Highlights
- •We examined 5-year trajectories of clinically diagnosed depression in a large, representative sample of older adults treated in secondary psychiatric care in Denmark.
- •Latent class growth analysis identified four trajectory patterns: consistently low (66%), high decreasing (19%), consistently high (9%), and moderate fluctuating (6%) probability of psychiatric hospital contact following the index depression.
- •Older age, greater severity, inpatient treatment and >12 months of prior antidepressant medication use predicted hospital contact trajectories.
- •Vascular pathology was not significantly associated with trajectory class membership
Objective
To examine 5-year trajectories of psychiatrist-treated late-life major depressive
disorder (MDD), and evaluate whether previous vascular pathology is associated with
more severe trajectories of late-life MDD.
Methods
Data were obtained from nationally representative civil, psychiatric, hospital, and
prescription registers in Denmark. The sample included 11,092 older adults (≥60 years)
who received their first diagnosis of MDD in a psychiatric facility in Denmark between
2000 and 2007. Trajectories of inpatient or outpatient contact at psychiatric hospitals
for MDD over the 5-year period following index MDD diagnosis were modeled using latent
class growth analysis. Measures of vascular disease (stroke, heart disease, vascular
dementia) and vascular risk factors (hypertension, diabetes) were defined based on
medication prescriptions and hospital-based diagnoses. Other predictors included demographic
characteristics and characteristics of the index MDD diagnosis.
Results
The final model included 4 trajectories with consistently low (66% of the sample),
high decreasing (19%), consistently high (9%), and moderate fluctuating (6%) probabilities
of contact at a psychiatric hospital for MDD during the 5-year period following the
index MDD diagnosis. We found no significant associations between any form of vascular
pathology and trajectory class membership. Relative to the consistently low class,
older age, greater severity and >12 months of prior antidepressant medication use
predicted membership in the other three classes.
Conclusions
A notable proportion (34%) of individuals diagnosed with MDD in late-life require
secondary psychiatric treatment for extended time periods. We did not find evidence
that vascular pathology predicts hospital contact trajectories in secondary-treated
late-life MDD.
Key Words
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Article info
Publication history
Published online: July 12, 2017
Accepted:
July 6,
2017
Received in revised form:
June 16,
2017
Received:
January 23,
2017
Footnotes
Presented in part in a poster session at the European Psychiatric Association 2017 conference in Florence, Italy, April 1–4, 2017.
Identification
Copyright
© 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
