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

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 (beta = 1.0, 95% CI: 0.2, 1.8), but more so in CR (beta = 2.3, 95% CI: 1.6, 3.0). Poorer ADL at follow-up was predicted by age (beta = 2.9, 95% CI: 1.8, 4.0) and economic status (beta = 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.