Psychiatry - life events and social support Alexandrino-Silva C et al. Depression in late life is a severe problem for the elderly.8,9 The Bambu´ı Health Ageing Study, carried out in the southeast of Brazil, reported a 1-month prevalence of depressive episode of 15.4% in a representative community elderly sample,3 and Blay et al.2 found a 1-month prevalence of depression morbidity of 22.7% in a cross-sectional study of non-institutionalized people aged 60 years or more in the southern area of the country. Population-based studies suggest a substantial relationship between social factors and depression in late life.10 Research has begun to look at the potential effects of the social support system on an individual’s susceptibility to developing late onset depression.8 A meta-analysis con- ducted by Kraaij et al.11 investigated the relationship of negative life events and depression in old age. The authors observed that an accumulation of negative stressful events and daily hassles were associated to the presence of a modest, but significant effect size. Fiske et al.12 also suggested that both negative life events may predict depressive symptoms, and that depressive symptoms may predict negative life events in the future, in a circle that one condition interfere and contribute to sustained the other. Besides adverse life events, poor social support is a known risk factor for development of depression.10 Social support is a coping resource that is obtained from interpersonal relationships, whose protective effects are well documented in the literature regarding its role in maintaining health and decreasing vulnerability to physical and mental illnesses in older adults,13 as well as contributing to buffer the adverse psychological effects created by stress.14 Koizumi et al.15 found an increased risk of depression status in subjects who lack social support in the Japanese population. Both life events and social support have been described as predictors to long-term depressive outcome. Leskela¨ et al.16 verified that both adverse life events and poor perceived social support predicted the outcome of subjects with major depression. In this context, it is of interest to understand the role of certain social predictors in the mental health of Brazilian seniors. Castro-Costa examining a series of indicators of social support network as determinants of depressive symptoms in a sample of community-dwelling in a small city in Brazil, found no association of social support with depressive symptoms assessed through a rating scale with low specificity.17 Due to the scarcity of studies investi- gating the association of life events and social support in late depression in Brazilian population-based samples, the pre- sent study provides an opportunity to examine these associations. Thus, the aim of this study is to examine possible effects of life events and social support in depression presented in elderly subjects that were living in two middle- class boroughs in the city of Sa˜o Paulo, Brazil. For the purpose of this study, we only considered those individuals 60 years old or more and evaluated whether current social support and life events occurring in the 2 years prior to the interview were predictors of depression in older adults. METHODS Design The data are from the Sa˜o Paulo Catchment Area Study, a cross-sectional study carried out in two boroughs in the city of Sa˜o Paulo, Brazil, that investigated the prevalence (lifetime, 12-month, 1-month) of mental disorders, their relationship with sociodemographic features, and the use of 234 CLINICS 2011;66(2):233-238 services in the population aged 18 years or older living in the catchment area of a large hospital complex in the city of Sa˜o Paulo, Brazil. A representative sample of 1,464 subjects, 18 years old or more were interviewed in households, with a response rate of 76.8%. An over-sampling of individuals 60 years old or more was performed in order to increase the probability of getting old age psychopathology (we inter- viewed all the residents within the stratum 60 years old or more living in the household selected). Although for most of the analyses performed in this sample weights were used to adjust for the differential effects of oversampling and no response,18 in the present report those weights were not used. This is due to the design chose for the analyses presented herein, a nested case-control study, for the asses- sment of factors associated with the presence of depressive symptomatology in old age. Diagnostic Assessment The Composite International Diagnostic Interview version 1.1 (CIDI 1.1), translated to Portuguese, was used to assess psychopathology. The CIDI is a structured psychiatric interview that provided lifetime, 12-month, and 1-month prevalence estimates for diagnoses according to the DSM- III-R and the ICD-10. Several questions targeting different symptoms were asked during the interview for depressive mood or anhedonia, and each of the nine depressive symptom groups in the diagnostic criteria of DSM-III-R major depression were asked, as follows: appetite problems, sleep problems, tiredness, slowness/restlessness, lost inter- est, worthlessness, trouble thinking, and thoughts of death. The diagnoses of depressive episode and dysthymia were generated from the algorithm based on ICD-10 criteria. Three groups were created, taking into account depres- sive symptomatology in old age. It is important to note that those who had a prior diagnosis of a depressive episode or dysthymia according to ICD-10, but whose symptoms were not presented within the age period considered, were excluded from the analysis of predictors, since our aim was to investigate the association of certain determinants with old age depression. Three groups were identified: 1. The ‘‘late depression’’ group was formed by subjects 60 years or older, presenting with an ICD-10 depressive episode or dysthymia, with onset after 60 years or recency in this period of life and with at least four depressive symptoms. 2. The ‘‘late subthreshold depression’’ group was com- posed of subjects who said yes to the statement ‘‘have had a period of feeling (depressed/having lost interest/ own equivalent) and also said ‘‘you’ve had some other problems like (list of symptom groups)’’, and for at least a period of 2 weeks or more, occurring after the age of 60 years or recency in this period of life. At least two, but less than four depressive symptoms should be present. We defined ‘‘late subthreshold depression’’ based on the ICD-10 criteria for ‘‘mild depressive episode’’, in which two or three depressive symptoms are usually present. For the group called "late depression’’, we used the concept of the ICD-10 for moderate and severe depressive episode. 3. The control group represented people aged 60 or more, with no lifetime depressive episode or dysthymia, and no lifetime subthreshold depression.