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 disorders in older people. Methods: Follow-up of 165 subjects age 65 or over, initially identified in a community study in inner London as depressed or having an anxiety disorder. Results: 117 subjects still living in the area; 25 had died. Death was predicted only by activity limitation at first interview and not by other demographic or morbidity variables. 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 female gender and more severe depression. Of those with phobic anxiety, 16% had recovered, 18% died and 66% were still phobic. Predictors of continuing phobic anxiety from initial interview were female gender and "stand-alone" phobic anxiety, i.e., not being depressed al initial interview. 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 predictor of psychotropic prescription was having sleep disturbance at initial interview. A low score on life satisfaction was significantly correlated 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 particularly likely to refuse an interview. Conclusion and clinical relevance: In older people, neither depression nor the anxiety disorders generally 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 treatment of older people with affective disorders. (C) 1997 Elsevier Science B.V.