Advertisement
Research Article| Volume 26, ISSUE 3, P386-395, March 2018

Download started.

Ok

Vascular Pathology and Trajectories of Late-Life Major Depressive Disorder in Secondary Psychiatric Care

  • Katherine L. Musliner
    Correspondence
    Send correspondence and reprint requests to Dr. Katherine L. Musliner, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Fuglesangs Alle 26, Bygning R, 8210 Aarhus V, Denmark.
    Affiliations
    National Center for Register-based Research, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark

    iPSYCH, The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Copenhagen, Denmark

    Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Search for articles by this author
  • Peter P. Zandi
    Affiliations
    Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Search for articles by this author
  • Xiaoqin Liu
    Affiliations
    National Center for Register-based Research, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark

    iPSYCH, The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Copenhagen, Denmark
    Search for articles by this author
  • Thomas M. Laursen
    Affiliations
    National Center for Register-based Research, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark

    iPSYCH, The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Copenhagen, Denmark
    Search for articles by this author
  • Trine Munk-Olsen
    Affiliations
    National Center for Register-based Research, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark

    iPSYCH, The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Copenhagen, Denmark
    Search for articles by this author
  • Preben B. Mortensen
    Affiliations
    National Center for Register-based Research, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark

    iPSYCH, The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Copenhagen, Denmark

    CIRRAU - Center for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
    Search for articles by this author
  • William W. Eaton
    Affiliations
    Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Search for articles by this author

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Geriatric Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pedersen C.B.
        • Mors O.
        • Bertelsen A.
        • et al.
        A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders.
        JAMA Psychiatry. 2014; 71: 573-581
        • Eaton W.W.
        • Anthony J.C.
        • Gallo J.
        • et al.
        Natural history of Diagnostic Interview Schedule/DSM-IV major depression. The Baltimore Epidemiologic Catchment Area follow-up.
        Arch Gen Psychiatry. 1997; 54: 993-999
        • Grayson L.
        • Thomas A.
        A systematic review comparing clinical features in early age at onset and late age at onset late-life depression.
        J Affect Disord. 2013; 150: 161-170
        • Musliner K.L.
        • Trabjerg B.B.
        • Waltoft B.L.
        • et al.
        Parental history of psychiatric diagnoses and unipolar depression: a Danish National Register-based cohort study.
        Psychol Med. 2015; 45: 2781-2791
        • Alexopoulos G.S.
        • Meyers B.S.
        • Young R.C.
        • et al.
        “Vascular depression” hypothesis.
        Arch Gen Psychiatry. 1997; 54: 915-922
        • Alexopoulos G.S.
        • Meyers B.S.
        • Young R.C.
        • et al.
        Clinically defined vascular depression.
        Am J Psychiatry. 1997; 154: 562-565
        • Alexopoulos G.S.
        The vascular depression hypothesis: 10 years later.
        Biol Psychiatry. 2006; 60: 1304-1305
        • Taylor W.D.
        • Aizenstein H.J.
        • Alexopoulos G.S.
        The vascular depression hypothesis: mechanisms linking vascular disease with depression.
        Mol Psychiatry. 2013; 18: 963-974
        • Sheline Y.I.
        • Pieper C.F.
        • Barch D.M.
        • et al.
        Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial.
        Arch Gen Psychiatry. 2010; 67: 277-285
        • Robinson R.G.
        • Jorge R.E.
        Post-stroke depression: a review.
        Am J Psychiatry. 2016; 173: 221-231
        • Kendler K.S.
        • Fiske A.
        • Gardner C.O.
        • et al.
        Delineation of two genetic pathways to major depression.
        Biol Psychiatry. 2009; 65: 808-811
        • Byers A.L.
        • Vittinghoff E.
        • Lui L.Y.
        • et al.
        Twenty-year depressive trajectories among older women.
        Arch Gen Psychiatry. 2012; 69: 1073-1079
        • Kooistra M.
        • van der Graaf Y.
        • Grool A.M.
        • et al.
        The natural course of elevated levels of depressive symptoms in patients with vascular disease over eight years of follow-up. The SMART-Medea study.
        J Affect Disord. 2016; 202: 95-101
        • Pedersen C.B.
        The Danish civil registration system.
        Scand J Public Health. 2011; 39: 22-25
        • Pedersen C.B.
        • Gøtzsche H.
        • Møller J.O.
        • et al.
        The Danish civil registration system. A cohort of eight million persons.
        Dan Med Bull. 2006; 53: 441-449
        • Mors O.
        • Perto G.P.
        • Mortensen P.B.
        The Danish psychiatric central research register.
        Scand J Public Health. 2011; 39: 54-57
        • Lynge E.
        • Sandegaard J.L.
        • Rebolj M.
        The Danish national patient register.
        Scand J Public Health. 2011; 39: 30-33
        • Kildemoes H.W.
        • Sørensen H.T.
        • Hallas J.
        The Danish national prescription registry.
        Scand J Public Health. 2011; 39: 38-41
        • Danish National Board of Health
        Classification of Diseases: Extended Danish-Latin Version of the World Health Organization International Statistical Classification of Diseases and Related Health Problems.
        8th Revision ed. Danish National Board of Health, Copenhagen, Denmark1971
        • World Health Organization
        The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research.
        WHO, Geneva1993
        • Thygesen S.K.
        • Christiansen C.F.
        • Christensen S.
        • et al.
        The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients.
        BMC Med Res Methodol. 2011; 11: 83-88
        • Johannessen L.
        • Strudsholm U.
        • Foldager L.
        • et al.
        Increased risk of hypertension in patients with bipolar disorder and patients with anxiety compared to background population and patients with schizophrenia.
        J Affect Disord. 2006; 95: 13-17
        • Horsdal H.T.
        • Benros M.E.
        • Köhler O.
        • et al.
        Metabolic profile at first-time schizophrenia diagnosis: a population-based cross-sectional study.
        Neuropsychiatr Dis Treat. 2017; 13: 621-630
        • Luchsinger J.A.
        • Reitz C.
        • Honig L.S.
        • et al.
        Aggregation of vascular risk factors and risk of incident Alzheimer disease.
        Neurology. 2005; 65: 545-551
        • Nagin D.S.
        Analyzing developmental trajectories: a semiparametric, group-based approach.
        Psychol Methods. 1999; 4: 139-157
        • Nagin D.S.
        Group-Based Modeling of Development.
        Harvard University Press, Cambridge, MA2005
        • Jones B.L.
        • Nagin D.S.
        • Roeder K.
        A SAS procedure based on mixture models for estimating developmental trajectories.
        Soc Methods Res. 2001; 29: 374-393
        • Jones B.L.
        • Nagin D.S.
        Advances in group-based trajectory modeling and an SAS procedure for estimating them.
        Soc Methods Res. 2007; 35: 542-571
        • Haviland A.M.
        • Jones B.L.
        • Nagin D.S.
        Group-based trajectory modeling extended to account for nonrandom participant attrition.
        Soc Methods Res. 2011; 40: 367-390
        • Vermunt J.K.
        Latent class modeling with covariates: two improved three–step approaches.
        Pol Anal. 2010; 18: 450-469
        • Nylund K.L.
        • Asparouhov T.
        • Muthen B.O.
        Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study.
        Struct Equal Modeling. 2007; 14: 535-569
        • Luppa M.
        • Luck T.
        • Konig H.H.
        • et al.
        Natural course of depressive symptoms in late life. An 8-year population-based prospective study.
        J Affect Disord. 2012; 142: 166-171
        • Beekman A.T.
        • Geerlings S.W.
        • Deeg D.J.
        • et al.
        The natural history of late-life depression: a 6-year prospective study in the community.
        Arch Gen Psychiatry. 2002; 59: 605-611
        • Jørgensen T.S.
        • Wium-Andersen I.K.
        • Wium-Andersen M.K.
        • et al.
        Incidence of depression after stroke, and associated risk factors and mortality outcomes in a large cohort of Danish patients.
        JAMA Psychiatry. 2016; 73: 1032-1040
        • Alexopoulos G.S.
        • Meyers B.S.
        • Young R.C.
        • et al.
        Executive dysfunction and long-term outcomes of geriatric depression.
        Arch Gen Psychiatry. 2000; 57: 285-290
        • Butters M.A.
        • Bhalla R.K.
        • Mulsant B.H.
        • et al.
        Executive functioning, illness course, and relapse/recurrence in continuation and maintenance treatment of late-life depression: is there a relationship?.
        Am J Geriatr Psychiatry. 2004; 12: 387-394
        • Hickie I.
        • Scott E.
        • Wilhelm K.
        • et al.
        Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression—a longitudinal evaluation.
        Biol Psychiatry. 1997; 42: 367-374