Shifting Sense of Control: State, Trait, and Scar Effects of Late-life Depression in Trajectories of Mastery

Depression may influence one's sense of control over life, i.e., mastery. However, course trajectories of mastery during a major depressive episode (MDE) in late-life are unknown. Our aim was to examine heterogeneity in the course of mastery, from 6 years before to 6 years after a MDE in late-life. We hypothesized that state, trait and scar effects may be identified.

Data were derived from the Longitudinal Aging Study Amsterdam (LASA), a prospective population-based study. A total of 246 respondents aged 55-84 with MDE and mastery scores (pre-, during and post-MDE) were included. Data were collected between 1992 and 2018. Piecewise Latent Class Growth Analysis (LCGA) was employed to identify distinct course trajectories of mastery. Multinomial regression analysis was conducted to examine the association between characteristics and mastery-trajectories.

Four distinct trajectories of mastery were identified. Two reflected stable levels of mastery over time (trait effect), one with high mastery (67.1% of the sample) and the other by low mastery (13.0%). A scar trajectory (11.8%) showed lasting decline in mastery after MDE. Finally, a temporary decline during MDE, with post episode recovery of mastery, was observed (8.1%), indicating a state-effect. Lower education level, chronic disease, lower levels of physical functioning, and higher depression severity were associated with unfavorable mastery-trajectories.

Course trajectories of mastery around MDE are heterogeneous. Differentiating between these trajectories may enable clinicians to tailor care to individual recovery patterns, which should be validated in future treatment studies.