Symptomatic and Functional Recovery From Major Depressive Disorder in the Ibadan Study of Ageing.

ABSTRACT

OBJECTIVES: 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. SETTING/PARTICIPANTS: Household multistage probability sample of 2,149 Nigerians who were aged 65 years or older. 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). RESULTS: 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 (ß = 1.0, 95% CI 0.2, 1.8), but more so in CR (ß = 2.3, 95% CI 1.6, 3.0). Poorer ADL at follow-up was predicted by age (ß = 2.9, 95% CI 1.8, 4.0) and economic status (ß = 1.4, 95% CI 0.3, 2.4). 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.