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The two-year course of late-life depression; results from the Netherlands study of depression in older persons
Open accessAbstract
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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“Background Late-life depression is a complex mood disorder with various etiological pathways [1] and high comorbidity with psychiatric and physical diseases, and cognitive decline [2-5].”
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“Late-life depression often has a chronic course and high relapse rates [6-15], probably worse compared to younger age groups [16].”
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“Among younger adults, clinical characteristics of the depression such as the severity of the depressive disorder, comorbid anxiety symptoms and age of onset are consistently found to be important predictors of the course [16-18].”
BackgroundCohort Profile: The Longitudinal Aging Study Amsterdam
Huisman, M. A., Poppelaars, J. L., van der Horst, M., Beekman, A. T. F., Brug, J., van Tilburg, T. G., & Deeg, D. J. H. (2011) · International Journal of Epidemiology · doi:10.1093/ije/dyq219 · Cited by 477
The Natural History of Late-Life Depression
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“[6] showed a gradient with respect to the prognosis of late-life depression, in which those with sub threshold disorders had the best outcome, followed by those with major depressive disorder (MDD), dysthymia and double depression (MDD and dysthymia).”
BackgroundResultPenninx, B. W. J. H., Nolen, W. A., Lamers, F., Zitman, F. G., Smit, J. H., Spinhoven, P., Cuijpers, P., de Jong, P. J., van Marwijk, H. W. J., der Meer, K. V., et al. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.03.027 · Cited by 354 · cited 5×
“In the aforementioned comparable NESDA study among younger adults aged 18–65, the two-year attrition rate was 12.9% which was relatively low compared to other epidemiological studies in psychiatric samples and was mainly due to refusal to further participate [33].”
BackgroundMethodInfluentialSelf-citationMitchell, A. J., & Subramaniam, H. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.9.1588 · Cited by 348 · cited 1×
“Late-life depression often has a chronic course and high relapse rates [6-15], probably worse compared to younger age groups [16].”
BackgroundExecutive dysfunction and the course of geriatric depression
Alexopoulos, G. S., Kiosses, D. N., Heo, M., Murphy, C. F., Shanmugham, B., & Gunning-Dixon, F. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.04.024 · Cited by 317 · cited 1×
“Increased time to recovery from late-life depression is previously found to be associated with severity of depressive symptoms [19], but also with chronicity, later age of onset, cognitive decline [19,20] and medical comorbidity [21].”
BackgroundTedeschini, E., Levkovitz, Y., Iovieno, N., Ameral, V. E., Nelson, J. C., & Papakostas, G. I. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10r06531 · Cited by 269
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Andreescu, C., Lenze, E. J., Dew, M. A., Begley, A. E., Mulsant, B. H., Dombrovski, A. Y., Pollock, B. G., STACK, J. A., Miller, M. D., & Reynolds, C. F. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.027169 · Cited by 199 · cited 1×
“Late-life depression often has a chronic course and high relapse rates [6-15], probably worse compared to younger age groups [16].”
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ResultComorbidity of depression and anxiety disorders in later life
Lenze, E. J., Mulsant, B. H., Shear, M. K., Alexopoulos, G. S., Frank, E., & Reynolds, C. F. (2001) · Depression and Anxiety · doi:10.1002/da.1050 · Cited by 180 · cited 1×
“Background Late-life depression is a complex mood disorder with various etiological pathways [1] and high comorbidity with psychiatric and physical diseases, and cognitive decline [2-5].”
BackgroundThe Netherlands study of depression in older persons (NESDO); a prospective cohort study
Comijs, H. C., van Marwijk, H., van der Mast, R. C., Naarding, P., Voshaar, R. C. O., Beekman, A. T. F., Boshuisen, M. L., Dekker, J. H., Kok, R., de Waal, M. W. M., et al. (2011) · BMC Research Notes · doi:10.1186/1756-0500-4-524 · Cited by 174
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“Although pharmacological and psychotherapy are effective treatments for late-life depression [35,36], it is suggested that antidepressants may be less efficacious in in older depressed patients compared to younger ones [37,38].”
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“Our findings are largely in line with expectations from community based, primary care and other clinical samples of older persons [6,10,13,15,32].”
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“Although pharmacological and psychotherapy are effective treatments for late-life depression [35,36], it is suggested that antidepressants may be less efficacious in in older depressed patients compared to younger ones [37,38].”
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“The IDS is sensitive to both change over time and to differences between treatment conditions [30].”
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“Among younger adults, clinical characteristics of the depression such as the severity of the depressive disorder, comorbid anxiety symptoms and age of onset are consistently found to be important predictors of the course [16-18].”
BackgroundIDS-C and IDS-SR: Psychometric properties in depressed in-patients
Corruble, E., Legrand, J. M., Duret, C., Charles, G., & Guelfi, J. D. (1999) · Journal of Affective Disorders · doi:10.1016/s0165-0327(99)00055-5 · Cited by 89
The Netherlands Study of Depression in Older persons (NESDO)
Comijs, H. C., & Dekker, J. H. (2011) · University of Groningen research database (University of Groningen / Centre for Information Technology) · Cited by 73
Self-citationThe Course of Depression in Elderly Patients
Mueller, T. I., Kohn, R., Leventhal, N., Leon, A. C., Solomon, D., Coryell, W. H., Endicott, J., Alexopoulos, G. S., & Keller, M. B. (2004) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200401000-00003 · Cited by 72 · cited 1×
“Late-life depression often has a chronic course and high relapse rates [6-15], probably worse compared to younger age groups [16].”
BackgroundThe prognosis of depression in old age: Outcome six to eight years after clinical treatment
Stek, M. L., van Exel, E. R., van Tilburg, W., Westendorp, R. G. J., & Beekman, A. T. F. (2002) · Aging & Mental Health · doi:10.1080/13607860220142413 · Cited by 61 · cited 1×
“Late-life depression often has a chronic course and high relapse rates [6-15], probably worse compared to younger age groups [16].”
BackgroundSelf-citationWïttchen, H. (2012) · Science · doi:10.1126/science.1230817 · Cited by 61 · cited 1×
“Background Late-life depression is a complex mood disorder with various etiological pathways [1] and high comorbidity with psychiatric and physical diseases, and cognitive decline [2-5].”
BackgroundLicht-Strunk, E., Beekman, A. T. F., de Haan, M., & van Marwijk, H. W. J. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.06.006 · Cited by 60 · cited 1×
“Our findings are largely in line with expectations from community based, primary care and other clinical samples of older persons [6,10,13,15,32].”
ResultDeveloping an intervention for depressed, chronically medically ill elders: A model from COPD
Alexopoulos, G. S., Raue, P. J., Sirey, J. A., & Arean, P. A. (2008) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1925 · Cited by 48 · cited 6×
“Lenze EJ, Mulsant BH, Shear MK, Alexopoulos GS, Frank E, Reynolds 3rd CF. Comorbidity of depression and anxiety disorders in later life.”
BackgroundInfluentialA multiplicity of approaches to characterize geriatric depression and its outcomes
Steffens, D. C. (2009) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32832fcd93 · Cited by 35 · cited 1×
“Background Late-life depression is a complex mood disorder with various etiological pathways [1] and high comorbidity with psychiatric and physical diseases, and cognitive decline [2-5].”
BackgroundThe Course of Depressive Symptoms in Older Adults With Comorbid Major Depression and Dysthymia
Hybels, C. F., Pieper, C. F., Blazer, D. G., & Steffens, D. C. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e318162f15f · Cited by 17 · cited 4×
“[13] were the first to study the course of severe depression in older patients.”
BackgroundResultInfluentialBogner, H. R., Morales, K. H., Reynolds, C. F., Cary, M. S., & BRUCE, M. L. (2012) · Aging & Mental Health · doi:10.1080/13607863.2011.638904 · Cited by 15 · cited 4×
“Also in contrast with our results, Bogner [14] showed in the PROSPECT study that married patients had a favourable course of depression, suggesting that depressed persons with a supportive relationship improve more quickly.”
BackgroundResultInfluentialMagnil, M., Janmarker, L., Gunnarsson, R. K., & Björkelund, C. (2013) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813432.2012.757074 · Cited by 13 · cited 3×
“[15] observed the two-year course of depression in a cohort of primary care patients aged 60 years and older and found that, 15 of the 51 depressed patients (29%) had a remitting course, 25 (49%) remained depressive, and 11 (22%) had a fluctuating course.”
BackgroundResultInternational Psychogeriatrics comes of age
Ames, D. (2008) · International Psychogeriatrics · doi:10.1017/s1041610208008144 · Cited by 12
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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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