kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2014.14.3.112 kjhp-14-112 Original Article Depressive Symptom Trajectories and Associated Risks among Korean Elderly NamIlSung 1 YoonHyunsook 2 Hallym University Institute of Aging, Chuncheon, Korea Department of Social Welfare, Hallym University, Chuncheon, Korea Corresponding author：IlSung Nam, PhD Hallym University Institute of Aging, 1 Hallimdaehak-gil, Chuncheon 200-702, Korea Tel: +82-33-248-3091, Fax: +82-33-248-3095 E-mail: ilsungn@gmail.com 01 2014 20 01 2014 14 3 112 120 02122013 10062014 Copyright © 2014 The Korean Society of Health Promotion and Disease Prevention 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Recent studies conducting changes in depressive symptoms among the elderly reported mixed results. The present study sought to determine if subgroups of elderly Koreans follow distinctive depressive symptom trajectories and the characteristics associated with the depressive symptom trajectories.

 Methods

Subjects were those who had participated in a longitudinal study of quality of life in older adults. A latent class mixture model was examined to identify the trajectories of depressive symptom changes with time.

 Results

We found four depressive symptom trajectories. Poorer health status, poor economic status, and less social support were risk factors in the high depression group.

 Conclusions

Early intervention to help elderly individuals manage their health, economic concerns, and social relationships may decrease the risk of high level depression.

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Four trajectories of depressive symptoms

Review of previous studies on depression trajectories in older adults

Author (year) Sample (N) Study duration, y Depression measurement Identified groups (%) Risks associated with the trajectory groups
Andreescu C (2008) Older adults aged above 65 (1,260) 12 CESD Persisting depressive symptoms group (2) Self-esteem,
        Remitting depressive symptoms group (4.8) interpersonal
        Emerging depressive symptoms group (4.2) difficulties,
        Stable low-depressed group (52.6) health-related
        Stable asymptomatic group 1 (28.1) worries
Byers AL (2012) Older women aged above 65 (7,240) 20 GDS Stable asymptomatic group 2 (8.2) Persistently high depressive symptoms (3.4) Smoking, diabetes,
        Increasing depressive symptoms (14.8) obesity,
        Persistently low depressive symptoms (54) physical activities,
        Minimal depressive symptoms (27.8) social network
Kuchibtatla MN (2012) Older adults aged above 65 (4,162) 10 CESD Depressed group (5.4) Self-reported health,
        Improver group (10) social network,
        Decliner group (8) life stresses
        Not depressed (76.6)  
Murphy BM (2008) Women interviewed following acute 1 HADS Depressed (16) Loneliness, having a first
        Not depressed (84) language other than
  myocardial       English
  infarction (226)        
Taylor DH Jr (2008) Dementia caregivers (1,580) 3 CESD High depression group (30.22) Education level,
        Moderate depression group (33.86) income level,
        Low depression group (21.88) quality of life
        Very low depression group (14.04)  

Abbreviations: CESD, The center for epidemiologic studies depression scale; GDS, Geriatric depression scale; HADS, The hospital anxiety and depression scale.

Comparisons of depressive trajectories using demographic, health-related, social informationa,b

  Total Low (Group 1) Emerging Decline High Group 1 vs.
(Group 2) (Group 3) (Group 4) Group 4
Demographic            
 Age, y 70.43±9.01 70.31±9.04 71.35±7.96 72.88±8.35 74.05±7.32 0.002
 Sex            
  Male 632 (39.75) 626 (40.6) 37 (33.9) 29 (29) 7 (13.5) <0.001
  Female 958 (60.25) 916 (59.4) 72 (66.1) 71 (71) 45 (86.5) <0.001
 Education, y 5.89±4.96 5.98±4.95 4.18±4.25 3.69±4.82 3.19±4.41 0.002
 Resident area            
  Seoul 621 (39.01) 594 (38.5) 17 (15.6) 38 (38) 31 (59.6) 0.002
  Chuncheon 971 (60.99) 950 (61.5) 92 (84.4) 62 (62) 21 (40.4) 0.002
 Resident area2            
  City 922 (57.91) 887 (57.4) 46 (42.2) 54 (54) 39 (75) 0.012
  Rural 670 (42.09) 657 (42.6) 63 (57.8) 46 (46) 13 (25) 0.012
 Widowed            
  Yes 621 (39.01) 593 (38.4) 40 (36.7) 53 (53) 31 (59.6) 0.002
  No 971 (60.99) 951 (61.6) 69 (63.3) 47 (47) 21 (40.4) 0.002
 Religion            
  Have 978 (61.43) 944 (61.1) 61 (56) 52 (52) 38 (73.1) 0.082
  Does not have 614 (38.57) 600 (38.9) 48 (44) 48 (48) 14 (26.9) 0.082
 Employed            
  Yes 1,131 (71.45) 443 (28.9) 33 (31.1) 12 (12.1) 9 (17.3) 0.069
  No 452 (28.55) 1,092 (71.1) 73 (68.9) 87 (87.9) 43 (82.7) 0.069
 Income, 10,000 Korean Won            
  0–99 643 (41.86) 610 (40.9) 60 (57.1) 56 (57.1) 36 (73.5) <0.001
  100–199 419 (27.28) 412 (27.6) 23 (21.9) 20 (20.4) 7 (13.3) <0.001
  ≤200 474 (30.86) 469 (31.5) 22 (21.0) 22 (22.5) 6 (12.2) <0.001
 Saving, 10,000 Korean Won 29.46±85.22 29.95±86.19 32.83±53.80 24.30±60.16 13.83±41.59 0.016
 Economic hardship 2.70±0.97 2.68±0.96 2.94±0.97 3.38±0.97 3.38±0.84 <0.001
Health-related            
 Self-reported 1.87±1.09 1.89±1.08 1.54±1.06 0.86±0.98 1.08±0.86 <0.001
 Fall Experience            
  Yes 334 (20.98) 316 (20.5) 27 (24.8) 30 (30.0) 19 (36.5) 0.005
  No 1,258 (79.02) 1,228 (79.5) 82 (75.2) 70 (70.0) 33 (63.5) 0.005
 BMI Number of disease 24.07±3.691.99±1.72 24.06±3.701.93±1.69 24.85±5.072.56±1.98 23.12±4.303.01±2.03 24.32±3.383.51±2.01 0.603<0.001
 MMSE score 24.69±4.47 24.78±4.45 24.03±4.13 22.48±5.19 22.04±4.38 <0.001
Social-related            
 Number of social group 1.43±1.20 1.44±1.21 1.40±1.17 0.9±0.95 1.08±0.97 0.037
 Social support 23.40±6.72 23.52±6.69 22.13±5.88 20.44±6.64 19.86±6.78 <0.001

Abbreviations: BMI, body mass index; MMSE, mini-mental state examination, SE, standard error.

Values are presented as mean±SE or N (%).

When comparing group differences chi-square test was used for the nominal variables, and t-test or Kruskal Wallis test was used for the continuous variable according to the normality test result.

Results of predicting the likelihood of falling in group 2, group 3, and group 4 compared to group 1a

Model Group 2 Group 3 Group 4
B SE OR P B SE OR P B SE OR P
1. Economic hardship 0.347 0.143 1.415 0.016 0.830 0.154 2.293 <0.001 0.590 0.369 1.804 0.004
2. Self-reported health –0.388 0.126 0.678 0.002 –1.028 0.152 0.358 <0.001 –0.634 0.167 0.530 <0.001
3. Fall experience –0.256 0.267 0.774 0.337 0.454 0.226 1.575 0.045 0.689 0.308 1.991 0.025
4. Number of diseases 0.161 0.075 1.175 0.032 0.274 0.054 1.315 <0.001 0.299 0.078 1.349 <0.001
5. MMSE score –0.016 0.025 0.984 0.529 –0.077 0.021 0.926 <0.001 –0.072 0.030 0.930 0.015
6. Number of social groups –0.078 0.107 0.925 0.461 –0.480 0.136 0.619 <0.001 –0.161 0.164 0.851 0.325
7. Social support –0.019 0.017 0.981 0.251 –0.073 0.016 0.930 <0.001 –0.065 0.023 0.938 0.006

Abbreviations: SE, standard error; OR, odds ratio; MMSE, mini-mental state examination.

A series of logit models were run controlling for age, sex, education, resident areas, marital status, religion, employment, income, and BMI.