THE NATURAL-HISTORY OF DEPRESSION AND THE ANXIETY DISORDERS IN OLDER-PEOPLE - THE ISLINGTON COMMUNITY STUDY

Background: This study reports the outcome of depression and anxiety d isorders in older people. Methods: Follow-up of 165 subjects age 65 or over, initially identified in a community study in inner London as de pressed or having an anxiety disorder. Results: 117 subjects still liv ing in the area; 25 had died. Death was predicted only by activity lim itation at first interview and not by other demographic or morbidity v ariables. Eighty-six subjects reinterviewed; 21 males, 65 females. Of the depressed, 34% had recovered, 39% were depressed and 27% were dead . Predictors from initial interview of continuing depression were fema le gender and more severe depression. Of those with phobic anxiety, 16 % had recovered, 18% died and 66% were still phobic. Predictors of con tinuing phobic anxiety from initial interview were female gender and ' 'stand-alone'' phobic anxiety, i.e., not being depressed al initial in terview. Sixty percent of those with early onset phobias had specific phobias; 82% of those with late-onset phobias had agoraphobia. Twenty- two subjects were prescribed psychotropics. The only significant predi ctor of psychotropic prescription was having sleep disturbance at init ial interview. A low score on life satisfaction was significantly corr elated with depression but not with phobic disorder. A high score was correlated with not having a current psychiatric disorder. Limitations : Some subjects were lost to follow-up. Those on psychotropics were pa rticularly likely to refuse an interview. Conclusion and clinical rele vance: In older people, neither depression nor the anxiety disorders g enerally remit spontaneously. Those with a particularly poor prognosis are women and those with a more severe depression. Agoraphobia may be precipitated in older people by stressful events and interferes with life satisfaction. There is potential for increased pharmacological tr eatment of older people with affective disorders. (C) 1997 Elsevier Sc ience B.V.