What predicts persistent depression in older adults across Europe? Utility of clinical and neuropsychological predictors from the SHARE study

Differential cross-lagged relations of frailty predicting later depression in older women versus men

This study aimed to investigate autoregressive and lagged associations over 2 years between frailty, depression and quality of life, and to examine sex differences in these longitudinal associations among European men and women aged ≥50 years. The analyses included 10,077 individuals (5589 women) from 12 European countries. Women attested to a higher frailty and depression score and lower quality of life than men. For both sexes, frailty and depression correlated positively cross-sectionally and longitudinally (2 years later), while quality of life correlated negatively with frailty and depression cross-sectionally and longitudinally. With regard to lagged associations, for both men and women, frailty proved to be a predictor of depression 2 years later. In turn, depression did not predict frailty and quality of life 2 years later in women, but it did among men.

Gouveia É, Marques A. Moderating Effect of Muscular Strength in the Association Between Cancer and Depressive Symptomatology

BACKGROUND/OBJECTIVES

Depression, as one of the leading causes of disease burden, frequently co-occurs with other diseases. Cancer seems to be strongly associated with depression more than any other disease. As an outcome of physical fitness, muscular strength seems to have a protective effect on depression. This study aimed to analyze how muscular strength moderates the relationship between cancer and depressive symptomatology among older European adults.

METHODS

Cross-sectional data from wave 8 (2019/2020), including 41,666 participants (17,986 males) of the population-based Survey of Health, Aging, and Retirement in Europe, were analyzed. Grip strength, used as the moderator, was measured twice on each hand using a dynamometer. The EURO-D 12-item scale was used to measure depressive symptomatology.

RESULTS

Grip strength had a significant effect as a moderator in the association between cancer and depressive symptoms (male: B = -0.025, 95% CI = -0.04, -0.01; female: B = -0.02, 95% CI = -0.04, 0.00). Also, the grip strength moderation values are below 55.3 kg for males and 39.4 kg for females.

CONCLUSIONS

Muscular strength, as measured by grip strength, moderated the relationship between cancer and depressive symptomatology. This supports the theory that recovery programs could include physical activity, namely muscle-strengthening exercises, to prevent depression.

Predictors of mood disturbance in older adults: a longitudinal cohort study

PURPOSE

Given the significant mental health challenges faced by the aging population, this study aimed to identify key predictors of mood disturbances among older adults, focusing on socioeconomic, health, and cognitive factors.

METHODS

This post-hoc analysis utilized publicly available data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal cohort study conducted in the United States. The analysis included 2,820 adults aged 65 years and above who were followed for three years (age average range 75-79 years, 54.7% female).

RESULTS

During the follow-up period, 21.8% of participants developed new-onset mood disturbances. High-income status is associated with decreased risk (OR 0.71, 95% CI 0.52-0.96), while being Black showed a risk effect compared to White participants (OR 1.38, 95% CI 1.06-1.29). With not good health status (OR 1.58, 95% CI 1.04-2.41), without presence of diabetes (OR 0.74, 95% CI 0.58-0.95), and poor memory status (OR 2.14, 95% CI 1.10-4.15) were significant predictors. Without fear of falling (OR 0.77, 95% CI 0.61-0.97) and increased physical performance (OR 0.94, 95% CI 0.91-0.98) also decreased risk. Income-stratified analysis revealed that low-income groups were particularly affected by cognitive function, middle-income by health status, and high-income by physical activity levels.

CONCLUSION

Socioeconomic status, race, health conditions, and cognitive function are significant predictors of mood disturbances in older adults. These findings suggest the importance of developing targeted interventions based on income levels and addressing modifiable risk factors.

Depression, reduced physical activity and the risk of heart disease: a prospective cohort of European middle-aged and older adults

OBJECTIVE

To assess the impact of depression and physical activity (PA) of different intensities on the incidence of heart disease.

METHODS

A prospective cohort study with 20 645 European middle-aged and older adults (mean baseline age 63 years; 55.1% women; median follow-up 9.5 years) was conducted using data from the Survey of Health, Ageing and Retirement in Europe. The EURO-D 12-item scale assessed depression. Moderate-intensity and vigorous-intensity PA and heart disease diagnoses were self-reported. We classified participants into the following four groups: (1) depression plus low PA, (2) no depression plus low PA, (3) depression plus moderate/high PA, (4) no depression plus moderate/high PA. Hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models adjusted for confounders.

RESULTS

Compared with having depression and low PA levels, adjusted HR for heart disease similarly decreased for participants with depression and moderate/high PA (moderate-intensity PA: HR=0.63, 95% CI=0.50, 0.78; vigorous-intensity PA: HR=0.69, 95% CI=0.53, 0.89) and participants without depression and low PA (moderate-intensity PA: HR=0.64, 95% CI=0.50, 0.82; vigorous-intensity PA: HR=0.68, 95% CI=0.58, 0.80). The greatest risk reduction was found in participants without depression and moderate/high PA (moderate-intensity PA: HR=0.46, 95% CI=0.37, 0.55; vigorous-intensity PA: HR=0.48, 95% CI=0.40, 0.58).

CONCLUSION

Moderate-intensity and vigorous-intensity PA seems to counteract the increased risk for heart disease associated with depression. This highlights the importance of PA as a possible intervention strategy aiming to manage the risk of heart disease among people with depression.

The effect of frailty on the relationship between cognition and depression symptoms in older people. A differential analysis by European regions

This study aimed to investigate the moderating effect of frailty on the relationship between cognition and symptoms of depression in individuals aged ≥65 and to explore differences between four European regions (West, North, South, and East). A cross-sectional analysis was conducted with 29,094 participants (16,365 women) from 27 countries, aged ≥65 years, who responded to wave 8 of the SHARE project. The variables analysed were depression (12-item EURO-D scale), frailty, and a general cognition index (CogId). A higher CogId was associated with less depression. Western and Northern European countries indicated better cognitive performance, lower depression symptomology, and frailty scores than those in the South and East. A pre-frail and frail status was a significant moderator, increasing the association between depression and cognition in the East, South, North, and West regions, respectively. The interaction effects between CogId and frailty were found in the West and East regions. Comparatively, the moderating role of frailty in countries in the Western region differed significantly from those in the North. In turn, countries in the South and East differed from those in the North region. Frailty was a moderator of depression symptoms, increasing its association with cognition. Strategies to prevent frailty are important to reduce the burden of depression and cognitive deficits in Europe.

The role of meaning in life in the association between loneliness and depression: a mediation study among older adults from 26 European countries

Loneliness and depression are serious public mental health problems. Meaning in life (MIL) is associated with reduced loneliness and depression. This study aimed to: (1) investigate associations between loneliness, MIL, and depression, differentiated by sex in individuals aged ≥ 50 years, residing in 26 European countries and Israel, and (2) to examine in men and women separately whether MIL mediated the relationship between loneliness and depression. We included 41,372 individuals (23,789 women) who responded to wave 8 of the SHARE project. The variables analyzed were loneliness (UCLA), depression (EURO-D scale), and MIL (CASP-19). The analytical procedures included regression analysis and exploratory mediation analysis. Among men and women, the odds of loneliness increasing depression were 3.6 and 3.3 times higher, respectively. Among men, feeling MIL sometimes or often had odds for reducing depression by 0.53 and 0.21, respectively. In women, feeling MIL sometimes or frequently reduced the odds of depression by 0.37 and 0.19, respectively. Regardless of sex, mediation analyses showed a positive association between loneliness and depression, while MIL was negatively associated with loneliness and depression. MIL partially mediated the association between LON and depression in male and female models by approximately 83.2% and 80.7%, respectively. No differences were found between men's and women's mediation models. Regardless of sex, high levels of MIL seem to be effective in benefiting the mental health of Europeans aged 50 and over. MIL proved to be a significant mediator of the relationship between loneliness and depression, while loneliness and depression strengthened each other.

Functional dependency and cardiometabolic multimorbidity in older people: pooled analysis of individual-level data from 20 countries

BACKGROUND

The impact of cardiometabolic multimorbidity (CMM) on functional dependency (FD) is well established, but the temporal effect of FD on CMM and its mechanisms remain underexplored.

DESIGN

A multicohort study pooled data from three international cohorts.

SETTING

Data were sourced from the Health and Retirement Study (USA), the China Health and Retirement Longitudinal Study (China) and the Survey of Health, Ageing and Retirement in 18 European countries.

METHODS

FD was defined as the inability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs) independently. CMM was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease and stroke. Generalised estimating equation models assessed associations between FD and CMM, with mediation analysis using the Karlson, Holm and Breen method to explore the effects of hypertension and depressive symptoms. Sensitivity analyses ensured robustness.

RESULTS

The final cohort included 157 512 and 190 249 individuals for ADL and IADL analyses, respectively. CMM prevalence was 18.97% and 16.65% in these groups. FD was consistently associated with higher CMM risk, with odds ratios ranging from 1.47 (95% confidence interval: 1.33-1.63) to 1.56 (1.42-1.73). Hypertension and depressive symptoms increased CMM risk, particularly at higher FD levels. Mediation analysis showed hypertension and depressive symptoms accounted for 8.01%-16.43% and 12.04%-18.36% of the adverse effect of FD on CMM, respectively, with more pronounced effects among smokers and heavy drinkers.

CONCLUSIONS

Targeted interventions focusing on hypertension, mental wellness, lifestyle factors, and integrated treatments for FD are crucial to prevent CMM in older adults.

Moderating Effect of Muscular Strength in the Association between Cardiovascular Events and Depressive Symptoms in Middle-Aged and Older Adults-A Cross Sectional Study

BACKGROUND

Depression and cardiovascular diseases are two main health conditions contributing to the global disease burden. Several studies indicate a reciprocal association between them. It is still unclear how changes in overall muscle strength may impact this association. This study aimed to analyse how muscular strength moderates the relationship between cardiovascular events and depressive symptoms among middle-aged and older adults.

METHODS

Wave 8 of the population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) cross-sectional data, which included 41,666 participants (17,986 men) with a mean age of 70.65 (9.1) years old, was examined. Grip strength was measured twice on each hand using a dynamometer. The 12-item EURO-D scale was employed to gauge depressive symptoms.

RESULTS

Grip strength negatively moderates the link between cardiovascular events and depressive symptoms (male: B = -0.03, 95% CI = -0.04, -0.03; female: B = -0.06, 95% CI = -0.06, -0.05). Additionally, the grip strength moderation values in the significant zone for males and females were less than 63.2 kg and 48.3 kg, respectively.

CONCLUSIONS

Muscular strength modifies depressive symptoms and lessens their correlation with cardiovascular diseases. Muscle-strengthening activities could be incorporated into primary and secondary preventive strategies to reduce the burden of depression in people with CVD.

Moderating Effect of Grip Strength in the Association between Diabetes Mellitus and Depressive Symptomatology

Diabetes mellitus and depression rank among the leading causes of disease burden and are present in the top ten causes of disability-adjusted life years worldwide. Numerous studies have shown that both depression and diabetes have a detrimental effect on the quality of life, and when they coexist, the effect is considerably worse. This study aimed to analyse how grip strength moderates the relationship between diabetes and depressive symptoms among middle-aged and older adults. In total, 41,701 participants (18,003 men) in wave 8 of the cross-sectional population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) data were studied. A dynamometer was used to test grip strength twice on each hand. Depressive symptoms were measured using the 12-item EURO-D scale. The relationship between diabetes and depressive symptoms is negatively moderated by grip strength (male: B = -0.03, 95% CI = -0.04, -0.03; female: B = -0.06, 95% CI = -0.07, -0.06). Furthermore, the significant zone grip strength moderation values for males and females were less than 48.7 kg and 38.9 kg, respectively. Muscular strength was a moderator of depressive symptoms, attenuating its association with diabetes. This supports the premise that physical activity, namely muscle-strengthening exercises, should be included in diabetes treatment programs.

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.

Evolution of Cognitive Impairments in Treatment-Resistant Depression: Results from the Longitudinal French Centers of Expertise for Treatment-Resistant Depression (FACE-DR) Cohort

Previous studies set out profound cognitive impairments in subjects with treatment-resistant depression (TRD). However, little is known about the course of such alterations depending on levels of improvement in those patients followed longitudinally. The main objective of this study was to describe the course of cognitive impairments in responder versus non-responder TRD patients at one-year follow-up. The second aim was to evaluate the predictive aspect of cognitive impairments to treatment resistance in patients suffering from TRD. We included 131 patients from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centers. They undertook comprehensive sociodemographic, clinical, global functioning, and neuropsychological testing (TMT, Baddeley task, verbal fluencies, WAIS-4 subtests, D2 and RLRI-16) at baseline (V0) and one-year follow-up (V1). Most patients (n = 83; 63.36%) did not respond (47 women, 49.47 ± 12.64 years old), while one-third of patients responded (n = 48, 30 women, 54.06 ± 12.03 years old). We compared the cognitive performances of participants to average theoretical performances in the general population. In addition, we compared the cognitive performances of patients between V1 and V0 and responder versus non-responder patients at V1. We observed cognitive impairments during the episode and after a therapeutic response. Overall, each of them tended to show an increase in their cognitive scores. Improvement was more prominent in responders at V1 compared to their non-responder counterparts. They experienced a more marked improvement in code, digit span, arithmetic, similarities, and D2 tasks. Patients suffering from TRD have significant cognitive impairments that persist but alleviate after therapeutic response. Cognitive remediation should be proposed after therapeutic response to improve efficiency and increase the daily functioning.

Dose-response association of handgrip strength and risk of depression: a longitudinal study of 115 601 older adults from 24 countries

BACKGROUND

Prior research has solely focused on the association between handgrip strength and risk of depression in single countries or general populations, but more knowledge is required from wider-spread cohorts and target populations.

AIMS

This study aimed to investigate the association between handgrip strength and risk of depression using repeated measures in adults aged 50 years and over.

METHOD

Data on handgrip strength and risk of depression were retrieved from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 1, 2, 4, 5, 6 and 7, using a hand dynamometer (Smedley, S Dynamometer, TTM) and the EURO-D 12-item scale, respectively. Time-varying exposure and covariates were modelled using both Cox regression and restricted cubic splines.

RESULTS

A total of 115 601 participants (mean age 64.3 years (s.d. = 9.9), 54.3% women) were followed-up for a median of 7.3 years (interquartile range: 3.9-11.8) and 792 459 person-years. During this period, 30 208 (26.1%) participants experienced a risk of depression. When modelled as a continuous variable, we observed an inverse significant association for each kg increase of handgrip strength and depression up to 40 kg in men and up to 27 kg in women.

CONCLUSIONS

Being physically strong may serve as a preventive factor for depression in older adults, but this is limited up to a maximum specific threshold for men and women.

Incident and Recurrent Depression among Adults Aged 50 Years and Older during the COVID-19 Pandemic: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging

The COVID-19 pandemic and accompanying public health measures have exacerbated many risk factors for depression in older adulthood. The objectives of the current study are: (1) to determine the risk of incident and recurrent depression during the COVID-19 pandemic among those with, or without, a history of depression; and (2) to identify factors that were predictive of depression in these two groups. The study population included 22,622 participants of the Canadian Longitudinal Study on Aging who provided data at baseline (2011-2015), follow-up (2015-2018), and twice during the pandemic (April-May 2020, September-December 2020). The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to classify individuals with depression. Logistic regression was used to estimate the odds of depression during COVID across a series of risk factors. Individuals with a history of depression had four times the risk of depression during the pandemic when compared to those without a history of depression, even after controlling for relevant covariates. Other factors associated with depression during the pandemic include being female, having fewer savings, and experiencing COVID-19 related stressors, such as health stressors, difficulties accessing resources, and family conflict. Clinicians working with older adults should consider interventions to support high-risk groups, such as those with recurrent depression.

Multimorbidity and depression among older adults in India: Mediating role of functional and behavioural health

Researchers have long been concerned about the association between depression and the prevalence of multiple chronic diseases or multimorbidity in older persons. However, the underlying pathway or mechanism in the multimorbidity-depression relationship is still unknown. Data were extracted from a baseline survey of the Longitudinal Ageing Survey of India (LASI) conducted during 2017–18 (N = 31,464; aged ≥ 60 years). Depression was assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). Multivariable logistic regression was used to examine the association. The Karlson–Holm–Breen (KHB) method was adopted for mediation analysis. The prevalence of depression among older adults was nearly 29% (men: 26% and women 31%). Unadjusted and adjusted estimates in binary logistic regression models suggested an association between multimorbidity and depression (UOR = 1.28; 95% CIs 1.27–1.44 and AOR = 1.12; 95% CIs 1.12–1.45). The association was particularly slightly strong in the older men. In addition, the association was mediated by functional health such as Self Rated Health (SRH) (proportion mediated: 40%), poor sleep (35.15%), IADL disability (22.65%), ADL disability (21.49%), pain (7.92%) and by behavioral health such as physical inactivity (2.28%). However, the mediating proportion was higher among older women as compared to older men. Physical inactivity was not found to be significant mediator for older women. The findings of this population-based study revealed that older people with multimorbidity are more likely to suffer depressive symptoms in older ages, suggesting the need for more chronic disease management and research. Multimorbidity and depression may be mediated by certain functional health factors, especially in older women. Further longitudinal research is needed to better understand the underlying mechanisms of this association so that future preventive initiatives may be properly guided.

Childhood Socioeconomic Disadvantage and Pathways to Memory Performance in Mid to Late Adulthood: What Matters Most?

OBJECTIVES

Childhood socioeconomic disadvantage is consistently associated with lower cognitive function in later life. This study aims to distinguish the contribution of specific aspects of childhood socioeconomic disadvantage for memory performance in mid-to-late adulthood, with consideration for direct and indirect effects through education and occupation.

METHODS

Data were from adults aged 50-80 years who completed the life history module in the 2006/07 wave of the English Longitudinal Study of Ageing (n=4,553). The outcome, memory score, was based on word recall tests (range: 0-20 points). We used the g-formula to estimate direct and indirect effects of a composite variable for childhood socioeconomic disadvantage, and its four individual components: lower-skilled occupation of the primary breadwinner, having few books in the home, overcrowding in the home, and lack of water and heating facilities in the home.

RESULTS

Few books were the most consequential component of childhood socioeconomic disadvantage for later life memory (total effect: ⎼0.82 points for few books; 95% CI: ⎼1.04, ⎼0.60), with roughly half being a direct effect. The total effect of a breadwinner in lower-skilled occupations was smaller but not significantly different from few books (⎼0.67 points; 95% CI: ⎼0.88, ⎼0.46), while it was significantly smaller with overcrowding (⎼0.31 points; 95% CI: ⎼0.56, ⎼0.06). The latter two total effects were mostly mediated by education and occupation.

DISCUSSION

A literate environment in the childhood home may have lasting direct effects on memory function in mid-to-later life, while parental occupation and overcrowding appear to influence memory primarily through educational and occupational pathways.

A Network Analysis of Depressive Symptoms in the Elderly with Subjective Memory Complaints

(1) Background: Subjective memory complaints (SMCs) are common among the elderly and are important because they can indicate early cognitive impairment. The factor with the greatest correlation with SMCs is depression. The purpose of this study is to examine depressive symptoms among elderly individuals with SMCs through a network analysis that can analyze disease models between symptoms; (2) Methods: A total of 3489 data collected from elderly individuals in the community were analyzed. The Subjective Memory Complaints Questionnaire and Patient Health Questionnaire-9 were evaluated. For statistical analysis, we investigated the features of the depressive symptoms network, including centrality and clustering; (3) Results: Network analysis of the SMC group showed strong associations in the order of Q1–Q2 (r = 0.499), Q7–Q8 (r = 0.330), and Q1–Q6 (r = 0.239). In terms of centrality index, Q2 was highest in strength and expected influence, followed by Q1 in all of betweenness, strength, and expected influence; (4) Conclusions: The network analysis confirmed that the most important factors in the subjective cognitive decline group were depressed mood and anhedonia, which also had a strong correlation in the network pattern.

The association between single and multiple chronic conditions and depression among older population in India: A comparative study between men and women

OBJECTIVE

The study aimed to estimate the prevalence of depression and to explore the association of specific chronic conditions as well as multi-morbidity with depression among the older population.

METHOD

The study utilized data from the Longitudinal Ageing Study in India Wave 1 (2017-2018). The total sample size for the present study was 31,464 older adults aged 60 and above, including 14,931 males and 16,533 females. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives.

RESULTS

The overall prevalence of depression among the elderly population in India was 8.7%. Older women had shown a greater prevalence rate of depression than older men. Among chronic conditions, hypertension, stroke, and bone-related diseases were found to be significantly associated with depression in the case of both men and women. The prevalence of depression among older adults with three or more chronic conditions was higher in males (14.5%) than in females (11.2%). The association between the number of chronic conditions and depression exhibited a linear trend with an increased odds ratio indicating a higher risk of depression among older adults with multiple chronic conditions.

CONCLUSION

Older individuals with a greater number of chronic illnesses have a higher risk of depression and the risk is proportional to the number of chronic conditions. This signifies the need for the identification of depressive symptoms at an early stage by focussing on the elderly suffering from chronic conditions and educating family members and the community about effective treatments and counselling.

Grip strength as a predictor of depressive symptoms among vulnerable elderly Europeans with musculoskeletal conditions

The present study aimed to investigate the grip strength (GS) discrimination capacity and cutoffs points for depressive symptoms among vulnerable elderly individuals with musculoskeletal conditions. The Survey of Health, Aging, and Retirement in Europe wave 6 was analyzed. GS was measured by a handgrip dynamometer, and EURO-D scale was used to assess depressive symptoms. GS cutoff values for depressive symptoms were calculated using the receiver operating characteristics curve. 2206 participants, mean age 74.0 (73.7-74.3), 78.8% with osteoarthritis/other rheumatism, enrolled in the study. Sensitivity varies between 0.44 (men, ≥ 85 years) and 0.82 (men, 75-84 years), and specificity varying between 0.35 (women, 75-84 years) and 0.70 (men 75-84 years). GS is associated with depressive symptoms just for women and it is not possible to use a GS cutoff point for screening depressive symptoms for vulnerable men and women with musculoskeletal conditions over the age of 65 years.

Organizing and Analyzing Data from the SHARE Study with an Application to Age and Sex Differences in Depressive Symptoms

The SHARE study contains health, lifestyle, and socioeconomic data from individuals ages 50 and older in European countries collected over several waves. Leveraging these data for research purposes can be daunting due to the complex structure of the longitudinal design. The two aims of our study are (1) to develop a framework and R code for data management of the SHARE data to prepare for data analysis, and (2) to demonstrate how to apply the framework to a specific research question, where the aim is to model the presence of clinically significant depression assessed by the 12-item Europe depression scale. The result is a framework that substantially reduces the time to initiate research studies using SHARE data, facilitating the data extraction, data preparation and initial data analysis, with reproducible R code. Further, we illustrate the extensive work required to prepare an analysis-ready data set to ensure the validity of the modeling results. This underlines the importance of carefully considering and recording data management decisions that have to be built into the research process. The results about sex differences in the probability of depression are consistent with previous literature. Our findings about age-associated changes can be opportunities for adequate treatment interventions.

Exploring grip strength as a predictor of depression in middle-aged and older adults

Grip strength (GS) is an indicator of health and vulnerability and inversely associated with depressive symptoms. The aim of this study was to explore GS discrimination capacity for depression; and possible GS cut-off values for depression by sex and age group. Data from 2011 and 2015 on 20,598 (10,416 women) middle-aged and older adults from 14 European countries was analysed. GS was assessed by dynamometer, and depressive symptoms using the EURO-D scale. GS cut-off values for depression were calculated and logistic regression models were used to quantify the odds of having depression in 2011 and in 2015 according to being bellow or above the cut-off value. GS had a weak discriminant capacity for depression, with the area under the curve varying between 0.54 and 0.60 (p < 0.001). Sensitivity varied between 0.57 and 0.74; specificity varied between 0.46 and 0.66. GS cut-off values for discriminating depression were 43.5 kg for men and 29.5 kg for women aged 50–64 years, 39.5 kg for men and 22.5 kg for women aged ≥ 65 years. Having GS above the cut-off represents significant lower odds of depression in 2011 and 4 years later, in 2015. Healthcare practitioners and epidemiologic researchers may consider the low GS cut-off values to screen for potential depression risk. However, due to its weak discriminant values these cut-offs should not be used to identify depression.

Correlation between Handgrip Strength and Depression in Older Adults-A Systematic Review and a Meta-Analysis

Background: Depression remains an important health problem among older adults and it may be correlated with the deterioration of physical fitness, whose chief indicator is hand grip strength (HGS). The aim of the study was to investigate the relationship between depression and HGS among older populations using the available literature. Methods: PubMed, Web of Science and Science Direct databases were searched. The inclusion criteria were as follows: written in English and published after 2009, subject age: ≥60 years, HGS measured using a hand dynamometer, assessment of the depressive symptoms using a validated tool. The following articles were excluded: studies conducted among institutionalized subjects and/or populations with a specific disease. Results: The total combined effect of 33 results presented in 16 studies included in the meta-analysis, converted to the correlation coefficient, was OEr = −0.148 (SE = 0.030, 95%CI: −0.206–−0.091), indicating a weak, negative correlation between HGS and depressive symptoms. Conclusions: The review of the literature and the meta-analysis demonstrated a relationship between low muscle strength and intensified depressive symptoms in older populations. Bearing in mind that depression is often unrecognized or underdiagnosed among older patients, lowered muscle strength should be an important sign for physicians and an incentive to screen them for depression.

Grip Strength and Depression Symptoms Among Middle-Age and Older Adults

OBJECTIVE

To analyze the relationship between grip strength and symptoms of depression, considering sex and age, in adults from 18 countries.

METHODS

Cross-sectional data for adults 50 years and older from the Survey of Health, Aging, and Retirement in Europe wave 6 (collected in 2015) were analyzed. Grip strength was measured twice on each hand using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depression symptoms. Multivariable logistic regression analysis was conducted. Data analyses were conducted between November 5, 2019, and February 7, 2020.

RESULTS

Men and women who were in quartiles 2, 3, and 4 of grip strength were less likely to have depression symptoms than those in the first quartile of grip strength. Having more grip strength decreased the odds of depression symptoms by 30% (odds ratio 0.70; 95% CI, 0.65 to 0.77) and 47% (odds ratio, 0.53; 95% CI, 0.49 to 0.57) for adults aged 50 to 64 years and 65 years and older, respectively, when compared with those with the lowest grip strength. The negative relationship between strong grip strength and depression symptoms was observed among men and women younger and older than 65 years.

CONCLUSION

There was an association between grip strength and depression symptoms. For clinical practice and geriatric health professionals, assessing adults' grip strength can be used as a signal to screen for physical and mental health.

Cross-sectional and prospective relationship between physical activity and depression symptoms

This study aimed to analyse the cross-sectional and prospective relationship between moderate and vigorous physical activity (PA) and depression symptoms. This study analysed 32,392 European late middle-aged to older adults, from 14 European countries across a 4-year follow-up. Data was collected in the fourth (in 2011) and sixth (in 2015) wave, from the Survey of Health, Ageing and Retirement in Europe (SHARE). For the present analysis, participants were considered who responded to the EURO-D 12-item scale of depression symptoms and reported the intensity and frequency of PA. ANCOVAs were conducted to assess the cross-sectional and prospective associations. For both men and women, engaging in moderate or vigorous PA in 2011 was associated with a lower score of depression in 2011 and 2015. From the prospective analysis, moderate and vigorous PA in 2011 was inversely associated with the score of depression. This association remains significant in the fully adjusted for self-rated health, sociodemographic characteristics, and the presence of chronic diseases. Moderate and vigorous PA at least once a week is negatively related to the score of depression, both in men and women. PA is negatively associated with depression symptoms, and from prospective analysis PA predicts lower depression scores 4 years later.

Different levels of physical activity and depression symptoms among older adults from 18 countries: A population-based study from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Objective: Analyse the relationship between different levels of physical activity (PA) and depression symptoms in a representative sample of European older adults. Methods: Data on PA, depression symptoms and sociodemographic variables from 64688 (28015 men) older adults participating in SHARE wave 6 was collected through a face-to-face interview. The EURO-D 12-item scale was administered for depression symptoms. Participants reported the frequency they engaged in moderate-intensity PA (MPA) and vigorous-intensity PA (VPA). Results: Men and women engaging in MPA and VPA once or more than once a week had less depression symptoms than those who engage less than once a week. MPA and VPA once or more than once a week were inversely associated with the depression symptoms score. Furthermore, engaging in MPA and VPA decreased the odds of depression (cut-off point of ≥4 depression symptoms) compared to engaging in PA less than once a week. Conclusions: Policies for promoting mental health should include PA for the prevention or treatment of depression symptoms. PA presents physical and psychological benefits and can be used as an overall health-promoting strategy, facing numerous problems at a time.

Feasibility and Outcome of an Inpatient Interpersonal Skills Group for Older Adults (65+) With Acute or Chronic Depression

Abstract. In light of ongoing demographic changes, it is essential to tailor psychotherapeutic approaches and interventions to the specific needs and characteristics of older adults. An interpersonal skills group (ISG) for older adults consisting of modified Cognitive Behavioral Analysis System of Psychotherapy (CBASP) elements (Situational Analysis, Kiesler Circle Training) was integrated into the treatment schedule of an inpatient setting in routine clinical care. Feasibility and outcome were evaluated in a pilot study including 13 older patients ( Mage = 77.3, range 66–87 years) diagnosed with a major depressive disorder. Results indicate very good feasibility as well as a significant reduction of depressive symptoms in self-report measures and observer rating at discharge ( d = 1.00 to d = 5.62). No significant changes were observed in interpersonal distress, whereas significant changes in the Emotion Regulation Questionnaire (ERQ reappraisal: p < .001) and the Impact Message Inventory (IMI: p = .002 to p < .001) were reported and discussed. However, the results in the observer rating are likely to have been overestimated through a nonblinded rater. Further studies should examine the efficacy of age-tailored CBASP programs for older adults in large randomized controlled trials.

Decomposing the effects of childhood adversity on later-life depression among Europeans: a comparative analysis by gender

The aims of the present study are twofold: first, to examine the importance of socio-economic disadvantage, adverse experiences and poor health in childhood on later-life depression by sex and, second, to discern the direct and indirect effects of childhood circumstances using a decomposition technique. Data are derived from Waves 2 and 3 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The methods involve use of logistic regression models and a decomposition approach. The findings indicate that childhood socio-economic status (SES) for both genders and cognitive function for men have only a significant direct effect, consistent with the critical period model. Childhood health for men and poor parental mental health for women are nearly fully mediated by adulthood and later-life circumstances, a fact in line with the pathway model. Poor childhood health, parental excessive alcohol consumption and cognitive function for women and adverse experiences for men have both significant direct and indirect effects, consistent with both models. Mediating factors include poor adulthood and later-life health, socio-economic adversity and stress; adulthood and later-life SES mediate early life health and adverse experiences more strongly for men, whereas stress seems to mediate early life adverse experiences to a greater extent among women. Intervening policies should address childhood adversity while considering the differential vulnerability of men and women.

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.

Toward Prevention of Mild Cognitive Impairment in Older Adults With Depression: An Observational Study of Potentially Modifiable Risk Factors

OBJECTIVE

Late-life depression has been associated with increased risk of mild cognitive impairment (MCI) and dementia. Predictors of increased risk are incompletely understood. Identification of potentially modifiable risk factors could facilitate prevention of MCI and dementia. This study aimed to determine which clinical characteristics are associated with increased risk of MCI among older adults with depression and normal cognition at baseline.

METHODS

Data from the National Alzheimer's Coordinating Center dataset were used. Study participants who attended a participating Alzheimer's Disease Center from September 2005 through September 2017 with normal cognition and a history of clinically defined depression (broadly based on DSM criteria) were followed until first diagnosis of MCI (or dementia when MCI was not diagnosed).

RESULTS

A total of 2,655 study participants were followed for a median duration of 41.8 months. Of these, 586 (22.1%) developed either MCI (n = 509, 19.2%) or dementia (n = 77, 2.9%). In survival analyses, cognitive decline was associated with age, sex, education, baseline cognition, and several potentially modifiable risk factors including vascular risk factors, hearing impairment, vitamin B₁₂ deficiency, active depression within the last 2 years, and increased severity of depression. In an adjusted survival analysis, the only variables that remained significantly associated with development of MCI or dementia were female sex (HR = 0.72; 95% CI, 0.59-0.88), higher education (HR = 0.96; 95% CI, 0.93-0.99), and higher baseline cognition (HR = 0.87; 95% CI, 0.82-0.93), which were associated with reduced risk, and older age (HR = 1.07; 95% CI, 1.05-1.08), active depression within the last 2 years (HR = 1.41; 95% CI, 1.15-1.74), and increased severity of depression (HR = 1.05; 95% CI, 1.02-1.09), which were associated with increased risk.

CONCLUSIONS

Development of MCI is associated with several potentially modifiable risk factors in older adults with depression. Future studies should determine whether active management of risk factors could reduce incidence of MCI in this vulnerable population.

Factor structure of depressive symptoms using the EURO-D scale in the over-50s in Europe. Findings from the SHARE project

OBJECTIVES

The aims of this study are: to analyze the factor structure of the EURO-D depression scale; to explore the variables associated with depressive symptoms in the total sample and in the EURO-D factors; and to compare the presence of depressive symptoms and the factor distribution in 15 European countries.

METHOD

62,182 participants in Wave 5 (2013) of the Survey of Health, Aging and Retirement in Europe (SHARE) were included.

INSTRUMENTS

The SHARE study and the EURO-D scale. Factor, bivariate and multilevel analyses were performed.

RESULTS

Higher levels of depressive symptoms were associated with a poorer self-perception of physical health (η² = 0.22) and economic difficulties (η² = 0.07). Factor analysis of the EURO-D identified two factors: Suffering and Motivation. Higher levels of depressive symptoms were associated with female gender and younger age (≤60) in the Suffering factor, and with less activity and exercise, older age (≥71), widowhood and lower educational level in the Motivation factor. Poorer self-perception of physical health and economic difficulties were associated with higher depressive symptomatology in both factors.

CONCLUSIONS

Poorer self-perception of physical health, female gender, economic difficulties, widowhood, lower levels of activity and exercise and lower educational level were associated with higher depressive symptomatology. In the countries of southern Europe, the Motivation factor predominated.

Exercise for Cognitive Symptoms in Depression: A Systematic Review of Interventional Studies

OBJECTIVE

To explore the effect of exercise on cognition in depression as well as the impact of potential moderators and intervention type.

METHOD

Controlled and uncontrolled interventional studies that described an exercise intervention and cognitive outcomes in participants with major depressive disorder (MDD) were included following a search of Pubmed, Ovid Medline, PsycInfo and Embase from inception to January 2017. Meta-analyses were conducted to calculate Hedges' g using a random-effects model. Meta-regression explored the relationships among age, baseline cognition, frequency and duration of exercise, and cognitive outcomes. Subgroup analyses were also conducted according to type and intensity of exercise interventions.

RESULTS

Of 12 controlled studies and 3 uncontrolled studies that met inclusion criteria, 9 (642 patients) were included in the meta-analysis. No significant effect of exercise was found on global cognition (Hedges' g = 0.08, P = 0.33, I2 = 0%) or on individual cognitive domains. Meta-regression analyses failed to find significant relationships among participant age, baseline cognition, number of exercise sessions per wk, duration of exercise per wk, total duration of exercise during the intervention, or improvement in global cognition. Interventions combining physical with cognitive activity significantly improved global cognition ( P = 0.048), whereas low-intensity interventions were also positive ( P = 0.048).

CONCLUSIONS

No impact of physical exercise was found on cognition in MDD overall. However, we found that interventions combining physical and cognitive activities had a positive impact, and that lower-intensity interventions, where adherence was improved, also impacted positively. There remains a lack of high-quality data in this population.

Depression in later life: A closer look at the gender gap

Gender differences in depressive symptoms have been extensively documented, with women reporting a higher number of depressive symptoms than men. However, studies offer different explanations for why such a gap exists. The goal of the current paper is to analyze how much of the observed gender gap in depression may be attributed to (1) compositional versus (2) reporting differences or (3) differences in reactivity to adversities. We contribute to this literature by testing, net of compositional differences, whether the relationship between reporting behavior and depressive symptoms is gendered and whether accounting for the possibility of gender-specific reactivity alters the structure of the gender gap at older ages. Our results show that the observed gender gap in depression (1) only partially derives from compositional differences; (2) is not an artifact of a gender-specific reporting style; and remarkably (3) men appear more sensitive to adversities.

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.

Associations of objective and subjective sleep disturbance with cognitive function in older men with comorbid depression and insomnia

OBJECTIVES

To examine whether poor objective and subjective sleep quality are differentially associated with cognitive function.

DESIGN

Cross-sectional.

SETTING

Participants were recruited from primary and secondary care, and directly from the community, in Sydney, Australia.

PARTICIPANTS

The sample consisted of 74 men 50years and older (mean [SD], 58.4 [6.2] years), with comorbid depression and above-threshold insomnia symptoms, participating in a trial of online cognitive behavioral therapy for insomnia.

MEASUREMENTS

Insomnia severity and depression severity were assessed via self-report. Objective sleep efficiency and duration were measured using actigraphy. Objective cognitive function was measured using 3 subtests of a computerized neuropsychological battery.

RESULTS

Poor objective sleep efficiency was associated with slower reaction time (r=-0.249, P=.033) and poorer executive functioning (odds ratio, 4.14; 95% confidence interval, 1.35-12.69), but not memory. These associations remained after adjusting for age, education, depression severity, cardiovascular risk, and medication. Subjective sleep quality was not related to cognitive function.

CONCLUSIONS

Among older men with depression and insomnia, objectively measured poor sleep efficiency may be associated with worse cognitive function, independent of depression severity. Objective poor sleep may be underpinned by neurobiological correlates distinct from those underlying subjective poor sleep and depression, and represent a potentially effective modifiable mechanism in interventions to improve cognitive functioning in this population. This supports the use of objective measures of sleep in diagnostic assessments and care.

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.

Depressive symptoms and cognitive decline: A longitudinal analysis of potentially modifiable risk factors in community dwelling older adults

BACKGROUND

Depressive symptoms have been associated with increased risk of cognitive decline in later life. There are no interventions proven to reduce risk of cognitive decline in older adults with depression, and it is unclear how these effects are mediated. We aim to determine what mediates the relationship between depressive symptoms and cognitive decline in later life.

METHODS

Seven thousand six hundred and sixty six community dwelling older adults (age ≥ 50) from the English Longitudinal study of Ageing (ELSA) underwent clinical assessment. Inflammation was assessed with C Reactive Protein and depressive symptoms were assessed with the 8-item version of the Center for Epidemiologic Studies (CESD) scale.

RESULTS

Five thousand, five hundred and ninety (73.5%) had a follow-up cognitive assessment after a median of 47 months. Depressive symptoms were independently associated with cognitive decline (B=0.09, p<0.001). Low physical activity, inflammation, metabolic syndrome and vascular risk factors were associated with elevated depressive symptoms. Low physical activity (z=2.16, p=0.03) and inflammation (z=2.3, p=0.02) mediated the relationship between depressive symptoms and cognitive decline while hypertension, diabetes and smoking also contributed.

LIMITATIONS

This is an observational study with a limited duration of follow up. Not all variables related to cognitive decline were accounted for in this analysis.

CONCLUSIONS

The relationship between depressive symptoms and cognitive decline in later life appears to be mediated by low physical activity, increased inflammation and vascular risk factors that may be amenable to modification.