Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults

Celia F. Hybels*, Joan M. Bennett, Lawrence R. Landerman, Jersey Liang, Brenda L. Plassman, Bei Wu

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

46 Scopus citations


Objective Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes. Methods The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008. Results Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism. Conclusions Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

Original languageEnglish
Pages (from-to)83-91
Number of pages9
JournalInternational Journal of Geriatric Psychiatry
Issue number1
StatePublished - 01 01 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2015 John Wiley & Sons, Ltd.


  • depressive symptoms
  • edentulism
  • latent class trajectory analysis
  • oral health


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