title: Heterogeneous depression trajectories in multiple sclerosis patients.
abstract: BACKGROUND
  Trajectories of depression over time may be heterogeneous in Multiple Sclerosis (MS) patients. Describing these trajectories will help clinicians understand better the progression of depression in MS patients to aid in patient care decisions.
  
  
  METHODS
  Latent class growth analysis (LCGA) was applied to 3507 MS patients using an electronic health records (EHR) data base to identify subgroups of MS patients based on self-reported depression screening (PHQ-9). Latent trajectory classes were used for group comparisons based on baseline clinical characteristics.
  
  
  RESULTS
  Three subgroups were found characterized by high (10.0% [of participants]), wavering above and below moderate (26.2%) and low and variable (63.8%) depression level trajectories. The subpopulation trajectories, respectively, were also characterized by high, moderate and low MS disability at baseline. In contrast, the overall average trajectory was slightly declining and below the moderate depression threshold.
  
  
  CONCLUSIONS
  The LCGA approach described in this paper and applied to MS patients provides a template for improved use of an EHR data base for understanding heterogeneous depression screening trajectories. Clinicians may use such information to more closely monitor patients that are expected to maintain high or unstable depression levels.
authors.affiliation: Case Western Reserve University, Center for Health Care Research & Policy, MetroHealth Medical Center, Cleveland, OH, USA. Electronic address: dgunzler@metrohealth.org.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Gunzler
authors.affiliation: Case Western Reserve University, Department of Epidemiology and Biostatistics, Cleveland, OH, USA. Electronic address: njm18@case.edu.
authors.forename: Nathan
authors.initials: N
authors.lastname: Morris
authors.affiliation: Case Western Reserve University, Center for Health Care Research & Policy, MetroHealth Medical Center, Cleveland, OH, USA. Electronic address: Adam.Perzynski@case.edu.
authors.forename: Adam
authors.initials: A
authors.lastname: Perzynski
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ontanedad@ccf.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ontaneda
authors.affiliation: Case Western Reserve University, Department of Epidemiology and Biostatistics, Cleveland, OH, USA. Electronic address: farren.briggs@case.edu.
authors.forename: Farren
authors.initials: F
authors.lastname: Briggs
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: millerd@ccf.org.
authors.forename: Deborah
authors.initials: D
authors.lastname: Miller
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: bermelr@ccf.org.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bermel
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology; D012189:Retrospective Studies
keywords: Depression; Electronic health records; Heterogeneity; Latent class growth analysis; Patient reported outcomes