The British Journal of Psychiatry (2009) 195: 510-515. doi: 10.1192/bjp.bp.109.064055
© 2009 The Royal College of Psychiatrists
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Late-life depression in Peru, Mexico and Venezuela: the 10/66 population-based study

Mariella Guerra, MD

Universidad Peruana Cayetano Heredia, Institute de la Memoria y Desordenes Relacionadas, Lima, Peru and Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, UK

Cleusa P. Ferri, PhD

Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, UK

Ana Luisa Sosa, MD

The Cognition and Behavior Unit, National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Mexico City, Mexico

Aquiles Salas, MD

Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela

Ciro Gaona, MD

Clínica Loira, Caracas, Venezuela

Victor Gonzales, MD

Institute de la Memoria y Desordenes Relacionadas, Lima, Peru

Gabriela Rojas de la Torre, BSc

Cognition and Behavior Unit, National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Mexico City, Mexico

Martin Prince, MD

Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, UK

Correspondence: Correspondence: Mariella Guerra, Alzheimer’s Association, Avda. Araquipa 3845, Miraflores, Lima 18, Peru. Email: mariella.guerra{at}kcl.ac.uk

Declaration of interest

The 10/66 Dementia Research Group works closely with Alzheimer’s Disease International, the non-profit federation of 77 Alzheimer associations around the world. Alzheimer’s Disease International is supported in part by grants from GlaxoSmithKline, Novartis, Lundbeck, Pfizer and Eisai.

Background

The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide.

Aims

To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America.

Method

A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM–IV and ICD–10 criteria, Geriatric Mental State–Automated Geriatric Examination for Computer Assisted Taxonomy (GMS–AGECAT) algorithm and EURO–D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD–10 depression.

Results

For DSM–IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD–10 depressive episode between 4.5% and 5.1%, for GMS–AGECAT depression between 30.0% and 35.9% and for EURO–D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD–10 and DSM–IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD–10 depressive episode.

Conclusions

The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector.


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