The British Journal of Psychiatry (2006) 188: 65-69. doi: 10.1192/bjp.188.1.65
© 2006 The Royal College of Psychiatrists
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Natural history of depression in the oldest old

Population-based prospective study

MAX L. STEK, MD, PhD

Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Centre, Leiden, and Department of Psychiatry, Valeriuskliniek GGZ Buitenamstel, Vrije Universiteit, Amsterdam

DAVID J. VINKERS, MD and JACOBIJN GUSSEKLOO, MD, PhD

Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Centre, Leiden

ROOS C. VAN DER MAST, MD, PhD

Department of Psychiatry, Leiden University Medical Centre, Leiden

AARTJAN T. F. BEEKMAN, MD, PhD

Department of Psychiatry, Valeriuskliniek GGZ Buitenamstel, Vrije Universiteit, Amsterdam

RUDI G. J. WESTENDORP, MD, PhD

Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands

Correspondence: Dr Max L. Stek, Leiden University Medical Centre, Section of Gerontology and Geriatrics, C2-R, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: +31 715266640; fax: +31 715248159; e-mail: m.l.stek{at}ggzba.nl

Declaration of interest None.

Background Despite its negative consequences, little is known about the natural history of depression in the oldest old.

Aims To study the incidence, course and predictors of depression in the general population of the oldest old.

Method The Leiden 85-plus Study is a prospective population-based study of 500 people from their 85th to their 89th birthdays. Depressive symptoms were annually assessed with the 15-item Geriatric Depression Scale, using a cut-off of 4 points.

Results During a mean follow-up of 3.9 years, the annual risk for the emergence of depression was 6.8%. Poor daily functioning and institutionalisation predicted depression. Among the 77 participants with depression at baseline (prevalence 15%) the annual remission rate was ony 14%. In more than half of the participants with a remission of depression, we observed a relapse of depression during follow-up. No predictors of remission could be identified.

Conclusions Among the oldest old, depression is frequent and highly persistent. More active case-finding and treatment would be potentially rewarding.