Major depression: The importance of clinical characteristics and treatment response to prognosis
ABSTRACT This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis.
This is a secondary analysis of data from a large primary care-based geriatric depression treatment trial that analyzes outcomes from the measurement-based stepped-care intervention arm (N=871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped-care algorithm, but would be less likely to reach remission and have a greater likelihood of re-emerging depression in the year after intervention.
Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression-free days during the 12-month intervention and in the postintervention year.
Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.
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- "To date, research has identified several prognostic factors for depression, including co-morbid physical disease, pain, and disability (Chen et al., 2012; Katon et al., 2010; Licht-Strunk et al., 2007). Cognitive impairment, neuroticism, age, education level, and higher baseline depression levels are also associated with the prognosis of late-life depression (Licht-Strunk et al., 2007; Roberts et al., 1997; Schoevers et al., 2003; Steunenberg et al., 2010). "
ABSTRACT: 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. 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. 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). 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. 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. Copyright © 2015 Elsevier B.V. All rights reserved.Journal of Affective Disorders 06/2015; 185:1-7. DOI:10.1016/j.jad.2015.06.036 · 3.71 Impact Factor
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- "that GP recognition of depression did not affect outcome over the course of a few years, probably due to higher severity of baseline depressive symptoms in the recognized (and treated) patients (Kamphuis et al., 2012; Simon and VonKorff, 1995b). However, previous research has shown that course and treatment outcomes of depressive and anxiety disorders are negatively affected by somatic health problems even independent of psychiatric symptom severity (Gerrits et al., 2012, 2013; Huijbregts et al., 2010; Katon et al., 2010; Means-Christensen et al., 2008; Teh et al., 2009). It would thus be interesting to know the difference in course of recognized and treated depressed or anxious somatically unhealthy patients compared to similar untreated patients. "
ABSTRACT: Recognition of depression and anxiety by general practitioners (GPs) is suboptimal and there is uncertainty as to whether particular somatic health problems hinder or facilitate GP recognition. The objective of this study was to investigate the associations between somatic health problems and GP recognition of depression and anxiety. We studied primary care patients with a DSM-IV based psychiatric diagnosis of depressive or anxiety disorder during a face-to-face interview (n=778). GPs' registrations of depression and anxiety diagnoses, based on medical file extractions, were compared with the DSM-IV based psychiatric diagnoses as reference standard. Somatic health problems were based on self-report of several chronic somatic diseases and pain symptoms, using the Chronic Pain Grade (CPG), during the interview. Depression and anxiety was recognized in sixty percent of the patients. None of the health problems were negatively associated with recognition. Greater severity of pain symptoms (OR=1.18, p=.02), and chest pain (OR=1.56, p=.02), in particular, were associated with more GP recognition of depression and anxiety. Mediation analyses showed that depression and anxiety in these patients were better recognized through the presence of more severe psychiatric symptoms. Some specific chronic diseases had low prevalence. This study shows that the presence of particular chronic diseases does not influence GP recognition of depression and anxiety. GPs tend to recognize depression and anxiety better in patients with pain symptoms, partly due to more severe psychiatric symptoms among those with pain.Journal of Affective Disorders 09/2013; 151(3). DOI:10.1016/j.jad.2013.08.030 · 3.71 Impact Factor
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- ". One trial, which evaluated the effect of a collaborative stepped-care program for late-life depression, found that greater pain severity was associated with higher levels of severity of depressive symptoms and lack of remission of the depressive disorder . A treatment trial for participants with panic disorder and generalized anxiety disorder showed that disabling pain was associated with more severe anxiety symptoms over time and a lower likelihood of responding to treatment . "
ABSTRACT: The combination of pain and depression or anxiety is commonly seen in clinical practice. Little is known about the influence of pain on psychopathology over time, as previous studies have been mainly cross-sectional. The objectives of this study are to determine the impact of pain on the course of depressive and/or anxiety disorders, and investigate to what extent the association between pain and course of these mental disorders is mediated by psychiatric characteristics. Data from the Netherlands Study of Depression and Anxiety (NESDA), collected between 2004 and 2009, were used. A total of 1209 participants with a depressive and/or anxiety disorder at baseline were followed up for 2 years. Baseline pain was assessed by location, duration, use of pain medication, and severity (based on Chronic Pain Grade). Course of depressive and anxiety disorders was assessed by Composite International Diagnostic Interview (CIDI) and Life Chart Interview. A higher number of pain locations (OR=1.10; P=.008), joint pain (OR=1.64; P<.001), ≥ 90 days of pain (OR=1.40; P=.009), daily use of pain medication (OR=1.57; P=.047), and a higher Chronic Pain Grade score (OR=1.27; P<.001) were associated with worse course of depressive and anxiety disorders. These associations were largely mediated by baseline severity of the mental disorder. However, joint pain remained associated with a worse course independent of baseline psychiatric characteristics. This study shows that patients with pain are more prone to a chronic course of depressive and anxiety disorders. More attention to pain seems to be necessary when diagnosing and treating these disorders. Future research should focus on treatment modalities for this co-occurrence, with joint pain in particular.Pain 12/2011; 153(2):429-36. DOI:10.1016/j.pain.2011.11.001 · 5.84 Impact Factor