Data-driven subtypes of late-life depression-secondary analysis of a cluster-randomized RCT

Area of Science:

• Geriatric Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• Cognitive performance variability impacts treatment outcomes in older adults with depression.
• Late-life depression presents diverse symptom profiles and cognitive deficits.
• Understanding depression subtypes is crucial for personalized treatment strategies.

Purpose of the Study:

• To identify distinct patient subgroups in late-life depression using a data-driven approach.
• To explore the course of depressive symptoms in different subgroups under two treatment conditions: behavioural activation (BA) and treatment as usual (TAU).
• To investigate the differential effectiveness of BA versus TAU across identified depression subtypes.

Main Methods:

• Latent class analysis (LCA) was performed on depressive symptoms and cognitive test performance in 161 older adults (≥65 years) with depression (PHQ ≥ 10).
• Participants were part of a cluster randomized controlled trial in primary care.
• The longitudinal course of depressive symptoms was visualized for each identified subgroup under BA and TAU.

Main Results:

• Five distinct subgroups of late-life depression were identified, characterized by varying symptom severity and the presence/absence of cognitive deficits.
• Subgroups included: mild depression without cognitive deficits; moderate depression with insomnia and cognitive deficits; severe depression with cognitive deficits; moderately severe depression with hypersomnia and cognitive deficits; and moderately severe depression with cognitive-affective symptoms but no cognitive deficits.
• Depressive symptoms improved more significantly in subgroups with severe depression during BA compared to TAU, irrespective of cognitive status.

Conclusions:

• Five distinct subgroups of late-life depression were identified, highlighting heterogeneity in symptom presentation and cognitive involvement.
• Behavioural activation (BA) demonstrated consistent effectiveness across all identified subgroups.
• Treatment as usual (TAU) appeared less effective in subgroups experiencing more severe depressive symptoms, suggesting a need for tailored interventions.