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Am Fam Physician. 2000;61(6):1852

It is increasingly important for physicians to recognize and understand the unique characteristics of depression in the elderly. Physiologic changes that normally affect this group can alter the presentation and course of major depression. Bereavement-related depression is also common in the elderly; therefore, an understanding of this type of depression is an important part of patient management. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), complicated bereavement is a grief response that lasts for more than two months after the loss or that impairs functioning in a number of areas. Turvey and colleagues studied the impact of conjugal loss in persons at least 70 years of age.

Participants in a longitudinal study cohort who were not institutionalized were eligible for the study. Spouses of those selected for the study also participated, regardless of age. The study was conducted in two 12-month phases. Demographic data were collected at baseline. Syndromal depression and depressive symptoms were assessed after the second phase using standardized instruments. Participants were divided into five groups based on their marital status. Persons considered newly bereaved were those who had lost a partner during the time between the two phases of the study. The long-term widowed were those who had lost their partner before the first phase of the study. The remaining three study groups consisted of the still-married, the divorced and the never-married.

Data were collected on 5,449 persons, with 223 considered newly bereaved. These persons had a higher rate of syndromal depression and depressive symptoms compared with any of the other study groups. About one third of the newly bereaved reported depressive symptoms one month after the partner's death. After two to three months, 12 percent still reported symptoms. This percentage remained relatively constant for up to 24 months. Even after two years, 12.2 percent of the newly bereaved reported depressive symptoms, compared with only 4 percent of their married counterparts. Of interest, depression rates did not differ between men and women.

The authors conclude that there is a strong association between depression and bereavement in elderly men and women. Newly bereaved persons were nine times more likely to be depressed than their married counterparts, and a significant proportion remained depressed up to two years after the loss. Given these results, bereavement must be recognized as a significant risk factor for depression in the elderly for which appropriate intervention is needed.

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