Depressive Symptom Trajectory Groups Research Articles

Caregivers' depressive symptom trajectories and risk of cognitive impairment among older adults with functional limitations: A prospective cohort study.

Caregiver (CG)'s depression is common and its prevalence is rising. The relationship of CG depression with care recipients (CR)'s subsequent cognitive impairment remains unclear. This study examines the association of CG depressive symptoms trajectories with 6-year cognitive impairment risk among care recipients (CR) who are older adults with functional limitations. Retrospective analysis of prospectively collected data cohorts from 2010 to 2016. The sample included 810 community-dwelling older adults aged ≥75years, dementia free at baseline, with their primary caregiver dyads. CG's depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. The main outcomes were incident mild, moderate, and severe cognitive impairment of CRs measured using Short Portable Mental Status Questionnaire. Group-based trajectory modeling identified three CG depressive symptom trajectory groups. Competing risks regression analysis modeled the hazards as a function of CG depressive symptom trajectories. Of 810 CRs, 3% developed severe cognitive impairment, 21% had moderate cognitive impairment, and 37% had mild cognitive impairment. Only CG's "Increasing" trajectory group predicted increased risk of CR's mild and moderate cognitive impairment relative to "persistently low" group (subhazard ratio [SHR]=1.52, 95% confidence interval [CI], p<0.05; SHR=1.87, 95% CI, p<0.05, respectively). Finding highlight the intricate and non-linear association between CG depressive trajectory and CR cognitive impairment. This evidence can be used to enlighten policymakers and health providers about the need for risk stratification screening for CG mental health and early treatment for CG depression to prevent or delay CR's cognitive impairment.

Longitudinal assessment of inflammatory markers in the peripartum period by depressive symptom trajectory groups

ObjectiveMechanisms driving temporal fluctuations of inflammatory markers during pregnancy, and how these might differ between distinct perinatal depressive trajectories, are not well understood. The aim of this study was to investigate cytokines levels over the course of pregnancy in women with different trajectories of depressive symptoms peripartum, and relate the levels to levels of non-pregnant controls. MethodsBased on the Edinburgh Postnatal Depression Scale and/or selective serotonin reuptake inhibitors use, 131 women were categorized into: no (n = 65); antepartum (APD, n = 19), postpartum (PPD, n = 17) and persistent (n = 30) depressive symptoms. Plasma samples (n = 386) were analyzed for levels of interleukin (IL)-8, IL-18, Tumor necrosis factor-α, macrophage colony-stimulating factor (M-CSF), vascular endothelial growth factor A (VEGF-A) and fractalkine, at four different time-points (twice during pregnancy, during childbirth, and postpartum) using Bio-Plex Pro Human Cytokine Assays. Generalized linear mixed models were applied to analyze the associations between cytokine levels, time-point, perinatal depressive symptom trajectory group and their interaction. ResultsFor all markers but VEGF-A, pregnancy was associated with higher cytokine levels compared to the non-pregnant controls, with delivery being the most prominent time-point. For M-CSF, IL-18 and VEGF-A, levels were back to the non-pregnant status at postpartum week 8. An effect of perinatal depressive symptom trajectory groups on cytokine levels was found for VEGF-A. Women with PPD and women with APD had lower levels of VEGF-A throughout the study period compared to women with persistent depression, and women with PPD had lower levels compared to non-depressed women. ConclusionsLower levels of VEGF-A were noted among women in some trajectories of depressive symptoms peripartum. The peripartum period is a time of tremendous immune system adaptations. Standardization of time-points for cytokine measurements in studies of perinatal depression are important in order to draw valid conclusions on the role of the immune system in perinatal depression.

Trajectories of depressive symptoms among community-dwelling Korean older adults: findings from the Korean longitudinal study of aging (2006\u20132016)

BackgroundDepression among older adults is an important public health concern associated with increased risk of suicide and decreased physical, cognitive, and social functioning. This study identified trajectories of depressive symptoms and investigated predictive variables of group-based trajectory modeling among Korean community-dwelling older adults.MethodsParticipants comprised 2016 community-dwelling Korean adults over 65 years. Data from the years 2006–2016 of the Korean Longitudinal Study of Aging, a nationally representative panel survey that has been conducted every two years since 2006, were used. We employed a group-based trajectory modeling analysis to identify depressive symptom trajectories. Multinomial logistic regression analysis was conducted to identify predictors of each class of depressive symptoms.ResultsFive depressive symptom trajectory groups were identified: Group 1, “None” (28.9%); Group 2, “Slowly worsening” (24.3%); Group 3, “Rapidly worsening” (17.5%); Group 4 “Improving” (12.4%); and Group 5, “Persistently severe” (16.9%). Older adults followed five distinct depressive symptom trajectories over 10 years. Mini-Mental State Examination scores, number of chronic diseases, educational level, and social activity were predictors associated with increasing depressive symptoms.ConclusionsThis study showed that many older adults living in the community have depressive symptoms. To prevent and treat depression and aid successful mental health aging among older adults, the development of interventions should be tailored to target specific needs for each symptom trajectory. It is necessary to develop community-based interventions and strategies to identify and prevent depressive symptom trajectories among older adults.

Abstract P047: Depressive Symptom Trajectory Associated With Step Counts From Smartwatch: The Electronic Framingham Heart Study

Introduction: Depression is a common and serious medical illness world-wide. Studies have demonstrated a protective effect of physical activity on depression, but few studies have examined the prospective association between depressive symptoms and objectively measured physical activity. Objective: To investigate if antecedent depressive symptoms predict subsequent daily step counts among participants enrolled in the electronic Framingham Heart Study (eFHS). We hypothesize that the trajectory group with a larger proportion of participants having depressive symptoms and antidepressant use is associated with a lower level of physical activity. Methods: We used group-based multi-trajectory modeling to construct depressive symptom trajectory patterns using both depressive symptoms and antidepressant use collected from eFHS participants who attended three FHS health exams over fourteen years. The presence of depressive symptoms was defined at each exam with a Center for Epidemiological Studies-Depression (CES-D) score &gt; 16. At the final exam, participants were provided with a study smartwatch to measure daily step counts. We excluded: a) person-day records with less than 5 hours of wear-time, or less than 1000 steps recorded in a day; b) participants who failed to return data for ≥1 day per week in the first month. We performed linear mixed effects models to examine the association between depressive symptom trajectories and average daily step counts during the first 30 days of smartwatch use and one-year of follow-up adjusting for age, sex, wear-hour, BMI, and smoking status. We used p&lt;0.05 for significance. Results: We identified two depressive symptom trajectory groups for the 724 eFHS participants (mean age 53 years, 60% women). The “low-stable” group (n=578; mean follow-up 286±110 days) consisted of &lt;5% of participants with depressive symptoms and &lt;3% of those with antidepressant medication use across the three exams. The “high-increasing” group ( n = 146; 269±114 days) consisted of &gt;21% of participants with depressive symptoms and &gt;46% of those with antidepressant medication use across the three exams. Compared to the low-stable trajectory group, the participants in the high-increasing depressive symptoms group walked 475 (95% CI: 24-927) fewer daily steps during the first 30 days of smartwatch use ( p = 0.04) and walked 550 (95% CI: 109-991) fewer daily steps during one-year of follow-up ( p = 0.01). Conclusion: Participants in the group with a larger proportion of antecedent depression and anti-depressant use walked significantly fewer steps compared to the group with a smaller proportion of antecedent depression and anti-depressant use. Our findings suggest that interventions via mHealth technologies that target mood may play an important role in promoting physical activity.

Metabolomic predictors for late-life depression

<h3>Introduction</h3> Depression is a major public health problem among older adults and among the leading causes of global burden of disease and disability. Yet, current understanding of pathophysiology and optimal prevention and/or treatment of late-life depression (LLD) is limited. Advanced approaches involving methods such as metabolomics present an innovative path to identify novel biomarkers of LLD outcomes. Several known biological pathways involving tryptophan and lipid-inflammatory molecules (eicosanoids) are relevant to depression; however, there have been few systematic investigations of metabolomic predictors of long-term trajectories of LLD. <h3>Methods</h3> This is a convenience sample of ∼7000 Nurses' Health Study (NHS) participants with known metabolites and who completed depression items every four years from 1992-2016. Between 1989 and 1990, blood samples were collected and stored under standard conditions. In NHS, data on known metabolites were generated by merging the data from multiple case-control studies; however, all metabolites were profiled using liquid chromatography mass spectrometry in the same laboratory. Continuous metabolite values were transformed to probit scores to account for batch effects. We used a previously developed harmonized depressive symptom scale that was indexed to the five-item Mental Health Inventory (MHI-5, range=0-100 points). For cross-sectional analysis, we performed multivariable logistic regression models to evaluate the associations of baseline metabolite levels and likelihood of the moderate or severe depressive symptoms (MHI-5 cut-off=60); for longitudinal analysis, we used latent growth-curve analysis to identify group-based trajectories of depressive symptoms and then related baseline metabolite levels to long-term trajectories. <h3>Results</h3> The mean age of female nurses at blood draw was 57.0 (range=42.6-70.2) years. There were ∼6300 NHS participants with available data on tryptophan metabolites and ∼1300 NHS participants with available data on eicosanoids. We observed stronger signals for cross-sectional associations of higher circulating levels of tryptophan, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) with lower risk of moderate or severe depressive symptoms, adjusted for age at blood draw, fasting status, case-control status, physical activity, body mass index, diet index, alcohol use, and cigarette smoking [multivariable odds ratio (95% confidence interval): for tryptophan=0.86 (0.80-0.93), p<0.01; for EPA=0.84 (0.71-1.01), p=0.06; for DHA=0.85 (0.71-1.02), p=0.07]. From 1992-2016, we identified four depressive symptom trajectory groups: minimal depressive symptoms (63%), worsening depressive symptoms (12%), improving depressive symptoms (20%), and persistent severe depressive symptoms (5%). Additional results from multinomial models evaluating the associations between metabolites and long-term LLD trajectories will be presented. <h3>Conclusions</h3> In this sample, tryptophan and omega-3 fatty acid metabolites were significantly related to LLD outcomes; these metabolites may play a role in the pathophysiology of LLD. <h3>Funding</h3> HMS Livingston Fellowship Award

Trajectories of Depressive Symptoms and Anxiety during Pregnancy and Associations with Pregnancy Stress

The purposes of this study were to investigate the trajectory groups of depressive symptoms and anxiety in women during pregnancy and to identify the factors associated with those groups. Participants were recruited from the outpatient clinic of a women’s health hospital in Seoul, Korea. Pregnant women (n = 136) completed a survey questionnaire that included questions on depressive symptoms, anxiety, and pregnancy stress; additionally, their saliva was tested for cortisol hormone levels three times during their pregnancies. The group-based trajectory modeling approach was used to identify latent trajectory groups. Ordinal logistic regressions were used to explore the association of latent trajectory groups with sociodemographic factors and pregnancy stress. Three trajectory groups of depressive symptoms were identified: low-stable (70%), moderate-stable (25%), and increased (5%). Four trajectory groups of anxiety were identified: very low-stable (10%), low-stable (67%), moderate-stable (18%), and high-stable (5%). The only factor associated with both the depressive symptoms and anxiety trajectory groups was pregnancy stress (p < 0.001). Most participants showed stable emotional status; however, some participants experienced higher levels of depressive symptoms and anxiety related to higher pregnancy stress. These pregnant women may need additional care from healthcare providers to promote their wellbeing during pregnancy.

Trajectories of Depressive Symptoms in Community-Dwelling Korean Older Adults

Objectives This study aimed to identify trajectories of depressive symptoms and investigate predictive variables of latent class in Korean community-dwelling older adults. Methods Study participants comprised 2,016 community-dwelling Korean adults aged over 65 years, using data from the Korean Longitudinal Study of Aging (KLoSA) from 2006–2016. The KLoSA, a nationally representative panel survey, has been conducted biannually since 2006. We used latent class growth analysis to identify depressive symptom trajectories. Multinomial logistic regression analysis was conducted to identify predictors of each class of depressive symptoms. Results Five depressive symptom trajectory groups were identified: Class 1, no depressive symptom (13.8%); Class 2, low depressive symptom (32.8%); Class 3, decreasing depressive symptom (10.6%); Class 4, increasing depressive symptoms (24.0%); and Class 5, persistent depressive symptoms (18.8%). We found that older adults followed five distinct depressive symptom trajectories over 10 years. Mini-Mental State Examination scores, number of chronic diseases, educational level, gender, current employment, contact with children, and social activity were associated with a higher risk of these trajectories. Conclusions Depressive symptoms are associated with social networks as cognitive function scores increase and number of chronic diseases decrease. Interventions to strengthening existing social networks and developing relationships should be tailored to target specific needs for each trajectory, and chronic disease management, including cognitive function, may be beneficial in preventing depressive symptoms among older adults. KEYWORDS Older adults, Depressive symptom, Trajectory, Latent class growth analysis, Korean

Association of trajectories of depressive symptoms with vascular risk, cognitive function and adverse brain outcomes: The Whitehall II MRI sub-study

BackgroundTrajectories of depressive symptoms over the lifespan vary between people, but it is unclear whether these differences exhibit distinct characteristics in brain structure and function. MethodsIn order to compare indices of white matter microstructure and cognitive characteristics of groups with different trajectories of depressive symptoms, we examined 774 participants of the Whitehall II Imaging Sub-study, who had completed the depressive subscale of the General Health Questionnaire up to nine times over 25 years. Twenty-seven years after the first examination, participants underwent magnetic resonance imaging to characterize white matter hyperintensities (WMH) and microstructure and completed neuropsychological tests to assess cognition. Twenty-nine years after the first examination, participants completed a further cognitive screening test. OutcomesUsing K-means cluster modelling, we identified five trajectory groups of depressive symptoms: consistently low scorers (“low”; n = 505, 62·5%), a subgroup with an early peak in depression scores (“early”; n = 123, 15·9%), intermediate scorers (“middle”; n = 89, 11·5%), a late symptom subgroup with an increase in symptoms towards the end of the follow-up period (“late”; n = 29, 3·7%), and consistently high scorers (“high”; n = 28, 3·6%). The late, but not the consistently high scorers, showed higher mean diffusivity, larger volumes of WMH and impaired executive function. In addition, the late subgroup had higher Framingham Stroke Risk scores throughout the follow-up period, indicating a higher load of vascular risk factors. InterpretationOur findings suggest that tracking depressive symptoms in the community over time may be a useful tool to identify phenotypes that show different etiologies and cognitive and brain outcomes.

Adolescent Context and Depressive Symptom Trajectories in a National Sample: Ages 13 to 34

Group-based trajectory analyses of depressive symptoms are often conducted with convenience samples, over limited developmental periods, or with a limited set of predictors in the adolescent context. Examinations of protective and risk factors in robust national samples are needed. Using an ecological approach, this study's purpose is to identify key relational and contextual factors associated with trajectory groups of depressive symptoms that span ages 13 to 34. 12,248 respondents in the National Study of Adolescent to Adult Health (Waves 1, 3, and 4) were analyzed with a group-based, cohort sequential design to identify trajectory classes, shapes, and adolescent (i.e., Wave 1) risk and protective factors for depressive symptom trajectories. A four-class quadratic solution was identified. Close attachment to parents was strongly associated with decreased odds of membership on elevated trajectories. No relationship with a mother or father was associated with better mental health than a poor relationship with that parent. Peer support, teacher support, and educational achievement were highly protective. Romantic relationships, increased number of sexual partners, and prayer were modestly associated with higher depressive symptom burden. Pregnancy was associated with increased burden later in life relative to the teenage years. Assessing adolescent family, school, peer, and religious contexts indicates several protective and risk factors for depressive symptoms that are persistent over time.

Maternal and paternal depressive symptoms and children's emotional problems at the age of 2 and 5 years: a longitudinal study

Maternal and paternal depressive symptoms are related to children's emotional problems, but their combined effect remains unclear. Here, we constructed four parental longitudinal depressive symptom trajectory groups and studied their associations with children's emotional problems at the age of 2 and 5years. We did an assessment of maternal and paternal depressive symptoms (gestational week 32, as well as 3, 8 and 24 months postnatally) and children's emotional problems at ages two (N=939) and five (N=700) in the CHILD-SLEEP cohort. Three separate maternal and paternal depressive symptom trajectories based on latent profile analysis were combined to form four parental depressive symptom trajectory groups. We compared groups with a general linear model, with children's emotional (total, internalizing and externalizing) - problem scores serving as the dependent variables. At both ages, combined parental depressive symptom trajectories were associated with children's emotional problems: effect sizes were medium for total and small for other domains. According to post hoc comparisons, children whose mothers or both parents had persistent depressive symptoms had significantly more total, externalizing and internalizing problems than did children who had neither parent nor only the father showing depressive symptoms. A higher (and persistent) level of maternal depressive symptoms was related to a higher level of these children's emotional problems, a pattern not evident with paternal depressive symptoms. In all analyses, the interaction effect was nonsignificant between parental trajectories and child gender. Findings suggest that an absence of depressive symptoms in their fathers cannot compensate for the adverse effects of maternal depressive symptoms upon their children. Moreover, paternal depressive symptoms alone do not lead to increased risk for emotional problems in these 2- and 5-year-old children. In contrast, even subclinical levels of maternal depressive symptoms in late pregnancy are associated with increased risk for their children's experiencing internalizing and externalizing emotional problems.

The relation of telomere length at midlife to subsequent 20-year depression trajectories among women.

Telomeres cap and protect DNA but shorten with each somatic cell division. Aging and environmental and lifestyle factors contribute to the speed of telomere attrition. Current evidence suggests a link between relative telomere length (RTL) and depression but the directionality of the relationship remains unclear. We prospectively examined associations between RTL and subsequent depressive symptom trajectories. Among 8,801 women of the Nurses' Health Study, depressive symptoms were measured every 4 years from 1992 to 2012; group-based trajectories of symptoms were identified using latent class growth-curve analysis. Multinomial logistic models were used to relate midlife RTLs to the probabilities of assignment to subsequent depressive symptom trajectory groups. We identified four depressive symptom trajectory groups: minimal depressive symptoms (62%), worsening depressive symptoms (14%), improving depressive symptoms (19%), and persistent-severe depressive symptoms (5%). Longer midlife RTLs were related to significantly lower odds of being in the worsening symptoms trajectory versus minimal trajectory but not to other trajectories. In comparison with being in the minimal symptoms group, the multivariable-adjusted odds ratio of being in the worsening depressive symptoms group was 0.78 (95% confidence interval, 0.62-0.97; p = 0.02), for every standard deviation increase in baseline RTL. In this large prospective study of generally healthy women, longer telomeres at midlife were associated with significantly lower risk of a subsequent trajectory of worsening mood symptoms over 20 years. The results raise the possibility of telomere shortening as a novel contributing factor to late-life depression.

Gender differences in the trajectory classes of depressive symptoms in Korean older adults

ABSTRACTObjectives: This study aimed (1) to identify gender-specific heterogeneous longitudinal patterns of depressive symptoms, (2) to explore the effects of economic status and various health conditions as risk factors in depressive symptom trajectories.Method: Data came from the Korean Longitudinal Study of Aging (2006–2012) focuing on older adults aged 65 and older. Latent class growth analysis was used to identify the depressive symptom trajectory groups. Multinomial logistic regression was used to examine the association between economic and health status changes and the depresison trajectories.Results: Among older women, three change groups were identified: stable low, stable high, and moderate but slightly increasing groups. Among older men, four groups were found: stable low, moderate but rapidly increasing, high but decreasing, and moderate but slightly increasing groups. Among women, poverty experience and sustained poor health, particularly constantly low cognition, were significantly associated with the stable high group. Among men, deteriorating economic and health status were significant predictors of membership in the most vulnerable subgroup, the moderate but rapidly increasing group.Conclusion: This study demonstrated among older adults, depressive symptoms change heterogeneously by gender. Identification of the most at risk subgroups among older men and women provides important initial empirical information to target clinical programs and policy development.

Common Factors and Depressive Symptom Relief Trajectories in Group Teletherapy for Persons Ageing with HIV.

In group teletherapy with older people living with HIV (OPLWHIV), three latent outcome trajectory groups emerged over the 12-week treatment period: (1) non-improvers (53%); (2) early improvers (31%) and (3) delayed improvers (16%). In group teletherapy with OPLWHIV, group cohesion is a stronger predictor of depressive symptom relief than is client-therapist alliance. OPLWHIV in group teletherapy who do not respond to treatment until the latter therapy sessions can still experience depressive symptom relief comparable with early responders.

Identifying depressive symptom trajectory groups among Korean adults and psychosocial factors as group determinants.

Longitudinal research is needed to examine the depressive symptom trajectories of different groups during adulthood and their antecedents and consequences, because depressive symptoms may be changeable and heterogeneous over time. This study examined the number of trajectory groups describing the depressive symptoms of Korean adults, as well as the shape of the trajectories and the association between trajectory group membership and psychosocial factors identified based on the ecosystem model. This study used Nagin's semi-parametric group-based modeling to analyze Year 1 to Year 7 data from Korea Welfare Panel Survey (N = 13,735), a nationally representative sample of community-dwelling adults. Three distinct trajectory groups were identified: a low stable depressive symptoms group, a moderate depressive symptoms group and a high depressive symptoms group. Result from multinominal logit analysis showed that all psychosocial factors except family relationships affected the likelihood of membership in the three depressive symptoms groups. Especially, self-esteem was the psychosocial factor with the largest impact on depressive symptom trajectory group membership. When screening for depressive symptoms, individuals with a low socioeconomic status should be a primary concern and intervention should be made available to them. Prevention or intervention with members of the identified trajectory groups would likely require integrative approaches targeting psychosocial factors across multiple contexts.

Heterogeneity in Adolescent Depressive Symptom Trajectories: Implications for Young Adults' Risky Lifestyle

The first objective of this study was to empirically identify adolescent depressive symptoms trajectory among classes. The second objective was to investigate the implications of adolescent depressive symptom trajectories for their lifestyle factors in young adulthood. Data came from the National Longitudinal Study of Adolescent Health (Addhealth). The analysis included the identification of depressive symptom trajectory groups using Latent Class Analyses. The identified trajectory groups were then compared with regard to risky lifestyle factors in young adulthood. Youth in the chronically high, increasing, and decreasing depressive symptoms groups showed significantly higher prevalence rates in most risky lifestyle factors compared with the consistently low trajectory group, after controlling for lagged measures, adolescent delinquency, family characteristics, and race/ethnicity. The risky lifestyle factors included: having multiple sex partners, having been arrested/committed crime, being an excessive drinker, being a smoker, and being unmarried. The associations of adolescent depressive symptom trajectory groups with young adult risky lifestyle factors provide evidence for the psychosocial processes through which experiences with depressive symptoms influence young adult lifestyle.

Heterogeneity in Youth Depressive Symptom Trajectories: Social Stratification and Implications for Young Adult Physical Health

The first objective of this study was to investigate young adult physical health implications of adolescent depressive symptom trajectories. The second objective was to investigate the social stratification of adolescent depressive symptom trajectories. Data came from the National Longitudinal Study of Adolescent Health. The analysis included the identification of depressive symptom trajectory groups. These four groups were then compared in terms of socioeconomic characteristics and change in physical health problems, from adolescence to young adulthood. Youth in the chronically high, increasing, and decreasing depressive symptoms groups showed significantly higher increases in physical health problems and poorer socioeconomic characteristics than did the consistently low group. The associations of adolescent depressive symptom trajectory groups with changes in physical health provide evidence for the etiological processes through which depression influences physical health. Differing socioeconomic characteristics of depressive symptom trajectory groups suggest social stratification of trajectories.