Highlights
- •What is the primary question addressed by this study?Are the subtypes of major depressive disorder according to the diagnostic and statistical manual of mental disorders (DSM-IV) specifiers stable in advanced age and what is the influence of mild cognitive impairment on this stability?
- •What is the main finding of this study?Longitudinal stability into advanced age of the atypical and the combined subtypes but not of the melancholic subtype of major depressive disorder according to the DSM-IV specifiers and absence of the effect of mild cognitive impairment on this stability.
- •What is the meaning of the finding?Additional support for the validity of the atypical subtype of major depressive disorder according to the DSM-IV specifier in older age.
Abstract
Objectives
To assess 1) the longitudinal stability of the atypical, melancholic, combined atypical-melancholic
and the unspecified subtypes of major depressive disorder (MDD) according to the diagnostic
and statistical manual of mental disorders (DSM –IV) specifiers in older adults, and
2) the effect of mild cognitive impairment (MCI) on the stability of these subtypes.
Design
Prospective cohort study with a 5.1 year-follow-up.
Setting
Population-based cohort from Lausanne, Switzerland.
Participants
A total of 1,888 participants (mean age: 61.7 years, women: 69.2%) with at least two
psychiatric evaluations, one after the age of 65 years.
Measurements
Semistructured diagnostic interview to assess lifetime and 12-month DSM-IV Axis-1
disorders at each investigation and neuro-cognitive tests to identify MCI in participants
aged 65 years and over. Associations between lifetime MDD status before and 12-month
depression status after the follow-up were assessed using multinomial logistic regression.
The effect of MCI on these associations was assessed by testing interactions between
MDD subtypes and MCI status.
Results
1) Associations between depression status before and after the follow-up were observed
for atypical (adjusted OR [95% CI] = 7.99 [3.13; 20.44]), combined (5.73 [1.50; 21.90])
and unspecified (2.14 [1.15; 3.98]), but not melancholic MDD (3.36 [0.89; 12.69]).
However, there was a certain degree of overlap across the subtypes, particularly between
melancholic MDD and the other subtypes. 2) No significant interactions were found
between MCI and lifetime MDD subtypes regarding depression status after follow-up.
Conclusion
The strong stability of the atypical subtype in particular highlights the need for
identifying this subtype in clinical and research settings, given its well-documented
links to inflammatory and metabolic markers.
Key Words
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Article info
Publication history
Published online: February 14, 2023
Accepted:
February 9,
2023
Received in revised form:
February 8,
2023
Received:
December 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
