Characterization of depression subtypes and depression chronicity in middle aged and older adults: An Analysis of the Canadian Longitudinal Study on Aging (CLSA)
Notice bibliographique
Résumé
Depression has heterogeneous symptom presentations and long-term courses, but little effort has been made to categorize depressive symptoms more finely among middle-aged and older adults, despite the increased tendency for chronic course of depression in older adults compared to younger adults. Adverse childhood experiences (ACE) and allostatic load (AL) are known to be associated with depression, but there is no comprehensive research linking these stressors to depression subtypes and its chronicity. The objectives of this research are: 1) to identify symptom-based depression subtypes at baseline among participants in the Canadian Longitudinal Study on Aging; 2) to assess their relationships with profiles of stress-related biological markers and early life adversities; and 3) to assess depression chronicity, its relationships with baseline depression subtypes, and its prognostic risk factors at three-year follow up. Participants with a baseline score of 10 or more on the Center for Epidemiological Studies Depression-10 item scale (CESD-10) were included in the analyses, and chronic depression was defined as a CESD-10 score of 10 more at both time points. Latent profile analyses were applied to baseline data on depressive symptoms, AL biomarkers and ACE, within the cross-sectional (n=3966) and longitudinal (n=3473) samples. In the cross-sectional study, multinominal logistic regression was used to determine the relationships between depression subtypes, stressors and other covariates. In the longitudinal study, chronic depression was regressed based on baseline variables using logistic regression. We identified four distinct depression subtypes, named positive affect, melancholic, typical and atypical, as well as three profiles of ACEs (low, moderate, physical abuse) and three profiles of AL (average, high-cardiovascular, low-cardiovascular). Depression subtypes had unique significant associations with stressor profiles. The strongest associations were observed for the atypical subtype (versus positive affect subtype) including a significantly lower relative risk (RRR 0.73, 95% CI: 0.57-0.93) for physical abuse-ACE, a higher risk for low-cardiovascular AL (RRR 1.31, 95%CI: 1.02-1.68), and a lower risk of high-cardiovascular AL (RRR 0.64, 95% CI: 0.49, 0.85), compared with the positive affect subtype. The prevalence of chronic depression was (46.6%), and was significantly associated with increased age group, total annual household income category, and chronic conditions score; decreased perceived social standing score; and current smoker status. Depression heterogeneity was identified, regarding symptom-based subtypes, their relationships with stress-related biological markers and early life adversities, and their relative risks for chronicity at three-year follow-up. Additionally, we characterized the prevalence of depression chronicity, relative to baseline factors including depression subtypes, which fills a gap in the literature regarding binary courses of depression subtypes within middle-aged and older adults. We found that prognostic factors for chronic depression are consistent with commonly identified depression incidence risk factors, and that stress profiles had distinct relationships with chronicity. Important factors for chronicity include baseline depressive symptom profiles, as well as ACE profile exposures and some AL profiles. Depression subtypes had distinct associations with stress-related biological markers and early life adversity profiles, as well as distinct risks for a more chronic course. Moreover, stressor exposures may not only have an impact on the profile of depressive symptoms experienced, but may also be significantly associated with depression chronicity. Such findings have implications for personalized clinical depression management strategies, earlier identification of depression, and potential primary and secondary intervention strategies
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,007 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».