Seven-Year Trajectories of Depressive Symptoms and Their Predictors Among Older Americans

Depressive symptoms and cognitive decline in older adults

OBJECTIVES

Few studies have examined the impact of late-life depression trajectories on specific domains of cognitive function. This study aims to delineate how different depressive symptom trajectories specifically affect cognitive function in older adults.

DESIGN

Prospective longitudinal cohort study.

SETTING

Australia and the United States of America.

PARTICIPANTS

In total, 11,035 community-dwelling older adults with a mean age of 75 years.

MEASUREMENTS

Depressive trajectories were modelled from depressive symptoms according to annual Centre for Epidemiological Studies Depression Scale 10 (CES-D-10) surveys. Four trajectories of depressive symptoms were identified: low ("nondepressed"), consistently mild ("subthreshold depression"), consistently moderate ("persistent depression"), and initially low but increasing ("emerging depression"). Global cognition (Modified Mini-Mental State Examination [3MS]), verbal fluency (Controlled Oral Word Association Test [COWAT]), processing speed (Symbol Digit Modalities Test [SDMT]), episodic memory (Hopkins Verbal Learning Test - Revised [HVLT-R]), and a composite z-score were assessed over a subsequent median 2 years.

RESULTS

Subthreshold depression predicted impaired performance on the SDMT (Cohen's d -0.04) and composite score (-0.03); emerging depression predicted impaired performance on the SDMT (-0.13), HVLT-R (-0.09), 3 MS (-0.08) and composite score (-0.09); and persistent depression predicted impaired performance on the SDMT (-0.08), 3 MS (-0.11), and composite score (-0.09).

CONCLUSIONS

Depressive symptoms are associated with later impaired processing speed. These effects are small. Diverse depression trajectories have different impacts on cognitive function.

Longitudinal association of spirituality with depressive symptom trajectories among older adults in mainland China

OBJECTIVES

The relationship between spirituality and depressive symptoms among the Chinese elderly is not well known. The current study explores this relationship using longitudinal data and trajectory modeling of depressive symptoms.

METHODS

A longitudinal study design was used to measure depressive symptoms repeatedly from 2012 to 2021 using the Geriatric Depression Scale (GDS). Group-based trajectory modeling analysis was conducted to determine the trajectories of depressive symptoms, and multiple logistic regression was used to explore the association between spirituality and depressive symptom trajectories.

RESULTS

A total of 2333 participants completed at least two GDS measures, and these were included in the Group-based trajectory modeling analysis. An optimal model of three trajectories was derived: no depressive symptoms group (75.2%), new-onset depressive symptoms group (14.4%), and persistent depressive symptoms group (10.4%). Logistic regression modeling revealed that higher spirituality was associated with a lower risk of both new-onset depressive symptoms (OR = 0.68, 95% CI = 0.49-0.93) and persistent depressive symptoms (OR = 0.32, 95% CI = 0.23-0.45).

CONCLUSIONS

Spirituality predicts a lower risk of new-onset depressive symptoms and persistent symptoms among older adults in mainland China.

Study on the trajectory of depression among middle-aged and elderly disabled people in China: Based on group-based trajectory model

Background

Previous studies have shown that middle-aged and elderly adults with disabilities are at higher risk for depressive symptoms. However, there are few studies on the long-term trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population.

Objective

This study aimed to identify the different development trajectories of depressive symptoms and their influencing factors in middle-aged and elderly people with disabilities in China.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, a longitudinal cohort was formed for the study. A total of 2053 participants underwent at least two measures of depressive symptoms, assessed using the Center for Epidemiological Studies Depression Scale (CES-D10), a depression symptom assessment scale. We constructed a Group-Based Trajectory Model (GBTM) to identify the development trajectory of depressive symptoms in 2053 middle-aged and elderly disabled individuals, screened the potential predictors using lasso regression, and analyzed the factors affecting the development trajectory of depression through multivariate logistic regression.

Results

We identified four depression symptom trajectories throughout the follow-up process: "low depressive symptom group", "worsening depressive symptom group", "relieved depressive symptom group", and "high depressive symptom group". We found that there were differences in basic characteristics among different subgroups of depression trajectory. However, middle-aged and elderly disabled women living in rural areas, with limited ADL or IADL, physical pain, poor self-reported health and self-reported memory, short sleep time, and no relatives and friends to take care of them were the key groups for the prevention and treatment of depressive symptoms.

Conclusion

There is heterogeneity in the trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population, it is necessary to focus on the characteristics of the trajectories of different subgroups.

Trajectories of depressive symptoms among older African Americans: the influence of neighborhood characteristics and gender

OBJECTIVES

Focusing on older African Americans, this study aims to (1) identify 9-year trajectories of depressive symptoms, (2) examine the association between baseline neighborhood characteristics (i.e., social cohesion and physical disadvantage) and trajectories of depressive symptoms, and (3) test whether the effects of neighborhood characteristics on depressive symptoms trajectories differ by gender.

METHODS

Data came from the National Health and Aging Trend Study. Older African Americans at baseline were selected (N = 1662) and followed up for eight rounds. Depressive symptom trajectories were estimated using group-based trajectory modeling. Weighted multinomial logistic regressions were conducted.

RESULTS

Three trajectories of depressive symptoms were identified: "persistently low," "moderate and increasing," and "high and decreasing" (Objective 1). Objective 2 and 3 were partially supported. Specifically, high perceived neighborhood social cohesion was associated with a lower relative risk of being on the "moderate and increasing" versus the "persistently low" trajectory (RRR = 0.64, p < 0.01). The association between neighborhood physical disadvantage and depressive symptom trajectories was stronger among older African American men compared to women.

CONCLUSIONS

High levels of neighborhood social cohesion may protect against increasing depressive symptoms in older African Americans. Compared to women, older African American men may be more vulnerable to negative mental health effects of neighborhood physical disadvantage.

The association between the Short Physical Performance Battery and longitudinal trajectories of depressive symptoms among Chinese older adults

BACKGROUND

In this study, the long-term trajectories of depressive symptoms in a 7-year prospective survey cohort of Chinese older adults were explored. Additionally, the study examined whether there was an independent association between scores on the Short Physical Performance Battery (SPPB) and the different trajectories of depressive symptoms.

METHODS

A total of 2177 elderly individuals had their depressive symptoms assessed based on the Center for Epidemiological Studies-Depression (CES-D) scale in the years 2011, 2013, 2015, and 2018. In addition, their demographic characteristics, chronic diseases, and lifestyle factors were also assessed. The trajectories of depressive symptoms were analysed using the group-based trajectories analysis model. Furthermore, the relationship between the objectively measured SPPB scores and the long-term trajectory of depressive symptoms was explored using multinomial logistic regression.

RESULTS

The group-based trajectory analysis model categorized the trajectories of depressive symptoms across four waves into four groups: persistent low depressive symptoms, increasing depressive symptoms, decreased depressive symptoms, and persistent high depressive symptoms. After controlling for confounding factors, it was observed that a higher baseline SPPB score was associated with an increased likelihood of persistent high depressive symptoms, OR (95% CI) = 0.724 (0.644, 0.814), for the persistent high depressive symptoms versus the persistent low depressive symptoms.

CONCLUSIONS

Low levels of SPPB score are associated with persistent high depressive symptoms in older adults. Conversely, improving physical performance as measured by the SPPB can help reduce the risk of major depressive disorder and persistent depressive disorder in the elderly.

Heterogenous trajectories in physical, mental and cognitive health among older Americans: Roles of genetics and life course contextual factors

We investigate the roles of genetic predispositions, childhood SES and adult educational attainment in shaping trajectories for three important components of the overall health of older adults -- BMI, depressive symptoms and cognition. We use the Health & Retirement Study (HRS) and group-based trajectory modeling (GBTM) to identify subgroups of people who share the same underlying trajectories ages 51-94 years. After identifying common underlying health trajectories, we use fractional multinomial logit models to estimate associations of (1) polygenic scores for BMI, depression, ever-smoked, education, cognition and subjective wellbeing, (2) childhood SES and (3) educational attainment with the probabilities of trajectory group memberships. While genetic predispositions do play a part in predicting trajectory group memberships, our results highlight the long arm of socioeconomic factors. Educational attainment is the most robust predictor-it predicts increased probabilities of belonging to trajectories with BMI in the normal range, low depressive symptoms and very-high initial cognition. Childhood circumstances are manifested in trajectories to a lesser extent, with childhood SES predicting higher likelihood of being on the low depressive symptoms and very-high initial cognition trajectories. We also find suggestive evidence that associations of educational attainment on the probabilities of being on trajectories with BMI in the normal range, low depressive symptoms and very-high initial cognition vary with genetic predispositions. Our results suggest that policies to increase educational attainment may improve population health by increasing the likelihood of belonging to "good" aging trajectories.

Trajectories of depressive symptoms and their predictors in Chinese older population: Growth Mixture model

BACKGROUND

Given the rapidly rising proportion of the older population in China and the relatively high prevalence of depressive symptoms among this population, this study aimed to identify the trajectories of depressive symptoms and the factors associated with the trajectory class to gain a better understanding of the long-term course of depressive symptoms in this population.

METHODS

Data were obtained from four wave's survey of the China Health and Retirement Longitudinal Study (CHARLS). A total of 3646 participants who aged 60 years or older during baseline survey, and completed all follow-ups were retained in this study. Depressive symptoms were measured using the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Growth mixture modelling (GMM) was adopted to identify the trajectory classes of depressive symptoms, and both linear and quadratic functions were considered. A multivariate logistic regression model was used to calculate the adjusted odds ratios (ORs) of the associated factors to predict the trajectory class of participants.

RESULTS

A four-class quadratic function model was the best-fitting model for the trajectories of depressive symptoms in the older Chinese population. The four trajectories were labelled as increasing (16.70%), decreasing (12.31%), high and stable (7.30%), and low and stable (63.69%), according to their trends. Except for the low and stable trajectory, the other trajectories were almost above the threshold for depressive symptoms. The multivariate logistic regression model suggested that the trajectories of chronic depressive symptoms could be predicted by being female, living in a village (rural area), having a lower educational level, and having chronic diseases.

CONCLUSIONS

This study identified four depressive symptom trajectories in the older Chinese population and analysed the factors associated with the trajectory class. These findings can provide references for prevention and intervention to reduce the chronic course of depressive symptoms in the older Chinese population.

Time-Varying Effect Models for Examining Age-Dynamic Associations in Gerontological Research

OBJECTIVES

Dynamic processes unfolding over later adulthood are of prime interest to gerontological researchers. Time-varying effect modeling (TVEM) accommodates dynamic change trajectories, but its use in gerontological research is limited. We introduce and demonstrate TVEM with an empirical example based on the National Health and Aging Trends Study (NHATS).

METHODS

We examined (a) age-varying prevalence of past month elevated symptoms of depression and anxiety and (b) age-varying associations between older adults' elevated symptoms of depression and anxiety and needing help with basic activities of daily living and educational attainment.

RESULTS

The proportion of participants reporting elevated symptoms of depression and anxiety in the past month increased gradually from 23-29% across the ages 70-92. Individuals needing help with ADLs had higher odds of reporting elevated symptoms of depression and anxiety, however the association was strongest for those in their 60s versus 80s. Across all ages, adults with lower education levels had higher odds of reporting elevated symptoms of depression and anxiety, an association that also varied by age.

CONCLUSION

We demonstrated TVEM's value for studying dynamic associations that vary across chronological age. With the recent availability of free, user-friendly software for implementing TVEM, gerontological researchers have a new tool for exploring complex change processes that characterize older adults' development.

Comorbidity Differences by Trajectory Groups as a Reference for Identifying Patients at Risk for Late Mortality in Childhood Cancer Survivors: Longitudinal National Cohort Study

BACKGROUND

Childhood cancer has a high long-term morbidity and mortality rate. Five years after the initial cancer diagnosis, approximately two-thirds of childhood cancer survivors experience at least one late complication, with one-quarter experiencing severe, life-threatening complications. Chronic health conditions can impact survivors' life planning and daily activities, reducing their health-related quality of life. Comprehensive and longitudinal data are required for investigations of national claims data.

OBJECTIVE

This study aimed to address clinical and health policy interventions and improved survival rates. A comprehensive categorization of the long-term morbidities associated with childhood cancer survivorship is required. We analyzed the trajectory groups associated with long-term mortality among childhood cancer survivors.

METHODS

We collected data from a nationwide claims database of the entire Korean population. Between 2003 and 2007, patients diagnosed with and treated for cancer before the age of 20 years were included. With 8119 patients who survived >10 years, 3 trajectory groups were classified according to yearly changes in the number of diagnoses (the lowest in group 1 and the highest in group 3).

RESULTS

The patterns of most comorbidities and survival rates differed significantly between the trajectory groups. Group 3 had a higher rate of mental and behavioral disorders, neoplasms, and blood organ diseases than the other two groups. Furthermore, there was a difference in the number of diagnoses by trajectory groups over the entire decade, and the disparity increased as the survival period increased. If a patient received more than four diagnoses, especially after the fourth year, the patient was likely to be assigned to group 3, which had the worst prognosis. Group 1 had the highest overall survival rate, and group 3 had the lowest (P<.001). Group 3 had the highest hazard ratio of 4.37 (95% CI 2.57-7.42; P<.001) in a multivariate analysis of late mortality.

CONCLUSIONS

Our findings show that the pattern of comorbidities differed significantly among trajectory groups for late death, which could help physicians identify childhood cancer survivors at risk for late mortality. Patients with neoplasms, blood organ diseases, or mental and behavioral disorders should be identified as having an increased risk of late mortality. Furthermore, vigilance and prompt action are essential to mitigate the potential consequences of a child cancer survivor receiving four or more diagnoses within a year.

Longitudinal trajectories of depressive symptoms: the role of multimorbidity, mobility and subjective memory

BACKGROUND

The high prevalence of depression among older people in China places a heavy burden on the health system. Multimorbidity, mobility limitation and subjective memory impairment are found to be risk indicators for depression. However, most studies on this topic focused on depression at a single point in time, ignoring the dynamic changes in depressive symptoms and the relationship between the trajectories and these three conditions. Therefore, we aimed to identify distinct trajectories of depressive symptoms in older people and investigate their associations with multimorbidity, mobility limitation and subjective memory impairment.

METHODS

Data was drawn from China Health and Retirement Longitudinal Study conducted during 2011-2018. A total of 5196 participants who completed 4 visits, conducted every 2-3 years were included in this study. Group-based trajectory modeling was conducted to identify distinct trajectories of depressive symptoms z-scores. Multinomial logistic regression was used to investigate the relationships.

RESULTS

Four distinct trajectories of depressive symptoms z-scores were identified, labeled as persistently low symptoms (68.69%, n = 3569), increasing symptoms (12.14%, n = 631), decreasing symptoms (14.05%, n = 730) and persistently high symptoms (5.12%, n = 266). Participants with multimorbidity had unfavorable trajectories of depressive symptoms compared with those without multimorbidity, with adjusted odds ratios (95% CIs) of 1.40 (1.15, 1.70), 1.59 (1.33, 1.90) and 2.19 (1.65, 2.90) for the increasing symptoms, decreasing symptoms and persistently high symptoms, respectively. We also observed a similar trend among participants with mobility limitations. Compared with participants who had poor subjective memory, participants with excellent/very good/good subjective memory had a lower risk of developing unfavorable trajectories of depressive symptoms. The adjusted odds ratios (95% CIs) of the increasing symptoms, decreasing symptoms and persistently high symptoms were 0.54 (0.40, 0.72), 0.50 (0.38, 0.65) and 0.48 (0.31, 0.73), respectively.

CONCLUSIONS

Multimorbidity, mobility limitation and subjective memory impairment were found to be potential risk factors for unfavorable depression trajectories.

Increased risk of incident diabetes after therapy with immune checkpoint inhibitor compared with conventional chemotherapy: A longitudinal trajectory analysis using a tertiary care hospital database

AIMS/HYPOTHESIS

Immune checkpoint inhibitor (ICI) has been emerged as a promising cancer treatment. However, ICI use induces immune-related adverse events, including diabetes mellitus. We compared the risk of new-onset diabetes between patients receiving an ICI and those receiving conventional chemotherapy (CC).

METHODS

Using a tertiary care hospital database, we included cancer patients without a previous history of diabetes who were treated with either CC or an ICI. One-to-five nearest neighbor propensity matching was applied, and the risk of diabetes was estimated using a Cox proportional hazards model. Latent class growth modeling was performed with a trajectory approach to determine distinct clusters that followed similar glucose trajectory patterns over time.

RESULTS

Among 1326 subjects, 1105 received CC, and 221 received an ICI. The risk of new-onset diabetes was significantly higher in the ICI group than the CC group (adjusted hazard ratio 2.454, 95 % confidence interval 1.528-3.940; p < 0.001). The ICI group had a higher proportion of subjects in the trajectory cluster with an increasing glucose pattern than the CC group (10.4 % and 7.4 %, respectively). Within the ICI group, the subjects with an increasing glucose pattern were predominantly male and associated with enhanced lymphocytosis after ICI administration.

CONCLUSIONS

ICI therapy is associated with an increased risk of incident diabetes compared with CC. The glucose levels of patients treated with an ICI, especially males and those with prominent lymphocytosis after ICI treatment, need to be monitored regularly to detect ICI-associated diabetes as early as possible.

Determinants of depressive symptom trajectories in self-reported chronic obstructive pulmonary disease patients

Background

The depressive symptom trajectories of COPD individuals and its’ predictors remain to be established. Therefore, this study aimed to explore the trajectories of depressive symptoms and predictors thereof in COPD patients.

Methods

A total of 1286 individuals over 45 years of age with self-reported COPD were assessed. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale short form, with depressive symptom trajectories being identified via latent class growth analysis. The predictors of depressive symptom trajectories were then identified through multinomial logistic regression.

Results

Finally, three depressive symptom trajectories were identified: “steadily high”, “consistently moderate”, and “consistently low”. Old age, longer night-time sleep duration, and high BMI were found to be associated with individuals being classified under the “consistently moderate” trajectory. Moreover, participants exhibiting more than two chronic conditions were more likely to be classified under the “consistently moderate” trajectory. Higher education and lower hand grip strength were important predictors of individuals classified in the “steadily high” trajectory.

Conclusions

To conclude, three depressive symptom trajectories were identified in self-reported COPD individuals. To ensure timely intervention aimed at preventing the worsening of depressive symptom progression among COPD individuals, health-care workers should regular analyze depressive symptoms and provide appropriate interventions when possible.

Black-White Differences in the Link Between Offspring College Attainment and Parents' Depressive Symptom Trajectories

This study examines whether the relationship between children's college attainment and their parents' mental health differs for Black and White parents as they age. Data come from the U.S. Health and Retirement Study (HRS) and multilevel growth curve models are used to assess parents' depressive symptom trajectories. Results indicated that parents over age 50 whose children all completed college had significantly lower initial levels of depressive symptoms than those with no college-educated children. The initial benefit was stronger for Blacks than Whites. Results stratified further by parents' education show that Black parents at nearly all levels of schooling experienced stronger returns to their mental health from children's college completion compared to White parents, for whom only those with a high school education showed an inverse association between offspring education and depression symptoms. The findings underscore how offspring education is a potential resource for reducing disparities in health across families.

Trajectories of General Health Status and Depressive Symptoms Among Persons With Cognitive Impairment in the United States

ObjectivesTo identify and examine heterogeneous trajectories of general health status (GHS) and depressive symptoms (DS) among persons with cognitive impairment (PCIs). Methods: We use group-based trajectory models to study 2361 PCIs for GHS and 1927 PCIs for DS from the National Health and Aging Trends Survey 2011-2018, and apply multinomial logistic regressions to predict identified latent trajectory group memberships using individual characteristics. Results: For both GHS and DS, there were six groups of PCIs with distinct trajectories over a 7-year period. More than 40% PCIs experienced sharp declines in GHS, and 35.5% experienced persistently poor GHS. There was greater heterogeneity in DS trajectories with 55% PCIs experiencing improvement, 16.4% experiencing persistently high DS, and 30.5% experiencing deterioration. Discussion: The GHS trajectories illustrate the heavy burden of poor and declining health among PCIs. Further research is needed to understand the factors underlying stable or improving DS despite declining GHS.

The Role of Social Isolation and the Development of Depression. A Comparison of the Widowed and Married Oldest Old in Germany

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, "widowed oldest old", who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of "married oldest old", women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms.

Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession

OBJECTIVES

To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession.

METHODS

We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression.

RESULTS

We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy.

DISCUSSION

Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

Longitudinal trajectory of disability in community-dwelling older adults: An observational cohort study in South Korea

Background

Disability, which is considered a health-related condition, increases care demands and socioeconomic burdens for both families and communities. To confirm the trend of dynamic longitudinal changes in disability, this study aims to explore how disability is divided by the trajectory method, which deals with time-sequenced data. Additionally, this study examines the differences in demographics, geriatric conditions, and time spent at home among the trajectory groups in community-dwelling older adults. Home time is defined as the period during which the patient was not in a hospital or health care facility during their lifetime.

Methods

Records of 786 community-dwelling older participants were analyzed from the Aging Study of PyeongChang Rural Area, a population-based cohort study that took place over three years. Using 7 domains of activities of daily living and 10 domains of instrumental activities of daily living, participants were grouped into no dependency (0 disabled domain), mild (1 disabled domain), and severe (2 or more disabled domains) disability groups. The longitudinal trajectory group of disability was calculated as a trajectory method. Three distinct trajectory groups were calculated over time: a relatively-stable group (78.5%; n = 617), a gradually-aggravated group (16.0%; n = 126), and a rapidly-deteriorated group (5.5%; n = 43).

Results

The average age of 786 participants was 73.3 years (SD: 5.8), and the percentage of female was 52.7%. It was found that 78.5% of patients showed relatively no dependence and 5.5% of older adults in a rural area showed severe dependence. Through applying the trajectory method, it was shown that the Short Physical Performance Battery (SPPB) score was 10.2 points in the relatively-stable group and 3.1 points in the rapidly-deteriorating group by the 3rd year. Additionally, by the trajectory method, the rate of decrease in home time was 3.33% in the rapidly-deteriorated group compared to the relatively-stable group.

Conclusions

This study shows the difference in demographics and geriatric conditions (such as SPPB) through the examination of longitudinal trajectory groups of disability in community-dwelling older adults. Significant differences were also found in the amount of home time among the trajectory groups.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12877-020-01834-y.