The prevalence of dementia associated with depressive symptomatology and antidepressant prescription rates in severe dementia is more common in community care settings than in people living in the in nursing homes.

Researchers studied 414 people with severe dementia along with their caregivers in England, Estonia, Finland, France, Germany, the Netherlands, Spain and Sweden. The study gathered information on quality of life, activities of daily living such as bathing, feeding and dressing and presence of depressive symptoms using standardized measures.

In the groups studied, 37% of the 217 people living in the community showed signs of depression compared to 23% of the 197 in care homes. It is one of the few studies comparing similar groups of people living at home and in nursing homes.

Findings indicated that 30% of the sample had depression, whilst the highest and lowest prevalence of depression was reported in Germany and Finland, respectively. Lower Quality of Life (QoL), the presence of pain and more frequent neuropsychiatric symptoms were associated with depressive symptomatology, whilst no significant relationship between impairment of activities of daily living, comorbidity, and depression emerged. Spain and Estonia had the highest and lowest rates of antidepressant prescribing, respectively, whilst Germany had the highest discrepancy between depressive symptomatology and prescription.

Professor David Challis, from the University of Manchester's Personal Social Services Research Unit, led the study. He said: "Despite the differences between the countries involved, the pattern of depression observed in the community-dwelling group was consistent."

"In addition this difference may be partly explained by the responses received from caregivers. Often, relatives of people with dementia are more distressed by symptoms of depression than professional care workers, so this may have influenced their ratings on the depression measure. "

"What we need is more support for caregivers to help them cope with their relatives' depressive symptoms and to recognize the problem before it gets to severe levels."

The study also looked at the rates of anti-depressant prescribing across the different countries. It found that England and Spain had the highest rates. In Germany there were more people suffering depressive symptoms, but they had the lowest rates of antidepressant use.

Overall Finland (15%) and the Netherlands (21%) had the lowest rates of depression in people with severe dementia, compared to 23% overall.

According to the research, this suggests other EU countries could learn from their example. "By studying a number of different countries you can gain insights into different ways of meeting needs," Professor Challis said.

"Certainly the system in Finland and the Netherlands seems to have much to offer to UK care providers and overall we found that more needs to be done to help family caregivers identify and cope with their relatives' symptoms of depression."

The study, 'Depressive Symptomatology in Severe Dementia in a European Sample: Prevalence, Associated Factors and Prescription Rate of Anti-Depressants' was published in the journal International Psychogeriatrics.