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The two-year course of late-life depression; results from the Netherlands study of depression in older persons
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BACKGROUND: We aimed to examine the course of depression during 2-year follow-up in a group clinically depressed older persons. Subsequently, we studied which socio-demographic and clinical characteristics predict a depression diagnoses at 2-year follow-up. METHODS: Data were used from the Netherlands Study of Depression in Older persons (NESDO; N = 510). Diagnoses of depression DSM-IV-TR criteria were available from 285 patients at baseline and at 2-year follow-up. Severity of the depressive symptoms, as assessed with the Inventory of Depressive Symptoms (IDS), was obtained from 6-monthly postal questionnaires. Information about socio-demographic and clinical variables was obtained from the baseline measurement. RESULT: From the 285 older persons who were clinically depressed at baseline almost half (48.4%) also suffered from a depressive disorder two years later. Patients with more severe depressive symptoms, comorbid dysthymia, younger age of onset and more chronic diseases were more likely to be depressed at 2-year follow-up. 61% of the persons that were depressed at baseline had a chronic course of depressive symptoms during these two years. CONCLUSIONS: Late-life depression often has a chronic course, even when treated conform current guidelines for older persons. Our results suggest that physical comorbidity may be candidate for adjusted and intensified treatment strategies of older depressed patients with chronic and complex pathology.
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![Figure 1 Course of depression (percentages). [Remission: at least the last two observations IDS score < 14; Intermittent: at least one of the observations IDS < 14 (not being the last two observations); Chronic depression, defined as all IDS scores > 14 and sub classified as: chronic mild to moderate depression, defined as all IDS scores between 14 and 26; chronic moderate to severe depression, defined as all IDS scores between 26 and 84; chronic depression with variable severity, defined as IDS scores varying between 14 to 84].](/paper-figures/3cef6723debe46aab071d484faab7eba/the-two-year-course-of-late-life-depression-results-from-the-netherlands-study-figure-1.jpg)
![Figure 2 Severity of depressive symptoms according to course during 2-year follow-up. [Remission: at least the last two observations IDS score < 14; Intermittent: at least one of the observations IDS < 14 (not being the last two observations); Chronic depression, defined as all IDS scores > 14 and sub classified as: chronic mild to moderate depression, defined as all IDS scores between 14 and 26; chronic moderate to severe depression, defined as all IDS scores between 26 and 84; chronic depression with variable severity, defined as IDS scores varying between 14 to 84].](/paper-figures/661796c74f554a4089fc4c6fbb45a400/the-two-year-course-of-late-life-depression-results-from-the-netherlands-study-figure-2.jpg)
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“The idiom 'thinking too much' denotes a broader mental health syndrome, with manifestations such as sadness, lack of motivation, poor concentration, sleep difficulties and irritability, perhaps similar to the construct of 'common mental disorders'. 112-117”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [115]
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Self-citationMetabolic dysregulation and late-life depression: a prospective study
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MethodMachine Learning Prediction of Treatment Outcome in Late-Life Depression
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“The study protocol of NESDO was approved by the ethical review boards of the five participating mental health centres and all participants have provided written informed consent (Comijs et al., 2015).”
Self-citationVucic, V., Radovanovic, S. M., Radevic, S. R., Savkovic, Z., Mihailović, N., Mihaljević, O., Mačužić, I. Ž., Djordjic, M. D., Gavrilović, A., & Matić, T. B. (2021) · Iranian Journal of Public Health · doi:10.18502/ijph.v50i10.7502 · Cited by 17
Orhan, M., Schouws, S. N. T. M., van Oppen, P., Stek, M. L., Naarding, P., Rhebergen, D., Dols, A., & Korten, N. C. M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.127 · Cited by 17
Self-citationde Wit, A. E., Giltay, E. J., de Boer, M. K., Bosker, F. J., van der Mast, R. C., Comijs, H. C., Voshaar, R. C. O., & Schoevers, R. A. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5040 · Cited by 14
“After baseline assessment, participants were invited for a second face‐to‐face interview with repeated measures of psychological, social, and physical functioning after 2 years.(23) During this period, 28 people died.”
MethodSelf-citationvan den Berg, K. S., Hegeman, J. M., van den Brink, R. H. S., Rhebergen, D., Voshaar, R. C. O., & Marijnissen, R. M. (2021) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5507 · Cited by 15
“The present study is part of the Netherlands Study of Depression in Older persons (NESDO), a multicentre prospective cohort study, designed to examine the determinants, course and consequences of late‐life depression.(22,23) Between 2007 and 2010, 378 depressed persons were recruited from both mental health institutio…”
BackgroundSelf-citationJones, E. C., Liebel, S. W., Hallowell, E. S., & Sweet, L. H. (2018) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2018.12.011 · Cited by 15
“Many studies suggest that depressive symptoms in middle-aged to older adults follow a chronic course, and that MDD prevention is much more effective than treatment (Comijs et al., 2015; Stahl et al., 2014).”
BackgroundLissemore, J. I., Mulsant, B. H., Rajji, T. K., Karp, J. F., Reynolds, C. F., Lenze, E. J., Downar, J. H., Chen, R. E., Daskalakis, Z. J., & Blumberger, D. M. (2021) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.200001 · Cited by 17
Age or age of onset: which is the best criterion to classify late-life depression?
Olgiati, P., Fanelli, G., & Serretti, A. (2023) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000472 · Cited by 13
“At the clinical level, LLD has been characterised by chronic course (Comijs et al., 2015) and increased morbidity and mortality (Unützer, 2007; Wei et al.”
BackgroundVoshaar, R. C. O., Dhondt, T. D. F., Fluiter, M., Naarding, P., Wassink‐Vossen, S., Smeets-Janssen, M. M. J., Pelzers, L. P. R. M., Lugtenburg, A., Veenstra, M. S., Marijnissen, R. M., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2176-6 · Cited by 13
Self-citationAnxiety in Late-Life Depression: Determinants of the Course of Anxiety and Complete Remission
van der Veen, D. C., Gulpers, B. J. A., van Zelst, W. H., Köhler, S., Comijs, H. C., Schoevers, R. A., & Voshaar, R. C. O. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.12.023 · Cited by 13
Self-citationThe predictive value of cortisol levels on 2-year course of depression in older persons
Kabia, F. M., Rhebergen, D., van Exel, E. R., Stek, M. L., & Comijs, H. C. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.10.006 · Cited by 13
Self-citationPsychoactive medication use and risk of suicide in long‐term care facility residents
Hedna, K., Fastbom, J., Jonson, M., Wilhelmson, K., & Wærn, M. (2022) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5684 · Cited by 10
“Identifying and treating depression among residents of LTCF may be challenging as symptoms are often experienced together with cognitive impairment, physical disorders, and other psychiatric disorders.(14,16) Therefore it may remain under recognized and under treated.”
BackgroundPorter, R., Moot, W., Inder, M., Crowe, M., Douglas, K. M., Carter, J. D., & FRAMPTON, C. M. A. (2022) · Brain Sciences · doi:10.3390/brainsci12121717 · Cited by 10
“Albers (2015 [22]) examined a slightly different measure—the Life Chart [23] in 285 elderly (>60 years) patients with depression (see also [24]).”
BackgroundSondermann, S., Stahl, J., Grave, U., Outzen, J., Moritz, S., & Klein, J. P. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00652 · Cited by 10
“This observation is in keeping with previous studies (33, 34), in particular Spijker et al.”
ResultLiu, Q., Leng, P., Gu, Y., Shang, X., Zhou, Y., Zhang, H., Zuo, L., Mei, G., Xiong, C., Wu, T., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04316-0 · Cited by 10
“Background Depression is a common mental illness in middle-aged and elderly men [1, 2], which reduces their life quality and expectancy, as well as increases risk of mortality and suicide [1–3].”
BackgroundAge as a moderating factor of treatment resistance in depression
Kautzky, A., Bartova, L., Fugger, G., Dold, M., Souery, D., Montgomery, S., Zohar, J., Mendlewicz, J., Fabbri, C., Serretti, A., et al. (2023) · European Psychiatry · doi:10.1192/j.eurpsy.2023.17 · Cited by 11
“Along these lines, in a longitudinal observation study in elderly MDD patients, being depressed 2 years after baseline was associated with earlier onset and chronicity of illness [50].”
Backgroundde Waal, M. W. M., Hegeman, J. M., Gussekloo, J., Verhaak, P. F. M., van der Mast, R. C., & Comijs, H. C. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.03.012 · Cited by 10
Self-citationOlder people with depression – a three-year follow-up
Borza, T., Engedal, K., Bergh, S., & Selbæk, G. (2019) · Tidsskrift for Den norske legeforening · doi:10.4045/tidsskr.18.0968 · Cited by 10
Value of Physical Activity and Sedentary Behavior in Predicting Depression in Older Adults
Wassink‐Vossen, S., Noorthoorn, E. O., Collard, R. M., Comijs, H. C., Voshaar, R. C. O., & Naarding, P. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14002 · Cited by 9
“1% female) and 132 elderly controls without depression.(3,4) In addition to site visits at baseline and 2-year follow-up for psychiatric assessment (Composite Interview Diagnostic Instrument version 2.”
BackgroundSelf-citationAtherogenic Indices Are Increased in Elderly Patients with Unipolar Depression—Case–Control Analysis
Łucka, A., Arabska, J., Fife, E., Kroc, Ł., Sołtysik, B. K., Kłoszewska, I., Sobów, T., Kostka, T., & Wysokiński, A. (2017) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2017.0008 · Cited by 9
“For the diagnosis of depression, the following codes were used: ICD-10: F32/F33, DSM-IV: 296.(2,3) In our units, diagnosis is based on the ICD-10 criteria, and DSM-IV codes were given as reference.”
MethodPeng, M., Liang, Z., & Wang, P. (2024) · International Journal of Social Psychiatry · doi:10.1177/00207640241255573 · Cited by 8
“Based on classification methods of changes in depression suggested by previous studies (Bruin et al., 2018; Comijs et al., 2015), using the data at 2011 baseline and 2018 follow-up, we categorized the participants into three groups, including those not at risk of depression (CES-D score < 8 at both…”
InfluentialThe impact of personality traits on the course of frailty
Bos, E. G. T., Douairi, J., Kok, R., Groeneweg‐Koolhoven, I., Ottenheim, N. R., Rhebergen, D., & Voshaar, R. C. O. (2023) · Clinical Gerontologist · doi:10.1080/07317115.2023.2165469 · Cited by 8
“%) were deceased (Comijs et al., 2015).”
InfluentialSelf-citationCardiovascular risk indicators among depressed persons: A special case?
van Zutphen, E. V., Kok, A. A. L., Muller, M., Voshaar, R. O., Rhebergen, D., Huisman, M., & Beekman, A. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.092 · Cited by 5
Self-citationBogers, I. C. H. M., Zuidersma, M., Boshuisen, M. L., Comijs, H. C., & Voshaar, R. C. O. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4541 · Cited by 8
“The baseline assessment took place between April 2007 and September 2010, and the 2-year follow-up assessments started in 2009 and were completed in September 2012 (Comijs et al., 2015).”
BackgroundSelf-citationStratmann, M. W., König, H., & Hajek, A. (2025) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.70160 · Cited by 9
Welsh, J., Banks, E., Joshy, G., Butterworth, P., Strazdins, L., & Korda, R. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-039628 · Cited by 5
Rosas, C., Oliveira, H. C., Neri, A. L., & Ceolim, M. F. (2022) · Enfermería Clínica (English Edition) · doi:10.1016/j.enfcle.2021.04.007 · Cited by 7
Hohls, J. K., König, H., & Hajek, A. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02373-0 · Cited by 7
Vascular and metabolic risk factors of late-life depression
Geraets, A. F. J., Köhler, S., & Schram, M. T. (2022) · Vessel Plus · doi:10.20517/2574-1209.2021.102 · Cited by 10
da Rocha, C. G., von Gunten, A., Vandel, P., Jopp, D. S., Ribeiro, O. M. P. L., & Verloo, H. (2025) · JMIR Aging · doi:10.2196/64352 · Cited by 6
“This aligns with existing literature documenting distinct clinical profiles for persistent and nonchronic depressive disorders in adults aged 18 to 79 years [96,97], with persistent cases often involving earlier onset, more severe symptoms, and greater treatment resistance [96].”
Early-onset late-life depression: Association with body mass index, obesity, and treatment response
Chae, W. R., Fuentes, M., Gutknecht, F., Ljubez, A., Gold, S. M., Wingenfeld, K., & Otte, C. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100096 · Cited by 8
“Similarly, younger age at onset and more chronic diseases were associated with chronic course of depression in elderly depressed patients [22].”
BackgroundZuidersma, M., Comijs, H. C., Naarding, P., & Voshaar, R. C. O. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4416 · Cited by 6
“Details of this study are described elsewhere (Comijs et al., 2011; Comijs et al., 2015).”
MethodSelf-citationPrevalence of depression in elderly and relations to chronic diseases
Gajović, G., Kocic, S. S., Radovanovic, S. M., Simić-Vukomanović, I., Janicijevic, K. M., & Radevic, S. R. (2019) · Vojnosanitetski pregled · doi:10.2298/vsp190719098g · Cited by 5
Wolter, D. K. (2016) · Zeitschrift für Gerontologie und Geriatrie · Cited by 5
Fiske, A., Ebert, A. R., Fenstermacher, E., & Owsiany, M. T. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00043-1 · Cited by 5
Open issues in bipolar and antipsychotic treatments
Serretti, A. (2022) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000440 · Cited by 4
Cesur, N. U., & Poyraz, B. Ç. (2023) · Psychiatric Quarterly · doi:10.1007/s11126-023-10053-8 · Cited by 4
“Notably, higher rates of persistent depression tend to be observed in clinical sample studies, ranging from 23% to 61.2% [48–50].”
BackgroundInfluentialShort-term course and outcome of late-life depression
Srivastava, S., Kumar, A., Khurana, H., Tiwari, S. C., & Akbar, S. (2015) · Journal of Geriatric Mental Health · doi:10.4103/2348-9995.174275 · Cited by 5
Feliciano, L., Gum, A. M., & Johanson, K. A. (2019) · Springer eBooks · doi:10.1007/978-1-4939-9127-3_9 · Cited by 4
Rivoli, F. M. S., Galhardo, A. P. G. M., Lucchetti, G., Ésper, L. A., Ribeiro, Y. L., Santos, G. D. S., JOSÉ, H. M. G., Sousa, L., Low, G., & Vitorino, L. M. (2025) · Healthcare · doi:10.3390/healthcare13070807 · Cited by 3
“The observed increase in depressive symptoms, as measured by the GDS-15, aligns with prior studies highlighting a growing burden of emotional distress among older adults over time [19–21].”
Trajectories of Depression in Late Life: A 1-Year Follow-Up Study
Borza, T., Engedal, K., Bergh, S., Benth, J. Š., & Selbæk, G. (2017) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000458148 · Cited by 3
Frailty measures in immuno-metabolic subtypes of late-life depression; A two-year prospective study
Kokkeler, K. J. E., Voshaar, R. C. O., Rhebergen, D., van den Brink, R. H. S., Spijker, J., & Marijnissen, R. M. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104603 · Cited by 3
Self-citation
Metadata
- Authors
- Comijs, H. C., Nieuwesteeg, J., Kok, R., van Marwijk, H. W., van der Mast, R. C., Naarding, P., Voshaar, R. C. O., Verhaak, P., de Waal, M. W., & Stek, M. L.
- Affiliations
- Amsterdam Public Health (NL)
- GGZ inGeest (NL)
- Parnassia Groep (NL)
- GGNet (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Comijs, Hannie C
- Venue
- BMC Psychiatry
- Published
- 2015-02-12
- Volume
- 15
- Issue
- 1
- Pages
- 20-20
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4329675
- OpenAlex
- W2059949121
- Cited by
- 136
- References
- 47
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 4 · 2023: 10 · 2022: 15 · 2021: 19 · 2020: 9 · 2019: 16 · 2018: 19 · 2017: 14 · 2016: 14 · 2015: 3
- FWCI
- 17.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Research Explorer (The University of Manchester) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Funders
- Vrije Universiteit Amsterdam
- Fonds NutsOhra (0701-065, project 0701‐065)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- geriatric depression, course of depression, older adults, chronic depression, depression severity, dysthymia, age of onset, comorbidities, chronic physical illness, predictors of recurrence
- MeSH terms
- Aged, Aged, 80 and over, Chronic Disease, Depression, Depressive Disorder, Female, Humans, Male, Middle Aged, Netherlands, Personality Inventory, Surveys and Questionnaires, Recurrence, Comorbidity, Treatment Outcome, Dysthymic Disorder
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