A Six-Year Prospective Study of the Prognosis and Predictors in Patients With Late-Life Depression
A Six-Year Prospective Study of the Prognosis and Predictors in Patients With Late-Life Depression
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DOI：
10.1016/j.jagp.2018.05.005
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发表时间：
2018-09-01
影响因子：
7.2
通讯作者：
Comijs, Hannie C.
中科院分区：
文献类型：
--
作者：
Jeuring, Hans W.;Stek, Max L.;Comijs, Hannie C.
目的：研究老年抑郁症患者的6年预后，并确定不利预后的因素。设计和设置：荷兰老年人抑郁症研究（NESDO）是一项多地点自然主义前瞻性队列研究，随访6年。参会人员：在2007年至2010年期间，纳入了378例临床抑郁症患者（根据精神疾病诊断和统计手册第四版文本修订标准）和132例非抑郁症患者的基线比较。测量值：抑郁症是衡量在6个月的时间间隔和诊断访谈的抑郁症状量表在2年和6年的后续行动。多项回归和混合模型分析都被用来确定抑郁症相关的临床，健康和心理社会预后因素的一个不利的过程。结果：在基线时的抑郁症患者中，46.8%失访; 15.9%的患者病程不利，即，慢性或复发; 24.6%部分缓解; 12.7%在6年随访时完全缓解。与非抑郁症患者相比，抑郁症患者死亡的相对风险为2.5（95%置信区间1.26-4.81）。抑郁症的不良病程与抑郁症发作时的年龄较小、抑郁症、疼痛和神经质的症状严重程度较高以及基线时的孤独感有关。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相关。结论：就死亡率和抑郁病程而言，老年抑郁症的长期预后较差。慢性病、孤独和疼痛可以作为优化复发和慢性病预防和治疗策略的假定目标。
Objectives: To examine the six-year prognosis of patients with late-life depression and to identify prognostic factors of an unfavorable course. Design and Setting: The Netherlands Study of Depression in Older Persons (NESDO) is a multisite naturalistic prospective cohort study with six-year follow-up. Participants: 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. Measurements: 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. Results: 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. Conclusions: 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.