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Determinants of depressive symptom trajectories among older adults in community and treatment settings

Smagula, Stephen (2015) Determinants of depressive symptom trajectories among older adults in community and treatment settings. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Sub-diagnostic depression, sleep, and circadian rest-activity rhythm (CAR) syndromes are common in late-life, but their characteristics, prevalence, and relations to future depression are unclear. We characterized commonly occurring sleep, CAR, and depressive sign/symptom patterns using a data-driven approach applied to a large population-based study of older men. We next examined relationships of these baseline syndromes with longitudinal change in depressive symptoms. Common (32.44%) probable depressive syndromes were characterized by somatic/apathy symptoms; a subset (5.74%) with only limited somatic/apathy symptoms also had emotional-related impairment. Subjective complaints without objectively (actigraph) assessed disturbances characterized two distinct classes of men (totaling 37.46%); a pattern of objective disturbance (including greater sleep fragmentation with probable prolonged sleep latency or short (<5 hour) sleep duration) occurred in both the presence (8.87%) and absence (8.51%) of subjective complaints. Only 32.18% appeared to be free of a non-normative CAR parameter; 8 classes were distinguished by activity timing, levels, and the active period length. Baseline sleep and depression latent classes were not meaningfully associated with rates of change in depression severity. The rate of increase in depressive symptoms was higher for classes with later activity and for a class with dampened, earlier, and compressed activity combined. Future work should assess the modifiability of the identified markers of depressive symptom increases through preventative interventions. Nevertheless, there remains a need to understand of mechanisms of variability in pharmacological treatment response among older adults with major depressive disorder (MDD). We therefore assessed prognostic factors associated with distinct trajectories of depressive symptom change over 12-weeks of open-label Venlafaxine XR treatment for MDD. Only about 42% of participants exhibited a clear response, and the clinical prognostic factors linked to unique patterns of non-response included: worse depressive severity, longer illness duration, prior adequate pharmacological treatment, and worse list recognition performance. Overall, this work has public health relevance by providing a novel description of common sleep-wake/depressive syndromes in the community and distinct symptom trajectories found when pharmacologically treating MDD in the clinic. There is a need to integrate the identified prognostic markers with neurobiological research towards a valid predictive science of depression pathogenesis, prevention, and treatment.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Smagula, Stephensfs26@pitt.eduSFS26
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCauley, Janejcauley@edc.pitt.eduJCAULEY
Committee MemberNewman, AnneNewmanA@edc.pitt.eduANEWMAN
Committee MemberBromberger, Joycebrombergerjt@upmc.eduJBROM
Committee MemberBoudreau, RobertBoudreauR@edc.pitt.eduROB21
Committee MemberReynolds, CharlesReynoldsCF@upmc.eduCHIPR
Date: 28 January 2015
Date Type: Publication
Defense Date: 3 December 2014
Approval Date: 28 January 2015
Submission Date: 13 November 2014
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 163
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: epidemiology, psychiatry, aging, sleep, circadian rest-activity rhythm, depression
Date Deposited: 28 Jan 2015 16:56
Last Modified: 19 Dec 2016 14:42


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