10-year Trajectories Research Articles

Heterogeneity in 10-Year Course Trajectories of Moderate to Severe Major Depressive Disorder: A Danish National Register-Based Study.

Evidence suggests that long-term trajectories of major depressive disorder (MDD) are heterogeneous. The Danish Psychiatric Central Research Register (DPCRR) provides a rare opportunity to examine patterns and correlates of long-term trajectories in a large sample of patients with moderate to severe MDD. To characterize patterns and correlates of 10-year course trajectories of MDD in the DPCRR. A cohort containing 11 640 individuals born in Denmark in 1955 or later with their first recorded MDD diagnosis in the DPCRR between 1995 and 2002 was established. Patients were followed for 10 years from the date of their initial MDD diagnosis. Data were obtained from Danish civil and psychiatric national registers in June 2013 and were analyzed from April 4, 2014, to December 17, 2015. Correlates of trajectory class membership were sex, characteristics of the first recorded MDD episode (ie, age, severity, inpatient treatment, and record of suicide attempt or self-harm), and psychiatric diagnoses in parents (ie, depression, bipolar disorder, schizophrenia-spectrum disorders, substance abuse, and anxiety or somatoform disorders). The outcome variable was past-year contact at a psychiatric hospital with a main diagnosis of MDD during each of the 10 years following the initial MDD diagnosis. Trajectories were modeled using latent class growth analysis. The sample included 11 640 individuals (7493 [64.4%] women) aged 18 to 48 years (mean [SD], 31.4 [7.3]) at their first recorded MDD diagnosis. Four trajectory classes were identified: brief contact (77.0%) (characterized by low probability of contact after 2 years); prolonged initial contact (12.8%) (characterized by high decreasing probability of contact during the first 5 years); later reentry (7.1%) (characterized by moderate probability of contact during the second 5 years); and persistent contact (3.1%) (characterized by high or moderate probability of contact throughout). Female sex (odds ratio [OR] range, 1.82-2.22), inpatient treatment (OR range, 1.40-1.50), and severity at first recorded MDD episode (OR range: moderate, 1.61-1.84; severe, 1.93-2.23; and psychotic, 2.73-3.07) were associated with more severe trajectories. Parental anxiety (OR, 1.34 [95% CI, 1.10-1.63]) and depression (OR, 1.63 [95% CI, 1.28-2.09]) were associated with the prolonged initial contact and later reentry classes, respectively. Parental schizophrenia was associated with the persistent contact class (OR range, 2.55-3.04). Most people treated for moderate to severe MDD in Danish psychiatric hospitals do not receive additional MDD treatment after 2 years; however, a minority receive specialty treatment for up to a decade. Observable heterogeneity in the course may be indicative of underlying etiologic differences.

The natural history of severe asthma and influences of early risk factors: a population-based cohort study

BackgroundSevere asthma is associated with disproportionately high morbidity, but little is known about its natural history and how risk factors at first year of diagnosis modify its subsequent development.MethodsUsing administrative...

Genomic Ancestry, Self-Rated Health and Its Association with Mortality in an Admixed Population: 10 Year Follow-Up of the Bambui-Epigen (Brazil) Cohort Study of Ageing.

BackgroundSelf-rated health (SRH) has strong predictive value for mortality in different contexts and cultures, but there is inconsistent evidence on ethnoracial disparities in SRH in Latin America, possibly due to the complexity surrounding ethnoracial self-classification.Materials/MethodsWe used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual genomic proportions of African, European and Native American ancestry, and ethnoracial self-classification, with baseline and 10-year SRH trajectories in 1,311 community dwelling older Brazilians. We also examined whether genomic ancestry and ethnoracial self-classification affect the predictive value of SRH for subsequent mortality.ResultsEuropean ancestry predominated among participants, followed by African and Native American (median = 84.0%, 9.6% and 5.3%, respectively); the prevalence of Non-White (Mixed and Black) was 39.8%. Persons at higher levels of African and Native American genomic ancestry, and those self-identified as Non-White, were more likely to report poor health than other groups, even after controlling for socioeconomic conditions and an array of self-reported and objective physical health measures. Increased risks for mortality associated with worse SRH trajectories were strong and remarkably similar (hazard ratio ~3) across all genomic ancestry and ethno-racial groups.ConclusionsOur results demonstrated for the first time that higher levels of African and Native American genomic ancestry—and the inverse for European ancestry—were strongly correlated with worse SRH in a Latin American admixed population. Both genomic ancestry and ethnoracial self-classification did not modify the strong association between baseline SRH or SRH trajectory, and subsequent mortality.

10-year trajectory of β-cell function and insulin sensitivity in the development of type 2 diabetes: a community-based prospective cohort study

The relative contributions of β-cell function and insulin sensitivity in the pathogenesis of type 2 diabetes are not fully understood. We investigated the longitudinal change in β-cell function and insulin sensitivity in the development of diabetes and the role of genetic variants in deterioration of glucose tolerance. We followed up 4106 participants with normal glucose tolerance (NGT) from the Korean Genome and Epidemiology Study with oral glucose tolerance tests every 2 years for 10 years. We estimated pancreatic β-cell function with the 60 min insulinogenic index (IGI60) and insulin sensitivity with the composite (Matsuda) insulin sensitivity index (ISI). We investigated the association of 66 known type 2 diabetes genetic variants with risk of prediabetes or diabetes and impaired β-cell function and insulin sensitivity. During 10 years of follow-up, 1093 (27%) of 4106 participants developed prediabetes and 498 (12%) participants developed diabetes. Compared with participants who remained NGT, those who progressed to diabetes had a lower IGI60 (unadjusted data 5·1 μU/mmol [95% CI 0·5-56·1] vs 7·9 μU/mmol [0·5-113·8]; p<0·0001) and lower ISI (unadjusted data 8·2 [2·6-26·0] vs 10·0 [3·2-31·6]; p<0·0001) at baseline. Participants who had NGT at 10 years showed a decrease in ISI (adjusted data 10·1 [9·9-10·3] vs 7·4 [7·3-7·6]; p<0·0001) but a compensatory increase in IGI60 (adjusted data 6·9 μU/mmol [6·5-7·2] vs 11·7 μU/mmol [11·2-12·1]; p<0·0001) compared with baseline. By contrast, participants who developed diabetes showed a decrease in ISI (adjusted data 8·4 [8·0-8·7] vs 3·0 [2·8-3·2]; p<0·0001) but no significant compensatory increase (p=0·95) in IGI60. A genetic variant near the glucokinase gene (rs4607517) was significantly associated with progression to prediabetes or diabetes (hazard ratio 1·27, 1·16-1·38; p=1·70 × 10(-7)). Decreased β-cell function, which might be determined partly by genetic factors, and impaired β-cell compensation for progressive decline in insulin sensitivity are crucial factors in the deterioration of glucose tolerance. South Korean Ministry of Health & Welfare.

A longitudinal examination of 10-year change in vocational and educational activities for adults with autism spectrum disorders.

The transition from adolescence to adulthood has been shown to be a time of amplified risk for individuals with autism spectrum disorders (ASD). It is unknown, however, whether problems in educational attainment and employment in the years after high school exit represent momentary perturbations in development or a turning point with long-lasting effects throughout adulthood. The present study addressed this question by examining 10-year trajectories of vocational and educational activities for adults with ASD, as well as the personal characteristics and environmental resources that predicted these activities. Participants were 161 adults with ASD (ages 18-52 years at the start of the study; M = 30.9) who were part of a larger longitudinal study. Data were collected at 6 time points over a 10-year period. Results indicated significant declines in the level of independence and engagement in vocational/educational activities over the study period, particularly for women. Greater independence in vocational activities was found for those with more independence in activities of daily living. After controlling for personal characteristics, receipt of more services was marginally related to greater improvement in vocational independence.

Differences in adiposity trajectories by birth cohort and childhood social class: evidence from cohorts born in the 1930s, 1950s and 1970s in the west of Scotland

BackgroundSince the 1930s, the environment has become increasingly obesogenic, leading to rising rates of adiposity and socioeconomic inequalities in adiposity. Building on studies comparing body mass index (BMI) for cohorts...

A categoria racionalidade médica e uma nova epistemologia em saúde

This article is an analytical report on the 20-year trajectory of the 'medical rationale' category that emerged in the early 1990s in the area of Social and Human Sciences in Health in the field of Public Health. Its objective was to study complex and therapeutic medical systems and traditional, complementary and alternative medicines. Based on a critical review of the literature, it presents some aspects of the cultural, political, institutional and social context of its emergence, as well as its main contributions and developments on a theoretical level and on social policies and practices in health. The southern epistemology concept of Boaventura de Sousa Santos is used to reflect upon the contribution of the 'medical rationale' category to the critique of the post-modern scientific rationale and to the creation of a new epistemology in health.

Association of Metabolic Risk with Longitudinal Physical Activity and Fitness: Coronary Artery Risk Development in Young Adults (CARDIA)

Despite established relationships between physical activity (PA) or physical fitness (fitness) and metabolic risk, the prospective association is not well understood. The purpose of this study was to determine whether metabolic risk in young adults is associated with 20-year PA or fitness trajectories. Young adults were from the Coronary Artery Risk Development in Young Adults (CARDIA) study, baseline ages 18-30 years (n=4161). PA was determined from a self-reported questionnaire administered at baseline and at follow-up exams at years 2, 5, 7, 10, 15, and 20. Fitness (seconds) was estimated from a graded exercise treadmill test at baseline and years 7 and 20. Baseline metabolic risk was calculated using age-adjusted principal components analysis (elevated=top 10% of first factor), for each sex-race group, from mean arterial pressure, glucose, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Repeated measures general linear modeling estimated PA and fitness trajectories over 20 years, separately in sex-race groups, adjusting for age and smoking status. PA was significantly lower among those with elevated metabolic risk compared with normal risk at baseline and each subsequent time point (black and white men, white women; all P<0.0001; black women P=0.27). Significant and consistent results were also found with fitness trajectories for all sex-race groups (P<0.0001). Despite these lower PA and fitness levels at baseline in young adults with elevated metabolic compared with normal risk, 20-year trajectories declined at similar rates. Elevated metabolic risk is associated with lower levels of PA and fitness in early adulthood, and these differences persist over 20 years.

A 20-year multi-follow-up of hallucinations in schizophrenia, other psychotic, and mood disorders

Hallucinations are a major aspect of psychosis and a diagnostic feature of both psychotic and mood disorders. However, the field lacks information regarding the long-term course of hallucinations in these disorders. Our goals were to determine the percentage of patients with hallucinations and the relationship between hallucinations and recovery, and work attainment. Method The present study was a prospective evaluation of the 20-year trajectory of hallucinations in 150 young patients: 51 schizophrenia, 25 schizoaffective, 25 bipolar with psychosis, and 49 unipolar depression. The patients were studied at an index phase of hospitalization for hallucinations, and then reassessed longitudinally at six subsequent follow-ups over 20 years. The longitudinal course of hallucinations clearly differentiated between schizophrenia and bipolar disorder with psychosis, and suggested some diagnostic similarities between schizophrenia and schizoaffective disorder, and between bipolar disorder and schizoaffective disorder and depression. Frequent or persistent hallucinatory activity over the 20-year period was a feature of 40-45% of schizophrenia patients. The early presence of hallucinations predicted the lack of future periods of recovery in all patients. Increased hallucinatory activity was associated with reduced work attainment in all patients. This study provides data on the prospective longitudinal course of hallucinations, which were previously unavailable to the field, and are one of the key features of psychosis in major psychiatric disorders. This information on the clinical course of major psychiatric disorders can inform accurate classification and diagnosis.

Depression trajectories and obesity among the elderly in Taiwan

The present study aimed to (a) characterize 10-year trajectory patterns of depressive symptoms and (b) investigate the association between depressive trajectory and subsequent obesity, metabolic function and cortisol level. In a prospective study of Taiwanese adults aged ≥60 years (n=3922) between 1989 and 1999, depression was assessed using a 10-item short-form of the Center for Epidemiologic Studies Depression Scale and information on body mass index (BMI) was collected by self-report. A subsample (n=445) of the original cohort in 1989 was drawn to assess metabolic variables and cortisol levels in a 2000 follow-up. After trajectory analyses were performed, multinomial logistic regression analyses were used to estimate the association estimates. We identified four distinctive trajectories of depressive symptoms: class 1 (persistent low, 41.8%); class 2 (persistent mild, 46.8%); class 3 (late peak, 4.2%); and class 4 (high-chronic, 7.2%). The results from both complete cases and multiple imputation analyses indicated that the odds of obesity were lower in the class 2, 3 or 4 elderly, as compared with those in class 1, while the odds of underweight were higher. The classes of older adults with more and persistent depressive symptoms showed a trend toward having both a lower BMI (p=0.01) and a higher cortisol level (p=0.04) compared with those with low depressive symptoms. Incremental increases in depressive symptoms over time were associated with reduced risk of obesity and higher cortisol levels.

Trajectories of cognitive decline over 10 years in a Brazilian elderly population: the Bambuí cohort study of aging

Few population-based studies have examined long term cognitive trajectory, and these studies were conducted in high income countries. We investigated the association of age, gender and education with 10-year cognitive trajectory in a well-defined population of elderly using data from the Bambuí Cohort Study of Aging, in Brazil. Cognition was measured using the Mini- Mental State Examination (MMSE). Cohort members underwent annual follow-ups. This analysis was based on 12,206 MMSE measurements from 1,461 (91%) baseline participants. We used mixed effects models to study MMSE as outcome. The key findings from this analysis are that women and people with a higher schooling level at baseline had high scores of MMSE, while older participants started off lower. Regarding cognitive decline, women, older people and those with a higher schooling level declined faster.

The 20-year trajectory of marital quality in enduring marriages: Does equity matter?

I examine the trajectory of marital quality as a function of relationship equity with data from a six-wave panel study of 704 married respondents between 1980 and 2000. Reporting that one "gives more" to the marriage (subjective underbenefit) is more likely for women than men at any given marital duration. Respondent's relative contribution to income, paid labor, housework, and health (objective underbenefit) raises this probability for women of average religiosity. For the more religious, objective underbenefit has no effect on women's sense of underbenefit, but reduces men's sense of underbenefit. Objective underbenefit lowers women's, but raises men's, marital quality, at any marital duration. The relevance of equity was not diluted by the passage of time in marriage.

Social support, problem solving, and the longitudinal course of newlywed marriage.

Married couples (N = 172) were observed as newlyweds and observed again 1 year later while engaging in 2 problem-solving and 2 personal support discussions. Microanalytic coding of these conversations was used to examine associations between problem-solving and social support behaviors for 1 year and their relative contributions to 10-year trajectories of self-reported relationship satisfaction and dissolution. Results demonstrated that initially lower levels of positive support behaviors and higher levels of negative support behaviors predicted 1-year increases in negative emotion displayed during problem-solving conversations. Emotions coded from the initial problem-solving conversations did not predict 1-year changes in social support behaviors. Controlling for emotions displayed during problem-solving interactions eliminated or reduced associations between initial social support behaviors and (a) later levels of satisfaction and (b) relationship dissolution. These findings corroborate models that prioritize empathy, validation, and caring as key elements in the development of intimacy (e.g., Reis & Shaver, 1988) and suggest that deficits in these domains foreshadow deterioration in problem solving and conflict management. Implications for integrating support and problem solving in models of relationship change are outlined, as are implications for incorporating social support in education programs for developing relationships.

Making connections: Ethno-mimesis, migration and diaspora

This paper presents a 10-year trajectory of research in the United Kingdom exploring the asylum-migration nexus and processes of belonging using participatory and arts-based methodologies. The relational dynamics involved in exploring the space between ethnography and arts-based practice (ethno-mimesis) are viewed through the work of critical theorists Theodor Adorno and Walter Benjamin. These psychoanalytic critical theorists provide a framework for thinking through the relationship between art and society, participatory research and the politics of representation.

Dysthymic disorder and double depression: Prediction of 10-year course trajectories and outcomes

We sought to identify baseline predictors of 10-year course trajectories and outcomes in patients with dysthymic disorder and double depression. Eighty-seven outpatients with early-onset (<21 years) dysthymic disorder, with or without superimposed major depression, were assessed five times at 30-month intervals for 10 years. Baseline evaluations included semi-structured diagnostic interviews for Axis I and II psychopathology and childhood adversity. Direct interview and family history data were collected on first-degree relatives. Follow-up assessments included the Longitudinal Follow-up Evaluation and Hamilton Depression Rating Scale. Using mixed effects growth curve models, univariate predictors of depression severity and functional impairment at 10-year outcome included older age, less education, concurrent anxiety disorder, greater familial loading for chronic depression, a history of a poorer maternal relationship in childhood, and a history of childhood sexual abuse. In addition, longer duration of dysthymic disorder also predicted greater impairment 10 years later. Predictors of a poorer trajectory of depressive symptoms over time included ethnicity and personality disorders; predictors of a poorer trajectory of social functioning included familial loading of chronic depression and quality of the childhood maternal relationship. Thus, demographic, clinical, family history, and early adversity variables all contribute to predicting the long-term trajectory and outcome of DD. These variables should be routinely assessed in clinical evaluations and can provide clinicians with valuable prognostic information.

Editorial

Editorial

Memory Complaint Is Not Necessary for Diagnosis of Mild Cognitive Impairment and Does Not Predict 10‐Year Trajectories of Functional Disability, Word Recall, or Short Portable Mental Status Questionnaire Limitations

To evaluate the prevalence and utility of memory complaint in a geographically representative cohort and, in cases with mild cognitive impairment (MCI), to determine whether memory complaint alters 10-year trajectories of disability in activities of daily living (ADLs), Short Portable Mental Status Questionnaire (SPMSQ) score, and 20-item word recall. Prospective cohort study. Washington and Iowa counties, Iowa. Iowa Established Populations for Epidemiologic Studies of the Elderly (N = 3,673; aged > or =65; 61.3% female; 99.9% white). Age, sex, education, SPMSQ score, 20-item word recall, ADL or instrumental ADL disability, and chronic medical conditions. The prevalence of memory complaint was 34%. Although proportionally more cognitively impaired individuals were in the memory complaint group (34% vs 27%), the pattern of subclassification into cognitively intact and MCI Stage 1 and 2 subgroups was similar for people with and without memory complaint. Median SPMSQ score and number of words recalled at baseline were comparable across memory complaint categories in each subgroup. MCI participants without subjective memory complaint constituted a larger proportion of the overall sample than individuals with subjective memory complaint (460 (14%) vs 295 (8.9%)) and of persons objectively classified as having MCI (61% vs 39%). The distribution of individual 10-year change in ADL disability, SPMSQ score, and word recall were similar for those with and without memory complaint across all subgroups of cognitive impairment. Memory complaint is not necessary for MCI diagnosis and does not distinguish cases with different progression rates in disability or cognitive impairment. 2006.

Mild Cognitive Impairment and 10‐Year Trajectories of Disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly Cohort

To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI. Prospective cohort; 10 years of follow-up. Community-based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa). Iowa Established Populations for Epidemiologic Studies of the Elderly (aged > or = 65; N = 3,673; 61.3% female; 99.9% white). Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20-item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions. MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (< or = 1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median = 0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range = 0.12-0.36). Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability--a prerequisite for a diagnosis of dementia.

The developmental cycle of domestic groups and Amazonian deforestation

It has been common to attribute tropical deforestation to population growth and/or migration. This paper finds that this is true only at large and aggregated spatial and temporal scales. When one examines regional-scaled processes, there are numberous mediating factors and more complex demographic processes that account for differences in rates of deforestation. Based upon three years of research in the Altamira region, Xingu Basin, Brazilian Amazon, we differenttiate between period and cohort effects in trajectories of deforestation. We find that every cohort of migrants follows the same overall trajectory of deforestation but that the magnitude of deforestation along a 20 year trajectory is dependent on period effects (such as hyperinflation, credit policy, land policy changes). Moreover, we find that the 20-year trajectory does indeed follow the constraints posed by the development cycle of the domestic group-refleting as it does the changing supply of labor.

Strategic planning for captive populations: projecting changes in genetic diversity

AbstractMaintenance of genetic diversity is critical for the preservation of small populations. Most captive populations are small and managers focus their efforts on reducing extinction risks by minimising loss of genetic diversity. To project changes in genetic diversity, managers use a genetic drift model. We used data from 40 managed captive populations to test whether this drift model is a good predictor of change in genetic diversity by comparing projected 10‐year trajectories of annual loss in expected heterozygosity with the changes estimated from pedigree analysis. We found that the drift model frequently overestimated the rate at which genetic diversity would be lost and could not predict increases, which we observed in 22 species. We suggest that the drift model does not adequately reflect the potential for management strategies, such as prioritised breeding recommendations and recruitment of potential founders, to slow the loss of genetic diversity. In many cases, the drift model may be overly pessimistic, leading managers to seek solutions such as importation, increased population size or the abandonment of a captive population, that may be unnecessary or premature. Managers should be cautious when interpreting results from genetic drift models, taking care to assess how management actions might lead to more optimistic prognoses.