A. T. F. Beekman

Physical health and the onset and persistence of depression in older adults: an eight-wave prospective community-based study

BACKGROUNDnPoor physical health has long been recognized to be one of the most important risk factors for depression in older adults. Since many aspects of physical health can be targeted for improvement in primary care, it is important to know whether physical health problems predict the onset and/or the persistence of depression.nnnMETHODSnThe study is based on a sample which at the outset consisted of 327 depressed and 325 non-depressed older adults (55-85) drawn from a larger random community-based sample in the Netherlands. Depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves.nnnRESULTSnFrom all incident episodes, the majority (57%) was short-lived. These short episodes could generally not be predicted by physical health problems. The remaining incident episodes (43%) were not short-lived and could be predicted by poor physical health. Chronicity (34%) was also predicted by physical health problems.nnnCONCLUSIONSnThe study design with its frequent measurements recognized more incident cases than previous studies; these cases however did have a better prognosis than is often assumed. The prognosis of prevalent cases was rather poor. Physical health problems were demonstrated to be a predictor of both the onset and the persistence of depression. This may well have implications for prevention and intervention.

Depression and physical health in later life: results from the Longitudinal Aging Study Amsterdam (LASA)

BACKGROUNDnIn later life, declining physical health is often thought to be one of the most important risk factors for depression. Major depressive disorders are relatively rare, while depressive syndromes which do not fulfill diagnostic criteria (minor depression) are common.nnnMETHODSnCommunity-based sample of older adults (55-85) in the Netherlands: baseline sample n = 3056; study sample in two stage screening procedure n = 646. Both relative (odds ratios) and absolute (population attributable risks) measures of associations reported.nnnRESULTSnIn multivariate analyses minor depression was related to physical health, while major depression was not. General aspects of physical health had stronger associations with depression than specific disease categories. Significant interactions between ill health and social support were found only for minor depression. Major depression was associated with variables reflecting long-standing vulnerability.nnnCONCLUSIONnMajor and minor depression differ in their association with physical health.nnnLIMITATIONnCross-sectional study relying largely on self-reported data.nnnCLINICAL RELEVANCEnIn major depression, with or without somatic co-morbidity, primary treatment of the affective disorder should not be delayed. In minor depression associated with declining physical health, intervention may be aimed at either or both conditions.

Longitudinal relationship between pain and depression in older adults: sex, age and physical disability

Objective Better understanding of the relationship between pain and depression in older adults in the community is of particular importance considering the high prevalence of both conditions in these adults. In the present study, the longitudinal relationship between pain and depression in older adults was examined, thereby taking into account the role of physical disability and the possibly modifying effect of sex and age. Methods The study is based on a sample which at the outset consisted of 325 non-depressed and 327 depressed persons (55–85) drawn from a larger random community-based sample in the Netherlands. Depression (CES-D) and pain (subscale of the Nottingham Health Profile) were measured at eight successive waves over 3 years. Results Pain was very persistent over time as was to a lesser extent depression. The prognosis of comorbid pain and depression was poor. In longitudinal analyses (Generalized Estimating Equations), pain and depression were strongly associated. At the symptom level, the pain-depression relationship was found to be stronger in men than in women. There was no effect of age on the pain-depression relationship. No support was found for the hypothesis that the pain-depression relationship is mediated by disability. Conclusion The persistent nature of pain and to a lesser extent depression and the intimate and probably reciprocal association between them stress the need for adequate treatment strategies.

Sex differences in late-life depression.

Sonnenberg CM, Beekman ATF, Deeg DJH, van Tilburg W. Sex differences in late‐life depression.

Predicting the course of depression in the older population : results from a community-based study in The Netherlands

This article is a report on the course of depressive syndromes in a community-based sample of older subjects in The Netherlands (n = 238). After baseline, the course of depression was assessed in five waves of follow-up measurements, covering 1 year. 52% of the subjects were never depressed; 16% suffered an incident depression, half of which remitted during the study; 8% had a depression at the start which remitted during the study; 14% were chronically depressed and in 10% the course was variable. Of those depressed at the start of the study, 32% remitted without relapse, 25% remitted but relapsed later and 43% were chronically depressed. While demographic variables were not predictive, health-related variables were predictive of both the onset and the course of depressive syndromes. Chronicity was associated with recent visits to general practitioners, indicating that treatment could have been provided relatively easily in many cases.

Functional disability and depression in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Objective:u2002 Data on the temporal relationships between duration of depression and recovery and functional disability are sparse. These relationships were examined in subjects from the general population (nu2003=u2003250) with newly originated episodes of DSM‐III‐R major depression.

The longitudinal effect of depression on functional limitations and disability in older adults: an eight-wave prospective community-based study.

BACKGROUNDnThe temporal relationship between depression and adverse functional outcomes in older adults is ambiguous. In the present eight-wave prospective community-based study, the longitudinal effect of depression on functional limitations and disability (in terms of disability days and bed days) was studied, thereby taking into account the role of chronic physical diseases.nnnMETHODSnThe study is based on a sample which at the outset consisted of 325 non-depressed and 327 depressed persons (55-85 years) drawn from a larger random community based sample in the Netherlands. Generalized estimating equations time-lag models were used to examine the longitudinal relation between depression and both functional limitations and disability.nnnRESULTSnFunctional limitations were very persistent over time, whereas disability days and bed days were more fluctuating functional outcomes. Only in the presence of chronic physical diseases, there was a significant longitudinal association between depression at the previous measurement and functional limitations, disability days and bed days at the next measurement. The effect on functional limitations was small, which was probably partly due to their persistent nature.nnnCONCLUSIONSnThe finding of a longitudinal relationship between depression and functional outcomes in older adults with a compromised health status provides a rationale for treatment of chronic physical diseases as well as depression in depressed chronically ill elderly, in order to prevent a spiralling decline in psychological and physical health.

Duration and severity of depression predict mortality in older adults in the community

BACKGROUNDnThe association between depression and mortality has become a topic of interest. Little is known about the association between the course of depression and mortality.nnnMETHODSnIn an initially non-depressed cohort (N = 325) and a depressed cohort (N = 327), depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves over a period of 3 years. Both cohorts were then followed with respect to mortality status for up to 3.5 additional years. Clinical course types as well as theoretical course type parameters (basic symptom levels, increases in symptoms and instability over time) were distinguished to study the effect of the course of depression on mortality.nnnRESULTSnContrary to transient states of depression, both chronic depression and chronic intermittent depression predicted mortality at follow-up. Additionally, evidence was found that the effect on mortality is related to severity of depression; high basic symptom levels and increases in symptoms over time were predictive of mortality. A high degree of instability over time was not associated with mortality.nnnCONCLUSIONSnSince the mortality effect of depression is a function of both exposure time and symptom severity, more attention should be paid to the treatment of depression in order to prevent severe longstanding depression.

What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).

BACKGROUNDnDepression is generally regarded as a serious, incapacitating illness. Although effective treatment strategies are available, timely recognition remains a stumbling block. We investigated the rates of health service uptake among depressed people and the specific depressive symptoms associated with service use, after adjustment for other illness characteristics and sociodemographic variables.nnnMETHODSnIn a representative sample (n=7076) of the Dutch adult population, we identified 1572 subjects with lifetime major or minor depression, using the Composite International Diagnostic Interview.nnnRESULTSnThe majority (73%) of subjects with depression had sought specialised mental health care, or to a lesser extent primary care. As expected, those with more severe (vegetative), complex (anxiety-comorbid) or dangerous symptoms (suicidal ideation) were more likely to be treated in the specialised mental health sector. However, subjects with comorbid substance use dependence were less likely to receive care, especially primary care, and those with more education were more likely to receive specialised care, even after adjustment for illness characteristics.nnnLIMITATIONSnThe use of lifetime measures of depression and service use may have introduced slight recall bias, but it made the assessments less vulnerable to selection bias for chronic cases and to misclassification of subjects with some lifetime treatment experience.nnnCONCLUSIONSnAlthough care for people with depression is readily accessible in the Netherlands, people with less education and people with comorbid substance use dependence remain unnecessarily out of reach of the care services. Primary care services need to be strengthened to enable the broad-scale application of stepped-care strategies.

The prognosis of depression in old age: Outcome six to eight years after clinical treatment

Previous studies suggest that the short-term outcome in severely depressed elderly in The Netherlands is worse compared to other studies in the Western world. The present study examines the long-term prognosis of hospitalized elderly patients with major depressive disorder and possible predictors of outcome. One hundred and five elderly inpatients with unipolar major depression, admitted by regional mental health services in a geographically delimited area, were evaluated six to eight years after index episode by trained residents using a structured diagnostic interview (C.I.D.I.) The GP was interviewed using a standard questionnaire. At follow-up 40% of the original sample had died. Of the survivors 33% had fared well, 24% had a relapsing course, 22% had residual symptoms, 11% were continuously ill, and 9% had probable dementia. With respect to prognostic factors, personality disorder predicted a worse outcome. All patients with a major depressive disorder at follow-up received specialised care and used antidepressants. None of the patients received ECT. The mortality rate in clinically treated elderly with major depressive disorder is high. Among survivors the long-term prognosis in The Netherlands is comparable with other studies to date. The presence of a personality disorder predicts worse outcome. Though the accessibility of services seems to be good, more vigorous treatment was not applied.