Resilience predicts remission in antidepressant treatment of geriatric depression.

Abstract

With the world population rapidly aging, it is increasingly important to identify sociodemographic, cognitive, and clinical features that predict poor outcome in geriatric depression. Self-report measures of resilience-ie, the ability to adapt and thrive in the face of adversity-may identify those depressed older adults with more favorable prognoses. We investigated the utility of baseline variables including 4 factors of resilience (grit, active coping self-efficacy, accommodative coping self-efficacy, and spirituality) for predicting treatment response and remission in a 16-week randomized controlled trial of methylphenidate, citalopram, or their combination in 143 adults over the age of 60 with MDD. Final logistic regression models revealed that greater total baseline resilience (Wald χ2 =3.8, P=0.05) significantly predicted both treatment response and remission. Specifically, a 20% increase in total resilience predicted nearly 2 times greater likelihood of remission (OR=1.98, 95% CI=[1.01, 3.91]). Examining the individual factors of resilience, only accommodative coping self-efficacy (Wald χ2 =3.7, P=0.05; OR=1.41 [1.00-2.01]) was significantly associated with remission. We found no relation between baseline sociodemographic factors (age, sex, race, education level) or measures of cognitive performance and posttreatment depressive symptoms. Self-reported resilience may predict greater responsivity to antidepressant medication in older adults with MDD. Future research should investigate the potential for resilience training-and in particular, interventions designed to increase accommodative coping-to promote sustained remission of geriatric depression.