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Predictors of recurrence in remitted late‐life depression
Author(s) -
Deng Yi,
McQuoid Douglas R.,
Potter Guy G.,
Steffens David C.,
Albert Kimberly,
Riddle Meghan,
Beyer John L.,
Taylor Warren D.
Publication year - 2018
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22772
Subject(s) - hazard ratio , depression (economics) , late life depression , montgomery–åsberg depression rating scale , medicine , psychiatry , psychology , comorbidity , major depressive disorder , confidence interval , mood , cognition , macroeconomics , economics
Background Late‐life depression (LLD) is associated with a fragile antidepressant response and high recurrence risk. This study examined what measures predict recurrence in remitted LLD. Methods Individuals of age 60 years or older with a Diagnostic and Statistical Manual ‐ IV (DSM‐IV) diagnosis of major depressive disorder were enrolled in the neurocognitive outcomes of depression in the elderly study. Participants received manualized antidepressant treatment and were followed longitudinally for an average of 5 years. Study analyses included participants who remitted. Measures included demographic and clinical measures, medical comorbidity, disability, life stress, social support, and neuropsychological testing. A subset underwent structural magnetic resonance imaging (MRI). Results Of 241 remitted elders, approximately over 4 years, 137 (56.8%) experienced recurrence and 104 (43.2%) maintained remission. In the final model, greater recurrence risk was associated with female sex (hazard ratio [HR] = 1.536; confidence interval [CI] = 1.027–2.297), younger age of onset (HR = 0.990; CI = 0.981–0.999), higher perceived stress (HR = 1.121; CI = 1.022–1.229), disability (HR = 1.060; CI = 1.005–1.119), and less support with activities (HR = 0.885; CI = 0.812–0.963). Recurrence risk was also associated with higher Montgomery–Asberg Depression Rating Scale (MADRS) scores prior to censoring (HR = 1.081; CI = 1.033–1.131) and baseline symptoms of suicidal thoughts by MADRS (HR = 1.175; CI = 1.002–1.377) and sadness by Center for Epidemiologic Studies‐Depression (HR = 1.302; CI, 1.080–1.569). Sex, age of onset, and suicidal thoughts were no longer associated with recurrence in a model incorporating report of multiple prior episodes (HR = 2.107; CI = 1.252–3.548). Neither neuropsychological test performance nor MRI measures of aging pathology were associated with recurrence. Conclusions Over half of the depressed elders who remitted experienced recurrence, mostly within 2 years. Multiple clinical and environmental measures predict recurrence risk. Work is needed to develop instruments that stratify risk.