Journal of Affective Disorders 58 (2000) 125–133 www.elsevier.com / locate / jad Research report Who becomes depressed? The Islington community study of older people * Gill Livingston MRCPsych, M.D. (Senior Lecturer in Psychiatry) , Vivienne Watkin BSc, MRCPsych (Senior Registrar in Psychiatry), Brian Milne RMN (Research Nurse), MonicaV. Manela M.D. (Research Doctor), Cornelius Katona FRCPsych, M.D. (Professor of Psychiatry of the Elderly) Department of Psychiatry and Behavioural Sciences, University College London Medical School, Wolfson Building, Middlesex Site, London W1N 8AA, UK Received 14 December 1998; accepted 27 April 1999 Abstract Background: Depression in older people is common and debilitating and associated with physical ill health. This is the first study of risk factors for depression in a representative sample of older people selected for high vulnerability because of physical ill health. Method: Subjects identified in an epidemiological community survey of morbidity in people $ 65 years old, who had activity limitation (ADL) but no psychiatric morbidity were reinterviewed after 3 years. Results: 79 (90%) of subjects were interviewed. Ten percent developed pervasive depression and 24% screened positive for depression. This latter group were more likely to consult doctors than others with similar levels of disability ( P , 0.005) mainly because of an acute physical illness. Frequent pain was associated with the development of depression ( P , 0.02). Conclusion: Older people who are ADL limited are known to be at high risk for depression. For the majority who do not become depressed, chronicity of illness does not lead to depression. Those who become depressed are most likely to be those with an acute illness and those who are in pain. They will usually increase their consultation rate with doctors but will not complain of depression. They may be undertreated for both pain and depression. Further studies are needed to confirm other risk factors.  2000 Elsevier Science B.V. All rights reserved. Keywords: Depression; Community study; Older people; Risk 1. Introduction dition in older people, which is associated with individual suffering, psychological distress in carers, Depression is a common and debilitating con- increased use of health services and risk of suicide (Cattell and Jolley, 1995; Livingston et al., 1996, 1997). Despite this, there is a lack of information about which older people are at particular risk of *Corresponding author. Tel.: 144-171-504-9460; fax 144- 171-323-1459. becoming depressed. 0165-0327 / 00 / $ – see front matter  2000 Elsevier Science B.V. All rights reserved. PII: S0165-0327(99)00103-2