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

Published online by Cambridge University Press:  12 September 2008

Jeffrey M. Lyness ,
Benjamin P. Chapman ,
Joanne McGriff ,
Rebecca Drayer  and
Paul R. Duberstein
Jeffrey M. Lyness*
Affiliation:
Geriatric Psychiatry Program, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, U.S.A.
Benjamin P. Chapman
Affiliation:
Geriatric Psychiatry Program, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, U.S.A.
Joanne McGriff
Affiliation:
Geriatric Psychiatry Program, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, U.S.A.
Rebecca Drayer
Affiliation:
Department of Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A., and Canandaigua VA Medical Center, Canandaigua, NY, U.S.A.
Paul R. Duberstein
Affiliation:
Geriatric Psychiatry Program, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, U.S.A.
*
Correspondence should be addressed to: Jeffrey M. Lyness, MD, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, U.S.A. Phone: +1 585 275 6741; Fax: +1 585 273 1082. Email: [email protected].
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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 ≥ 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.

Keywords

depressiongeriatricprimary careoutcomes
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 60 - 68
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Alexopoulos, G. S. et al. (1996). Recovery in geriatric depression. Archives of General Psychiatry, 53, 305–312.Google Scholar
Bruce, M. L. et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 291, 1081–1091.Google Scholar
Charney, D. S. et al. (2003). Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life. Archives of General Psychiatry, 60, 664–672.Google Scholar
Ciechanowski, P. et al. (2004). Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA, 291, 1569–1577.CrossRefGoogle ScholarPubMed
Cole, M. G. and Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160, 1147–1156.CrossRefGoogle ScholarPubMed
Costa, P. T. and McCrae, R. R. (1992). The NEO Personality Inventory: Revised Professional Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Cui, X., Lyness, J. M., Tu, X., King, D. A. and Caine, E. D. (2007). Does depression precede or follow executive dysfunction? Outcomes in older primary care patients. American Journal of Psychiatry, 164, 1221–1228.Google Scholar
Cui, X., Lyness, J. M., Tang, W., Tu, X. and Conwell, Y. (2008). Outcomes and predictors of late-life depression trajectories in older primary care patients. American Journal of Geriatric Psychiatry, 16, 406–415.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Gallo, J. J. and Coyne, J. C. (2000). The challenge of depression in late life: bridging science and service in primary care. JAMA, 284, 1570–1572.Google Scholar
Gallo, J. J., Bogner, H. R., Morales, K. H. and Ford, D. E. (2005). Patient ethnicity and the identification and active management of depression in late life. Archives of Internal Medicine, 165, 1962–1968.Google Scholar
Harris, T., Cook, D. G., Victor, C., DeWilde, S. and Beighton, C. (2006). Onset and persistence of depression in older people–results from a 2-year community follow-up study. Age and Ageing, 35, 25–32.Google Scholar
Karnofsky, D. A. and Burchenal, J. H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In C. M. MacLeod (Ed.) Evaluation of Chemotherapeutic Agents New York: Columbia.Google Scholar
Landerman, R., George, L. K., Campbell, R. T. and Blazer, D. G. (1989). Alternative models of the stress buffering hypothesis. American Journal of Community Psychology, 17, 625–642.Google Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people. Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.Google Scholar
Linn, B. S., Linn, M. W. and Gurel, L. (1968). Cumulative illness rating scale. Journal of the American Geriatrics Society, 16, 622–626.Google Scholar
Lyness, J. M. et al. (2006). Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Annals of Internal Medicine, 144, 496–504.Google Scholar
Lyness, J. M. et al. (2007). The clinical significance of subsyndromal depression in older primary care patients. American Journal of Geriatric Psychiatry.Google Scholar
McAvay, G. J., Bruce, M. L., Raue, P. J. and Brown, E. L. (2004). Depression in elderly homecare patients: patient versus informant reports. Psychological Medicine, 34, 1507–1517.Google Scholar
Murrell, S. A., Norris, F. H. and Hutchins, G. M. (1984). Distribution and desirability of life events in older adults: population and policy implications. Journal of Community Psychology, 12, 301–311.Google Scholar
Pinquart, M., Duberstein, P. R. and Lyness, J. M. (2006). Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy. American Journal of Psychiatry, 163, 1493–1501.CrossRefGoogle ScholarPubMed
Schoevers, R. A. et al. (2006). Prevention of late-life depression in primary care: do we know where to begin? American Journal of Psychiatry, 163, 1611–1621.Google Scholar
Schulberg, H. C., Mulsant, B., Schulz, R., Rollman, B. L., Houck, P. R. and Reynolds, C. F. (1998). Characteristics and course of major depression in older primary care patients. International Journal of Psychiatry in Medicine, 28, 421–436.CrossRefGoogle ScholarPubMed
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165–173.Google Scholar
Simon, G. E. et al. (2002). Cost-effectiveness of a program to prevent depression relapse in primary care. Medical Care, 40, 941–950.CrossRefGoogle ScholarPubMed
Smit, F., Ederveen, A., Cuijpers, P., Deeg, D. and Beekman, A. (2006). Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Archives of General Psychiatry, 63, 290–296.Google Scholar
Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1994). Structured Clinical Interview For Axis I DSM-IV Disorders: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Travis, L. A., Lyness, J. M., Shields, C. G., King, D. A. and Cox, C. (2004). Social support, depression, and functional disability in older adult primary-care patients. American Journal of Geriatric Psychiatry, 12, 265–271.CrossRefGoogle ScholarPubMed
Unutzer, J. et al. (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288, 2836–2845.CrossRefGoogle ScholarPubMed
Williams, J. B. W. (1988). A structured interview guide for the Hamilton depression rating scale. Archives of General Psychiatry, 45, 742–747.Google Scholar