International Psychogeriatrics

2007 IPA RESEARCH AWARDS – FIRST-PRIZE WINNER

Twelve-year depressive symptom trajectories and their predictors in a community sample of older adults

Carmen Andreescua1a2 c1, Chou-Chung H. Changa3a4, Benoit H. Mulsanta1a2a5 and Mary Gangulia1a6a7

a1 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, U.S.A.

a2 The Advanced Center in Intervention and Services Research for Late-Life Mood Disorders, and the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, U.S.A.

a3 Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, U.S.A.

a4 Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, U.S.A.

a5 Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada

a6 Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, U.S.A.

a7 Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, U.S.A.

ABSTRACT

Introduction: The aim of this study is to understand the long-term course and outcomes of depressive symptoms among older adults in the community by examining trajectories of depressive symptoms over time and identifying profiles of depressive symptoms predicting different trajectories.

Method: We measured depressive symptoms biennially for up to 12 years, using the modified Center for Epidemiological Studies-Depression (mCES-D) scale, in 1260 community-based adults aged 65+ years. We determined latent trajectories of total mCES-D scores over time. We identified symptom profiles based on subgroups of baseline depressive symptoms derived from factor analysis, and examined their associations with the different trajectories.

Results: Six trajectories were identified. Two had one or no depressive symptoms at baseline and flat trajectories during follow-up. Two began with low baseline symptom scores and then diverged; female sex and functional disability were associated with future increases in depressive symptoms. Two trajectories began with high baseline scores but had different slopes: the higher trajectory was associated with medical burden, higher overall baseline score, and higher baseline scores on symptom profiles including low self-esteem, interpersonal difficulties, neurovegetative symptoms, and anhedonia. Mortality was higher among those in the higher trajectories.

Conclusions: In the community at large, those with minimal depressive symptoms are more likely to experience future increases in symptoms if they are women and have functional disability. Among those with higher current symptom levels, depression is more likely to persist over time in individuals who have greater medical burden and specific depressive symptoms.

(Received August 22 2007)

(Accepted August 22 2007)

Correspondence:

c1 Correspondence should be addressed to: Dr. Carmen Andreescu, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, U.S.A. Phone +1 412 383 5164; Fax: +1 412 383 5458. Email: andreescuc@upmc.edu.

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