title: Heterogeneity in the three-year course of major depression among older adults.
abstract: The objective of this research was to identify distinct trajectories of recovery in older depressed patients in order to identify optimal samples and points for interventions.
  
  
  
  The sample was 368 patients ages 60 years and older diagnosed with major depression and enrolled in a naturalistic treatment study and followed for up to 3 years.
  
  
  
  A model with four trajectory classes fit the data best: a quick recovery class (43%), a persistent moderate symptom class (27%), a persistent high symptom class (15%), and a slow recovery class (15%). Compared with patients in the quick recovery class, patients in the persistent moderate symptom class had more instrumental activities of daily living/mobility limitations and lower levels of subjective social support. Patients in the persistent high symptom class had higher levels of perceived stress and lower levels of social support compared with those with a quick recovery. Patients in the slow recovery class had a younger age of onset compared with those in the quick recovery group. In multinomial logistic regression, levels of perceived stress and social support at baseline significantly differed across classes controlling for demographic and health variables.
  
  
  
  Older patients diagnosed with major depression can have varying patterns of response to treatment. Interventions targeting those patients with higher levels of perceived stress and lower levels of subjective social support at the time of the index episode may lead to more favorable long-term trajectories. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham, NC, 27710, USA.
authors.forename: Celia F
authors.initials: CF
authors.lastname: Hybels
authors.affiliation: Department of Biostatistics and Bioinformatics, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
authors.affiliation: Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06032, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Steffens
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis
keywords: aged; depression; latent class analyses; social support; trajectories