title: Loneliness is associated with poor prognosis in late-life depression: Longitudinal analysis of the Netherlands study of depression in older persons.
abstract: BACKGROUND
  Although depression and loneliness are common among older adults, the role of loneliness on the prognosis of late-life depression has not yet been determined. Therefore, we examined the association between loneliness and the course of depression.
  
  
  METHODS
  We conducted a 2-year follow-up study of a cohort from the Netherlands Study of Depression in Older Persons (NESDO). This included Dutch adults aged 60-90 years with a diagnosis of major depression, dysthymia, or minor depression according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We performed regression analyses to determine associations between loneliness at baseline and both severity and remission of depression at follow-up. We controlled for potential confounders and performed multiple imputations to account for missing data.
  
  
  RESULTS
  Of the 285 respondents, 48% were still depressed after 2 years. Loneliness was independently associated with more severe depressive symptoms at follow-up (beta 0.61; 95% CI 0.12-1.11). Very severe loneliness was negatively associated with remission after 2 years compared with no loneliness (OR 0.25; 95% CI 0.08-0.80).
  
  
  CONCLUSIONS
  Despite using multiple imputation, the large proportion of missing values probably reduces the study's precision. Generalizability to the general population may be limited by the overrepresentation of ambulatory patients with possibly more persistent forms of depression.
  
  
  CONCLUSIONS
  In this cohort, the prognosis of late-life depression was adversely affected by loneliness. Health care providers should seek to evaluate the degree of loneliness to obtain a more reliable assessment of the prognosis of late-life depression.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands. Electronic address: f.holvast@umcg.nl.
authors.forename: Floor
authors.initials: F
authors.lastname: Holvast
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands.
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Margot M W
authors.initials: MM
authors.lastname: de Waal
authors.affiliation: Clinical Chair in Primary Care Research, Centre for Primary Care, University of Manchester, United Kingdom.
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.affiliation: Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hannie C
authors.initials: HC
authors.lastname: Comijs
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands; NIVEL, Netherlands Institute of Health Services Research, The Netherlands.
authors.forename: Peter F M
authors.initials: PF
authors.lastname: Verhaak
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008132:Loneliness / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis
keywords: Depression; Loneliness; Older age/aged; Prognosis; Social relations