Age and remission of psychiatric disorders

Abstract

Objective: To examine the relationship between remission of psychiatric disorders and age.

Methods: We interviewed 3258 randomly selected adult residents of Edmonton using the Diagnostic Interview Schedule (DIS), which yielded DIS/DSM-III diagnoses. Remission was defined as being free of symptoms of the index lifetime disorder in the year preceding the interview, this being the difference between the lifetime and one-year prevalence. For each age group, the proportion of cases with and without symptoms in the preceding year was calculated. Numbers and proportions of cases were estimated after adjusting to the census population and weighting for household size. Only the more common disorders were examined; any comorbidities were ignored.

Results: Drug abuse or dependence, antisocial personality disorder (in both sexes), and alcohol abuse or dependence (in men) all showed remission rates that increased with age. Panic disorder and obsessive-compulsive disorder (OCD) showed a decreased likelihood of remission with increasing age. Major depression and phobias showed little tendency to remission with age. Considering all disorders together, the one-year remission rate for all ages combined was only 33.2%, with a tendency for lower remission rates to be found in those aged 55 to 64.

Conclusions: As may be expected, antisocial personality, drug abuse or dependence, and alcohol abuse or dependence tend to show increased remission rates with increasing age. In OCD and panic disorder, the low rates of remission found in all age groups indicate that these disorders produce significant long-term morbidity. For depression, which had an overall remission rate of less than 50%, the stable low rate of remission probably indicates not only the difficulties of treatment but also the low rates at which cases get treated.