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Original Research |

Outcomes of Minor and Subsyndromal Depression among Elderly Patients in Primary Care Settings

Jeffrey M. Lyness, MD; Moonseong Heo, PhD; Catherine J. Datto, MD, MS; Thomas R. Ten Have, PhD; Ira R. Katz, MD, PhD; Rebecca Drayer, MD; Charles F. Reynolds III, MD; George S. Alexopoulos, MD; and Martha L. Bruce, PhD, MPH*
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From University of Rochester Medical Center, Rochester, New York; Weill Medical College of Cornell University, White Plains, New York; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Grant Support: PROSPECT is a collaborative research study funded by the National Institute of Mental Health. The 3 collaborative sites include the Advanced Centers for Intervention and Services Research of Cornell University (R01 MH59366, P30 MH68638), the University of Pennsylvania (R01 MH59380, P30 MH52129), and the University of Pittsburgh (R01 MH59381, P30 MH52247, P30 MH71944). Additional small grants came from Forest Laboratories and the John D. Hartford Foundation. Dr. Bruce is a recipient of National Institute of Mental Health grant NIMH K02 MH01634, and Dr. Lyness is supported by NIMH R01 MH61429 and K24 MH71509 from the Institute.

Potential Financial Conflicts of Interest: Consultancies: G.S. Alexopoulos (Forest Pharmaceuticals); Honoraria: G.S. Alexopoulos (Forest Pharmaceuticals, Janssen, Cephalon, Pfizer Inc., Bristol-Myers Squibb, Eli Lilly Inc., Glaxo Wellcome); Grants received: G.S. Alexopoulos (Forest Pharmaceuticals, Cephalon); Other (tablets and placebos): C.F. Reynolds III (Forest Pharmaceuticals, GlaxoSmithKline, Pfizer Inc., Eli Lilly Inc.).

Requests for Single Reprints: Jeffrey M. Lyness, MD, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642; e-mail, Jeffrey_Lyness@urmc.rochester.edu.

Current Author Addresses: Dr. Lyness: Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642.

Drs. Heo, Alexopoulos, and Bruce: New York Hospital Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605.

Drs. Datto, Ten Have, and Katz: University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104.

Drs. Drayer and Reynolds: Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213.

Author Contributions: Conception and design: J.M. Lyness, T.R.Ten Have, I.R. Katz, C.F. Reynolds III, G.S. Alexopoulos, M.L. Bruce.

Analysis and interpretation of the data: J.M. Lyness, M. Heo, C.J. Datto, R. Drayer, I.R. Katz, M.L. Bruce.

Drafting of the article: J.M. Lyness, C.J. Datto, C.F. Reynolds III, G.S. Alexopoulos, M.L. Bruce.

Critical revision of the article for important intellectual content: J.M. Lyness, M. Heo, T.R.Ten Have, C.J. Datto, R. Drayer, C.F. Reynolds III, G.S. Alexopoulos, I.R. Katz, M.L. Bruce.

Final approval of the article: J.M. Lyness, M. Heo, T.R.Ten Have, C.J. Datto, C.F. Reynolds III, G.S. Alexopoulos, I.R. Katz, M.L. Bruce.

Provision of study materials or patients: C.F. Reynolds III, G.S. Alexopoulos, I.R. Katz, M.L. Bruce.

Statistical expertise: T.R.Ten Have, M. Heo.

Obtaining of funding: T.R.Ten Have, C.F. Reynolds III, G.S. Alexopoulos, I.R. Katz, M.L. Bruce.

Administrative, technical, or logistic support: I.R. Katz, M.L. Bruce.

Collection and assembly of data: C.J. Datto, G.S. Alexopoulos, I.R. Katz, M.L. Bruce.

Ann Intern Med. 2006;144(7):496-504. doi:10.7326/0003-4819-144-7-200604040-00008
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We confirmed some but not all of our study hypotheses. Elderly patients with minor or subsyndromal depression had better outcomes than patients with major depression and poorer outcomes than persons who were not depressed. This group had a risk for a diagnosis of major depression at 1 year that was more than 5 times greater than that of nondepressed elderly individuals, which is similar to the 1-year risk in younger adults with subsyndromal depression (56). Furthermore, the group with minor and subsyndromal depression had greater functional disability at 1 year; however, these patients were not as disabled as those in the major depression group. Of interest, the minor depression and non–DSM-IV subsyndromal depression subgroups did not differ substantially in their outcomes. These data support the clinical importance of both minor and subsyndromal depression and suggest that, as in younger persons, they represent part of a spectrum of depression severity rather than a discrete entity.

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Summary for Patients

Outcomes of Patients with Mild Depression after 1 Year

The summary below is from the full report titled “Outcomes of Minor and Subsyndromal Depression among Elderly Patients in Primary Care Settings.” It is in the 4 April 2006 issue of Annals of InternalMedicine (volume 144, pages 496-504). The authors are J.M. Lyness, M. Heo, C.J. Datto, T.R. Ten Have, I.R. Katz, R. Drayer, C.F. Reynolds III, G.S. Alexopoulos, and M.L. Bruce.


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