Psychiatry - life events and social support Alexandrino-Silva C et al. relationship with another person than women,33 the death of their wife can place a man in a situation in which he must cope with the loss of, perhaps, his only confidante. Furthermore, friends in a similar age group tend to be married, or have entered into a new marriage, and this can increase the sense of loneliness and the perceived lack of social support.35 Finally, among elderly couples, the wife often assumes the role of caregiver in the home, and her death can force the husband to assume a new role of housekeeper, posing a significant source of stress.35 George et al.36 found that impaired social support is frequently associated with poorer outcome of depression in older men, but not in older women. In conclusion, our findings contribute to the literature by studying a subtype of depression occurring in later life. Moreover, the gender differences found here in relation to life events and social support can contribute to a better understanding of the functioning of elderly people facing difficult, but common, situations in their lives. This is expected to help health professionals provide guidance to families to build a network of support capable of reducing the risk of depression in their elderly family members. REFERENCES 1. Kohn R, Levav I, de Almeida JM, Vicente B, Andrade L, Caraveo- Anduaga JJ, et al. Mental disorders in Latin America and the Caribbean: a public health priority. Rev Panam Salud Publica. 2005;18:229-40. 2. Blay SL, Andreoli SB, Fillenbaum GG, Gastal FL. Depression morbidity in later life: prevalence and correlates in a developing country. Am J Geriatr Psychiatry. 2007;15:790-9, doi: 10.1097/JGP.0b013e3180654179. 3. Costa E, Barreto SM, Uchoa E, Firmo JO, Lima-Costa MF, Prince M. Prevalence of International Classification of Diseases, 10th Revision common mental disorders in the elderly in a Brazilian community: The Bambui Health Ageing Study. Am J Geriatr Psychiatry. 2007;15:17-27, doi: 10.1097/01.JGP.0000230659.72417.a0. 4. Barcelos-Ferreira R, Izbicki R, Steffens DC, Bottino CM. Depressive morbidity and gender in community-dwelling Brazilian elderly: sys- tematic review and meta-analysis. Int Psychogeriatr. 2010;18:1-15. 5. Palloni A, Pinto-Aguirre G, Pelaez M. Demographic and health con- ditions of ageing in Latin America and the Caribbean. Int J Epidemiol. 2002;31:762-71, doi: 10.1093/ije/31.4.762. 6. Wong R, Pela´ez M, Palloni A, Markides K. Survey data for the study of aging in Latin America and the Caribbean: selected studies. J Aging Health. 2006;18:157-79, doi: 10.1177/0898264305285655. 7. IBGE Censo Demogra´fico. (2000). Fundac¸ a˜o Instituto Brasileiro de Geografia e Estat´ıstica. Available at: http://www.ibge.gov.br/home/ estatistica/populacao/perfilidoso/tabela1_2.shtm 8. Blazer DG 2ndHybels CF. Origins of depression in later life. Psychol Med. 2005;35:1241-52, doi: 10.1017/S0033291705004411. 9. Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand. 2006;113:372-87, doi: 10.1111/j. 1600-0447.2006.00770.x. 10. Prince MJ, Harwood RH, Blizard RA, Thomas A, Mann AH. Social support deficits, loneliness and life events as risk factors for depression in old age. The Gospel Oak Project VI. Psychol Med. 1997;27:323-32, doi: 10.1017/S0033291796004485. 11. Kraaij V, Arensman E, Spinhoven P. Negative life events and depression in elderly persons: a meta-analysis. J Gerontol B Psychol Sci Soc Sci. 2002;57:P87-94. 12. Fiske A, Gatz M, Pedersen NL. Depressive symptoms and aging: the effects of illness and non-health-related events. J Gerontol B Psychol Sci Soc Sci. 2003;58:P320-8. 13. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:e1000316, doi: 10.1371/ journal.pmed.1000316. 14. Seematter-Bagnoud L, Karmaniola A, Santos-Eggimann B. Adverse life events among community-dwelling persons aged 65-70 years: gender differences in occurrence and perceived psychological consequences. Soc Psychiatry Psychiatr Epidemiol. 2010;45:9-16, doi: 10.1007/s00127-009- 0035-3. 238 CLINICS 2011;66(2):233-238 15. Koizumi Y, Awata S, Kuriyama S, Ohmori K, Hozawa A, Seki T, et al. Association between social support and depression status in the elderly: results of a 1-year community-based prospective cohort study in Japan. Psychiatry Clin Neurosci. 2005;59:563-9, doi: 10.1111/j.1440-1819.2005. 01415.x. 16. Leskela¨ U, Rytsa¨la¨ H, Komulainen E, Melartin T, Sokero P, Lestela¨- Mielonen P, et al. The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms. Psychol Med. 2006;36:779-88, doi: 10.1017/S0033291706007276. 17. Castro-Costa E, Lima-Costa MF, Carvalhais S, Firmo JO, Uchoa E. Factors associated with depressive symptoms measured by the 12-item General Health Questionnaire in community-dwelling older adults (The Bambu´ı Health Aging Study). Rev Bras Psiquiatr. 2008;30:104-9. 18. Andrade L, Walters EE, Gentil V, Laurenti R. Prevalence of ICD-10 mental disorders in a catchment area in the city of Sa˜o Paulo, Brazil. Soc Psychiatry Psychiatr Epidemiol. 2002;37:316-25, doi: 10.1007/s00127-002- 0551-x. 19. VanItallie TB. Subsyndromal depression in the elderly: underdiagnosed and undertreated. Metabolism. 2005;54(5 Suppl 1):39-44, doi: 10.1016/j. metabol.2005.01.012. 20. Judd LL, Paulus MP, Wells KB, Rapaport MH. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psychiatry. 1996;153:1411-7. 21. Fraguas R Jr, Henriques SG Jr, De Lucia MS, Iosifescu DV, Schwartz FH, Menezes PR, et al. The detection of depression in medical setting: a study with PRIME-MD. J Affect Disord. 2006;91:11-7, doi: 10.1016/j.jad.2005.12. 003. 22. Gurland B, Golden RR, Teresi JA, Challop J. The SHORT-CARE: an efficient instrument for the assessment of depression, dementia and disability. J Gerontol. 1984;39:166-9. 23. ABS. (2006). Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia. ABS cat. no. 2033.0.55.001. Canberra: ABS. 24. Folstein MF, Folstein SE, McHugh PR. ‘‘Mini-mental state’’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-98, doi: 10.1016/0022-3956(75)90026-6. 25. Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962;27:645-58. 26. Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ. Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self- reports and on determinants of inaccuracy. J Clin Epidemiol. 1996;49:1407-17, doi: 10.1016/S0895-4356(96)00274-0. 27. Noble RE. Depression in women. Metabolism. 2005;54(5 Suppl 1):49-52, doi: 10.1016/j.metabol.2005.01.014. 28. Beekman AT, de Beurs E, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W. Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am J Psychiatry. 2000;157:89-95. 29. Byers AL, Yaffe K, Covinsky KE, Friedman MB, Bruce ML. High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication. Arch Gen Psychiatry. 2010;67:489-96, doi: 10.1001/archgenpsychiatry.2010.35. 30. Panza F, Frisardi V, Capurso C, D’Introno A, Colacicco AM, Imbimbo BP, et al. Late-life depression, mild cognitive impairment, and dementia: possible continuum? Am J Geriatr Psychiatry. 2010;18:98-116, doi: 10. 1097/JGP.0b013e3181b0fa13. 31. van Gelder BM, Tijhuis M, Kalmijn S, Giampaoli S, Nissinen A, Kromhout D. Marital status and living situation during a 5-year period are associated with a subsequent 10-year cognitive decline in older men: the FINE Study. J Gerontol B Psychol Sci Soc Sci. 2006;61:P213-9. 32. Phillipson C. Social relationships in later life: a review of the research literature. Int J Geriatr Psychiatry. 1997;12:505-12, doi: 10.1002/ (SICI)1099-1166(199705)12:5,505::AID-GPS577.3.0.CO;2-Q. 33. Umberson D, Wortman CB, Kessler RC. Widowhood and depression: explaining long-term gender differences in vulnerability. J Health Soc Behav. 1992;33:10-24, doi: 10.2307/2136854. 34. IBGE Censo Demogra´fico. (2008). Fundac¸ a˜o Instituto Brasileiro de Geografia e Estat´ıstica. Available at: http://www.ibge.gov.br/home/ estatistica/indicadores/trabalhoerendimento/pme_mulher/Suplemento_ Mulher_2008.pdf 35. van Grootheest DS, Beekman AT, Broese van Groenou MI, Deeg DJ. Sex differences in depression after widowhood. Do men suffer more? Soc Psychiatry Psychiatr Epidemiol. 1999;34:391-8, doi: 10.1007/ s001270050160. 36. George LK, Blazer DG, Hughes DC, Fowler N. Social support and the outcome of major depression. Br J Psychiatry. 1989;154:478-85, doi: 10. 1192/bjp.154.4.478.