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Correspondence |
Sir Douglas Crawford Unit, Mossley Hill Hospital, Park Avenue, Liverpool L18 8BU
The analysis of the data reported by Tuma (2000) is seriously flawed. In this report there are no primary outcome data for 26 (48%) of the elderly cohort and 8 (14%) of the younger adults. The eight elderly people developing dementia at the 4.5 years outcome point are included in the analysis of the outcome of depression but their depression outcome is not reported. Dementia is not the primary outcome in this study and, therefore, either subjects with dementia are excluded (as the author has done with natural deaths) or the depression outcome is reported. Presumably, they all survived or they would have been included as deaths.
This produces a serious bias and unfounded conclusions. For instance, if the eight subjects with dementia are excluded (as they must be if their depression outcome is not reported) then the elderly cohort at 4.5 years consists of 28 and not 36 subjects. Then, referring to Table 1, natural deaths removed, the outcome is lasting recovery 46% (not 36%), relapse and recovery 39% (not 30%), residual symptoms 7% (not 5.5%) and chronic 7% (not 5.5%). Of the elderly, 85% are recovered compared to 78% of younger adults.
If the eight dementia subjects were included and all had a lasting recovery from depression, or relapse with recovery, then the recovery rate is 88%. The conclusions reported for good outcome would be correct only if all eight subjects with dementia were included in the residual symptoms or chronic categories.
Of course, if all natural deaths had recovered from depression at the time of death, this would also paint a different picture. We all die but the issue here is whether we die happy or depressed.
It is critical that data are reported accurately. Misrepresentation of this sort could be extremely damaging.
REFERENCES
Tuma, T. A. (2000) Outcome of hospital-treated
depression at 4.5 years. An elderly and a younger adult cohort compared.
British Journal of Psychiatry,
176,
224-228.
Department of Old Age Psychiatry, General Hospital, Holdforth Road, Hartlepool TS24 9AH
Dr Anderson is right in claiming that if patients with dementia are excluded from the calculations, the prognosis for the depression among the elderly will improve: but can dementia be regarded as a successful outcome from index depression which is incident in old age? This question may also be applied to those elderly subjects who had died at follow-up. As such, dementia and death were given special outcome categories in this study.
As to the depression status of the elderly subjects before death, they were: four died during their index illness; six achieved full recovery; two recovered, relapsed and recovered; five had chronic illness and one had dementia.
The depression status of the elderly subjects prior to developing dementia were: one recovered completely; six recovered, relapsed and recovered; and in one the depressive illness became chronic and dementia subsequently developed.
None of the younger adults recovered prior to their death but: three recovered, relapsed and recovered again; one developed chronic depressive illness; one developed post-stroke dementia; and three were classified as dead during the index illness (one by suicide).
Given this new information the reader may work out the figures accordingly.
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