Regular Research ArticlesOutcomes of Subsyndromal Depression in Older Primary Care Patients
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Procedures and Subjects
The methods of this study have been described previously.18 Briefly, we attempted to enroll all patients aged 65 years or older who presented for care at primary care offices on select days. Sites for enrollment included internal medicine and family medicine private practices and hospital-based clinic settings. Patients gave written consent to participate in the study, using procedures approved by the University of Rochester Research Subjects Review Board. Consenting subjects underwent
RESULTS
Of the 745 subjects initially enrolled, 472 were women (63.3%), 684 were whites (91.8%), 44 African Americans (5.9%), and 17 from other racial or ethnic groups (2.3%). Of the whole group, 41 (5.5%) had major depression, 52 (6.9%) minor depression, and 146 (19.6%) had SSD-A. Using the alternative SSD definitions, 113 (15.2%) had SSD-B and 206 (27.7%) had SSD-C. Overall, 280 (37.6%) met criteria for at least one SSD diagnosis, leaving 372 (49.9%) who were nondepressed by all SSD definitions.
CONCLUSIONS
Our findings confirmed a key aspect of our hypothesis: Patients with SSD had poorer outcomes than nondepressed subjects in terms of psychiatric symptoms and functional status. In many cases, the SSD outcomes were not significantly different from the outcomes of minor and even major depression, e.g., with respect to 1-year lagged overall depressive symptom severity, suicidal ideation, psychic anxiety, cognition, and medical burden. These results build on prior work regarding the clinical
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The authors thank the patients, staff, and providers of the following primary care practices: University of Rochester Medical Center, Department of Medicine; Pulsifer Medical; East Ridge Family Medicine; Highland Family Medicine; Olsan Medical; Clinton Crossings Medical; Panorama Internal Medicine; Highland Geriatric Medicine; and Culver Medical. The authors thank the following members for technical assistance: Karen Gibson, M.S.Ed.; Constance Bowen, M.A.; James Evinger, M.Div.; Cameron Gardner, M.D.; Iwona Juskiewicz, M.D., Ayesha Khan, M.D., Michael New; Andra Niculescu, M.D.; Jean Sauvain, B.S.; Jill Scheltz, B.A., L.M.T.; and Judy Woodhams, M.F.A.
This work was supported by NIMH grants R01 MH061429 and K24 MH071509.
Presented in part at the American Association for Geriatric Psychiatry, Orlando, FL, March 16, 2008.