Kivela et al identified risk factors associated with chronicity of depression in community-dwelling elderly patients. These can help identify patients who may require more aggressive therapy and follow-up to control the depression. The authors are from the University of Oulu in Finland.


Outcomes: Initially depressed patients were separated into 2 groups:

(1) chronically depressed (still depressed during follow-up visits)

(2) recovered (not depressed in follow-up visits)


Risk factors:

(1) diurnal variation in symptoms

(2) poor self-appreciation

(3) drinking beer

(4) severe disease during follow-up

(5) death of a family member during follow-up

(6) marital problems during follow-up

(7) taking care of a disabled spouse during follow-up

(8) worsening of health status during follow-up


Odds Ratio

95% CI

diurnal variation of symptoms


1.10 – 13.5

poor self-appreciation


1.08 – 19.3

drinking beer


1.49 – 91.1

severe disease during follow-up


1.46 – 19.3

death of a family member during follow-up


0.99 – 10.2

marital problems during follow-up


1.30 – 118

taking care of disabled spouse


1.16 – 200

worse health status during follow-up


1.07 – 19.8

from Table 2, page 190



• Beer drinking was found to be a risk factor for chronicity, but drinking wine or spirits was not. I wonder if this may have been related to the population selected (a third did not finish required schooling and the previous occupation was "agriculture or other independent" for half).

• In the implementation I replaced drinking beer with being an alcoholic. This may be a stretch, since the volume of beer drunk per day was not given.

• Severe disease or worsening health status seem to be fairly similar concepts.

• Only 6% of the patients were in a nursing home, while 11% needed assistance to use stairs.


Additional risk factors referred to from previous studies:

(1) severe depressive symptoms

(2) history of previous depressive episodes (? history of chronic depression)

(3) long duration prior to treatment (? history of chronic depression)


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