Refining Diagnostic Approaches to Depression in Older Patients with Cancer: A Latent Profile Analysis

Increases in the number of older adults living in the U.S. will result in an ever growing number of older cancer patients, many of which will experience depressive symptoms, ranging from mild and fleeting to severe and chronic. Depression is still poorly managed in complicated clinical populations such as older adults with medical comorbidities such as cancer. The primary source of this difficulty lies at least partially in the overlap between the DSM criteria for depression, aging-related changes, and the symptoms attributable to cancer and the side effects of treatment. However, the precise details of how aging might influence the expression of depressive symptoms in older cancer patients remains unexplored. This study is the first to examine which of the major diagnostic approaches to depression (i.e., inclusive, exclusive, substitutive) appears optimal for use with older adult cancer patients. Depressive symptoms were assessed using the PHQ-9, Endicott Criteria, and CES-D in a group of older and younger patients with cancer. Additionally, latent profile analysis (LPA) was utilized to characterize the underlying latent depressive symptom profiles for each group. Confirmatory LPA was used to determine how well the younger adult model fit the older adult group. The results indicated that participants in the younger group were significantly more likely to endorse depressive symptoms compared to the older group, including somatic items. Consistent with hypotheses, the inclusive approach identified the largest number of participants as having MDD, followed by the substitutive approach and the exclusive approach. LPA revealed 4 distinct classes in each group, which were labeled low symptom, mild negative affect, minor depression, and major depression. CLPA indicated that the underlying structures were significantly different in each group, supporting the hypothesis that aging impacts the phenomenology of depression in cancer patients. These results underscore the necessity of considering alternative diagnostic approaches to depression in older patients with cancer. Future studies should further determine the reliability and validity of the substitutive approach to depression and the unique longitudinal trajectories of latent classes over time in order to inform development and application of assessment strategies and treatments for older adults in the cancer setting