Article

Heterogeneity in symptom profiles among older adults diagnosed with major depression

Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, U.S.A.
International Psychogeriatrics (Impact Factor: 1.89). 08/2011; 23(6):1-17. DOI: 10.1017/S1041610210002346
Source: PubMed

ABSTRACT Background: Late-life depression may be undiagnosed due to symptom expression. These analyses explore the structure of depressive symptoms in older patients diagnosed with major depression by identifying clusters of patients based on their symptom profiles.Methods: The sample comprised 366 patients enrolled in a naturalistic treatment study. Symptom profiles were defined using responses to the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D) and the depression section of the Diagnostic Interview Schedule (DIS) administered at enrollment. Latent class analysis (LCA) was used to place patients into homogeneous clusters. As a final step, we identified a risk profile from representative items across instruments selected through variable reduction techniques.Results: A model with four discrete clusters provided the best fit to the data for the CES-D and the DIS depression module, while three clusters best fit the HAM-D. Using LCA to identify clusters of patients based on their endorsement of seventeen representative symptoms, we found three clusters of patients differing in ways other than severity. Age, sex, education, marital status, age of onset, functional limitations, level of perceived stress and subjective social support were differentially distributed across clusters.Conclusions: We found considerable heterogeneity in symptom profiles among older adults with an index episode of major depression. Clinical indicators such as depression history may play less of a role differentiating clusters of patients than variables such as stress, social support, and functional limitations. These findings can help conceptualize depression and potentially reduce misdiagnosis for this age group.

0 Followers
 · 
109 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Diabetic Macular Edema (DME) is a common cause of impaired vision and blindness amongst diabetics. If not detected and treated early, the resulting vision loss can lead to considerable health costs and decreased health-related quality of life (HRQoL). The aim of this study was to provide evidence of the psychometric properties of the National Eye Institute - Visual Functioning Questionnaire (VFQ-25) for use in a cohort of DME patients who participated in a clinical efficacy and safety trial of pegaptinib sodium (Macugen). METHODS: A phase 2/3 randomised, double masked trial evaluated pegaptanib injection versus sham injection in patients with DME. The analysis was conducted using baseline HRQoL data of the VFQ-25 and the EQ-5D, on a modified intent-to-treat sample of 235 patients. These measures were administered by a trained interviewer by telephone in all but one of the study countries, where face-to-face interviews were conducted in the clinic. The measures were completed in the week prior to baseline, and after 54 weeks of treatment. Distance visual acuity, measured according to the Early Treatment Diabetic Retinopathy Study (ETDRS), was assessed at all time points. Psychometric properties of the VFQ-25 assessed included domain structure, reliability, concurrent and construct validity, responsiveness. RESULTS: The VFQ-25 was found to consist of 11 domains slightly different than those proposed. Nevertheless, none of the eight established multi-item scales met the criterion for further splitting and the VFQ-25 was scored as in the developers' instructions. Internal consistency reliability was demonstrated for six out of the eight original multi-item scales, with Cronbach's alpha ranging from 0.58 (Distance Activities) to 0.85 (Vision Specific: Dependency). The VFQ-25 domains generally showed a low to moderate correlation with EQ-5D visual analogue scale (range 0.16-0.43) and with the visual acuity score (range 0.10-0.41). Construct validity was upheld with higher VFQ-25 scores for patients who saw more letters according to the ETDRS. Almost all scales were shown to be responsive with Guyatt's statistic ranging from 0.10 to 0.56 at 54 weeks. CONCLUSIONS: The VFQ-25 has evidence to support its validity and reliability for measuring HRQoL in DME. However, some operating characteristics of the instrument need further consideration and discussion in the case of DME patients. Further research is therefore warranted in this indication.
    Health and Quality of Life Outcomes 01/2013; 11(1):10. DOI:10.1186/1477-7525-11-10 · 2.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Identifying sources of heterogeneity in late life depression remains an important focus of psychiatric investigation. Community samples are particularly informative since many older adults have clinically significant depressive symptoms but fail to meet criteria for major depression and older adults generally do not seek treatment for their depressive symptoms. The primary data used for these analyses were those collected in a community-based survey of over 3000 adults age 65 or older followed for up to ten years. Depressive symptoms were measured by the Center for Epidemiologic Studies-Depression scale (CES-D). Latent class analysis was used to identify clusters of participants based on their symptom profiles at baseline. Mixed models were used to examine trajectories of CES-D scores based on cluster assignment. A model with three unique clusters best fit the data. Cluster 1 (59%) had a low probability of any symptom endorsement. Cluster 2 (31%) endorsed as a group some negative affect and somatic symptoms but their endorsement of low positive affect did not differ from Cluster 1. Participants in Cluster 3 (10%) had a higher probability of endorsement of all symptoms compared to Clusters 1 and 2. The results did not appreciably differ when symptom severity was included. Cluster assignment was a significant predictor of change in CES-D score over the ten-year follow-up period, and the effects over time differed by sex. Depressive symptom profiles predict the longitudinal course of depression in a community sample of older adults, findings that are important especially in primary care settings.
    Journal of Psychiatric Research 06/2013; 47(10). DOI:10.1016/j.jpsychires.2013.05.033 · 4.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: Vascular risk has been associated with late-life depression, but it is less certain whether it is also associated with the endorsement of depressive symptoms among euthymic older adults. We explore whether vascular risk is associated with endorsement of depressive symptoms among euthymic older adults and examine associations with cognitive function. METHODS: Fifty-seven adults (50-89 years), were assessed for: 1) vascular risk (Framingham Stroke Risk Profile, FSRP); 2) depressive mood (Center for Epidemiologic Studies Depression, CESD self-rating questionnaire; Hamilton Depression Rating Scale, HDRS clinical interview); and 3) cognitive domains, (Learning and Memory, L-M; Attention and Information Processing, AIP; Executive Function, EF; Semantic Language, SL). RESULTS: Significant correlations were observed between FSRP and both depression scales, independent of age. No significant correlations were observed between HDRS and any cognitive domain; in contrast, CESD correlated significantly with L-M, AIP and EF but not SL. FSRP correlated significantly with L-M and EF measures only. Regression analyses revealed that 11.5% of the variance in HDRS scores was explained by FSRP, whereas CESD scores were explained by EF (20.8% of variance). CONCLUSIONS: Vascular risk was associated with endorsement of depressive symptoms in euthymic older adults. However, the patterns of associations with the two depression scales are distinct and may reflect both differences in administration and item characteristics. A limitation of this study was the exclusion of individuals with subclinical depression, leading to a restricted range on depression scales; future studies should include a full population sample to more fully explore low mood in late-life.
    The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 06/2013; DOI:10.1016/j.jagp.2013.01.074 · 3.52 Impact Factor

Full-text (2 Sources)

Download
56 Downloads
Available from
Jun 3, 2014