Outcomes and predictors of late-life depression trajectories in older primary care patients
Outcomes and predictors of late-life depression trajectories in older primary care patients
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DOI：
10.1097/jgp.0b013e3181693264
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发表时间：
2008-05-01
影响因子：
7.2
通讯作者：
Conwell, Yeates
中科院分区：
文献类型：
--
作者：
Cui, Xingjia;Lyness, Jeffrey M.;Conwell, Yeates
目标：老年初级保健患者抑郁症的自然结局尚不清楚。作者试图确定两年内的抑郁轨迹并检查特定的结果预测因素。设计：两年观察性队列研究。地点：大罗彻斯特大学的独立实践初级保健实践。参与者：所有在选定的招募日就诊的年龄 > 65 岁的患者都有资格参加。在 392 名受试者中，316 名（80.6%）在 2 年随访期间完成了研究措施。测量：通过对纵向间隔随访评估中的每周抑郁状态应用纵向聚类分析，得出抑郁轨迹。结果：作者确定了遵循临床直观模式的六个不同的轨迹簇。尽管最初不抑郁或处于亚综合征至轻度抑郁范围的受试者在 2 年内有一系列可能的结果，但最初接近重度抑郁水平的群体随着时间的推移仍保持在该水平。抑郁轨迹的一致预测因素是基线抑郁症状严重程度、医疗负担和精神功能状态；对于某些群体来说，既往抑郁史和感知的社会支持也具有预后意义。结论：具有更严重抑郁症状的患者的“现实世界”结果非常差。鉴于亚综合征至轻度轻度抑郁症患者的结局各不相同，临床医生可能会将治疗重点放在那些不良结局风险最高的人群上，即患有抑郁症的人。例如，那些抑郁症状和医疗负担较重、精神功能和社会支持较低的人。预防性干预研究可能侧重于开发治疗方法，以减轻潜在的可改变的风险，例如社会支持的赤字。
Objectives: The naturalistic outcomes of depression in older primary care patients have been poorly characterized. The authors sought to identify depressive trajectories over 2 years and to examine specified outcome predictors. Design: Two-year observational cohort study. Setting: University-based and independent practice primary care practices in greater Rochester. Participants: All patients aged > 65 years presenting for care on selected recruitment days were eligible to participate. Of 392 subjects enrolled, 316 ( 80.6%) completed study measures over a 2-year follow-up. Measurements: Depression trajectories were derived by applying longitudinal cluster analysis to weekly depression status from the Longitudinal Interval Follow-up Evaluation. Results: The authors identified six distinct trajectory clusters that followed clinically intuitive patterns. Although subjects initially nondepressed or in the subsyndromal to minor depression range had a range of possible outcomes over 2 years, the cluster initially near the major depression level remained at that level over time. Consistent predictors of depression trajectory were baseline depressive symptom severity, medical burden, and psychiatric functional status; for some clusters, previous history of depression and perceived social support also had prognostic significance. Conclusion: The "real-world" outcomes of patients with more severe depressive symptoms are strikingly poor. Given the diverse outcomes of those with subsyndromal to mild forms of minor depression, clinicians might focus treatments on those at highest risk of poor outcome, i. e., those with greater depressive symptoms and medical burden and lower psychiatric functioning and social support. Preventive interventions research might focus on developing treatments to mitigate potentially modifiable risks such as deficits in social support.