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Psychological Medicine, 2005, 35, 1–12. f 2005 Cambridge University Press
DOI: 10.1017/S0033291705004411 Printed in the United Kingdom
INVITED REVIEW
Origins of depression in later life
D A N G. B L A Z E R I I* A N D C E L I A F. H Y B E L S
Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
ABSTRACT
Background. Despite the burden of depression in late life, its origins present a paradox to
investigators and clinicians alike.
Method. We review biological (genetics and heredity factors, neurotransmitter dysfunction,
endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality
attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy)
and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage
and impaired social support) origins of late-life depression based upon an extensive though not
exhaustive review of the extant literature. In addition, modifying psychological and social factors
are discussed.
Results. Older adults appear to be at greater risk for major depression biologically, such as
depression resulting from vascular changes, yet the frequency of depression is lower compared
to younger adults. Older adults may be protected psychologically due to factors such as socio-
emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected
from social risks.
Conclusions. A biopsychosocial approach to evaluating the origins of late-life depression is
heuristically valuable, a continual reminder of the many factors that contribute to the onset and
persistence of clinically significant sy
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