In a comparison between elderly depressed subjects and normal elderly people in the general population, an association was found between severe life events, major social difficulties, poor physical health and the onset of depression. Working class subjects within the general population had a higher incidence of depression and this appeared to be explained by their poorer health and greater social difficulties. Those elderly people who lacked a confiding relationship were more vulnerable to depression. Evidence is presented that the lack of a confidant was a reflection of life-long personality traits.
The paper describes a one year prospective study of 124 elderly depressed patients. Only one third of the group had a good outcome. Poor outcome was associated with severity of initial illness, those with depressive delusions having a particularly poor outcome. Outcome was also influenced by physical health problems and severe life events in the follow-up year. Social class differences in outcome were thought to be due to class differences in the experience of severe life events. There was no evidence that an intimate relationship protected against relapse in the face of continuing life stress.
Physical illness at referral and subsequent mortality were studied in a group of elderly patients with depression, and compared with age/sex-matched controls. The depressed group was significantly less well at first interview, and had a significantly higher 4-year mortality. When the effect of physical illness was controlled, the depressed patients (particularly the men) still had a significantly higher 4-year mortality, suggesting that the greater mortality in the depressed group was not due to differences in physical health alone.
CORRESPONDENCE male pharmacists clearly suggests that these must be significant factors. On the other hand, if being a doctor or a doctor's wife carries with it a special kind of distress loading, clearly the physician is not unique in this either. Being an unskilled worker may be a worse predicament. By the same token, there appear to be some professions (e.g., the clergy, politicians) that are spared excessive risks of suicide. If we are to understand why doctors and their wives are at higher risk for suicide, we might benefit from undertaking in depth comparisons of their demographics, lifestyles and value systems with those of other occupational groups.
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