Impact of acute psychiatric inpatient treatment on major depression in late life and prediction of response

Gs, Zubenko; Bh, Mulsant; Ah, Rifai; Ra, Sweet; re, P. Ducimeti; Lj, Marino; Xm, Tu

doi:10.1176/ajp.151.7.987

Cited by 53 publications

(5 citation statements)

References 29 publications

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“…In the present study, worse physical health was significantly associated with a worse outcome in terms of response. Our finding is in line with previous findings, showing that a high medical burden can complicate the treatment of DLL [ 2 , 8 , 11 ].…”

Section: Discussionsupporting

confidence: 93%

“…A treatment response (a reduction of 50 % or more of the MADRS score) was found in 99 (68.3 %) patients. These figures are comparable to the results from similar studies [ 8 , 9 ], however the results from prospective observational studies of the prognosis of hospitalized patients with DLL vary largely [ 9 ]. Our study differs from other observational studies of DLL in that patients with dementia are included, as we wanted the study population to be as representative as possible of the clinical practice of old-age psychiatry in specialist health care services in Norway.…”

Section: Discussionsupporting

confidence: 87%

“…Depressive episodes in old persons are potentially reversible, and full recovery is the main goal of treatment [ 7 ]. Compared to clinical trials, prospective observational studies of inpatients have shown lower recovery rates from depressive episodes in old persons, varying from 38–69 % [ 8 , 9 ]. Studies have also shown that 50 % of patients with DLL can be partial- or non-responders to initial treatment [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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The course of depression in late life as measured by the Montgomery and Asberg Depression Rating Scale in an observational study of hospitalized patients

et al. 2015

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BackgroundDepression and depressive symptoms are highly prevalent in old persons but are potentially reversible. Full recovery is the main goal in the treatment of depressive episodes. Compared to clinical trials, observational studies of patients with depression in late life (DLL) show poorer prognoses in terms of response and remission. However, observational studies on the course of DLL are scarce.The aims of this study were to examine the course of DLL in terms of response, remission and symptom-specific changes as measured by the Montgomery and Asberg Depression Rating Scale (MADRS), and to explore which clinical variables were associated with the response and remission.MethodsThis is an observational, multicenter and prospective study of patients aged 60 years and older who were referred to treatment of depression in the department of old-age psychiatry at specialist health care services in Norway. The patients were evaluated with the MADRS at admission to and discharge from hospital. The mean, median, minimum and maximum values for days stayed in hospital were 68, 53, 16 and 301, respectively.Effect size (ES) was calculated to determine which MADRS symptoms changed most during the treatment. To assess the predictors for change in the MADRS score (continuous variable) and for remission and response (both dichotomous variables), regression models adjusting for cluster effects within center were estimated.ResultsOf 145 inpatients, 99 (68.3 %) had a response to treatment (50 % or more improvement of the MADRS score). Remission (MADRS score ≤9 at discharge) was experienced in 74 (51.0 %) of the patients. Of the individual MADRS items, “reported sadness” (ES =0.88) and “lassitude” (ES = 0.80) showed the greatest amount of improvement, and “concentration difficulties” (ES = 0.50) showed the least amount of improvement during treatment. Having a diagnosis of dementia was associated with a lower remission rate and less improvement in the MADRS score during the treatment. Poorer physical health was associated with a lower response rate. Having experienced previous episode(s) of depression was associated with a lower remission rate.ConclusionsRecurrent episodes of depression, poor somatic health and a diagnosis of dementia were found to be negative prognostic factors for the course of DLL. Clinicians should therefore pay close attention to these factors when evaluating treatment.Trial registrationClinicalTrials.gov NCT01952366.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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The course of depression in late life as measured by the Montgomery and Asberg Depression Rating Scale in an observational study of hospitalized patients

et al. 2015

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“…They had better response to medications than Caucasians on psychiatric inpatient units because they either delayed treatment or were treated less aggressively prior to hospitalization (Zubenko et al, 1994). Older African Americans nursing home residents were less likely to receive an antidepressant and/or psychotherapy than Caucasians (Adjusted Odds Ratios (AOR) = 0.79, p<0.05) (Siegel et al, 2012).…”

Section: Resultsmentioning

confidence: 99%

Late‐life depression in older African Americans: a comprehensive review of epidemiological and clinical data

Pickett

Bazelais

Bruce

2012

Int J Geriat Psychiatry

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Objective The population of older African Americans is expected to triple by 2050, highlighting the public health importance of understanding their mental health needs. Despite evidence of the negative impact of late-life depression, less is known of how this disorder affects the lives of older African Americans. Lack of studies focusing on how depression presents in older African Americans and their subsequent treatment needs lead to a gap in epidemiologic and clinical knowledge for this population. In this review, we aim to present a concise report of prevalence, correlates, course, outcomes, symptom recognition, and treatment of depression for these individuals. Method We performed a literature review of English-language articles identified from PubMed and Medline published between January 1990 and June 2012. Studies included older adults and contained the key words “geriatric depression in African Americans,” “geriatric depression in Blacks,” and geriatric depression in minorities.” Results Although in most studies older African Americans had higher or equivalence prevalence of depression compared to Caucasian Americans, we also found lower rates of recognition of depression and treatment. Many studies reported worse outcomes associated for depression among older African Americans compared older Caucasians. Conclusions Serious racial and ethnic disparities persist in the management of older African Americans with depression. Understanding their unmet needs and improving depression care for these individuals is necessary to reduce these disparities.

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“…These differences possibly reflect unique cultural values, and distinct perceptions of such caregiving institutions as psychiatric hospitals. 23-26 …”

Section: Discussionmentioning

confidence: 99%

Characteristics Associated with Inpatient Versus Outpatient Status in Older Adults with Bipolar Disorder

Jurdi

Schulberg

Greenberg

et al. 2012

J Geriatr Psychiatry Neurol

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Objectives This is an exploratory analysis of ambulatory and inpatient services utilization by older persons with type I bipolar disorder experiencing elevated mood. The association between type of treatment setting and the person’s characteristics is explored within a framework that focuses upon predisposing, enhancing, and need characteristics. Method Baseline assessments were conducted with the first 51 inpatients and 49 outpatients 60 years of age and older, meeting criteria for type I bipolar disorder, manic, hypomanic, or mixed episode enrolled in the geriatric bipolar disorder study (GERI-BD) study. We compared participants recruited from inpatient versus outpatient settings in regard to the patients’ predisposing, enabling, and need characteristics. Results Being treated in an inpatient rather than an outpatient setting was associated with the predisposing characteristic of being non-Hispanic caucasian (odds ratio [OR]: 0.1; P = .005) and past history of treatment with first-generation antipsychotics (OR: 6.5; P < .001), and the need characteristic reflected in having psychotic symptoms present in the current episode (OR: 126.08; P < .001). Conclusion Ethnicity, past pharmacologic treatment, and current symptom severity are closely associated with treatment in inpatient settings. Clinicians and researchers should investigate whether closer monitoring of persons with well-validated predisposing and need characteristics can lead to their being treated in less costly but equally effective ambulatory rather than inpatient settings.

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Impact of acute psychiatric inpatient treatment on major depression in late life and prediction of response

Abstract: Short-term psychiatric hospitalization offers an effective and efficient vehicle for the treatment of severe or complicated cases of major depression in the elderly, even when considerable medical and psychiatric comorbidity is present.

Cited by 53 publications

References 29 publications

The course of depression in late life as measured by the Montgomery and Asberg Depression Rating Scale in an observational study of hospitalized patients

The course of depression in late life as measured by the Montgomery and Asberg Depression Rating Scale in an observational study of hospitalized patients

Late‐life depression in older African Americans: a comprehensive review of epidemiological and clinical data

Characteristics Associated with Inpatient Versus Outpatient Status in Older Adults with Bipolar Disorder

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