Document Detail


Biological and social predictors of long-term geriatric depression outcome.
MedLine Citation:
PMID:  15948303     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. METHOD: 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.
Authors:
David C Steffens; Carl F Pieper; Hayden B Bosworth; James R MacFall; James M Provenzale; Martha E Payne; Bernard J Carroll; Linda K George; K Ranga R Krishnan
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  International psychogeriatrics / IPA     Volume:  17     ISSN:  1041-6102     ISO Abbreviation:  Int Psychogeriatr     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-06-10     Completed Date:  2005-09-26     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9007918     Medline TA:  Int Psychogeriatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  41-56     Citation Subset:  IM    
Affiliation:
Department of Psychiatry, Duke University Medical Center, Box 3903, Durham, NC 27710, USA. steff001@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Antidepressive Agents / therapeutic use
Brain / blood supply,  pathology
Cerebrovascular Circulation
Cognition Disorders / diagnosis
Cohort Studies
Depressive Disorder, Major / diagnosis,  physiopathology*,  therapy
Electroconvulsive Therapy
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuropsychological Tests
Prospective Studies
Treatment Outcome
Grant Support
ID/Acronym/Agency:
P50 MH60451/MH/NIMH NIH HHS
Chemical
Reg. No./Substance:
0/Antidepressive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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