Treatment-resistant late-life depression prevalence and clinical/sociodemographic correlates: An electronic health records study

TY - JOUR

T1 - Treatment-resistant late-life depression prevalence and clinical/sociodemographic correlates

T2 - An electronic health records study

AU - Pozuelo Moyano, Beatriz

AU - Orgeta, Vasiliki

AU - von Gunten, Armin

AU - Vandel, Pierre

AU - Ma, Ruimin

AU - Stewart, Robert

AU - Mueller, Christoph

N1 - Copyright © 2025. Published by Elsevier B.V.

PY - 2025/7/15

Y1 - 2025/7/15

N2 - BACKGROUND: Treatment-resistant late-life depression (TRLLD) remains a clinical challenge. Our aim was to identify demographic and clinical factors associated with TRLLD.METHODS: A large naturalistic retrospective cohort study was conducted using mental health records from south London. Patients were selected at first recorded depression diagnosis after the age of 60. We defined TRLLD when ≥3 antidepressants were prescribed across their mental health record or a natural language processing algorithm indicated depression was described as treatment-resistant. We collected demographic and clinical characteristics around the first depressive episode diagnosis at age ≥ 60 and used multivariate logistic regression models to investigate factors associated with TRLLD.RESULTS: Of 8171 patients with late-life depression, 1443 (17.7 %) had TRLLD. Amongst those with severe, psychotic or recurrent depression the prevalence of TRLLD was 30.7 %, 31.4 % and 27.0 % respectively. Female sex, recurrent, severe, or psychotic depression and higher self-harm risk were associated with higher odds of TRLLD after adjustment for demographics (Adjusted Odds ratio (aOR): 1.36, 2.05, 2.34, 2.21 and 1.30 respectively). Older age, Black ethnicity, cognitive impairment and difficulties in activities of daily living were associated with a lower likelihood of TRLLD (aOR: 0.97, 0.65, 0.71 and 0.76 respectively). Several physical conditions examined were associated with increased odds for TRLLD, the strongest association was with hypertension (aOR: 2.20).CONCLUSIONS: This is the first large-scale study examining the socio-demographic data as well as psychiatric and physical comorbidities in TRLLD without known dementia. Prevention and management of multi-morbidity should be considered in primary or secondary prevention of treatment-resistant depression.

AB - BACKGROUND: Treatment-resistant late-life depression (TRLLD) remains a clinical challenge. Our aim was to identify demographic and clinical factors associated with TRLLD.METHODS: A large naturalistic retrospective cohort study was conducted using mental health records from south London. Patients were selected at first recorded depression diagnosis after the age of 60. We defined TRLLD when ≥3 antidepressants were prescribed across their mental health record or a natural language processing algorithm indicated depression was described as treatment-resistant. We collected demographic and clinical characteristics around the first depressive episode diagnosis at age ≥ 60 and used multivariate logistic regression models to investigate factors associated with TRLLD.RESULTS: Of 8171 patients with late-life depression, 1443 (17.7 %) had TRLLD. Amongst those with severe, psychotic or recurrent depression the prevalence of TRLLD was 30.7 %, 31.4 % and 27.0 % respectively. Female sex, recurrent, severe, or psychotic depression and higher self-harm risk were associated with higher odds of TRLLD after adjustment for demographics (Adjusted Odds ratio (aOR): 1.36, 2.05, 2.34, 2.21 and 1.30 respectively). Older age, Black ethnicity, cognitive impairment and difficulties in activities of daily living were associated with a lower likelihood of TRLLD (aOR: 0.97, 0.65, 0.71 and 0.76 respectively). Several physical conditions examined were associated with increased odds for TRLLD, the strongest association was with hypertension (aOR: 2.20).CONCLUSIONS: This is the first large-scale study examining the socio-demographic data as well as psychiatric and physical comorbidities in TRLLD without known dementia. Prevention and management of multi-morbidity should be considered in primary or secondary prevention of treatment-resistant depression.

UR - https://www.scopus.com/pages/publications/105001733520

U2 - 10.1016/j.jad.2025.03.169

DO - 10.1016/j.jad.2025.03.169

M3 - Article

C2 - 40174785

SN - 0165-0327

VL - 381

SP - 77

EP - 83

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -