Course, risk factors, and prognostic factors in elderly primary care patients with mild depression: a two-year observational study

Magnil, Maria, Janmarker, Lena, Gunnarsson, Ronny, and Bjorkelund, Cecilia (2013) Course, risk factors, and prognostic factors in elderly primary care patients with mild depression: a two-year observational study. Scandinavian Journal of Primary Health Care, 31 (1). pp. 20-25.

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Abstract

Objective. The aim of this study was to observe course, risk factors, and prognostic factors in a primary care cohort aged > 60 with mild to moderate depression during two-year follow-up. Design. Observational study. Setting. Primary care. Subjects and method. During an 11-month period all (n = 302) consecutive patients aged 60 and above attending a primary care centre in Gothenburg, Sweden were screened by a nurse for depressive symptoms with the Primary Care Evaluation of Mental Disorders, Patient Questionnaire (PRIME-MD PQ) and the Montgomery-Asberg Depression Rating Scale, self-rated version (MADRS-S) and by a GP with a patient-centred consultation model. In the second step, the GPs diagnosed depression in screen-positives by use of the PRIME-MD Clinical Evaluation Guide (PRIME-MD CEG). All patients with mild to moderate depression were followed up for two years to assess course with several MADRS-S score assessments. Main outcome measures. Risk factors, prognostic factors, and symptoms at baseline and after two years were tested with logistic regression, using the DSM-IV and MADRS-S (cut-off >= 13) respectively. Course patterns were observed and described. Results. A total of 54 patients were diagnosed with depression. Follow-up revealed declining median MADRS-S scores and three course patterns: remitting, stable, and fluctuating. History of depression, significant life events, lacking leisure activities, and use of sedatives were risk factors for depression, all previously known. An important finding was that lacking leisure activities also increased the risk of depressive symptoms after two years (odds ratio 12, confidence interval 1.1-136). Conclusion. It is desirable to identify elderly individuals with less severe depression. Three course patterns were observed; this finding requires further study of the clinical characteristics related to the different patterns. Awareness of risk factors may facilitate identification of those at highest risk of poor prognosis.

Item ID: 25515
Item Type: Article (Research - C1)
ISSN: 1502-7724
Keywords: depression, elderly, general practice, longitudinal, primary care, prognosis, Sweden
Additional Information:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.

Funders: Region Västra Götaland, Gothenburg Primary Care
Date Deposited: 13 Mar 2013 05:25
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111702 Aged Health Care @ 40%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 60%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920502 Health Related to Ageing @ 70%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920410 Mental Health @ 30%
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