Psychological Medicine

Original Articles

Factors associated with symptoms of anxiety and depression in five cohorts of community-based older people: the HALCyon (Healthy Ageing across the Life Course) Programme

C. R. Galea1a2 c1, A. Aihie Sayera1, C. Coopera1, E. M. Dennisona1, J. M. Starra2a3, L. J. Whalleya4, J. E. Gallachera5, Y. Ben-Shlomoa6, D. Kuha7, R. Hardya7, L. Craiga4, I. J. Dearya2 and the HALCyon Study Team

a1 MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

a2 Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK

a3 Geriatric Medicine Unit, University of Edinburgh, Royal Victoria Hospital, Edinburgh, UK

a4 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

a5 Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, Cardiff University, Cardiff, UK

a6 Department of Social Medicine, University of Bristol, Bristol, UK

a7 MRC Unit for Lifelong Health and Ageing, University College London, London, UK


Background Symptoms of anxiety and depression are common in older people, but the relative importance of factors operating in early and later life in influencing risk is unclear, particularly in the case of anxiety.

Method We used data from five cohorts in the Healthy Ageing across the Life Course (HALCyon) collaborative research programme: the Aberdeen Birth Cohort 1936, the Caerphilly Prospective Study, the Hertfordshire Ageing Study, the Hertfordshire Cohort Study and the Lothian Birth Cohort 1921. We used logistic regression to examine the relationship between factors from early and later life and risk of anxiety or depression, defined as scores of 8 or more on the subscales of the Hospital Anxiety and Depression Scale, and meta-analysis to obtain an overall estimate of the effect of each.

Results Greater neuroticism, poorer cognitive or physical function, greater disability and taking more medications were associated in cross-sectional analyses with an increased overall likelihood of anxiety or depression. Associations between lower social class, either in childhood or currently, history of heart disease, stroke or diabetes and increased risk of anxiety or depression were attenuated and no longer statistically significant after adjustment for potential confounding or mediating variables. There was no association between birth weight and anxiety or depression in later life.

Conclusions Anxiety and depression in later life are both strongly linked to personality, cognitive and physical function, disability and state of health, measured concurrently. Possible mechanisms that might underlie these associations are discussed.

(Received February 17 2010)

(Revised December 19 2010)

(Accepted January 19 2011)

(Online publication February 24 2011)


c1 Address for correspondence: C. R. Gale, Ph.D., MRC Lifecourse Epidemiology Unit (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK. (Email: