated (box 5).

Box 5: Investigations to consider when depression is suspected

Full blood count

Urea and electrolytes

Liver function tests

Thyroid function tests

Vitamin B12

Fasting glucose

Bone profile

Further tests dictated by clinical presentation

In subsyndromal and mild depression, psychosocial interventions may be sufficient to cause an improvement. These include increasing social contact and adding structure to the day; for example, assistance in accessing local community events, day centres, or befriending services. Evidence from randomised trials suggests that depressive symptoms in older adults may improve with structured exercise programmes. 12 A RCT of a stepped care approach to the management of subthreshold depressive symptoms found that the intervention (watchful waiting, bibliotherapy based on cognitive behavioural therapy, problem solving therapy, and medication) was associated with a 50% reduction in depression and anxiety disorders at 12 months 13 compared with treatment as usual and was cost effective w6 .

Current NICE guidance recommends that patients with mild or sub-threshold illness who do not respond well to initial supportive interventions are offered psychological therapy or antidepressant medication, while a combination of both interventions is recommended for those with moderate or severe illness.

When should I refer?

NICE guidance recommends that patients are referred to specialist services if they have not responded adequately to management options available in primary care; in severe depression, psychosis, or complex psychosocial situations; and where the degree of risk warrants specialist input. We also emphasise the need to refer older people with comorbid cognitive decline.

Services available in the UK vary geographically and are constantly evolving. A randomised controlled trial of home treatment versus conventional outpatient care for patients aged over 64 living independently and recruited from primary and secondary care services in Austria found significantly reduced depressive symptoms, improved global function, fewer admissions and lower costs of care in the home treatment arm at 3 and 12 months’ follow-up. 14 Studies of collaborative care interventions, where care is delivered through integrated mental health and primary care providers, have also repeatedly reported improved outcomes compared with usual care w7 although the effect appeared to be associated with prescription of antidepressant medication rather than better communication between primary care providers and mental health services.

Which medication should be prescribed?

Selective serotonin reuptake inhibitors (SSRIs) are well established as first line treatment for depression in older adults. A Cochrane review included 32 randomised controlled trials of antidepressant treatment in people aged 55 or over and reported that SSRIs and tricyclic antidepressants had similar efficacy, but that tricyclics were associated with more side effects and withdrawal from treatment. 15 It was not possible to compare efficacy for other antidepressant groups. Findings from a 2008 meta-analysis of second generation antidepressants in older adults (SSRIs, selective serotonin and noradrenaline reuptake inhibitors, bupropion, and mirtazapine) found that treatment in studies lasting 10 weeks or longer was associated with an improved response, supporting the long held belief that response to antidepressants is delayed in older adults. 16 A recent meta-analysis showed an advantage of SSRIs or tricyclic antidepressants over placebo in the treatment of patients with depression in the context of chronic physical illness. 17 Furthermore, evidence from randomised controlled trials has shown that antidepressants are efficacious in depression after stroke 18 and myocardial infarction. 19 Interestingly, a 2007 meta-analysis of 10 randomised controlled trials of prophylactic antidepressant treatment after stroke reported a significant reduction in the rate of post-stroke depression in treatment groups. 20 However, a large randomised controlled trial has recently shown that two commonly used antidepressants, sertraline and mirtazapine, were not appreciably different from placebo in treating depression in patients with Alzheimer’s disease. This effect was sustained at 10 months’ follow-up and side effects were increased in the antidepressant group. 21

Overall, an SSRI is usually the safest choice in patients with physical illness; the most common drug interactions are mediated via cytochrome p450 enzymes, and citalopram, escitalopram, and sertraline are safest in this regard.

Common side effects of particular concern in the elderly are anticholinergic effects, postural hypotension, and sedation, all of which are more common with tricyclic antidepressants than with SSRIs. 20 The risk can be minimised by starting at a low dose and slowly titrating upward. The risk of hyponatraemia induced by antidepressants increases with age and is associated with female sex, low body weight, renal failure, prescription of other drugs associated with hyponatraemia (such as diuretics), and medical comorbidity. w8 w9 Older patients prescribed SSRIs are also at increased risk of both upper and lower gastrointestinal bleeding. w10 Monitoring of serum sodium levels may be necessary, and the risk of gastrointestinal bleeding can be reduced by prescribing proton pump inhibitors.

NICE guidance recommends that antidepressant treatment is continued for at least six months for a single episode and at least two years if patients are thought to be at risk of relapse. A meta-analysis of eight double-blind placebo controlled trials of maintenance antidepressant therapy between 6 and 36 months in people over 55, published in 2011, found that the optimal duration in older adults is uncertain. 22 We suggest that a practical approach is to regularly review depressive symptoms, side effects, comorbidity, and current psychosocial stressors and to involve the patient in the decision making process about ongoing drug treatment.

What if first line drug treatment doesn’t work?

A 2011 systematic review and meta-analysis of inadequate response to treatment in older patients included 13 studies, most of which were open label. 23 The overall response rate for active treatment was 52%, and studies reporting positive results for augmentation of treatment with lithium or antipsychotics, and treatment with venlafaxine, duloxetine, selegiline, or phenelzine, were included. Lithium augmentation was the only treatment for which evidence of efficacy was replicated in more than two studies. We suggest that augmentation of treatment with antipsychotic medication should be used with particular caution in view of the susceptibility of older people to adverse drug reactions, and the paucity of data on safety.

Electroconvulsive therapy is sometimes used after inadequate response to drug treatment, although the usual indication is severe depressive illness in which life threatening refusal of food or fluid, risk of suicide, or psychotic features are present. Electroconvulsive therapy is a safe and effective treatment in the elderly despite an absence of methodologically sound evidence from randomised controlled trials. 24

Can older adults benefit from psychological therapy?

Results from a 2009 meta-regression analysis suggest that psychological therapy—particularly cognitive behavioural therapy, interpersonal therapy, and problem solving therapy—is equally effective in older and younger adults with depression. 25 Combined psychological therapy and pharmacological therapy is more effective than psychological treatment alone for older people with depression. 26

What is the outlook for older adults with depression?

A 2005 systematic review of studies comparing outcomes in depression in middle life with those in later life found that rates of remission were similar in both groups, but that late life depression was associated with higher rates of relapse. 27 A longitudinal primary care cohort study in the Netherlands reported that the median duration of a major depressive episode in late life was 18 months, with two thirds of patients taking three years to recover. 28 In the PRISM-E study, a large study of older patients with major depressive disorder, complete remission was attained in only 29% of patients at six month follow-up. 29 Factors associated with prolonged recovery in these studies included severity of depression at baseline, a family history of depression, comorbid anxiety, and general medical comorbidity.

A population based, age stratified, longitudinal study found that adults aged 70-84 years with depression have an increased risk of mortality compared with those who do not have depression, dying on average three years earlier. This risk holds beyond the effects of age, sex, and the presence of dementia, cardiovascular, and other somatic diseases, but did not persist in the oldest old—defined as those aged 85 to 101. w11

Tips for the non-specialist

Exclude physical illness as a cause for apparent depressive symptoms

Bear in mind that factors associated with ageing and the later stages of life, including physical illness, organic brain disease, pain, disability, losses (such as bereavement) , and social isolation, create vulnerability to depression

Be aware that older people with depression may minimise depressive symptoms and may present with somatic problems

Discuss options for treatment with the patient

Consider psychosocial interventions first in subsyndromal depressive states and mild depression

If medication is needed, use an SSRI at a therapeutic dose as first line treatment unless contraindications are present

Use the same criteria for referral for psychological therapy as in younger adults; older people are just as able to benefit

Evaluate risk; more people aged over 65 commit suicide than any other age group and most have major depression

Refer to specialist care if there is substantial risk of self harm, psychosis, need for complex multiprofessional care, inadequate response to treatment, or cognitive impairment

If treatment is started, evaluate response and need for ongoing treatment regularly

Points to discuss with the patient

Depression can affect people in different ways; some people may have strong feelings of sadness, but others may be more aware of feeling tired, slowed down, irritable, indecisive, that everything is an effort, or that they worry unnecessarily about small things and experience various physical problems—all these can be symptoms of depression and are not necessarily just part of “getting old”

There are many different ways to help people get well, for example taking part in social activities, attending clubs and interest groups; physical exercise; talking therapies, and medication

The beneficial effects of medication may take two to six weeks to be noticeable, but side effects may occur straight away; medication should ideally be continued for at least six months

Additional educational resources

For patients.

Depression ( www.ageuk.org.uk/health-wellbeing/conditions-illnesses/depression )—informative web page from Age UK, a charity supporting people in later life

Depression in older adults—( www.rcpsych.ac.uk/mentalhealthinfoforall/problems/depression/depressioninolderadults.aspx ) online information leaflet from the UK Royal College of Psychiatrists

CG90 Depression in adults: understanding NICE guidance ( http://guidance.nice.org.uk/CG90/PublicInfo/pdf/English )—explanation of NICE guidance for those using health services in NHS England and Wales

For healthcare professionals

Depression: the treatment and management of depression in adults (update) ( http://guidance.nice.org.uk/CG90 )—guidance from NICE

Depression ( www.cks.nhs.uk/depression/view_whole_topic )—clinical knowledge summary from NHS Evidence

GPNotebook ( www.gpnotebook.co.uk )—online medical encyclopaedia

Questions for future research

How can we differentiate between depressive syndromes in older adults, for example those overlapping with anxiety and cognitive impairment?

Does neuroimaging have a role in assessment of depression in older people?

How can we better identify and manage depression in dementia?

Are there ways of preventing depression in older adults at a population level?

What is the optimal period of maintenance treatment for depression in older adults?

Cite this as: BMJ 2011;343:d5219

Contributors: JR and JC were responsible for the planning, research, writing, and editing of the article. ZW was involved in the planning, writing and editing. JC is the guarantor.

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work ; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Provenance and peer review: Commissioned, externally peer reviewed.

• ↵ Manthorpe J, Iliffe S. Suicide in later life: public health and practitioner perspectives. Int J Geriatr Psychiatry 2010 ; 25 : 1230 -8. OpenUrl CrossRef PubMed
• ↵ Meeks TW, Vahia IV, Lavretsky H, Kulkarni G, Jeste DV. A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011 ; 129 : 126 -42. OpenUrl CrossRef PubMed
• ↵ Alvarez P, Urretavizcaya M, Benlloch L, Vallejo J, Menchon JM. Early- and late-onset depression in the older: no differences found within the melancholic subtype. Int J Geriatr Psychiatry 2011 ; 26 : 615 -21. OpenUrl CrossRef PubMed
• ↵ Beekman AT, de BE, van Balkom AJ, Deeg DJ, van DR, van TW. Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am J Psychiatry 2000 ; 157 : 89 -95. OpenUrl PubMed Web of Science
• ↵ Jorm AF. History of depression as a risk factor for dementia: an updated review. Aust N Z J Psychiatry 2001 ; 35 : 776 -81. OpenUrl Abstract / FREE Full Text
• ↵ Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 2006 ; 63 : 530 -8. OpenUrl CrossRef PubMed Web of Science
• ↵ Byers AL, Yaffe K. Depression and risk of developing dementia. Nat Rev Neurol 2011 ; 7 : 323 -31. OpenUrl CrossRef PubMed
• ↵ Sneed JR, Culang-Reinlieb ME. The vascular depression hypothesis: an update. Am J Geriatr Psychiatry 2011 ; 19 : 99 -103. OpenUrl CrossRef PubMed Web of Science
• ↵ Tsopelas C, Stewart R, Savva GM, Brayne C, Ince P, Thomas A, et al. Neuropathological correlates of late-life depression in older people. Br J Psychiatry 2011 ; 198 : 109 -14. OpenUrl Abstract / FREE Full Text
• ↵ Alexopoulos GS, Kiosses DN, Heo M, Murphy CF, Shanmugham B, Gunning-Dixon F. Executive dysfunction and the course of geriatric depression. Biol Psychiatry 2005 ; 58 : 204 -10. OpenUrl CrossRef PubMed Web of Science
• ↵ Vilalta-Franch J, Planas-Pujol X, Lopez-Pousa S, Llinas-Regla J, Merino-Aguado J, Garre-Olmo J. Depression subtypes and 5-years risk of mortality in aged 70 years: a population-based cohort study. Int J Geriatr Psychiatry 2011 , doi: 10.1002/gps.2691 .
• ↵ Blake H, Mo P, Malik S, Thomas S. How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clin Rehabil 2009 ; 23 : 873 -87. OpenUrl Abstract / FREE Full Text
• ↵ Van’t Veer-Tazelaar PJ, van Marwijk HW, van Oppen P, van Hout HP, van der Horst HE, Cuijpers P, et al. Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Arch Gen Psychiatry 2009 ; 66 : 297 -304. OpenUrl CrossRef PubMed Web of Science
• ↵ Klug G, Hermann G, Fuchs-Nieder B, Panzer M, Haider-Stipacek A, Zapotoczky HG, et al. Effectiveness of home treatment for elderly people with depression: randomised controlled trial. Br J Psychiatry 2010 ; 197 : 463 -7. OpenUrl Abstract / FREE Full Text
• ↵ Mottram P, Wilson K, Strobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev 2006 ; 1 : CD003491 . OpenUrl PubMed
• ↵ Nelson JC, Delucchi K, Schneider LS. Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. Am J Geriatr Psychiatry 2008 ; 16 : 558 -67. OpenUrl CrossRef PubMed Web of Science
• ↵ Taylor D, Meader N, Bird V, Pilling S, Creed F, Goldberg D. Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy. Br J Psychiatry 2011 ; 198 : 179 -88. OpenUrl Abstract / FREE Full Text
• ↵ Robinson RG, Spalletta G. Poststroke depression: a review. Can J Psychiatry 2010 ; 55 : 341 -9. OpenUrl PubMed
• ↵ Green LA, Dickinson WP, Nease DE, Schellhase KG, Campos-Outcalt D, Schoof BK et al. AAFP guideline for the detection and management of post-myocardial infarction depression. Ann Fam Med 2009 ; 7 : 71 -9. OpenUrl FREE Full Text
• ↵ Chen Y, Patel NC, Guo JJ, Zhan S. Antidepressant prophylaxis for poststroke depression: a meta-analysis. Int Clin Psychopharmacol 2007 ; 22 : 159 -66. OpenUrl CrossRef PubMed Web of Science
• ↵ Banerjee S, Hellier J, Dewey M, Romeo R, Ballard C, Baldwin R, et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 2011 ; 378 : 403 -11. OpenUrl CrossRef PubMed Web of Science
• ↵ Kok RM, Heeren TJ, Nolen WA. Continuing treatment of depression in the elderly: a systematic review and meta-analysis of double-blinded randomized controlled trials with antidepressants. Am J Geriatr Psychiatry 2011 ; 19 : 249 -55. OpenUrl PubMed Web of Science
• ↵ Cooper C, Katona C, Lyketsos K, Blazer D, Brodaty H, Rabins P, et al. A systematic review of treatments for refractory depression in older people. Am J Psychiatry 2011 .
• ↵ Stek ML, Van der Wurff FB, Hoogendijk WL, Beekman AT. Electroconvulsive therapy for the depressed elderly. Cochrane Database Syst Rev 2006 ; 2 : CD003593 . OpenUrl
• ↵ Cuijpers P, van SA, Smit F, Andersson G. Is psychotherapy for depression equally effective in younger and older adults? A meta-regression analysis. Int Psychogeriatr 2009 ; 21 : 16 -24. OpenUrl CrossRef PubMed
• ↵ Cuijpers P, van SA, Warmerdam L, Andersson G. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety 2009 ; 26 : 279 -88. OpenUrl CrossRef PubMed Web of Science
• ↵ Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. Am J Psychiatry 2005 ; 162 : 1588 -601. OpenUrl CrossRef PubMed Web of Science
• ↵ Licht-Strunk E, Van Marwijk HW, Hoekstra T, Twisk JW, De HM, Beekman AT. Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up. BMJ 2009 ; 338 : a3079 . OpenUrl Abstract / FREE Full Text
• ↵ Azar AR, Chopra MP, Cho LY, Coakley E, Rudolph JL. Remission in major depression: results from a geriatric primary care population. Int J Geriatr Psychiatry 2011 ; 26 : 48 -55. OpenUrl CrossRef PubMed
• ↵ Colasanti V, Marianetti M, Micacchi F, Amabile GA, Mina C. Tests for the evaluation of depression in the elderly: a systematic review. Arch Gerontol Geriatr 2010 ; 50 : 227 -30. OpenUrl CrossRef PubMed

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Essay On Depression In Older People

Type of paper: Essay

Topic: Life , Business , Psychology , Health , Depression , Family , Nursing , Services papers

Words: 2250

Published: 12/13/2019

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Depression in Older Persons

Depression is a mental disorder, which distresses mind, body and spirit of the victim. The condition significantly reduces the individual’s quality of life, productivity and own joy. Most people become depressed in their old stages, this is not an ageing process, but it is a common disorder among the older people (Hoek, 2008). At this point, older people experience a sense of loss in their existence, this disorder can be controlled with the assistance of caregivers (Baldwin, 2003). Most elderly who are depressed avoid going through diagnosis for fear of stigmatization. The depressed becomes hot tempered and disturbed; they normally experience nausea and weight reduction. Other experiences are memory lapse, be deficient in of concentration and can even engaging in reckless behaviours (Gavin & Julian, 2007). The depressed older persons would have strange thoughts of executing suicide. Regarding decision-making, depressed older people should be given the chance to make some decisions concerning his life. Such decisions can be; psychological, legal, practical, and spiritual or even medical decisions (Black Dog Institute Australia, 2012).

The elderly has a responsibility in deciding the kind of care he needs and whether the care is carried out at the health institution or home. They are also entitled to opinions, which facilitate the satisfaction of his needs and thus, assist them to overcome depression. Their decision-making and opinions reflects their preferences on matters pertaining care giving (Hoek, 2008). Every decision, preferences, and opinions they give should be considered as a step towards their satisfaction and thus part of relief from the depression (Black Dog Institute Australia, 2012). It is the responsibility of doctors and caregivers to ascertain if the victim can make a sound decision-making concerning their health before they are granted the opportunity to make. The satisfaction of the depressed older persons lies on their opinions and decision-making implementation; this will motivate the victims and consequently boosting their health (Liffe, 2009). Satisfaction in the life of older persons, with depression, is significantly affected by the status of their mood and contribution in making a decision (Hinrichsen & Clougherty, 2006). Ignoring depressed older persons in decision-making is giving them problem in coping with the situation. Letting them make a decision on their care utility placement is a vital factor on their life satisfaction (Baldwin, 2003).

There should be a good care for depressed old people to cope with the challenges associated with the disorder (McCredie, 2009). Caregivers, like family members, friends, or nurses have their own needs to execute their duties of care to the victims of depression (Tom, and Milne, 2009). With the spectacular aging and depression among older people, family members have the responsibility of taking care of them for a long time, this is a demanding responsibility, and thus the caregivers ought to be given enough support (Hinrichsen & Clougherty, 2006). There are several challenges associated with care giving; the strain of resources, exposure to health risks and more so the balance other personal or family duties and care-giving (Williamson, et al, 2007).

Families require information and their personal support facilities and services to safeguard their essential responsibility as caregivers, however habitually they are ignorant of where they can get assistance and support (Hellen, O’Connor, and Robinson, 2007). Due to their ignorance, caregivers cannot look for support from the ever-cooperating community organizations that are willing to offer sufficient supports, in terms of finance or emotional (Hellen, O’Connor, and Robinson, 2007). The centralized government can facilitate by putting effort to guarantee information to every family caregiver so as to the access support, high quality, realistic, and reasonably priced community and home -based amenities and other services (Tom, and Milne, 2009). Mental health services and community organizations offer medication, spiritual, medication and funds to the elderly. These are harsh economic moments, but funding family caregivers is among the most gainful lasting care investments that can carry out (Liffe, 2009).

Caregivers are frequently capable to delay expensive nursing home placements and decrease dependence on programs like Medicare as long as they carry their responsibilities of caring (Frazer & Griffths, 2005). Owing the many-sided responsibility that informal and family caregivers participate, they require a variety of support facilities and services to maintain their healthy, develop their care giving skilfulness and maintain their responsibility of care-giving (Gray, 2008). Support services comprise of support, counselling, information, home modification, respite, or assistive machines, family and caregiver counselling, and assistance groups (Hoek, 2008). While numerous facilities and services are accessible through local administration agencies, religious organizations, or service organizations, employers' programs also can lessen the effect of care giving on employees (Hinrichsen, et al, 2006).

Family caregivers experienced some stress on their duties; they are advised to carry bigger burdens for la long time (McCredie, 2009). In spite the more intricate care, escalating economic pressure, contradictory stress of family and jobs, and the emotional and physical needs of lasting care-giving can cause significant health effects on caregivers (Tom, and Milne, 2009). Generally, caregivers who undergo the furthermost emotional stress are mostly female (Kasper, et al, 2005). They are prone to dangers of; depression, frustration, high stress level, exhaustion, anxiety and irritation, abridged immune response, extra use of alcohol or other substances, deteriorated physical health and additional chronic conditions, abandoning their own care and have increased mortality rates (McCurren, 2002).

Furthermore, most caregivers are poorly prepared for their responsibility and offer care with modest or no assistance; nevertheless more than one-third of them keep on to offer passionate care to others whilst suffering from poor healthiness themselves (Gray, 2008). The coping strategies for caregivers entail entering into partnership with other health care experts, the partnership will enable them acquire relevant information and other support like funding and counselling (Gavin & Julian, 2007). Caregivers offer a wide variety of services, from easy assist such as shopping, to intricate medical processes (Hinrichsen, et al, 2006).

Innovations and implication of nursing care are fundamental towards prevention and identification of depression among older persons (McCurren, 2002). The campaign towards nurses' responsiveness of depression reacts to opinion-based research that depression is an unnoticed and ignored area of care. The promotion seeks to make the nurses detect depression in older people, hence drawing notice to a range of risk factors particularly to the later life. The promotion to changes to care home is a significant region for nursing involvement (Bruce, et al, 2004). The shift from the hospital of community or of other residential place to home care can be a disturbing life experience and among the greatest foundation of stress and fear for depressed older people (Kasper et al, 2005).

Nursing workers have a significant role contribution in offering the suitable social, spiritual, physical and psychological support that facilitate the development in quality of life for the depressed elderly people and their families (Rapaport et al, 2003). Physical support may entail recommendation to specialist services and facilities for the rectification of visual and hearing disabilities, which hamper the individual and stop them from coping with the new condition (Frazer, et al, 2005). The availability of written care assistance stressing the impact of transition, the possible gains and losses, is among the ways of offering substantiation that these are essential regions for supportive care (McCredie, 2009). Another innovation is the campaign for positive well-being and mental health it outlines the methods of supportive care that aid to simplicity the change and enhance the depressed older person's feelings of self-rule and control (Denby, 2004).

A completely coordinated, planned, and incorporated advance to admittance to the care home, or systematic care service is significant (McCredie, 2009). This incorporates provision of comprehensive information regarding the care service, and preferably, a pre-admission appointment to meet personnel. There is also an area for dealing with evidence around care planning and assessment (Bruce & Reynolds, 2004). Nurses are meant to be in close association with clients, and it is suggested that the first evaluation for depression starts in 48 hours of admittance and is concluded in 14 days (Sanson, 2003). Practical care planning emphasizes on the depressed older people's potencies, usual coping techniques, and their living patterns (Denby & Godfrey, 2004). Other interventions like allowing the depressed older people to access encouragement services, offering psychosocial assistance, sustaining community links, and encouraging the individual to be involved in significant activities are suggested since they contribute significantly in the deterrence of depression (McCredie, J. (2009).

Ultimately, good practice depression care necessitates the expertise of a variety of proficient other than nurses. Registered nurse ought to makes medical appointments to take gain of the specialist acquaintances (McCredie, 2009). On education and training nurses are sufficiently equipped to execute their responsibilities in caring for depressed older persons. The innovation is meant to train and educate nurses and other caregivers on depression in older persons especially for nursing workers operating in care homes (Gaugler, Mittelman, & Newcommer, 2009; Tom, and Milne, 2009). The innovation also assists the nurses to ease their work by training the caregivers and other family member involved on how to take responsibilities (Tom, and Milne, 2009).

In conclusion, Nurses are idyllically positioned to employ proactive strategies to thwart depression in elderly persons, to encourage early recognition of symptoms, and to ascertain access to efficient treatment (McCurren, 2002). Preventative strategies are founded on a consideration of danger factors for depression in elderly individuals and approval of how it feels to shift from one's residence into progressing care surroundings late in life (Frazer & Griffths, 2005). This finest practice statement has been build up to enhance development programs for national practice. (McCredie, 2009). It endeavours to depict the way nurses can work with depressed older persons and their members of their family at times of vital transformation, offering support and thwarting the usual responses to loss and misery from leading to clinical depression (Gaugler, Mittelman, & Newcommer, 2009).

Baldwin, R. (2003). Delusional depression in elderly patients: Characteristics and relationship to age at onset. Int J Geriatr Psychiatry 10:981–985.

Bruce, M., & Reynolds II. (2004). Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients: A Randomized Controlled Trial. Journal of the American Medical Association, 2004, 291:1081-1091 Black Dog Institute Australia. (2012). Depression Explained: In over 65s. Retrieved from http://www.blackdoginstitute.org.au/public/depression/inover65s.cfm

Denby, T & Godfrey, M. (2004). Depression and Older People: Towards Securing Well- being in Later Life. New York: Springer.

Frazer, C & Griffths, K. (2005). Effectiveness of Treatments for Depression in Older People. The Medical Journal of Australia; 182 (12): 627-632. Gavin, A & Julian, A. (2007). Age Shall Not Weary Them: Mental Health in the Middle- Aged and the Elderly. Australian & New Zealand Journal of Psychiatry, 41 (7)

Gray, H. (2008). Work and Depression in Economic Organization: The Need for Action. Development and Learning in Organization. 10 (3).

Gaugler, J., Mittelman, M & Newcommer, R. (2009). Predictors of change in Caregivers Burden and Depressive Symptoms Following Nursing Home Admission. Psychology and Aging: 385-396. Hellen, S., O’Connor, M. and Robinson, H. (2007). “Depression in older adults: Exploring the relationship between goal setting and physical health.” International Journal of geriatric psychiatry. John Wiley and Sons, Ltd

Hoek, R. (2008). The Many Faces of Geriatric Depression. Current Opinions in Psychiatry. 6:540-545.

Hinrichsen, G. A., & Clougherty, K. F. (2006). Depression and older adults. In Interpersonal psychotherapy for depressed older adults (Ch. 2, pp. 21- 42). American Psychological Association: Washington, D.C.

Kasper S, de Swart H, Andersen HF. (2005). Escitalopram in the treatment of depressed elderly patients. Am J Geriatr Psychiatry, 13:884–891.

Lliffe, S. (2009). "Recognition and response: Approaches to late-life depression and mental health problems in primary care", Quality in Ageing and Older Adults, 10 (1), pp.9 – 15

Miller, C. (2009). Nursing for Wellness in Older Adults. London: Wiley

McCurren C.(2002). Assessment for depression among nursing home elders: Evaluation of the MDS mood assessment. Geriatr Nurse, 23(2):103–108. McCredie, J. (2009). Aged care: The Depressing Reality. ABC Health & Wellbeing. Retrieved from http://www.abc.net.au/health/features/stories/2009/08/20/2661451.htm Rapaport MH, Schneider LS, Dunner DL, Davies JT, & Pitts CD.(2003). Efficacy of controlled-release paroxetine in the treatment of late-life depression. J Clin Psychiatry 2003; 64 (9):1065–1074.

Sanson, A. (2003). Ageing: Issues for Australian Families. Family Matters. Australian Institute of Family Studies 66, p 2-5

Tom D., and Milne, A. (2009). "Depression and mental health in care homes for older people.” Quality in Ageing and Older Adults, 10 (1), pp.40 - 46 Williamson, G.M., Shaffer, D.R., & Parmelee, P.A. (2000). Physical illness and depression in older adults: A handbook of theory, research, and practice. New York: Kluwer Academic/ Plenum Publishers.

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Health/Essays/Depression in older adults

Because the word depression is used so commonly in our society, it is important to learn what depression is and what that actually means. According to the Centers for Disease Control, Someone who is depressed has “feelings of sadness or anxiety that last for weeks at a time. He or she may also experience feelings of hopelessness and guilt, irritability, restlessness, loss of interest in activities or hobbies once pleasurable, fatigue and decreased energy, difficulty concentrating, insomnia, overeating or appetite loss, Thoughts of suicide or suicide attempts, Persistent aches or pains, headaches, and cramps.” When a person has depression, signs are seen and symptoms are felt even after healing time and even treatment. While this is a serious matter at any age, older adults are prone to have a heightened danger of developing depression. According to the CDC, about 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more common in people who already have other illnesses or when their body’s function and mobility start to lessen (“Depression and Suicide Facts” n.d.). Because the human body and mind deteriorate with age, older adults are often misdiagnosed and undertreated for depression (“Depression and Suicide Facts” n.d.). Healthcare providers could easily mistake an older adult's symptoms of depression as just a person’s natural reaction to illness life changes. Because of this people would not see depression as something to be treated. Older adults could agree the feelings being felt at that time are just part of life (“Depression and Older Adults” n.d.). Some older adults don't understand that they could feel better with appropriate treatment and can continue to live a life that has quality and happiness as its foundation. An important aspect of learning about depression is that there are treatments available to combat this illness. Costs for the depression care had a mean cost of $580 per patient (“Depression and Older Adults” n.d.). If this cost could be reduced and eventually be eliminated, that in itself could be seen as a perk to older adults feeling uneasy about treating their depression. A popular treatment method is the home or clinic based depression care management. This involves using a team approach. A trained social worker, nurse, or other practitioner oversees patient education, tracks specific outcomes, and delivers an evidence-based treatment that a primary care provider and psychiatrist would prescribe (“Depression in the Elderly” n.d.). This treatment could be in a clinical setting when an older individual lives in a nursing home or home care could be provided where every treatment option happens within the home environment. Another popular treatment option is cognitive therapy. This form of therapy gives the patient an opportunity to battle against the negative thoughts triggering depression. According to WedMd, patients with depression have continual negative thoughts that feed the depression. These thoughts are known to be automatic, which is a good benchmark of knowing when someone has depression. Cognitive therapy, defined by WebMd, is a treatment plan that helps patients recognize and correct the constant negative thoughts that continually pop into the patient’s head. Studies have shown that cognitive therapy works at least as well as antidepressants in helping people with mild to moderate depression (“Depression in the Elderly” n.d.). This plan does not need medication to be effective which can be seen as a benefit. Older adults already take medication for other problems, patients should recognize there is treatment available and it does not need to come in the form of a pill. Treatment with therapy can shorten the course of depression and can help reduce symptoms seen in depressed patients (“Depression in the Elderly” n.d.). Treatment is such a pivotal part of what depression is and how it can affect someone’s life forever but the harsh reality is that 75% of depressed older adults do not receive appropriate treatment and 80% of nursing home residents fail to receive appropriate treatment. (“CDC Promotes Public Health Approach” n.d.). There is so much that has been learned about depression over the years through multiple studies and scientific breakthroughs but there is so much more out there to be learned and even more people that need help.

Depression in the Elderly: Symptoms, Causes, Treatments. (n.d.). WebMD – Better information. Better health.. Retrieved January 15, 2012, from http://www.webmd.com/depression/guide/depression-elderly


NIMH Older Adults: Depression and Suicide Facts (Fact Sheet).(n.d.). NIMH Home. Retrieved January 16, 2012, from http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-fact-sheet/index.shtml

Missouri Department of Mental Health. (2006). Depression and Older Adults. Mental Health – Mental Illness. Retrieved January 15, 2012, from http://dmh.mo.gov/docs/mentalillness/elderlydepress.pdf

CDC Data & Statistics. (n.d.). CDC Promotes Public Health Approach To Address Depression among Older Adults. Centers for Disease Control and Prevention. Retrieved January 14, 2012, http://www.cdc.gov/aging/pdf/CIB_mental_health.pdf

• Depression (mood)

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Depression in the Elderly

Introduction, clinical depression or typical depression, forms of behavior, therapy and the consequence.

Depression can be defined as a state of anxiety, sadness, hopelessness, and worthlessness (Kail & Cavanaugh, 2011). It can affect people across all ages, who present with diverse signs and symptoms (Blatt, 2004). It has been shown that there are different types of depression, which require unique approaches with regard to diagnosis and treatment (Kail & Cavanaugh, 2011).

This paper aims at discussing how a person would know whether a relative had clinical depression or was sad due to specific changes or losses in life. It also focuses on highlighting the behaviors that could indicate that a person undergoing depression requires therapy. Finally, it offers recommendations with regard to therapy and the consequence of such a therapy in the elderly.

It would be important to determine whether a relative had clinical depression or was sad because of changes in life. This would help in determining the course of action in treatment.

Clinical depression persists in a patient longer than the other type of depression and it makes an individual not carry out his or her daily activities in a normal way. The following signs would characterize a relative suffering from clinical depression (Blatt, 2004; Kail & Cavanaugh, 2011):

• Insomnia or hypersomnia
• Lack of appetite
• Changed concentration
• Restlessness
• Worthlessness
• Considerable weight loss or gain
• Persistent suicidal thoughts

On the other hand, depression that is caused by changes or losses in life does not last long and there are no severe symptoms that could guarantee medications (Blatt, 2004). In fact, this type of depression can be resolved through the application of counselling.

Thus, it would be important to assess whether a relative encountered major changes in life. Changes could be brought by new jobs and responsibilities, among others (Blatt, 2004). Losses could be due to the death of a close family member or friend and loss of job, among others.

It is important to note the behaviors in a person undergoing depression that imply that he or she requires therapy (Kail & Cavanaugh, 2011). Most importantly, clinical depression should be treated when detected so that a person cannot result in life-threatening acts such as committing suicide. The following behaviors would indicate that a person requires therapy:

• Abrupt change of mood patterns
• Suicidal thoughts
• Hopelessness
• Prolonged anxiety
• Social withdrawal signs

A student would recommend the use of antidepressant medications aimed at curing the symptoms of a depressed patient (Kail & Cavanaugh, 2011). However, they would be selected based on behavior patterns that would be present in a patient.

Specifically, monoamine oxidase inhibitors (MAOIs), which treat depression by blocking the enzyme monoamine oxidase, would be recommended. Examples of the medications are phenelzine and isocarboxazid. The medicines would be suggested because they have fast modes of therapeutic activities (Henry et al., 2007).

The consequence of administering the drugs is that they would adversely react with other drugs and some types of food (Henry et al., 2007). In order to avoid the consequence, it would be important to tell a patient the drugs that he or she would not use while using the antidepressants. In addition, aged cheese and meats should be avoided.

Blatt, S. J. (2004). Experiences of depression: Theoretical, clinical, and research perspectives . New York, NY: American Psychological Association.

Henry, C., M’Baïlara, K., Poinsot, R., Casteret, A. A., Sorbara, F., Leboyer, M., & Vieta, E. (2007). Evidence for two types of bipolar depression using a dimensional approach. Psychotherapy and psychosomatics , 76 (6), 325-331.

Kail, R. V., & Cavanaugh, J. C. (2011). Human Development: A Life-Span View: A Life- Span View . Boston, MA: Cengage Learning.

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Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature

Olivia remes.

1 Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK

João Francisco Mendes

2 NOVA Medical School, Universidade NOVA de Lisboa, 1099-085 Lisbon, Portugal; ku.ca.mac@94cfj

Peter Templeton

3 IfM Engage Limited, Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK; ku.ca.mac@32twp

4 The William Templeton Foundation for Young People’s Mental Health (YPMH), Cambridge CB2 0AH, UK

Associated Data

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

1. Introduction

Depression is one of the most common mental health issues, with an estimated prevalence of 5% among adults [ 1 , 2 ]. Symptoms may include anhedonia, feelings of worthlessness, concentration and sleep difficulties, and suicidal ideation. According to the World Health Organization, depression is a leading cause of disability; research shows that it is a burdensome condition with a negative impact on educational trajectories, work performance, and other areas of life [ 1 , 3 ]. Depression can start early in the lifecourse and, if it remains unmanaged, may increase the risk for substance abuse, chronic conditions, such as cardiovascular disease, and premature mortality [ 4 , 5 , 6 , 7 , 8 ].

Treatment for depression exists, such as pharmacotherapy, cognitive behavioural therapy, and other modalities. A meta-analysis of randomized, placebo-controlled trials of patients shows that 56–60% of people respond well to active treatment with antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants) [ 9 ]. However, pharmacotherapy may be associated with problems, such as side-effects, relapse issues, a potential duration of weeks until the medication starts working, and possible limited efficacy in mild cases [ 10 , 11 , 12 , 13 , 14 ]. Psychotherapy is also available, but access barriers can make it difficult for a number of people to get the necessary help.

Studies on depression have increased significantly over the past few decades. However, the literature remains fragmented and the interpretation of heterogeneous findings across studies and between fields is difficult. The cross-pollination of ideas between disciplines, such as genetics, neurology, immunology, and psychology, is limited. Reviews on the determinants of depression have been conducted, but they either focus exclusively on a particular set of determinants (ex. genetic risk factors [ 15 ]) or population sub-group (ex. children and adolescents [ 16 ]) or focus on characteristics measured predominantly at the individual level (ex. focus on social support, history of depression [ 17 ]) without taking the wider context (ex. area-level variables) into account. An integrated approach paying attention to key determinants from the biological, psychological, and social spheres, as well as key themes, such as the lifecourse perspective, enables clinicians and public health authorities to develop tailored, person-centred approaches.

The primary aim of this literature review: to address the aforementioned challenges, we have synthesized recent research on the biological, psychological, and social determinants of depression and we have reviewed research from fields including genetics, immunology, neurology, psychology, public health, and epidemiology, among others.

The subsidiary aim: we have paid special attention to important themes, including the lifecourse perspective and interactions between determinants, to guide further efforts by public health and medical professionals.

This literature review can be used as an evidence base by those in public health and the clinical setting and can be used to inform targeted interventions.

2. Materials and Methods

We conducted a review of the literature on the biological, psychological, and social determinants of depression in the last 4 years. We decided to focus on these determinants after discussions with academics (from the Manchester Metropolitan University, University of Cardiff, University of Colorado, Boulder, University of Cork, University of Leuven, University of Texas), charity representatives, and people with lived experience at workshops held by the University of Cambridge in 2020. In several aspects, we attempted to conduct this review according to PRISMA guidelines [ 18 ].

The inclusion and exclusion criteria are the following:

• - We included documents, such as primary studies, literature reviews, systematic reviews, meta-analyses, reports, and commentaries on the determinants of depression. The determinants refer to variables that appear to be linked to the development of depression, such as physiological factors (e.g., the nervous system, genetics), but also factors that are further away or more distal to the condition. Determinants may be risk or protective factors, and individual- or wider-area-level variables.
• - We focused on major depressive disorder, treatment-resistant depression, dysthymia, depressive symptoms, poststroke depression, perinatal depression, as well as depressive-like behaviour (common in animal studies), among others.
• - We included papers regardless of the measurement methods of depression.
• - We included papers that focused on human and/or rodent research.
• - This review focused on articles written in the English language.
• - Documents published between 2017–2020 were captured to provide an understanding of the latest research on this topic.
• - Studies that assessed depression as a comorbidity or secondary to another disorder.
• - Studies that did not focus on rodent and/or human research.
• - Studies that focused on the treatment of depression. We made this decision, because this is an in-depth topic that would warrant a separate stand-alone review.
• Next, we searched PubMed (2017–2020) using keywords related to depression and determinants. Appendix A contains the search strategy used. We also conducted focused searches in Medline, Scopus, and PsycInfo (2017–2020).
• Once the documents were identified through the databases, the inclusion and exclusion criteria were applied to the titles and abstracts. Screening of documents was conducted by O.R., and a subsample was screened by J.M.; any discrepancies were resolved through a communication process.
• The full texts of documents were retrieved, and the inclusion and exclusion criteria were again applied. A subsample of documents underwent double screening by two authors (O.R., J.M.); again, any discrepancies were resolved through communication.
• a. A data charting form was created to capture the data elements of interest, including the authors, titles, determinants (biological, psychological, social), and the type of depression assessed by the research (e.g., major depression, depressive symptoms, depressive behaviour).
• b. The data charting form was piloted on a subset of documents, and refinements to it were made. The data charting form was created with the data elements described above and tested in 20 studies to determine whether refinements in the wording or language were needed.
• c. Data charting was conducted on the documents.
• d. Narrative analysis was conducted on the data charting table to identify key themes. When a particular finding was noted more than once, it was logged as a potential theme, with a review of these notes yielding key themes that appeared on multiple occasions. When key themes were identified, one researcher (O.R.) reviewed each document pertaining to that theme and derived concepts (key determinants and related outcomes). This process (a subsample) was verified by a second author (J.M.), and the two authors resolved any discrepancies through communication. Key themes were also checked as to whether they were of major significance to public mental health and at the forefront of public health discourse according to consultations we held with stakeholders from the Manchester Metropolitan University, University of Cardiff, University of Colorado, Boulder, University of Cork, University of Leuven, University of Texas, charity representatives, and people with lived experience at workshops held by the University of Cambridge in 2020.

We condensed the extensive information gleaned through our review into short summaries (with key points boxes for ease of understanding and interpretation of the data).

Through the searches, 6335 documents, such as primary studies, literature reviews, systematic reviews, meta-analyses, reports, and commentaries, were identified. After applying the inclusion and exclusion criteria, 470 papers were included in this review ( Supplementary Table S1 ). We focused on aspects related to biological, psychological, and social determinants of depression (examples of determinants and related outcomes are provided under each of the following sections.

3.1. Biological Factors

The following aspects will be discussed in this section: physical health conditions; then specific biological factors, including genetics; the microbiome; inflammatory factors; stress and hypothalamic–pituitary–adrenal (HPA) axis dysfunction, and the kynurenine pathway. Finally, aspects related to cognition will also be discussed in the context of depression.

3.1.1. Physical Health Conditions

Studies on physical health conditions—key points:

• The presence of a physical health condition can increase the risk for depression
• Psychological evaluation in physically sick populations is needed
• There is large heterogeneity in study design and measurement; this makes the comparison of findings between and across studies difficult

A number of studies examined the links between the outcome of depression and physical health-related factors, such as bladder outlet obstruction, cerebral atrophy, cataract, stroke, epilepsy, body mass index and obesity, diabetes, urinary tract infection, forms of cancer, inflammatory bowel disorder, glaucoma, acne, urea accumulation, cerebral small vessel disease, traumatic brain injury, and disability in multiple sclerosis [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. For example, bladder outlet obstruction has been linked to inflammation and depressive behaviour in rodent research [ 24 ]. The presence of head and neck cancer also seemed to be related to an increased risk for depressive disorder [ 45 ]. Gestational diabetes mellitus has been linked to depressive symptoms in the postpartum period (but no association has been found with depression in the third pregnancy trimester) [ 50 ], and a plethora of other such examples of relationships between depression and physical conditions exist. As such, the assessment of psychopathology and the provision of support are necessary in individuals of ill health [ 45 ]. Despite the large evidence base on physical health-related factors, differences in study methodology and design, the lack of standardization when it comes to the measurement of various physical health conditions and depression, and heterogeneity in the study populations makes it difficult to compare studies [ 50 ].

The next subsections discuss specific biological factors, including genetics; the microbiome; inflammatory factors; stress and hypothalamic–pituitary–adrenal (HPA) axis dysfunction, and the kynurenine pathway; and aspects related to cognition.

3.1.2. Genetics

Studies on genetics—key points:

There were associations between genetic factors and depression; for example:

• The brain-derived neurotrophic factor (BDNF) plays an important role in depression
• Links exist between major histocompatibility complex region genes, as well as various gene polymorphisms and depression
• Single nucleotide polymorphisms (SNPs) of genes involved in the tryptophan catabolites pathway are of interest in relation to depression

A number of genetic-related factors, genomic regions, polymorphisms, and other related aspects have been examined with respect to depression [ 61 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ]. The influence of BDNF in relation to depression has been amply studied [ 117 , 118 , 141 , 142 , 143 ]. Research has shown associations between depression and BDNF (as well as candidate SNPs of the BDNF gene, polymorphisms of the BDNF gene, and the interaction of these polymorphisms with other determinants, such as stress) [ 129 , 144 , 145 ]. Specific findings have been reported: for example, a study reported a link between the BDNF rs6265 allele (A) and major depressive disorder [ 117 ].

Other research focused on major histocompatibility complex region genes, endocannabinoid receptor gene polymorphisms, as well as tissue-specific genes and gene co-expression networks and their links to depression [ 99 , 110 , 112 ]. The SNPs of genes involved in the tryptophan catabolites pathway have also been of interest when studying the pathogenesis of depression.

The results from genetics studies are compelling; however, the findings remain mixed. One study indicated no support for depression candidate gene findings [ 122 ]. Another study found no association between specific polymorphisms and major depressive disorder [ 132 ]. As such, further research using larger samples is needed to corroborate the statistically significant associations reported in the literature.

3.1.3. Microbiome

Studies on the microbiome—key points:

• The gut bacteria and the brain communicate via both direct and indirect pathways called the gut-microbiota-brain axis (the bidirectional communication networks between the central nervous system and the gastrointestinal tract; this axis plays an important role in maintaining homeostasis).
• A disordered microbiome can lead to inflammation, which can then lead to depression
• There are possible links between the gut microbiome, host liver metabolism, brain inflammation, and depression

The common themes of this review have focused on the microbiome/microbiota or gut metabolome [ 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 ], the microbiota-gut-brain axis, and related factors [ 152 , 162 , 163 , 164 , 165 , 166 , 167 ]. When there is an imbalance in the intestinal bacteria, this can interfere with emotional regulation and contribute to harmful inflammatory processes and mood disorders [ 148 , 151 , 153 , 155 , 157 ]. Rodent research has shown that there may be a bidirectional association between the gut microbiota and depression: a disordered gut microbiota can play a role in the onset of this mental health problem, but, at the same time, the existence of stress and depression may also lead to a lower level of richness and diversity in the microbiome [ 158 ].

Research has also attempted to disentangle the links between the gut microbiome, host liver metabolism, brain inflammation, and depression, as well as the role of the ratio of lactobacillus to clostridium [ 152 ]. The literature has also examined the links between medication, such as antibiotics, and mood and behaviour, with the findings showing that antibiotics may be related to depression [ 159 , 168 ]. The links between the microbiome and depression are complex, and further studies are needed to determine the underpinning causal mechanisms.

3.1.4. Inflammation

Studies on inflammation—key points:

• Pro-inflammatory cytokines are linked to depression
• Pro-inflammatory cytokines, such as the tumour necrosis factor (TNF)-alpha, may play an important role
• Different methods of measurement are used, making the comparison of findings across studies difficult

Inflammation has been a theme in this literature review [ 60 , 161 , 164 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 ]. The findings show that raised levels of inflammation (because of factors such as pro-inflammatory cytokines) have been associated with depression [ 60 , 161 , 174 , 175 , 178 ]. For example, pro-inflammatory cytokines, such as tumour necrosis factor (TNF)-alpha, have been linked to depression [ 185 ]. Various determinants, such as early life stress, have also been linked to systemic inflammation, and this can increase the risk for depression [ 186 ].

Nevertheless, not everyone with elevated inflammation develops depression; therefore, this is just one route out of many linked to pathogenesis. Despite the compelling evidence reported with respect to inflammation, it is difficult to compare the findings across studies because of different methods used to assess depression and its risk factors.

3.1.5. Stress and HPA Axis Dysfunction

Studies on stress and HPA axis dysfunction—key points:

• Stress is linked to the release of proinflammatory factors
• The dysregulation of the HPA axis is linked to depression
• Determinants are interlinked in a complex web of causation

Stress was studied in various forms in rodent populations and humans [ 144 , 145 , 155 , 174 , 176 , 180 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 ].

Although this section has some overlap with others (as is to be expected because all of these determinants and body systems are interlinked), a number of studies have focused on the impact of stress on mental health. Stress has been mentioned in the literature as a risk factor of poor mental health and has emerged as an important determinant of depression. The effects of this variable are wide-ranging, and a short discussion is warranted.

Stress has been linked to the release of inflammatory factors, as well as the development of depression [ 204 ]. When the stress is high or lasts for a long period of time, this may negatively impact the brain. Chronic stress can impact the dendrites and synapses of various neurons, and may be implicated in the pathway leading to major depressive disorder [ 114 ]. As a review by Uchida et al. indicates, stress may be associated with the “dysregulation of neuronal and synaptic plasticity” [ 114 ]. Even in rodent studies, stress has a negative impact: chronic and unpredictable stress (and other forms of tension or stress) have been linked to unusual behaviour and depression symptoms [ 114 ].

The depression process and related brain changes, however, have also been linked to the hyperactivity or dysregulation of the HPA axis [ 127 , 130 , 131 , 182 , 212 ]. One review indicates that a potential underpinning mechanism of depression relates to “HPA axis abnormalities involved in chronic stress” [ 213 ]. There is a complex relationship between the HPA axis, glucocorticoid receptors, epigenetic mechanisms, and psychiatric sequelae [ 130 , 212 ].

In terms of the relationship between the HPA axis and stress and their influence on depression, the diathesis–stress model offers an explanation: it could be that early stress plays a role in the hyperactivation of the HPA axis, thus creating a predisposition “towards a maladaptive reaction to stress”. When this predisposition then meets an acute stressor, depression may ensue; thus, in line with the diathesis–stress model, a pre-existing vulnerability and stressor can create fertile ground for a mood disorder [ 213 ]. An integrated review by Dean and Keshavan [ 213 ] suggests that HPA axis hyperactivity is, in turn, related to other determinants, such as early deprivation and insecure early attachment; this again shows the complex web of causation between the different determinants.

3.1.6. Kynurenine Pathway

Studies on the kynurenine pathway—key points:

• The kynurenine pathway is linked to depression
• Indolamine 2,3-dioxegenase (IDO) polymorphisms are linked to postpartum depression

The kynurenine pathway was another theme that emerged in this review [ 120 , 178 , 181 , 184 , 214 , 215 , 216 , 217 , 218 , 219 , 220 , 221 ]. The kynurenine pathway has been implicated not only in general depressed mood (inflammation-induced depression) [ 184 , 214 , 219 ] but also postpartum depression [ 120 ]. When the kynurenine metabolism pathway is activated, this results in metabolites, which are neurotoxic.

A review by Jeon et al. notes a link between the impairment of the kynurenine pathway and inflammation-induced depression (triggered by treatment for various physical diseases, such as malignancy). The authors note that this could represent an important opportunity for immunopharmacology [ 214 ]. Another review by Danzer et al. suggests links between the inflammation-induced activation of indolamine 2,3-dioxegenase (the enzyme that converts tryptophan to kynurenine), the kynurenine metabolism pathway, and depression, and also remarks about the “opportunities for treatment of inflammation-induced depression” [ 184 ].

3.1.7. Cognition

Studies on cognition and the brain—key points:

• Cognitive decline and cognitive deficits are linked to increased depression risk
• Cognitive reserve is important in the disability/depression relationship
• Family history of cognitive impairment is linked to depression

A number of studies have focused on the theme of cognition and the brain. The results show that factors, such as low cognitive ability/function, cognitive vulnerability, cognitive impairment or deficits, subjective cognitive decline, regression of dendritic branching and hippocampal atrophy/death of hippocampal cells, impaired neuroplasticity, and neurogenesis-related aspects, have been linked to depression [ 131 , 212 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 ]. The cognitive reserve appears to act as a moderator and can magnify the impact of certain determinants on poor mental health. For example, in a study in which participants with multiple sclerosis also had low cognitive reserve, disability was shown to increase the risk for depression [ 63 ]. Cognitive deficits can be both causal and resultant in depression. A study on individuals attending outpatient stroke clinics showed that lower scores in cognition were related to depression; thus, cognitive impairment appears to be associated with depressive symptomatology [ 226 ]. Further, Halahakoon et al. [ 222 ] note a meta-analysis [ 240 ] that shows that a family history of cognitive impairment (in first degree relatives) is also linked to depression.

In addition to cognitive deficits, low-level cognitive ability [ 231 ] and cognitive vulnerability [ 232 ] have also been linked to depression. While cognitive impairment may be implicated in the pathogenesis of depressive symptoms [ 222 ], negative information processing biases are also important; according to the ‘cognitive neuropsychological’ model of depression, negative affective biases play a central part in the development of depression [ 222 , 241 ]. Nevertheless, the evidence on this topic is mixed and further work is needed to determine the underpinning mechanisms between these states.

3.2. Psychological Factors

Studies on psychological factors—key points:

• There are many affective risk factors linked to depression
• Determinants of depression include negative self-concept, sensitivity to rejection, neuroticism, rumination, negative emotionality, and others

A number of studies have been undertaken on the psychological factors linked to depression (including mastery, self-esteem, optimism, negative self-image, current or past mental health conditions, and various other aspects, including neuroticism, brooding, conflict, negative thinking, insight, cognitive fusion, emotional clarity, rumination, dysfunctional attitudes, interpretation bias, and attachment style) [ 66 , 128 , 140 , 205 , 210 , 228 , 235 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , 257 , 258 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271 , 272 , 273 , 274 , 275 , 276 , 277 , 278 , 279 , 280 , 281 , 282 , 283 , 284 , 285 , 286 , 287 , 288 , 289 , 290 ]. Determinants related to this condition include low self-esteem and shame, among other factors [ 269 , 270 , 275 , 278 ]. Several emotional states and traits, such as neuroticism [ 235 , 260 , 271 , 278 ], negative self-concept (with self-perceptions of worthlessness and uselessness), and negative interpretation or attention biases have been linked to depression [ 261 , 271 , 282 , 283 , 286 ]. Moreover, low emotional clarity has been associated with depression [ 267 ]. When it comes to the severity of the disorder, it appears that meta-emotions (“emotions that occur in response to other emotions (e.g., guilt about anger)” [ 268 ]) have a role to play in depression [ 268 ].

A determinant that has received much attention in mental health research concerns rumination. Rumination has been presented as a mediator but also as a risk factor for depression [ 57 , 210 , 259 ]. When studied as a risk factor, it appears that the relationship of rumination with depression is mediated by variables that include limited problem-solving ability and insufficient social support [ 259 ]. However, rumination also appears to act as a mediator: for example, this variable (particularly brooding rumination) lies on the causal pathway between poor attention control and depression [ 265 ]. This shows that determinants may present in several forms: as moderators or mediators, risk factors or outcomes, and this is why disentangling the relationships between the various factors linked to depression is a complex task.

The psychological determinants are commonly researched variables in the mental health literature. A wide range of factors have been linked to depression, such as the aforementioned determinants, but also: (low) optimism levels, maladaptive coping (such as avoidance), body image issues, and maladaptive perfectionism, among others [ 269 , 270 , 272 , 273 , 275 , 276 , 279 , 285 , 286 ]. Various mechanisms have been proposed to explain the way these determinants increase the risk for depression. One of the underpinning mechanisms linking the determinants and depression concerns coping. For example, positive fantasy engagement, cognitive biases, or personality dispositions may lead to emotion-focused coping, such as brooding, and subsequently increase the risk for depression [ 272 , 284 , 287 ]. Knowing the causal mechanisms linking the determinants to outcomes provides insight for the development of targeted interventions.

3.3. Social Determinants

Studies on social determinants—key points:

• Social determinants are the conditions in the environments where people are born, live, learn, work, play, etc.; these influence (mental) health [ 291 ]
• There are many social determinants linked to depression, such as sociodemographics, social support, adverse childhood experiences
• Determinants can be at the individual, social network, community, and societal levels

Studies also focused on the social determinants of (mental) health; these are the conditions in which people are born, live, learn, work, play, and age, and have a significant influence on wellbeing [ 291 ]. Factors such as age, social or socioeconomic status, social support, financial strain and deprivation, food insecurity, education, employment status, living arrangements, marital status, race, childhood conflict and bullying, violent crime exposure, abuse, discrimination, (self)-stigma, ethnicity and migrant status, working conditions, adverse or significant life events, illiteracy or health literacy, environmental events, job strain, and the built environment have been linked to depression, among others [ 52 , 133 , 235 , 236 , 239 , 252 , 269 , 280 , 292 , 293 , 294 , 295 , 296 , 297 , 298 , 299 , 300 , 301 , 302 , 303 , 304 , 305 , 306 , 307 , 308 , 309 , 310 , 311 , 312 , 313 , 314 , 315 , 316 , 317 , 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , 351 , 352 , 353 , 354 , 355 , 356 , 357 , 358 , 359 , 360 , 361 , 362 , 363 , 364 , 365 , 366 , 367 , 368 , 369 , 370 , 371 ]. Social support and cohesion, as well as structural social capital, have also been identified as determinants [ 140 , 228 , 239 , 269 , 293 , 372 , 373 , 374 , 375 , 376 , 377 , 378 , 379 ]. In a study, part of the findings showed that low levels of education have been shown to be linked to post-stroke depression (but not severe or clinical depression outcomes) [ 299 ]. A study within a systematic review indicated that having only primary education was associated with a higher risk of depression compared to having secondary or higher education (although another study contrasted this finding) [ 296 ]. Various studies on socioeconomic status-related factors have been undertaken [ 239 , 297 ]; the research has shown that a low level of education is linked to depression [ 297 ]. Low income is also related to depressive disorders [ 312 ]. By contrast, high levels of education and income are protective [ 335 ].

A group of determinants touched upon by several studies included adverse childhood or early life experiences: ex. conflict with parents, early exposure to traumatic life events, bullying and childhood trauma were found to increase the risk of depression (ex. through pathways, such as inflammation, interaction effects, or cognitive biases) [ 161 , 182 , 258 , 358 , 362 , 380 ].

Gender-related factors were also found to play an important role with respect to mental health [ 235 , 381 , 382 , 383 , 384 , 385 ]. Gender inequalities can start early on in the lifecourse, and women were found to be twice as likely to have depression as men. Gender-related factors were linked to cognitive biases, resilience and vulnerabilities [ 362 , 384 ].

Determinants can impact mental health outcomes through underpinning mechanisms. For example, harmful determinants can influence the uptake of risk behaviours. Risk behaviours, such as sedentary behaviour, substance abuse and smoking/nicotine exposure, have been linked to depression [ 226 , 335 , 355 , 385 , 386 , 387 , 388 , 389 , 390 , 391 , 392 , 393 , 394 , 395 , 396 , 397 , 398 , 399 , 400 , 401 ]. Harmful determinants can also have an impact on diet. Indeed, dietary aspects and diet components (ex. vitamin D, folate, selenium intake, iron, vitamin B12, vitamin K, fiber intake, zinc) as well as diet-related inflammatory potential have been linked to depression outcomes [ 161 , 208 , 236 , 312 , 396 , 402 , 403 , 404 , 405 , 406 , 407 , 408 , 409 , 410 , 411 , 412 , 413 , 414 , 415 , 416 , 417 , 418 , 419 , 420 , 421 , 422 , 423 , 424 , 425 , 426 , 427 , 428 ]. A poor diet has been linked to depression through mechanisms such as inflammation [ 428 ].

Again, it is difficult to constrict diet to the ‘social determinants of health’ category as it also relates to inflammation (biological determinants) and could even stand alone as its own category. Nevertheless, all of these factors are interlinked and influence one another in a complex web of causation, as mentioned elsewhere in the paper.

Supplementary Figure S1 contains a representation of key determinants acting at various levels: the individual, social network, community, and societal levels. The determinants have an influence on risk behaviours, and this, in turn, can affect the mood (i.e., depression), body processes (ex. can increase inflammation), and may negatively influence brain structure and function.

3.4. Others

Studies on ‘other’ determinants—key points:

• A number of factors are related to depression
• These may not be as easily categorized as the other determinants in this paper

A number of factors arose in this review that were related to depression; it was difficult to place these under a specific heading above, so this ‘other’ category was created. A number of these could be sorted under the ‘social determinants of depression’ category. For example, being exposed to deprivation, hardship, or adversity may increase the risk for air pollution exposure and nighttime shift work, among others, and the latter determinants have been found to increase the risk for depression. Air pollution could also be regarded as an ecologic-level (environmental) determinant of mental health.

Nevertheless, we have decided to leave these factors in a separate category (because their categorization may not be as immediately clear-cut as others), and these factors include: low-level light [ 429 ], weight cycling [ 430 ], water contaminants [ 431 ], trade [ 432 ], air pollution [ 433 , 434 ], program-level variables (ex. feedback and learning experience) [ 435 ], TV viewing [ 436 ], falls [ 437 ], various other biological factors [ 116 , 136 , 141 , 151 , 164 , 182 , 363 , 364 , 438 , 439 , 440 , 441 , 442 , 443 , 444 , 445 , 446 , 447 , 448 , 449 , 450 , 451 , 452 , 453 , 454 , 455 , 456 , 457 , 458 , 459 , 460 , 461 , 462 , 463 , 464 , 465 , 466 , 467 , 468 , 469 ], mobile phone use [ 470 ], ultrasound chronic exposure [ 471 ], nighttime shift work [ 472 ], work accidents [ 473 ], therapy enrollment [ 226 ], and exposure to light at night [ 474 ].

4. Cross-Cutting Themes

4.1. lifecourse perspective.

Studies on the lifecourse perspective—key points:

• Early life has an importance on mental health
• Stress has been linked to depression
• In old age, the decline in social capital is important

Trajectories and life events are important when it comes to the lifecourse perspective. Research has touched on the influence of prenatal or early life stress on an individual’s mental health trajectory [ 164 , 199 , 475 ]. Severe stress that occurs in the form of early-life trauma has also been associated with depressive symptoms [ 362 , 380 ]. It may be that some individuals exposed to trauma develop thoughts of personal failure, which then serve as a catalyst of depression [ 380 ].

At the other end of the life trajectory—old age—specific determinants have been linked to an increased risk for depression. Older people are at a heightened risk of losing their social networks, and structural social capital has been identified as important in relation to depression in old age [ 293 ].

4.2. Gene–Environment Interactions

Studies on gene–environment interactions—key points:

• The environment and genetics interact to increase the risk of depression
• The etiology of depression is multifactorial
• Adolescence is a time of vulnerability

A number of studies have touched on gene–environment interactions [ 72 , 77 , 82 , 119 , 381 , 476 , 477 , 478 , 479 , 480 , 481 ]. The interactions between genetic factors and determinants, such as negative life events (ex. relationship and social difficulties, serious illness, unemployment and financial crises) and stressors (ex. death of spouse, minor violations of law, neighbourhood socioeconomic status) have been studied in relation to depression [ 82 , 135 , 298 , 449 , 481 ]. A study reported an interaction of significant life events with functional variation in the serotonin-transporter-linked polymorphic region (5-HTTLPR) allele type (in the context of multiple sclerosis) and linked this to depression [ 361 ], while another reported an interaction between stress and 5-HTTLPR in relation to depression [ 480 ]. Other research reported that the genetic variation of HPA-axis genes has moderating effects on the relationship between stressors and depression [ 198 ]. Another study showed that early-life stress interacts with gene variants to increase the risk for depression [ 77 ].

Adolescence is a time of vulnerability [ 111 , 480 ]. Perceived parental support has been found to interact with genes (GABRR1, GABRR2), and this appears to be associated with depressive symptoms in adolescence [ 480 ]. It is important to pay special attention to critical periods in the lifecourse so that adequate support is provided to those who are most vulnerable.

The etiology of depression is multifactorial, and it is worthwhile to examine the interaction between multiple factors, such as epigenetic, genetic, and environmental factors, in order to truly understand this mental health condition. Finally, taking into account critical periods of life when assessing gene–environment interactions is important for developing targeted interventions.

5. Discussion

Depression is one of the most common mental health conditions, and, if left untreated, it can increase the risk for substance abuse, anxiety disorders, and suicide. In the past 20 years, a large number of studies on the risk and protective factors of depression have been undertaken in various fields, such as genetics, neurology, immunology, and epidemiology. However, there are limitations associated with the extant evidence base. The previous syntheses on depression are limited in scope and focus exclusively on social or biological factors, population sub-groups, or examine depression as a comorbidity (rather than an independent disorder). The research on the determinants and causal pathways of depression is fragmentated and heterogeneous, and this has not helped to stimulate progress when it comes to the prevention and intervention of this condition—specifically unravelling the complexity of the determinants related to this condition and thus refining the prevention and intervention methods.

The scope of this paper was to bring together the heterogeneous, vast, and fragmented literature on depression and paint a picture of the key factors that contribute to this condition. The findings from this review show that there are important themes when it comes to the determinants of depression, such as: the microbiome, dysregulation of the HPA axis, inflammatory reactions, the kynurenine pathway, as well as psychological and social factors. It may be that physical factors are proximal determinants of depression, which, in turn, are acted on by more distal social factors, such as deprivation, environmental events, and social capital.

The Marmot Report [ 291 ], the World Health Organization [ 482 ], and Compton et al. [ 483 ] highlight that the most disadvantaged segments of society are suffering (the socioeconomic context is important), and this inequality in resources has translated to inequality in mental health outcomes [ 483 ]. To tackle the issue of egalitarianism and restore equality in the health between the groups, the social determinants need to be addressed [ 483 ]. A wide range of determinants of mental health have been identified in the literature: age, gender, ethnicity, family upbringing and early attachment patterns, social support, access to food, water and proper nutrition, and community factors. People spiral downwards because of individual- and societal-level circumstances; therefore, these circumstances along with the interactions between the determinants need to be considered.

Another important theme in the mental health literature is the lifecourse perspective. This shows that the timing of events has significance when it comes to mental health. Early life is a critical period during the lifespan at which cognitive processes develop. Exposure to harmful determinants, such as stress, during this period can place an individual on a trajectory of depression in adulthood or later life. When an individual is exposed to harmful determinants during critical periods and is also genetically predisposed to depression, the risk for the disorder can be compounded. This is why aspects such as the lifecourse perspective and gene–environment interactions need to be taken into account. Insight into this can also help to refine targeted interventions.

A number of interventions for depression have been developed or recommended, addressing, for example, the physical factors described here and lifestyle modifications. Interventions targeting various factors, such as education and socioeconomic status, are needed to help prevent and reduce the burden of depression. Further research on the efficacy of various interventions is needed. Additional studies are also needed on each of the themes described in this paper, for example: the biological factors related to postpartum depression [ 134 ], and further work is needed on depression outcomes, such as chronic, recurrent depression [ 452 ]. Previous literature has shown that chronic stress (associated with depression) is also linked to glucocorticoid receptor resistance, as well as problems with the regulation of the inflammatory response [ 484 ]. Further work is needed on this and the underpinning mechanisms between the determinants and outcomes. This review highlighted the myriad ways of measuring depression and its determinants [ 66 , 85 , 281 , 298 , 451 , 485 ]. Thus, the standardization of the measurements of the outcomes (ex. a gold standard for measuring depression) and determinants is essential; this can facilitate comparisons of findings across studies.

5.1. Strengths

This paper has important strengths. It brings together the wide literature on depression and helps to bridge disciplines in relation to one of the most common mental health problems. We identified, selected, and extracted data from studies, and provided concise summaries.

5.2. Limitations

The limitations of the review include missing potentially important studies; however, this is a weakness that cannot be avoided by literature reviews. Nevertheless, the aim of the review was not to identify each study that has been conducted on the risk and protective factors of depression (which a single review is unable to capture) but rather to gain insight into the breadth of literature on this topic, highlight key biological, psychological, and social determinants, and shed light on important themes, such as the lifecourse perspective and gene–environment interactions.

6. Conclusions

We have reviewed the determinants of depression and recognize that there are a multitude of risk and protective factors at the individual and wider ecologic levels. These determinants are interlinked and influence one another. We have attempted to describe the wide literature on this topic, and we have brought to light major factors that are of public mental health significance. This review may be used as an evidence base by those in public health, clinical practice, and research.

This paper discusses key areas in depression research; however, an exhaustive discussion of all the risk factors and determinants linked to depression and their mechanisms is not possible in one journal article—which, by its very nature, a single paper cannot do. We have brought to light overarching factors linked to depression and a workable conceptual framework that may guide clinical and public health practice; however, we encourage other researchers to continue to expand on this timely and relevant work—particularly as depression is a top priority on the policy agenda now.

Acknowledgments

Thank you to Isla Kuhn for the help with the Medline, Scopus, and PsycInfo database searches.

Supplementary Materials

The following are available online at https://www.mdpi.com/article/10.3390/brainsci11121633/s1 , Figure S1: Conceptual framework: Determinants of depression, Table S1: Data charting—A selection of determinants from the literature.

Appendix A.1. Search Strategy

Search: ((((((((((((((((“Gene-Environment Interaction”[Majr]) OR (“Genetics”[Mesh])) OR (“Genome-Wide Association Study”[Majr])) OR (“Microbiota”[Mesh] OR “Gastrointestinal Microbiome”[Mesh])) OR (“Neurogenic Inflammation”[Mesh])) OR (“genetic determinant”)) OR (“gut-brain-axis”)) OR (“Kynurenine”[Majr])) OR (“Cognition”[Mesh])) OR (“Neuronal Plasticity”[Majr])) OR (“Neurogenesis”[Mesh])) OR (“Genes”[Mesh])) OR (“Neurology”[Majr])) OR (“Social Determinants of Health”[Majr])) OR (“Glucocorticoids”[Mesh])) OR (“Tryptophan”[Mesh])) AND (“Depression”[Mesh] OR “Depressive Disorder”[Mesh]) Filters: from 2017—2020.

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions(R)

• exp *Depression/
• exp *Depressive Disorder/
• exp *”Social Determinants of Health”/
• exp *Tryptophan/
• exp *Glucocorticoids/
• exp *Neurology/
• exp *Genes/
• exp *Neurogenesis/
• exp *Neuronal Plasticity/
• exp *Kynurenine/
• exp *Genetics/
• exp *Neurogenic Inflammation/
• exp *Gastrointestinal Microbiome/
• exp *Genome-Wide Association Study/
• exp *Gene-Environment Interaction/
• exp *Depression/et [Etiology]
• exp *Depressive Disorder/et
• or/4-16   637368
• limit 22 to yr = “2017–Current”
• “cause* of depression”.mp.
• “cause* of depression”.ti.
• (cause adj3 (depression or depressive)).ti.
• (caus* adj3 (depression or depressive)).ti.

Appendix A.2. PsycInfo

(TITLE ( depression OR “ Depressive Disorder ”) AND TITLE (“ Social Determinants of Health ” OR tryptophan OR glucocorticoids OR neurology OR genes OR neurogenesis OR “ Neuronal Plasticity ” OR kynurenine OR genetics OR “ Neurogenic Inflammation ” OR “ Gastrointestinal Microbiome ” OR “ Genome-Wide Association Study ” OR “ Gene-Environment Interaction ” OR aetiology OR etiology )) OR TITLE ( cause* W/3 ( depression OR depressive )).

Author Contributions

O.R. was responsible for the design of the study and methodology undertaken. Despite P.T.’s involvement in YPMH, he had no role in the design of the study; P.T. was responsible for the conceptualization of the study. Validation was conducted by O.R. and J.F.M. Formal analysis (data charting) was undertaken by O.R. O.R. and P.T. were involved in the investigation, resource acquisition, and data presentation. The original draft preparation was undertaken by O.R. The writing was conducted by O.R., with review and editing by P.T. and J.F.M. Funding acquisition was undertaken by O.R. and P.T. All authors have read and agreed to the published version of the manuscript.

This research was funded by The William Templeton Foundation for Young People’s Mental Health, Cambridge Philosophical Society, and the Aviva Foundation.

Conflicts of Interest

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Depression in older adults

This information is written for older adults who have or think they might have depression, and the people who care for them.

This leaflet provides information, not advice.

The content in this leaflet is provided for general information only. It is not intended to, and does not, mount to advice which you should rely on. It is not in any way an alternative to specific advice.

You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet.

If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.

If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider.

Although we make reasonable efforts to compile accurate information in our leaflets and to update the information in our leaflets, we make no representations, warranties or guarantees, whether express or implied, that the content in this leaflet is accurate, complete or up to date.

Depression in older people

This information looks at:

• the challenges older adults with depression can face
• how the signs of depression can be different in older adults
• barriers to accessing care
• how to get information and support.

In this resource, when we say ‘older adults’ we are referring to people over the age of 65. However, we know that not everyone who is over 65 will find this information relevant to them.

What is depression?

Depression is a mental illness that affects the way you think and feel. It is quite common, and affects people of all ages. Around 3 in 100 people in England are diagnosed with depression every week.

What are the symptoms of depression?

Depression isn’t just feeling sad. If you have depression, you might:

• feel unhappy, hopeless or that life isn’t worth living
• feel anxious or worried
• struggle to do things
• struggle to concentrate or remember things
• lose interest in the things you once enjoyed.

In your body you might:

• feel exhausted or restless
• struggle to sleep, or sleep too much
• have physical health problems like headaches or stomach aches
• lose interest in sex
• eat less or more than usual.

Other people might notice that you:

• seem more quiet, worried, irritable or sad than usual
• struggle to focus
• sleep more or less than usual
• complain about aches and pains
• stop looking after yourself or your home
• seem more isolated or lonely.

Depression can be mild, moderate or severe, and depending on the severity of your depression you might have different symptoms. It might not be obvious straight away that you or someone else is experiencing depression. You can find out more about depression in our information resource  on the topic.

When should I get help?

Most of us have some of these feelings from time to time. However, it’s important to ask for help if:

• you experience a lot of these feelings
• the feelings go on for more than a couple of weeks
• the feelings start to affect lots of areas of your life
• you feel that life is not worth living.

Is depression a new thing?

Depression isn’t something new. However, in the past talking openly about mental health and mental illness wasn’t encouraged. There were also a lot of misconceptions and stereotypes about depression and the people who had it. Some of the words used to describe depression were stigmatising and unkind.

Over the years, we have learnt more about why depression happens and how best to treat it. While stigma around depression and other mental illnesses still exists, things are much better than they were. There is now a lot of support available to people of all ages who have depression.

Why do older people develop depression?

There are lots of reasons why people develop depression, such as difficult life experiences, physical health problems and genetic factors. You can find out more about the causes of depression in our depression resource .

There are also some things that might make older people more likely to develop depression. These include:

Physical health problems

Older people are more likely to be diagnosed with one or more long-term health conditions. Research has shown that this can make people more likely to develop depression.

Dementia is a condition that affects your memory, language and behaviour, and mostly affects older people. It’s estimated that around 3 in every 10 people living with dementia are depressed.

Parkinson’s disease

Parkinson’s disease is a condition that affects how your brain works. It causes symptoms like shaking, slow movement and stiff muscles, and is most common in people over the age of 50. Feelings of depression are common in people with Parkinson’s disease.

Loneliness is more common in people who have been widowed, have health problems or live alone. However, even people who have support from friends and family can experience loneliness. While being lonely is not the same as being depressed, older people who experience loneliness are also more likely to experience depression.

When someone you care about dies, it is normal to experience feelings of grief, especially if the person who died was very close to you. You probably won’t ever completely ‘get over’ the death of a loved one. However, if your feelings of grief continue to feel intense for a long time, or feel like they are getting worse, you might need professional help.

When someone dies, it is also common to have trouble sleeping, or to lose your appetite. Changes to your sleep and diet can also have a negative effect on your mental health.

Vascular depression

Illnesses that affect the circulation of blood to the brain can make someone more likely to develop depression. These include heart disease, strokes, and high blood pressure or cholesterol.

Alcohol use

Alcohol affects the chemistry of the brain, increasing the risk of depression. If you already have depression, alcohol can also make this worse.

Moving into care homes

Depression is more common in people who live in care homes than in people who don’t. This could be because people who live in care homes are more likely to be experiencing some of the factors we’ve already mentioned. It could also be because people who live in care homes can lose their usual familiar routines and supportive environments.

What treatments are available?

Depression is treatable. There are lots of different kinds of support available, and research has shown that these can be very effective.

The first thing you should do if you think you are experiencing depression, is to speak to your GP. They will ask you questions about how you have been feeling and what is going on in your life. They might use a questionnaire to find out whether you have depression and how severe it is.

Once you have discussed what is happening, your GP can support you to get the help you need.

Helping yourself

If your depression is mild or this is the first time you have experienced depression, your GP might recommend that you do some things to support yourself.

The NHS suggests 5 steps you can take to improve your mental health and wellbeing. These are:

• Connecting with other people – This could be a friend or family member, religious leader, or anyone you know who you trust and respect. Often when we talk to others about how we are feeling we find out that they have had similar experiences, and that we aren’t as alone as we thought.
• Being physically active – This could be anything from going for a daily walk around your local park to joining a dance class. Staying active, cutting down on alcohol, quitting smoking, eating healthily and sleeping well are good for everyone, but can be particularly helpful if you are experiencing depression.
• Learning new skills – You could try cooking a new meal, taking on new responsibilities, or signing up for a course. This can help you to improve your self-confidence and connect with others.
• Give to others – This could mean giving your time by volunteering in your local community, giving your skills by helping a neighbour or friend with a task, or just telling a friend something you appreciate about them.
• Pay attention – This is also called mindfulness, and is when you pay attention to yourself and the world around you. This can help you to feel more connected to your environment, and to become less overwhelmed by your thoughts and feelings. There are lots of different ways to practice mindfulness .

Find out more about these steps  on the NHS website .

Social prescribing

Social prescribing helps to connect people to community services and local groups to support their mental and physical health.

Your GP can refer you to a ‘link worker’ who can help you to find activities that you might be interested in. You can take part in these activities alongside other treatments like medication or talking therapies.

You can find out more about social prescribing on our website .

Psychological therapies

If you have tried helping yourself and are still struggling, or if your depression is moderate or severe, your GP might suggest a psychological therapy .

Psychological therapies, or talking therapies, are when you talk to a professional, known as a therapist, about how you are feeling. There are lots of different kinds of psychological therapy, and they work in different ways. Which you are offered will depend on your needs and your unique life circumstances.

You can find out about the different psychological therapies available on our website .

At first, it might feel uncomfortable to talk to a stranger about your life, but remember that:

• These sessions are confidential . Your therapist won’t share any information with your friends or family unless you say they can. There are some other specific situations where your information might be shared with someone else, which you can find out more about in our resource on caring for someone with a mental illness .
• Your therapist won’t judge you or be shocked by anything you tell them. It is their job to listen respectfully.
• Psychological therapies have been shown to be effective , and if you give them a chance you are more likely to get well.

Research suggests that older adults with depression are even more likely to benefit from psychological therapies than younger people are, so it is important that they are offered them. If you feel you would benefit from a psychological therapy, speak to your GP. You can find out more about the therapies available for depression in our depression resource .

Antidepressants

Antidepressants are medications that can help to improve the symptoms of depression. You normally take them as a pill once a day. Your GP might prescribe you an antidepressant at the same time as a psychological therapy.

There are lots of different kinds of antidepressants, and your GP will speak with you to understand the kind of antidepressant that might work for you. In some cases, you might need to take more than one medication. It will usually take one or two weeks before you start feeling the benefits of an antidepressant.

When taking medications, an older person may need to start on a lower dose than someone younger, and increase their dose slowly.

Can people with dementia take antidepressants?

There is no medical reason why people with dementia can’t take antidepressants.

However, research has found that antidepressants are less effective in people who have dementia than in people who don’t. People with dementia should not be offered antidepressants to manage mild to moderate depression unless they have had depression in the past.

Do antidepressants have side-effects?

Like any medication, antidepressants can cause side-effects. These can affect some people more than others, and the kinds of side-effects you have might depend on the kind of antidepressant you are taking.

The person prescribing your medication should talk to you about any possible side-effects. Ask your prescriber or pharmacist for some written information on side-effects and read this carefully.

Some antidepressants used in the past had more side-effects than more recent medications. If you were given antidepressants in the past, they might not be the same ones you will be given now. Make sure that you let your doctor know if you have taken antidepressants before.

What if I get unpleasant side-effects?

If antidepressants are giving you unpleasant side-effects or aren’t working for you, speak to your GP.

You should usually not stop taking any medication without first speaking to the person who prescribed them. However, if you start to have suicidal feelings, or any other serious side-effects, you should stop the antidepressant and get help urgently. This can be done by contacting the person who prescribed them or your GP.

If you feel you are in danger, you should call 999 or go to A&E.

You can find out more about antidepressants and side-effects on our website . We also have information on stopping antidepressants . 

What if I’m taking other medications?

If you are taking other medications, or have other health problems, you might not be able to take certain antidepressants. Or your doctor might need to monitor you more than usual. Tell your doctor about any other medication you are taking.

I’m not sure if antidepressants are right for me

It can feel like a big step to start taking antidepressants. You might be unsure about whether it’s the right decision for you.

It can be helpful to think about antidepressants in the same way you would any other medication. For example, if you had a problem with your heart and your doctor gave you medication for it, you probably wouldn’t hesitate to take it.

Finding out more about antidepressants can help you to make an informed decision.

Antipsychotics

Sometimes antipsychotics are given to people who are experiencing psychosis and depression, or people who are experiencing high levels of anxiety.

When you are given antipsychotics, your doctor will talk to you about the increased risks of falls, heart problems and circulation problems. If you are taking antipsychotics, this should be reviewed regularly.

Practical support

Your mental health might be linked to the other things in your life, even if those things don’t seem related. Problems with money, housing, care, work and retirement can all have a negative effect on your mental health. Working to fix these could be an important step in treating your depression.

There is lots of information at the end of this resource that can help you to get support with different areas of your life.

Further treatment

If your depression is very severe, you might be referred to a specialist mental health service or team. You may need to spend time in hospital if you need a lot of treatment and support, or if you are a risk to yourself or someone else. You may be offered other medication instead of or as well as antidepressants.

Sometimes, when someone is very unwell and other treatments haven’t worked, electroconvulsive therapy (ECT) might be considered. In ECT, you are given a general anaesthetic and your brain is stimulated with short electric pulses while you are asleep. ECT has been shown to be successful in treating severe cases of depression.

What are older adult mental health services?

Older adult mental health services take into account the unique needs that older people might have, and provide them with appropriate care.

When someone gets older, there are changes that happen in their lives that need to be considered if they have a mental illness. Older people might have:

• multiple health issues
• frailty , which means they find it harder to recover from illnesses or injuries
• experienced bereavements and other losses.

If an older adult has other conditions like dementia, these might be confused with anxiety or depression. Older adult mental health services have the expertise to consider this when making a diagnosis of depression.

Older adult mental health services also have the facilities to help people who need assistance with mobility.

When does someone need older adult mental health services?

The decision for you to be referred to an older adult mental health services should be based on your individual needs, and not just your age. The following things should be considered:

• the kinds of services available locally
• other health conditions you might have
• your level of frailty.

If you move from a mental health service for adults to one for older people, the people who have been treating you should make sure that the new service understands your needs, such as:

• your treatment history
• your preferences
• the support systems available to you
• your personal history.

What if I live in a care home?

People in care homes are entitled to mental health support just like everyone else. If you are in a care home, this means:

• you should be provided with activities that promote your physical and mental health
• care home staff should be trained to know if you might be experiencing a mental health problem
• any mental health problems identified should be recorded in your personal care plan.

Depression is more common in people who are in care homes. If you have depression and are in a care home, it is important that you receive the high standard of care that you are entitled to. You should have your medication reviewed regularly, and any side-effects should be carefully considered.

How can I get mental health care in a care home?

Through a gp.

If you live in a care home, you should be registered with a GP. You have the right to choose your GP practice. You might choose to remain with your previous GP practice or to move to a practice that is linked to your care home.

If you are in a care home and are experiencing a mental health problem, you should speak to your GP. Your GP should work to rule out other physical health problems that can have a negative effect on mood.

Through care home staff

Care home staff are sometimes trained to provide psychological support like counselling. If care home staff feel that you need more intense support or have a mental illness, you or your carer can speak to your GP, who can refer you to a dedicated care home liaison team.

Care home liaison teams are available at most care homes, and will be able to provide psychological therapies like cognitive behavioural therapy (CBT) or psychodynamic therapy.

The charity Age UK provides information on care homes , while the charity Carers Trust has useful information on caring for someone who is in a care home .

Why might an older person not get the help they need?

There are some things that can make it more challenging for older people to get support for depression.

Other health problems

If you have another health problem, it could be difficult for you or your doctor to work out whether you are also experiencing depression.

Depression can sometimes be confused with other mental or physical health problems. For example, memory problems that can happen with depression can be mistaken for dementia, or the other way around.

Depression might also make it difficult for you to take medications or go to appointments. As a result, your physical health might get worse, which might make your depression worse.

Stereotypes

Unfortunately, some people hold harmful stereotypes about older people. For example, some people think that it is normal for older people to feel tired all the time, or that loneliness is a normal part of getting older.

People who hold these stereotypes might be less likely to recognise that an older person they know is depressed. Feelings of depression are not a normal part of aging, and you deserve help and support whatever age you are.

Many years ago, they changed the phrase from old age pensioner to senior citizen to sort of try to change the label. But the reality is, it’s not about changing labels. It's about treating people the same.” - Bernie

In the past, mental illnesses and the people who had them were treated very differently to how they are now. If you heard negative things about people with depression in the past, you might find it hard to get help for depression now. It’s important to remember that depression is common, treatable and you deserve help. All sorts of people get depression, and it isn’t a reflection on who you are as a person.

Seeing depression as just a part of life

If you are used to feeling depressed, you might not think there’s any point in getting help. Even though it can feel difficult, the sooner you ask for help the sooner you can start getting better.

Technological barriers

Some GP appointments are now held over the phone or online. Some older people can find digital technology more challenging to use, or just prefer to do things in person. It can also be hard to talk about sensitive things over the phone or online.

It can also be hard for doctors to tell if someone is experiencing depression through a phone call. It might take a face-to-face appointment for this to be noticed.

What support can family and friends offer?

If an older person you know has depression, it can be hard to know how to help. Here are some things you can consider when you are supporting an older person with depression:

Communicating sensitively

It can be hard to know what to say to someone who is experiencing depression. Sometimes the most important thing you can do is listen and encourage someone to get help.

You should try to avoid saying things that could be taken negatively. For example, telling someone they’ll ‘get over it’ or telling them that other people have it worse than they do. This can make it harder for the person to get help.

Remember the individual

All the things that make someone unique, like their life experiences, values and interests, don’t disappear when they get older. By seeing the person you know as an individual, you will be able to support them better.

Encourage independence

While some older people might need support with certain things, such as accessing services or managing their care, it’s important to think about how the person you know can remain independent. Work with them to understand how you can both be involved in their care and help them to do things for themselves.

Consider cultural differences

There are some things to consider if the person you know grew up or spent time in another country, or speaks a different language.

• Communication barriers – If the person you know doesn’t speak English, or it isn’t the language they are most comfortable using, they might struggle to communicate with healthcare professionals. They should be offered a professional interpreter if this would help them to communicate their needs more clearly. More time should be given in appointments for this to happen.
• Stigma – Different cultures and generations have different attitudes to mental illness. If the person you know grew up in a place or time where there was stigma around mental illness, they might struggle to ask for help. Psychoeducation, where someone learns about their mental illness, can be helpful. They might also benefit from the support of a faith leader or community group.
• Peer support – Everyone can benefit from speaking to people with similar cultural experiences to them. There might be groups near you where the person you know can meet people of the same ethnicity or cultural background. You can find out about peer support near you and the kinds of services they offer on the Mind website .
• Challenges accessing records – If the person you know has lived in another country and received care there, it might be challenging to get hold of their records.

What if I'm a carer?

A carer is anyone who looks after someone else because they find it hard to look after themselves. Carers can offer practical, emotional and financial support, and might be involved in the medical care of the person they care for.

Being a carer can be very challenging, and as a carer you might experience difficult and conflicting emotions, such as anger, guilt, worry or sadness.

Being a carer can also be rewarding. Many carers have very close relationships with the people they care for, and learn important practical and emotional skills. Whatever your experiences and feelings are, they are legitimate.

As a carer, there are lots of things that you can do to support the person you care for, including:

• encouraging them to get help when they need it
• working with them to understand how much they want you to be involved in their care
• forming positive relationships with the people who provide their medical care
• making a plan for what to do in an emergency.

There are also things that you can do to support yourself, including:

• sharing your stresses and worries with a trusted friend or family member
• taking care of your physical and mental health. This is just as important as looking after the person you care for, and can be beneficial for you both
• getting a break with the help of friends or a professional caring service
• accessing support like carers assessments and workplace adjustments
• meeting with other carers for support
• planning ahead for the future
• applying for the benefits you are entitled to.

It is important to remember that it is not your responsibility to ‘fix’ the person you are caring for

You can find out more about being a carer in our resource on caring for someone with a mental illness .

“As a carer I need to plan, everything is connected. Not just the next few weeks, but the next few years.” Sofija

Further information

Information on depression.

• Depression, NHS – NHS information on depression.
• Depression, Royal College of Psychiatrists – The Royal College of Psychiatrists’ information on depression.
• Depressions and anxiety, Age UK – Information from the charity Age UK about depression and anxiety in older people.

Information for carers

• Carers UK – Carers UK is a charity offering support, information and advice to carers.
• Help and support for carers respite and support, Age UK – Information for carers from the charity Age UK.

Further information for older people

• Get help with loneliness, British Red Cross – Information on getting help with loneliness from the British Red Cross.
• Advice and support for veterans & ex-forces, Veterans' Gateway – Advice and support for veterans from the charity Veterans’ Gateway.
• Advice for LGBT older people, Age UK – Information from lesbian, gay, bisexual and transgender older people from the charity Age UK.

National Institute for Health and Care Excellence (NICE) guidance on depression

• Depression in adults: recognition and management guidance, NICE – NICE guidance on the management of depression in adults.
• Depression in adults with a chronic physical health problem: recognition and management guidance, NICE – NICE guidance on the management of depression in adults with chronic physical health problems.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Manoj Rajagopal, Dr Kapila Sachdev and Dr Qutub Jamali

Thank you to the people with lived experience of depression who helped to develop this resource: Bernie, Philip and Sofija Opacic. Some of their experiences have been included in this resource as quotes.

Full references available on request.

Published:  Sep 2023

Review due:  Sep 2026

© Royal College of Psychiatrists

About our information

Translations, frequently asked questions, choosing wisely.

Opinion It’s not so ‘terribly strange to be 70’

I turned 70 today, a young age for an older person to be, but it is the oldest I have ever been by a long shot. It has been well over six decades since I learned in arithmetic how to carry the one, and the rest has sped by like microfiche.

One big juicy, messy, hard, joyful, quiet life. That’s what my 70 years have bequeathed me.

In my teens, already drinking and drugging, I didn’t expect to see 21, and at 21, out of control, I didn’t expect to see 30. At 30, I had published three books but, as a sober friend put it, was deteriorating faster than I could lower my standards.

Then at 32, I got clean and sober, the miracle of my life from which all other blessings flow. My son was born three years later. The apple fell close to the tree: My son went off the rails, too. He and his partner had a baby at 19, which had not been in my specific plans for him, but you know the old line: If you want to make God laugh, tell Her your plans.

The baby, soon to get his learner’s permit, turned out to be the gift of a lifetime. My son got clean and sober 13 years ago, and the three of us grew up together. Then after a long search, I met this brilliant, kind writer guy and, three days after I started getting Social Security, I married him. Yesterday, I published my 20th book, called “Somehow.” Today, when I woke up, I was 70. Seventy!

I think that I am only 57, but the paperwork does not back this up. I don’t feel old, because your inside self doesn’t age. When younger people ask me when I graduated from high school and I say 1971, there’s a moment’s pause, as if this is inconceivable and I might as well have said 20 B.C. That’s when I feel my age. But I smile winsomely because, while I would like to have their skin, hearing, vision, memory, balance, stamina and focus, I would not go back even one year.

My older friends and I know a thing or two.

In general, though, I know how little I know. This is a big relief.

I know that my lifelong belief, that to be beyond reproach offers shelter and protection, is a lie. Shelter is an inside job, protection an illusion. We are as vulnerable as kittens. Love fends off the worst of it.

I know now that everyone is screwed up to some degree, and that everyone screws up. Phew. I thought for decades it was just me, that all of you had been issued owner’s manuals in second grade, the day I was home with measles. We are all figuring it out as we go. Aging is grad school.

I know a very little bit about God, or goodness, or good orderly direction. I am a believer, but I don’t trouble myself about ultimate reality, the triune nature of the deity or who shot the Holy Ghost. I say help a lot, and thanks, and are You kidding me??? Have You been drinking again, Friend?

I know about something I will call cloak hope, most obvious to me in the people who swooped in and helped me get sober in 1986, and swooped down again in 2012 for my child. In my case, an elderly sober woman named Ruby saw me in my utter, trembly hopelessness — afraid, smelly and arrogant; she swept in and took me under her wing. She wrapped her cloak around me and was the counternarrative to all I believed at 32, i.e., that I needed to figure things out, especially myself, and who to blame.

I know the beauty of shadows. Shadows show us how life can gleam in contrast. Sunshine might be dancing outside the window, but the wonder is in the variegation, with fat white clouds bunched up on the right casting shadows on the hills and gardens, and brushstrokes of gray clouds on the left and — most magical — the long narrow shawl of fog right across the top of the ridge. The day is saying, Who knows how the weather will morph, but meanwhile so much is possible. And that is life asserting itself.

I know life will assert itself. Knowing this means I have a shot at some measure of pliability, like a willow tree that is maybe having an iffy day.

I know everything is in flux, that all things will turn into other things. I am uncomfortable with this but less so than in younger years. Michael Pollan wrote, “Look into a flower, and what do you see? Into the very heart of nature’s double nature — that is, the contending energies of creation and dissolution, the spiring toward complex form and the tidal pull away from it.” So I don’t sweat feeling a little disoriented some days.

I have grown mostly unafraid of my own death, except late at night when I head to WebMD and learn that my symptoms are probably cancer.

I know and am constantly aware of how much we have all lost and are in danger of losing — I am not going to name names — and am awash with gratitude for lovely, funny things that are still here and still work.

I know how to let go now, mostly, although it is not a lovely Hallmark process, and when well-wishers from my spiritual community exhort me to let go and let God, I want to Taser them. But I know that when I finally tell a best friend of my thistly stuckness, the telling is the beginning of release. You have to learn to let go. Otherwise, you get dragged, or you become George Costanza’s father pounding the table and shouting, “Serenity now!”

I know that people and pets I adore will keep dying, and it will never be okay, and then it will, sort of, mostly. I know the cycle is life, death, new life, and I think this is a bad system, but it is the one currently in place.

I know I will space out and screw up right and left as I head out on this book tour, say things I wish I could take back, forget things, sometimes onstage, and lose things. I just will.

I recently went to Costa Rica, where my husband was giving a spiritual retreat, and I forgot my pants. My pants! And last month, I went to give a talk at a theater two states away and forgot to bring any makeup. I am quite pale, almost light blue in some places — think of someone from “Game of Thrones” with a head cold — and ghostly under bright lights. When I discovered this omission, I was wearing only tinted moisturizer, powder on my nose and light pink lip gloss.

I gave myself an inspiring pep talk on my inner beauty, the light within. And then I had a moment of clarity: I asked the person driving me to the venue to stop at CVS, where I bought blush and a lipstick that was accidentally brighter and glossier than I usually wear. I looked fabulous. Age is just a number when you still know how to shine. And I shone.

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Mental health and the pandemic: What U.S. surveys have found

The coronavirus pandemic has been associated with worsening mental health among people in the United States and around the world . In the U.S, the COVID-19 outbreak in early 2020 caused widespread lockdowns and disruptions in daily life while triggering a short but severe economic recession that resulted in widespread unemployment. Three years later, Americans have largely returned to normal activities, but challenges with mental health remain.

Here’s a look at what surveys by Pew Research Center and other organizations have found about Americans’ mental health during the pandemic. These findings reflect a snapshot in time, and it’s possible that attitudes and experiences may have changed since these surveys were fielded. It’s also important to note that concerns about mental health were common in the U.S. long before the arrival of COVID-19 .

Three years into the COVID-19 outbreak in the United States , Pew Research Center published this collection of survey findings about Americans’ challenges with mental health during the pandemic. All findings are previously published. Methodological information about each survey cited here, including the sample sizes and field dates, can be found by following the links in the text.

The research behind the first item in this analysis, examining Americans’ experiences with psychological distress, benefited from the advice and counsel of the COVID-19 and mental health measurement group at Johns Hopkins Bloomberg School of Public Health.

At least four-in-ten U.S. adults (41%) have experienced high levels of psychological distress at some point during the pandemic, according to four Pew Research Center surveys conducted between March 2020 and September 2022.

Young adults are especially likely to have faced high levels of psychological distress since the COVID-19 outbreak began: 58% of Americans ages 18 to 29 fall into this category, based on their answers in at least one of these four surveys.

Women are much more likely than men to have experienced high psychological distress (48% vs. 32%), as are people in lower-income households (53%) when compared with those in middle-income (38%) or upper-income (30%) households.

In addition, roughly two-thirds (66%) of adults who have a disability or health condition that prevents them from participating fully in work, school, housework or other activities have experienced a high level of distress during the pandemic.

The Center measured Americans’ psychological distress by asking them a series of five questions on subjects including loneliness, anxiety and trouble sleeping in the past week. The questions are not a clinical measure, nor a diagnostic tool. Instead, they describe people’s emotional experiences during the week before being surveyed.

While these questions did not ask specifically about the pandemic, a sixth question did, inquiring whether respondents had “had physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart” when thinking about their experience with the coronavirus outbreak. In September 2022, the most recent time this question was asked, 14% of Americans said they’d experienced this at least some or a little of the time in the past seven days.

More than a third of high school students have reported mental health challenges during the pandemic. In a survey conducted by the Centers for Disease Control and Prevention from January to June 2021, 37% of students at public and private high schools said their mental health was not good most or all of the time during the pandemic. That included roughly half of girls (49%) and about a quarter of boys (24%).

In the same survey, an even larger share of high school students (44%) said that at some point during the previous 12 months, they had felt sad or hopeless almost every day for two or more weeks in a row – to the point where they had stopped doing some usual activities. Roughly six-in-ten high school girls (57%) said this, as did 31% of boys.

On both questions, high school students who identify as lesbian, gay, bisexual, other or questioning were far more likely than heterosexual students to report negative experiences related to their mental health.

Mental health tops the list of worries that U.S. parents express about their kids’ well-being, according to a fall 2022 Pew Research Center survey of parents with children younger than 18. In that survey, four-in-ten U.S. parents said they’re extremely or very worried about their children struggling with anxiety or depression. That was greater than the share of parents who expressed high levels of concern over seven other dangers asked about.

While the fall 2022 survey was fielded amid the coronavirus outbreak, it did not ask about parental worries in the specific context of the pandemic. It’s also important to note that parental concerns about their kids struggling with anxiety and depression were common long before the pandemic, too . (Due to changes in question wording, the results from the fall 2022 survey of parents are not directly comparable with those from an earlier Center survey of parents, conducted in 2015.)

Among parents of teenagers, roughly three-in-ten (28%) are extremely or very worried that their teen’s use of social media could lead to problems with anxiety or depression, according to a spring 2022 survey of parents with children ages 13 to 17 . Parents of teen girls were more likely than parents of teen boys to be extremely or very worried on this front (32% vs. 24%). And Hispanic parents (37%) were more likely than those who are Black or White (26% each) to express a great deal of concern about this. (There were not enough Asian American parents in the sample to analyze separately. This survey also did not ask about parental concerns specifically in the context of the pandemic.)

Looking back, many K-12 parents say the first year of the coronavirus pandemic had a negative effect on their children’s emotional health. In a fall 2022 survey of parents with K-12 children , 48% said the first year of the pandemic had a very or somewhat negative impact on their children’s emotional well-being, while 39% said it had neither a positive nor negative effect. A small share of parents (7%) said the first year of the pandemic had a very or somewhat positive effect in this regard.

White parents and those from upper-income households were especially likely to say the first year of the pandemic had a negative emotional impact on their K-12 children.

While around half of K-12 parents said the first year of the pandemic had a negative emotional impact on their kids, a larger share (61%) said it had a negative effect on their children’s education.

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How Americans View the Coronavirus, COVID-19 Vaccines Amid Declining Levels of Concern

Online religious services appeal to many americans, but going in person remains more popular, about a third of u.s. workers who can work from home now do so all the time, how the pandemic has affected attendance at u.s. religious services, economy remains the public’s top policy priority; covid-19 concerns decline again, most popular.

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Max azzarello struggled with depression before self-immolation outside trump trial as friends mourn ‘brilliant’ conspiracy theorist: ‘almost too smart’.

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Loneliness, conspiracy theories and loss apparently drove the troubled man who set himself on fire this week across the street from the courthouse where former President Donald Trump is on trial.

The final, fatal act was a tragic denouement in the life of Max Azzarello, who friends described as intelligent and kind — but somewhat depressed, and still reeling from the 2022 death of his mother, who he followed when he moved to Florida a few years ago.

Azzarello, 37, grew up on Long Island’s North Shore, in the tiny village of Sea Cliff, and moved to Florida, following his parents.

“He was the grandest man I ever met in my life and I adored him,” Jamie Black, 63, of Sea Cliff, who was friends with Max’s late mother, Libby, and had known him since he was about 8.

“He was brilliant and one of my closest friends. I am devastated.”

Sources who knew Azzarello said he was prescribed anti-depressants, along with Adderall, in his earlier years, and fairly recently started taking amphetamines.

Azzarello was “almost too smart,” Black said.

“He was so caring and kind and hilarious and he was brought up in a great family. I don’t think he had any mental illness. I think he was just too smart.”

Azzarello’s lifelong friend, Daniel Carleton, who went to middle school and high school with Azzarello and roomed with him at UNC-Chapel Hill for four years, said he always had some mental health issues.

“There may have been a chemical imbalance there that was made worse by substance abuse but there was no specific diagnosis,” he said.

Azzarello was lonely, Carleton said. Azzarello, who was straight, never seemed to have a girlfriend, he added.

He was very close, however, to his sister Katherine, 38, who lives in Brooklyn.

“He’s always been very smart, since middle school,” Carleton told The Post.

“He was good guy and he was always political.”

“He was alone for a long time and I think it was a major contributor to his decline,” he added.

“His family is great. They knew he had issues and they had him checked into a mental health facility last year but they couldn’t keep him past a three-day hold.”

“Max was smart enough to game the system and fool the system. The mental health system actually failed him.”

Azzarello took a turn for the worse with the start of 2023, not long after his mother died, Carleton said.

He quit what had been a series of well-paying tech consultant jobs by the end of 2022.

When news broke in March 2023 that the Silicon Valley Bank had suddenly collapsed, Azzarello became obsessed.

The financial institution — a 40-year-old lender to startups and venture capitalists — became the second-biggest bank casualty in US history when it was abruptly shut down by regulators.

Billionaire Peter Thiel had urged startups to pull their cash or risk losing it entirely ahead of the bank’s failure.

“He somehow connected Thiel to all that and went down this huge rabbit hole and started posting crazy conspiracies,” Carleton said.

“The drugs were out of control in 2023.”

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Azzarello was arrested three times in Florida last year, including for throwing wine at a framed autograph featuring Bill Clinton, according to police records.

He was jailed Aug. 21 and remained there until Oct. 3, when he was sentenced to 180 days of probation and released.

“He was passionate that government and business elites screwed over the common person and he wanted to fight that. He wanted to start a revolution so much so that he was willing to light himself on fire to get his message out.”

Carleton said Azzarello had been sober since his jail stint.

Azzarello had posted his admiration for Aaron Bushnell, the young airman who self-immolated outside the Israeli embassy in Washington DC last month.

Like a number of his friends, Carleton wanted the positive side of Azzarello remembered.

Azzarello was considered an elite online chess player with a peak rating of over 2000 points which put him in the 96th percentile of online chess players, Carleton said.

“We played chess on the chess app and our last game was two weeks ago and he beat me and I’m a pretty good player,” Carleton said.

“So you can see he was still thinking rationally.”

If you are struggling with suicidal thoughts or are experiencing a mental health crisis and live in New York City, you can call 1-888-NYC-WELL for free and confidential crisis counseling. If you live outside the five boroughs, you can dial the 24/7 National Suicide Prevention hotline at 988 or go to  SuicidePreventionLifeline.org .

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327 Depression Essay Titles & Examples

When choosing a title about depression, you have to remain mindful since this is a sensitive subject. This is why our experts have listed 177 depression essay topics to help you get started.

🌧️ How to Write a Depression Essay: Do’s and Don’ts

🏆 unique titles about depression, 🥇 most interesting depression title ideas, 📌 good titles for depression essay, ✅ simple & easy depression essay titles, 🎓 interesting topics to write about depression, 📑 good research topics about depression.

• ❓ Research Questions for a Depression Essay

Depression is a disorder characterized by prolonged periods of sadness and loss of interest in life. The symptoms include irritability, insomnia, anxiety, and trouble concentrating. This disorder can produce physical problems, self-esteem issues, and general stress in a person’s life. Difficult life events and trauma are typical causes of depression. Want to find out more? Check out our compilation below.

A depression essay is an important assignment that will help you to explore the subject and its impact on people. Writing this type of paper may seem challenging at first, but there are some secrets that will make achieving a high grade much easier. Check below for a list of do’s and don’ts to get started!

DO select a narrow topic. Before starting writing, define the subject of the paper, and write down some possible titles. This will help you to focus your thoughts instead of offering generic information that can easily be found on Wikipedia. Consider writing about a particular population or about the consequences of depression. For example, a teenage depression essay could earn you excellent marks! If you find this step challenging, try searching for depression essay topics online. This will surely give you some inspiration.

DON’T copy from peers or other students. Today, tutors are usually aware of the power of the Internet and will check your paper for plagiarism. Hence, if you copy information from other depression essays, you could lose a lot of marks. You could search for depression essay titles or sample papers online, but avoid copying any details from these sources.

DO your research before starting. High-quality research is crucial when you write essays on mental health issues. There are plenty of online resources that could help you, including Google Scholar, PubMed, and others. To find relevant scientific articles, search for your primary and secondary topics of interest. Then filter results by relevance, publication date, and access type. This will help you to identify sources that you can view online and use to support your ideas.

DON’T rely on unverified sources. This is a crucial mistake many students make that usually results in failing the paper. Sources that are not academic, such as websites, blogs, and Wiki pages, may contain false or outdated information. Some exceptions are official publications and web pages of medical organizations, such as the CDC, APA, and the World Health Organization.

DO consider related health issues. Depression is often associated with other mental or physical health issues, so you should reflect on this in your paper. Some examples of problems related to depression are suicide, self-harm, eating disorders, and panic attack disorder. To show your in-depth understanding of the issue, you could write a depression and anxiety essay that shows the relationship between the two. Alternatively, you can devote one or two paragraphs to examining the prevalence of other mental health problems in people with depression.

DON’T include personal opinions and experiences unless required. A good essay on the subject of depression should be focused and objective. Hence, you should rely on research rather than on your understanding of the theme. For example, if you have to answer the question “What is depression?” look for scientific articles or official publications that contain the definition rather than trying to explain it in your own words.

DON’T forget about structure. The structure of your essay helps to present arguments or points logically, thus assisting the reader in making sense of the information. A good thing to do is to write a depression essay outline before you start the paper. You should list your key points supported by relevant depression quotes from academic publications. Follow the outline carefully to avoid gaps and inconsistencies.

Use these do’s and don’ts, and you will be able to write an excellent paper on depression! If you want to see more tips and tricks that will help you elevate your writing, look around our website!

• Understanding Teen Depression Impacts of depression on teenagers Depression is characterized by several effects; however, most of them impact negatively to the teens. For instance, a considerable percentage of teens use extra-curriculum activities such as sports and games, […]
• Beck Depression Inventory, Its History and Benefits Therefore, the detection of depression at its early stage, the evaluation of the risks, and the definition of the level of depression are the main goals.
• Depression and Grief in the “Ordinary People” Film At the end of the film, he is healed and ready to forgive his mother and stop blaming himself. I believe that the relationship between Conrad and his therapist, Dr.
• Report Writing About Depression There is concrete evidence that many people in Australia tend to believe that depression is the cause of all suicide deaths in the world, but this not true.
• Cognitive Behavioral Therapy in Treating Depression CBT works on the principle that positive thoughts and behaviour heralds positive moods and this is something that can be learned; therefore, by learning to think and behave positively, someone may substitute negative thoughts with […]
• Social Networking and Depression The findings of the study confirmed that once an individual engages in social networking, his or her feeling of safety goes down and depression mood emerges meaning that a correlation between depression and social networking […]
• The Problem of Childhood Depression Thus, it is essential to explore the reasons for the disease and possible ways to treat depression in kids. In kids, the prevention of depression is fundamental to understanding the cause of the poor mood […]
• Depression in the Lens of History and Humanities In terms of history, this paper analyzes the origin of depression and the progress made over the years in finding treatment and preventive mechanisms.
• Case Study of Depression and Mental Pressure Alison believes that her illness is severe and taking a toll all the time, and the environment is worsening the condition.
• Depression, Grief, Loss in “Ordinary People” Film The coach is curious to know Conrad’s experiences at the hospital and the use of ECT. Towards the end of the film, Conrad reveals to the therapist that he feels guilty about his brother’s death.
• The Difference Between Art Deco and Depression Modern Design By and whole, Art Deco and Depression differ in their characteristics and their meanings as they bring unlike messages to the viewers.
• Obesity Co-Occurring With Depression The assessment will identify the patient with the two conditions, address the existing literature on the issue, examine how patients are affected by organizational and governmental policies, and propose strategies to improve the patient experience.
• Depression: A Cognitive Perspective Therefore, the cause of depression on this line may be a real shortage of skills, accompanied by negative self-evaluation because the individual is more likely to see the negative aspects or the skills he lacks […]
• Emotional Wellness: The Issue of Depression Through Different Lenses As for the humanities lens, the increasing prevalence of depression causes the institution of religion to incorporate the issue into major confessions’ mindsets and messages.
• Anxiety and Depression Among College Students The central hypothesis for this study is that college students have a higher rate of anxiety and depression. Some of the materials to be used in the study will include pencils, papers, and tests.
• Biological and Social-Cognitive Perspectives on Depression The social-cognitive perspective states that the disorder’s development is influenced by the events in the patient’s life and their way of thinking.
• Depression as a Psychological Disorder Summarizing and evaluating the information that trusted journals have published on the topic of depression might help create a well-rounded review of the condition and the scientific community’s understanding of it.
• Depression and Melancholia Expressed by Hamlet The paper will not attempt and sketch the way the signs or symptoms of depression/melancholia play a part in the way Shakespeare’s period or culture concerning depression/melancholia, but in its place portrays the way particular […]
• Depression and Its Causes in the Modern Society The higher instances of depression among women can be explained using a number of reasons including the lifestyle of the modern woman and her role in the society.
• NICE Guidelines for Depression Management: Project Proposal This topic is of importance for VEGA because the center does not employ any specific depression management guidelines.
• Depression in Older Adults The understanding and modification of the contributions of these factors is the ultimate goal of the clinicians who engage in the treatment of depression.
• PICO Analysis of Depression In other words, the causes of the given mental disorder can highly vary, and there is no sufficient evidence to point out a primary factor that triggers depression.
• Depression Among University Students The greatest majority of the affected individuals in different universities will be unable to take good care of their bodies and living rooms.
• Teenage Depression: Psychology-Based Treatment This finding underlines the need to interrogate the issue of depression’s ontology and epistemology. Hence, there is the need to have an elaborate and comprehensive policy for addressing teenage depression.
• Depression Symptoms and Cognitive Behavior Therapy The tone of the article is informative and objective, throughout the text the authors maintain an academic and scientific mood. The structure of the article is well organized and easy to read.
• Proposal on Depression in Middle-Aged Women By understand the aspect of unhappiness among the young women; it will be easier for the healthcare institutions to formulate effective and appropriate approaches to reduce the menace in the society.
• Biological Psychology: Lesion Studies and Depression Detection The purpose of this article is to share the research findings and discussion on the new methodological developments of Lesion studies.
• Using AI to Diagnose and Treat Depression One of the main features of AI is the ability to machine learning, that is, to use data from past experiences to learn and modify algorithms in the future.
• Artificial Intelligence Bot for Depression By increasing the availability and accessibility of mental health services, these technologies may also contribute to the development of cognitive science practices in Malaysia.
• COVID-Related Depression: Lingering Signs of Depression The purpose of the article is to depict the research in a more approachable way, while the latter accentuates the importance of various factors and flaws of the results. While the former is more simplified, […]
• Depression and Anxiety Among African Americans Finally, it should be insightful to understand the attitudes of friends and family members, so 5 additional interviews will be conducted with Black and White persons not having the identified mental conditions. The selected mental […]
• Depression in Dialysis Patients: Treatment and Management If I were to conduct experimental research about the treatment and management of depression in dialysis patients, I would focus on finding the most effective and safe medication for the condition among adults.
• The Serotonin Theory of Depression by Moncrieff et al. The serotonin theory of depression is closely related to antidepressants since the advent of SSRIs played a significant role in the popularization of the theory.
• Avery’s Depression in “The Flick” Play by Baker The emotional and mental state of Avery, the only African-American character out of the three, is fairly obvious from the get-go when asked about why he is so depressed, the answer is: “Um.
• Depression: A Quantitative-Qualitative Analysis A decision tree can be used due to the nature of the research question or hypothesis in place, the measurement of the dependent or research variable, the number of groups or independent variable levels, and […]
• Depression Detection Tests Analysis The problem of the abundance of psychological tests leads to the need to compare multiple testing options for indicators of their purpose, features, and interpretations of the evaluation and validity.
• Nursing Care for Patients With COVID-19 & Depression The significance of the selected problem contributed to the emergence of numerous research works devoted to the issue. This approach to choosing individuals guaranteed the increased credibility of findings and provided the authors with the […]
• 16 Personality Factors Test for Depression Patient Pablos results, it is necessary to understand the interaction and pattern of the scores of the primary factors. A combination of high Apprehension and high Self-Reliance is a pattern describing a tendency to isolate oneself.
• Depression in a 30-Year-Old Female Client In the given case, it would be useful to identify the patterns in Alex’s relationships and reconsider her responses to her partner.
• Using the Neuman Model in the Early Diagnosis of Depression In the history of the academic development of nursing theories, there are a variety of iconic figures who have made significant contributions to the evolution of the discipline: one of them is Betty Neuman.
• Depression in Primary Care: Screening and Diagnosis The clinical topics for this research are the incidence of depression in young adults and how to diagnose this disorder early in the primary care setting using screening tools such as PHQ9.
• Major Depression and Cognitive Behavior Therapy Since the intervention had no significant effect on Lola, the paper will explore the physical health implication of anxiolytics and antidepressants in adolescents, including the teaching strategies that nurses can utilize on consumers to recognize […]
• Jungian Psychotherapy for Depression and Anxiety They work as a pizza delivery man in their spare time from scientific activities, and their parents also send them a small amount of money every month.S.migrated to New York not only to get an […]
• COVID-19 and Depression: The Impact of Nursing Care and Technology Nevertheless, combatting depression is a crucial step in posing positive achievements to recover from mental and physical wellness caused by COVID-19.
• Depression Disorder Intervention The researchers evaluated the socioemotional signs of mental illnesses in a sample of diagnostically referred adolescents with clinical depression required to undergo regular cognitive behavioral therapy in a medical setting.
• Financial Difficulties in Childhood and Adult Depression in Europe The authors found that the existence of closer ties between the catalyst of depression and the person suffering from depression leads to worse consequences.
• Activity During Pregnancy and Postpartum Depression Studies have shown that women’s mood and cardiorespiratory fitness improve when they engage in moderate-intensity physical activity in the weeks and months after giving birth to a child.
• Clinical Depression: Causes and Development Therefore, according to Aaron Beck, the causes and development of depression can be explained through the concepts of schema and negative cognitive triad.
• Aspects of Working With Depression It also contributes to the maintenance and rooting of a bad mood, as the patient has sad thoughts due to the fact that the usual does not cause satisfaction.
• Depression Among Nurses in COVID-19 Wards The findings are of great significance to researchers and governments and can indicate the prevalence of anxiety and depression among nurses working in COVID-19 wards in the North-East of England during the pandemic.
• Depression Associated With Sleep Disorders Y, Chang, C. Consequently, it directly affects the manifestation of obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder in people with depression.
• Depression in a 25-Year-Old Male Patient Moreover, a person in depression complains of the slowness in mental processes, notes the oppression of instincts, the loss of the instinct of self-preservation, and the lack of the ability to enjoy life.
• Aspects and Manifestation of Depression Although, symptoms of depression in young people, in contrast to older adults, are described by psychomotor agitation or lethargy, fatigue, and loss of energy.
• Complementary Therapy for Postpartum Depression in Primary Care Thus, the woman faced frustration and sadness, preventing her from taking good care of the child, and the lack of support led to the emergence of concerns similar to those in the past.
• Depression and Anxiety Clinical Case Many of the factors come from the background and life experiences of the patient. The client then had a chance to reflect on the results and think of the possible alternative thoughts.
• Uncontrolled Type 2 Diabetes and Depression Treatment The data synthesis demonstrates that carefully chosen depression and anxiety treatment is likely to result in better A1C outcomes for the patient on the condition that the treatment is regular and convenient for the patients.
• Technology to Fight Postpartum Depression in African American Women I would like to introduce the app “Peanut” the social network designed to help and unite women exclusively, as a technology aimed at fighting postpartum depression in African American Women.
• Complementary Therapy in Treatment of Depression Such practices lower the general level of anxiety and remove the high risks of manifestation of states of abulia, that is, clinical lack of will and acute depression.
• Social Determinants of Health and Depression Among African American Adults The article “Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research” examines the current research on the relationship between social determinants of health and depression among African American […]
• Outcomes Exercise Has on Depression for People Between 45-55 Years According to the WHO, the rate of depression in the U.S.was 31. 5% as of October 2021, with the majority of the victims being adults aged between 45 and 55 years.
• The Postpartum Depression in Afro-Americans Policy The distribution of the funds is managed and administered on the state level. Minnesota and Maryland focused on passing the legislation regulating the adoption of Medicaid in 2013.
• Depression Among the Medicare Population in Maryland The statistics about the prevalence and comorbidity rates of depression are provided from the Medicare Chronic Conditions Dashboard and are portrayed in the table included in the paper.
• Depression as Public Health Population-Based Issue In regard to particular races and ethnicities, CDC provided the following breakdown of female breast cancer cases and deaths: White women: 128 new cases and 20 deaths per 100.
• Managing Mental Health Medications for Depression and its Ethical Contradiction The second objective is to discover ethical contradictions in such treatment for people of various cultures and how different people perceive the disorder and react to the medication.
• Aspects of Depression and Obesity In some cases, people with mild to severe depression choose not to seek professional care and instead try to overcome their depression with self-help or the support of family and friends.
• Antidepressant Treatment of Adolescent Depression At the same time, scientists evidenced that in the case of negative exposure to stress and depression, the human organism diminishes BDNF expression in the hippocampus.
• Online Peer Support Groups for Depression and Anxiety Disorder The main objective of peer support groups is connecting people with the same life experiences and challenges to share and support each other in healing and recovery.
• Depression in Adolescence and Treatment Approaches The age of adolescence, commonly referred to as children aged 10-19, is characterized by a variety of changes to one’s physical and mental health, as the child undergoes several stages of adjustment to the environment […]
• Emotional Encounter With a Patient With Major Depression Disorder I shared this idea with him and was trying to create the treatment plan, sharing some general thoughts on the issue.
• Childhood Depression in Sub-Saharan Africa According to Sterling et al, depression in early childhood places a significant load on individuals, relatives, and society by increasing hospitalization and fatality and negatively impacting the quality of life during periods of severe depression.
• Anxiety and Depression: The Case Study As he himself explained, he is not used to positive affirmation due to low self-esteem, and his family experiences also point to the fact that he was not comforted often as a child.
• Breastfeeding and Risk of Postpartum Depression The primary goal of the research conducted by Islam et al.was to analyze the correlation between exclusive breastfeeding and the risk of postpartum depression among new mothers.
• Nursing Intervention in Case of Severe Depression The patient was laid off from work and went through a divorce in the year. This led to a change in prescribed medications, and the patient was put on tricyclic anti-depressants.
• Screening for Depression in Acute Care The literature review provides EB analysis for the topic of depression to identify the need for an appropriate screening tool in addition to the PHQ-9 in the assessment evaluation process.
• Social Media Use and the Risk of Depression Thapa and Subedi explain that the reason for the development of depressive symptoms is the lack of face to face conversation and the development of perceived isolation. Is there a relationship between social media use […]
• Depression in the Field of a Healthcare Administrator According to Davey and Harrison, the most challenging part of healthcare administration in terms of depression is the presence of distorted views, shaped by patients’ thoughts.
• The Treatment of Adolescents With Depression While treating a teenager with depression, it is important to maintain the link between the cause of the mental illness’ progression and the treatment.
• Depression in the Black Community The speaker said that her counselor was culturally sensitive, which presumes that regardless of the race one belongs to, a specialist must value their background.
• Loneliness and Depression During COVID-19 While the article discusses the prevalence of loneliness and depression among young people, I agree that young people may be more subject to mental health problems than other population groups, but I do not agree […]
• Depression Screening in the Acute Setting Hence, it is possible to develop a policy recommending the use of the PHQ-9, such as the EBDST, in the acute setting.
• Ketamine for Treatment-Resistant Depression: Neurobiology and Applications It is known that a violation of the functions of the serotonergic pathways leads to various mental deviations, the most typical of which is clinical depression.
• Treating Obesity Co-Occurring With Depression In most cases, the efficiency of obesity treatment is relatively low and commonly leads to the appearance of a comorbid mental health disorder depression.
• Treadmill Exercise Ameliorates Social Isolation-Induced Depression The groups included: the social isolation group, the control group, and the exercise and social isolation and exercise group. In the treadmill exercise protocol, the rat pups ran on the treadmill once a day for […]
• Depression and Anxiety Among Chronic Pain Patients The researchers used The Depression Module of the Patient Health Questionnaire and the Generalized Anxiety Disorder Scale to interview participants, evaluate their answers, and conduct the study.
• Postpartum Depression in African American Women As far as African American women are concerned, the issue becomes even more complex due to several reasons: the stigma associated with the mental health of African American women and the mental health complications that […]
• The Depression Construct and Instrument Analysis For the therapist, this scaling allows to assess the general picture of the patient’s psychological state and obtain a result that is suitable for measurement.
• The Effects of Cognitive Behavioral Therapy (CBT) on Depression in Adults Introduction It is hard to disagree that there is a vast number of mental disorders that prevent people from leading their normal lives and are quite challenging to treat. One such psychological condition is depression (Li et al., 2020). Since there is a social stigma of depression, and some of its symptoms are similar to […]
• Stress and Depression Among Nursing Students The study aims to determine how different the manifestations of stress and depression are among American nursing students compared to students of other disciplines and what supports nursing students in continuing their education.
• Depression in Diabetes Patients The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease.
• Depression among Homosexual Males The literature used for the research on the paper aims to overview depression among homosexual males and describe the role of the nurse and practices based on the Recovery Model throughout the depression.
• “What the Depression Did to People” by Edward Robb Ellis Nevertheless, the way the facts are grouped and delivered could be conducive to students’ ability to develop a clearer picture of the catastrophic downturn’s influences on the nation’s and the poor population’s mentalities.
• Economic Inequality During COVID-19: Correlation With Depression and Addiction Thus, during the pandemic, people with lower incomes experienced depression and increased their addictive behaviors to cope with the stress of COVID-19.
• Depression in the Black and Minority Ethnic Groups The third sector of the economy includes all non-governmental, non-profit, voluntary, philanthropic, and charitable organizations and social enterprises specializing in various types of activities, which did not find a place in either the public or […]
• A Description on the Topic Screening Depression If there is the implementation of evidence-based care, a reduction in the proportion of disability for patients with depression would be expected. A proposal was written describing the need for screening depression patients of nearly […]
• “Disclosure of Symptoms of Postnatal Depression, …” by Carolyn Chew-Graham Critique In light of hypothesizing the research question, the researchers suggest that health practitioners have the ability to create a conducive environment for the disclosure of information.
• Depression – Psychotherapeutic Treatment Taking into account the fact that the specialist is not able to prescribe the medicine or a sort of treatment if he/she is not sure in the positive effect it might have on the health […]
• Depression as a Major Health Issue The purpose of the study was to examine the implications of cognitive behavior approaches for depression in old women receiving health care in different facilities.
• Effective Ways to Address Anxiety and Depression Looking deep into the roots of the problem will provide a vast and detailed vision of it, and will help to develop ways to enhance the disorders.
• Einstepam: The Treatment of Depression The treatment of depression has greatly revolutionized since the development of tricyclic antidepressants and monoamine oxidase inhibitors in the 1950s. In the brain, it inhibits the NMDA receptors and isoforms of NOS.
• The Potential of Psilocybin in Treating Depression First of all, it is essential to understand the general effects of psilocybin on the brain that are present in the current literature.
• Depression Among High School Students The major problem surrounding depression among adolescents is that they are rarely diagnosed in time and therefore do not receive treatment they need.
• Depression: Diagnostics, Prevention and Treatment Constant communication with the patient and their relatives, purposeful questioning of the patient, special scales and tests, active observation of the patient’s appearance and behavior are the steps in the nursing diagnosis of depression.
• Depression and Anxiety Intervention Plan John’s Wort to intervene for her condition together with the prescribed anti-depressant drugs, I would advise and educate her on the drug-to-drug relations, and the various complications brought about by combining St. Conducting proper patient […]
• Depression and Generalized Anxiety Disorder Therapy On the other hand, behavioral therapy relies on the assumption that “both abnormal behavior and normal behavior are learned”. The two approaches are thus highly complementary, as while humanistic therapy aims at perceiving and resolving […]
• The Use of Psychedelic Drugs in Treating Depression This study aims to establish whether depressive patients can significantly benefit from psilocybin without substantial side effects like in the case of other psychedelic drugs.
• Postpartum Depression Among the Low-Income U.S. Mothers Mothers who take part in the programs develop skills and knowledge to use the existing social entities to ensure that they protect themselves from the undesirable consequences associated with the PPD and other related psychological […]
• The Beck Depression Contrast (BDI) The second difference between the two modes of the BDI is in the methodology of conducting the survey. This is where the interviewer first gets the history of the patient to try and get the […]
• Depression: Description, Symptoms and Diagnosis, Prognosis and Treatment A diagnosis is made in situations where the symptoms persist for at least two weeks and lead to a change in the individual’s level of functioning.
• Psychedelic Drugs and Their Effects on Anxiety and Depression The participants must also be willing to remain in the study for the duration of the experiments and consent to the drugs’ use.
• VEGA Medical Center: The Quality of Depression Management This presentation is going to provide an overview of a project dedicated to the implementation of NICE guidelines at the VEGA Medical Center.
• Anxiety and Depression in Hispanic Youth in Monmouth County Therefore, the Health Project in Monmouth County will help Hispanic children and adolescents between the ages of 10 and 19 to cope with anxiety and depression through behavioral therapy.
• Anxiety Disorders and Depression In her case, anxiety made her feel that she needed to do more, and everything needed to be perfect. She noted that the background of her depression and anxiety disorders was her family.
• Clinical Case Report: Depression It is possible to assume that being in close contact with a person who has depression also increases the probability of experiencing its symptoms.
• Interventions for Treating Depression after Stroke Inherently, the link between depression and stroke can be analyzed on the basis of post-stroke depression that is identified as the major neuropsychiatric corollary of stroke.
• Depression: The Implications and Challenges in Managing the Illness At home, these people lack interest in their family and are not be able to enjoy the shared activities and company of the family.
• Expression Symptoms of Depression A major finding of the critique is that although the research method and design are appropriate to this type of study, the results may be speculative in their validity and reliability as the researchers used […]
• Researching Postnatal Depression Health professionals suggest that the fluctuations in the level of hormones cause changes in the chemical composition of the brain. The researcher has stated that the sample was selected from the general practitioners and health […]
• The Older Women With Depression Living in Long-Term Care The researchers used the probability-sampling method to select the institutions that were included in the study. The health care professionals working in the nursing homes were interviewed to ascertain the diagnosis of depression as well […]
• Medical Evaluation: 82-Year-Old Patient With Depression Her extreme level of weakness unfolded when the patient admitted that she lacked the strength to stand on her feet and to head back to her sleeping bed on a disastrous night.Mrs.
• Depression in Adults: Community Health Needs The challenge of depression in the elderly is the recognition of signs and symptoms or the frequent underreporting of the symptoms of depression in adults over the age of 65.
• The Discussion about Depression in Older Patients Depression is often identified as the most prevalent psychiatric disorder in the elderly and is usually determined by symptoms that belong to somatic, affective, and cognitive categories.
• Depression in Older People in Australia Although a good number of depressed elderly patients aspire to play an active role in the treatment decision-making process, some prefer to delegate this role to their doctors.
• In-Vitro Fertilization and Postpartum Depression The research was conducted through based on professional information sources and statistical data collected from the research study used to further validate the evidence and outcome of this study.
• Depression: Screening and Diagnosis What he tries to do is to live a day and observe the changes that occur around. What do you do to change your attitude to life?
• Depression in Australia. Evaluation of Different Factors In attempts to identify the biological causes of depression, the researchers focus on the analysis of brain functioning, chemical mediators, their correlations with the neurologic centers in the brain, and impact on the limbic system […]
• Mental Health Paper: Depression The prevalence of mental health conditions has been the subject of many studies, with most of these highlighting the increase in these illnesses.
• The Two Hit Model of Cytokine-Induced-Depression The association between IL-6 polymorphism and reduced risk of depressive symptoms confirms the role of the inflammatory response system in the pathophysiology of IFN-alpha-induced depression.
• Ante-Partum & Postpartum Exposure to Maternal Depression The researchers engaged in the research work on this particular study topic by approaching it on the basis of maternal behavior and circumstances, as they connect to depressive conditions in their own lives and the […]
• Depression in Australia, How Treat This Disorder According to The World Health Organization, depression is defined as a disorder in the mental health system that is presented with feelings of guiltiness, low concentration, and a decrease in the need for sleep.
• Steroid Use and Teen Depression In this manner, the researcher will be in a position to determine which of the two indicators is strongest, and then later, the indicators can be narrowed down to the most basic and relevant.
• Depression Among Minority Groups Mental disorders are among the major problems facing the health sector in America and across the world in the contemporary society.
• Aspects and Definition of Depression: Psychiatry This is the personal counseling of a patient with the doctor, and it is one of the very best processes. In the case of a physician dealing with a mental patient, the most preferable way […]
• Dual Illness – Depression and Alcohol Abuse The intention of the research paper is to assess if indeed there is an association between alcoholism as manifested by Jackson, and a case of depression.
• Depression and Paranoid Personality Disorder Bainbridge include: The analysis of paranoia and anxiety caused by substance abuse reveals that the diagnosis can be correct based on the symptoms, but the long-lasting nature of the symptoms rejects this diagnosis in favor […]
• Antidepressant Drugs for Depression or Dysthymia These are the newer form of antidepressant that are based on both the principle of serotonin reuptake prevention and norepinephrine action.
• The Relationship of Type 2 Diabetes and Depression Type 2 diabetes is generally recognized as an imbalance between insulin sensitivity and beta cell function We have chosen a rural area in Wisconsin where we can focus our study and select a group of […]
• Teenage Depression and Alcoholism There also has been a demonstrated connection between alcoholism and depression in all ages; as such, people engage in alcoholism as a method of self medication to dull the feelings of depression, hopelessness and lack […]
• “Relationships of Problematic Internet Use With Depression”: Study Strengths and Weaknesses One of the study strengths is that the subject selection process is excellently and well-designed, where the subjects represent the study sample, in general.
• Depression Treatment: Biopsychosocial Theory More to the point, the roles of nurses, an interprofessional team, and the patient’s family will be examined regarding the improvement of Majorie’s health condition.
• Postpartum Depression and Its Impact on Infants The goal of this research was “to investigate the prevalence of maternal depressive symptoms at 5 and 9 months postpartum in a low-income and predominantly Hispanic sample, and evaluate the impact on infant weight gain, […]
• Postpartum Depression: Statistics and Methods of Diagnosis The incorporation of the screening tools into the existing electronic medical support system has proved to lead to positive outcomes for both mothers and children.
• Comorbidity of Depression and Pain It is also known that dysregulation of 5-HT receptors in the brain is directly related to the development of depression and the regulation of the effects of substance P, glutamate, GABA and other pain mediators. […]
• Hallucinations and Geriatric Depression Intervention Sandy has asserted further that the cleaners at the residence have been giving him the wrong medication since they are conspiring to end his life with the FBI.Mr.
• Changes in Approaches to the Treatment of Depression Over the Past Decade In spite of the fact that over the past decade many approaches to the treatment of depression remained the same, a lot of new methods appeared and replaced some old ones due to the development […]
• Management of Treatment-Resistant Depression The significance of the problem, the project’s aims, the impact that the project may have on the nursing practice, and the coverage of this condition are the primary focuses of this paper.
• Depression and Anxiety in Dialysis Patients However, the study indicates the lack of research behind the connection of depression and cognitive impairment, which is a significant limitation to the conclusive statement.
• Adolescent Grief and Depression In looking for an activity that may help him or her keep away from the pain he or she is experiencing, the victim may decide to engage in sexual activities. Later, the adolescent is also […]
• Suicide and Depression in Students Students who belong to racial and ethnic minorities constitute the group of risk connected with high depression and suicidal rates and it is the primary task of health teachers to reduce suicidal rates among all […]
• Depression Disorder: Key Factors Epidemiology refers to the study of the distribution and determinants of health related events in specific populations and its applications to health problems.
• Depression Effects of School Children However the present difficulties that he is going through being a 16 year old; may be associated to a possible cause of Down syndrome complications, or the feelings and behavioral deficiency he associates to the […]
• Depression, Hallucination, and Suicide: Mental Cases How they handle the process determines the kind of aftermath they will experience for instance it can take the route of hallucinations which is treatable or suicide which is irreversible thus how each case is […]
• Depression, Its Perspective and Management Therefore this paper seeks to point out that stress is a major ingredient of depression; show the causes, symptoms, highlight how stresses is manifested in different kinds of people, show how to manage stress that […]
• Daily Living, Depression, and Social Support Activities of Elderly Turkish People Navigating the delicate and often convoluted maze of the current issues affecting the elderly has continued to present challenges to the professionals in the field especially with the realization that these issues and needs are […]
• The Theory of Personality Psychology During Depression The study concerns personality pathology, and the results of the treatment given to patients who are under depression, and how personalities may have adverse effects on the consequences of the cure.
• Depression and the Media Other components of the cognitive triad of depression are the aspect of seeing the environment as overwhelming and that one is too small to make an impact and also seeing the future as bleak and […]
• Poor Body Image, Anxiety, and Depression: Women Who Undergo Breast Implants H02: There is no difference in overt attractiveness to, and frequency of intimacy initiated by, the husband or cohabitating partner of a breast implant patient both before and after the procedure.
• Reducing Anxiety and Depression With Exercise Regardless of the type of results achieved, it is recommendable for people undergoing mental problems like depression and anxiety to exercise regularly.
• Stress, Depression and Psychoneuroimmunology The causes and symptoms of stress may vary from person to person and the symptoms can be mental as well as physical.
• A Critical Evaluation of Major Depression This paper has actively shown how factors such as financial insecurity, job loss, income, and educational inequalities, lifestyle diseases, and breakdown of the social fabric have acted to propel the mental disorder by making use […]
• Depression, Substance Abuse and Suicide in Elderly While significant body of research has been devoted to the study of depression in elderly, little attention has been paid to the investigation of substance abuse, emotional instability, burden feelings, and depression.
• Adult Depression Sufferer’s and Withdrawal From Family and Friends
• Depression: Helping Students in the Classroom
• Major Depression: Treating Depression in the Context of Marital Discord
• Family Therapy for Treating Major Depression
• Adverse Childhood Experiences Cause Depression
• Depression and Alzheimer’s Disease
• Rumination, Perfectionism and Depression in Young People
• “Gender Differences in Depression” by Nolen-Hoeksema
• Anxiety and Depression Disorders
• Beck’s Cognitive Therapy Approach to Depression Treatment
• Cannabis Abuse Increases the Risk of Depression
• Depression: Risk Factors, Incidence, Preventive Measures & Prognostic Factors
• Depression Diagnostics Methods
• Concept Analysis of Loneliness, Depression, Self-esteem
• Teen Suicide and Depression
• Depression and Diabetes Association in Adults
• The Correlation Between Perfectionism and Depression
• Geriatric Dementia, Delirium, and Depression
• Dementia, Delirium, and Depression in Older Adults
• Dealing with Depression in the Workplace
• Depression in People With Alcohol Dependence
• Depression and Anxiety Due to School and Work-Related Stress
• Creating a Comprehensive Psychological Treatment Plan: Depression
• Experimental Psychology. Bouldering for Treating Depression
• Depression and Psychotherapy in Adolescence
• Postpartum Depression: Treatment and Therapy
• Atypical Depression Symptoms and Treatment
• Dementia, Delirium, and Depression in Frail Elders
• Depression & Patient Safety: Speak Up Program
• Mindfulness Meditation Therapy in Depression Cases
• A Review of Postpartum Depression and Continued Post Birth Support
• Psychodynamic Therapy for Depression
• Depression Screening in Primary Care for Adolescents
• Freud’s Depression: Cognitive-Behavioral Interventions
• Optimal Mental Health Approaches: Depression & Anxiety
• Great Depression in “A Worn Path” by Eudora Welty
• Depression in Adolescents and Interventions
• Bipolar Disorder: Reoccurring Hypomania & Depression
• Postpartum Depression: Understanding the Needs of Women
• Major Depression Treatment During Pregnancy
• Patients’ Depression and Practitioners’ Suggestions
• Traditional Symptoms of Depression
• Social Media Impact on Depression and Eating Disorder
• Anxiety and Depression in Children and Adolescents
• Depression Studies and Online Research Sources
• Drug Abuse and Depression Treatment
• Depression Explanation in Psychological Theories
• Food Insecurity and Depression in Poor Families
• Peer Popularity and Depression Among Adolescents
• Alcohol Abuse, Depression and Human Trafficking
• Depression Assessment Using Intake Notes
• Depression in Adolescents and Cognitive Therapy
• Diagnosing Depression: Implementation and Evaluation Plan
• Beck Depression Inventory: Evaluation Plan
• Depression in Iranian Women and Health Policies
• Depression Patients and Psychiatrist’s Work
• Depression Patients’ Needs and Treatment Issues
• Suicide and Depression: Connection, Signs and Age
• Health Promotion: Depression Awareness in Teenagers
• Depression and Cancer in Caucasian Female Patient
• Depression in Patients with Comorbidity
• Depression After Transcranial Magnetic Stimulation Treatment
• Depression and Psychosis: 32-Year-Old Female Patient
• Postpartum Depression and Acute Depressive Symptoms
• Women with Heart Disease: Risk of Depression
• Postpartum Depression and Its Peculiarities
• Exercises as a Treatment for Depression
• Depression Treatment Changes in 2006-2017
• Depression in Elders: Social Factors
• Depression Among High School Students
• False Memories in Patients with Depression
• Postpartum Depression Analysis in “Yellow Wallpaper”
• The Canadian Depression Causes
• Widowhood Effects on Men’s and Women’s Depression
• Teen Website: Fish Will Keep Depression Away
• Bipolar Expeditions: Mania and Depression
• Obesity and Major Depression Association
• Fast Food, Obesity, Depression, and Other Issues
• Depression in the Future Public Health
• Depression: Patients With a Difficult Psychological State
• Depression: Pathophysiology and Treatment
• Stress, Depression, and Responses to Them
• Beck Depression Inventory in Psychological Practice
• Problem of the Depression in Teenagers
• Supporting the Health Needs of Patients With Parkinson’s, Preeclampsia, and Postpartum Depression
• Hamilton Depression Rating Scale Application
• Psychological Measures: The Beck Depression Inventory
• Yoga for Depression and Anxiety
• Sleep Disturbance, Depression, Anxiety Correlation
• Depression in Late Life: Interpersonal Psychotherapy
• Postpartum Depression and Comorbid Disorders
• Arab-Americans’ Acculturation and Depression
• Organizational Behaviour: Depression in the Workplace
• Relationship Between Depression and Sleep Disturbance
• Child’s Mental Health and Depression in Adulthood
• Parents’ Depression and Toddler Behaviors
• Managing Stress and Depression at Work Places – Psychology
• Job’ Stress and Depression
• Depression Measurements – Psychology
• Methodological Bias Associated with Sex Depression
• Relationship Between Sleep and Depression in Adolescence
• The Effects of Depression on Physical Activity
• Psychological Disorder: Depression
• Depression and Workplace Violence
• The Effects of Forgiveness Therapy on Depression, Anxiety and Posttraumatic Stress for Women After Spousal Emotional Abuse
• Depression Diagnosis and Theoretical Models
• The Impact of Exercise on Women Who Suffer From Depression
• Evolutionary Psychology: Depression
• Effect of Social Media on Depression
• Depression in the Elderly
• Poly-Substance Abuse in Adolescent Males With Depression
• How Does Peer Pressure Contribute to Adolescent Depression?
• How Do Genetic and Environmental Factors Contribute To The Expression of Depression?
• Depression and Cognitive Therapy
• Cognitive Treatment of Depression
• Book Review: “Breadwinning Daughters: Young Women Working in a Depression- Era City, 1929-1939” by Katrina Srigley
• Depression: A Critical Evaluation
• Psychopharmacological Treatment for Depression
• “Breadwinning Daughters: Young Working Women in a Depression-Era City” by Katrina Srigley
• Depression in female adolescents
• Interpersonal Communication Strategies Regarding Depression
• Depression: Law Enforcement Officers and Stress
• Social Influences on Behavior: Towards Understanding Depression and Alcoholism Based on Social Situations
• Depression Experiences in Law Enforcement
• Childhood Depression & Bi-Polar Disorder
• Depression Psychological Evaluation
• Concept of Childhood Depression
• Correlation Between Multiple Pregnancies and Postpartum Depression or Psychosis
• Depression and Its Effects on Participants’ Performance in the Workplace
• Catatonic Depression: Etiology and Management
• The Children’s Depression Inventory (CDI) Measure
• Depression: A Cross-Cultural Perspective
• Depression Levels and Development
• Depression Treatment: Rational Emotive Behavior Therapy
• Concept of Depression Disorder
• Does Divorce Have a Greater Impact on Men than on Women in Terms of Depression?
• Oral versus Written Administration of the Geriatric Depression Scale

❓Research Questions for a Depression Essay

• Does Poverty Impact Depression in African American Adolescents and the Development of Suicidal Ideations?
• Does Neighborhood Violence Lead to Depression Among Caregivers of Children With Asthma?
• Does Parent Depression Correspond With Child Depression?
• How Depression Affects Our Lives?
• Does Brain-Derived Neurotrophic Factor Have an Effect on Depression Levels in Elderly Women?
• How Can Overcome Depression Through 6 Lifestyle Changes?
• Does Maternal Depression Have a Negative Effect on Parent-Child Attachment?
• Can Providers’ Education About Postpartum Depression?
• Can Vacation Help With Depression?
• How Children Deal With Depression?
• Can Diet Help Stop Depression and Violence?
• Does Depression Assist Eating Disorders?
• Does Depression Lead to Suicide and Decreased Life Expectancy?
• Can Obesity Cause Depression?
• Can Exercise Increase Fitness and Reduce Weight in Patients With Depression?
• Does Fruit and Vegetable Consumption During Adolescence Predict Adult Depression?
• Does Depression Cause Cancer?
• Does Money Relieve Depression?
• Does the Average Person Experience Depression Throughout Their Life?
• Are Vaccines Cause Depression?
• Does Social Anxiety Lead to Depression?
• Does Stress Cause Depression?
• How Bipolar and Depression Are Linked?
• Does Postpartum Depression Affect Employment?
• Does Postpartum Depression Predict Emotional and Cognitive Difficulties in 11-Year-Olds?
• Does Regular Exercise Reduce Stress Levels, and Thus Reduce Symptoms of Depression?
• Does the Natural Light During Winters Really Create Depression?
• How Can Art Overcome Depression?
• How Anxiety and Depression Are Connected?
• Does Positive Psychology Ease Symptoms of Depression?
• Chicago (A-D)
• Chicago (N-B)

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When It’s Time for an Aging Driver to Hit the Brakes

The “car key conversation” can be painful for families to navigate. Experts say there are ways to have it with empathy and care.

By Catherine Pearson

Sherrie Waugh has been yelled at, insulted and wept upon in the course of her job administering driving tests. Typically these extreme reactions happen when she is forced to render an upsetting verdict: It’s time to hang up the car keys.

Ms. Waugh, a certified driving rehabilitation specialist with The Brain Center, a private neuropsychology practice in Indiana, often works with older drivers, putting them through an assessment that measures things like visual skills, reaction time and processing speed.

“I had one gentleman, who had early onset dementia, who was just sitting here crying,” Ms. Waugh said. “His wife was out in the car and she was crying. And we all came back, and we were all crying. Because it’s so hard.”

Decisions about when an older person (or someone whose physical or mental circumstances make operating a vehicle dangerous) should stop driving are often agonizing. They can rock the driver’s sense of independence and identity, and add to the responsibilities that many family caregivers shoulder.

“It’s a major, major loss for older people,” said Lauren Massimo, an assistant professor at Penn Nursing. “It’s been described to me as dehumanizing.”

But it is important to raise concerns as soon as you have them, experts said, and there are ways to make the car key conversation less painful for older drivers and their loved ones.

Get a good look at the problem.

Before you ask a partner or parent to give up driving, do your research, experts say. Ms. Waugh, for instance, is surprised by the number of caregivers she sees who raise concerns about older drivers they haven’t actually driven with recently.

“If they need to pick up something at the grocery store, hop in the car,” she said. Take note: Are they missing traffic lights or safety signs? Are they struggling to maintain the speed limit or stay in their lane? Are they becoming confused about directions, particularly on familiar routes? Those are all signs that their driving skills may be waning.

And beware of ageism, especially when figuring out how to approach the conversation.

“It’s really not about their age,” said Marvell Adams Jr., the chief executive officer of the nonprofit Caregiver Action Network. “It’s about changes in their ability, which can happen to anyone.”

Mr. Adams suggested this opening gambit for a talk: “‘Hey, you know, I noticed it looks like your tires are getting beat up. Are you hitting the curb more often?’” His own mother made the decision to stop driving herself, he said, after she hit the gas pedal instead of the brake.

Pin the decision on someone else.

The driving conversation is one of the hardest parts of Dr. Massimo’s job as a health care provider who works with patients with neurodegenerative disease, she said. But she is happy to relieve caregivers of that burden.

“Make the provider the bad guy,” she said.

Many of Ms. Waugh’s clients come to her through referrals from primary care doctors, neurologists or eye doctors, though family members also reach out directly. She charges $175 for a 90-minute clinical assessment, and $200 for a road evaluation — fees that she acknowledged might be prohibitive for some families. (She has not succeeded in getting insurance to reimburse her clients.) But, experts say, professional driving evaluations can offer objectivity and clarity.

Ms. Waugh recently saw an older client who used to teach driver’s education and was miffed that his wife and doctor had been urging him to stop driving. During the evaluation, he struggled to finish short-term memory tests, including a simple maze and a counting exercise. When Ms. Waugh showed him his results, he finally understood that he posed a safety risk to himself and others on the road.

Have solutions ready.

Although giving up driving is rarely easy, services such as grocery delivery and ride-sharing apps can lessen the inconvenience and offer continued autonomy and independence, Mr. Adams said.

Make a plan for how you will help a retired driver get around. In addition to ride-sharing apps, the experts also mentioned public transportation and car pools, as well as friends and family members who might be able to give rides.

Consider risk-reduction strategies, too, Mr. Adams said. Maybe your partner or parent is safe to drive during the day, but not at night and not on the highway.

Even though older drivers and their family members may be loath to do it, look ahead.

“Make this a part of the conversation early,” said Cheryl Greenberg, who coaches seniors and their families on life transitions and planning in North Carolina. “You know, ‘You’re 60 years old and you’re driving just fine, but Mom, what would you do if the time came and you were less comfortable and less able?’”

All of the experts said that it was important to make space for big emotions around these conversations.

“Be empathic,” Dr. Greenberg said. “Don’t just go in and say, ‘Well, now you’re done driving.’ Listen. Ask questions that might help them be centered in the process.”

Catherine Pearson is a Times reporter who writes about families and relationships. More about Catherine Pearson

A Guide to Aging Well

Looking to grow old gracefully we can help..

Researchers are investigating how our biology changes as we grow older — and whether there are ways to stop it .

You need more than strength to age well — you also need power. Here’s how to measure how much power you have  and here’s how to increase yours .

Ignore the hyperbaric chambers and infrared light: These are the evidence-backed secrets to aging well .

Your body’s need for fuel shifts as you get older. Your eating habits should shift , too.

People who think positively about getting older often live longer, healthier lives. These tips can help you reconsider your perspective .

The sun’s rays cause the majority of skin changes as you grow older. Here’s how sunscreen helps prevent the damage .

Joint pain, stiffness and swelling aren’t always inevitable results of aging, experts say. Here’s what you can do to reduce your risk for arthritis .

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Brazilian woman arrested after taking corpse to sign bank loan: ‘She knew he was dead’

Shock in Brazil after woman is arrested and charged with violating a corpse and attempted theft through fraud

When Érika de Souza Vieira wheeled her lethargic-looking uncle into a Brazilian bank, clerks quickly sensed something was amiss.

“I don’t think he’s well. He doesn’t look well at all,” remarked one distrustful employee as Vieira tried to get her elderly relative to sign off on a 17,000 reais ($3,250) loan.

Paulo Roberto Braga was indeed indisposed. In fact, the 68-year-old appears to have been dead.

Shortly after entering the lender in Rio late on Tuesday with her late uncle, Vieira was arrested and charged with violating a corpse and attempted theft through fraud, according to the Rio newspaper O Dia .

“She knew he was dead … he had been dead for at least two hours,” the investigating officer, Fábio Luiz Souza, told the breakfast news program Bom Dia Rio on Wednesday.

“I have never come across a story like this in 22 years [as a cop],” added Souza, who said visible signs of livor mortis left no doubt as to Braga’s state.

Footage of Vieira’s surreal and macabre alleged attempt to cash in on her relative’s corpse has gone viral on social media, with Brazilians voicing stupefaction at the scene.

At one point in the images – which bank workers began filming after smelling a rat – one suspicious employee comments on Braga’s pallid complexion. “That’s just what he’s like,” Vieira replies, before trying to place a pen in his limp hand once again.

Brazilian journalists shared their viewers’ bewilderment.

“It is just unbelievable. It seems like a wind-up, but this is serious,” the news presenter Leilane Neubarth exclaimed as she told viewers about the scandal on the network GloboNews. “She has gone into the bank with a cadaver – and has tried to get money with a human being who is dead.”

Another journalist, Camila Bomfim, was similarly stunned. “This is the last straw … This goes beyond all limits because there can be no doubt … about the difference between a living person and a dead person,” Bomfim said.

Ana Carla de Souza Correa, a lawyer representing Vieira, insisted it was not. “The facts did not occur as has been narrated. Paulo was alive when he arrived at the bank,” Correa told reporters, claiming there were witnesses who could prove that. “All of this will be cleared up,” the lawyer added . “We believe in Érika’s innocence.”

The police chief Souza said he was also investigating if Vieira was in fact the deceased man’s niece. “Anyone who sees that [footage] can see the person was dead,” he said.

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