title: The role of spousal loss in the development of depressive symptoms in the elderly - implications for diagnostic systems.
abstract: BACKGROUND
  In the revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the Mood Disorder Workgroup for DSM-V the bereavement exclusion criterion for the diagnosis of major depression has been eliminated.
  
  
  OBJECTIVE
  To investigate the impact of bereavement on the incidence of depression and depressive symptoms in the elderly.
  
  
  METHODS
  Participants over 75 years from the longitudinal German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) that were still married at baseline were investigated (n=1,193). Data from four follow-ups (time frame: 6 years) were investigated. The response rate at baseline was 50.3%. Three clinical endpoints were analyzed: depressive symptoms according to Geriatric Depression Scale (1) GDS≥6, (2) GDS≥10, and (3) Major Depression (MD). The effect of loss was investigated using random-effects regression models.
  
  
  RESULTS
  Experiencing a loss of spouse was predictive of a higher incidence in GDS≥6 (OR 4.52, 95% CI 2.6-7.9) and 10 (OR 5.59, 95% CI 1.8-17.0) even after adjusting for age, gender, impairment at baseline, and GDS score at baseline. Associations with MD were not significant (OR 1.77, 96% CI 0.9-3.5).
  
  
  CONCLUSIONS
  Older adults experiencing the loss of their spouse are more likely to display elevated levels of depressive symptoms, that may reach a concerning level of severity.
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany. Electronic address: Claudia.Sikorski@medizin.uni-leipzig.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Sikorski
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Luppa
authors.affiliation: Department of Psychiatry, University of Bonn, Bonn, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Heser
authors.affiliation: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Ernst
authors.affiliation: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Lange
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Werle
authors.affiliation: Department of Psychiatry, Technical University of Munich, Munich, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.affiliation: Department of Psychiatry, Technical University of Munich, Munich, Germany.
authors.forename: Edelgard
authors.initials: E
authors.lastname: Mösch
authors.affiliation: Institute for Biometrics, Hannover Medical School, Hannover, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Institute for Biometrics, Hannover Medical School, Hannover, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Prokein
authors.affiliation: Institute of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: Institute of General Practice, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Pentzek
authors.affiliation: Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.affiliation: Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.affiliation: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Department of Psychiatry, University of Bonn, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001601:Bereavement; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D018454:Spouses
keywords: Depression; Depressive symptoms; Eldery; Grief; Loss; Primary care