title: Childhood Abuse and the Two-Year Course of Late-Life Depression.
abstract: OBJECTIVE
  Late-life depression often has a chronic course, with debilitating effects on functioning and quality of life; there is still no consensus on important risk factors explaining this chronicity. Cross-sectional studies have shown that childhood abuse is associated with late-life depression, and in longitudinal studies with chronicity of depression in younger adults. We aim to investigate the impact of childhood abuse on the course of late-life depression.
  
  
  METHODS
  Two-year longitudinal cohort study.
  
  
  METHODS
  Data were derived from the Netherlands Study of Depression in Older Persons (NESDO).
  
  
  METHODS
  282 participants with a depression diagnosis in the previous 6 months (mean age: 70.6 years), of whom 152 (53.9%) experienced childhood abuse.
  
  
  METHODS
  Presence of childhood abuse (yes/no) and a frequency-based childhood abuse index (CAI) were calculated. Dependent variable was depression diagnosis after 2 years.
  
  
  RESULTS
  Multivariable mediation analysis showed an association between childhood abuse and depression diagnosis at follow-up. Depression severity, age at onset, neuroticism, and number of chronic diseases were important mediating variables of this association, which then lost statistical significance. For childhood abuse (yes/no), loneliness was an additional, significant mediator. Depression severity was the main mediating variable, reducing the direct effect by 26.5% to 33.3% depending on the definition of abuse (respectively, 'yes/no" abuse and CAI).
  
  
  CONCLUSIONS
  More depressive symptoms at baseline, lower age at depression onset, higher levels of neuroticism and loneliness, and more chronic diseases explain a poor course of depression in older adults who reported childhood abuse. When treating late-life depression it is important to detect childhood abuse and consider these mediating variables.
authors.affiliation: GGZ inGeest / Department of Psychiatry and Amsterdam Public Health research institute, Department of Mental Health, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: i.wielaard@ggzingeest.nl.
authors.forename: Ilse
authors.initials: I
authors.lastname: Wielaard
authors.affiliation: GGZ inGeest / Department of Psychiatry and Amsterdam Public Health research institute, Department of Mental Health, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Hannie C
authors.initials: HC
authors.lastname: Comijs
authors.affiliation: GGZ inGeest / Department of Psychiatry and Amsterdam Public Health research institute, Department of Mental Health, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.affiliation: GGZ inGeest / Department of Psychiatry and Amsterdam Public Health research institute, Department of Mental Health, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Didi
authors.initials: D
authors.lastname: Rhebergen
mesh_terms: D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D017668:Age of Onset; D000368:Aged; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D000067562:Late Onset Disorders / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology
keywords: Childhood abuse; chronic course; chronicity; late-life depression; longitudinal cohort study