ReviewChronic diseases and risk for depression in old age: A meta-analysis of published literature
Introduction
The prevalence of clinical depression and presence of elevated depressive symptoms are higher among persons with some chronic diseases, such as diabetes, stroke, cardiac disease, chronic lung disease, and hypertension and so on, compared with the general population (Talbot and Nouwen, 2000, Anderson et al., 2001, Hackett and Anderson, 2005, Nicholson et al., 2006, Scalco et al., 2005, Norwood, 2007). These associations may be related to increased risk of depressive symptoms in individuals with these chronic diseases, increased risk of these chronic diseases in individuals with depressive symptoms, or both. Several factors associated with depressive symptoms, including obesity-promoting health, behaviors (e.g., physical inactivity, hypercaloric diets) and activation of the neuroendocrine and inflammatory responses (resulting in increased cortisol, catecholamines, and cytokines), can induce the development of these chronic diseases (Carnethon et al., 2007, Golden, 2007, Winokur et al., 1988, Lake et al., 1982, Roy et al., 1988, Maes et al., 1990, Kiecolt-Glaser and Glaser, 2002, Ford and Erlinger, 2004).
Depression is a major contributor to healthcare costs associated with older populations, and is projected to be the leading cause of disease burden in older populations by the year 2020 (Goodwin, 2003, Katon et al., 2003). The prevalence of depression in patients aged 65 and older may be as high as 40% in hospitalized and 30% in nursing home patients, and 8–15% in community settings (Leon et al., 2003, Birrer and Vemuri, 2004). The prognosis of these depressive states is poor. A meta-analysis of outcomes at 24 months estimates that only 33% of subjects are well, 33% are depressed, and 21% have died (Cole et al., 1999). Moreover, studies of depressed adults indicate that those with depressive symptoms, with or without depressive disorder, have poorer functioning, comparable to or worse than that of people with chronic medical conditions such as heart and lung disease, arthritis, hypertension, and diabetes (Gurland et al., 1988, von Korff et al., 1992, Wells and Burman, 1991). In addition to poor functioning, depression can induce the development of these chronic diseases and increase the perception of poor health, the utilization of medical services, and health care costs (Wells and Burman, 1991, Katon et al., 1992, Unutzer et al., 1997).
A diagnosis of some chronic diseases may also lead to symptoms of depression (Talbot and Nouwen, 2000), which has been shown in many longitudinal and cross-sectional studies (Al-Shammari and Al-Subaie, 1999, Blay et al., 2007, Carvakhais et al., 2008, Chen et al., 2005, Giltay et al., 2006, Harris et al., 2006, Kennedy et al., 1990). However, converse conclusion has been also conducted by some studies (de Beurs et al., 2001, Friedman et al., 2007, McDougall et al., 2007). Moreover, a recent systematic review and meta-analysis showed that odds ratio (OR) of poor health status as a function of increased depression in the elderly was un-significant (OR = 1.8, 95% confidence intervals (95% CI) = 0.5–12.8) (Cole and Dendukuri, 2003). This systematic review did not assess the association between chronic diseases and risk of depression in the elderly. Therefore, it has still been unknown whether chronic diseases are risk factors for depression in the old age or not.
Depression is a critically important issue for the old age and those working with the old age. The population of the old and the oldest-old person increases, the number of depression the old individuals can be expected to rise (Harpole et al., 2005, Koenig et al., 1988). In old age, both depression and chronic diseases have high prevalence and depression and chronic diseases may induce the development each other. Therefore, it is important to investigate the relationship between chronic diseases and risk for depression in old age. So we decided to conduct a meta-analysis in order to measure the magnitude and shape of the association between chronic diseases and risk for depression in old age. In this meta-analysis, depression included depressive symptoms, minor and major depression.
Section snippets
Search method
This was one part of a best-evidence research on depression in older people. In the research, we collected literature through searching MEDLINE (from the beginning of 1966), EMBASE (from the beginning of 1980) and The Cochrane Library (1990 to August 2007). The search terms (provided by Cochrane Center) included depression, older and clinical trials. Four researchers selected literature which involved clinical trials, depression (diagnostic criteria in formal depression scale) and old patients
The search
Our search found 1027 potential etiology or epidemiology related literature. 901 of the 1027 articles were rejected as obviously unsuitable (unrelated with chronic diseases) and 126 remained. 94 of these 126 articles were rejected for a variety of reasons, including (a) no usable data; (b) no recognized instrument used for diagnosis. 32 studies were remained. Since the subjects in these studies except one were aged 60 years or more (Sonnenberg et al., 2000, Steunenberg et al., 2006), we
Discussion
We conducted the meta-analysis of cross-sectional studies and that of prospective longitudinal studies respectively. The results were clear: some chronic diseases were risk factors for depression in old age such as stroke, poor hearing, poor vision, cardiac disease and chronic lung disease; there were associations of depression in old age with arthritis, hypertension, diabetes, urologic problems and kidney, but it had still unknown whether these disease were risk factors for depression in old
Conflicts of interest
None.
Acknowledgements
This work was supported by Discipline Construction Foundation of Sichuan University. Mr. Rebbo is also acknowledged for their language assistance.
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