Distinct Trajectories Of Depressive Symptoms Research Articles

The association between depressive trajectories and disability-free survival among middle-aged and older adults in China: a prospective cohort study.

This study aims to examine the association of depressive trajectories with disability-free-survival (DFS). This prospective cohort study used data from the China Health and Retirement Longitudinal Study, 2011-2015. Depressive symptoms were assessed using the Centre for Epidemiology Studies Depression Scale-10. Disability was assessed using activities of daily living (ADLs) and instrumental ADLs. Trajectories of depressive symptoms were identified and classified by latent mixture modelling. Logistic regression models were used to examine the association between depressive trajectories and DFS. A total of 8373 participants aged 45 years and older were included. We identified four distinct trajectories of depressive symptoms: 'no depressive symptoms', 'decreasing depressive symptoms', 'increasing depressive symptoms', and 'persistent depressive symptoms'. Compared to participants in the no depressive symptom trajectory, those in the decreasing depressive symptoms, increasing depressive symptoms and persistent depressive symptoms trajectories had an increased risk of disability or mortality, with multiple-adjusted hazard ratios (95% confidence intervals) of 1.75 (1.45-2.12), 2.05 (1.77-2.38) and 3.50 (2.77-4.42). Our study shows that among middle-aged and older Chinese adults, individuals with a trajectory of depressive symptoms are at increased risk of disability or mortality. Our findings underscore the importance of early prevention, identification and intervention of depression in clinical care to promote healthy ageing.

Temporal Relationship between HbA1c and Depressive Symptom Trajectories in a Longitudinal Cohort Study: The Mediating Role of Healthy Lifestyles.

This study analyzed China Health and Retirement Longitudinal Study data to explore the HbA1c-depression link, including depressive trajectories, while considering the mitigating impact of healthy lifestyles. Cross-lagged panel models and group-based trajectory modeling were performed to investigate the temporal relationship between HbA1c levels and depressive symptoms, as well as the depressive trajectories. Structural equation models were used to assess the mediating effects of healthy lifestyles. The mean age of the participants was 57.66 ± 9.04 years, with 53.68% being female. Analyzing 8826 participants across three waves, we observed a significant prediction of subsequent depressive symptoms by the preceding HbA1c levels (β = 0.296; p < 0.001). Four distinct trajectories of depressive symptoms were distinguished: stable low, stable moderate, increasing, and stable high. Elevated HbA1c levels were associated with a higher risk of developing stable high (OR 1.12 and 95% CI 1.02-1.23), increasing (OR 1.21 and 95% CI 1.11-1.32), and stable moderate depressive symptoms (OR 1.07 and 95% CI 1.01-1.13). Engaging in two healthy life behaviors reduced stable high and increasing depressive pattern risks by 32% and 30%, respectively. Adherence to a healthy lifestyle lessened 7.2% of the impact of high HbA1c levels on the subsequent depressive symptoms. These findings highlight the potential benefits of incorporating adequate sleep and light physical activities, which might reduce the adverse impact of elevated HbA1c levels on depressive symptoms.

Maternal depressive symptom trajectories and associations with child feeding

BackgroundResponsive feeding, when caregivers attend to children’s signals of hunger and satiation and respond in an emotionally supportive and developmentally appropriate way, is associated with the development of healthy eating behaviors, improved diet quality, and healthy weight status for children. However, gaps in the literature remain on how factors, such as maternal depressive symptoms and child temperament, influence feeding interactions.MethodsThis longitudinal secondary data analysis explored the association between maternal depressive symptom trajectory and child temperament with maternal feeding practices in women with obesity who participated in a prenatal lifestyle intervention trial. Mothers self-reported depressive symptoms at baseline, 35 weeks gestation, and 6, 12, and 18 months postpartum. At 18- and 24-months postpartum, mothers completed self-reported assessments of feeding practices and child temperament and completed in-home video-recorded meals with their child, coded using the Responsiveness to Child Feeding Cues Scale. We used group-based trajectory modeling to identify distinct trajectories of depressive symptoms and generalized regressions to assess the association between symptom trajectory group and feeding. We also explored interactions between depressive symptoms and child temperament.ResultsThree distinct trajectories of depressive symptoms were identified: No-Minimal and Decreasing, Mild-Moderate and Stable, and Moderate-Severe and Stable. At 18-months, when compared to the No-Minimal and Decreasing group, membership in the Moderate-Severe and Stable group was associated with higher observed responsiveness to child satiation cues (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$B$$\\end{document} =2.3, 95%CI = 0.2, 4.4) and lower self-reported pressure to eat (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$B$$\\end{document}=-0.4, 95%CI= -0.7, 0.0). When compared to the No-Minimal and Decreasing group, membership in the Mild-Moderate and Stable group was associated with higher self-reported restriction (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$B$$\\end{document} =0.4, 95%CI = 0.0,0.7). The associations between trajectory group membership and feeding practices did not reach statistical significance at 24 months. Associations between depressive symptoms and restriction were moderated by child effortful control at 18 months \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(B=0.2, 95\\% CI (0.0, 04)$$\\end{document}) and surgency at 24 months \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$B=-0.3, 95\\% CI (-0.6, 0.0)$$\\end{document}).ConclusionA Moderate-Severe and Stable depressive symptom trajectory was associated with more responsive feeding practices and a Mild-Moderate and Stable trajectory was associated with higher restrictive feeding. Preliminary evidence suggests that depressive symptoms impact mothers’ ability to match their use of restriction to the temperamental needs of their child.

중⋅고령 만성질환자의 우울궤적 유형과 예측요인

This study was conducted to identify different trajectories of depressive symptoms among older adults transitioning to patients with chronic diseases and to test the associated predictors. Four waves of Korean Longitudinal Study of Ageing were used for analyses, and demographic, clinical, and social factors were included as predictors. Among 433 middle-aged and older adults transitioning between 1st and 2nd waves, three distinct depressive symptom trajectories were identified through growth mixture modeling: low and decreasing(17.2%), increasing then persistently moderate(61%), and increasing then persistently high(21.8%) depressive symptoms over time. Results of logistic regression showed that changes in marital status, cognitive function, perceived limitation of activities, frequency of social contact and satisfaction with family relationships distinguished the trajectories. Notably, cognitive function and family relationships emerged as crucial factors across all trajectory classes. Thus, it is highly recommended to exert great effort to reduce depression levels of chronic patients by enhancing their cognitive function levels and family relationship satisfaction.

Trajectories of maternal depressive symptoms from infancy through early childhood: The roles of perceived financial strain, social support, and intimate partner violence.

Although new mothers are at risk of heightened vulnerability for depressive symptoms, there is limited understanding regarding changes in maternal depressive symptoms over the course of the postpartum and early childhood of their child's life among rural, low-income mothers from diverse racial backgrounds. This study examined distinct trajectories of depressive symptoms among rural low-income mothers during the first five years of their child's life, at 6, 15, 24, and 58 months, using data from the Family Life Project (N = 1,292). Latent class growth analysis identified four distinct trajectories of maternal depressive symptoms, including Low-decreasing (50%; n = 622), Low-increasing (26%; n = 324), Moderate-decreasing (13%; n = 156), and Moderate-increasing (11%; n = 131) trajectories. Multinomial logistic regression demonstrated that higher perceived financial strain and intimate partner violence, and lower social support predicted higher-risk trajectories (Low-increasing, Moderate-decreasing, and Moderate-increasing) relative to the Low-decreasing trajectory. Compared to the Low-decreasing trajectory, lower neighborhood safety/quietness predicted to the Low-increasing trajectory. Moreover, lower social support predicted the Moderate-increasing trajectory, the highest-risk trajectory, compared to those in Moderate-decreasing. The current analyses underscore the heterogeneity on patterns of depressive symptoms among rural, low-income mothers, and that the role of both proximal and broader contexts contributing to distinct trajectories of maternal depressive symptoms over early childhood.

Childhood maltreatment and association with trajectories of depressive symptoms among older adults: a longitudinal study in China

Objectives Childhood maltreatment has long-lasting effects on mental health. Existing evidence suggests that trajectories of depressive symptoms vary among individuals; however, little is known about how childhood maltreatment shapes these trajectory patterns. Therefore, this study investigated the impacts of childhood maltreatment on eight-year depressive trajectories among Chinese older adults. Method Five waves of longitudinal data from the China Health and Retirement Longitudinal Study were utilized. Growth Mixture Modelling was performed to identify distinct trajectories of depressive symptoms, and multinomial logistic regression was conducted to explore the associations between these trajectories and childhood maltreatment. Results Four trajectories of depressive symptoms were identified: the ‘no symptoms’ class (61.83%), the ‘increasing symptoms’ class (14.49%), the ‘decreasing symptoms’ class (16.44%), and the ‘chronic symptoms’ class (7.24%). Older adults who experienced childhood physical abuse were more likely to be in the ‘chronic symptoms’ class than in the ‘no symptoms’ class, whereas emotional neglect did not show a significant association with three problematic trajectories. Conclusion This study provides empirical evidence that childhood physical abuse increases the likelihood of developing chronic depressive symptoms in later life. To mitigate this risk, it is crucial to institute comprehensive treatment plans that incorporate trauma-informed care principles, employ evidence-based therapies specifically designed to address the long-term effects of abuse, and prioritize regular screening and assessment of mental health among older adults.

Poor mobility and lower limb weakness are associated with three distinct depressive symptom trajectories over 6 years in older people.

Physical decline can be associated with the onset of depressive symptoms in later life. This study aimed to identify physical and lifestyle risk factors for depressive symptom trajectories in community-dwelling older adults. Participants were 553 people aged 70-90 years who underwent baseline physical, psychological and lifestyle assessments. Group-based trajectory analysis was used to identify patterns of depressive symptom development over 6 years of follow-up. Strengths of associations between baseline functional test performances and depressive symptom trajectories were evaluated with univariable ordinal models. Subsequently, the adjusted cumulative odds ratio for the association between identified risk factors, demographic factors and baseline anti-depressant use were measured using multivariable ordinal logistic regression. Three distinct depressive symptom trajectories were identified: a low-and-stable course (10% of participants), a low-and-increasing course (81%) and a moderate-and-increasing course (9%). Timed Up and Go test time was the strongest risk factor of depressive symptom trajectory, followed by Five Times Sit-to-Stand test performance, planned physical activity levels, and knee extension strength (adjusted standardised ORs 1.65, 95% CI 1.34-2.04; 1.44, 95% CI 1.16-1.77; 1.44, 95% CI 1.17-1.76 and 1.41, 95% CI 1.15-1.73 respectively). After adjusting for age, sex, body mass index and baseline anti-depressant use, Timed Up and Go test performance and knee extension strength were independently and significantly associated with depressive trajectories. Timed Up and Go test times, Five Times Sit-to-Stand test performance, planned physical activity levels and knee extension strength are associated with three discrete depressive symptom trajectories. These clinical tests may help identify older adults aged 70-90 years at risk of developing depressive symptoms and help guide subsequent strength and mobility interventions.

Trajectories of depressive symptoms early in the course of bereavement: Patterns, psychosocial factors and risk of prolonged grief.

In the context of bereavement, little is known about the mechanisms that differentiate normative adjustment patterns from those that may indicate potential psychopathology. This study aimed to replicate and extend previous work by (1) characterizing the trajectories of depressive symptoms from 3 to 12months after the loss of a spouse, (2) examining whether (a) childhood maltreatment and attachment style predicted distinct depression trajectories, and (b) different depression trajectories were associated with the risk of prolonged grief at 12months post-loss. Recently bereaved individuals (N=175) completed self-report assessments at 3, 4, 6, and 12-months post-loss. Trajectories of depressive symptoms were estimated using group-based trajectory modelling. Four distinct trajectories of depressive symptoms were identified: (1) resilience (minimal/no depression across time points; 45%), (2) moderate depression-improved (alleviated to 'mild' by 12months; 31%), (3) severe depression-improved (alleviated to 'moderate' by 12months; 15%), and (4) chronic depression ('severe' symptoms across time points; 9%). Higher childhood maltreatment predicted a greater likelihood of belonging to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' and 'moderate depression-improved' groups. Widow(er)s with higher attachment anxiety were more likely to belong to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' group. The trajectory groups with persistent levels of depressive symptoms up until 6months were more likely to exhibit prolonged grief at 12months post-loss. Changes from pre-loss functioning cannot be estimated. Our findings provide insight into the early identification of post-loss prolonged grief.

Trajectories of maternal depressive symptoms from pregnancy to 11 years postpartum: Findings from Avon Longitudinal Study of Parents and Children (ALSPAC) cohort

BackgroundMaternal depressive symptoms are common in pregnancy and may extend to the perinatal period and beyond for some women. To date, few longitudinal studies have investigated maternal depressive symptoms from pregnancy to eleven years postpartum. Drawing data from a large population-based study cohort the aims of this study were to 1) identify distinct groups of mothers defined by their trajectories of depressive symptoms spanning from pregnancy to eleven years following the birth of the child, and 2) to identify psychosocial risk factors during pregnancy and in the first few postnatal years that are associated with these trajectories. MethodsData were analyzed from 14,170 mothers who participated in Avon Longitudinal Study of Parents and Children (ALSPAC). The Edinburgh Postnatal Depression Scale (EPDS) was used to capture maternal depressive symptoms across 10 time points including two prenatal (18 and 32 weeks), and eight postnatal (2, 8, 21, 33, 61, 73, 97 and 134 months) time points. The latent growth model was created to describe the course of maternal depressive symptoms across the preceding time points followed by a latent growth mixture modelling (LGMM) to identify distinct trajectories of depressive symptoms over time within the overall sample. The predictors of maternal depressive symptoms trajectories were categorized into sociodemographic, child, and psychosocial factors. The multinomial regression analyses were conducted to explore associations between the risk factors and depressive symptoms trajectories. ResultsLGMM identified four distinct trajectories of maternal depressive symptoms over time: minimal symptoms, increasing symptoms, persistent symptoms, and decreasing symptoms. Predictors of all patterns of depression - persistent, increasing and decreasing symptoms include smoking during pregnancy, and partner conflict. The strongest predictors of the persistent symptom trajectory included maternal history of depression and inadequate social support. LimitationsThe use of self-reported maternal mental health symptoms and under representation of ethnic minorities are our study's limitations. ConclusionsThe study findings highlight the importance of early identification and treatment for mothers experiencing depressive symptoms from pregnancy to the perinatal period and beyond.

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

BackgroundThe 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.MethodsData 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.ResultsFour 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.ConclusionsMultimorbidity, mobility limitation and subjective memory impairment were found to be potential risk factors for unfavorable depression trajectories.

Understanding stability and change in depressive symptom trajectories across young adulthood through the lens of career development: A mixed-methods study

Research has documented both stable and nonstable trajectories of depressive symptoms across young adulthood, but has not explored the mechanisms that might explain change in level of depressive affect over time. To explore this question, the current study draws on data from an Israeli longitudinal study of 205 young adults who reported their depressed symptoms four times from ages 23 to 35 years. Employing a latent profile analysis (LPA), three distinct trajectories of depressive symptoms were identified: stable low, moderate and decreasing, and stable high. To understand how stability and change in the course of depressive symptoms across time aligns with career development, 60 participants (20 from each profile), who had completed in-depth career development history interviews at age 29, were randomly selected. Subjecting the interviews to qualitative analysis showed that participants belonging to the stable low depressive symptoms trajectory were more likely to be intrinsically motivated, having the capacity to learn from their experiences, which resulted in a more successful career pursuit. In contrast, participants who consistently exhibited a high level of depressive affect were more likely to lack motivation, tended to feel at a loss, and were less likely to know what they want to do with their lives. Participants who were identified as belonging to the moderate and decreasing trajectory were more likely to describe the lack of a clear view of their future career plans. However, due to encouragement from significant others, they eventually found their niche. Conceptually, findings underscore the importance of understanding career factors that could covary with stability or change in the level of depressive symptoms during young adulthood.

DEPRESSIVE SYMPTOM TRAJECTORIES AND COGNITIVE FUNCTION AMONG OLDER COUPLES: A DYADIC PERSPECTIVE

Abstract Despite the well-documented health interdependence in the spousal context, empirical evidence on how psychological wellbeing of one’s partner might affect one’s cognitive function remains limited. Using dyadic data, the objective of this study is to examine trajectories of depressive symptoms and associated cognitive function outcomes among U.S. older married couples. Longitudinal Health and Retirement Study data (2004-2016) were used (N=6,289 heterosexual couples). Latent class growth analysis characterized depressive symptom trajectories for wives and husbands, separately. Structural equation models examined the actor and partner effects of depressive symptom trajectories on cognitive function in 2016 after adjusting for covariates. Four distinct depressive symptom trajectories were identified, including persistently low (wives: 73.61%; husbands: 79.59%), increasing (wives: 8.60%; husbands: 8.27%), decreasing (wives: 12.80%; husbands: 8.32%), and persistently high (wives: 4.99%; husbands: 3.81%). Compared to the low trajectory, increasing and high depressive symptom trajectories were associated with poorer cognitive function for wives and husbands (β_(wife,increasing,actor)=-0.92,95%CI=-1.30,-0.54; β_(wife,high,actor)=-0.71,95%CI=-1.19,-0.23; β_(husband,increasing,actor)=-0.81,95%CI=-1.16,-0.45; β_(husband,high,actor)=-1.20,95%CI=-1.78,-0.63). Notable gender discrepancies in partner effects were observed. Specifically, wife’s depressive symptom trajectories were not associated with husband’s cognitive function (P&amp;gt;0.05). However, husband’s decreasing depressive symptom trajectory was linked to wife’s better cognitive function. One’s own depressive symptom trajectories predicts his/her own cognitive function. Specifically, older adults with increasing and persistently high depressive symptoms over time may experience poorer cognitive function, and thereby warrant additional policy and clinical attention. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses’ cognitive function. Future studies need to validate such gender differences.

Distinct depressive symptom trajectories are associated with incident diabetes among Chinese middle-aged and older adults: The China Health and Retirement Longitudinal Study

ObjectivePrevious studies have reported that depression and depressive symptom are associated with diabetes incident. However, the association between long-term depressive symptom patterns and risk of diabetes remains unknown. The aim of present study was to evaluate the association between depressive symptom trajectories and risk of diabetes. MethodsWe used data of 8806 participants (≥45 years old) from the China Health and Retirement Longitudinal Study (CHARLS). Trajectories of depressive symptom were identified by latent mixture modeling. Multivariable logistic regression model was used to examine the association of depressive symptom trajectories with diabetes. ResultsFive depressive symptom trajectories were identified, characterizing by maintaining a low CES-D scores throughout the follow-up (low-stable; 3227 participants [36.65%]); maintaining a moderate CES-D scores throughout the follow-up (moderate-stable; 3402 participants [38.63%]); moderate starting CES-D scores then increasing scores (moderate-increasing; 681 participants [7.73%%]); high starting CES-D scores but then decreasing scores (high-decreasing; 1061 participants [12.05%]); and maintained high CES-D scores throughout the follow-up (high-stable; 435 participants [4.94%]). During 2015 to 2018 (Wave 3 to Wave 4), a total of 312 respondents experienced diabetes. Compared with participants in the low-stable depressive symptom trajectory, those following a high-decreasing (ORs = 2.04; 95%CIs 1.48–2.98) and high-stable depressive symptom trajectories (ORs = 3.26; 95%CIs 2.06–5.16) were at substantially higher risk of developing diabetes. ConclusionsIndividuals with high-decreasing and high-stable depressive symptom trajectories over time were associated with increased risk of incident diabetes. Long-term depressive symptom may be a strong predictor of having diabetes.

Modifiable factors of depressive-symptom trajectories from caregiving through bereavement

Background/purposeThe purpose of this secondary-analysis study was to identify never-before-examined factors associated with distinct depressive-symptom trajectories among family caregivers from end-of-life caregiving through the first 2 bereavement years.Participants/methodsParticipants (N=661) were family caregivers who provided end-of-life caregiving for terminally ill cancer patients. Multinomial logistic regressions were conducted to identify modifiable factors associated with caregivers’ seven previously identified depressive-symptom trajectories: minimal-impact resilience, recovery, preloss-depressive-only, delayed symptomatic, relief, prolonged symptomatic, and chronically persistent distressed. Drawing from the stress-appraisal-coping model, modifiable time-varying factors associated with distinct depressive-symptom trajectories were examined in three domains: (1) stressors, (2) stress appraisal, and (3) available resources (internal coping capacity and external social support).ResultsProfound objective caregiving demands were associated with caregivers’ increased likelihood of belonging to more distressing depressive-symptom trajectories than to the minimal-impact-resilience trajectory. But, stronger negative appraisal of end-of-life caregiving increased odds of caregiver membership in preloss-depressive-only and relief trajectories over the recovery, delayed, and prolonged-symptomatic trajectories. Stronger internal coping capacity and perceived social support buffered the tremendous stress of end-of-life caregiving and permanent loss of a relative, as evidenced by higher odds of being in the minimal-impact-resilience and recovery trajectories.ConclusionFamily caregivers’ distinct depressive-symptom trajectories were linked to their preloss caregiving demands, appraisal of negative caregiving impact, personal coping capacity, and perceived social support. Our results highlight actionable opportunities to improve end-of-life-care quality by boosting family caregivers’ coping capacity and enhancing their social support to help them adequately manage daily caregiving loads/burdens thus relieving the emotional toll before patient death and throughout bereavement.

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.

Trajectories of depressive symptoms in older adults and associated health outcomes.

With the progressive aging of the world's population, prolongation of a healthy lifespan in old age has become a medical research priority. The presence of depressive symptoms in later life is associated with poor health prognosis and increased mortality1,2. Here we explore distinct trajectories of depressive symptoms in later life and their association with several health-related outcomes in 19,110 older individuals followed for a median of 4.7 years. Using a latent class, mixed-modeling approach we identified four distinct trajectories of depressive symptoms with scoring patterns of consistently low, moderate, emerging and persistently high. Compared to those with minimal depressive symptoms, membership of any other class was associated with specific patterns of baseline sociodemographic and medical factors. Membership of any group with depressive symptoms was associated with a higher likelihood of health events, including physical disability, cancer and major bleeding episodes. Membership of the persistently depressed class was associated with increased mortality, while a diagnosis of dementia was generally limited to the class with initially low and progressively rising symptoms. The course of depressive symptoms in older individuals can vary widely and depend on several factors. The presence of depressive symptoms, including those that do not meet criteria for major depression, can flag a poor prognosis and risk for specific health conditions. Systematic assessment of depressive symptoms may facilitate early identification of at-risk populations.

Instrumental support primarily provided by adult children and trajectories of depressive symptoms among older adults with disabilities in rural China

Objectives This study aimed to examine the trajectories of depressive symptoms over a 5-year period in a sample of community-dwelling older adults with disabilities in rural China, and the association between duration of instrumental support primarily provided by adult children and the trajectories of depressive symptoms. Methods Data were drawn from three waves of the China Health and Retirement Longitudinal Study (2011–2015). The sample included 1,466 older adults living in rural areas aged 60 and over who had at least one child in all three waves. Duration of instrumental support provided by adult children was measured by the number of waves that older adults received instrumental support primarily from any adult children in the data collection. Growth mixture modelling was used to identify the trajectory classes of depressive symptoms among these older adults, and logistic regression was used to examine the association between duration of instrumental support primarily provided by adult children and the trajectory classes of depressive symptoms. Results This study identified two distinct trajectories of depressive symptoms among the respondents: high but decreasing levels of symptoms and persistently low levels of symptoms. Respondents who received a longer duration of instrumental support primarily from adult children were more likely to have high but decreasing symptoms after controlling for other covariates. Conclusion The findings have important implications for promoting the mental health of older adults with disabilities in rural China. There are still very limited long-term care services and programs are available for older adults, particularly in rural China. It is critical to develop these services at both community and institutional levels to meet the care needs of older adults and their families.

Depressive symptom trajectory following romantic relationship breakup and effects of rumination, neuroticism and cognitive control.

Studying individuals who recently experienced a romantic reltionship breakup allows us to investigate mood disturbances in otherwise healthy individuals. In our study, we aimed to identify distinct depressive symptom trajectories following breakup and investigate whether these trajectories relate to personality traits and cognitive control. Subjects (n=87) filled out questionnaires (RRS-NL-EXT trait rumination and NEO-FFI neuroticism) and performed cognitive tasks (trail making test, Stroop task) during a period of 30weeks. To identify distinct depressive symptom trajectories ('trajectory groups'), we performed K-means clustering on the consecutive (assessed every 2weeks) Major Depression Inventory scores. This resulted in four trajectory groups; 'resilience', 'fast recovery', 'slow recovery' and 'chronic distress'. The 'slow recovery group' and the 'chronic distress group' were found to have higher neuroticism and trait rumination levels compared to the 'resilience group', and the 'chronic distress group' also had higher neuroticism levels than the 'fast recovery group'. Moreover, the 'chronic distress group' showed worse overall trail making test performance than the 'resilience group'. Taken together, our findings show that distinct patterns of depressive symptom severity can be observed following breakup and that personality traits and cognitive flexibility seem to play a role in these depressive symptom patterns.

Discriminating Heterogeneous Trajectories of Resilience and Depression After Major Life Stressors Using Polygenic Scores

Major life stressors, such as loss and trauma, increase the risk of depression. It is known that individuals show heterogeneous trajectories of depressive symptoms following major life stressors, including chronic depression, recovery, and resilience. Although common genetic variation has been associated with depression risk, genomic factors that could help discriminate trajectories of risk vs resilience following adversity have not been identified. To assess the discriminatory accuracy of a deep neural net combining joint information from 21 psychiatric and health-related multiple polygenic scores (PGSs) for discriminating resilience vs other longitudinal symptom trajectories with use of longitudinal, genetically informed data on adults exposed to major life stressors. The Health and Retirement Study is a longitudinal panel cohort study in US citizens older than 50 years, with data being collected once every 2 years between 1992 and 2010. A total of 2071 participants who were of European ancestry with available depressive symptom trajectory information after experiencing an index depressogenic major life stressor were included. Latent growth mixture modeling identified heterogeneous trajectories of depressive symptoms before and after major life stressors, including stable low symptoms (ie, resilience), as well as improving, emergent, and preexisting/chronic symptom patterns. Twenty-one PGSs were examined as factors distinctively associated with these heterogeneous trajectories. Local interpretable model-agnostic explanations were applied to examine PGSs associated with each trajectory. Data were analyzed using the DNN model from June to July 2020. Development of depression and resilience were examined in older adults after a major life stressor, such as bereavement, divorce, and job loss, or major health events, such as myocardial infarction and cancer. Discriminatory accuracy of a deep neural net model trained for the multinomial classification of 4 distinct trajectories of depressive symptoms (Center for Epidemiologic Studies-Depression scale) based on 21 PGSs using supervised machine learning. Of the 2071 participants, 1329 were women (64.2%); mean (SD) age was 55.96 (8.52) years. Of these, 1638 (79.1%) were classified as resilient, 160 (7.75) in recovery (improving), 159 (7.7%) with emerging depression, and 114 (5.5%) with preexisting/chronic depression symptoms. Deep neural nets distinguished these 4 trajectories with high discriminatory accuracy (multiclass micro-average area under the curve, 0.88; 95% CI, 0.87-0.89; multiclass macro-average area under the curve, 0.86; 95% CI, 0.85-0.87). Discriminatory accuracy was highest for preexisting/chronic depression (AUC 0.93), followed by emerging depression (AUC 0.88), recovery (AUC 0.87), resilience (AUC 0.75). The results of the longitudinal cohort study suggest that multivariate PGS profiles provide information to accurately distinguish between heterogeneous stress-related risk and resilience phenotypes.

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