International Psychogeriatrics

Biological and social predictors of long-term geriatric depression outcome

David C. Steffens a1a3a5c1, Carl F. Pieper a2, Hayden B. Bosworth a1a3a5a7, James R. MacFall a4, James M. Provenzale a4, Martha E. Payne a1, Bernard J. Carroll a1a8, Linda K. George a1a5a6 and K. Ranga R. Krishnan a1
a1 Duke University, Department of Psychiatry, Durham VA Medical Center 3, NC, U.S.A.
a2 Duke University, Department of Community and Family Medicine, Durham VA Medical Center 3, NC, U.S.A.
a3 Duke University, Department of Medicine, Durham VA Medical Center 3, NC, U.S.A.
a4 Duke University, Department of Radiology, Durham VA Medical Center 3, NC, U.S.A.
a5 Duke University, Center for the Study of Aging and Human Development, Durham VA Medical Center 3, NC, U.S.A.
a6 Duke University, Duke University Medical Center, Department of Sociology, Durham VA Medical Center 3, NC, U.S.A.
a7 Duke University, Duke University Health Services Research and Development, Durham VA Medical Center 3, NC, U.S.A.
a8 Duke University, Pacific Behavioral Research Foundation, Carmel, CA, U.S.A.

Article author query
steffens dc   [PubMed][Google Scholar] 
pieper cf   [PubMed][Google Scholar] 
bosworth hb   [PubMed][Google Scholar] 
macfall jr   [PubMed][Google Scholar] 
provenzale jm   [PubMed][Google Scholar] 
payne me   [PubMed][Google Scholar] 
carroll bj   [PubMed][Google Scholar] 
george lk   [PubMed][Google Scholar] 
krishnan kr   [PubMed][Google Scholar] 


Objective: In this study, we examined 204 older depressed individuals for up to 64 months to determine factors related to depression outcome. We hypothesized that both presence of vascular brain lesions seen on baseline magnetic resonance imaging (MRI) scans and lower baseline social support measures would be related to worse depression outcome.

Method: At study entry, all subjects were at least 59 years old, had a diagnosis of major depression, and were free of other major psychiatric illness and primary neurological illness, including dementia and stroke. Depression was diagnosed via structured interview and clinical assessment by a geriatric psychiatrist who completed a Montgomery Asberg Depression Rating Scale (MADRS) to determine severity of depression. Subjects provided self-report data on social support variables and ability to perform basic and instrumental activities of daily living (ADL, IADL). All subjects agreed to have a baseline standardized MRI brain scan. Ratings of severity of hyperintensities were determined for the periventricular white matter, deep white matter, and subcortical gray matter by two readers who decided by consensus. Treatment was provided by geropsychiatrists following clinical guidelines. Using mixed models to analyze the data, we determined the effect of a variety of demographic, social and imaging variables on the trajectory of MADRS score, the outcome variable of interest.

Results: MADRS scores decreased steadily over time. In a final HLM model, in which time since entry, a baseline time indicator, age, gender, education and Mini-mental State Examination score were controlled, subjective social support, instrumental ADL impairment, subcortical gray matter severity, and the interactions of time with social network and with subcortical gray matter lesions remained significantly associated with MADRS score.

Conclusions: Both social and biological factors at baseline are associated with longitudinal depression severity in geriatric depression.

(Received January 22 2004)
(returned to authors for revision March 1 2004)
(revised version received March 16 2004)
(Accepted March 17 2004)

Key Words: Depression; elderly; neuroimaging; social factors.

c1 Correspondence should be addressed to: David C. Steffens, Duke University Medical Center, Box 3903 Durham, NC 27710, U.S.A. Phone: +1 919 684 3746 Fax: +1 919 681 7668 Email: