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Summary (2 min read)
Introduction (Words: 558)
- Late-life depression is a complex and heterogeneous disorder, often accompanied by an unfavorable prognosis.
- 28 Whether these factors are also associated with the prognosis of depression on the long-term remains to be explored.
- The aim of the present study was twofold.
- Second, prognostic factors of long-term course types were identified.
- The authors hypothesized that the long-term prognosis of late-life depression is poor, with a high mortality rate and an unfavorable course, including recurrence and chronicity, in most patients.
Study Design
- The Netherlands Study of Depression in Older persons is a multi-site prospective cohort study designed to examine the course and consequences of depressive disorders in older adults (≥60 years).
- Sampling procedures have been previously described in detail.
- Non-depressed comparisons were recruited from general practitioners and were included if they had no lifetime diagnosis of depression.
- Follow-up assessments by means of a face-to-face interview were performed two-years, 13 and six-years after baseline using the same measurement instruments as at baseline.
Sample
- At baseline, NESDO included 378 depressed patients, having major depressive disorder (n=265), dysthymia (n=6), double depression (n=94) (major depression and dysthymia) or minor depression (n=13) according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR criteria), 30 and 132 non-depressed comparisons, aged ≥ 60 years.
- 13 Depressed patients did not differ from non-depressed comparisons with respect to mean age and sex, but depressed patients had less education, were more often divorced or widowed, and had lower cognitive functioning.
- From the 510 respondents at baseline, 401 were retained in the two-year follow-up assessment with an overall attrition rate of 21.4%.
Measurements Depression
- The DSM-IV-TR-diagnosis of major depression, dysthymia and minor depression was assessed with the Composite Interview Diagnostic Instrument (CIDI, WHO, version 2.1) at two-and six-year of follow-up.
- 30 Severity of depressive symptoms was measured by a postal assessment every six months as a continuous variable with the Inventory of Depressive Symptoms (IDS), 31 which is a 30-item self-report scale that was developed to assess all core criterion diagnostic depressive symptoms.
- The IDS scores range between 0 and 84 with higher scores indicating more severe depression.
- 32 The scale has acceptable psychometric properties in depressed outpatients, 31 and depressed inpatients.
Course types
- The course types were categorized according to the two-year and six-year measurement into: a) full remission, b) partial remission, c) recurrent, and d) chronic, using both the symptom severity level (according to the IDS) and diagnosis of depression (according to the DSM-IV-TR).
- Full remission was defined as the absence of a depression diagnosis at six-year follow-up, combined with an IDS score < 14 at six-year follow-up (at measurement cycles 12 and 13, thereby covering six months).
- Presence of a depression diagnosis both at two-and six-year follow-up was labeled as 'chronic'.
- The last two categories (recurrent and chronic) were based on diagnosis of depression according to the CIDI only.
Prognostic factors
- Demographics were assessed using standard questions and included sex, age, and educational level .
- As compared to full remission, partial remission was only associated with chronic diseases and loneliness, and not with any of the depression-related clinical factors.
- From multivariate longitudinal analyses (Table 3 ), a younger age of onset of depression, higher severity of depression, chronic pain, neuroticism, and loneliness at baseline were significantly associated with higher levels of depression over the six-year follow-up.
Statistical Analyses
- First, descriptive analyses were used to describe attrition and its determinants in the patient group (eTable 1).
- Second, study sample characteristics were described according to the 'course of late-life depression', in which the groups 'recurrent' and 'chronic' were combined to ensure equal group sizes for the purpose of subsequent statistical analyses (Table 1 ).
- A correlation matrix was derived for the independent variables to rule out multicollinearity.
- The goodness of fit for all multivariate models was evaluated with the -2 Log Likelihood (-2LL) method by comparing the fitted fixed-effects models to the model with no predictors (null model).
Prognosis of late-life depression
- Of those with a full remission at six years, 43.8% reached this after two years.
- Table 1 shows the characteristics from 201 clinically depressed patients who were able to participate in the study over the full six years according to their course type.
Discussion (Words: 1124)
- The most important conclusion to be drawn from this study among depressed older patients is that the long-term prognosis for this group is poor in terms of mortality and course of depression.
- During six-years of follow-up, nearly 47% of the depressed patients were loss to follow-up, mainly due to mortality (relative risk of 2.5 versus non-depressed comparisons) and cognitive impairment.
- The authors also demonstrated that results were biased in the direction of a more favorable prognosis if attrition was excluded as outcome, as this may lead to a selection of the more healthy and motivated patients (30% would have had an unfavorable course, 46% partial remission and 24% full remission).
- These numbers from both community and clinical studies are in line with their results and strongly indicate that depression in later life is a disabling chronic disorder with a poor outcome.
- Also, most of the variables that remained statistically significant (p<0.05) in the final multivariate model, had a stronger association with the outcome in the preceding groupwise models at p≤0.01 (except for 'age of onset').
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Frequently Asked Questions (11)
Q2. What is the comorbidity of the rasch type?
The transition of pure mood, anxiety and substance use disorders into 520 comorbid conditions in a longitudinal population-based study.
Q3. What was the goodness of fit for all multivariate models?
The goodness of fit for all multivariate models was 226evaluated with the -2 Log Likelihood (-2LL) method by comparing the fitted fixed-effects 227models to the model with no predictors (null model).
Q4. What are the limitations of this study?
because of a lack of power, multivariate 332analyses were not performed on course types, making it difficult to clarify the strongest 333prognostic factors of an unfavorable course type.
Q5. How long after baseline did the study take?
Follow-up assessments by means of a face-to-face 120 interview were performed two-years,13 and six-years after baseline using the same 121measurement instruments as at baseline.
Q6. What was the recent study of the Netherlands Study of Depression in Older persons?
In their previous 75two-year follow-up study of the Netherlands Study of Depression in Older persons (NESDO), 76we found that nearly 50% of the clinically depressed patients still had a depression 77 diagnosis, and 61% had a chronic course of depressive symptoms.
Q7. how many patients had a full remission at six years?
251252253254Page 12 of 3213Prognosis of late-life depression 255Among the total of 378 depressed patients at baseline, 177 (46.8%) were loss to follow-up, 25660 (15.9%) had a recurrent or chronic depression, 93 (24.6%) had a partial remission and 257only 48 (12.7%) had a full remission at six-year follow-up.
Q8. How did Beekman et al. (2002) study the course of late-life?
9–14 Beekman et al. (2002) studied the six-year 72course of community-dwelling older adults with late-life depression, using both diagnostic 73Page 3 of 324interviews and self-reports, and found that 32% had a severe chronic course and 44% an 74 unfavorable but fluctuating course, whereas only 23% showed remission.
Q9. What is the important conclusion to draw from this study?
283Page 14 of 3215Discussion (Words: 1124) 284The most important conclusion to be drawn from this study among depressed older patients 285is that the long-term prognosis for this group is poor in terms of mortality and course of 286depression.
Q10. How did Stek et al. (2002) determine the prognosis of major?
5 Stek et al. (2002) 306examined the long-term prognosis of major depression in hospitalized older patients six to 307Page 15 of 3216eight year after clinical treatment and found that 40% had died, while among the survivors 308 33% had no residual symptoms or relapses,11 which approximately corresponds to their 309finding that among survivors 24% reached full remission.
Q11. What were the health and lifestyle factors included in the study?
The following health and 181Page 8 of 329lifestyle factors were included: chronic physical diseases were self-reported and assessed by 182 the LASA Questionnaire (LAPAQ),37 functional limitations were assessed by the WHO-183 Disability Assessment Scale II (WHODAS 2.0),38 metabolic syndrome was assessed by the 184 original ATP-III criteria,39 chronic pain was assessed by the Chronic Graded Pain Scale 185 (CPGS),40 body-mass-index was measured by weight (kg)/squared height (m2), physical 186activity was assessed by the International Physical Activities Questionnaire (IPAQ) and 187 dichotomized (low versus moderate/high),41 smoking was assessed by asking current 188smoking behavior (y/n), and alcohol use was assessed by Alcohol Use Disorders 189 Identification (AUDIT).