Prim Care Companion J Clin Psychiatry 2007;9:74-79
© Copyright 2014 Physicians Postgraduate Press, Inc.
To assess the incidence and clinical predictors of symptom
deterioration in depressed elderly patients who have responded to treatment
in primary care.
Method: This was a cohort study enrolling 901 older adults who met
DSM-IV criteria for major depressive disorder and/or dysthymia at baseline.
Participants were drawn from 18 primary care clinics in 5 states.
They had participated in a trial of collaborative care for depression compared
with usual care and had improved sufficiently to no longer meet
criteria for major depressive disorder at 12 months. Participants were
evaluated for 1 year (18 and 24 months) after enrolling in the original
Results: Over the 12- to 24-month observational period, 40% of patients
met criteria for significant depressive symptom deterioration.
Greater initial severity of depression and a greater number of residual
DSM-IV depressive symptoms at 12 months constituted significant predictors
of symptom deterioration among usual-care patients. Symptom deterioration
in intervention patients was not predicted by any variables.
Conclusions: Elderly patients in primary care who are treated for
depression evince a high rate of symptom deterioration. Attempts to improve
long-term outcomes of older patients with major depressive disorder
and/or dysthymia ought to concentrate on supplying more intensive treatment
and follow up for patients with residual symptoms of depression.