Depression Treatment Trajectories and Associated Social Determinants: A Three-Year Follow-Up Study in 66,540 Older Adults Undergoing First-Time Depression Treatment in Denmark

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY International Journal of Geriatric Psychiatry Pub Date : 2024-11-02 DOI:10.1002/gps.70006

Kazi Ishtiak-Ahmed, Christopher Rohde, Ole Köhler-Forsberg, Kaj Sparle Christensen, Christiane Gasse

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Abstract

Objective

This study aimed to describe depression treatment patterns, identify unique trajectory groups using a group-based trajectory approach, and explore associated social determinants in older adults undergoing first-time depression treatment during a 3-year follow-up.

Methods

This Danish register-based cohort study included all adults aged ≥ 65 who initiated depression treatment by redeeming first-time antidepressant prescriptions (no prescriptions in the last 10 years) between 2006 and 2015. The outcome of interest during the 2-year follow-up was depression treatment, assessed as antidepressant prescriptions redemptions and psychiatric hospital contacts for depression. Latent class growth analyses were applied to model treatment trajectories during 3 years. Multinomial logistic regression analyses were used to analyze adjusted associations between social determinates and trajectory group membership.

Results

Among the 66,540 older adults (55.2% females, mean age: 77.3 years), we identified three distinct groups with unique patterns of depression treatment trajectories: ‘brief-treatment’ where individuals stopped depression treatment within 6 months (33.7%); ‘gradual-withdrawal’ (26.5%) where treatment was gradually stopped over 2 years; and ‘persistent-treatment’ where individuals continued depression treatment for the entire 3 years (39.8%). Females, single-person households, and residents of less-urbanized regions were associated with higher odds of membership in the ‘persistent-treatment’ group, while older age, widowhood or separation, and non-Danish ethnicities were associated with lower odds.

Conclusions

Three distinct patterns of depression treatment trajectories were identified in older adults, indicating differential clinical courses of depression—potentially influenced by social determinants, including sex, marital status, urban residence, and ethnicity. Early patient stratification and targeted interventions are crucial in depression care for older adults.

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抑郁症治疗轨迹及相关社会决定因素：丹麦首次接受抑郁症治疗的 66540 名老年人的三年随访研究》。

目的：本研究旨在描述抑郁症的治疗模式，使用基于群体的轨迹方法识别独特的轨迹群体，并探索首次接受抑郁症治疗的老年人在三年随访期间的相关社会决定因素：本研究旨在描述抑郁症的治疗模式，使用基于群体的轨迹方法识别独特的轨迹群体，并在为期 3 年的随访中探讨首次接受抑郁症治疗的老年人的相关社会决定因素：这项基于丹麦登记册的队列研究纳入了所有年龄≥65岁、在2006年至2015年期间通过兑换首次抗抑郁药处方（过去10年中没有处方）开始接受抑郁治疗的成年人。2 年随访期间的关注结果是抑郁症治疗情况，评估指标是抗抑郁药处方的兑换情况和因抑郁症入住精神病院的情况。采用潜类增长分析来模拟 3 年间的治疗轨迹。多项式逻辑回归分析用于分析调整后的社会决定因素与轨迹组成员之间的关联：在 66,540 名老年人（55.2% 为女性，平均年龄为 77.3 岁）中，我们发现了三个具有独特抑郁治疗轨迹模式的不同群体："短暂治疗"，即在 6 个月内停止抑郁治疗（33.7%）；"渐进-退出"（26.5%），即在 2 年内逐渐停止治疗；以及 "持续治疗"，即在整个 3 年中持续进行抑郁治疗（39.8%）。女性、单人家庭和城市化程度较低地区的居民属于 "持续治疗 "组的几率较高，而年龄较大、丧偶或分居以及非丹麦族裔的人属于 "持续治疗 "组的几率较低：结论：在老年人中发现了三种不同的抑郁症治疗轨迹模式，表明抑郁症的临床过程存在差异，这可能受到性别、婚姻状况、城市居住地和种族等社会决定因素的影响。早期对患者进行分层和有针对性的干预对老年人的抑郁症治疗至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.