Using novel data from ELSA on the accumulation of traumatic stress across the life course, we examined whether the risk of experiencing depression in later life is associated with facing adversities earlier in the life course. The research finds that the negative effects of traumatic or stressful events in early life persist across the life course and are associated with both a higher prevalence and, importantly, a higher incidence of depression in later life. This points to the need for practitioners to take a whole life course approaching to understanding the factors associated with depression in later life.
There are now more people in the United Kingdom aged 60 or over than aged under 18, and by mid-2039 more than one in 12 of the total UK population are projected to be aged 80 or over. Depression is the most common mental disorder in later life, with a higher recorded prevalence in older women than in older men. There is wide array of literature on depression in older adults, but only a handful of studies have explored the connection between depression and traumatic stress, although in reality most people experience stress at some point in their life and nearly one-third are exposed to multiple traumas. Traumatic or stressful events can cause negative affective states, which in turn impact upon biological processes or behavioural patterns influencing disease risk. Therefore, research tends to show that the overall impact of traumatic events on the health of the person experiencing them is negative. Most of the existing research focusses on the current period or examines the effects over a short period, usually 1-3 years. The mechanisms through which adversities earlier in the life course influence later life depression are less clear-cut. One possibility is that people who experience traumas in early life are more likely to amplify their biological and emotional response to any later stressful life events; thus the negative effects accumulate as individuals lack the personal and psychosocial resources to cope with them. Some individuals may also be more predisposed to self-medicating behaviours such as smoking, drug use and consumption of high-fat/sugar diets, all known risk factors for depression (Figure 1).
The limited existing empirical studies on older adult trauma survivors have mainly been conducted on select groups including combat veterans (typically men), older adults who experienced Holocaust-related trauma earlier in their life, and people who experienced other natural or human-made disasters. Although important, the generalisability of these studies is limited. This study therefore represents an important contribution to the literature by focussing on a sample drawn from the general population, including both women and men from a range of socioeconomic backgrounds.
The English Longitudinal Study of Ageing provides unique information on life-history adversities, asking all respondents aged 60 and over to recall their experience of a range of stressful events and adversities across their lifecourse, ranging from divorce and bereavement through to sexual assault, witnessing violent death and participation in armed conflict. Using advanced statistical techniques, five clusters were identified: those who had experienced none or relatively few life course adversities (58.6%), those who had lost relationships (27.0%), those experiencing adversities during childhood (6.3%), war-related adversities (5.7%) and chained adversities (2.4%). We then examined the relationship between these clusters and the experience of depression in later life.
Firstly, we examined the prevalence of depression in 2006, taken as the study baseline. As expected from previous literature, there was a clear relationship between adversity and the likelihood of reporting suffering from depression. We then selected all those not suffering from depression in 2006 and followed them over time, looking at their survey responses in 2008, 2010, 2012, and 2014. We found that accumulated adversities were associated with a heightened risk of the onset of a new episode of depression over time, pointing to the persisting effect of earlier life adversity into and through later life. The effects were particularly marked for women, suggesting that some sub-groups of women may be more vulnerable to the persistent effect of earlier life stresses, especially those who have accumulated fewer pension rights and other economic resources.
Given the world’s population is ageing rapidly, there is likely to be an increasing demand for mental health services for older adults globally. Understanding how events earlier in the life course impact upon later life health will become of increasing importance. Replicating the research conducted using ELSA in other countries that have data for nationally representative samples of community-dwelling older adults, such as the Survey of Health, Aging and Retirement in Europe (SHARE), the US Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS), will provide important new evidence on the prevalence and impact of traumatic experiences across the life course on mental health in later life. This is very exciting and is likely to provide new insights on old-age mental illness prevention and management. Going forward, we hope that this will lead to greater public attention and more research efforts in the areas of life course traumatic stress and geriatric mental health.
About the authors:
Jane Falkingham, ESRC Centre for Population Change, University of Southampton
Maria Evandrou, ESRC Centre for Population Change and Centre for Research on Ageing, University of Southampton, Southampton, UK
Min Qin, ESRC Centre for Population Change and Centre for Research on Ageing, University of Southampton, Southampton, UK
Athina Vlachatoni, ESRC Centre for Population Change and Centre for Research on Ageing, University of Southampton, Southampton, UK
This article is based on:
Falkingham J., Evandrou M., Qin M. and Vlachantoni A.: Accumulated lifecourse adversities and depressive symptoms in later life among older men and women in England: a longitudinal study, Ageing and Society (2019).