1
|
Leoutsakos JMS, Wise EA, Lyketsos CG, Smith GS. Trajectories of neuropsychiatric symptoms over time in healthy volunteers and risk of MCI and dementia. Int J Geriatr Psychiatry 2019; 34:1865-1873. [PMID: 31452260 PMCID: PMC6854285 DOI: 10.1002/gps.5203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/06/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To identify subtypes of neuropsychiatric symptom (NPS) course among cognitively normal individuals and to assess the association between these subtypes and hazard of later mild cognitive impairment (MCI) or dementia diagnosis. METHODS We modeled neuropsychiatric inventory questionnaire (NPI-Q) scores from 4184 volunteers over approximately 4 years using growth mixture models, generating latent classes of trajectory. We then fit Cox proportional hazard models to determine if membership in trajectory classes was associated with increased hazard of diagnosis of MCI or dementia. RESULTS We identified four trajectory classes: the majority of the sample (65%) would be expected to belong to a class with consistently low or zero NPS. The next most prevalent class, (16%) showed a decrease over time in NPI-Q total score but, compared with the majority class had an almost threefold increase in hazard of MCI or dementia (HR: 2.92; 95% CI: 1.82-4.68). Another class (14%) showed an increase in NPS over time and was also associated with greater hazard of MCI or dementia (HR: 3.96; CI: 2.61-6.03). The smallest class (5%) had high and fluctuating NPI-Q total scores and had the greatest hazard (HR: 4.57; CI: 2.72-7.63). CONCLUSION We have demonstrated that it is possible to identify meaningful groups of NPS trajectories and that trajectory of NPS can convey information beyond a single cross-sectional measure. While even those whose NPS improved were at increased hazard of MCI or dementia, hazard increased as a function of the severity of the NPS trajectory.
Collapse
Affiliation(s)
- Jeannie-Marie S Leoutsakos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Elizabeth A Wise
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Constantine G Lyketsos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Gwenn S Smith
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| |
Collapse
|
2
|
Armstrong NM, Surkan PJ, Treisman GJ, Sacktor NC, Irwin MR, Teplin LA, Stall RC, Jacobson LP, Abraham AG. Optimal metrics for identifying long term patterns of depression in older HIV-infected and HIV-uninfected men who have sex with men. Aging Ment Health 2019; 23:507-514. [PMID: 29424569 PMCID: PMC6085148 DOI: 10.1080/13607863.2017.1423037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Center of Epidemiologic Studies-Depression Scale (CES-D) provides a snapshot of symptom severity at a single point in time. However, the best way of using CES-D to classify long-term depression is unclear. METHOD To identify long-term depression among HIV-infected and HIV-uninfected 50+ year-old men who have sex with men (MSM) with at least 5 years of follow-up, we compared sensitivities and specificities of CES-D-based metrics (baseline CES-D; four consecutive CES-Ds; group-based trajectory models) thresholded at 16 and 20 to a clinician's evaluation of depression phenotype based on all available data including CES-D history, depression treatment history, drug use history, HIV disease factors, and demographic characteristics. RESULTS A positive depressive phenotype prevalence was common among HIV-infected (prevalence = 33.1%) and HIV-uninfected MSM (prevalence = 23.2%). Compared to the depressive phenotype, trajectory models of CES-D≥20 provided highest specificities among HIV-infected (specificity = 99.9%, 95% Confidence Interval [CI]:99.4%-100.0%) and HIV-uninfected MSM (specificity = 99.0%, 95% CI:97.4%-99.7%). Highest sensitivities resulted from classifying baseline CES-D ≥ 16 among HIV-infected MSM (sensitivity = 75.0%, 95% CI:67.3%-81.7%) and four consecutive CES-Ds ≥ 16 among HIV-uninfected MSM (sensitivity = 81.0%, 95% CI:73.7%-87.0%). CONCLUSION Choice of method should vary, depending on importance of false positive or negative rate for long-term depression in HIV-infected and HIV-uninfected MSM.
Collapse
Affiliation(s)
- Nicole M. Armstrong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Telephone: 410-955-0491
| | - Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Telephone: 410-502-7396
| | - Glenn J. Treisman
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA, Telephone: 410-955-2343
| | - Ned C. Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, Telephone: 410-550-5624
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA, Telephone: 310-825-8281
| | - Linda A. Teplin
- Departments of Psychiatry and Behavioral Sciences and Medicine: Infectious Diseases, Feinberg School of Medicine, Chicago, IL, USA, Telephone: 312-503-3500
| | - Ron C. Stall
- Department of Behavioral and Community Health, University of Pittsburgh Medical Center, Pittsburgh, PA, USA, Telephone: (412) 624-7933
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Telephone: 410-955-4320
| | - Alison G. Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Telephone: 410-502-9763
| |
Collapse
|
3
|
Bingham KS, Kumar S, Dawson DR, Mulsant BH, Flint AJ. A Systematic Review of the Measurement of Function in Late-Life Depression. Am J Geriatr Psychiatry 2018; 26:54-72. [PMID: 29050912 DOI: 10.1016/j.jagp.2017.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/17/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022]
Abstract
Recovery of everyday premorbid function is a primary goal in the treatment of depression. Measurement of function is an important part of achieving this goal. A multitude of scales have been used to measure function in depression, reflecting the complex, multifaceted nature of functioning. Currently, however, there are no evidence-based guidelines to assist the researcher or clinician in deciding which instruments are best suited to measure function in late-life depression (LLD). Thus, the aims of this study are to 1) systematically review and identify the instrumental activities of daily living and social functioning assessment instruments used in the LLD literature; 2) identify and appraise the measurement properties of these instruments; and 3) suggest factors for LLD researchers and clinicians to consider when selecting functional assessment instruments and make pertinent recommendations. We performed a systematic review of MEDLINE and CINAHL to identify studies that i) incorporated subjects aged 60 years and older with a depressive disorder, and ii) measured instrumental activities of daily living and/or social functioning. Our search yielded 21 functional assessment instruments. Only two of these instruments, the 36-Item Short Form Survey and the Performance Assessment of Self-Care Skills, have formal validation data in LLD. Four additional instruments, although not formally validated, have relevant data regarding their measurement properties. The primary finding of this study is that very few functional assessment instruments have been validated in LLD, and the available measurement property data are mixed; there is a need for further instrument validation in late-life depression. With this caveat in mind, we provide evidence-based suggestions for researchers and clinicians assessing functioning in LLD patients.
Collapse
Affiliation(s)
- Kathleen S Bingham
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Abstract
OBJECTIVES This study examines the impact of social capital on depressive symptoms trajectories among Korean women aged 65 years or older. It also examines the difference in depressive symptoms and social capital by economic status (poverty group, non-poverty group) among community-dwelling older women in Korea. METHOD This study used 2435 older women of the Korean Welfare Panel Study from 2006 (wave 1) to 2013 (wave 8) data using latent growth modeling. Social capital variables were cognitive (interpersonal trust, reciprocity) and structural (the size of family, the number of friends or neighbors, participation in leisure and volunteer activities). RESULTS The results showed both intra- and inter-individual variability in depressive symptoms over time. Interpersonal trust and reciprocity as cognitive social capital had an effect on the change of depressive symptoms in intercept and slope. The size of family, participation in leisure activities among structural social capital were associated with lower levels of depressive symptoms in intercept and slope. CONCLUSION The results of this study suggest some practical implications for depression intervention and prevention and further research on late-life depression.
Collapse
Affiliation(s)
- Mi-Jin Park
- a Department of Aging and Social Work , Catholic University of Pusan , Busan , South Korea
| |
Collapse
|
5
|
Briggs R, Kenny RA, Kennelly SP. Systematic Review: The Association between Late Life Depression and Hypotension. J Am Med Dir Assoc 2016; 17:1076-1088. [DOI: 10.1016/j.jamda.2016.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 12/17/2022]
|
6
|
Holvast F, Burger H, de Waal MMW, van Marwijk HWJ, Comijs HC, Verhaak PFM. Loneliness is associated with poor prognosis in late-life depression: Longitudinal analysis of the Netherlands study of depression in older persons. J Affect Disord 2015; 185:1-7. [PMID: 26142687 DOI: 10.1016/j.jad.2015.06.036] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although depression and loneliness are common among older adults, the role of loneliness on the prognosis of late-life depression has not yet been determined. Therefore, we examined the association between loneliness and the course of depression. METHODS We conducted a 2-year follow-up study of a cohort from the Netherlands Study of Depression in Older Persons (NESDO). This included Dutch adults aged 60-90 years with a diagnosis of major depression, dysthymia, or minor depression according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We performed regression analyses to determine associations between loneliness at baseline and both severity and remission of depression at follow-up. We controlled for potential confounders and performed multiple imputations to account for missing data. RESULTS Of the 285 respondents, 48% were still depressed after 2 years. Loneliness was independently associated with more severe depressive symptoms at follow-up (beta 0.61; 95% CI 0.12-1.11). Very severe loneliness was negatively associated with remission after 2 years compared with no loneliness (OR 0.25; 95% CI 0.08-0.80). LIMITATIONS Despite using multiple imputation, the large proportion of missing values probably reduces the study's precision. Generalizability to the general population may be limited by the overrepresentation of ambulatory patients with possibly more persistent forms of depression. CONCLUSION In this cohort, the prognosis of late-life depression was adversely affected by loneliness. Health care providers should seek to evaluate the degree of loneliness to obtain a more reliable assessment of the prognosis of late-life depression.
Collapse
Affiliation(s)
- Floor Holvast
- University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands.
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Margot M W de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Harm W J van Marwijk
- Clinical Chair in Primary Care Research, Centre for Primary Care, University of Manchester, United Kingdom
| | - Hannie C Comijs
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter F M Verhaak
- University of Groningen, University Medical Center Groningen, Department of General Practice, PO Box 196, 9700 AD Groningen, The Netherlands; NIVEL, Netherlands Institute of Health Services Research, The Netherlands
| |
Collapse
|
7
|
What predicts persistent depression in older adults across Europe? Utility of clinical and neuropsychological predictors from the SHARE study. J Affect Disord 2013; 147:192-7. [PMID: 23174500 DOI: 10.1016/j.jad.2012.10.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression in later life frequently persists and perpetuating factors are of immediate therapeutic relevance to clinicians. No studies of this scale have examined both clinical and neuropsychological predictors of persistent depression in a cross-national European context. METHODS 4095 community dwelling older adults (≥ 50 yr) with clinically signficant depression (EURO-D ≥ 4) from eleven European countries in the Survey of Heath, Ageing, and Retirement in Europe (SHARE) were followed for a median of 28 months. Logistic regression analyses were conducted to determine predictors of persistent depression. RESULTS 2187 (53.4%) remained depressed at follow up. Independent predictors included: female gender, baseline functional impairment, functional decline, physical symptoms, past history of depression, increased severity of depression, early age of onset (< 50 yr), life events, financial distress and country of residence. Neuropsychological variables were associated with persistent depression but not independently of other variables. LIMITATIONS The assessment of depression was by self-report and the data source did not contain a number of potentially relevant predictors. CONCLUSION Individuals at risk of persistent depression may be identified and targeted for intervention. Therapeutic interventions should adopt a multimodal approach to optimise current function, prevent further functional decline and treat symptoms of depression. Country of residence may be associated with further modifiable variables.
Collapse
|
8
|
Paulson D, Bowen ME, Lichtenberg PA. Does brain reserve protect older women from vascular depression? J Gerontol B Psychol Sci Soc Sci 2013; 69:157-67. [PMID: 23448867 DOI: 10.1093/geronb/gbt007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Brain reserve theory, typically discussed in relation to dementia, was examined with regard to late-life depression symptomatology and cerebrovascular burden (CVB) in older-old women. METHOD It was predicted that in a 6-year longitudinal sample (Health and Retirement Study) of 1,355 stroke-free women aged 80 years and older, higher levels of depressive symptomatology (8-item Center for Epidemiologic Studies-Depression score) would be predicted by high CVB, less educational attainment, and the education × CVB interaction after controlling for age and cognitive functioning (Telephone Interview for Cognitive Status). A latent growth curve model was used to identify differences in depression symptomatology at baseline and over time. Logistic regression analyses were used to predict clinically significant depressive symptomatology at each wave based on CVB, education, and the education × CVB interaction. RESULTS Results indicate that among older women, greater educational attainment predicted fewer depression symptoms at baseline, but this advantage was partially eroded over time. The education × CVB interaction predicted clinically significant depressive symptoms at baseline when the benefits of education were most robust. DISCUSSION Brain reserve, characterized by educational attainment, may counterbalance the effect of high CVB with respect to depressive symptoms, thereby preserving mood in late life. These findings support the application of brain reserve theory to late-life depression.
Collapse
Affiliation(s)
- Daniel Paulson
- Correspondence should be addressed to Daniel Paulson, Institute of Gerontology and Department of Psychology, Wayne State University, 87 East Ferry Street, 226 Knapp Building, Detroit, MI 48202. E-mail:
| | | | | |
Collapse
|
9
|
Gilman SE, Bruce ML, Have TT, Alexopoulos GS, Mulsant BH, Reynolds CF, Cohen A. Social inequalities in depression and suicidal ideation among older primary care patients. Soc Psychiatry Psychiatr Epidemiol 2013; 48:59-69. [PMID: 22948560 PMCID: PMC3543515 DOI: 10.1007/s00127-012-0575-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 08/18/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Depression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults. METHODS Data come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period. RESULTS Mean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67-2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34-3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38-3.98). CONCLUSIONS There exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations.
Collapse
Affiliation(s)
- Stephen E. Gilman
- Department of Society, Human Development and Health, and Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA; Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114 USA
| | - Martha L. Bruce
- Department of Psychiatry, Weill-Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Thomas Ten Have
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104-6021 USA
| | - George S. Alexopoulos
- Department of Psychiatry, Weill-Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Benoit H. Mulsant
- Center for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, 1001 Queen Street West, Toronto, Ontario M6J 1H4 Canada
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213 USA
| | - Alex Cohen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT United Kingdom
| |
Collapse
|
10
|
Moldovan R, Cobeanu O, David D. Cognitive Bibliotherapy for Mild Depressive Symptomatology: Randomized Clinical Trial of Efficacy and Mechanisms of Change. Clin Psychol Psychother 2012; 20:482-93. [DOI: 10.1002/cpp.1814] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Ramona Moldovan
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
| | - Oana Cobeanu
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
| | - Daniel David
- Babes-Bolyai University; Department of Clinical Psychology and Psychotherapy; Cluj-Napoca Romania
- Mount Sinai School of Medicine; Oncological Sciences Department; New York USA
| |
Collapse
|
11
|
Zannas AS, McQuoid DR, Steffens DC, Chrousos GP, Taylor WD. Stressful life events, perceived stress, and 12-month course of geriatric depression: direct effects and moderation by the 5-HTTLPR and COMT Val158Met polymorphisms. Stress 2012; 15:425-34. [PMID: 22044241 PMCID: PMC3319482 DOI: 10.3109/10253890.2011.634263] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although the relation between stressful life events (SLEs) and risk of major depressive disorder is well established, important questions remain about the effects of stress on the course of geriatric depression. Our objectives were (1) to examine how baseline stress and change in stress is associated with course of geriatric depression and (2) to test whether polymorphisms of serotonin transporter (5-HTTLPR) and catechol-O-methyltransferase (COMT Val158Met) genes moderate this relation. Two-hundred and sixteen depressed subjects aged 60 years or older were categorized by remission status (Montgomery-Asberg depression rating scale≤6) at 6 and 12 months. At 6 months, greater baseline numbers of self-reported negative and total SLEs and greater baseline perceived stress severity were associated with lower odds of remission. At 12 months, only baseline perceived stress predicted remission. When we examined change in stress, 12-month decrease in negative SLEs and level of perceived stress were associated with improved odds of 12-month remission. When genotype data were included, COMT Val158Met genotype did not influence these relations. However, when compared with 5-HTTLPR L/L homozygotes, S allele carriers with greater baseline numbers of negative SLEs and with greater decrease in negative SLEs were more likely to remit at 12 months. This study demonstrates that baseline SLEs and perceived stress severity may influence the 12-month course of geriatric depression. Moreover, changes in these stress measures over time correlate with depression outcomes. 5-HTTLPR S carriers appear to be more susceptible to both the effects of enduring stress and the benefit of interval stress reduction.
Collapse
Affiliation(s)
- Anthony S Zannas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | |
Collapse
|
12
|
Haringsma R, Spinhoven P, Engels GI, Leeden R. Effects of sad mood on autobiographical memory in older adults with and without lifetime depression. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 49:343-57. [DOI: 10.1348/014466509x454840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
13
|
Batistoni SST, Neri AL, Cupertino APFB. Medidas prospectivas de sintomas depressivos entre idosos residentes na comunidade. Rev Saude Publica 2010; 44:1137-43. [DOI: 10.1590/s0034-89102010000600020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 08/19/2010] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Identificar fatores sociodemográficos associados a padrões de incidência, remissão e estabilidade de sintomas depressivos entre idosos residentes na comunidade. MÉTODOS: Estudo prospectivo em que foram entrevistados 310 idosos residentes na comunidade, em Juiz de Fora, MG, entre 2002 e 2004. O seguimento (T2) foi realizado 15,7 meses após a primeira entrevista (T1). Os sintomas de depressão foram avaliados pela escala do Center for Epidemiological Studies - Depression. Os idosos foram classificados segundo a evolução dos sintomas de depressão e comparados quanto às variáveis sociodemográficas com o teste de qui-quadrado e Exato de Fisher. RESULTADOS: Não houve diferenças na prevalência de sintomas depressivos entre T1 e T2 (33,8%). Foram identificados quatro grupos segundo a evolução dos sintomas da primeira para a segunda medida: livres de depressão (50,9%); recorrência (19,7%); incidência (15,2%); remissão (14,2%). Ter pontuado para depressão em T1, ser do sexo feminino e possuir baixa escolaridade representaram riscos para a manifestação de sintomas depressivos em T2. CONCLUSÕES: Piores trajetórias de evolução em sintomatologia depressiva (incidência e recorrência) associaram-se ao gênero feminino.
Collapse
|
14
|
Steunenberg B, Beekman ATF, Deeg DJH, Kerkhof AJFM. Personality predicts recurrence of late-life depression. J Affect Disord 2010; 123:164-72. [PMID: 19758704 DOI: 10.1016/j.jad.2009.08.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association of personality with recurrence of depression in later life. METHOD A subsample of 91 subjects from the Longitudinal Aging Study Amsterdam (LASA; baseline sample size n=3107; aged > or = 55 years) depressed at baseline, who had recovered in the course of three years (first follow-up cycle) was identified. 41 (45%) respondents experienced a recurrence during the subsequent six years. The influences of personality and late life stress (demographic factors, health and social factors) on recurrence were investigated prospectively. RESULTS Recurrence of depression was associated with a high level of neuroticism and low level of mastery, residual depressive symptoms at time of recovery, female gender, pain complaints and feelings of loneliness. In multivariable analysis entering all predictors significant in single variable analysis, residual depressive symptoms and lack of mastery remained significantly associated with recurrence. CONCLUSION In predicting the recurrence of depression in later life, the direct effects of personality remain important and comparable in strength with other late life stressors related to recurrence.
Collapse
Affiliation(s)
- Bas Steunenberg
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
15
|
Abstract
OBJECTIVES There are a paucity of long-term studies from the United States concerning predictors of outcome among depressed older community adults. This article examines predictors of depression in a biracial sample of older persons in Brooklyn, NY. METHODS The authors conducted a naturalistic study of 110 persons aged 55 years and older living in randomly selected block groups who had a Center for Epidemiologic Studies-Depression (CES-D) score of > or = 8 at baseline. Persons were reassessed on an average of 3 years later. Their mean age was 69 years, 52% were women, and 35% were whites, and 65% were blacks, among whom 71% were African Caribbeans. Using George's Social Antecedent Model of Depression, the authors examined the impact of 13 predictor variables on two outcome measures: presence of either subsyndromal or syndromal depression (CES-D score > or = 8) and presence of syndromal depression (CES-D score > or = 16). To control for design effects, the authors used SUDAAN for the data analysis. RESULTS On follow-up, 82% and 88% of subsyndromally and syndromally depressed persons at baseline, respectively, were depressed (CES-D > or = 8). In logistic regression, baseline depressive symptoms, baseline anxiety symptoms, greater increase in anxiety symptoms during the follow-up period, and higher locus of control were predictors of any level of depression. These four variables along with greater paranoid ideation and/or psychoses and more reliable social contacts were significant predictors of syndromal depression on follow-up. There were no inter- or intraracial differences in outcome. CONCLUSION Depressed community elders in Brooklyn have highly unfavorable outcomes. Preventive strategies that target at-risk persons-i.e., especially those with baseline subsyndromal depression, greater anxiety symptoms, and more paranoid ideation and/or psychoses-may reduce the development of severe or persistent depression.
Collapse
|
16
|
Fuller-Thomson E, Battiston M. Remission from depressive symptoms among older adults with mood disorders: findings of a representative community sample. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2009; 52:744-760. [PMID: 19787530 DOI: 10.1080/01634370903235439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine factors associated with remission in a community-dwelling sample of older Canadians with mood disorders. METHODS We used a representative community survey conducted in 6 Canadian provinces. Data were gathered by telephone and in-person interviews. The response rate was 79%. Those in institutions were excluded from the sampling frame. Our sample was limited to community-dwelling individuals, aged 55 and over, who reported that they had been diagnosed by a health professional with a mood disorder at some point in their life. Only those with mood disorders that lasted 6 months or more were included in the sample (n = 1,161). Remission from depression was calculated using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Individuals were classified as in remission if CIDI-SF < 0.9. RESULTS Three-quarters (76%) of older adults with mood disorders had been symptom-free for the preceding year. The logistic regression analyses indicated that the married, those aged 65 and over, those in good to excellent health, and those who reported minimal stress had the highest odds of remission. Gender, immigration status, education level, household income, number of chronic conditions, activities of daily living limitations, comorbid anxiety disorders, and physical activity level were not associated with the likelihood of remission. CONCLUSION Remission rates in this community sample of older adults with mood disorders were much higher than in previous clinical samples. Strategies to improve identification and outreach to those least likely to be in remission from depression are discussed.
Collapse
Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
17
|
Schoevers RA, Geerlings MI, Deeg DJH, Holwerda TJ, Jonker C, Beekman ATF. Depression and excess mortality: evidence for a dose response relation in community living elderly. Int J Geriatr Psychiatry 2009; 24:169-76. [PMID: 18642389 DOI: 10.1002/gps.2088] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Depression is associated with an increased mortality risk. It is not known to what extent depression characteristics such as severity and length of exposure to depression contribute to the association with excess mortality. OBJECTIVES To investigate the association between depression severity and duration with mortality in community-living elderly. DESIGN Two-wave prospective cohort study with 10-year follow-up of vital status. Assessment of depression at baseline and at three year follow-up (GMS-AGECAT). Cox proportional hazards analyses of mortality with depression according to severity and length of exposure, adjusted for demographic variables, physical illnesses, cognitive decline and functional disabilities. SETTING AND PARTICIPANTS Randomly selected cohort of 3 746 non-demented older community-living persons in the city of Amsterdam. MAIN OUTCOME MEASURES Excess mortality of both the baseline cohort, and of non-demented subjects participating in both assessments (n = 1989). RESULTS Both moderate (MHR 1.29, 95% CI 1.03-1.61) and severe depression (MHR 1.34, 95% CI 1.07-1.68) predicted 10-year mortality after multivariate adjustment. Chronic depression was associated with a 41% higher mortality risk in 6-year follow-up compared to subjects without depression. CONCLUSIONS Severity and chronicity of depression are associated with a higher mortality risk. In combination with other findings this is suggestive of a causal relationship and may have implications for both preventive and treatment strategies of late-life depression.
Collapse
Affiliation(s)
- R A Schoevers
- VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
18
|
Diefenbach GJ, Disch WB, Robison JT, Baez E, Coman E. Anxious depression among Puerto Rican and African-American older adults. Aging Ment Health 2009; 13:118-26. [PMID: 19197697 DOI: 10.1080/13607860802591062] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine racial/ethnic differences in the prevalence and impact of anxious depression (i.e. major depressive disorder, MDD, occurring concomitant with generalized anxiety symptoms) among older adults. METHOD Interviews were conducted with 218 Puerto Rican and 206 African American older (age > or =60) urban senior housing residents. Data were collected on diagnostic status, depression severity and psychosocial functioning. RESULTS Results indicated a higher prevalence of MDD and anxious depression among Puerto Rican participants. Anxious depression was associated with more severe ratings of distress and suicidality compared with MDD alone, and the impact of depression and anxiety was most pronounced for the Puerto Rican participants. Puerto Rican participants also reported poorer subjective health and more substantial disability; however, these effects were independent of depression or anxiety status. CONCLUSIONS Anxious depression is common among older ethnic minority adults and the impact of these symptoms differs by race/ethnicity. These results highlight the importance of conducting culturally sensitive assessments of depression and anxiety among older adults.
Collapse
|
19
|
Ladin K. Risk of late-life depression across 10 European Union countries: deconstructing the education effect. J Aging Health 2008; 20:653-70. [PMID: 18635752 DOI: 10.1177/0898264308321002] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assess influence of education and noneducation-based measures of socioeconomic status on depression, illuminating the cumulative and income-adjusted effects cross-nationally. METHOD Cross-sectional study of 22,777 men and women (50 to 104 years) from 10 European countries. Individual-level data were collected from the Survey of Health, Ageing and Retirement in Europe (SHARE). RESULTS Educational attainment was a strong predictor of late-life depression across all countries. Depression rates ranged from 18.10% in Denmark to 36.84% in Spain, reflecting a North- South gradient. Odds of depression were approximately twice as high among adults with less than a high school education compared with those of greater educational background (p < .001). Inverse association between educational attainment and depression remained significant independent of all other sociodemographic variables. DISCUSSION Socioeconomic disparities in depression persist throughout later life. Variation in impact of education on depression cross-nationally illuminates need for future research into the protective effects of early-life education.
Collapse
Affiliation(s)
- Keren Ladin
- Harvard School of Public Health; Mannheim Research Institute for the Economics of Aging (MEA), Universität Mannheim, 68131 Mannheim, Germany.
| |
Collapse
|
20
|
Abstract
OBJECTIVE To identify target groups for prevention of chronic or recurrent depression in old age such that prevention is likely to become cost-effective. METHODS Data were used from a population-based cohort study (N = 2,200). Chronic or recurrent depression was defined when people presented with clinically high levels of depression at two time points separated by 3 years. Risk profiles of these conditions were identified using classification and regression trees analysis. The combinations of risk factors were then evaluated in multivariate models to ascertain their utility for preventing depression in high-risk groups. RESULTS People are placed at a high risk of depression when having symptoms of anxiety, functional impairments, two or more chronic illnesses, and either a low attained educational level or below average levels of mastery, while living without a partner. These risk profiles correspond with groups no larger than 8.3% of the older population. Containing the adverse effects of the risk factors would help to reduce the incidence of depression by possibly as much as 48.7%, indicating that large health gains can be generated, which can also be done efficiently with numbers-needed-to-be-treated, perhaps as small as three. CONCLUSION Targeting prevention on the selected high-risk groups is likely to become a cost-effective endeavor, because optimal health gains can be generated efficiently in groups small enough to be logistically manageable. The burden of illness associated with depression, particularly depression, in aging populations underscores the public health significance of such an approach.
Collapse
|
21
|
Barry LC, Allore HG, Guo Z, Bruce ML, Gill TM. Higher burden of depression among older women: the effect of onset, persistence, and mortality over time. ACTA ACUST UNITED AC 2008; 65:172-8. [PMID: 18250255 DOI: 10.1001/archgenpsychiatry.2007.17] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT The prevalence of depression is disproportionately higher in older women than men, yet the reasons for this sex difference are not clear. OBJECTIVE To determine whether the higher burden of depression among older women than men might be attributable to sex differences in the onset (ie, first or recurrent episodes) or persistence of depression and/or to differential mortality among those who are depressed. DESIGN Prospective cohort study. SETTING General community in greater New Haven, Connecticut, from March 23, 1998, to August 31, 2005. PARTICIPANTS A total of 754 persons, 70 years or older, who were evaluated at 18-month intervals for 72 months. MAIN OUTCOME MEASURES The 3 outcome states were depressed, nondepressed, and death, with scores of 20 or more and less than 20 on the Center for Epidemiological Studies Depression Scale denoting depressed and nondepressed, respectively. The association between sex and the likelihood of 6 possible transitions (namely, from nondepressed or depressed to nondepressed, depressed, or death) was evaluated over time. RESULTS The prevalence of depression was substantially higher among women than men at each of the 5 time points (P < .001). In most cases, transitions between the nondepressed and depressed states were characterized by moderate to large absolute changes in depression scores (ie, > or = 10 points). Adjusting for other demographic characteristics, women had a higher likelihood of transitioning from nondepressed to depressed (odds ratio, 2.02; 95% confidence interval, 1.39-2.94) and a lower likelihood of transitioning from depressed to nondepressed (odds ratio, 0.27; 95% confidence interval, 0.13-0.56) or death (odds ratio, 0.24; 95% confidence interval, 0.09-0.60). CONCLUSION Among older persons, the higher burden of depression in women than men seems to be attributable to a greater susceptibility to depression and, once depressed, to more persistent depression and a lower probability of death.
Collapse
Affiliation(s)
- Lisa C Barry
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
| | | | | | | | | |
Collapse
|
22
|
Vink D, Aartsen MJ, Schoevers RA. Risk factors for anxiety and depression in the elderly: a review. J Affect Disord 2008; 106:29-44. [PMID: 17707515 DOI: 10.1016/j.jad.2007.06.005] [Citation(s) in RCA: 324] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 06/12/2007] [Accepted: 06/13/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although a number of studies have examined risk factors for anxiety and depression at a later age, there have been no systematic comparisons of risk profiles across studies. Knowledge on such risk profiles may further our understanding of both the etiology and early recognition of these highly prevalent disorders. This paper gives a comprehensive overview and compares risk factors associated with anxiety and depression in the elderly. METHODS The databases MEDLINE, PsycINFO and Sociological Abstracts were systematically searched, and relevant English-language articles from January 1995 to December 2005 were reviewed. Cross-sectional and longitudinal studies on risk factors in elderly from a community or primary care setting were included. The associations between risk factors and pure anxiety or depressive symptoms or disorders were summarized and compared. RESULTS The abstracted risk factors from studies on anxiety (N=17) and depression (N=71) were clustered into the categories biological, psychological and social. Although risk factors for anxiety and depression showed many similarities, some differences were found. Biological factors may be more important in predicting depression, and a differential effect of social factors on depression and anxiety was found. LIMITATION Due to a high heterogeneity between studies, no meta-analysis could be conducted. CONCLUSIONS There is considerable overlap between the risk profiles for anxiety and depression in the elderly, which suggests a dimensional approach on the interrelationship between anxiety and depression is more appropriate. To improve the recognition and preventive mental health programs, a clearer understanding of differentiating etiological factors will be needed.
Collapse
Affiliation(s)
- Dagmar Vink
- Knowledge Centre of Psychiatry in the Elderly, Oude Arnhemseweg 260, 3705 BK Zeist, The Netherlands.
| | | | | |
Collapse
|
23
|
Abstract
Anxiety symptoms are frequently present in patients with late-life depression. The designation “anxious depression” has been used to describe major depressive disorder (MDD) accompanied by clinically significant but subsyndromal anxiety symptoms. MDD may also present comorbid with diagnosable anxiety disorders, although this presentation is less common in late life. Diagnosis of anxious depression in the elderly is complicated by several factors (eg, their tendency to experience and report psychiatric symptoms as somatic illness) and is associated with a more severe clinical presentation, increased risk for suicidal ideation, increased disability, and poorer prognosis. Standard pharmacotherapy for depression may be sufficient but for many patients must be modified or augmented. Psychosocial interventions may also be an important component in the treatment of these patients, although no specific psychosocial treatments have been developed for late-life anxious depression.
Collapse
Affiliation(s)
- Gretchen J Diefenbach
- Anxiety Disorders Center, Hartford Hospital, Institute of Living, Hartford, CT 06106, USA.
| | | |
Collapse
|
24
|
Abstract
OBJECTIVES The aim of this study was to investigate factors associated with depression among men and women aged 85 and over. METHOD A population-based study was undertaken in northern Sweden. Out of 527 eligible participants, aged 85, 90 or > or = 95, 363 were evaluated for depression. Data were collected from structured interviews, assessments and medical charts and from relatives and caregivers. Depression was screened for using the Geriatric Depression Scale-15 and further assessed using the Montgomerysberg Depression Rating Scale (MADRS). RESULTS A higher proportion of women were diagnosed with depression (33% vs. 18.6%, p = 0.006). In both men and women experienced loneliness (OR 3.4 vs. 7.0) and not going outside independently (OR 2.6 vs. 26.0) were associated with depression in the final regression model. Depression among men was also independently associated with loss of a child/children during the preceeding ten years (OR 30.0). CONCLUSION Depression was more common among women than among men. Experienced loneliness and not going outside independently seem to be closely related to depression in both men and women. Loss of a child seems to be the most important factor among men.
Collapse
Affiliation(s)
- Ellinor Bergdahl
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
| | | | | | | | | |
Collapse
|
25
|
Abstract
INTRODUCTION The aim was to compare an urban and a rural old population regarding depression. METHOD A population-based, cross-sectional study in five depopulated areas and one expanding urban city in northern Sweden. Participants aged 85 and above were evaluated for depression. Data were collected from structured interviews and assessments and from relatives, caregivers and medical charts. Depression was screened for using the Geriatric Depression Scale-15 (GDS-15) and evaluated by the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS In total, 29% of the 363 participants were depressed (34% in the rural municipality and 27% in the urban municipality). Fifty-one percent versus 69% were receiving treatment with antidepressants. In the rural areas, those with depression were less frequently treated with selective serotonin reuptake inhibitor (SSRI) medications (36% versus 65%; p = 0.004), instead there were participants treated with Tri Cyclic Antidepressant's (TCA's) (10%, versus 0%; p = 0.0018). A larger proportion of the participants in the urban sample had responded to treatment (59% versus 27%; p = 0.175). CONCLUSION Depression in old age appears to be a common cause of emotional suffering among the oldest old. In the rural areas, depression was more often inadequately treated and it was also treated with inappropriate medications.
Collapse
Affiliation(s)
- E Bergdahl
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
| | | | | | | |
Collapse
|
26
|
Abstract
Depression and anxiety frequently coexist in the same individual, either concurrently or at different times, and numerous studies show that the presence of an anxiety disorder is the single strongest risk factor for development of depression. When the two coexist simultaneously, either as diagnosed disorders or subsyndromal states, they may be viewed as mixed anxiety-depression or as comorbid syndromes, i.e. separate disorders occurring concurrently. Controversy continues over the nature of the relationship between depression and anxiety, some believing they are distinct, separate entities while others - now the majority - view them as overlapping syndromes that present at different points on a phenomenological and/or chronological continuum, and share a common neurobiology, the degree of overlap depending on whether each is described at the level of symptoms, syndrome or diagnosis. Community data likely underestimate true prevalence, since affected individuals frequently present in primary care with somatic, rather than psychological, complaints. Irrespective of the nature of the relationship, patients with both disorders experience significant vocational and interpersonal impairment, and more frequent recurrence, with greater likelihood of suicide, than individuals with single disorders. Various classes of antidepressant drugs offer symptom relief for these patients, the most selective of th SSRIs holding the greatest promise for sustained clinical improvement. Yet, the crucial parameter of successful pharmacotherapy seems to be the length of treatment, ensuring enhancement of the compromised neuroprotective and neuroplastic mechanisms. Further clarification of the relationship is a prerequisite for offering effective treatment to the many patients who experience lifetime depression and anxiety.
Collapse
Affiliation(s)
- Luchezar G Hranov
- Department of Psychiatry, Medical University of Sofia, Sofia, Bulgaria
| |
Collapse
|
27
|
Friedman B, Conwell Y, Delavan RL. Correlates of late-life major depression: a comparison of urban and rural primary care patients. Am J Geriatr Psychiatry 2007; 15:28-41. [PMID: 17194813 DOI: 10.1097/01.jgp.0000224732.74767.ad] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether factors associated with depression differ between elderly residents of rural and urban areas. METHODS The research design was cross-sectional and observational. The study subjects consisted of 926 Medicare primary care patients (650 urban and 276 rural) who were age 65+ and cognitively intact and had enrolled in a randomized, controlled Medicare demonstration. Major depression was identified by the Mini International Neuropsychiatric Interview. A logistic regression model was estimated that included a rural-urban indicator variable, additional independent variables, and interaction terms between the rural-urban indicator and independent variables that were significant at p <0.10. RESULTS A total of 8.3% of the rural and 14.8% of the urban patients were identified as having major depression. Reporting 0-1 close friends (odds ratio [OR]: 6.86; 95% confidence interval [CI]: 2.18-21.58), 2+ emergency room visits during the past 6 months (OR: 4.00; 95% CI: 1.19-13.43), and more financial strain (OR: 1.50; 95% CI: 1.01-2.23) were associated with significantly higher likelihood of major depression among rural as compared with urban patients. The SF-36 Physical Component Summary score had a curvilinear relationship with major depression and was higher for urban patients. The predicted probability for major depression is lower for the rural patients when financial strain is low, about the same for rural and urban patients when strain is intermediate, and higher for rural patients when strain is high. CONCLUSIONS Clinicians in rural areas should be vigilant for major depression among patients with very few close friends, several recent emergency department visits, and financial strain.
Collapse
Affiliation(s)
- Bruce Friedman
- Department of Community Medicine, University of Rochester Medical Center, Rochester, New York, USA.
| | | | | |
Collapse
|
28
|
Abstract
Major depressive disorder is a potentially debilitating condition that often is unrecognized or undertreated in the elderly. Even when aggressively treated, the course of geriatric depression can be severe. There is growing evidence that suggests that late-life depression may carry a higher illness burden than depression with onset earlier in life, and that severity is linked to medical and psychiatric comorbidity. Data continue to accumulate in support of various treatment modalities, including medication, electroconvulsive therapy, and psychotherapy. Given the increased risk of adverse outcomes associated with geriatric depression, such as dementia and suicide, it is essential that future investigations continue to build on the evidence base supporting improved diagnosis and treatment of this complex disorder.
Collapse
Affiliation(s)
- Robert Kohn
- Brown University, Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA.
| | | |
Collapse
|
29
|
Harris T, Cook DG, Victor C, DeWilde S, Beighton C. Onset and persistence of depression in older people--results from a 2-year community follow-up study. Age Ageing 2006; 35:25-32. [PMID: 16303774 DOI: 10.1093/ageing/afi216] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND baseline physical health, disability and social support have been shown to predict depression onset, but findings for persistence are inconsistent. For onset and persistence of depression, the effect of changes in these risk factors over time is unclear. OBJECTIVE to use baseline factors and change in factors over time to predict onset and persistence of depression over a 2-year period. METHODS a prospective cohort study with index assessment and 2-year follow-up of patients initially aged > or =65 years registered with two South London practices (n = 1,164). Depression was defined by a score >5/15 on the 15-item Geriatric Depression Scale. Associations between risk factors and onset and persistence of depression were analysed using multiple logistic regression. RESULTS the incidence of depression was 8.4%, while depression persisted amongst 61.2% of those depressed at baseline. Comparing onset and persistence suggested some common predictors: greater baseline depression score; and follow-up measures of poor general health and compromised social support. There was some evidence that pain and worsening disability were more important for depression onset. In contrast, low baseline belief in powerful others (health locus of control measure) predicted persistence only. CONCLUSION focusing on older people with increasing disability, pain, physical ill-health and compromised social support should help in both the prevention and recognition of onset of later-life depression. In older people with depression, those with the highest symptom scores and low belief in powerful others at baseline were more likely to develop chronic symptoms and could be targeted for more intensive treatment and support.
Collapse
Affiliation(s)
- Tess Harris
- St George's University of London (SGUL), Cranmer Terrace, Tooting, London SW17 0RE, UK.
| | | | | | | | | |
Collapse
|
30
|
Smalbrugge M, Jongenelis L, Pot AM, Beekman ATF, Eefsting JA. Comorbidity of depression and anxiety in nursing home patients. Int J Geriatr Psychiatry 2005; 20:218-26. [PMID: 15717344 DOI: 10.1002/gps.1269] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To assess the occurrence and risk indicators of depression, anxiety, and comorbid anxiety and depression among nursing home patients and to determine whether depression and anxiety are best described in a dimensional or in a categorical classification system. METHODS DSM and subthreshold anxiety disorders, anxiety symptoms, major and minor depression and depressive symptoms were assessed in 333 nursing home patients of somatic wards of 14 nursing homes in the north west of the Netherlands with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Geriatric Depression Scale (GDS). Comorbidity was studied along a severity gradient. Logistic regression analyses were carried out to identify demographic, health-related, psychosocial and care-related correlates of anxiety and depression. RESULTS The prevalence of pure depression (PD) was 17.1%, of pure anxiety (PA) 4.8%, and of comorbid anxiety and depression (CAD) 5.1%. Comorbidity increased dependent on severity of both anxiety and depression. Different patterns of risk indicators were demonstrated for PA, PD and CAD for the investigated baseline characteristics. CONCLUSIONS Comorbidity of anxiety and depression is most prevalent in the more severe depressive and anxious nursing home patients. The gradual increase of comorbidity of anxiety and depression dependent on the levels of severity of depression and anxiety suggests that for nursing home patients a dimensional classification of depression and anxiety is more appropriate than a categorical one. The observed differences in patterns of risk indicators for PA, PD and CAD support a distinguishing of anxiety and depression. Future studies are needed to assess the effect of treatment of PA, PD and CAD in nursing home patients.
Collapse
Affiliation(s)
- Martin Smalbrugge
- Department of Nursing Home Medicine, VU University Medical Center in Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
31
|
Mecocci P, Cherubini A, Mariani E, Ruggiero C, Senin U. Depression in the elderly: new concepts and therapeutic approaches. Aging Clin Exp Res 2004; 16:176-89. [PMID: 15462460 DOI: 10.1007/bf03327382] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is one of the leading causes of suffering in the elderly, but it is often under-diagnosed and under-treated, partly due to the false belief that depression is a common aspect of aging. Depression in the elderly is frequently comorbid with medical illnesses, may often be expressed by somatic complaints, and may be a risk factor for other diseases such as dementia and coronary artery disease. Depression decreases the quality of life and increases disability and the risk of mortality, also due to suicide. Although several effective antidepressant drugs are available, with a favorable therapeutic index, non-pharmacological treatments, such as psychotherapy and exercise, should receive greater attention, since combination therapy is probably more effective.
Collapse
Affiliation(s)
- Patrizia Mecocci
- Section of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
| | | | | | | | | |
Collapse
|