The side of the primary tumor affects overall survival in colon adenocarcinoma: an analysis of the national cancer database.

BACKGROUND: Due to conflicting study results on the effect of laterality on overall survival in primary colon cancers, we sought to examine the impact of left compared to right-sided primary tumors on overall survival for stage I-III colon cancer using the largest dataset to date. METHODS: The 2006-2013 NCDB was queried for patients with single primary, stage I-III colon adenocarcinoma and grouped by stage and tumor location. RESULTS: For stage I-II tumors, 114,839 patients had resection (62% right:38% left). After adjustment, patients with right-sided tumors had superior survival ([HR right as reference]: 1.13, 95% CI 1.09-1.17, p < 0.001). For stage III tumors, 71,024 patients had resection, (59% right:41% left). After adjustment, patients with left-sided tumors had superior survival with chemotherapy (HR 0.85, p < 0.001) and no difference in survival without chemotherapy (HR 0.97, p = 0.18). CONCLUSIONS: The side of the primary tumor impacts overall survival across stages for colon adenocarcinoma. Patients with right-sided tumors have superior survival for stage I-II disease while patients with left-sided stage III disease demonstrate a survival advantage, suggesting an opportunity for investigators to use sidedness as a surrogate for prognosis and chemoresponsiveness.

Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders.

BACKGROUND: Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized. METHOD: We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs. RESULTS: NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system. CONCLUSIONS: Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.

Trajectory classes of depressive symptoms in a community sample of older adults.

OBJECTIVE: To identify trajectories of depressive symptoms in older community residents. METHOD: Depressive symptomatology, based on a modified Center for Epidemiological Studies-Depression scale, was obtained at years 0, 3, 6, and 10, in the Duke Established Populations for Epidemiologic Studies of the Elderly (n = 4162). Generalized growth mixture models identified the latent class trajectories present. Baseline demographic, health, and social characteristics distinguishing the classes were identified using multinomial logistic regression. RESULTS: Four latent class trajectories were identified. Class 1 - stable low depressive symptomatology (76.6% of the sample); class 2 - initially low depressive symptomatology, increasing to the subsyndromal level (10.0%); class 3 - stable high depressive symptomatology (5.4%); class 4 - high depressive symptomatology improving over 6 years before reverting somewhat (8.0%). Class 1 was younger, male gender, with better education, health, and social resources, in contrast to class 3. Class 2 had poorer cognitive functioning and higher death rate. Class 4 had better health and social resources. CONCLUSION: Reduction in high depressive symptomatology is associated with more education, better health, fewer stressful events, and a larger social network. Increasing depressive symptomatology is accompanied by poorer physical and cognitive health, more stressful life events, and greater risk of death.

Abuse and dependence on prescription opioids in adults: a mixture categorical and dimensional approach to diagnostic classification.

BACKGROUND: For the emerging DSM-V, it has been recommended that dimensional and categorical methods be used simultaneously in diagnostic classification; however, little is known about this combined approach for abuse and dependence. METHOD: Using data (n=37 708) from the 2007 National Survey on Drug Use and Health (NSDUH), DSM-IV criteria for prescription opioid abuse and dependence among non-prescribed opioid users (n=3037) were examined using factor analysis (FA), latent class analysis (LCA, categorical), item response theory (IRT, dimensional), and factor mixture (hybrid) approaches. RESULTS: A two-class factor mixture model (FMM) combining features of categorical latent classes and dimensional IRT estimates empirically fitted more parsimoniously to abuse and dependence criteria data than models from FA, LCA and IRT procedures respectively. This mixture model included a severely affected group (7%) with a comparatively moderate to high probability (0.32-0.88) of endorsing all abuse and dependence criteria items, and a less severely affected group (93%) with a low probability (0.003-0.16) of endorsing all criteria. The two empirically defined groups differed significantly in the pattern of non-prescribed opioid use, co-morbid major depression, and substance abuse treatment use. CONCLUSIONS: A factor mixture model integrating categorical and dimensional features of classification fits better to DSM-IV criteria for prescription opioid abuse and dependence in adults than a categorical or dimensional approach. Research is needed to examine the utility of this mixture classification for substance use disorders and treatment response.

The complex relationship between depressive symptoms and functional limitations in community-dwelling older adults: the impact of subthreshold depression.

BACKGROUND: Depressive symptoms above screening thresholds have been shown to predict functional decline in older adults. Less is known about the impact of subthreshold depression, and whether more symptoms confer significantly greater risk compared to fewer symptoms. METHOD: Using data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) collected over 10 years, we used repeated-measures mixed models to predict functional change by depression status at the prior (index) in-person interview. Depressive symptoms were measured using a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D). Subthreshold depression was operationalized as 6-8 symptoms and CES-D-defined depression as 9-20 symptoms in the previous week. Three domains of functional status were assessed at the subsequent in-person interview: limitations in basic activities of daily living (ADL), instrumental ADL (IADL) and mobility. RESULTS: Controlling for race, sex, age, education, marital status, cognitive status, health status, self-perceived health, perceived social support and functional status at the index interview, having 6 depressive symptoms predicted an increase of 0.12 IADL limitations 3-4 years later (p=0.03). The incremental effect of CES-D-defined depression (9 symptoms compared to 6-8 symptoms) was not significant, suggesting that the effect of more symptomatic depression did not add to that of subthreshold depression. CES-D score modeled as a continuous variable predicted functional change for all domains, but the relationship was not linear, supporting a possible threshold effect. CONCLUSIONS: The relationship between depressive symptoms and functional change is complex, not necessarily linear, and may vary by tasks assessed.

Association of MDMA/ecstasy and other substance use with self-reported sexually transmitted diseases among college-aged adults: a national study.

OBJECTIVES: MDMA/ecstasy use among college students has increased and reportedly leads to risky sexual behaviours. However, little is known about its association with sexually transmitted diseases (STDs). To evaluate this public health concern, this study examined the association between substance use (particularly MDMA) and self-reported STDs (chlamydia, gonorrhoea, herpes and syphilis) among college students and non-students aged 18-22 years (n=20,858). STUDY DESIGN: A cross-sectional data analysis of a national survey. METHODS: Data were drawn from the 2005-2006 National Surveys on Drug Use and Health; a nationally representative survey of non-institutionalized Americans. Self-reported STDs and substance use were assessed by the audio computer-assisted self-interviewing method. The association between MDMA use and STDs was determined while taking into account young adults' use of other substances, healthcare utilization and sociodemographic characteristics. RESULTS: Overall, 2.1% of college students and 2.5% of non-students reported contracting an STD in the past year. MDMA use in the past year was not associated with STDs. Among non-students, onset of MDMA use before 18 years of age increased the odds of past-year STDs. In both groups, alcohol use, marijuana use, female gender and African American race increased the odds of both past-year and lifetime STDs. Additional analyses indicated that, regardless of college-attending status, greater odds of past-year STDs were noted among users of alcohol and drugs, and users of alcohol alone, but not among users of drugs alone. CONCLUSIONS: Alcohol use is a robust correlate of STDs. Irrespective of college-attending status, young women and African Americans have a higher rate of STDs than young men and Whites.

The boundary of social phobia. Exploring the threshold.

BACKGROUND: Individuals with subthreshold social phobia (SSP) in the community are characterized relative to nonphobic, healthy controls (C), and diagnosed social phobics (SP). METHODS: Data from 1488 subjects from the Duke University Epidemiological Catchment Area Study were examined. Bivariate and multivariate methods were used to compare the SSP, SP, and C groups on 10 sets of variables. RESULTS: Compared with C respondents, SSP respondents were more likely to be female and unmarried and to report less income and education. The SSP respondents were also more likely to report work attendance problems, poor grades in school, symptoms of conduct disturbance, impaired subjective social support, lack of self-confidence, lack of a close friend, use of psychotropic drugs in past year, and a greater number of life changes, chronic medical problems, and mental health visits within the past 6 months. In a multivariate logistic regression model with group membership as the dependent variable, compared with C respondents, SSP respondents were more likely to be female, to have less education, and to report more indicators of poor school performance and symptoms of adolescent conduct disturbance. In contrast, in a similar but separate multivariate model, compared with SP respondents, SSP respondents met the criteria for fewer DSM-III psychiatric disorders and were less likely to report impaired instrumental support. CONCLUSION: Social phobia adversely affects over 10% of the population. Previous epidemiologic catchment area-based prevalence estimates have probably been unrealistically low.

The association of sexual assault and attempted suicide within the community.

BACKGROUND: Lifetime community rates of attempted suicide were compared between those who reported a history of sexual assault and a control group without such a history. METHODS: The 2918 respondents in the Duke University Epidemiological Catchment Area Study were placed into groups with reported sexual assault (n = 67) and those with no known history of such (n = 2851). Multivariate and bivariate procedures were used to examine the relation between sexual assault and attempted suicide. RESULTS: Subjects reporting a history of sexual assault were more likely to be female, younger, and to report higher rates of lifetime suicide attempt and post-traumatic stress symptoms; no differences were found in the number of chronic medical disorders, major depression, substance abuse or substance dependence, or panic attacks. Nine (14.9%) of the 67 index group subjects reported a suicide attempt, 4 of whom reported their first sexual assault as occurring before age 16 years. A sexual assault history was associated with increased prevalence of lifetime suicide attempt after controlling for sex, age, education, posttraumatic stress symptoms, and psychiatric disorder. Findings were similar in the female-only subsample (n = 1778). For women, the odds of attempting suicide was 3 to 4 times greater when the first reported sexual assault occurred prior to age 16 years compared with age 16 years or older. CONCLUSIONS: Sexual assault is associated with an increased lifetime rate of attempted suicide. In women, a history of sexual trauma before age 16 years is a particularly strong correlate of attempted suicide.

Elevated plasma concentrations of alpha 1-acid glycoprotein, a putative endogenous inhibitor of the tritiated imipramine binding site, in depressed patients.

The plasma concentration of alpha 1-acid glycoprotein, a putative endogenous inhibitor of the site labeled by tritiated imipramine, was measured by a radial immunodiffusion assay in 36 normal human volunteers and 51 drug-free patients who fulfilled DSM-III criteria for major depression. The depressed patients exhibited a significant elevation in the plasma concentration (+/- SEM) of alpha 1-acid glycoprotein (79.6 +/- 4 mg/dL) when compared with the age- and sex-matched controls (61.7 +/- 3 mg/dL). Fourteen of the 51 patients with major depression had plasma alpha 1-acid glycoprotein concentrations that were higher than the highest values of the normal controls. There was no relationship between plasma alpha 1-acid glycoprotein concentrations and sex or affinity of platelet tritiated imipramine binding of either the normal volunteers or the depressed patients. In the depressed patients, there was a significant positive correlation between plasma concentrations of alpha 1-acid glycoprotein and postdexamethasone plasma cortisol concentrations, and two measures of depression severity, the Montgomery-Asberg Rating Scale for Depression and the Center for Epidemiologic Studies-Depression Scale, and a significant negative correlation with age. These data provide the first evidence of alterations of an endogenous inhibitor of the tritiated imipramine binding site/serotonin transporter in depressed patients.

Marked reduction in the number of platelet-tritiated imipramine binding sites in geriatric depression.

The number (Bmax) and affinity (Kd) of platelet-tritiated imipramine binding sites was determined in young and middle-aged controls 50 years of age and younger (n = 25), elderly normal controls over 60 years of age (n = 18), patients who fulfilled DSM-III criteria for major depression who were under 50 years of age (n = 29), patients who fulfilled DSM-III criteria for major depression who were 60 years of age and older (n = 19), and patients who fulfilled both DSM-III criteria for primary degenerative dementia and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease (n = 13). Both groups of depressed patients (under 50 and over 60 years of age) exhibited significant reductions (decreases 42%) in the number of platelet-tritiated imipramine binding sites with no change in affinity, when compared with their age-matched controls. There was little overlap in Bmax values between the elderly depressed patients and their controls. The patients with probable Alzheimer's disease showed no alteration in platelet-tritiated imipramine binding. There was no statistically significant relationship between postdexamethasone plasma cortisol concentrations and tritiated imipramine binding. These results indicate that platelet-tritiated imipramine binding may have potential utility as a diagnostic adjunct in geriatric depression, and moreover that the reduction in the number of platelet-tritiated imipramine binding sites is not due to hypercortisolemia.

The NIMH Epidemiologic Catchment Area program. Historical context, major objectives, and study population characteristics.

The National Institute of Mental Health multisite Epidemiologic Catchment Area (ECA) program is described in the context of four previous psychiatric epidemiologic surveys that included a combined total of 4,000 subjects from Stirling County, the Baltimore Morbidity Study, Midtown Manhattan, and the New Haven third-wave survey. The ECA program is distinguished by its sample size of at least 3,500 subjects per site (about 20,000 total); the focus on Diagnostic Interview Schedule--defined DSM-III mental disorders; the one-year reinterview-based longitudinal design to obtain incidence and service use data; the linkage of epidemiologic and health service use data; and the replication of design and method in multiple sites. Demographic characteristics of community and sample populations are provided for New Haven, Conn, Baltimore, and St Louis.

A multivariate analysis of factors associated with depression: evaluating the role of health literacy as a potential contributor.

BACKGROUND: High rates of low health literacy among elderly populations along with a high prevalence of chronic conditions may lead to increased levels of depression symptomatology. We sought to determine whether older adults with inadequate health literacy were more likely to report depressive symptoms and whether health literacy was an independent predictor of depression symptomatology. METHODS: A total of 3260 new Medicare enrollees 65 years or older were interviewed in person between June and December 1997 from 4 managed care plans (853 in Cleveland, Ohio, 498 in Houston, Tex, 975 in South Florida, and 934 in Tampa, Fla). Depression symptoms were measured by the Geriatric Depression Scale. RESULTS: Overall, 13% of respondents were classified as depressed. Individuals with inadequate health literacy had 2.7 times the odds (95% confidence interval, 2.2-3.4) of being depressed compared with individuals with adequate health literacy skills. However, after controlling for health status with multiple logistic regression, individuals with inadequate health literacy were not more likely to be depressed (adjusted odds ratio, 1.2; 95% confidence interval, 0.9-1.7). Individuals who had less social support, exercised less than twice a week, drank alcohol heavily, or had poor health status (at least 3 health conditions, physical limitations, or fair or poor self-rated health) had significantly higher odds of depression symptomatology. CONCLUSIONS: Although individuals with inadequate health literacy were more than twice as likely to report depressive symptoms, this was mostly explained by their worse health status. The strong relation between depression symptoms and poor health status suggests the need to research interventions to improve mental and physical health concurrently. The influence of particular interventions on depression, such as referral to community support contacts and recommendations for an exercise program, needs to be further evaluated. Arch Intern Med. 2000;160:3307-3314.

Depression in elderly hospitalized patients with medical illness.

Depressive symptoms and disorders were identified by structured psychiatric interview in 130 consecutively admitted male inpatients aged 70 years and over. Major depression was found in 11.5% and other depressive syndromes in 23%. While depressive symptoms and syndromes are common among the medically ill, this study demonstrated the need for careful diagnostic assessment of older patients with depressive symptoms before initiating treatment that may itself convey significant risk. Sociodemographic and health characteristics of older men at higher risk for depression were also identified. Patients more likely to be depressed were over age 75 years, had less formal education, experienced cognitive dysfunction, suffered from more severe medical illness (particularly recent myocardial infarction), and had a history of psychiatric illness. Depressive symptoms were also common among patients with renal or neurologic diseases, those having a family history of psychiatric illness, the unmarried, and the more severely disabled. Given the impact of depression on recovery from medical illness, compliance with medical therapy, and costs of extended hospital stays, detection and treatment of this disorder are imperative.

Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.

OBJECTIVE: In the United States, 20% or more of nursing home residents receive antipsychotic drugs, primarily for the behavioral manifestations of dementia. This high level of use of drugs with substantial toxicity has engendered a strong and persistent controversy and recently has led to explicit regulatory measures to curtail use (Omnibus Budget Reconciliation Act of 1987). We developed and tested a comprehensive program to reduce antipsychotic use through education of physicians, nurses, and other nursing home staff. The primary elements of the program were instruction in use of behavioral techniques to manage behavior problems and encouragement of a trial of gradual antipsychotic withdrawal. DESIGN: In a nonrandomized controlled trial, the program was implemented (beginning in August 1990) in two rural Tennessee community nursing homes with elevated antipsychotic use; two other comparable homes were selected as concurrent controls. PATIENTS: Throughout the study 194 residents were in the education homes and 184 were in the control homes. Residents in both groups of homes had comparable demographic characteristics and functional status, and each group had a baseline rate of 29 days of antipsychotic use per 100 days of nursing home residence. MAIN OUTCOME MEASURES: The primary end points were postintervention changes in administration of antipsychotics and other psychotropic drugs, use of physical restraints, and frequency of behavior problems. RESULTS: Days of antipsychotic use decreased by 72% in the education homes vs 13% in the control homes (P < .001). No significant changes were noted in the use of other psychotropic drugs in either group. Days of physical restraint use decreased 36% in the education homes vs 5% in the control homes (P < .001). Behavior problem frequency did not increase in either group, even among the 48% of baseline antipsychotic users in the education homes who had antipsychotic drug regimens discontinued for 3 or more months. CONCLUSIONS: The educational program led to a substantial reduction in antipsychotic use with no increase in the frequency of behavior problems. This suggests that for many antipsychotic drug users benefits may be marginal and that programs to reduce such drug use among the 250,000 US nursing home residents receiving these drugs should have high priority.

Reduced inhibitory effect of imipramine on radiolabeled serotonin uptake into platelets in geriatric depression.

Tritiated imipramine binding, uptake of radiolabeled serotonin, and inhibition of uptake by imipramine in vitro were studied in platelets obtained from four groups of subjects: (1) normal controls 50 years of age or younger, (2) patients with major depression 50 years of age or younger, (3) normal controls 60 years of age or older, and (4) patients with major depression 60 years of age or older. Depression in both age groups was associated with a substantial decrease in the number of [3H]imipramine binding sites; the elderly depressed patients exhibited a small but significant (p less than 0.05) reduction in platelet [3H]serotonin uptake. However, the inhibition of serotonin uptake into platelets by imipramine was markedly reduced only in the elderly depressed patients. This reduced sensitivity to imipramine may explain the reduced responsiveness of patients with geriatric depression to the therapeutic effects of imipramine and other tricyclic antidepressants.

Rhythmicity and response to A.M. and P.M. CRH challenge in elderly subjects.

Cortisol and ACTH exhibit circadian rhythmicity, peaking in the early morning. These peaks are associated with increased activity and alertness. We sought to determine whether self-reported daily rhythms predict outcome of a.m. and p.m. CRH challenge in elderly subjects. We surveyed 96 elderly subjects to determine daily rhythms in activity levels, mood, alertness, and performance. Seven healthy subjects were given a cumulative activity score reflecting propensity toward morningness or eveningness. Subjects underwent CRH challenge testing during the morning and evening hours of different days. Baseline plasma ACTH and cortisol concentrations were higher in the morning than in the evening and lower values were associated with lower activity scores (i.e., greater morningness). No trends were apparent between activity score and net hormone response or percent change in hormone concentration.

Benzodiazepine use and cognitive function among community-dwelling elderly.

OBJECTIVE: To evaluate the relation between benzodiazepine use and cognitive function among community-dwelling elderly. METHODS: This prospective cohort study included 2765 self-reporting subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly. The subjects were cognitively intact at baseline (1986-1987) and alive at follow-up data collection 3 years later. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (unimpaired versus impaired and change in score) and on the basis of the number of errors on the individual domains of the Orientation-Memory-Concentration Test. Benzodiazepine use was determined during in-home interviews and classified by dose, half-life, and duration. Covariates included demographic characteristics, health status, and health behaviors. RESULTS: After control for covariates, current users of benzodiazepine made more errors on the memory test (beta coefficient, 0.35; 95% confidence interval [CI], 0.10 to 0.61) than nonusers. Further assessment of the negative effects on memory among current users suggested a dose response in which users taking the recommended or higher dose made more errors (beta coefficient, 0.57; 95% CI, 0.26 to 0.88) and a duration response in which long-term users made more errors (beta coefficient, 0.39; 95% CI, 0.05 to 0.73) than nonusers. Users of agents with long half-lives and users of agents with short half-lives both had increased memory impairment (beta coefficient, 0.32; 95% CI, 0.01 to 0.64 and beta coefficient, 0.38; 95% CI, 0.02 to 0.75, respectively) relative to nonusers. Previous benzodiazepine use was unrelated to memory problems, and current and previous benzodiazepine use was unrelated to level of cognitive functioning as measured with the other 4 tests. CONCLUSIONS: The results suggested that current benzodiazepine use, especially in recommended or higher doses, is associated with worse memory among community-dwelling elderly.

Psychiatry and the oldest old.

OBJECTIVE: This article reviews the assessment and management of psychiatric problems among the oldest old. METHOD: The author reviewed the English-language literature pertinent to the characteristics of people 85 years old or older and the assessment and management of psychiatric disorders in this age group with a special focus on depression in the oldest old. RESULTS: Much of the current literature in geriatric psychiatry ignores the oldest old, focusing instead on the treatment of specific psychiatric disorders with unimodal or bimodal therapies. In contrast, geriatric medicine has focused on geriatric syndromes, functional status, comprehensive geriatric assessment, and multimodal intervention. The author describes an approach to treating the oldest old that incorporates depression as an example. This approach is based on the philosophy that has worked well in geriatric medicine but has been increasingly abandoned by psychiatry over recent years. CONCLUSIONS: Comprehensive, interdisciplinary assessment and therapy were the cornerstones of geriatric psychiatry 30 years ago. As psychiatry has moved toward a medical model and emphasized pharmacological therapies, it has moved away from the mainstream of geriatric practice. The time has come for geriatric psychiatry to rejoin geriatric medicine so that psychiatry can recapture its roots and deliver optimal care to the oldest old.

Impact of late-life depression on the social network.

The author tested the hypothesis that a major depressive disorder contributes to a decline in social support by studying data from 331 subjects 65 years of age and older who had been selected at random from a larger community group and screened for a major depressive disorder and the availability of social supports. Impaired social support was associated with the presence of a major depressive disorder. Thirty months later, however, the surviving subjects whose social supports had improved were 2.62 times more likely to have been depressed earlier than those whose social supports did not improve. Major depressive disorder was a significant predictor of improvement in social supports at follow-up.

Does age make a difference in the effects of physical health and social support on the outcome of a major depressive episode?

OBJECTIVE: The authors examined the effects of physical health and social support on 6-month outcome of a major depressive episode in 67 patients who were less than 60 years old and 46 patients who were 60 years old or older. They hypothesized that despite their higher rate of troublesome health problems, older patients would have fewer depressive symptoms at follow-up than would younger patients. METHOD: The Center for Epidemiologic Studies Depression Scale (CES-D Scale) and a modified version of the National Institute of Mental Health Diagnostic Interview Schedule were used to gather data from inpatients and outpatients treated at Duke University Medical Center during a face-to-face interview at baseline and over the telephone at 6-month follow-up. At baseline, all patients met DSM-III-R criteria for a major depressive episode. Data analyses included bivariate and multivariate procedures. RESULTS: At baseline, the mean CES-D Scale scores of the two age groups were similar. As expected, the mean illness index score of the older patients was significantly higher and their mean impaired subjective social support score was slightly lower than those of the younger patients. At 6-month follow-up, the mean CES-D Scale score of the younger patients was above the depressive threshold, but the mean CES-D Scale score of the older patients was below the depressive threshold. The illness index and impaired subjective support measures were significant predictors of depressive symptoms at 6 months for the younger patients but not for the older patients. CONCLUSIONS: The authors conclude that older depressed patients have a more favorable prognosis than younger depressed patients. Predictors of outcome vary by age.