- •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
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.
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.
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.
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.
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- A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders.JAMA Psychiatry. 2014; 71: 573-581
- Natural history of Diagnostic Interview Schedule/DSM-IV major depression. The Baltimore Epidemiologic Catchment Area follow-up.Arch Gen Psychiatry. 1997; 54: 993-999
- 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
- Parental history of psychiatric diagnoses and unipolar depression: a Danish National Register-based cohort study.Psychol Med. 2015; 45: 2781-2791
- “Vascular depression” hypothesis.Arch Gen Psychiatry. 1997; 54: 915-922
- Clinically defined vascular depression.Am J Psychiatry. 1997; 154: 562-565
- The vascular depression hypothesis: 10 years later.Biol Psychiatry. 2006; 60: 1304-1305
- The vascular depression hypothesis: mechanisms linking vascular disease with depression.Mol Psychiatry. 2013; 18: 963-974
- 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
- Post-stroke depression: a review.Am J Psychiatry. 2016; 173: 221-231
- Delineation of two genetic pathways to major depression.Biol Psychiatry. 2009; 65: 808-811
- Twenty-year depressive trajectories among older women.Arch Gen Psychiatry. 2012; 69: 1073-1079
- 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
- The Danish civil registration system.Scand J Public Health. 2011; 39: 22-25
- The Danish civil registration system. A cohort of eight million persons.Dan Med Bull. 2006; 53: 441-449
- The Danish psychiatric central research register.Scand J Public Health. 2011; 39: 54-57
- The Danish national patient register.Scand J Public Health. 2011; 39: 30-33
- The Danish national prescription registry.Scand J Public Health. 2011; 39: 38-41
- 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
- The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research.WHO, Geneva1993
- 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
- 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
- Metabolic profile at first-time schizophrenia diagnosis: a population-based cross-sectional study.Neuropsychiatr Dis Treat. 2017; 13: 621-630
- Aggregation of vascular risk factors and risk of incident Alzheimer disease.Neurology. 2005; 65: 545-551
- Analyzing developmental trajectories: a semiparametric, group-based approach.Psychol Methods. 1999; 4: 139-157
- Group-Based Modeling of Development.Harvard University Press, Cambridge, MA2005
- A SAS procedure based on mixture models for estimating developmental trajectories.Soc Methods Res. 2001; 29: 374-393
- Advances in group-based trajectory modeling and an SAS procedure for estimating them.Soc Methods Res. 2007; 35: 542-571
- Group-based trajectory modeling extended to account for nonrandom participant attrition.Soc Methods Res. 2011; 40: 367-390
- Latent class modeling with covariates: two improved three–step approaches.Pol Anal. 2010; 18: 450-469
- 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
- Natural course of depressive symptoms in late life. An 8-year population-based prospective study.J Affect Disord. 2012; 142: 166-171
- The natural history of late-life depression: a 6-year prospective study in the community.Arch Gen Psychiatry. 2002; 59: 605-611
- 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
- Executive dysfunction and long-term outcomes of geriatric depression.Arch Gen Psychiatry. 2000; 57: 285-290
- 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
- Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression—a longitudinal evaluation.Biol Psychiatry. 1997; 42: 367-374
Published online: July 12, 2017
Accepted: July 6, 2017
Received in revised form: June 16, 2017
Received: January 23, 2017
Presented in part in a poster session at the European Psychiatric Association 2017 conference in Florence, Italy, April 1–4, 2017.
© 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.