Depression in later life in primary care

Published 2 February 2009, doi:10.1136/bmj.a3079
Cite this as: BMJ 2009;338:a3079

Research

Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up

E Licht-Strunk, general practitioner and postdoctoral fellow¹, H W J Van Marwijk, general practitioner and associate professor of general practice¹, T Hoekstra, PhD student², J W R Twisk, professor of methodology and applied biostatistics³, M De Haan, general practitioner and professor of general practice¹, A T F Beekman, psychiatrist and professor of psychiatry⁴

¹ Department of General Practice and the EMGO Institute for Health and Care Research of VU University Medical Centre, Van der Boechorstraat 7, 1081 BT, Amsterdam, Netherlands, ² Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Netherlands, ³ Department of Methodology and Applied Biostatistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, ⁴ Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Centre

Correspondence to: E Licht-Strunk e.licht@vumc.nl

Abstract

Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (55 years) in primary care.

Design Longitudinal cohort study, with three years’ follow-up.

Setting 32 general practices in West Friesland, the Netherlands.

Participants 234 patients aged 55 years or more with a prevalent major depressive disorder.

Main outcome measures Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Åsberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariableanalyses were used to identify variables predicting prognosis.

Results The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but notin those who had recovered.

Conclusion Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.