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

doi:10.1136/bmj.a3079

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{at}vumc.nl

Objectives To study the duration of depression, recovery overtime, 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 prevalentmajor depressive disorder.

Main outcome measures Depression at baseline and every six monthsusing structured diagnostic interviews (primary care evaluationof mental disorders according to diagnoses in Diagnostic andStatistical Manual of Mental Disorders, fourth edition) anda measure of severity of symptoms (Montgomery Åsberg depressionrating scale). The main outcome measures were time to recoveryand 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 was18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressedpatients recovered within one year, 60% within two years, and68% within three years. A poor outcome was associated with severityof depression at baseline, a family history of depression, andpoorer physical functioning. During follow-up functional statusremained limited in patients with chronic depression but notin those who had recovered.

Conclusion Depression among patients aged 55 years or more inprimary care has a poor prognosis. Using readily available prognosticfactors (for example, severity of the index episode, a familyhistory of depression, and functional decline) could help directtreatment to those at highest risk of a poor prognosis.

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Rapid Responses:

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