Biological and social predictors of long-term geriatric depression outcome.
OBJECTIVE
In this study, we examined 204 older depressed individuals for up to 64 months to determine factors related to depression outcome. We hypothesized that both presence of vascular brain lesions seen on baseline magnetic resonance imaging (MRI) scans and lower baseline social support measures would be related to worse depression outcome.


METHODS
At study entry, all subjects were at least 59 years old, had a diagnosis of major depression, and were free of other major psychiatric illness and primary neurological illness, including dementia and stroke. Depression was diagnosed via structured interview and clinical assessment by a geriatric psychiatrist who completed a Montgomery Asberg Depression Rating Scale (MADRS) to determine severity of depression. Subjects provided self-report data on social support variables and ability to perform basic and instrumental activities of daily living (ADL, IADL). All subjects agreed to have a baseline standardized MRI brain scan. Ratings of severity of hyperintensities were determined for the periventricular white matter, deep white matter, and subcortical gray matter by two readers who decided by consensus. Treatment was provided by geropsychiatrists following clinical guidelines. Using mixed models to analyze the data, we determined the effect of a variety of demographic, social and imaging variables on the trajectory of MADRS score, the outcome variable of interest.


RESULTS
MADRS scores decreased steadily over time. In a final HLM model, in which time since entry, a baseline time indicator, age, gender, education and Mini-mental State Examination score were controlled, subjective social support, instrumental ADL impairment, subcortical gray matter severity, and the interactions of time with social network and with subcortical gray matter lesions remained significantly associated with MADRS score.


CONCLUSIONS
Both social and biological factors at baseline are associated with longitudinal depression severity in geriatric depression.
Steffens
David C
DC
Department of Psychiatry, Duke University Medical Center, Box 3903, Durham, NC 27710, USA. steff001@mc.duke.edu
Pieper
Carl F
CF
Bosworth
Hayden B
HB
MacFall
James R
JR
Provenzale
James M
JM
Payne
Martha E
ME
Carroll
Bernard J
BJ
George
Linda K
LK
Krishnan
K Ranga R
KR
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002560:Cerebrovascular Circulation; D003072:Cognition Disorders / Q000175:diagnosis; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D004565:Electroconvulsive Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D016896:Treatment Outcome
D000928:Antidepressive Agents