Research reportDispositional optimism and the risk of depressive symptoms during 15 years of follow-up: The Zutphen Elderly Study
Introduction
Major depression is among the most important mental health problems and affects 1% to 3% of elderly people, whereas 8% to 25% have minor depression (Beekman et al., 1999, Cole and Dendukuri, 2003, Hybels et al., 2001, Reynolds and Kupfer, 1999). Depressive symptoms are associated with future impairments in mobility and functioning (Bula et al., 2001, Penninx et al., 1999) and with higher medical costs (Unutzer et al., 1997). Moreover, elderly men have the highest suicide rate, which is importantly the result of depression (Reynolds and Kupfer, 1999, Waern et al., 2003). Therefore, it is important to establish potentially malleable risk factors of depression in older adults.
Dispositional optimism, defined in terms of generalized positive outcome expectancies, life engagement, and a future orientation, has been associated with a low level of depressive symptoms (Scheier and Carver, 1985, Scheier et al., 1994). However, many studies showing this inverse relationship in elderly subjects had a cross-sectional design and can therefore not disentangle the temporal relationship between optimism and depression. Yet, several prospective studies did link dispositional optimism to lower future depressive symptoms, but these studies were done in young or middle-aged subjects or in patients (Bromberger and Matthews, 1996, Carver and Gaines, 1987, Cohen et al., 2001, Epping-Jordan et al., 1999, Fontaine and Jones, 1997, Schou et al., 2004, Shnek et al., 2001, Vickers and Vogeltanz, 2000) and it is therefore unclear whether optimism also protects against future depression in community-dwelling elderly men. One study included a small number of 24 elderly men, but did no separate analyses stratified for sex (Isaacowitz and Seligman, 2002). The time interval of follow-up in previous studies ranged from several weeks up to 12 months, and 3 years in one study among women (Bromberger and Matthews, 1996), and therefore the predictive power of dispositional optimism over even longer periods of time is unknown.
We aimed to study the association between baseline dispositional optimism and cumulative depressive symptoms. We studied community-living elderly men since depression is an important mental health problem in the elderly, and the effects of dispositional optimism on depressive symptoms have received only limited attention in men. Since prior depressive symptoms are a risk for subsequent depression (Roberts et al., 1997, Schoevers et al., 2000), and dispositional optimism may be a marker for the lack of depressive symptoms, we repeated our analyses using only new cases with depressive symptoms.
Section snippets
Study sample
The Zutphen Elderly study is an extension of the Zutphen Study that was initiated in 1960, and 367 of 555 men who were still alive in 1985 were re-examined. In addition, a random sample of 711 men of the same age also living in Zutphen but not belonging to the original cohort was invited to participate, which resulted in a total target sample of 1266 men aged 64 to 84 years, of whom 887 (response rate 70%) participated in the study in 1985. Of these men, 560 surviving men were re-examined
Results
The cumulative incidence of depressive symptoms (Zung SDS ≥ 50) at 3 time points in this sample of elderly men aged mean 70.8 (SD 4.6) was 44% (n = 202 of 464), and for more severe depressive symptoms (Zung SDS ≥ 60) was 15% (n = 70 of 464). During follow-up, the scores of dispositional optimism strongly declined over 15 years follow-up, whereas the Zung SDS and depressive symptoms increased over 10 years follow-up in men with complete data (Table 1). The cross-sectional Spearman correlation
Discussion
This cohort study sought to identify whether dispositional optimism influences the risk of subsequent depressive symptoms in community-living elderly men. Dispositional optimism significantly predicted a reduced incidence of depressive symptoms over up to 15 years. Excluding men who had depressive symptoms did not importantly affect the protective relationship, indicating that optimism was not related to subsequent depressive symptoms just because it reflected a higher mood.
Our results are
Acknowledgment
The Zutphen Elderly Study was supported by the Netherlands Prevention Foundation (Praeventiefonds).
References (49)
The benefits of optimism: a meta-analytic review of the life orientation test
Pers. Individ. Differ.
(1996)- et al.
The health benefits of writing about intensely positive experiences
J. Res. Pers.
(2004) - et al.
Management of general medical patients with symptoms of depression
Gen. Hosp. Psych.
(1989) - et al.
Risk factors for depression in later life; results of a prospective community based study (AMSTEL)
J. Affect. Disord.
(2000) - et al.
Dispositional optimism as a predictor of depressive symptoms over time
Pers. Individ. Differ.
(2000) - et al.
Hopelessness depression: a theory-based subtype of depression
Psychol. Rev.
(1989) - et al.
Optimism and depression as predictors of physical and mental health functioning: the Normative Aging Study
Ann. Behav. Med.
(2000) - et al.
Comparison of six depression rating scales in geriatric stroke patients
Stroke
(1989) - et al.
The specificity of attributional style and expectations to positive and negative affectivity, depression, and anxiety
Cogn. Ther. Res.
(1993) Cognitive models of depression
J. Cogn. Psychother.
(1987)
Review of community prevalence of depression in later life
Br. J. Psychiatry
The role of optimism in social network development, coping, and psychological adjustment during a life transition
J. Pers. Soc. Psychol.
A longitudinal study of the effects of pessimism, trait anxiety, and life stress on depressive symptoms in middle-aged women
Psychol. Aging
Dimensions of dysfunctional attitudes as vulnerabilities to depressive symptoms
J. Abnorm. Psychol.
Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients
Arch. Intern. Med.
Optimism, pessimism, and postpartum depression
Cogn. Ther. Res.
The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen Study, 1985
Am. J. Epidemiol.
The association between treatment-specific optimism and depressive symptomatology in patients enrolled in a Phase I cancer clinical trial
Cancer
Risk factors for depression among elderly community subjects: a systematic review and meta-analysis
Am. J. Psychiatry
De zelfbeoordelingsschaal voor depressie van Zung (The self-rating scale for depression by Zung)
Positive psychology in clinical practice
Ann. Rev. Clin. Psychol.
Psychological adjustment in breast cancer: processes of emotional distress
Health Psychol.
Self-esteem, optimism, and postpartum depression
J. Clin. Psychol.
Optimism, social support, and premenstrual dysphoria
J. Clin. Psychol.
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