The natural history of late-life depression - A 6-year prospective study in the community
The natural history of late-life depression - A 6-year prospective study in the community
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DOI：
10.1001/archpsyc.59.7.605
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发表时间：
2002-07-01
影响因子：
--
通讯作者：
van Tilburg, W
中科院分区：
文献类型：
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作者：
Beekman, ATF;Geerlings, SW;van Tilburg, W
背景：对晚年抑郁症自然史的准确评估需要长期的频繁观察。在晚年，符合严格诊断标准的抑郁症相对罕见，而阈下障碍则很常见。主要目的是研究晚年抑郁症的自然史，系统地比较那些谁没有满足严格的诊断criteria.Methods：在纵向老龄化研究阿姆斯特丹，一个大的队列抑郁症老年人（n = 277）被确定和随访6年，使用14个观察。抑郁症是通过自我报告（流行病学研究中心抑郁量表）和诊断访谈（诊断访谈时间表）来测量的。自然史，进行了评估的症状严重程度（中心流行病学研究抑郁量表评分），症状持续时间，临床病程类型，和稳定的diagnosis.Results：平均症状严重程度保持在人口平均水平的第85百分位数以上6年。只有14%的患者症状短暂。23%的患者病情缓解，44%的患者病情不利但波动，32%的患者病情严重（由于四舍五入，百分比总和未达到100）。比较结果，有一个明显的梯度，其中阈下障碍的结果最好，其次是重度抑郁症，心境恶劣障碍和双重抑郁症。然而，在大多数情况下，阈下障碍的预后是不利的，而这组是在高风险的发展DSM的情感disorders.Conclusions：晚年抑郁症的自然史在社区是穷人。DSM情感障碍在老年人中相对罕见，但确实确定了那些预后最差的人，然而，阈下抑郁症在许多情况下是严重的和慢性的。
Background: Accurate assessment of the natural history of late-life depression requires frequent observation over time. In later life, depressive disorders fulfilling rigorous diagnostic criteria are relatively rare, while subthreshold disorders are common. The primary aim was to study the natural history of late-life depression, systematically comparing those who did with those who did not fulfill rigorous diagnostic criteria.Methods: Within the Longitudinal Aging Study Amsterdam, a large cohort of depressed elderly persons (n = 277) was identified and followed up for 6 years, using 14 observations. Depression was measured using self-reports (the Center for Epidemiological Studies Depression Scale) and diagnostic interviews (the Diagnostic Interview Schedule). The natural history, was assessed for symptom severity (Center for Epidemiological Studies Depression Scale score), symptom duration, clinical course type, and stability of diagnoses.Results: The average symptom severity remained above the 85th percentile of the population average for 6 years. Symptoms were short-lived in only 14%. There were remissions in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32% (percentages do not total 100 because of rounding). Comparing the outcome, there was a clear gradient in which those with subthreshold disorders had the best outcome, followed by those with major depressive disorder, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases, while this group was at high risk of developing DSM affective disorders.Conclusions: The natural history of late-life depression in the community is poor. DSM affective disorders are relatively rare among elderly persons, but do identify those with the worst prognosis, However, subthreshold depression is serious and chronic in many cases.