Department of Old-age Psychiatry, GGNet Apeldoorn/Zutphen, The Netherlands.
Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
Eur Psychiatry. 2019 Oct;62:90-96. doi: 10.1016/j.eurpsy.2019.09.003. Epub 2019 Sep 21.
In mental health research, functional recovery is increasingly valued as an important outcome in addition to symptomatic remission.
Course types of functional limitations among depressed older patients and its relation with symptomatic remission were explored in a naturalistic cohort study (Netherlands Study of Depression in Older persons). 378 depressed older patients (≥60 years) and 132 non-depressed persons were included. Depressive disorders were assessed with Composite International Diagnostic Interview at baseline and two-year follow-up. Functional limitations were assessed every 6 months with the World Health Organization Disability Assessment II.
Depressed patients had more functional limitations compared to their non-depressed counterparts. Growth Mixture Modeling among depressed patients identified two trajectories of functional limitations, both starting at a high disability level. The largest subgroup (81.2%) was characterized by a course of high disability levels over time. The smaller subgroup (18.8%) had an improving course (functional recovery). After two years, the main predictor of functional recovery was the remission of depression. Among symptomatic remitted patients, female sex, higher level of education, higher gait speed, and less severe depression were associated with no functional recovery. Non-remitted patients without functional recovery were characterized by the presence of more chronic somatic diseases, a lower sense of mastery, and a higher level of anxiety.
1 in 5 depressed older patients have a course with functional recovery. Combining functional and symptomatic recovery points to a subgroup of older patients that might profit from more rigorous psychiatric treatment targeted at psychiatric comorbidity and a group of frail depressed older patients that might profit from integrated geriatric rehabilitation.
在精神健康研究中，除了症状缓解外，功能恢复也越来越被视为一个重要的结果。
在一项自然队列研究（荷兰老年人抑郁研究）中，探讨了老年抑郁患者功能障碍的类型及其与症状缓解的关系。纳入 378 名老年抑郁患者（≥60 岁）和 132 名非抑郁者。在基线和两年随访时，使用复合国际诊断访谈评估抑郁障碍。每 6 个月用世界卫生组织残疾评估量表 II 评估一次功能障碍。
与非抑郁者相比，抑郁患者的功能障碍更多。对抑郁患者进行增长混合建模，发现了两种功能障碍轨迹，都从高残疾水平开始。最大的亚组（81.2%）表现为随时间残疾水平升高的轨迹。较小的亚组（18.8%）表现为改善的轨迹（功能恢复）。两年后，功能恢复的主要预测因素是抑郁的缓解。在症状缓解的患者中，女性、较高的教育水平、较高的步速和较轻的抑郁与无功能恢复相关。无功能恢复的非缓解患者的特征是存在更多的慢性躯体疾病、较低的控制感和较高的焦虑水平。
1/5 的老年抑郁患者有功能恢复的过程。结合功能和症状缓解，指向了一个可能从更严格的针对精神共病的精神科治疗中获益的老年患者亚组，和一个可能从综合老年康复中获益的体弱抑郁老年患者亚组。
