Depression
Consistent association between physical health and depression amongst old
By British Journal of Psychiatry
Jul 5, 2005, 22:23

A Europe-wide study has shown a consistent association between declining physical health and depression amongst older people.

Links between physical health and depression have been found across cultures amongst adults up to the age of 65. In later life, the impact of physical health on depression is much more substantial, and may depend on sociocultural factors.

Published in the July issue of the British Journal of Psychiatry, this study set out to examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe.

EURODEP Concerted Action is a consortium of 14 research groups from 11 European countries, all engaged in population-based research into late-life depression. The overall sample size of the pooled EURODEP data amounts to 22,570 respondents aged 65 and over.

In this study, the European countries were categorised in 'building blocs: 'Western Isles' (England and Ireland); 'Nordic' (Iceland, Sweden and Finland); 'Western continent' (Belgium, Germany and The Netherlands); and 'Southern/Mediterranean (south of France, Italy and Spain).

Measures were compared of demographic variables, depressive symptoms, physical health (functional limitations and chronic physical conditions) and cognitive functioning in each building bloc.

It was found that the pattern of associations between physical health variables and depressive symptoms in later life was very similar in the 11 countries studied.

In the majority of centres, there was a linear association between depressive symptoms and disability, as well as with chronic diseases, indicating a 'dose-response' relationship.

Furthermore, the relative contribution of these aspects of physical health showed the same pattern in all centres involved: disability had a stronger association with depression than chronic diseases.

The findings are compatible with previous studies without a cross-national approach, and suggest that sociological and cultural factors give way to life-cycle perspectives and biological mechanisms that affect all people, irrespective of cultural traditions.

Some differences between the main regions of Europe were found in this study, however. In contrast to what was expected, the association between physical health and depressive symptoms was somewhat more pronounced in the UK and Ireland, compared with western Europe or the Scandinavian countries.

One explanation may be that health services are less accessible in Britain. Indeed, the national expenditure per capita in Britain in 1990 was clearly below that of most other western European countries, in spite of at least equally high standards in the British health care system. Further research is needed in this area.

The authors of the study comment that as physical disability is closely linked with depressive symptoms in later life, assessment and management of disability is needed in the treatment of depression in the older population.

This study has demonstrated that the application of brief, harmonised procedures to identify the causes of depressive symptoms is feasible across cultures.

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