Outcomes and Predictors of Late-Life Depression Trajectories in Older Primary Care Patients

Cui, Xingjia; Lyness, Jeffrey M.; Tang, Wan; Tu, Xin; Conwell, Yeates

doi:10.1097/01.jgp.0000308881.22956.27

Cited by 88 publications

(53 citation statements)

References 29 publications

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“…18–31,34,57 Additionally, CI may serve as a phenotypic marker of individuals with greater medical burden and/or neurodegenerative disease, 58–65 which could also strengthen the association between CI and mental healthcare costs given commonly documented relationships between medical burden and psychiatric treatment outcomes. 66 Nonetheless, to our knowledge, this is the first study to investigate the relationship of clinically defined CI to mental healthcare costs specifically for older, low-income adults with severe psychiatric illness, and our results suggest that CI is a significant factor in mental healthcare costs in this population.…”

Section: Discussionmentioning

confidence: 63%

The Effect of Cognitive Impairment on Mental Healthcare Costs for Individuals With Severe Psychiatric Illness

Mackin¹,

Delucchi²,

Bennett

et al. 2011

The American Journal of Geriatric Psychiatry

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Objective This study was conducted to determine the effect of cognitive impairment (CI) on mental healthcare costs for older low-income adults with severe psychiatric illness. Methods Data were collected from 62 ethnically diverse low-income older adults with severe psychiatric illness who were participating in day programming at a large community mental health center. CI was diagnosed by a neuropsychologist utilizing the Mattis Dementia Rating Scale-Second Edition and structured ratings of functional impairment (Clinical Dementia Rating Scale). Mental healthcare costs for 6, 12, and 24-month intervals before cognitive assessments were obtained for each participant. Substance abuse history was evaluated utilizing a structured questionnaire, depression symptom severity was assessed utilizing the Hamilton Depression Rating Scale, and psychiatric diagnoses were obtained through medical chart abstraction. Results CI was exhibited by 61% of participants and was associated with significantly increased mental healthcare costs during 6, 12, and 24-month intervals. Results of a regression analysis indicated that ethnicity and CI were both significant predictors of log transformed mental healthcare costs over 24 months with CI accounting for 13% of the variance in cost data. Conclusions CI is a significant factor associated with increased mental healthcare costs in patients with severe psychiatric illness. Identifying targeted interventions to accommodate CI may lead to improving treatment outcomes and reducing the burden of mental healthcare costs for individuals with severe psychiatric illness.

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Section: Discussionmentioning

confidence: 63%

The Effect of Cognitive Impairment on Mental Healthcare Costs for Individuals With Severe Psychiatric Illness

Mackin¹,

Delucchi²,

Bennett

et al. 2011

The American Journal of Geriatric Psychiatry

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show abstract

“…The undertreatment of mental disorders remains the greatest among vulnerable groups, including older adults (Wang et al, 2005). Third, other studies have focused only on major depression (Licht-Strunk et al, 2009) or not incorporated treatment into the analyses (Cui, Lyness, Tang, Tu, & Conwell, 2008). Thus, to our knowledge, no study has examined prognostic factors, pattern of time-varying depression, and outcome in a primary care trial of depression management among older adults with the ultimate goal of translating the knowledge into reducing the persistence of depression symptoms.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors, course, and outcome of depression among older primary care patients: The PROSPECT study

Bogner

Morales

Reynolds

et al. 2012

Aging & Mental Health

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Objectives We sought to examine whether there are patterns of evolving depression symptoms among older primary care patients that are related to prognostic factors and long-term clinical outcomes. Method Primary care practices were randomly assigned to Usual Care or to an intervention consisting of a depression care manager offering algorithm-based depression care. In all, 599 adults 60 years and older meeting criteria for major depression or clinically-significant minor depression were randomly selected. Longitudinal analysis via growth curve mixture modeling was carried out to classify patients according to the patterns of depression symptoms across 12 months. Depression diagnosis determined after a structured interview at 24 months was the long-term clinical outcome. Results Three patterns of change in depression symptoms over 12 months were identified: high persistent course (19.1% of the sample), high declining course (14.4% of the sample), low declining course (66.5% of the sample). Being in the intervention condition was more likely to be associated with a course of high and declining depression symptoms than high and persistent depression symptoms (OR = 2.53, 95% CI [1.01, 6.37]). Patients with a course of high and persistent depression symptoms were much more likely to have a diagnosis of major depression at 24 months compared with patients with a course of low and declining depression symptoms (adjusted OR = 16.46, 95% CI [7.75, 34.95]). Conclusion Identification of patients at particularly high risk of persistent depression symptoms and poor long-term clinical outcomes is important for the development and delivery of interventions. Trial Registration clinicaltrials.gov registration number: NCT00000367.

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“…This approach does not capture intraindividual variability in symptoms or the longitudinal course of depressive symptoms, which may be particularly important because older individuals appear to experience different patterns of depressive symptoms over time. 6–8 For example, a study 7 of older women followed up for approximately 20 years showed that individuals tended to exhibit the following 4 longitudinal patterns of depressive symptoms: trajectories of “minimal,” “persistently low,” “increasing,” and “persistently high” symptoms. It remains unclear whether different trajectories of depressive symptoms confer differential risk for dementia.…”

mentioning

confidence: 99%

Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia

et al. 2016

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Outcomes and Predictors of Late-Life Depression Trajectories in Older Primary Care Patients

Cited by 88 publications

References 29 publications

The Effect of Cognitive Impairment on Mental Healthcare Costs for Individuals With Severe Psychiatric Illness

The Effect of Cognitive Impairment on Mental Healthcare Costs for Individuals With Severe Psychiatric Illness

Prognostic factors, course, and outcome of depression among older primary care patients: The PROSPECT study

Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia

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