The Netherlands study of depression in older persons (NESDO); a prospective cohort study

Hannie C Comijs,Rob Kok,Brenda Wjh Penninx,Harm W Van Marwijk,Marjolein Boshuisen,Richard C Oude Voshaar,Paul Naarding,Aartjan Tf Beekman,Max L Stek,Margot Wm De Waal,Johannes H Smit,Roos C Van Der Mast,Janny Dekker

doi:10.1186/1756-0500-4-524

Abstract

BackgroundTo study late-life depression and its unfavourable course and co morbidities in The Netherlands.MethodsWe designed the Netherlands Study of Depression in Older Persons (NESDO), a multi-site naturalistic prospective cohort study which makes it possible to examine the determinants, the course and the consequences of depressive disorders in older persons over a period of six years, and to compare these with those of depression earlier in adulthood.ResultsFrom 2007 until 2010, the NESDO consortium has recruited 510 depressed and non depressed older persons (≥ 60 years) at 5 locations throughout the Netherlands. Depressed persons were recruited from both mental health care institutes and general practices in order to include persons with late-life depression in various developmental and severity stages. Non-depressed persons were recruited from general practices. The baseline assessment included written questionnaires, interviews, a medical examination, cognitive tests and collection of blood and saliva samples. Information was gathered about mental health outcomes and demographic, psychosocial, biological, cognitive and genetic determinants. The baseline NESDO sample consists of 378 depressed (according to DSM-IV criteria) and 132 non-depressed persons aged 60 through 93 years. 95% had a major depression and 26.5% had dysthymia. Mean age of onset of the depressive disorder was around 49 year. For 33.1% of the depressed persons it was their first episode. 41.0% of the depressed persons had a co morbid anxiety disorder. Follow up assessments are currently going on with 6 monthly written questionnaires and face-to-face interviews after 2 and 6 years.ConclusionsThe NESDO sample offers the opportunity to study the neurobiological, psychosocial and physical determinants of depression and its long-term course in older persons. Since largely similar measures were used as in the Netherlands Study of Depression and Anxiety (NESDA; age range 18-65 years), data can be pooled thus creating a large longitudinal database of clinically depressed persons with adequate power and a large set of neurobiological, psychosocial and physical variables from both younger and older depressed persons.

Highlights

To study late-life depression and its unfavourable course and co morbidities in The Netherlands
Former studies suggest that personality, genetic factors as well as problems at work and in family relationships may play a larger role in the onset of depression at early age, whereas late-life depression has been hypothesized to be more strongly associated with frailtyassociated processes and neurodegenerative biological abnormalities. [16,17] It is shown that psychosocial as well as biological factors play a role in late-life depression and its co morbidities. [4,18,19,20,21,22,23] Several of these determinants are supposed to be common in older adults, such as loneliness and losses in social environment, [24] systemic low-grade inflammation [25] and functional and cognitive limitations
When we extend the Netherlands Study of Depression in Older Persons (NESDO) sample with younger age groups, the sample size will be suitable to detect even small effects in these biological measures

Summary

Introduction

To study late-life depression and its unfavourable course and co morbidities in The Netherlands. [26] In addition, some of these determinants seem to function differently in older compared to younger adults, such as the hypo activation instead of hyper activation of biological stress-regulation systems; the hypothalamic-pituitary-adrenal (HPA)-axis and the autonomic nervous system (ANS) [27,28,29,30,31,32] Many of these determinants for late-life depression are interrelated, for instance, dysregulation of stress regulating systems in turn give rise to dysregulation of the immune system and to altered vascular and metabolic processes, which may have deleterious effects on the cardiovascular system, cognition and mood regulation, [33,34] studies in this field show conflicting results. Compared to younger depressed adults, older depressed persons were found to show more psychomotor dysregulation and somatic disturbances such as fatigue and sleep disturbance [43,44] and to have more apathy without the more traditional symptoms of depression [45,46]

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