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One-year outcomes of minor and subsyndromal depression in older primary care patients

  • Jeffrey M. Lyness (a1), Benjamin P. Chapman (a1), Joanne McGriff (a1), Rebecca Drayer (a2) and Paul R. Duberstein (a1)...

Background: Despite the high prevalence and morbidity of minor and subsyndromal depression in primary care elderly people, there are few data to identify those at highest risk of poor outcomes. The goal of this observational cohort study was to characterize the one-year outcomes of minor and subsyndromal depression, examining the predictive strength of a range of putative risks including clinical, functional and psychosocial variables.

Methods: Patients aged ≥ 65 years were recruited from primary care medicine and family medicine practices. Of 750 enrollees, 484 (64.5%) completed baseline and one-year follow-up assessments of depression diagnosis (major depression vs. minor and subsyndromal depression vs. non-depressed) by the Structured Clinical Interview for DSM-IV, depressive symptom severity (Hamilton Rating Scale for Depression), and validated measures of other predictors.

Results: Patients with baseline minor and subsyndromal depression were more depressed than the non-depressed group at follow-up: They had a 7.0-fold (95% CI 4.5–10.8) risk of developing major depression, and a one-year adjusted Hamilton Depression Score of 11.0 (95% CI 10.2–11.8) compared with 7.8 (95% CI 7.1–8.5) for the non-depressed group; these outcomes were less severe than those of the major depression group. Independent predictors of depression outcomes included race, psychiatric and physical functioning, and social support.

Conclusions: Minor and subsyndromal depression are likely to persist, and pose an elevated risk of worsening over one year. Clinicians and preventive interventions researchers should focus on modifiable risks, such as psychiatric functioning or social support, in elders suffering clinically significant depressive symptoms.

Corresponding author
Correspondence should be addressed to: Jeffrey M. Lyness, MD, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, U.S.A. Phone: +1 585 275 6741; Fax: +1 585 273 1082. Email:
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Alexopoulos, G. S. et al. (1996). Recovery in geriatric depression. Archives of General Psychiatry, 53, 305312.
Bruce, M. L. et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 291, 10811091.
Charney, D. S. et al. (2003). Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life. Archives of General Psychiatry, 60, 664672.
Ciechanowski, P. et al. (2004). Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA, 291, 15691577.
Cole, M. G. and Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160, 11471156.
Costa, P. T. and McCrae, R. R. (1992). The NEO Personality Inventory: Revised Professional Manual. Odessa, FL: Psychological Assessment Resources.
Cui, X., Lyness, J. M., Tu, X., King, D. A. and Caine, E. D. (2007). Does depression precede or follow executive dysfunction? Outcomes in older primary care patients. American Journal of Psychiatry, 164, 12211228.
Cui, X., Lyness, J. M., Tang, W., Tu, X. and Conwell, Y. (2008). Outcomes and predictors of late-life depression trajectories in older primary care patients. American Journal of Geriatric Psychiatry, 16, 406415.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Gallo, J. J. and Coyne, J. C. (2000). The challenge of depression in late life: bridging science and service in primary care. JAMA, 284, 15701572.
Gallo, J. J., Bogner, H. R., Morales, K. H. and Ford, D. E. (2005). Patient ethnicity and the identification and active management of depression in late life. Archives of Internal Medicine, 165, 19621968.
Harris, T., Cook, D. G., Victor, C., DeWilde, S. and Beighton, C. (2006). Onset and persistence of depression in older people–results from a 2-year community follow-up study. Age and Ageing, 35, 2532.
Karnofsky, D. A. and Burchenal, J. H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In C. M. MacLeod (Ed.) Evaluation of Chemotherapeutic Agents New York: Columbia.
Landerman, R., George, L. K., Campbell, R. T. and Blazer, D. G. (1989). Alternative models of the stress buffering hypothesis. American Journal of Community Psychology, 17, 625642.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people. Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.
Linn, B. S., Linn, M. W. and Gurel, L. (1968). Cumulative illness rating scale. Journal of the American Geriatrics Society, 16, 622626.
Lyness, J. M. et al. (2006). Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Annals of Internal Medicine, 144, 496504.
Lyness, J. M. et al. (2007). The clinical significance of subsyndromal depression in older primary care patients. American Journal of Geriatric Psychiatry.
McAvay, G. J., Bruce, M. L., Raue, P. J. and Brown, E. L. (2004). Depression in elderly homecare patients: patient versus informant reports. Psychological Medicine, 34, 15071517.
Murrell, S. A., Norris, F. H. and Hutchins, G. M. (1984). Distribution and desirability of life events in older adults: population and policy implications. Journal of Community Psychology, 12, 301311.
Pinquart, M., Duberstein, P. R. and Lyness, J. M. (2006). Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy. American Journal of Psychiatry, 163, 14931501.
Schoevers, R. A. et al. (2006). Prevention of late-life depression in primary care: do we know where to begin? American Journal of Psychiatry, 163, 16111621.
Schulberg, H. C., Mulsant, B., Schulz, R., Rollman, B. L., Houck, P. R. and Reynolds, C. F. (1998). Characteristics and course of major depression in older primary care patients. International Journal of Psychiatry in Medicine, 28, 421436.
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165173.
Simon, G. E. et al. (2002). Cost-effectiveness of a program to prevent depression relapse in primary care. Medical Care, 40, 941950.
Smit, F., Ederveen, A., Cuijpers, P., Deeg, D. and Beekman, A. (2006). Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Archives of General Psychiatry, 63, 290296.
Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1994). Structured Clinical Interview For Axis I DSM-IV Disorders: Biometrics Research Department, New York State Psychiatric Institute.
Travis, L. A., Lyness, J. M., Shields, C. G., King, D. A. and Cox, C. (2004). Social support, depression, and functional disability in older adult primary-care patients. American Journal of Geriatric Psychiatry, 12, 265271.
Unutzer, J. et al. (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288, 28362845.
Williams, J. B. W. (1988). A structured interview guide for the Hamilton depression rating scale. Archives of General Psychiatry, 45, 742747.
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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
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