title: Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults.
abstract: OBJECTIVE
  Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes.
  
  
  METHODS
  The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008.
  
  
  RESULTS
  Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism.
  
  
  CONCLUSIONS
  Chronic moderate depressive symptoms are associated with poorer oral health in older adults.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.|Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
authors.forename: Celia F
authors.initials: CF
authors.lastname: Hybels
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Bennett
authors.affiliation: Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.|Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Landerman
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jersey
authors.initials: J
authors.lastname: Liang
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.|Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Plassman
authors.affiliation: Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.|School of Nursing, Duke University Medical Center, Durham, NC, USA.|Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Bei
authors.initials: B
authors.lastname: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003866:Depressive Disorder / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009909:Oral Health / Q000706:statistics & numerical data*; D012044:Regression Analysis
keywords: depressive symptoms; edentulism; latent class trajectory analysis; oral health