Department of Psychiatry, GGZ in Geest, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Department of Psychiatry, GGZ in Geest, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Am J Geriatr Psychiatry. 2018 Sep;26(9):985-997. doi: 10.1016/j.jagp.2018.05.005. Epub 2018 May 17.
To examine the six-year prognosis of patients with late-life depression and to identify prognostic factors of an unfavorable course.
The Netherlands Study of Depression in Older Persons (NESDO) is a multisite naturalistic prospective cohort study with six-year follow-up.
Three hundred seventy-eight clinically depressed patients (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria) and 132 nondepressed comparisons were included at baseline between 2007 and 2010.
Depression was measured by the Inventory of Depressive Symptomatology at 6-month intervals and a diagnostic interview at 2- and 6-year follow-up. Multinomial regression and mixed model analyses were both used to identify depression-related clinical, health, and psychosocial prognostic factors of an unfavorable course.
Among depressed patients at baseline, 46.8% were lost to follow-up; 15.9% had an unfavorable course, i.e., chronic or recurrent; 24.6% had partial remission; and 12.7% had full remission at six-year follow-up. The relative risk of mortality in depressed patients was 2.5 (95% confidence interval 1.26-4.81) versus nondepressed comparisons. An unfavorable course of depression was associated with a younger age at depression onset; higher symptom severity of depression, pain, and neuroticism; and loneliness at baseline. Additionally, partial remission was associated with chronic diseases and loneliness at baseline when compared with full remission.
The long-term prognosis of late-life depression is poor with regard to mortality and course of depression. Chronic diseases, loneliness, and pain may be used as putative targets for optimizing prevention and treatment strategies for relapse and chronicity.
研究老年期抑郁症患者的六年预后，并确定预后不良的预测因素。
荷兰老年人抑郁研究（NESDO）是一项多地点自然前瞻性队列研究，随访时间为六年。
共有 378 名临床确诊的抑郁患者（根据《精神障碍诊断与统计手册》第四版修订版标准）和 132 名非抑郁对照者在 2007 年至 2010 年期间被纳入基线。
采用抑郁症状清单在 6 个月的时间间隔内进行抑郁评估，并在 2 年和 6 年的随访中进行诊断访谈。采用多项回归和混合模型分析来确定与抑郁相关的临床、健康和心理社会预后不良的预测因素。
在基线时有抑郁症状的患者中，有 46.8%的患者失访；15.9%的患者预后不良，即慢性或复发性；24.6%的患者部分缓解；12.7%的患者在六年随访时完全缓解。与非抑郁对照组相比，抑郁患者的死亡风险相对较高，为 2.5（95%置信区间 1.26-4.81）。在基线时，抑郁发病年龄较小、抑郁、疼痛和神经质症状严重程度较高、孤独感较强与预后不良的抑郁有关。此外，与完全缓解相比，部分缓解与基线时的慢性疾病和孤独感有关。
老年期抑郁症的长期预后较差，死亡率和抑郁的病程都不理想。慢性疾病、孤独感和疼痛可能被用作优化复发和慢性预防和治疗策略的潜在靶点。
