title: The prognosis of undetected depression in older general practice patients. A one year follow-up study.
abstract: BACKGROUND
  Late-life depression often remains undetected in primary care. However, as there is evidence that GPs do identify those with the most severe and persistent disorders, it is important to know more about the prognosis of depressive disorders that are not detected by GPs.
  
  
  METHODS
  A one-year follow-up study of depressed patients of 55 years and older consulting their GP in The Netherlands. A two-stepped screening procedure was used to diagnose depression using the GDS-15 and PRIME-MD. GPs and patients were not informed about the results. The course of depression was measured with the MADRS and PRIME-MD, at six and twelve months. Remission was defined by no longer fulfilling DSM-criteria for depressive disorder and a MADRS-score below 10. The prognosis of those not detected by GPs was compared to those that were detected.
  
  
  RESULTS
  73 patients were followed for one year. Among the 49 (67%) patients that were not detected by their GP as being depressed, 33% had remitted after one year. Of the 24 (33%) depressed patients that were detected by their GP, 37% had remitted after one year. Detected patients tended to have more serious depression and more comorbid anxiety than undetected patients.
  
  
  CONCLUSIONS
  Although GPs identify older depressed patients who are most in need of treatment, the prognosis of patients that go undetected is poor.
authors.affiliation: Department of General Practice, Institute for Extramural Medicine (EMGO) of the VU University Medical Centre Amsterdam, The Netherlands. e.licht@vumc.nl
authors.forename: Els
authors.initials: E
authors.lastname: Licht-Strunk
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.forename: Marten
authors.initials: M
authors.lastname: de Haan
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003937:Diagnosis, Differential; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index