Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0EPIDEMIOLOGY OF DEPRESSION 393EURODEP—Prevalence of Depression in EuropeJohn R. M. CopelandRoyal Liverpool University Hospital, Liverpool, UKThe aims of the EURODEP Concerted Action were to useexisting studies which had employed the GMS–AGECAT methodof diagnosis to assess the prevalence of depression in nineEuropean countries (10 centres)—Liverpool, Amsterdam (sampleA), Berlin, Dublin, Iceland, London, Maastricht, Munich, Veronaand Zaragoza. Later Tirana was added (not reported here), andfive non-AGECAT centres joined after the study commenced—Bordeaux, Oulu, Antwerp, Amsterdam (sample B) and Go¨teborg.All subjects were aged 65 or over. In Munich the subjects wereaged 85 and above and in Iceland 85–87. The Amsterdam study(sample A) had an upper age limit of 84. All the studies tookrandom samples in the community except Dublin, which sampleda general practice. Sample size varied from 202 in Verona to 5222in Liverpool, giving a total sample of 13 803. Substantialdifferences in the prevalence of depression were found, withIceland having the lowest level at 8.8%, followed by Liverpool,10.0%; Zaragoza, 10.7%; Dublin, 11.9%; Amsterdam, 12.0%;Berlin, 16.5%; London, 17.3%; Verona, 18.3%; and Munich,23.6%. When all five AGECAT depression levels, including bothsubcases of depression and cases, were added together, five highscoringcentres emerged, namely Amsterdam, Berlin, Munich,London and Verona (30.4–37.9%) and four low-scoring centres,Dublin, Iceland, Liverpool and Zaragoza (17.7–21.4%). There wasno constant association between prevalence and age. A meta-analysisof the pooled data on the nine European centres yielded an overallprevalence of 12.3% (95% CI, 11.8–12.9); for women, 14.1% (95%CI, 13.5–14.8) and for men, 8.6% (95% CI, 7.9–9.3%) 1 .The proportions of depressive symptoms were found to varybetween centres. In Amsterdam, for example, 40% of a generalpopulation of older people admitted to depressive mood,compared to only 26% in Zaragoza. Symptoms such as ‘‘futurebleak’’, ‘‘hopelessness’’, ‘‘wish to be dead’’, were generally rare,but the last reached higher levels in Berlin, Munich and Verona.Sleep disturbance was admitted by only 15% of the population inDublin, but 54% and 60% in Munich and Berlin. Largedifferences for some depressive symptoms were found within thevery old populations, with lower levels in Iceland and higher levelsin Munich. Overall, the levels of depressive symptoms among over60% of the older general population of Europe were low, so thatpejorative stereotypes of old age in Europe were not upheld 2 .In order to include non-AGECAT centres, attempts were madeto harmonize the depression measures that had been used withitems from the Geriatric Mental State examination. A scale wasconstructed, the Euro-D scale 3 . The scale appeared to work welland was applied to data from 21 724 subjects. Euro-D scorestended to increase with increasing age, unlike the levels ofprevalence of depression. Women had generally higher scoresthan men, and widowed and separated subjects higher than thosewho were currently or never married 4 .Depression was confirmed as a common illness among olderpeople in Europe. A number of other studies have shown poortreatment levels. It was concluded that opportunities for effectivetreatment were almost certainly being lost.REFERENCES1. Copeland JRM, Beekman ATF, Dewey ME et al. Depression inEurope. Geographical distribution among older people. Br J Psychiat1999; 174: 312–21.2. Copeland JRM, Beekman ATF, Dewey ME et al. Cross-culturalcomparison of depressive symptoms in Europe does not supportstereotypes of ageing. Br J Psychiat 1999; 174: 322–9.3. Prince MJ, Reischies F, Beekman ATF et al. Development of theEURO-D Scale—A European union initiative to compare symptomsof depression in 14 European centres. Br J Psychiat 1999; 174: 330–8.4. Prince MJ, Beekman ATF, Deeg DJH et al. Depression symptoms inlate life assessed using the EURO-D Scale. The effect of age, gender andmarital status in 14 European Centres. Br J Psychiat 1999; 174: 339–45.Depression in Older Primary Care Patients:Diagnosis and CourseJeffrey M. Lyness and Eric D. CaineUniversity of Rochester Medical Center, Rochester, NY, USADepressive symptoms and syndromes in later life are a majorpublic health problem 1,2 . Primary care clinical settings areespecially important venues to better understand depressivepsychopathology among older people. Older people with psychiatricdisorders utilize mental health services infrequently,especially in comparison with younger persons, yet they aremore likely to see their primary care physicians regularly 3,4 . Elderswho complete suicide have often seen their primary care providersshortly before death, and the majority of them were suffering fromdepressive conditions at the time of their death 4 . There are alsomany lines of evidence suggesting that the nature of psychopathologyseen in primary care differs from that seen in