Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-upBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.a3079 (Published 02 February 2009) Cite this as: BMJ 2009;338:a3079
- 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
- 1Department 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
- 2Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Netherlands
- 3Department of Methodology and Applied Biostatistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University
- 4Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Centre
- Correspondence to: E Licht-Strunk
- Accepted 20 October 2008
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. Multivariable analyses 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 not in 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.
We thank the respondents for their participation.
Contributors: EL-S carried out the study, did the analyses, and wrote the paper. HvM and AB had the original idea for the study, designed the study, obtained the grants, helped in the analyses and interpretation of the data, supervised the project, and cowrote the paper. TH and JT assisted with the analyses and interpretation of the data and cowrote the paper. MdH supervised the project and cowrote the paper. All authors approved the final version of the manuscript. EL-S and HvM are guarantors.
Funding: The data reported on were collected in the context of the West Friesland Study, which was financed by The Netherlands Organisation for Health Research and Development (grant No 2200.0019) and the Dutch Organization for Scientific Research (MW grant 904.57.127).
Competing interests: None declared.
Ethical approval: This study was approved by the medical ethical committee of the VU University Medical Centre.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.