Course and risk factors for depression in late life

Summary

Principal Investigator: Hillary Bogner
Affiliation: University of Pennsylvania
Country: USA
Abstract: DESCRIPTION (provided by applicant): This application building on a randomized clinical trial carried out in primary care to study trajectories of depressive symptoms and medical comorbidity in relation to the outcomes of Major Depression and suicidal ideation at 2 years aligns with the NIMH Strategic Plan and is submitted in response to PA-07-082, "Risk factors for psychopathology using existing data sets," released 11 May 2007. Recent studies have demonstrated that a variety of primary care interventions can improve late life Major Depression outcomes. However, these interventions have not been found to be effective for minor depression. While some research has previously identified subtypes of depression, little work has focused on subtypes of late life depression, and that work has been conducted in cross-sectional data and not in the context of an intervention trial. The specific aims of this study are: (1) To identify subgroups of primary care elderly patients based on baseline characteristics and two different types of longitudinal profiles: 1) depressive symptoms and 2) overall medical comorbidity, and the association of subgroups with criterion-based Major Depression and/or suicidal ideation at 2 years;(2) To assess whether the different subgroups identified in Aim 1 on the basis of either depressive symptoms or overall medical comorbidity modify the effect of the collaborative care intervention on criterion- based Major Depression and/or suicidal ideation at 2 years, such that the intervention will show significant effects in certain subgroups;and (3) To assess how the effect modification of the intervention effect on criterion-based Major Depression or suicidal ideation at 2 years in Aim 1 is mediated by varying intensity of exposure to antidepressant medication or psychotherapy. To accomplish these aims, we will capitalize on screening, clinical assessment, treatment, and follow-up assessments which have occurred for up to 2 years in PROSPECT (the "Prevention of Suicide in Primary Care Elderly: Collaborative Trial"). In all, 1,226 patients, including all patients who screened positive for depression and a random sample of patients who screened negative, were enrolled in the 2-year longitudinal study. The primary care practices were randomized into: (1) treatment as usual by the primary care practice (n = 617 patients);and (2) a guideline management intervention consisting of antidepressant or psychotherapeutic treatment for depression following AHCPR guidelines, revised for the elderly, under the responsibility of the primary care physician who is assisted by a Masters-level specialist (the intervention condition;n = 609 patients). Among the sample of 1226 primary care elderly patients, we want to emphasize that our analysis will be based on course of depressive symptoms and not DSM-IV diagnoses. We propose to supplement PROSPECT data with medication records to classify and quantify medical comorbidity over the course of the 2-year follow-up interval. The foundation for the analysis to improve our understanding of the dynamic association of course of depressive symptoms and medical comorbidity will be the general growth curve mixture model (GGCMM). This project can have a significant public health impact because a further understanding of the association of the course of depressive symptoms and the onset and course of medical comorbidity among elderly primary care patients would be a key step in intervening to improve recognition and treatment of late life depression. PUBLIC HEALTH RELEVANCE: The overall goal of this application is to identify subgroups of primary care elderly patients, based on baseline characteristics and two different types of longitudinal profiles: 1) depressive symptoms and 2) overall medical comorbidity, for whom the collaborative care intervention reduces the persistence or onset of Major Depression and/or suicidal ideation. This project can have a significant public health impact because a further understanding of the association of the course of depressive symptoms and the onset and course of medical comorbidity among primary care elderly patients would be a key step in intervening to improve recognition and treatment of depression in late life.
Funding Period: ----------------2009 - ---------------2011-
more information: NIH RePORT

Top Publications

  1. pmc Urinary incontinence (UI) and new psychological distress among community dwelling older adults
    Heather F de Vries
    Department of Family Medicine and Community Health, University of Pennsylvania, School of Medicine, 2 Gates, 3400 Spruce Street, Philadelphia, PA 19104, USA
    Arch Gerontol Geriatr 55:49-54. 2012
  2. pmc Course of depression and mortality among older primary care patients
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA
    Am J Geriatr Psychiatry 20:895-903. 2012
  3. pmc Measuring concurrent oral hypoglycemic and antidepressant adherence and clinical outcomes
    Hillary R Bogner
    Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, 9 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104, USA
    Am J Manag Care 19:e85-92. 2013
  4. pmc Pilot trial of a licensed practical nurse intervention for hypertension and depression
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA
    Fam Med 45:323-9. 2013
  5. pmc The temporal relationship between anxiety disorders and urinary incontinence among community-dwelling adults
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA 19104, USA
    J Anxiety Disord 25:203-8. 2011
  6. pmc Chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women
    Heather F de Vries
    Department of Family Medicine and Community Health, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA
    Menopause 18:1298-302. 2011
  7. pmc Self-reported estrogen use and newly incident urinary incontinence among postmenopausal community-dwelling women
    GINA M NORTHINGTON
    Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
    Menopause 19:290-5. 2012
  8. pmc Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
    Ann Fam Med 10:15-22. 2012
  9. pmc Prognostic factors, course, and outcome of depression among older primary care patients: the PROSPECT study
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, USA
    Aging Ment Health 16:452-61. 2012

Scientific Experts

Detail Information

Publications9

  1. pmc Urinary incontinence (UI) and new psychological distress among community dwelling older adults
    Heather F de Vries
    Department of Family Medicine and Community Health, University of Pennsylvania, School of Medicine, 2 Gates, 3400 Spruce Street, Philadelphia, PA 19104, USA
    Arch Gerontol Geriatr 55:49-54. 2012
    ..57, 95%CI=2.92-19.62). We conclude that UI, especially when associated with condition-specific functional loss, predicted the onset of psychological distress among community dwelling older adults...
  2. pmc Course of depression and mortality among older primary care patients
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA
    Am J Geriatr Psychiatry 20:895-903. 2012
    ..Depression is a treatable illness that disproportionately places older adults at increased risk for mortality...
  3. pmc Measuring concurrent oral hypoglycemic and antidepressant adherence and clinical outcomes
    Hillary R Bogner
    Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, 9 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104, USA
    Am J Manag Care 19:e85-92. 2013
    ..Our objective was to compare selfreported adherence and electronic monitoring of adherence to oral hypoglycemic agents and antidepressants and to examine the relationship of adherence with clinical outcomes...
  4. pmc Pilot trial of a licensed practical nurse intervention for hypertension and depression
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA
    Fam Med 45:323-9. 2013
    ..Our objective was to examine whether an intervention carried out by Licensed Practical Nurses (LPNs) integrating depression treatment into care for hypertension improved blood pressure control and depressive symptoms...
  5. pmc The temporal relationship between anxiety disorders and urinary incontinence among community-dwelling adults
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA 19104, USA
    J Anxiety Disord 25:203-8. 2011
    ..The purpose of this paper was to carefully examine the temporal relationships between anxiety disorders and urinary incontinence among community-dwelling adults...
  6. pmc Chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women
    Heather F de Vries
    Department of Family Medicine and Community Health, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA
    Menopause 18:1298-302. 2011
    ..The aim of this study was to examine the association between chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women...
  7. pmc Self-reported estrogen use and newly incident urinary incontinence among postmenopausal community-dwelling women
    GINA M NORTHINGTON
    Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
    Menopause 19:290-5. 2012
    ..The aim of this study was to examine the relationship between self-reported estrogen use and newly incident urinary incontinence (UI) among community-dwelling postmenopausal women...
  8. pmc Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
    Ann Fam Med 10:15-22. 2012
    ....
  9. pmc Prognostic factors, course, and outcome of depression among older primary care patients: the PROSPECT study
    Hillary R Bogner
    Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, USA
    Aging Ment Health 16:452-61. 2012
    ..We sought to examine whether there are patterns of evolving depression symptoms among older primary care patients that are related to prognostic factors and long-term clinical outcomes...