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

TY - JOUR

T1 - Depression Treatment Trajectories and Associated Social Determinants

T2 - A Three-Year Follow-Up Study in 66,540 Older Adults Undergoing First-Time Depression Treatment in Denmark

AU - Ishtiak-Ahmed, Kazi

AU - Rohde, Christopher

AU - Köhler-Forsberg, Ole

AU - Christensen, Kaj Sparle

AU - Gasse, Christiane

PY - 2024/11

Y1 - 2024/11

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - Antidepressive Agents/therapeutic use

KW - Cohort Studies

KW - Denmark

KW - Depressive Disorder/therapy

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Logistic Models

KW - Male

KW - Registries

KW - Social Determinants of Health

KW - register-based cohort study

KW - psychiatric hospital contacts for depression

KW - brief treatment

KW - persistent treatment

KW - antidepressant prescriptions

UR - http://www.scopus.com/inward/record.url?scp=85208290973&partnerID=8YFLogxK

U2 - 10.1002/gps.70006

DO - 10.1002/gps.70006

M3 - Journal article

C2 - 39487699

SN - 0885-6230

VL - 39

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

IS - 11

M1 - e70006

ER -