Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
BMC Psychiatry. 2024 Nov 21;24(1):839. doi: 10.1186/s12888-024-06281-2.
Depression is among the leading causes of the global burden of disease and is associated with substantial morbidity in old age. The importance of providing timely intervention, particularly those with subclinical symptoms, has thus increasingly been emphasised. Despite their overall effectiveness, a small but notable subgroup tends to be less responsive to interventions. Identifying predictors of non-remission and non-response is critical to inform future strategies for optimising intervention outcomes.
A total of 4153 older adults aged 60 years and above with subclinical depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] = 5-19) were recruited from JC JoyAge, a large-scale collaborative stepped-care intervention service across Hong Kong. A wide range of clinical and modifiable risk and protective factors at baseline were assessed, including depressive symptoms, anxiety symptoms, loneliness, suicidal ideation, cognitive capacity, multimorbidity, chronic pain, need for informal care due to mental health reasons, history of abuse, and sociodemographic characteristics. Separate multivariable logistic regression models were applied to identify predictors of non-remission (PHQ-9 ≥ 5) and non-response (< 50% reduction in PHQ-9) following intervention.
The rates of non-remission and non-response were 18.9% (n = 784) and 23.0% (n = 956), respectively. Comorbid anxiety symptoms (adjusted odds ratio [aOR] = 2.08, CI = 1.72-2.51; 1.28, 1.05-1.57), loneliness (2.00, 1.66-2.42; 1.67, 1.38-2.01), need for informal care (1.86, 1.49-2.33; 1.48, 1.18-1.85), lower cognitive capacity (0.95, 0.93-0.97; 0.94, 0.92-0.96), and absence of chronic pain (0.59, 0.48-0.72; 0.76, 0.64-0.91) predicted both non-remission and non-response. Meanwhile, moderate-to-severe depressive symptoms predicted higher odds of non-remission (1.41, 1.18-1.69) and lower odds of non-response (0.28, 0.23-0.34), respectively. Subgroup analyses conducted separately in older adults with mild and moderate-to-severe depressive symptoms at baseline revealed that comorbid anxiety, loneliness, need for informal care, and absence of chronic pain were consistent predictors of non-remission. Those with non-remission and non-response showed more depression-related functional impairments and poorer health-related quality of life post-intervention.
Older adults with subclinical depressive symptoms showing comorbid anxiety, higher loneliness, need for informal care, and chronic pain may be offered more targeted interventions in future services. A personalised risk-stratification approach may be helpful.
ClinicalTrials.gov identifiers: NCT03593889 (registered 29 May 2018), NCT04863300 (registered 23 April 2021).
抑郁症是全球疾病负担的主要原因之一，与老年人的大量发病有关。因此，提供及时的干预措施变得越来越重要，特别是对于有亚临床症状的患者。尽管干预措施总体上是有效的，但一小部分患者的反应往往较差。识别缓解不良和无反应的预测因素对于为优化干预效果的未来策略提供信息至关重要。
从香港大规模合作的阶梯式护理干预服务 JC JoyAge 招募了 4153 名年龄在 60 岁及以上、有亚临床抑郁症状（患者健康问卷-9 [PHQ-9] 为 5-19）的老年人。在基线评估了广泛的临床和可改变的风险和保护因素，包括抑郁症状、焦虑症状、孤独感、自杀意念、认知能力、多种合并症、慢性疼痛、因心理健康原因需要非正式护理、虐待史以及社会人口学特征。分别应用多变量逻辑回归模型来识别干预后缓解不良（PHQ-9≥5）和无反应（PHQ-9 降低<50%）的预测因素。
缓解不良和无反应的发生率分别为 18.9%（n=784）和 23.0%（n=956）。共患焦虑症状（调整后的优势比[aOR]为 2.08，95%置信区间 [CI]为 1.72-2.51；1.28，1.05-1.57）、孤独感（2.00，1.66-2.42；1.67，1.38-2.01）、需要非正式护理（1.86，1.49-2.33；1.48，1.18-1.85）、认知能力较低（0.95，0.93-0.97；0.94，0.92-0.96）和没有慢性疼痛（0.59，0.48-0.72；0.76，0.64-0.91）预测了缓解不良和无反应。同时，中重度抑郁症状预测缓解不良的可能性更高（1.41，1.18-1.69），预测无反应的可能性更低（0.28，0.23-0.34）。在基线时轻度和中重度抑郁症状的老年人中分别进行的亚组分析表明，共患焦虑、孤独感、需要非正式护理和没有慢性疼痛是缓解不良的一致预测因素。缓解不良和无反应的患者在干预后表现出更多的与抑郁相关的功能障碍和较差的健康相关生活质量。
在未来的服务中，可能需要针对有亚临床抑郁症状且共患焦虑、孤独感、需要非正式护理和慢性疼痛的老年人提供更有针对性的干预措施。个性化的风险分层方法可能会有所帮助。
ClinicalTrials.gov 标识符：NCT03593889（2018 年 5 月 29 日注册），NCT04863300（2021 年 4 月 23 日注册）。
