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

Abstract

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.

The Economic, Public Health, and Caregiver Burden of Late-life Depression

“…Once these risk factors are controlled, the relationship between age and depressive symptoms becomes non-significant. 12 Other studies have found several distinct patterns of LLD depressive symptoms over time, including high or low levels of persistent symptoms, 21 or remitting, intermittent, and chronic courses, 13 with variations by age and birth cohort. 15 These studies demonstrate the variability and diversity in patient experiences of LLD.…”

Trajectories of Depression in Late Life: A 1-Year Follow-Up Study

“…Two previous trajectory class analyses of depressive symptoms among older primary care patients have included cognitive measures in the analyses, but did not find cognition to be a significant predictor of trajectory class membership [15,26] . Cui et al [26] also included a specific assessment of executive functions in their study.…”

“…Previous studies have reported results from trajectory analyses in different settings for DLL [1,[13][14][15][24][25][26][27][28][29] . However, few such studies have included hospitalized older patients in specialist health care services for old age psychiatry.…”

“…Patients with bipolar disorder and dementia have generally been excluded from observational longitudinal studies on the course of DLL [9,[13][14][15] . Symptoms of depression and dementia may overlap and often should be considered together [6,[16][17][18][19][20][21] .…”

Chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women

“…Based on follow-up interviews, a positive response to any of these conditions was considered a chronic medical condition. Consistent with prior publications, 21 persons with 3 or more conditions were considered to have high medical burden.…”