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Outcomes and predictors of late-life depression trajectories in older primary care patients.
Am J Geriatr Psychiatry. 2008 May; 16(5):406-15.AJ

Abstract

OBJECTIVES

The naturalistic outcomes of depression in older primary care patients have been poorly characterized. The authors sought to identify depressive trajectories over 2 years and to examine specified outcome predictors.

DESIGN

Two-year observational cohort study.

SETTING

University-based and independent practice primary care practices in greater Rochester.

PARTICIPANTS

All patients aged >65 years presenting for care on selected recruitment days were eligible to participate. Of 392 subjects enrolled, 316 (80.6%) completed study measures over a 2-year follow-up.

MEASUREMENTS

Depression trajectories were derived by applying longitudinal cluster analysis to weekly depression status from the Longitudinal Interval Follow-up Evaluation.

RESULTS

The authors identified six distinct trajectory clusters that followed clinically intuitive patterns. Although subjects initially nondepressed or in the subsyndromal to minor depression range had a range of possible outcomes over 2 years, the cluster initially near the major depression level remained at that level over time. Consistent predictors of depression trajectory were baseline depressive symptom severity, medical burden, and psychiatric functional status; for some clusters, previous history of depression and perceived social support also had prognostic significance.

CONCLUSION

The "real-world" outcomes of patients with more severe depressive symptoms are strikingly poor. Given the diverse outcomes of those with subsyndromal to mild forms of minor depression, clinicians might focus treatments on those at highest risk of poor outcome, i.e., those with greater depressive symptoms and medical burden and lower psychiatric functioning and social support. Preventive interventions research might focus on developing treatments to mitigate potentially modifiable risks such as deficits in social support.

Authors+Show Affiliations

Geriatric Psychiatry Program, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18448851

Citation

Cui, Xingjia, et al. "Outcomes and Predictors of Late-life Depression Trajectories in Older Primary Care Patients." The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, vol. 16, no. 5, 2008, pp. 406-15.
Cui X, Lyness JM, Tang W, et al. Outcomes and predictors of late-life depression trajectories in older primary care patients. Am J Geriatr Psychiatry. 2008;16(5):406-15.
Cui, X., Lyness, J. M., Tang, W., Tu, X., & Conwell, Y. (2008). Outcomes and predictors of late-life depression trajectories in older primary care patients. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 16(5), 406-15. https://doi.org/10.1097/JGP.0b013e3181693264
Cui X, et al. Outcomes and Predictors of Late-life Depression Trajectories in Older Primary Care Patients. Am J Geriatr Psychiatry. 2008;16(5):406-15. PubMed PMID: 18448851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes and predictors of late-life depression trajectories in older primary care patients. AU - Cui,Xingjia, AU - Lyness,Jeffrey M, AU - Tang,Wan, AU - Tu,Xin, AU - Conwell,Yeates, PY - 2008/5/2/pubmed PY - 2008/8/7/medline PY - 2008/5/2/entrez SP - 406 EP - 15 JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry JO - Am J Geriatr Psychiatry VL - 16 IS - 5 N2 - OBJECTIVES: The naturalistic outcomes of depression in older primary care patients have been poorly characterized. The authors sought to identify depressive trajectories over 2 years and to examine specified outcome predictors. DESIGN: Two-year observational cohort study. SETTING: University-based and independent practice primary care practices in greater Rochester. PARTICIPANTS: All patients aged >65 years presenting for care on selected recruitment days were eligible to participate. Of 392 subjects enrolled, 316 (80.6%) completed study measures over a 2-year follow-up. MEASUREMENTS: Depression trajectories were derived by applying longitudinal cluster analysis to weekly depression status from the Longitudinal Interval Follow-up Evaluation. RESULTS: The authors identified six distinct trajectory clusters that followed clinically intuitive patterns. Although subjects initially nondepressed or in the subsyndromal to minor depression range had a range of possible outcomes over 2 years, the cluster initially near the major depression level remained at that level over time. Consistent predictors of depression trajectory were baseline depressive symptom severity, medical burden, and psychiatric functional status; for some clusters, previous history of depression and perceived social support also had prognostic significance. CONCLUSION: The "real-world" outcomes of patients with more severe depressive symptoms are strikingly poor. Given the diverse outcomes of those with subsyndromal to mild forms of minor depression, clinicians might focus treatments on those at highest risk of poor outcome, i.e., those with greater depressive symptoms and medical burden and lower psychiatric functioning and social support. Preventive interventions research might focus on developing treatments to mitigate potentially modifiable risks such as deficits in social support. SN - 1545-7214 UR - https://www.unboundmedicine.com/medline/citation/18448851/Outcomes_and_predictors_of_late_life_depression_trajectories_in_older_primary_care_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/16/5/406 DB - PRIME DP - Unbound Medicine ER -