Abstract
Very little is known about the association between symptomatic and functional recovery from late-life major depressive disorder (MDD) in sub-Saharan Africa. We investigated factors associated with sustained symptomatic remission (SR) from MDD and the 5-year trajectory of post-MDD physical functioning. 5-year prospective study with three follow-up waves in 2007, 2008, and 2009. Household multistage probability sample of 2,149 Nigerians who were aged 65 years or older. Activities of Daily Living (ADL) and MDD were assessed using the Kadz index and Composite International Diagnostic Interview, respectively. We studied those with current MDD (prevalent in 2003-2004 or incident in 2007), and who achieved SR in subsequent waves compared with a chronic/recurrent course (CR). Baseline demographic characteristics, health, and lifestyle factors were not associated with SR in logistic regression analyses. In mixed-effect linear regression models adjusting for age, sex, and socioeconomic status, ADL worsened in SR (β = 1.0, 95% CI: 0.2, 1.8), but more so in CR (β = 2.3, 95% CI: 1.6, 3.0). Poorer ADL at follow-up was predicted by age (β = 2.9, 95% CI: 1.8, 4.0) and economic status (β = 1.4, 95% CI: 0.3, 2.4). There was a deteriorating course of disability despite symptomatic recovery from late-life MDD in this sample. This finding has implications for policy and guidelines for the management of late-life depression and disability.
Highlights
We compared the sociodemographic characteristics of participants who could not be followed up in 2009 with those who were followed up using designbased F tests
Complete follow-up data were available for 90% of participants in the trajectory groups. Those who died or were lost to follow-up were more likely to belong to the lowest age category (65–69 years)
The pattern of changes in physical functioning in the present study suggests that, following symptomatic recovery from late-life major depressive disorder (MDD), physical disability may linger and, in this population, even worsen over time
Summary
Very little is known about the association between symptomatic and functional recovery from late-life major depressive disorder (MDD) in sub-Saharan Africa. We investigated factors associated with sustained symptomatic remission (SR) from MDD and the 5-year trajectory of post-MDD physical functioning. Design: 5-year prospective study with three follow-up waves in 2007, 2008, and 2009. Measurements: Activities of Daily Living (ADL) and MDD were assessed using the Kadz index and Composite International Diagnostic Interview, respectively.We studied those with current MDD (prevalent in 2003–2004 or incident in 2007), and who achieved SR in subsequent waves compared with a chronic/ recurrent course (CR). Conclusions: There was a deteriorating course of disability despite symptomatic recovery from late-life MDD in this sample. This finding has implications for policy and guidelines for the management of late-life depression and disability. This finding has implications for policy and guidelines for the management of late-life depression and disability. (Am J Geriatr Psychiatry 2018; 26:657–666)
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