Prognosis for depression in general practice, one-third of over 55 s have still not recovered after 3 years

OBJECTIVE: Acquire information in the general practice setting about the duration of a depressive episode, the likelihood of recovery and predictive prognostic factors for over 55 s suffering from depression. DESIGN: Descriptive, cohort study. METHOD: Over 55 s who visited one of the 32 participating general practice centres in West Friesland, the Netherlands, were screened for the presence of a depressive disorder using two consecutive tests. We included 234 participants with a depressive disorder according to DSM-IV criteria. They were interviewed during the baseline period and every 6 months thereafter for a period of 3 years. The primary outcome measures were time to recovery and the likelihood of recovery at the various measurement points. Multivariate regression analyses were used to identify which factors were correlated with the prognosis. RESULTS: The median duration of the depression was 18 months (95{\%} CI: 13-23). Thirty-five percent recovered within 1 year, 60{\%} within 2 years and 68{\%} within 3 years. There was a correlation between not recovering from the depression on the one hand and a more severe depression, a positive family history for depression and the presence of several functional limitations on the other hand. In the group of depressive patients the physical functioning deteriorated during the follow-up. However, this was not the case for the patients who recovered. CONCLUSION: In the general practice setting, depression in the over 55 s has an unfavourable prognosis. Variables that predict the prognosis are simple to determine in everyday practice. This could enable a more intensive treatment of the depression to be targeted at an early stage to people with the highest risk of an unfavourable prognosis.