CLINICS 2011;66(2):233-238 We graded the ‘‘late depression’’ and ‘‘late subthreshold depression’’ groups into a broader group of ‘‘old age symptomatic depression’’, thus considered the ‘‘cases’’ or symptomatic group. The rationale for this strategy is to limit age stratum and thereby view the influence of life events and social support while considering the whole spectrum of depressive symptomatology in elderly. Although subthres- hold depression is not an official diagnostic label, many studies have demonstrated disabilities in individuals who presented this group of symptoms.19 This broader diagnos- tic syndrome (‘‘old age symptomatic depression’’) has the advantage of including subthreshold symptomatic depres- sive elders, which are often underdiagnosed and under- treated.19 Subthreshold depression has been compared to the negative impact of major depressive disorder in terms of physical disabilities, poor health status, and restricted activity days.20 Moreover, previous studies suggest the existence of a continuum between subthreshold depression and major depressive disorder.21 A recent meta-analysis of the prevalence of depressive morbidity in community- dwelling Brazilian elderly highlighted the importance of studying subthreshold depressive symptoms in the elderly, considering the high prevalence of clinically significant depressive symptoms and its association with cardiovascu- lar disease.4 Lifetime anxiety disorder was analyzed as a comorbid psychiatric disorder that could be associated with ‘‘old age symptomatic depression’’. Predictors of ‘‘old age symptomatic depression’’ Prior to starting the CIDI interview, and hence without the influence of the questions on psychopathological symptoms, all subjects answered a questionnaire about general health status, presence of chronic somatic condi- tions, and use of health care services in the 30 days prior to the interview, including both private and public health systems. Only ‘‘yes’’ and ‘‘no’’ answers were possible, and these answers were analyzed as dependent variables in a logistic regression analyses model. The following socio- demographic variables were analyzed: age, sex, marital status (married subjects not living together were considered separated), years of education, and professional status (employed or unemployed). The following predictors of depression in late life were selected for entering into the logistic regression models: gender, bereavement, living alone, perceived lack of social support, life events in the last 2 years, socioeconomic disadvantage, chronic somatic illness, lifetime anxiety disorders, and current cognitive impairment.8,9 Social support and life events were measured using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE),22 a brief semi-structured interview that covers a wide range of social problems and life events of elderly adults. Social support is a complex construct, including perception, structure of the social network, and tangible help and assistance.8 However, the strongest relationship between social support and late life depression has been found with perceived lack of support.8 Thus, we considered perceived social support in our analysis by aggregating questions asking about difficulty or lack of satisfaction in relationships with friends, neighbors, or relatives (e.g. seeing a relative less than weekly; having no supportive neighbors; experiencing problems in a relation- ship with offspring/brothers/sisters; experiencing dissatis- faction with support received from friends; experiencing 235 Psychiatry - life events and social support Alexandrino-Silva C et al. dissatisfaction with support received from neighbors). In an attempt to distinguish the influence of ‘‘living alone’’ on depressive symptoms from the influence of other variables, we analyzed this variable independently of the pooled variable ‘‘lack of social support’’. A list of thirteen life events in the previous two years were asked, and considered present if the respondent referred a considerable level of distress associated with each type of event. A variable ‘‘life events’’ was created as a dichot- omous variable, and considered present if any of the following events occurred with associated distress: serious illnesses; crisis or events outside one’s control; separation/ divorce; breakup of love relationships or important friend- ships; experiencing problems in a relationship with friends, neighbors or relatives; serious financial problems; losing something important; being robbed; bad event; and moving home. Recent death of a friend or distant relative and occurrence of a good event were not considered in the pooled variable of life events in the previous 2 years – the former is common and frequent amongst the elderly and the later is not a negatively valued event. Bereavement was analyzed separately because it is a life event potentially associated with depression in late life.8 Socioeconomic disadvantage is an important concept to be considered when researching negative life events. However, it is neither simple, nor well defined. A broad definition of socioeconomic disadvantage is related to people’s access to material and social resources, and their ability to take part in society.23 Socioeconomic disadvantage can have many forms, including low income, low educa- tional attainment, unemployment, dwellings without motor vehicles, living in poor housing, and having limited access to health services.23 This condition can affect health throughout life. People who are socially disadvantaged live shorter lives and suffer more illness than those who are well off.23 In our study, we used the concept of socioeconomic disadvantage referring to those who were from the lowest income quartile and with less than 8 years of education. Years of education were coded categorically in the ranges 0–8, 9–11, 12–15 and 16 and over. Income was calculated as the average annual net income per family. The sample was divided into three income categories: the 25% with the highest income, a 50% middle bracket, and the 25% with the lowest income. As late life depression and cognitive impairment are usually associated, cognitive impairment at the time of interview was assessed by the Mini-Mental State Examination (MMSE) 24. The MMSE is embedded within the CIDI 1.1, thus allowed to detect ICD-10 1-month Organic Mental Disorder cases, a dichotomous variable considered in the analyses. Nevertheless, it should be considered that in this survey, subjects with severe cognitive impairment were not able to participate due to the self-report characteristic of the measurement schedule. Participants were asked about their lifetime experiences of six selected chronic somatic conditions: high blood pressure, stroke, asthma, heart disease, diabetes, and/or cancer. The questions: ‘‘have you ever had …’’ or ‘‘has a doctor ever told you that you have…’’ were asked for high blood pressure, diabetes, stroke, and/or cancer. Heart disease was defined as a self-reported medical diagnosis of any cardiac disease and/or a positive answer on the Rose Angina Questionnaire.25 Asthma diagnosis was defined as the presence of recurrent bronchospasm and/or wheezing.