老年抑郁症的随访研究存在的问题(4.5)：(1)因老年抑郁症的病人病死率和失访率 高，可能会造成老年抑郁症的发病率低。一般发病率的研究仅针对存活者目前的发病情况。 (2)随访的时间间隔的长短。随访期间有些老年人可能发病但又恢复了，随访时不会发现。 故许多研究得出的发病率仅为最小发病率即随访时新发病病例占随访人群的比例。(3)很难 估计新发病例的发病时间。(4)使用不同的诊断方法，老年抑郁症的发病率亦不同。(5)老年 人 认知功能会有程度不同的减低，会因记忆下降而对某些症状难以回忆导致遗忘偏倚。(6)老 年人躯体疾病较多，有些抑郁症状亦归因于躯体疾病所致而未暴露。
四、今后的研究展望
1.标准化诊断的量表项目和提问的问题应尽可能简化。可以发展一个简单的老年抑郁症测 查的量表，特别是能应用在社区研究中。
2.社区调查间隔时间的长短对发病率的影响，了解抑郁的自然病程。
3.使用同一筛查工具、诊断方法在不同的地区或国家进行协作流行病学研究。尤其随访研 究，可以了解老年人抑郁的发病情况，对今后老年人预防保健能够提供一个很好的帮助。
4.抑郁是否是老年痴呆的先驱症状?有认知损害的老年人抑郁的发生率是否升高?
5.配合临床在社区中进一步探讨分子生物学与基因水平的病因学因素，这些工作无论对科 学研究还是社区保健，均是很有意义的。
主要参考文献
1，王祖新，老年抑郁综合征，中国新药与临床杂志，1998，17(3)：175-176
2，张心保，欧红霞，仇爱平等，抑郁性神经症的诊断研究，中华医学杂志，1994，74(10) ：595-597
3，王鲁宁，重视老年抑郁症的诊断及治疗，中华内科杂志，1999，38(1)：68
4，Barbel Knauper,Hans-Ulreich Wittchen,Diagnosing major depression in the elder ly evidence for response bias in standardized diagnostic interviews?J.Psychiatr .Res.,1994,28(2):147-164
5，Eaton WW,Karmer M,Anthony JC,et al.The incidence of specific DIS/DSM-Ⅲ ment al disorders:data from the NIMH epidemiologic Catchment Area program,Acta Psychiat r Scand,1989,79:163-178
6，Copeland,J.R.M.,Dvaidson,I.A.,Dewey,M.E., et al.,Alzheimer’s Disease, Other De mentias,Depression and Pseudodementia:Prevalence,Incidence and Three-Year Outcom e in Liverpool,Br.J.Psychiatry,1992,161:230-239.
7，nowdon J,Lane F.The Botany survey:A longitudinal study of depression an d cogn itive impairment in an elderly population.Int J Geriatr Psychiatry.1995,10:349 -358
8，Blanchard MR,Waterreus A,Mann AH,The nature of depression among older people in inner London,and the contract with primary care,Br J Psychiatry 1994,164:396- 402
9，Magnusson H,Mental health of octogenarians in Iceland.An epidemiologal study .,Acta Psychiatr Scand,1989,79(suppl 349):1-112
10，Roraman B,Grasbeck A,Hagnell o,et al.A prospective study of first-i ncid ence depression：the Lundby study,1957-1972,Br J Psychiatry,1990,156,29:336-342
11，Jerome Yesavage,Differential diagnosis between depression and dementia,Am J Med,1993,94(SUPPL5A):23S-28S
12，Patricia A.Pamelee,Ira R.Katz,M.Powell Lawton,Incidence of depression in long-term care settings,5-gezonolology(Medical Sciences),1992,47(6),M189-M196
13，Henderson-AS;Korsten-AE;Jacomb-PA;et al,The course of depression in the elde rly:A longitudinal community-based study in Australia,Psychol Med.1997,27(1):11 9-129
14，Snowdon-J,Epidemiologic questions on mood disorders in old age ,Clin Neurosc i.1997,4(1):3-7
15，Cervilla-JA;Prince-MJ,Cognitive impairment and social distress as different pathways to depression in the elderly:A cross-sectional study,Int J Geriatr Psyc hiatry.1997;12(10):995-1000
16，C.G.Ballard,C.Bannister,F.Oyebode,Depression in Dementia Sufferes,Int J Geriatr Psychiatry.1996,11:507-515
17，.Hans-Ulrich Wittchen,Barbel Knauper,Ronald C.Kessler,Life risk in depressio n,Br.J.Psychiatry,1994,165(Suppl.26):16-22
18，Antonio Lobo;Pedro Saz;Guillermo Marcos,et al., The prevalenc e of dementia and depression in the elderly community in a Southern European popu lation,Arch Gen Psychiatry,1995,52:497-506
19，Thomas F.Wernicke,Friedel M.Reischies,Depression in Late life：the use of c linical characteristics to focus screening efforts,Neurology,1994,49(1):M9-M14
20，Topinkova-E;Neuwirth-J,Depressive syndrome in geriatric patients in long-ter m institutional care,Cesko Slov Psychiatry.1997,93(4):181-188
21，Zarb-J,Correlates of depression in cognitively impaired hospitalized elderly referred for neuropsychological assessment,J Clin Exp Neuropsychol.1996,18(5): 713-723
22，A.S.Henderson;A.F.Jorm.Some contributions to the epidemiology of dement ia and depression.,Int J Geriatr Psychiatry,1997,12:145-154
23，Dufouil,C.;Fuhrer,R.,Dartigues,J.F.,et al.,Longitudinal analysis of the asso ciation between
