Natural course of depressive symptoms in late life. An 8-year population-based prospective study

A comparative study of the impact of meditation and Buddhist five precepts on stress and depression between older adults and younger adults

Older adults frequently face a myriad of physical and mental health challenges, which can contribute to feelings of stress and subsequent depression. Nevertheless, with age often comes a wealth of life experience and resilience. Perceived stress commonly predicts depression across all age groups, while meditation has been associated with lower levels of depression. Additionally, adherence to the Five Precepts is a prevalent practice among Thai individuals, particularly among older adults. However, it remains unclear how the combination of meditation and the Buddhist Five Precepts influences depression levels. This study aims to explore the predictive roles of meditation, the practice of the Five Precepts, and perceived stress on depression among older adults, with comparisons drawn to younger adults. A sample of 1472 individuals (232 were older adults and 1240 were adults) participated in the study. All completed the questionnaires for depression, perceived stress, meditation, and five precepts using the core symptom index, perceived stress scale, and inner strength-based inventory. Moderation model and mediation model analyses were employed to analyze the relationship between the perceived stress scores and the symptoms of depression for both older and younger samples. In the older adults group, 59.9% were female, with a mean age of 67.96 years (SD 6.8). In the adult group, 71.3% were male, with a mean age of 29.04 years (SD 10.5). The findings revealed that among the older adults' group, precepts, meditation, and their interaction significantly predicted a lower level of depressive symptoms (estimated coefficient = - 0.1082, 95% CI = - 0.1865, - 0.03). However, this association was not observed in the younger adults' group (estimated coefficient = -0.0199, 95% CI = - 0.0465, 0.0066). The variance explained in depressive symptoms changed from 24.9% in the linear model of perceived stress to 31.8% in the moderated moderation model, representing a 27.7% increase. Conversely, meditation and the five precepts mediated the relationship between stress and depressive symptoms in younger people but not in older adults. The indirect effect of perceived stress was significant only through the five precepts (estimated coefficient = - 0.3173, 95% CI = - 0.4787, - 0.1558; p = .0001). The variance explained in depressive symptoms changed from 42.2% in the linear model of perceived stress to 43.2% in the mediation model, representing a 2.5% increase. This study emphasizes that older adults may experience enhanced benefits from meditation and adherence to the Five Precepts compared to younger adults. Additionally, the effectiveness of meditation appears to be influenced by the extent of precept practice. Older individuals who actively engage in both high levels of precept adherence and meditation demonstrate a more significant buffering effect on the relationship between stress and depression. These findings suggest that lifestyle factors, such as religious practices like meditation and adherence to precepts, may have a differential impact on older adults compared to younger counterparts. The implications for older individuals are promising and warrant encouragement, while further research is needed to explore relevant factors contributing to reduced depression among younger populations.

Association between cognitive decline and depression in middle-aged and older adults: Findings from six large cohorts in different countries

BACKGROUND

The relationship between depression and cognition in middle-aged adults is a topic of interest. Whether poor cognitive function exacerbates depression remains controversial. We clarified the association between cognitive decline and depression based on six nationwide cohorts.

METHODS

89,056 participants were retrieved from six cohorts in Europe, North America, Asia and Africa. Each two consecutive interviews were collected as a sample set with a total of twenty-eight sample sets to assess changes in depression and cognitive function. Multiple linear regression was conducted within each sample set to evaluate the association between cognitive decline and depression. A two-stage meta-analysis was performed to obtain the average effect within each cohort and the overall effect excluding population and regional heterogeneity. Meta-regression and subgroup analysis were used to explore heterogeneity and potential effect modifiers.

RESULTS

Almost all sample sets indicated negative association between changes in cognitive function and depression scores. The average effects varied across regions: Korea (-0.150 [-0.175, -0.126]), Europe (-0.130 [-0.149, -0.112]), South Africa (-0.090 [-0.129, -0.060]), China (-0.083 [-0.137, -0.030]), Mexico (-0.063 [-0.084, -0.042]), and North America (-0.048 [-0.056, -0.040]). The overall effect excluding population and regional heterogeneity was -0.094 [-0.129, -0.060], and was robust across populations of different age, sex, alcohol consumption, daily living activities and marital status.

LIMITATIONS

The cross-sectional design limited our ability to determine causal relationships.

CONCLUSION

Cognitive decline was associated with the exacerbation of depression status in middle-aged and older adults worldwide. Country-level factors, rather than individual-level factors, are more likely to modify this effect.

Machine learning algorithms to predict depression in older adults in China: a cross-sectional study

Objective

The 2-fold objective of this research is to investigate machine learning's (ML) predictive value for the incidence of depression among China's older adult population and to determine the noteworthy aspects resulting in depression.

Methods

This research selected 7,880 older adult people by utilizing data from the 2020 China Health and Retirement Longitudinal Study. Thereafter, the dataset was classified into training and testing sets at a 6:4 ratio. Six ML algorithms, namely, logistic regression, k-nearest neighbors, support vector machine, decision tree, LightGBM, and random forest, were used in constructing a predictive model for depression among the older adult. To compare the differences in the ROC curves of the different models, the Delong test was conducted. Meanwhile, to evaluate the models' performance, this research performed decision curve analysis (DCA). Thereafter, the Shapely Additive exPlanations values were utilized for model interpretation on the bases of the prediction results' substantial contributions.

Results

The range of the area under the curve (AUC) of each model's ROC curves was 0.648-0.738, with significant differences (P < 0.01). The DCA results indicate that within various probability thresholds, LightGBM's net benefit was the highest. Self-rated health, nighttime sleep, gender, age, and cognitive function are the five most important characteristics of all models in terms of predicting the occurrence of depression.

Conclusion

The occurrence of depression among China's older adult population and the critical factors leading to depression can be predicted and identified, respectively, by ML algorithms.

Combined healthy lifestyles and risk of depressive symptoms: A baseline survey in China

BACKGROUND

Little evidence exists about whether a combination of healthy lifestyle factors is associated with a lower risk of depressive symptoms among Chinese population. We aimed to investigate the association between combined healthy lifestyle factors and risk of depressive symptoms.

METHODS

We conducted a baseline survey from July 2021 to December 2023, including 53,642 Chinese adults from general population. A healthy lifestyle score was constructed based on six lifestyle factors (physical activity, smoking status, alcohol consumption, diet, sleep duration, and body mass index). Logistic regression models were used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) adjusted for confounding variables.

RESULTS

Each additional healthy lifestyle score was associated with a 20 % lower risk of having depressive symptoms (OR (95 % CI): 0.80 (0.78-0.81)). Compared with individuals with ≤2 healthy lifestyle factors, individuals with all the six healthy lifestyle factors had a 58 % reduced risk of having depressive symptoms (0.42 (0.37-0.47)). After stratification by gender, education and urbanization, the significant inverse association with healthy lifestyle score was stronger in women, individuals with high education, and urban residents. Besides, the significant negative association between healthy lifestyle score and depressive symptoms remained for different severity of depressive symptoms.

LIMITATIONS

Given the cross-sectional nature of data, we cannot make causal inferences.

CONCLUSIONS

Our study indicated that adherence to healthy lifestyle factors was associated with a reduced risk of having depressive symptoms among Chinese adults. The observed associations were modified by gender, education and urbanization. These findings warrant further verification in interventional studies.

Age-specific risk factors of depression among the oldest-old - evidence from the multicenter AgeCoDe-AgeQualiDe study

Purpose

The present study aimed to investigate age-group-specific incidence rates and risk factors for depressive symptoms in the highest age groups.

Methods

Data were derived from a prospective multicenter cohort study conducted in primary care - the AgeCoDe/AgeQualiDe study. In total, 2,436 patients 75 years and older were followed from baseline to ninth follow-up. To assess depressive symptoms, the short version of the Geriatric Depression Scale (GDS-15, cutoff score 6) was used. Age-specific competing risk regressions were performed to analyze risk factors for incident depressive symptoms in different age groups (75 to 79, 80 to 84, 85+ years), taking into account the accumulated mortality.

Results

The age-specific incidence rate of depression was 33 (95% CI 29-38), 46 (95% CI 40-52) and 63 (95% CI 45-87) per 1,000 person years for the initial age groups 75 to 79, 80 to 84 and 85+ years, respectively. In competing risk regression models, female sex, mobility as well as vision impairment, and subjective cognitive decline (SCD) were found to be risk factors for incident depression for age group 75 to 79, female sex, single/separated marital status, mobility as well as hearing impairment, and SCD for age group 80 to 84, and mobility impairment for age group 85+.

Conclusion

Depressive symptoms in latest life are common and the incidence increases with increasing age. Modifiable and differing risk factors across the highest age groups open up the possibility of specifically tailored prevention concepts.

Social Support as a Correlate of Depression and Quality of Life Among Nigerian Older Adults: a Cross-Sectional Study

Reduced social support has been associated with presence of depression and reduced quality of life among older adults. The relationships may be better understood by exploring the interactions of individual domains among the constructs. This cross-sectional survey involved a consecutive sample of 206 (116 females and 90 males) older adults living in a Southern Nigeria community. The Multidimensional Scale of Perceived Social Support, Geriatric Depression Scale, and World Health Organization Quality of Life-OLD Questionnaire, were used to measure social support, depression, and quality of life respectively. Data was analyzed using frequency counts, percentages, mean, standard deviation, multiple regression and Spearman rank-order correlation coefficient, at 0.05 alpha level. Prevalence rate of depression among participants was 45.5%. Social support was perceived to be low by 37.4% of participants with the lowest mean social support score coming from friends domain. Participants' quality of life was generally fairly good (> 60%) with the lowest scores coming from the intimacy domain. Significant correlations between social support domains and each of quality of life (p < 0.05) and depression were respectively positive and negative; but weakest for the friend and strongest for significant others domains. All quality of life domains were significantly correlated with social support except the death and dying domain. All the domains of social support (family and significant other) were significant predictors of depression except the friend domain. Significant others around individual older adults particularly those with depression ought to be educated on the importance of their roles. Stakeholders including healthcare providers may create and support programmes for improved social networking for the older adults in order to enhance their general wellbeing and quality of life.

Three-Year Prognosis of Late-Life Depression in an Outpatient Geriatric Psychiatry Clinic: Medical Comorbidities Worsen Outcomes

Depression is one of the most important reasons for psychiatric referrals in elderly patients. Geriatric depression can be chronic and is associated with an increased risk of dementia. We aimed to determine the prognosis of major depression patients and associated risk factors regarding persistence of depression. Patients who were admitted to the tertiary geriatric psychiatric outpatient unit of Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul between January and December 2018 and were diagnosed with major depression according to DSM-5 diagnostic criteria were included in the study. A structured telephone interview was conducted with between February-April 2022. For detailed clinical evaluation, Turkish version of Structured Clinical Interview for DSM-5-Disorders/Clinician Version (SCID-5/CV-TR), Telephone Cognitive Screen (T-cogS-TR), Geriatric Depression Scale (GDS), Clinical Dementia Rating Scale (CDR), Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) and Beck Anxiety Inventory (BAI) were used. Of the 123 patients interviewed, 40.9% were diagnosed with major depression and 14.6% with minor depression. 43.4% showed significant anxiety and depression symptoms. Dementia developed in 14.6% of the patients. Only 29.5% of the patients recovered completely. Hypertension, orthopedic disease or arthritis, cancer, and absence of prior work experience were found to be predictors of current depression diagnosis. Geriatric depression has an unfavorable prognosis despite continued antidepressant treatment and may even serve as a prodrome for future dementia. Timely management of co-morbid medical conditions such as hypertension can potentially improve the prognosis of geriatric depression.

[Incidence of depression and associated factors in older adults in Bagé, Rio Grande do Sul State, Brazil]

To evaluate the cumulative incidence of depression and its associated factors in the older population living in the urban area of the municipality of Bagé, Rio Grande do Sul State, Brazil, a prospective cohort study was conducted from 2008 to 2016/2017. The analysis was restricted to 615 older adults with complete information on the Geriatric Depression Scale (GDS-15), both at baseline and at follow-up, and who did not present depression in 2008. To calculate crude and adjusted incidence ratios and 95% confidence interval, Poisson regression with robust variance adjustment was used, including the baseline variables. A hierarchical model of four levels of determination was used. The variables were controlled for those of the same or of higher levels, and the p-value ≤ 0.20 was established to remain in the analysis model. In 2008, 523 older people did not have depression and 92 had been screened with the disease. In 2016/2017, of the 523 individuals without depression in the baseline measure, 10.3% tested positive at screening (incident cases), whereas 89.7% of the older adults remained free of the condition. Of the 92 older adults with depression in 2008, 32.6% continued to present depressive symptoms at follow-up and 67.3% had remission of symptoms. Leaving home once or never and being incapable of doing functional and instrumental activities of daily living were associated with a higher risk of positive screening for depression. The results reinforce the multidimensional and dynamic character of depression, which alternates short and long episodes, and may become recurrent and chronic.

The trajectory of non-depressed suicidal ideation in community-dwelling older people in a rural area in Japan: a prospective longitudinal study with a 3-year follow-up

BACKGROUND

Suicidal ideation is closely related to severe suicidal behaviour and is an important predictor of suicide attempt and completion, including in older people. Older people tend to have many opportunities to be conscious of death, and may have vague suicidal ideation because of various loss experiences, even if they are not depressed. We hypothesised that suicidal ideation among older people might be a risk factor for later transition to depression. The present study aimed to clarify risk factors that predict the incidence of depression in older people 3 years post-baseline in a rural area of Japan, and to examine the subsequent course of depression among non-depressed older people with suicidal ideation.

METHODS

In 2015 and 2018, survey questionnaires were mailed to residents aged 65 years and over living in a rural area in Japan. Participants were divided into a depression group and a non-depression group using 15-item Geriatric Depression Scale scores 3 years post-baseline. Logistic regression analysis was used to identify predictive factors of late-life depression 3 years post-baseline.

RESULTS

We received 597 valid responses, with a 3-year follow-up rate of 78.8%. Regarding suicidal ideation, 6.7% of non-depressed older people exhibited suicidal ideation at baseline. Of these, 9.8% exhibited depression after 3 years post-baseline. Logistic regression analysis indicated that development of late-life depression is significantly associated with suicidal ideation, being female, and poor health-related quality of life (HRQOL).

CONCLUSIONS

The results revealed that suicidal ideation, being female, and poor HRQOL were predictive factors of the development of late-life depression 3 years post-baseline in a rural area of Japan. These findings provide novel information regarding the transition to depression among community-dwelling older people who are not depressed but have suicidal ideation. Whereas suicidal ideation is considered to be a symptom of depression, the current results suggest that suicidal ideation may precede depression in some older people.

Suicidality in the geriatric population

Suicide in older adults is a major global concern in both public and mental health. With an ageing population on the rise, a surge in suicidal deaths is predicted in the coming years. The objectives of this paper are to review the risk factors, protective factors, assessment rating scales and current prevention strategies in the geriatric population. The identification of modifiable risk factors and strengthening of protective factors as well as staging according to suicidal ideation, behaviors and/or attempt(s) are necessary to devise appropriate personalized interventions in vulnerable older adults. A history or current psychiatric illness particularly depression, physical illnesses, previous suicide attempt, substance abuse, loneliness, marital status, financial stress, a family history of psychiatric illnesses or suicide in 1st degree relatives and low social support most commonly increase suicidal susceptibility in older adults. Conversely, factors that increase resilience in older adults include a good physical health and cognitive function, religiousness, good quality of life and life satisfaction, ability to perform activities of daily living, marital status, having friends and social connectedness. While the risk factors associated with suicide in the geriatric population are complex and multidimensional in nature, the current preventive strategies have provided no substantial decline in suicidal risk. Therefore, a combination of strategies applied via a multilevel prevention program at a primary, mental healthcare, societal and community level could mitigate suicidal risk. Further research and better preventive measures are warranted to diminish suicidal risk in older adults.

Incidence and risk factors of depressive symptoms in the highest age groups and competing mortality risk. Evidence from the AgeCoDe-AqeQualiDe prospective cohort study

INTRODUCTION

Only a few studies have investigated incidence and risk factors of depression in the highest age groups. This study aims to determine incidence rates as well as risk factors of incident depressive symptoms in latest life, adjusting for the competing event of mortality.

METHODS

Data of a prospective, longitudinal, multi-centered cohort study conducted in primary care - the AgeCoDe-/AgeQualiDe study. 2436 GP patients aged 75+ years were assessed from baseline to sixth follow-up every 18 months and from seventh to ninth follow-up every 10 months. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (cut-off ≥6). Competing risk regression models were used to assess determinants of incident depressive symptoms, taking care of accumulated mortality.

RESULTS

The incidence of depressive symptoms was 39 per 1000 person-years (95% CI 36-42; last observed exit 13.26 person-years at risk). In a competing risk regression model, female sex, unmarried family status, subjective cognitive decline as well as vision and mobility impairment were significant risk factors of incident depression.

LIMITATIONS

Excluding individuals with a lack of ability to provide informed consent at baseline may have influenced the incidence of depression. Depressive symptoms were not assessed by DSM criteria. Furthermore, in studies with voluntary participation, participation bias can never be completely avoided.

CONCLUSION

Findings provide a better understanding of risk and protective factors of depressive symptoms in the oldest age taking mortality as a competing event into account. Addressing this aspect in future research may yield new insights in that research field.

Incidence and risk factors of mental disorders in the elderly: The European MentDis_ICF65+ study

OBJECTIVE

While incidence rates of depression and anxiety disorders in the elderly have been comprehensively investigated, the incidence rates of other mental disorders have rarely been researched. The incidence rate and predictors of various mental disorders in the elderly were evaluated in different European and associated countries.

METHODS

A cross-sectional and longitudinal multi-centre survey of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnoses was conducted in different European and associated countries (Germany, Italy, Spain, Switzerland, the United Kingdom and Israel) to collect data on the prevalence and incidence of mental disorders in the elderly. The sample size of the longitudinal wave was N = 2592 elderly.

RESULTS

The overall 1-year incidence rate for any mental disorder in the elderly is 8.65%. At 5.18%, any anxiety disorder had the highest incidence rate across all diagnostic groups. The incidence rate for any affective disorder was 2.97%. The lowest incidence rates were found for agoraphobia (1.37%) and panic disorder (1.30%). Risk factors for the development of any mental disorder were never having been married, no religious affiliation, a higher number of physical illnesses and a lower quality of life.

CONCLUSION

In comparison to other studies, lower incidence rates for any affective disorder and middle-range incidence for any anxiety disorder were found. To the authors' knowledge, no prior studies have reported 1-year incidence rates for somatoform disorder, bipolar disorder and substance misuse in community-dwelling elderly. These findings indicate the need to raise awareness of psychosocial problems in the elderly and to ensure adequate availability of mental health services.

Association of Alcohol and Tobacco Consumption with Depression Severity in the Oldest Old. Results from the Age Different Old Age Cohort Platform

This study aimed to examine the association of alcohol and tobacco use with severity of depression in older age. Analyses were performed on a pooled data set (n = 3724) from two German old-age cohort studies (LEILA 75+, 6 follow-ups and AgeCoDe/AgeQualiDe, 9 follow-ups). Depressive symptoms were assessed via two screening scales for depression (CES-D and GDS-15) which were harmonized for pooled analysis. A mixed-effects linear regression model for the total sample and additional stratified models for men and women were used. Smoking at baseline was significantly associated with a higher level of depression severity (β = 0.142, 95% CI: 0.051–0.233, p = 0.002), whereas drinking was significantly associated with a decreased level of depression (β = −0.069, 95% CI: −0.119–−0.021, p = 0.005). Concurrent substance use at baseline increased longitudinal depression severity (β = 0.193, 95% CI: 0.011–0.375, p = 0.037). Analyses stratified by gender showed a significant inverse association between drinking and depressive symptoms in men (β = −0.138, 95% CI: −0.231–−0.045, p = 0.004), but not in women (β = −0.060, 95% CI: −0.120–0.001, p = 0.052). Given the burden of major depression, it is important that health care providers, especially primary care physicians, assess and monitor lifestyle factors, even at older ages.

The Role of Social Isolation and the Development of Depression. A Comparison of the Widowed and Married Oldest Old in Germany

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, "widowed oldest old", who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of "married oldest old", women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms.

Risk factors and protective factors of depression in older people 65+. A systematic review

OBJECTIVES

Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required.

DESIGN

A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized.

RESULTS

Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results.

LIMITATIONS

Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results.

CONCLUSION

Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.

Grief and loss in old age: Exploration of the association between grief and depression

BACKGROUND

The proportion of older adults is increasing due to demographic changes. Depression belongs to the most common mental disorders in late life. The loss of an emotionally significant person is a risk factor for the development of depression. The aim of this study is to analyze the association between depression and grief burden resulting from loss. Based on prior evidence, we examined loneliness as a possible mediator and social support as possible moderator of this association.

METHODS

The cross-sectional analyses are based on a sample (N = 863) of study participants aged 75+ (M = 81.4 years, SD = 4.4, 62.2% female) with loss experience deriving from the multicenter prospective German cohort study AgeMooDe. Regression analyses (moderated mediation) were performed.

RESULTS

With increasing age (β = 0.10, p = .005) and grief burden (β = 0.33, p <. 001) depression severity increased. There was an indirect mediating effect of loneliness on the correlation of grief burden and depression (b = 0.04, CI [0.03, 0.05]), but no moderating effect of social support on the correlation of grief burden and loneliness. People living alone had a significantly higher risk of depression, increased loneliness and lack of social support.

LIMITATIONS

Assessments were based on self-reporting and recorded dimensionally. The cross-sectional design limits conclusions about directions and causality of associations. Sampling bias cannot be completely excluded.

CONCLUSION

The study provides empirical evidence and a better understanding of the association between grief and depression among the very old and the mediating role of loneliness.

Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: a systematic review and meta-analysis of cohort studies

BACKGROUND AND AIMS

Alcohol use disorders (AUD) are often comorbid with depressive symptoms. Cohort studies on the association between AUD and subsequent depressive symptoms have produced inconsistent results. Moreover, regarding alcohol intake, the risk of developing depressive symptoms might vary with alcohol intake level. We aimed to investigate the association between AUD, alcohol intake and subsequent depressive symptoms.

DESIGN AND SETTING

We conducted a systematic search in PubMed, Embase and PsycINFO for cohort studies on the association between AUD or alcohol intake and subsequent depressive symptoms.

PARTICIPANTS

We included 338 426 participants from 42 studies. Six and four studies analyzed only females and males, respectively.

MEASUREMENTS

We combined risk estimates for developing depressive symptoms using a random-effects model. We divided alcohol intake into abstinence, light (0-84 g/week), moderate (85-168 g/week) and heavy drinking (> 168 g/week or > 48 g/day at least weekly). We conducted a categorical analysis to compare the risk of depressive symptoms between abstinence and different intake categories. Further, we conducted a dose-response analysis to investigate the alcohol-depression association.

FINDINGS

We analyzed 42 studies (follow-up time: 1-40 years). AUD was associated with significantly increased risk of subsequent depressive symptoms [relative risk (RR) = 1.57, 95% confidence interval (CI) = 1.41-1.76]. Regarding alcohol intake, heavy drinking had an increased risk of depressive symptoms; however, the association was only significant when controls were limited to non-heavy drinkers (RR = 1.13, 95% CI = 1.05-1.22). Taking into consideration the possibility of publication bias and confounding factors made the association non-significant. We observed J-shaped associations in both categorical and dose-response analyses where light-moderate drinking had a significantly decreased risk of depression, while heavy drinking did not show a significant association with depressive symptoms compared with non-drinkers.

CONCLUSION

Alcohol use disorders are associated with increased the risk of subsequent depressive symptoms. Heavy drinking does not significantly predict occurrence of depressive symptoms after adjusting for potential confounders.

Military-related experiences and late-life depressive symptomatology among Japanese-American world war II veterans

Objectives: To examine military service-related variables and late-life depressive symptomatology among older Japanese-American males.Method: This study is a secondary data analysis of a longitudinal, community-based study. A sample of 2669 participants (771 World War II veterans, 1898 civilians) was drawn from the Honolulu-Asia Aging Study. Depressive symptoms were assessed twice across a 9-year period with the Center for Epidemiologic Studies-Depression scale. Covariates included sociodemographic, physical health, health behavior, and psychosocial variables. Combat exposure and symptomatology were examined among a subset of 426 veterans. Cross-sectional and longitudinal designs were analyzed with linear regression.Results: Veterans and civilians did not differ in depression scores. Baseline depression scores significantly predicted follow-up depression scores. For the full sample, lower ratings of quality of life satisfaction, daily activity control and general health were associated with higher depression scores both cross-sectionally and longitudinally. Among veterans, light combat exposure was marginally associated with lower depression scores and longitudinally, previous depression scores and poorer health ratings were significant predictors of depression scores.Conclusion: Results suggest that military service does not affect late-life depressive symptomatology. However, combat exposure may play a marginal role in increased symptoms. Reasons for results include the possibility that other factors are more relevant to late-life depression, symptomatology naturally decreasing over time, or type of combat exposure measurement. Results expand literature by examination of an ethnoracial group not studied often and longitudinal examination of late-life depressive symptoms within a military-related context. Stakeholders should be knowledgeable of the distinct issues presented when serving aging veterans.

Effects of Pharmacogenetic Screening for CYP2D6 Among Elderly Starting Therapy With Nortriptyline or Venlafaxine: A Pragmatic Randomized Controlled Trial (CYSCE Trial)

PURPOSE/BACKGROUND

The duration of untreated depression is a predictor for poor future prognosis, making rapid dose finding essential. Genetic variation of the CYP2D6 isoenzyme can influence the optimal dosage needed for individual patients. The aim of this study was to determine the effectiveness of CYP2D6 pharmacogenetic screening to accelerate drug dosing in older patients with depression initiating nortriptyline or venlafaxine.

METHODS/PROCEDURES

In this randomized controlled trial, patients were randomly allocated to one of the study arms. In the intervention arm (DG-I), the specific genotype accompanied by a standardized dosing recommendation based on the patients' genotype and the prescribed drug was directly communicated to the physician of the participant. In both the deviating genotype control arm (DG-C) and the nonrandomized control arm, the physician of the participants was not informed about the genotype and the associated dosing advise. The primary outcome was the time needed to reach adequate drug levels: (1) blood levels within the therapeutic range and (2) no dose adjustments within the previous 3 weeks.

FINDINGS/RESULTS

No significant difference was observed in mean time to reach adequate dose or time to adequate dose between DG-I and DG-C. Compared with the nonrandomized control arm group, adequate drug levels were reached significantly faster in the DG-I group (log-rank test; P = 0.004), and there was a similar nonsignificant trend for the DG-C group (log-rank test; P = 0.087).

IMPLICATIONS/CONCLUSIONS

The results of this study do not support pharmacogenetic CYP2D6 screening to accelerate dose adjustment for nortriptyline and venlafaxine in older patients with depression.

[Community pharmacists' and pharmacy technicians' attitudes and beliefs about depression in elderly]

OBJECTIVES

To analyze attitudes and beliefs of community pharmacists and pharmacy technicians about depression and treatment in older patients.

METHODS

A qualitative study was conducted with community pharmacists and pharmacy technicians. The first step of the study was to develop an interview guide to conduct semi-directive interviews. A thematic analysis was conducted based on the transcripts of the recording of audio interviews.

RESULTS

Eight pharmacists and 5 pharmacy technicians were included. The mean duration of semi-directive interviews was 14.8±4.6minutes. The main identified themes were as follows: 1/the depression: beliefs about depression and its risk factors in older patients; how to talk about depression with older patients at the counter; 2/the management of depression: how to talk about antidepressant with older patients at the counter, including treatment duration, dosage, efficacy and adverse effects of treatment, but also alternative therapies and advices; 3/barriers and facilitators of antidepressant adherence in older patients.

CONCLUSIONS

Barriers to conduct pharmaceutical care focusing on depression among older patients in community pharmacy have been identified: disease stigmatization, lack of privacy at the counter and lack of communication with the prescribing physician; but also a lack of knowledge concerning the specific therapeutic strategy for depression in the elderly. Thus, strengthening the pharmacy student teaching and the community pharmacist and pharmacy technician training regarding the posture to adopt and the therapeutic management of older patients with mental illness would be beneficial.

Course of depressive symptoms and associated factors in people aged 65+ in Europe: A two-year follow-up

BACKGROUND

The epidemiology of depressive disorders presents notable differences among European countries. The objectives of the study are to determine the prevalence, incidence, persistence and remission rates of depressive symptoms and to identify risk factors and differences between four European regions.

METHOD

Prospective cohort design using data from waves 5 and 6 (2013-15) of the Survey of Health, Ageing and Retirement in Europe. Sample size included 31,491 non-institutionalized adults aged 65+. Depressive symptoms were assessed using the EURO-D.

RESULTS

The prevalence of depressive symptoms (EURO-D ≥4) was 29.8% and 31.5%in waves 5 and 6, respectively. The risk factors associated depressive symptoms were poorer self-rated health, loneliness, impairment in ADL, female gender and financial difficulties. Incidence was 6.62 (99.9% CI: 6.61-6.63)/100 person-years and the persistence and remission rates were 9.22 and 5.78, respectively. Regarding the differences between European regions, the incidence (4.93 to 7.43) and persistence (5.14 to 11.86) rates followed the same ascending order: Northern, Eastern, Continental and Southern. The remission presented higher rates in the Eastern and Southern (6.60-6.61) countries than in the Northern and Continental (4.45-5.31) ones.

LIMITATIONS

The EURO-D scale is unable to distinguish between clinically relevant depressive symptoms and major depression.

CONCLUSION

The risk factors related to the incidence of depressive symptoms differed across European regions. In countries of eastern and southern Europe the most important predictors were female gender and impairment in ADL. Poorer self-rated health and older age were more relevant in the Northern countries, and chronic diseases were a key factor in the Continental region.

Depressive spectrum states in a population-based cohort of 70-year olds followed over 9 years

OBJECTIVE

Depression may be understood as a spectrum of more or less symptomatic states. Little is known about the long-term course of these states in older populations. We examined the prevalence and course of depressive states of different severity in a Swedish population sample of older people followed over 9 years.

METHODS

A population-based sample of 70-year olds without dementia (N = 563, response rate 71.1%) underwent a psychiatric examination; 450 survivors without dementia were reexamined at ages 75 and/or 79 years. Three depressive spectrum states were defined: major depression (MD), minor depression (MIND), and subsyndromal depression (SSD).

RESULTS

The cumulative 9-year prevalence of any depressive spectrum state was 55.3% (MD 9.3%, MIND 27.6%, SSD 30.9%). The cross-sectional prevalence increased with age, especially for MIND and SSD. Among those with baseline MD and MIND, 75.0% and 66.7%, respectively, had MD or MIND during follow-up. Among those with SSD, 47.2% had SSD also during follow-up and 36.1% had MD or MIND. Among those with MD during follow-up, 63.1% were in a depressive spectrum state at baseline. The corresponding proportion was 30% for those with MIND (but no MD) during follow-up.

CONCLUSION

In this population-based sample, over half experienced some degree of depression during their eighth decade of life. The findings give some support for the validity of a depressive spectrum in older adults. Most new episodes of major depression occurred in people who were in a depressive spectrum state already at baseline, which may have implications for late-life depression prevention strategies.

Unmet needs in the depressed primary care elderly and their relation to severity of depression: results from the AgeMooDe study

OBJECTIVES

This study aims at examining the distribution of unmet environmental, physical, social and psychological care needs in a sample of the oldest old primary care patients with different levels of depression severity. Furthermore, the objective of this study was to analyze the association between specific unmet care needs and severity of depression.

METHOD

The sample of patients aged 75 years (n = 202) and more was derived from the multicenter prospective cohort study AgeMooDe ('Late-life depression in primary care: Needs, health care utilization and costs'). Patients were assessed via structured clinical interviews containing the German version of the Camberwell Assessment of Need for the Elderly (CANE) and the German Hospital Anxiety and Depression Scale (HADS-D). Descriptive statistics, Spearman correlation coefficients and binary logistic regression analyses were computed.

RESULTS

Unmet needs appeared to be substantially higher in the patient group with higher levels of depression severity according to the HADS-D score. Overall, there was weak positive linear correlation between depression and CANE total unmet needs. Except of the physical unmet needs category, all other CANE care categories showed little to moderate positive linear correlations with depression according to the HADS-D score. Depression and psychological unmet needs showed the strongest of all correlations, followed by social unmet needs. The binary logistic regression analysis revealed that patients having psychological unmet needs were 4.8 times more likely diagnosed with a probable depression.

CONCLUSION

Systematic needs assessment, especially psychological needs, may play a crucial role in the course of prevention and effective treatment of late-life depression in the primary care context.

Lifestyle factors and the course of depression in older adults: A NESDO study

OBJECTIVES

To investigate whether lifestyle indicators including physical exercise, sleep duration, alcohol use, body mass index, smoking status, and a composite lifestyle index are associated with the depression course in older adults.

METHODS

Data of 283 older adults were used from the Netherlands Study of Depression in Older Persons. Depressive disorders at baseline were assessed with the Composite International Diagnostic Interview. The depression course at 2-year follow-up was assessed with the Inventory of Depressive Symptoms (IDS, score 0-84) every 6 months; physical exercise with the International Physical Activity Questionnaire; alcohol use with the Alcohol Use Disorders Identification Test; body mass index by anthropometry; and sleep duration and smoking status by interview questions. A composite lifestyle index was calculated by summing scores assigned to each lifestyle factor, with a higher score indicating healthier behavior.

RESULTS

Of all participants, 61.1% had chronic depression (all IDS scores 14-84), 20.1% had intermittent depression (1 IDS score ≤ 14), and 18.7% remitted depression (last 2 IDS scores ≤14). None of the investigated lifestyle indicators, nor the composite lifestyle index was associated with depression course, after adjustment for covariates.

CONCLUSIONS

Lifestyle factors do not predict the course of depression at 2-year follow-up in older adults.

Social capital, socioeconomic status, and depression in community-living elderly

A growing body of evidence has suggested that social capital is an upstream social determinant of mental health. We investigated the association of cognitive social capital, including interpersonal trust and reciprocity, with depressive symptoms in the elderly. We also explored the mediating role of cognitive social capital in the association between socioeconomic status (SES) and depressive symptoms and the moderating effect of SES on the relationship between social capital and depressive symptoms. Data from the 2012 Korea Welfare Panel Study (KOWEPS) was analyzed for 5969 participants aged 60 years or older. Cognitive components of social capital, including interpersonal trust and reciprocity, were evaluated using single-item questionnaires. Socioeconomic and health-related characteristics were investigated and depressive symptoms were evaluated by an 11-item version of the Center for Epidemiologic Studies Depression Scale. Low interpersonal trust and reciprocity levels were significantly associated with depressive symptoms in the elderly. Reciprocity level mediated the association between household income level and depressive symptoms. We did not observe any significant moderating effect of SES on the association between cognitive social capital and depressive symptoms. A significant association between cognitive social capital and depressive symptoms in Korean elderly was found. We elucidated how SES interacted with depressive symptoms through the mediation pathway of cognitive social capital using a representative sample of the Korean elderly population.

Vascular Pathology and Trajectories of Late-Life Major Depressive Disorder in Secondary Psychiatric Care

OBJECTIVE

To examine 5-year trajectories of psychiatrist-treated late-life major depressive disorder (MDD), and evaluate whether previous vascular pathology is associated with more severe trajectories of late-life MDD.

METHODS

Data were obtained from nationally representative civil, psychiatric, hospital, and prescription registers in Denmark. The sample included 11,092 older adults (≥60 years) who received their first diagnosis of MDD in a psychiatric facility in Denmark between 2000 and 2007. Trajectories of inpatient or outpatient contact at psychiatric hospitals for MDD over the 5-year period following index MDD diagnosis were modeled using latent class growth analysis. Measures of vascular disease (stroke, heart disease, vascular dementia) and vascular risk factors (hypertension, diabetes) were defined based on medication prescriptions and hospital-based diagnoses. Other predictors included demographic characteristics and characteristics of the index MDD diagnosis.

RESULTS

The final model included 4 trajectories with consistently low (66% of the sample), high decreasing (19%), consistently high (9%), and moderate fluctuating (6%) probabilities of contact at a psychiatric hospital for MDD during the 5-year period following the index MDD diagnosis. We found no significant associations between any form of vascular pathology and trajectory class membership. Relative to the consistently low class, older age, greater severity and >12 months of prior antidepressant medication use predicted membership in the other three classes.

CONCLUSIONS

A notable proportion (34%) of individuals diagnosed with MDD in late-life require secondary psychiatric treatment for extended time periods. We did not find evidence that vascular pathology predicts hospital contact trajectories in secondary-treated late-life MDD.

Correlates of depressive symptoms in late middle-aged Taiwanese women: findings from the 2009 Taiwan National Health Interview Survey

Background

Previous studies have shown that depressive symptoms in middle-aged women were associated with a number of factors such as climacteric symptoms. Nevertheless, studies based on population-based data with a wide range of potential correlates are still scarce. Therefore, the aim of this study was to investigate the correlates of depressive symptoms in late middle-aged Taiwanese women using data from a nationally-representative, population-based survey.

Methods

Women aged 50.0–65.0 years were identified from the dataset of the 2009 Taiwan National Health Interview Survey. The outcome measure was depressive symptoms in the past week, evaluated using the Center for Epidemiologic Studies Short Depression Scale (CES-D 10) with a cut-off score of 10 or greater. Univariate and multiple logistic regression analyses were used to evaluate the correlates of depressive symptoms.

Results

The mean age of the 533 respondents was 56.7 years. Depressive symptoms were present in 53 respondents (9.9%). Multiple logistic regression analysis revealed that an education level of elementary school or below (adjusted odds ratio [AOR] = 3.19, P = 0.003), nulliparity (AOR = 8.10, P = 0.001), living alone (AOR = 5.47, P = 0.003), never having worked (AOR = 4.14, P = 0.008), lack of regular exercise (AOR = 3.01, P = 0.003), a perceived health status of fair or bad (AOR = 4.34, P < 0.001), and somatic climacteric symptoms (AOR = 2.32, P = 0.012) were independent and significant factors of depressive symptoms in late middle-aged Taiwanese women.

Conclusions

Findings from this secondary analysis of a population-based survey suggested independent associations of somatic climacteric symptoms, and a number of socio-demographic and health-related factors with depressive symptoms in late middle-aged Taiwanese women.

Childhood Abuse and the Two-Year Course of Late-Life Depression

OBJECTIVES

Late-life depression often has a chronic course, with debilitating effects on functioning and quality of life; there is still no consensus on important risk factors explaining this chronicity. Cross-sectional studies have shown that childhood abuse is associated with late-life depression, and in longitudinal studies with chronicity of depression in younger adults. We aim to investigate the impact of childhood abuse on the course of late-life depression.

DESIGN

Two-year longitudinal cohort study.

SETTING

Data were derived from the Netherlands Study of Depression in Older Persons (NESDO).

PARTICIPANTS

282 participants with a depression diagnosis in the previous 6 months (mean age: 70.6 years), of whom 152 (53.9%) experienced childhood abuse.

MEASUREMENTS

Presence of childhood abuse (yes/no) and a frequency-based childhood abuse index (CAI) were calculated. Dependent variable was depression diagnosis after 2 years.

RESULTS

Multivariable mediation analysis showed an association between childhood abuse and depression diagnosis at follow-up. Depression severity, age at onset, neuroticism, and number of chronic diseases were important mediating variables of this association, which then lost statistical significance. For childhood abuse (yes/no), loneliness was an additional, significant mediator. Depression severity was the main mediating variable, reducing the direct effect by 26.5% to 33.3% depending on the definition of abuse (respectively, 'yes/no" abuse and CAI).

CONCLUSIONS

More depressive symptoms at baseline, lower age at depression onset, higher levels of neuroticism and loneliness, and more chronic diseases explain a poor course of depression in older adults who reported childhood abuse. When treating late-life depression it is important to detect childhood abuse and consider these mediating variables.

Chronic Illnesses and Depressive Symptoms Among Older People: Functional Limitations as a Mediator and Self-Perceptions of Aging as a Moderator

OBJECTIVE

This research examined the mediation of functional limitations in the relationship between chronic illnesses and depressive symptoms among older Americans along with tests for the moderation of self-perceptions of aging.

METHOD

Data from the Health and Retirement Study (2008, 2010, and 2012) were used. Longitudinal mediation models were tested using a sample of 3,382 Americans who responded to psychosocial questions and were over 65 years old in 2008.

RESULTS

Functional limitations mediated the linkage between chronic illnesses and depressive symptoms. Negative self-perceptions of aging exacerbated the effects of chronic illnesses on depressive symptoms.

DISCUSSION

Health care professionals should be aware of depressive symptoms in older adults reporting chronic illnesses and particularly in those reporting functional limitations. To decrease the risk of depressive symptoms caused by chronic illnesses, negative self-perceptions of aging may need to be challenged.

Trajectories of depressive symptoms in community-dwelling older adults: A six-month longitudinal study with monthly assessment

BACKGROUND

This study aimed to examine six-month trajectories of depressive symptoms and their predictors for community-dwelling older adults. Innovations included monthly assessments, examination of non-linear trajectories, and inclusion of coping styles as predictors.

METHOD

Data were derived from a six-month longitudinal study of 144 community-dwelling older adults with depressive symptoms (Short-Geriatric Depression Scale [S-GDS]≥5) with seven waves of data. Descriptive analyses and individual growth curve modeling were conducted.

RESULTS

The majority of participants changed symptom levels over time; most participants with severe symptoms at baseline remained at least mildly depressed at six months. Younger participants were more depressed at baseline and improved slightly more than older participants. Those who used more active and emotional support coping had faster improvement and maintained gains, whereas those who used less of these coping styles demonstrated worse symptoms over the six-month follow-up period.

LIMITATIONS

The most significant limitations are the convenience sampling methods and relatively small sample size, although the large number of assessments (7 waves) increases precision of the statistical methods used.

CONCLUSIONS

Findings suggest that it may be beneficial to target interventions to older adults with more severe depressive symptoms and who display low levels of active and emotional support coping. Behavioral interventions that improve these coping styles may help depressed older adults recover and maintain treatment gains over time.

Association of Self-Rated Health in Midlife With Mortality and Old Age Frailty: A 26-Year Follow-Up of Initially Healthy Men

BACKGROUND

The aim was to investigate the relationship between self-rated health (SRH) in healthy midlife, mortality, and frailty in old age.

METHODS

In 1974, male volunteers for a primary prevention trial in the Helsinki Businessmen Study (mean age 47 years, n = 1,753) reported SRH using a five-step scale (1 = "very good," n = 124; 2 = "fairly good," n = 862; 3 = "average," n = 706; 4 = "fairly poor," or 5 = "very poor"; in the analyses, 4 and 5 were combined as "poor", n = 61). In 2000 (mean age 73 years), the survivors were assessed using a questionnaire including the RAND-36/SF-36 health-related quality of life instrument. Simplified self-reported criteria were used to define phenotypic prefrailty and frailty. Mortality was retrieved from national registers.

RESULTS

During the 26-year follow-up, 410 men had died. Frailty status was assessed in 81.0% (n = 1,088) of survivors: 434 (39.9%), 552 (50.7%), and 102 (9.4%) were classified as not frail, prefrail, and frail, respectively. With fairly good SRH as reference, and adjusted for cardiovascular risk in midlife and comorbidity in old age, midlife SRH was related to mortality in a J-shaped fashion: significant increase with both very good and poor SRH. In similar analyses, average SRH in midlife (n = 425) was related to prefrailty (odds ratio: 1.52, 95% confidence interval: 1.14-2.04) and poor SRH (n = 31) both to prefrailty (odds ratio: 3.56, 95% confidence interval: 1.16-10.9) and frailty (odds ratio: 8.38, 95% confidence interval: 2.32-30.3) in old age.

CONCLUSIONS

SRH in clinically healthy midlife among volunteers of a primary prevention trial was related to the development of both prefrailty and frailty in old age, independent of baseline cardiovascular risk and later comorbidity.

Above-moderate physical activity reduces both incident and persistent late-life depression in rural Koreans

OBJECTIVE

To investigate the natural course of depressive symptoms among community-dwelling elderly over 5 years. Rates and correlates of the incidence and the persistence of late-life depression were examined.

METHODS

A total of 701 elderly people 65 years of age or older without dementia at baseline were included in this study. The association between categorically defined late-life depression (score of ≥ 8 on the Korean version of the Geriatric Depression Scale-Short Form) and possible lifestyle and clinical risk factors, including physical activity assessed with a modified Korean version of the International Physical Activity Questionnaire (IPAQ) and transformed into weekly Metabolic Equivalent Task (MET) values, was longitudinally investigated using multiple logistic regression analyses. Adjustment was done with sociodemographic variables, chronic medical illnesses, and cognitive dysfunction.

RESULTS

During the 5-year follow-up, 74 (26.5%) of the non-depressed elderly developed depression, whereas 30 (49.2%) of the depressed elderly experienced persistent depression. Above-moderate baseline physical activity was independently associated with decreased incidence and persistence rates of late-life depression (adjusted odds ratio (AOR) = 0.44, 95% confidence interval (CI) = 0.22-0.85; AOR = 0.17, 95% CI = 0.03-0.92, respectively), whereas mild physical activity was not. Conversely, poorer executive function also predicted 5-year incident depression (AOR = 0.93, 95% CI = 0.89-0.98) but not persistent depression.

CONCLUSION

This study suggests that a minimum of moderate physical activity is related to both emergent and persistent depression in elderly individuals. Research with an extended follow-up period and a shorter inter-assessment interval is needed to confirm this result.

Self-Rated Health, Cognition, and Dual Sensory Impairment Are Important Predictors of Depression Among Home Care Clients in Ontario

Depression can be a disabling and debilitating condition among older adults (aged 65+). This study examined risk factors for symptoms of depression in a large sample of older home care clients ( n = 218,850) in Ontario, Canada, using existing data collected with the Resident Assessment Instrument for Home Care (RAI-HC). The RAI-HC has been mandated across the province since 2002. The most important predictors of depression were lower self-rated health (odds ratio [OR] = 3.4), cognitive impairment (OR = 2.9), dual sensory impairment (OR = 1.2), and a primary language other than English or French (OR = 1.5). This suggests that not only physical health but also sensory impairments and communication difficulties increase the risk for depression among home care recipients.

The role of spousal loss in the development of depressive symptoms in the elderly - implications for diagnostic systems

BACKGROUND

In the revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the Mood Disorder Workgroup for DSM-V the bereavement exclusion criterion for the diagnosis of major depression has been eliminated.

AIM

To investigate the impact of bereavement on the incidence of depression and depressive symptoms in the elderly.

METHOD

Participants over 75 years from the longitudinal German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) that were still married at baseline were investigated (n=1,193). Data from four follow-ups (time frame: 6 years) were investigated. The response rate at baseline was 50.3%. Three clinical endpoints were analyzed: depressive symptoms according to Geriatric Depression Scale (1) GDS≥6, (2) GDS≥10, and (3) Major Depression (MD). The effect of loss was investigated using random-effects regression models.

RESULTS

Experiencing a loss of spouse was predictive of a higher incidence in GDS≥6 (OR 4.52, 95% CI 2.6-7.9) and 10 (OR 5.59, 95% CI 1.8-17.0) even after adjusting for age, gender, impairment at baseline, and GDS score at baseline. Associations with MD were not significant (OR 1.77, 96% CI 0.9-3.5).

CONCLUSIONS

Older adults experiencing the loss of their spouse are more likely to display elevated levels of depressive symptoms, that may reach a concerning level of severity.

Challenges in assessing depressive symptoms in Fiji: A psychometric evaluation of the CES-D

BACKGROUND AND AIM

The CES-D is a commonly used self-report assessment for depressive symptomatology. However, its psychometric properties have not been evaluated in Fiji. This study aims to evaluate the reliability and validity of English language and Fijian vernacular versions in ethnic Fijian adolescent schoolgirls.

METHODS

As part of the HEALTHY Fiji study, ethnic Fijian female adolescents (N = 523) completed the CES-D. Participants selected to respond in English or the local vernacular. Reliability (internal consistency, item-total score correlation, and test-retest estimates), validity (associations with other proxies for depression) and factor structure were assessed. Evaluations considered differences between language versions.

RESULTS

In this sample, the CES-D had a Cronbach's α of 0.81 and item-total score correlation coefficients ranged between 0.2 and 0.63. One week test-retest reliability (ICC(2)) was 0.57. CES-D scores were higher among individuals who endorsed feelings of depression and suicidality compared to those who did not. ROC analyses of the CES-D versus binary depression and suicidality variables produced AUCs around 0.70 and did not support a discrete cut-off for significant disturbance. Findings were similar across the two language groups.

CONCLUSIONS

The CES-D has acceptable reliability and validity among ethnic Fijian female adolescents in English and in the Fijian vernacular language. Findings support its utility as a dimensional measure for depressive symptomatology in this study population. Further examination of its clinical utility for case finding for depression in Fijian school-based and community populations is warranted.

Social relations and depression in late life-a systematic review

OBJECTIVE

Social relations have become the focus of much research attention when studying depressive symptoms in older adults. Research indicates that social support and being embedded in a network may reduce the risk for depression. The aim of the review was to analyze the association of social relations and depression in older adults.

METHODS

Electronic databases were searched systematically for potentially relevant articles published from January 2000 to December 2012. Thirty-seven studies met the inclusion criteria for this review.

RESULTS

Factors of social relations were categorized into 12 domains. Factors regarding the qualitative aspects of social relations seem to be more consistent among studies and therefore provide more explicit results. Thus, social support, quality of relations, and presence of confidants were identified as factors of social relations significantly associated with depression. The quantitative aspects of social relations seem to be more inconsistent. Cultural differences become most obvious in terms of the quantitative aspects of social relations.

CONCLUSION

Despite the inconsistent results and the methodological limitations of the studies, this review identified a number of factors of social relations that are significantly associated with depression. The review indicates that it is needful to investigate social relations in all their complexity and not reduce them to one dimension. Simultaneously, it is important to conduct longitudinal studies because studies with cross-sectional design do not allow us to draw conclusions on causality. Beyond that, cultural differences need to be considered.

The economic, public health, and caregiver burden of late-life depression

This article reviews the burden of late-life depression (LLD) from several perspectives, including costs of depression treatment and treatment of other comorbid psychiatric and medical conditions; the impact of LLD on job functioning, disability, and retirement; and how LLD influences others, such as family members and caregivers.

[Depression in old age: challenge for aging societies]

Depression in old age is common and has severe consequences. The paper reviews the most recent results of population-based and primary care-based studies reporting the prevalence, course and risk factors for depression in old age. Consequences of late life depression for the individual and for the society in terms of costs of illness are outlined. Studies of health service utilization and costs showed homogeneously that healthcare costs for depressive elderly individuals are one third higher compared to non-depressive individuals even though most do not receive depression-specific treatment. Late life depression is underrecognized and undertreated and data from Germany are rare. Improvement strategies, such as collaborative care models are discussed; however, adaptation and implementation to the German context are still pending. Future demographic changes will facilitate mental health service research into late life depression.

Predictors of Treatments Acceptable to Patients for Late-Life Depression

Objectives. Describe older patients' perceptions about depression and characteristics associated with acceptance of treatments. Design. Cross-sectional study. Setting. Three primary care clinics in Iowa. Participants. Consecutive sample of 529 primary care patients. Measurements. Depression screening tool (a 9-item patient health questionnaire [PHQ-9]) and questionnaire including sociodemographic data, patient attitudes about depression, and acceptability of different treatments. Results. Mean age was 71.9 years (range 60–93 years), 314 (59%) female. Among the 529 participants, 93 (17.5%) had history of depression and 60 (11.3%) had PHQ-9 scores of 10 or greater. Participants believed depression is a disease for which they would use medication and counseling. Accepting medications from primary physicians was strongly associated with a past history of depression (P < 0.01) and with agreeing that depression needs treatment (P < 0.01). Counseling was not acceptable for those believing that they can control depression on their own (P < 0.01). Older patients (P < 0.001) and those with higher education levels (P < 0.01) were less likely to accept herbs or supplements as treatment options. Willingness to discuss treatments with family was associated with not using alcohol as a treatment and acceptance of all other treatment options (P < 0.001). Conclusions. Attitude that depression is a disease and the willingness to discuss depression with family may enhance treatment acceptance.