TY - JOUR
T1 - Vascular Pathology and Trajectories of Late-Life Major Depressive Disorder in Secondary Psychiatric Care
AU - Musliner, Katherine L.
AU - Zandi, Peter P.
AU - Liu, Xiaoqin
AU - Laursen, Thomas M.
AU - Munk-Olsen, Trine
AU - Mortensen, Preben B.
AU - Eaton, William W.
N1 - Funding Information:
The authors would like to thank Dr. Karen Swartz, Dr. Jeannie-Marie Leoutsakos, Dr. Alden Gross, and Dr. Tamar Mendelson for their advice and support throughout the planning and execution of this study, and Dr. Matthew Loftis for his help creating Figure 4 . This study was supported by a grant from the Lundbeck Foundation: The Lundbeck Foundation Initiative for Integrated Psychiatric Research ( i PSYCH; grant R155-2014-1724 ), and by a National Institute of Mental Health T32 training grant in psychiatric epidemiology (grant 2T32MH014593-36 , PI: P. Zandi). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2017 American Association for Geriatric Psychiatry
PY - 2018/3
Y1 - 2018/3
N2 - Objective: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Objective: 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Major depression
KW - trajectories
KW - vascular disease
KW - vascular risk factors
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U2 - 10.1016/j.jagp.2017.07.006
DO - 10.1016/j.jagp.2017.07.006
M3 - Article
C2 - 28807498
AN - SCOPUS:85028330057
SN - 1064-7481
VL - 26
SP - 386
EP - 395
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
IS - 3
ER -