CLINICS 2011;66(2):233-238 DISCUSSION The above results must be interpreted in the context of several limitations. Respondents with severe neurocognitive impairment were not able to participate. This presumably precluded our ability to capture the well clinically docu- mented old age psychopathology.8,9 The oversampling of old age subjects was done as a tentative to overcome this limitation, but still our survey has a small number of subjects in this age group. This is reflected in the small number of men with the outcome examined herein. Some of these caveats may have biased our results to an under- estimation of the prevalence of depression, restricted the possibility to better detect differences in the subtypes ‘‘late depression’’ and ‘‘late subthreshold depression’’, and may probably make the strengths of associations weaker. In addition, because the survey site is consisted of two boroughs of Sa˜o Paulo with a high socioeconomic level, it is difficult to generalize the results to other socioeconomic strata and, thus, these findings should not be extended to other communities. Further limitations of the study are the cross-sectional design, thus it is not possible to detect the direction of the association. Notwithstanding these limitations, we found that approximately one in each five elderly (18.8%) in our sample presented significant depressive symptoms that started or continued through this period of life. Bearing in mind that this estimate does not represent lifetime esti- mates, as cases were restricted to those subjects who presented symptomatic depression with onset or recency after 60 years of age, and that comparisons with previous studies in Brazil are hampered by different assessment, time frame, studies design and objectives, our findings are consistent with previous studies in Brazil, in showing a high prevalence of depressive symptomatology in this age group.2,3 Women were more likely to present ‘‘old age sympto- matic depression’’. There is no consensus concerning the influence of female gender in depression in old age.9 Although several studies have reported that female gender is associated with more depressive disorders and depressive symptom cases than male gender, gender differences have not always been demonstrated.9 Possible explanations that justify a higher prevalence of depressive symptoms in women compared to men are related to the fact that there is a continuum of risk factors, which can contribute to the development of depression during the woman’s life, such as genetically determined vulnerability, personality traits, biological factors, body dissatisfaction, social challenges, stressful events in life (e.g., sexual abuse, postpartum depression), history of depression, and higher body mass index.27 In our study, lifetime anxiety disorder was a significant predictor for ‘‘old age symptomatic depression’’, when other determinants considered in these analyses were controlled for. Depression in late life tends to co-occur with other psychiatric disorders, though this co-occurrence seems to be less frequent than earlier in life.8 Beekman et al.28 examined the comorbidity of major depressive disorder with anxiety disorders in later life, and found that almost half of older people with major depressive disorder met criteria for anxiety disorders, while a quarter of those subjects with anxiety disorders also met criteria for major depressive disorder.28 The authors point out that many of 237 Psychiatry - life events and social support Alexandrino-Silva C et al. the risk factors often associated with depression in later life may be more appropriately associated with comorbid anxiety.28 A recent study has reported the high occurrence of mood and anxiety disorders among older adults, espe- cially in women, showing that their prevalence rates, although decline with age, still remain very common,29 causing significant impairment in the quality of life of elders. In our survey, cognitive impairment was not associated with ‘‘old age symptomatic depression’’. The exclusion of severe cognitive impairment subjects, low sample size, and validity of measurements might have made this association weaker in our survey. This association is common in clinical practice, and probably what is captured in surveys in clinical samples is the end of a continuum that could start with depressive symptoms in later life.30 Living alone was also a significant determinant for ‘‘old age symptomatic depression’’. Older adults who live alone tend to report less social support and more loneliness, and to experience accelerated cognitive decline.31 These factors are associated with higher rates of depression, and decreased life satisfaction.9 Our finding that in the final model living alone is not a significant determinant should be an indication of that complex inter-relation of loneliness and social support. In our survey, life events and social support operate differentially across genders. Perceived lack of social support was significantly associated with ‘‘old age sympto- matic depression’’ in men, while life events were associated with ‘‘old age symptomatic depression’’ in women. In recent decades, the elders had to deal with two key points in their lives: earlier retirement and changes in household composition, characterized by the decline of conviviality between elderly parents and their adult children.32 The literature shows that retirement can bring out the negative aspects of a marriage, especially for women, who usually benefit less from their husband’s retirement than do the retiring husbands.32 Another important life event that plays a special role in the lives of older women is the loss of close friends. Although we could not observe this in our study, the literature is well-documented with respect to the role that a confidante plays in the maintenance of psychological well- being and mental health.32 While women tend to have a close confiding relationship with another person for this kind of support, men usually depend more on their wives for intimacy, social support and social participation.33 Divorce can also be associated with ‘‘old age symptomatic depression’’ in older women. Since men earn, on average, substantially more than women,34 women usually obtain more financial advantages from marriage.35 Consequently, many wives experience a decline in economic pattern with the separation from their husband, which can become a stressful life event associated with the development of depression. Perceived lack of social support was an important predictor of ‘‘old age symptomatic depression’’ only for men. It seems that the death of the wife tends to lead to a loss of social support over time, and this can be an explanation for the difference in depression rates between men and women after widowhood; there is a stronger association for men, especially among those widowed for a longer period of time.35 As mentioned above, men usually name their wife as their main source of emotional support. Because men are less likely to have a close confiding