The British Journal of Psychiatry
The Management and Nature of Depressive Illnesses in Late Life: A Follow-Through Study


The progress of 92 depressives over the age of 60 after discharge from hospital was compared with that of 81 subjects of an earlier follow-up study. On account mainly of earlier, and presumably often successful treatment in the community, the recent sample of hospital patients turned out to be more seriously and persistently ill. In spite of this, long-term results were similar to those obtained during an earlier period, possibly because of more effective after-care and maintenance therapy with anti-depressant drugs, which had in the meantime been introduced.

In the after-care of elderly depressives, optional attendance at a psychiatric out-patient clinic was shown to be more practicable than, and equally efficient as, a more rigidly structured community care programme.

It was possible to classify patients as severely psychotic, intermediate psychotic, or neurotic on the basis of their mental states. Patients belonging to these three groups also differed from one another in frequency of abnormalities of previous personality. Hereditary and other constitutional characteristics, as well as precipitating factors and further course were evenly distributed among patients presenting with contrasting clinical pictures, which did not, therefore, indicate the existence of different syndromes. These findings were consonant with a view according to which, in the present sample at any rate, the phenomena observed in every depressive attack are uniquely shaped by the constitutional status of the patient at the time of the attack, by the emotional significance of preceding events, and by existing strengths and weaknesses of his personality structure.