Profiles of Depressive Symptoms in Older Adults Diagnosed With Major Depression: Latent Cluster Analysis
Profiles of Depressive Symptoms in Older Adults Diagnosed With Major Depression: Latent Cluster Analysis
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DOI：
10.1097/jgp.0b013e31819431ff
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发表时间：
2009-05-01
影响因子：
7.2
通讯作者：
Steffens, David C.
中科院分区：
文献类型：
--
作者：
Hybels, Celia F.;Blazer, Dan G.;Steffens, David C.
目的：通过识别基于症状特征的同质个体群，探索老年抑郁症患者症状表现的潜在结构。设计：使用潜在类别聚类分析进行二级数据分析。背景：杜克大学晚年抑郁症临床研究中心。参会人员：366例60岁以上的患者符合精神疾病诊断与统计手册第四版（DSM-IV）的重性抑郁症标准，并参加了一项纵向自然主义治疗研究。测量：在研究入组时对蒙哥马利-阿斯伯格抑郁评定量表的10个项目的反应。结果：作者确定了四个潜在的老年抑郁症患者群。第1组患者（47.2%）报告和明显悲伤和倦怠的平均严重程度的平均评分以及食欲减退的平均评分较低。第2组患者（27.1%）在所有项目上的平均得分均高于第1组，特别是明显的悲伤。第3组（18.9%）的患者在明显和报告的悲伤方面的平均得分最低，但与第1组相比，在内心紧张、睡眠减少、食欲下降和注意力集中困难方面的得分相似。第4组（6.8%）每个项目的平均得分最高。明显的和报告的悲伤在四个集群中占了很大的差异。第4组的患者更有可能接受12年或更少的教育和/或一种或多种功能限制。结论：诊断为重度抑郁症的老年人症状表现的异质性可能会为DSM-V的发展提供信息（Am J Geriatr Psychiatry 2009; 17：387-396）。
Objective: To explore the underlying structure of symptom presentation in older adults with major depression by identifying homogeneous clusters of individuals based on symptom profiles. Design: Secondary data analysis using latent class cluster analysis. Setting: Clinical Research Center for the Study of Depression in Later Life conducted at Duke University. Participants: Three hundred sixty-six patients age 60+ who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression and were enrolled in a longitudinal naturalistic treatment study. Measurements: Responses to the 10 items of the Montgomery-Asberg Depression Rating Scale at the time of study enrollment. Results: The authors identified four latent clusters of older adults with major depression. Patients in Cluster 1 (47.2%) had mean scores of average severity for reported and apparent sadness and lassitude and low mean scores for reduced appetite. Patients in Cluster 2 (27.1%) had higher mean scores compared with Cluster 1 for all items, and particularly for apparent sadness. Patients in Cluster 3 (18.9%) had the lowest mean scores for both apparent and reported sadness, but a similar profile compared with Cluster 1 for inner tension, reduced sleep, reduced appetite, and concentration difficulties. Cluster 4 (6.8%) had the highest mean scores for each item. Both apparent and reported sadness accounted for a large amount of variance among the four clusters. Patients in Cluster 4 were more likely to have 12 or less years of education and/or one or more functional limitations. Conclusion: The heterogeneity in symptom presentation among older adults diagnosed with major depression can potentially inform the development of DSM-V. (Am J Geriatr Psychiatry 2009; 17: 387-396)