Articlegold2008

One-year outcomes of minor and subsyndromal depression in older primary care patients

Jeffrey M. Lyness · Benjamin P. Chapman · Joanne A. McGriff · Rebecca A. Drayer · Paul R. Duberstein

96 citations0/0 files storedInternational Psychogeriatrics

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Mental Health Treatment and Access Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Aging, Health, and Disability

Abstract

BACKGROUND: Despite the high prevalence and morbidity of minor and subsyndromal depression in primary care elderly people, there are few data to identify those at highest risk of poor outcomes. The goal of this observational cohort study was to characterize the one-year outcomes of minor and subsyndromal depression, examining the predictive strength of a range of putative risks including clinical, functional and psychosocial variables. METHODS: Patients aged > or = 65 years were recruited from primary care medicine and family medicine practices. Of 750 enrollees, 484 (64.5%) completed baseline and one-year follow-up assessments of depression diagnosis (major depression vs. minor and subsyndromal depression vs. non-depressed) by the Structured Clinical Interview for DSM-IV, depressive symptom severity (Hamilton Rating Scale for Depression), and validated measures of other predictors. RESULTS: Patients with baseline minor and subsyndromal depression were more depressed than the non-depressed group at follow-up: They had a 7.0-fold (95% CI 4.5-10.8) risk of developing major depression, and a one-year adjusted Hamilton Depression Score of 11.0 (95% CI 10.2-11.8) compared with 7.8 (95% CI 7.1-8.5) for the non-depressed group; these outcomes were less severe than those of the major depression group. Independent predictors of depression outcomes included race, psychiatric and physical functioning, and social support. CONCLUSIONS: Minor and subsyndromal depression are likely to persist, and pose an elevated risk of worsening over one year. Clinicians and preventive interventions researchers should focus on modifiable risks, such as psychiatric functioning or social support, in elders suffering clinically significant depressive symptoms.

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References

2002Collaborative Care Management of Late-Life Depression in the Primary Care Setting 1988A Structured Interview Guide for the Hamilton Depression Rating Scale 2004Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients 2003Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Late Life 2006Outcomes of Minor and Subsyndromal Depression among Elderly Patients in Primary Care Settings 2006Treatments for Later-Life Depressive Conditions: A Meta-Analytic Comparison of Pharmacotherapy and Psychotherapy 2006Opportunities for cost-effective prevention of late-life depression: an epidemiological approach.2006Treatments for Later-Life Depressive Conditions: A Meta-Analytic Comparison of Pharmacotherapy and Psychotherapy

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