Depressive disorders and symptoms in older primary care patients: one-year outcomes

Syndromically diagnosable and subsyndromal depressions have substantial prevalence and functional morbidity among older persons seen in primary care, but their naturalistic outcome is largely unknown. The authors describe depressive symptoms and syndromes and functional outcomes at 1-year follow-up and examine specific outcome predictors in a cohort study using psychopathological, medical, and functional assessments at intake and 1-year follow-up. Subjects were 247 patients over age 60, recruited from private internal medicine offices and a university-affiliated family medicine clinic. Multiple-regression techniques examined the independent association of intake variables to outcome measures. Of the 63 subjects with an active depression diagnosis at study intake, 36 (57%) still had an active depression diagnosis at 1 year. The outcome for major depression was worse than for minor or subsyndromal depression. Medical illness burden and neuroticism were independent predictors of outcome. Major depression and depressive symptom severity were independently associated with poorer social functioning at follow-up. Depressive conditions had considerable rates of persistence, yet the outcome was not uniformly poor. Longer-term naturalistic study is needed, as are treatment studies targeting those at highest risk of recurrence or chronicity.