Journal of Affective Disorders 65 (2001) 131–138 www.elsevier.com / locate / jad Research report Emergence and persistence of late life depression: a 3-year follow-up of the Longitudinal Aging Study Amsterdam * A.T.F. Beekman , D.J.H. Deeg, S.W. Geerlings, R.A. Schoevers, J.H. Smit, W. van Tilburg Department of Psychiatry of the Vrije Universiteit Amsterdam, Valerius Clinic, Valeriusplein 9, 1075 BG Amsterdam, The Netherlands Received 27 July 1999; received in revised form 10 May 2000; accepted 23 May 2000 Abstract Background: The present study was designed to assess onset and persistence of late-life depression, systematically comparing the factors associated with prevalence, onset and prognosis. Methods: The data were derived from a large ( n 5 2200), random, age and sex stratified sample of the elderly (55–85 years) in The Netherlands. Using a 3-year, prospective longitudinal design, both the onset and the persistence of depression were assessed. Depression was measured using the Center for Epidemiologic Studies Depression Scale. Risk factors associated with prevalence, onset and persistence were compared using both bivariate and multivariate analyses. Results: In those not depressed at index assessment, the onset of depression was 9.7%. Among those depressed at baseline, persistence occurred in 50.4%. Risk factors predicting onset were almost identical to those associated with prevalence. Persistence was predicted by very few factors (external locus of control and chronic physical illness). Conclusions: The data suggest that cross-sectional studies are biased due to their overrepresenting chronic depressive episodes. However, the risk factors derived from cross-sectional studies do seem to adequately reflect factors associated with onset. The prognosis is not adequately predicted by variables usually included in epidemiological studies of late life depression. It is speculated that including more biological correlates of depression and data concerning positive life-changes may improve our understanding of the prognosis of late life depression.  2001 Elsevier Science B.V. All rights reserved. Keywords: Late life depression; Longitudinal Aging Study Amsterdam; Onset; Prevalence; Persistence; Risk factors 1. Introduction Blazer, 1994; Burvill and Hall, 1994; Beekman et al., 1995a, 1997a). Nevertheless, little is known about There is accumulating evidence confirming the the natural history of late life depression and about clinical and public health significance of late life the factors determining both onset and prognosis. depression (Copeland et al., 1992; Gurland, 1992; Studies of risk factors associated with onset are of importance to disentangle the aetiology and patho- genesis of late life depression, and to identify high *Corresponding author. Tel.: 1 31-20-5736-666 / 4446-770; fax: 1 31-20-4446-775. risk groups or key processes that may be targeted for 0165-0327 / 01 / $ – see front matter  2001 Elsevier Science B.V. All rights reserved. PII: S0165-0327(00)00243-3