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Time-to-Remission From Geriatric Depression

Psychosocial and Clinical Factors

Received June 22, 2001; revised August 3, November 20, 2001; accepted November 27, 2001. From the Health Services Research and Development, Durham VAMC (HBB), the Center for Aging and Human Development, Duke University Medical Center (HBB,DRM,LKG,DCS), the Department of Medicine, Division of General Internal Medicine, Duke University Medical Center (HBB), the Department of Psychiatry and Behavioral Science, Duke University Medical Center (HBB,DRM,LKG,DCS), and the Department of Sociology, Duke University, Durham, NC (LKG). Address correspondence to Dr. Bosworth, Health Services Research and Development, Building 16, Room 70, Durham Veterans Affairs Medical Center (152), 508 Fulton St., Durham NC 27705. e-mail: hboswort{at}acpub.duke.edu

OBJECTIVE: The authors examined psychosocial and clinical predictors of time-to-remission in a sample of initially clinically depressed elderly patients. METHODS: Using a standardized algorithm, a prospective cohort study enrolled 239 patients undergoing treatment. Patients were followed for up to 4.5 years, until death or withdrawal from the study. Baseline predictor variables included psychosocial factors, such as four domains of social support; basic and instrumental activities of daily living; and clinical factors, including use of electroconvulsive therapy (ECT), past history of depression, comorbidities, and antidepressant treatment. RESULTS: Only 33% of the sample (n=79) met our classification for depression remission. A lack of instrumental and subjective social support, poor self-rated health, the use of antipsychotic medication, or use of an antidepressant in the last 7 days were predictors of longer time-to-remission. Use of ECT in the last year was related to shorter time-to-remission. CONCLUSION: Baseline psychosocial factors were just as important, as predictors of depression remission, as were clinical and diagnostic variables. Interventions directed toward social support resources, in addition to clinical intervention, including the use of ECT where appropriate, are likely to improve rates of depression remission.

Key Words: Depression • Psychosocial Factors • Outcome Studies

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