Wednesday, 20 August 2003
This presentation is part of : Predictors of Psychopathology in the Elderly

S065-001 Predicting the Prognosis of Late Life Depression: Is Community-Based Prevention of Chronicity Feasible?

Robert Schoevers1, Aartjan Beekman2, Dorly Deeg3, Cees Jonker2, and Willem Van Tilburg2. (1) psychiatry, Vrije Universiteit Amsterdam & Mentrum GGZ Amsterdam, Amsterdam, Netherlands, (2) psychiatry, GGZ Buitenamstel Vrije Universiteit, Amsterdam, Netherlands, (3) Institute for Extramural Medicine, Vrije Universiteit Amsterdam, Amsterdam, Netherlands

Objective: To study risk factors related to incidence and prognosis of late-life depression. To determine whether community based prevention of chronicity is feasible based on these and other findings in the literature.

Design: A prospective model for prognosis of depression (chronic or remitted course) in later life was studied in 236 depressed community-living elderly, as part of the Amsterdam Study of the Elderly. Subjects were interviewed at baseline, and at follow-up three years later.

Materials and Methods: Bivariate and multivariate relationships between risk factors and chronic depression (GMS-AGECAT) were assessed. Effect modification was studied between stressors and two types of vulnerability: vulnerability through a personal history of depression, and gender.

Results: A personal history of depression, baseline functional limitations and incident anxiety syndrome predicted chronic depression, whereas life-events occurring between assessments, and changes in physical, functional or cognitive status did not. In subjects without a previous history, functional disabilities, male gender and receiving instrumental support correlated with a poor prognosis. The prognosis for subjects with a personal history of depression was not affected by other factors. In women, the development of chronicity was more strongly associated with a personal history than in men, whereas in men recent psychosocial and health related characteristics were more important than in women.

Conclusion: In the elderly, the impact of risk factors on the course of depression is modified by longstanding vulnerability characteristics, such as a personal history of depression and gender. More recent life stresses are related to prognosis in subjects without a personal history, and in men. The implications and limitations of these and related findings of community based studies for designing preventive strategies of chronic depression will be discussed.

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