Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-19T00:43:43.665Z Has data issue: false hasContentIssue false
  • English
  • Français

Depressive morbidity and gender in community-dwelling Brazilian elderly: systematic review and meta-analysis

Published online by Cambridge University Press:  18 May 2010

Ricardo Barcelos-Ferreira ,
Rafael Izbicki ,
David C. Steffens  and
Cássio M. C. Bottino
Ricardo Barcelos-Ferreira*
Affiliation:
Old Age Research Group (Proter), Institute of Psychiatry, University of São Paulo Medical School, Brazil
Rafael Izbicki
Affiliation:
Department of Statistics, University of São Paulo, Brazil
David C. Steffens
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, U.S.A.
Cássio M. C. Bottino
Affiliation:
Old Age Research Group (Proter), Institute of Psychiatry, University of São Paulo Medical School, Brazil
*
Correspondence should be addressed to: Dr. Ricardo Barcelos-Ferreira, Old Age Research Group (Proter), Institute of Psychiatry, University of São Paulo Medical School, R. Dr. Ovidio Pires de Campos, 785, 3° andar, CEAPESQ, sala 14, São Paulo/SP. CEP: 05403–010, Brazil. Phone: +55 11 3069 6973; Fax: +55 11 3069 8118. Email: barcelosfr@usp.br.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Although studies indicate that community-dwelling elderly have a lower prevalence of major depression compared with younger age groups, prevalence estimates in Brazil show that clinically significant depressive symptoms (CSDS) and depression are frequent in the older population. However, a systematic review and meta-analysis of prevalence of and factors associated with depressive disorders and symptoms in elderly Brazilians has not previously been reported. The aims were (i) to perform a survey of studies dating from 1991 to 2009 on the prevalence of depressive disorders and CSDS in elderly Brazilians residing in the community; (ii) to determine depression prevalence and identify associated factors; and (iii) develop a meta-analysis to indicate the combined prevalence and the influence of gender on depressive morbidity in this population.

Methods: Studies were selected from articles dated between January 1991 and May 2009, extracted from Medline, LILACS and SciELO databases.

Results: A total of 17 studies were found, 13 with CSDS, 1 with major depression alone and 3 with major depression and dysthymia, involving the evaluation of 15,491 elderly people. The average age of participants varied between 66.5 and 84.0 years. Prevalence rates of 7.0% for major depression, 26.0% for CSDS, and 3.3% for dysthymia were found. The odds ratios for major depression and CSDS were greater among women. There was a significant association between major depression or CSDS and cardiovascular diseases.

Conclusion: The review indicates greater prevalence of both major depression and CSDS compared to rates reported in the international literature, while the prevalence of dysthymia was found to be similar. The high prevalence of CSDS and its significant association with cardiovascular diseases reinforces the importance of evaluating subthreshold depressive symptoms in the elderly in the community.

Keywords

depressive disordersdepressive symptomsBrazilian elderlyprevalencemeta-analysissystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 5 , August 2010 , pp. 712 - 726
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Almeida, O. P. (1999). Elderly treated in mental health emergency rooms: demographic and clinic characteristics. Revista Brasileira de Psiquiatria, 21, 12–18.CrossRefGoogle Scholar
Almeida, O. P. and Almeida, S. A. (1999). Reliability of the Brazilian version of the depression in elderly. Arquivos de Neuropsiquiatria, 57, 421–426.CrossRefGoogle Scholar
Almeida, O. P. et al. (1997). Psychiatric morbidity among the elderly in a primary care setting: report from a survey in São Paulo, Brazil. International Journal Geriatric Psychiatry, 12, 728–736.3.0.CO;2-C>CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association.Google Scholar
Andrade, L. H., Silveira, C. M. and Gentil, V. (2001). Unpublished oral presentation, International Federation of Psychiatric Epidemiology. Asia Pacific Regional Conference, Shah Alam, Malaysia.Google Scholar
Andrade, L., Walters, E. E., Gentil, V. and Laurenti, R. (2002). Prevalence of ICD-10 mental disorders in a catchment area in the city of São Paulo, Brazil. Social Psychiatry and Psychiatric Epidemiology, 37, 316–325.CrossRefGoogle Scholar
Ávila, R. and Bottino, C. M. C. (2006). Cognitive alterations update among elderly with depressive syndrome. Revista Brasileira de Psiquiatria, 28, 316–320.CrossRefGoogle ScholarPubMed
Balbé, G. P. and Garces, S. B. B. (2008). Levels of physical activity and signs of depression in the elderly: a cross-sectional study. Revista Digital efdeportes. Buenos Aires. Available at http://www.efdeportes.com.Google Scholar
Barcelos, R., Faria, J., Grossi, P., Moscoso, M. A. M., Bottino, C. M. C. (2007). Vascular depression in elderly: response to treatment with antidepressant associated to cholinesterase inhibitor. Revista de Psiquiatria Clínica, 34, 290–293. doi:10.1590/S0101-60832007000600006CrossRefGoogle Scholar
Barcelos-Ferreira, R., Junior, J. A. P., Nakano, E. Y., Steffens, D. C., Litvoc, J. and Bottino, C. M. C. (2009). Clinically significant depressive symptoms and associated factors in community elderly subjects from São Paulo, Brazil. American Journal of Geriatric Psychiatry, 17, 582–590. doi:10.1097/JGP. 0b013e3181a76ddcCrossRefGoogle ScholarPubMed
Barry, L. C., Allore, H. G., Guo, Z., Bruce, M. L. and Gill, T. M. (2008). Higher burden of depression among older women: the effect of onset, persistence, and mortality over time. Archives of General Psychiatry, 65, 172–178.CrossRefGoogle ScholarPubMed
Batistoni, S. S. T. et al. (2007). Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly. Rev Saúde Pública, 41, 598–605. doi:10.1590/S0034-89102007000400014.CrossRefGoogle Scholar
Beekman, A. T., Deeg, D. J., Smit, J. H. and van Tilburg, W. (1995). Predicting the course of depression in the older population: results from a community-based study in The Netherlands. Journal of Affective Disorders, 34, 41–49. doi:10.1016/0165-0327(94)00103-G.CrossRefGoogle ScholarPubMed
Beekman, A. T. F., Copeland, J. R. M. and Prince, M. J. (1999). Review of community prevalence of depression in later life. British Journal of Psychiatry, 174, 307–311.CrossRefGoogle ScholarPubMed
Bertoldi, A. D., Barros, A. J. D., Hallal, P. C. and Lima, R. C. (2004). Drug utilization in adults: prevalence and individual determinants. Revista de Saúde Pública, 38, 228–238. doi:10.1590/S0034-89102004000200012.CrossRefGoogle Scholar
Blay, S. L., Ramos, L. R. and Mari, J. J. (1988). Validity of a Brazilian version of the Older Americans Resources and Services (OARS) mental health screening questionnaire. Journal of the American Geriatrics Society, 36, 687–692.CrossRefGoogle ScholarPubMed
Blay, S., Andreoli, S., Fillenbaum, G. and Gastal, F. L. (2007). Depression morbidity in later life: prevalence and correlates in a developing country. American Journal of Geriatric Psychiatry, 15, 790–799.CrossRefGoogle ScholarPubMed
Blazer, D. G. (1994). Epidemiology of late-life depression. In Schneider, L. J. et al. (eds.), Depression and Treatment of Late Life Depression: Results of the NIH Consensus Development Conference, pp. 9–21. Washington, DC: American Psychiatric Association.Google Scholar
Blazer, D. G. (2003). Depression in late life: review and commentary. Journal of Gerontology: Medical Sciences, 58, 249–265.Google Scholar
Blazer, D. and Hybels, C. (2004). What symptoms of depression predict mortality in community-dwelling elders? Journal of the American Geriatrics Society, 52, 2052–2056.CrossRefGoogle ScholarPubMed
Bottino, C. M. C. (2003). The challenge of treating depression in the elderly. International clinical psychopharmacology, 18, S39–S45.Google Scholar
Borges, L. J., Benedetti, T. R. B. and Mazo, G. Z. (2007). Cognitive tracking and depressive symptoms in elderly starting out on physical exercise program. Brazilian Journal of Psychiatry, 56, 273–279.Google Scholar
Brugha, T. et al. (1999). Cross validation of general population survey diagnostic interview: a comparison of CIS-R with SCAN ICD-10 diagnostic categories. Psychological Medicine, 29, 1029–1042.CrossRefGoogle ScholarPubMed
Cabrera, M. A. S. et al. (2007). Malnutrition and depression among community-dwelling elderly people. Journal of the American Medical Directors Association, 8, 582–584.CrossRefGoogle ScholarPubMed
Castro-Costa, E. et al. (2007). Prevalence of depressive symptoms and syndromes in later life in ten European countries: the SHARE study. British Journal of Psychiatry, 191, 393–401.CrossRefGoogle ScholarPubMed
Castro-Costa, E., Lima-Costa, M. F., Carvalhais, S., Firmo, J. O. and Uchoa, E. (2008). Factors associated with depressive symptoms measured by the 12-item General Health Questionnaire in community-dwelling older adults (The Bambuí Health Aging Study). Revista Brasileira de Psiquiatria, 30, 104–109.CrossRefGoogle ScholarPubMed
Cole, M. G. and Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160, 1147–1156.CrossRefGoogle ScholarPubMed
Costa, E., Barreto, S. M., Uchoa, E., Firmo, J. O., Lima-Costa, M. F. and Prince, M. (2007). Prevalence of International Classification of Diseases, 10th Revision Common Mental Disorders in the elderly in a Brazilian community: the Bambui Health Ageing Study. American Journal of Geriatric Psychiatry, 15, 17–27.CrossRefGoogle Scholar
Cupertino, A. P. F. B. et al. (2006). Estresse e suporte social na infância e adolescẽncia relacionados com sintomas depressivos em idosos. Psicologia: Reflexão e Critica, 19, 371–378.Google Scholar
Duarte, M. B. and Rego, M. A. V. (2007). Depression and clinical illness: comorbidity in a geriatric outpatient clinic. Cademo de Saúde Pública, 23, 691–700.CrossRefGoogle Scholar
FIBGE (2007). Censo Demográfico. Fundação Instituto Brasileiro de Geografia e Estatística. Available at: http://www.ibge.gov.br/home/estatística/populacao/perfilidoso/tabela1_2.sGoogle Scholar
FIBGE (2008). Projeções Demográficas Preliminares. Available at http://tabnet.datasus.gov.br/cgi/idb2007/a14uft.htm and http://tabnet.datasus.gov.br/cgi/idb2007/a11t.htm.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1998). Structured Clinical Interview for DSM-IV (SCID-I/P, versão 2). Versão Brasileira, Marcelo Tavares Brasília: Universidade de Brasília.Google Scholar
Fortes-Burgos, A. C. G., Neri, A. L. and Cupertino, A. P. F. B. (2008). Stressful events, coping strategies, self-efficacy and depressive symptoms among the elderly residing in the community. Psicologia: Reflexão e Crítica, 21, 74–82.Google Scholar
Gazalle, F. K., Lima, M. S. De., Tavares, B. F. and Hallal, P. C. (2004). Depressive symptoms and associated factors in an elderly population in southern Brazil. Revista de Saúde Pública, 38, 365–371.CrossRefGoogle Scholar
Gershon, E. S. and Hamovit, J. H. (1987). Birth-cohort changes in manic and depressive disorders in relatives of bipolar and schizoaffective patients. Archives of General Psychiatry, 44, 314–319.CrossRefGoogle ScholarPubMed
Harris, A. H., Cronkite, R. and Moos, R. (2006). Physical activity, exercise coping and depression in a 10-year cohort study of depressed patients. Journal of Affective Disorders, 93, 79–85.CrossRefGoogle Scholar
Hasin, D. and Link, B. (1988). Age and recognition of depression: implications for a cohort effect in major depression. Psychological Medicine, 18, 683–688.CrossRefGoogle ScholarPubMed
Irigaray, T. Q. and Schneider, R. H. (2007). Characteristics of personality and depression in elderly women of the University for the Third Age. Revista de Psiquiatria do Rio Grande do Sul, 29, 19–27.CrossRefGoogle Scholar
Kalache, A., Veras, R. P. and Ramos, L. R. (1987). The ageing of the world's population: a new challenge. Revista de Saúde Pública, 21, 200–210. doi:10.1590/S003489101987000300005CrossRefGoogle ScholarPubMed
Katon, W. J. (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry, 54, 216–226.CrossRefGoogle ScholarPubMed
Kempen, G. M., Jelicic, M. and Ormel, J. (1997). Personality, chronic medical morbidity, and health-related quality of life among older persons. Health Psychology, 16, 539–546.CrossRefGoogle ScholarPubMed
Krishnan, K. R., Hays, J. C. and Blazer, D. G. (1997). MRI-defined vascular depression. American Journal of Psychiatry, 154, 497–501.Google ScholarPubMed
Lebrão, M. L. and Laurenti, R. (2005). Health, well-being and aging: the SABE Study in São Paulo, Brazil. Revista Brasileira de Epidemiologia, 8, 127–141.CrossRefGoogle Scholar
Leite, V. M. M., Carvalho, E. M. F. de, Barreto, K. M. L. and Falcão, I. V. (2006). Depression and aging: study comprising participants of the “Senior Citizens Open University”. Revista Brasileira de Saúde Materno Infantil, 6, 31–38.CrossRefGoogle Scholar
Maciel, A. C. C. and Guerra, R. O. (2006). Prevalence and associated factors of depressive simptomatology in elderly residents in the Northeast of Brazil. Brazilian Journal of Psychiatry, 55, 26–33.Google Scholar
Miranda, C. T., Mari, J. J., Ricciardi, A. and Arruda, M. E. (1990). Patients' reactions to the CIDI in Brazil. In Stefanis, C. N., Rabavillas, A. D. and Soldatos, C. R. (eds.), Psychiatry: A World in Perspective (pp. 133–137). Amsterdam: Elsevier.Google Scholar
Montgomery, S. A. and Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Nardi, E. F. R. and Andrade, O. G. (2005). Depressive states among old people in the community of Jandaia do Sul City, State of Paraná, Brazil. Arquivos de Ciências da Saúde/UNIPAR, 9, 109–116.Google Scholar
Newman, J. P. (1989). Aging and depression. Psychology and Aging, 4, 150–165.CrossRefGoogle Scholar
Oliveira, D. A. A. P., Gomes, L. and Oliveira, R. F. (2006). Prevalence of depression among the elderly population who frequent community centers. Revista de Saúde Pública, 40, 734–736. doi:10.1590/S0034-89102006000500026CrossRefGoogle ScholarPubMed
Paradela, E. M. P., Lourenço, R. A., and Veras, R. P. (2005). Validation of geriatric depression scale in a general outpatient clinic. Revista de Saúde Pública, 39, 918–923. doi:10.1590/S0034–89102005000600008CrossRefGoogle Scholar
Porcu, M., Fritzen, C. V., Cano, M. F. F., Bemvides, M. N. and Colombari, I. (2002). Depressive symptoms in seniors’ population in Maringá, state of Parana. Acta Scientiarum Maringá, 24, 703–705.Google Scholar
Roriz-Cruz, M. et al. (2007). Stroke-independent association between metabolic syndrome and functional dependence, depression, and low quality of life in elderly community-dwelling Brazilian people. Journal of the American Geriatrics Society, 55, 374–382.CrossRefGoogle ScholarPubMed
Shah, A., Herber, T. R., Lewis, S., Mahendran, R., Platt, J. and Bhattacharyya, B. (1997). Screening for depression among acutely ill geriatric inpatients with a short geriatric depression scale. Age and Ageing, 26, 217–221.CrossRefGoogle ScholarPubMed
Schedules for Clinical Assessment in Neuropsychiatry. (1992). Geneva, World Health Organization, Division of Mental Health.Google Scholar
Silberman, C. et al. (1995). Cognitive deficit and depressive symptoms in a community group of elderly people: a preliminary study. Revista de Saúde Pública, 29, 444–450.CrossRefGoogle Scholar
Silveira, D. X. and Jorge, M. R. (2000). Escala de rastreamento populacional para depressão CES-D em populações clínicas e não clínicas de adolescentes e adultos jovens. In Gorenstein, C., Andrade, L. H. S. G and Zuardi, A. W. (eds.), Escalas de avaliação clínica. em psiquiatria e psicofarmacologia (pp. 125–134). São Paulo: Lemos Editorial.Google Scholar
Siqueira, G. R. de et al. (2009). Analysis of depression in elderly living in the shelter “Christ the Redeemer”, applying the Scale of Geriatric Depression (SGD). Ciência e Saúde Coletiva, 14, 253–259.CrossRefGoogle ScholarPubMed
Smith, M. A. C. et al. (2005). Frequency of Werner helicase 1367 polymorphism and age-related morbidity in an elderly Brazilian population. Brazilian Journal of Medical and Biological Research, 38, 1053–1059.CrossRefGoogle Scholar
Steffens, D. C. et al. (2006). Perspectives on depression, mild cognitive impairment, and cognitive decline. Archives of General Psychiatry, 63, 130–138.CrossRefGoogle ScholarPubMed
Steffens, D. C., Fisher, G. G., Langa, K. M., Potter, G. C. and Plassman, B. L. (2009). Prevalence of depression among older Americans: the Aging, Demographics and Memory Study. International Psychogeriatrics, 21, 879–888.CrossRefGoogle ScholarPubMed
Tuesca-Molina, R. et al. (2003). Los grupos de socializacion como factor protector contra la depresion em personas ancianas. Baranquilla, Colômbia. Revista Española de Salud Pública, 77, 595–604.CrossRefGoogle Scholar
United Nations Organization (1985). The World Aging Situation: Strategies and Policies. Technical Report. New York: UN Department of International Economic and Social Affairs.Google Scholar
Veras, R. P. and Coutinho, E. S. F. (1991). Prevalence of depression and organic cerebral syndrome in the elderly population (Brazil). Revista de Saúde Pública, 25, 209–217.CrossRefGoogle ScholarPubMed
Wang, Y. P., Andrade, L. H. and Gorenstein, C. (2005). Validation of the Beck Depression Inventory for a Portuguese-speaking Chinese community in Brazil. Brazilian Journal of Medical and Biological Research, 38, 399–408.CrossRefGoogle ScholarPubMed
Weissman, M. M. and Klerman, G. L. (1977). Sex differences and the epidemiology of depression. Archives of General Psychiatry, 34, 99–111.CrossRefGoogle ScholarPubMed
World Health Organization (1992). Mental health and behavioral disorders. In International Classification of Diseases, 10th revision (pp. 311–387). Geneva: World Health Organization.Google Scholar
Xavier, F. M. F., Ferraz, M. P. T., Bertollucci, P., Poyares, D. and Moriguchi, E. H. (2001). The prevalence of major depression and its impact in the quality of life, sleep patterns and cognitive function in an octogenarian population. Revista Brasileira de Psiquiatria, 23, 62–70. doi:10.1590/S1516-44462001000200004.CrossRefGoogle Scholar
Yesavage, J. A. et al. (1983). Development and validation of a Geriatric Depression Screening Scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.CrossRefGoogle Scholar