Predictors of partial remission in older patients treated for major depression: the role of comorbid dysthymia.
OBJECTIVE: The authors studied demographic, clinical, social, and perceived health and well-being factors as predictors of partial remission in older patients treated for major depressive disorder (MDD). METHODS: The sample included 186 patients who met DSM-IV criteria for MDD and underwent naturalistic treatment. Remission status was determined by Montgomery-Asberg Depression Rating Scale score. Ordinal logistic-regression was used to model the relationship between predictors and remission on an ordinal scale. RESULTS: A total of 26.9% patients were in partial remission (score: 7-15), and 25.8% were not in remission (score: 16-60) 1 year after the index evaluation. In bivariate analyses, the odds of partial/no remission were significantly increased for those with comorbid MDD and dysthymia and for those with higher baseline depression scores, and decreased for those with higher perceived social support. Other factors potentially associated with outcome included number of mobility/IADL limitations, perceived stress, self-perceived health, life dissatisfaction, and heart trouble. Controlling for these potential confounders, comorbid MDD and dysthymia significantly predicted outcome. The effect of mobility/IADL limitations differed for those with comorbid dysthymia. CONCLUSIONS: Among older adults treated for MDD, factors predicting partial remission appear to be similar to those predicting no remission. Patients with comorbid MDD and dysthymia are at increased risk for poor outcome, and predictors may vary by dysthymia status.
Hybels, CF; Blazer, DG; Steffens, DC
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