Joint modeling of longitudinal changes in depressive symptoms and mortality in a sample of community-dwelling elderly people

Protocol for an observational cohort study on psychological, addictive, lifestyle behavior and highly prevalent affective disorders in primary health care adults

Background

Depression and anxious symptoms are prevalent in the general population, and their onset and persistence may be linked to biological and psychosocial factors, many of which are lifestyle-related. The way we manage our care, physical and emotional health and/or discomfort is highly influenced by our own abilities, skills and attitudes despite life's circumstances. The main aim of this protocol to analyze the relationship between psychological constructs (self-efficacy, activation, health literacy, resilience, personality traits, sense of coherence, self-esteem), and the presence of affective-emotional problems (anxiety, depression) and addictions in primary health care.

Methods

This is a protocol of a prospective longitudinal cohort study including people of 35-74 years old of Aragon primary health care centers (Spain). Three evaluations will be conducted: baseline evaluation, and follow-up assessments five and ten years after recruitment. The primary outcomes will be severity of depression, severity of anxiety, and addictive behaviors. A detailed set of secondary outcomes will be assessed across all three assessments. This will include psychosocial or personal factors on health behavior, social support, lifestyle patterns, quality of life, the use of health and social resources, and chronic comorbid pathology.

Discussion

The analysis of the impact of psychological constructs and lifestyles on the mental health of people and communities will provide evidence that will make it possible to better address and prevent these prevalent problems and address their improvement from a more global and holistic perspective. The evaluation of psychological constructs should be incorporated into health services to improve people's ability their self-care, the level of knowledge of managing their disease and their physical, mental and social health.

Clinical trial registration

https://www.isrctn.com/, identifier ISRCTN12820058.

Sintomatologia depressiva e mortalidade em idosos da América Latina: uma revisão sistemática com metanálise

Objetivo.

Averiguar a associação entre sintomatologia depressiva e mortalidade em idosos da América Latina.

Métodos.

Realizou-se uma revisão sistemática com metanálise de estudos indexados nas bases PubMed, Scientific Electronic Library Online (SciELO), Web of Science, Cochrane Library, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). O estudo foi registrado na base PROSPERO (International Prospective Register of Systematic Reviews) e estruturado de acordo com o referencial metodológico PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A metanálise foi realizada usando modelos de efeitos aleatórios, e os dados analisados incluíram as medidas de risco relativo (RR) bruto e heterogeneidade, com estimativas pontuais e intervalos de confiança de 95% (IC95%).

Resultados.

Cinco estudos, realizados no Brasil e no México, foram incluídos na metanálise, abrangendo 8 954 idosos. O RR para mortalidade na presença de sintomatologia depressiva foi de 1,44 (IC95%: 1,16; 1,78). A heterogeneidade encontrada foi de 80,87%. As metarregressões mostraram que quanto maior a proporção de mulheres nas amostras dos estudos, maior o risco de mortalidade associada à sintomatologia depressiva, e quanto maior o tempo de acompanhamento do estudo, menor o risco de mortalidade associada à sintomatologia depressiva.

Conclusão.

A presença de sintomatologia depressiva associou-se positivamente à mortalidade em idosos latino-americanos, com RR de óbito 44% maior em relação aos idosos sem sintomatologia depressiva. As principais limitações do estudo foram o pequeno número de trabalhos encontrados na revisão sistemática e a variação entre as escalas utilizadas para determinar a presença de sintomatologia depressiva.

Depressive symptoms as an independent risk factor for mortality

OBJECTIVE

To evaluate the relationship between presence of depressive symptoms and risk of death in older adults residing in a municipality in Southern Brazil.

METHODS

Between 2009 and 2014, 1,391 people participated in the EpiFloripa Aging Cohort Study, a population-based longitudinal study. Depressive symptoms were assessed through the Geriatric Depression Scale. The initial time was considered the age at the first interview, and the end time, the age at the last contact or death. Cox regression models were used to estimate the mortality risk associated with depressive symptoms, adjusted by sex, education, income, paid work, smoking status, alcohol consumption, morbidities, medication use, physical activity, disability, cognitive impairment, and body mass index.

RESULTS

The prevalence of depressive symptoms was 23.5% (95%CI 20.4-26.9). On crude analysis, the risk of mortality was 1.86 (95%CI 1.35-2.55) for individuals with depressive symptoms; in adjusted models, the risk of mortality was 1.67 (95%CI 1.15-2.40).

CONCLUSION

Depressive symptoms are an independent risk factor for mortality in older Brazilian adults. Our findings highlight the importance of screening this population for depression and the practice of preventive actions.

The Geriatric Depression Scale: does it measure depressive mood, depressive affect, or both?

OBJECTIVE

Self-report measures of depression are highly important tools used in research and in various healthcare settings for the diagnosis of different levels of depression. The Geriatric Depression Scale (GDS) is the first and the most popular scale used to screen for late-life depression. It is endorsed by the Royal College of Physicians and the British Geriatric Society (1992). The purpose of the present research was to investigate whether scores on the GDS₁₅ capture depressive mood (i.e. trait depression), depressive affect (i.e. short-term depressive state), or both.

METHODS

For this purpose, a trait-state model (stable trait, autoregressive trait, and state model) was applied to GDS₁₅ scores obtained at four time points over a 6-year period among a sample of community-dwelling older persons (N = 753). This model allows decomposing the GDS₁₅ scores into three different variance components: stable trait variance, autoregressive trait variance, and state variance.

RESULTS

Our findings revealed a general pattern of a major proportion of stable trait (69%) and autoregressive trait (22%) variance and a very smaller amount of state variance (9%) in the GDS scores across 6 years. Age and gender (i.e. being female) were shown to be positively linked to more stable trait variance.

CONCLUSIONS

Depression, as assessed with the GDS₁₅ , should be regarded as a relatively stable and enduring trait construct, reflecting a stable core of a person's depressivity. The negligible amount of state elements in the variation of the GDS₁₅ scores provides evidence that changing the context will not be enough to cause significant changes in depressive symptoms. Copyright © 2016 John Wiley & Sons, Ltd.

Joint models for longitudinal and time-to-event data: a review of reporting quality with a view to meta-analysis

BACKGROUND

Joint models for longitudinal and time-to-event data are commonly used to simultaneously analyse correlated data in single study cases. Synthesis of evidence from multiple studies using meta-analysis is a natural next step but its feasibility depends heavily on the standard of reporting of joint models in the medical literature. During this review we aim to assess the current standard of reporting of joint models applied in the literature, and to determine whether current reporting standards would allow or hinder future aggregate data meta-analyses of model results.

METHODS

We undertook a literature review of non-methodological studies that involved joint modelling of longitudinal and time-to-event medical data. Study characteristics were extracted and an assessment of whether separate meta-analyses for longitudinal, time-to-event and association parameters were possible was made.

RESULTS

The 65 studies identified used a wide range of joint modelling methods in a selection of software. Identified studies concerned a variety of disease areas. The majority of studies reported adequate information to conduct a meta-analysis (67.7% for longitudinal parameter aggregate data meta-analysis, 69.2% for time-to-event parameter aggregate data meta-analysis, 76.9% for association parameter aggregate data meta-analysis). In some cases model structure was difficult to ascertain from the published reports.

CONCLUSIONS

Whilst extraction of sufficient information to permit meta-analyses was possible in a majority of cases, the standard of reporting of joint models should be maintained and improved. Recommendations for future practice include clear statement of model structure, of values of estimated parameters, of software used and of statistical methods applied.

Changes in life satisfaction when losing one's spouse: individual differences in anticipation, reaction, adaptation and longevity in the German Socio-economic Panel Study (SOEP)

Losing a spouse is among the most devastating events that may occur in people's lives. We use longitudinal data from 1,224 participants in the German Socio-economic Panel Study (SOEP) to examine (a) how life satisfaction changes with the experience of spousal loss; (b) whether socio-demographic factors and social and health resources moderate spousal loss-related changes in life satisfaction; and (c) whether extent of anticipation, reaction and adaptation to spousal loss are associated with mortality. Results reveal that life satisfaction shows anticipatory declines about two and a half years prior to (anticipation), steep declines in the months surrounding (reaction) and lower levels after spousal loss (adaptation). Older age was associated with steeper anticipatory declines, but less steep reactive declines. Additionally, younger age, better health, social participation and poorer partner health were associated with better adaptation. Higher pre-loss life satisfaction, less steep reactive declines and better adaptation were associated with longevity. The discussion focuses on the utility of examining the interrelatedness among anticipation, reaction and adaptation to further our understanding of change in life satisfaction in the context of major life events.

[Depression, anxiety, stress, and mortality]

The analytical paper summarizes the main results of recent investigations of the relationships of depression, anxiety, and stress with overall and cardiovascular mortality. It shows that depression and stress are associated with an increased risk of death mainly from cardiovascular diseases, and depression treatment and stress control can increase life expectancy.

Aging and religious participation in late life

The aim of the study is to evaluate the relationship between two dimensions of religiosity and the process of aging. Secondary analysis of longitudinal data from the Florida Retirement Study was used to assess the trajectories of religious development over time. We analyzed data from six interview waves with 1,000 older adults aged 72 or over. A baseline model of growth processes only indicated significant variation and mean decline in religious attendance, but no significant variation nor mean change in religious beliefs over time. A final model including a set of 17 covariates was estimated, and the model fit statistics indicated very good fit for this latent growth curve model. The decline in mean religious attendance across time did not accompany a mean increase in religious beliefs as expected. There were numerous individual differences in the trajectory of decline for religious attendance, as well as in the initial levels of attendance and religious beliefs.

Ageing and trajectories of depressive symptoms in community-dwelling men and women

OBJECTIVE

The aim of this study was to investigate age-related patterns of depressive symptoms in older men and women and to identify their determinants.

METHODS

The Center for Epidemiological Studies Depression Scale was used to prospectively assess depressive symptoms in 1059 men and 1531 women, enrolled in a French representative population-based cohort (PAQUID study) and followed over a period of 20 years. Using a group-based trajectory method with an accelerated longitudinal design, we modelled the course of depressive symptoms between 65 and 104 years of age and examined associations between trajectory patterns and baseline socio-demographic and health variables.

RESULTS

In men, we identified three rising trajectories: 'never depressed' including 65% of the sample, 'emerging depression' (28%) and 'increasing depression' (7%). Compared with the membership of the never-depressed trajectory, that of the two higher trajectories was significantly associated with a history of depression and dyspnoea. In women, we identified two slightly rising trajectories (never depressed, 56%, and 'rising subclinical', 33%) and one stable high trajectory ('persistent depression', 11%). Membership of the two higher trajectories was significantly associated with the use of benzodiazepine, polymedication and dyspnoea. A history of nondepressive psychiatric disorder was a risk factor for membership of the persistent-depression group, whereas being widowed seemed to be a protective factor for membership of this group.

CONCLUSION

High-risk groups for later-life depression should be targeted differently in older men and women in order to implement appropriate interventions to prevent chronicity and disability.

An exploration of the dynamic longitudinal relationship between mental health and alcohol consumption: a prospective cohort study

BACKGROUND

Despite intense investigation, the temporal sequence between alcohol consumption and mental health remains unclear. This study explored the relationship between alcohol consumption and mental health over multiple occasions, and compared a series of competing theoretical models to determine which best reflected the association between the two.

METHODS

Data from phases 5 (1997 to 1999), 7 (2002 to 2004), and 9 (2007 to 2009) of the Whitehall II prospective cohort study were used, providing approximately 10 years of follow-up for 6,330 participants (73% men; mean ± SD age 55.8 ± 6.0 years). Mental health was assessed using the Short Form (SF)-36 mental health component score. Alcohol consumption was defined as the number of UK units of alcohol drunk per week. Four dynamic latent change score models were compared: 1) a baseline model in which alcohol consumption and mental health trajectories did not influence each other, 2) and model in which alcohol consumption influenced changes in mental health but mental health exerted no effect on changes in drinking and 3) vice versa, and (4) a reciprocal model in which both variables influenced changes in each other.

RESULTS

The third model, in which mental health influenced changes in alcohol consumption but not vice versa, was the best fit. In this model, the effect of previous mental health on upcoming change in alcohol consumption was negative (γ = -0.31, 95% CI -0.52 to -0.10), meaning that those with better mental health tended to make greater reductions (or shallower increases) in their drinking between occasions.

CONCLUSIONS

Mental health appears to be the leading indicator of change in the dynamic longitudinal relationship between mental health and weekly alcohol consumption in this sample of middle-aged adults. In addition to fuelling increases in alcohol consumption among low-level consumers, poor mental health may also be a maintaining factor for heavy alcohol consumption. Future work should seek to examine whether there are critical levels of alcohol intake at which different dynamic relationships begin to emerge between alcohol-related measures and mental health.

Depressive symptoms as an independent risk factor for mortality in elderly persons: results of a national longitudinal study

OBJECTIVE

Depressive symptoms have been associated with increased mortality risk in previous cohort studies, but there is a paucity of research on Asian elderly in recent years. The authors investigated the depression-mortality link using data from a representative national cohort.

METHODS

Data came from the Survey of Health and Living Status of the Elderly in Taiwan. A cohort of 2416 men and women in Taiwan aged 65 or older were followed up for eight years from 1999 to 2007. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale. The mortality risk of depression was computed after adjustment for a variety of covariates. Data on the presence or absence of chronic diseases were further analyzed.

RESULTS

Overall, depressive symptoms were associated with all-cause mortality (hazard ratio (HR), 1.21; 95% confidence interval (CI), 1.03-1.42) after eight years follow-up, but this mortality risk was detected in men only (HR, 1.27; 95% CI, 1.03-1.56), not in women (HR, 1.1; 95% CI, 0.86-1.4). Further analyses showed that in the group without chronic diseases (without diabetes mellitus, stroke, lung disease, cancer, or cognitive impairment), depressive symptoms were associated with mortality (HR, 1.40; 95% CI, 1.12-1.76) after eight years follow-up; however, there was no association between depressive symptoms and mortality in participants with chronic diseases (HR, 1.02; 95% CI, 0.82-1.26).

CONCLUSION

Depressive symptoms are an independent risk factor for mortality in the elderly. Elderly depressive men and elderly without chronic diseases seemed to have a greater mortality risk.

Altruism, helping, and volunteering: pathways to well-being in late life

OBJECTIVE

We examined the influence of prosocial orientations including altruism, volunteering, and informal helping on positive and negative well-being outcomes among retirement community dwelling elders.

METHOD

We utilize data from 2 waves, 3 years apart, of a panel study of successful aging (N = 585). Psychosocial well-being outcomes measured include life satisfaction, positive affect, negative affect, and depressive symptomatology.

RESULTS

Ordinal logistic regression results indicate that altruistic attitudes, volunteering, and informal helping behaviors make unique contributions to the maintenance of life satisfaction, positive affect and other well being outcomes considered in this research. Predictors explain variance primarily in the positive indicators of psychological well-being, but are not significantly associated with the negative outcomes. Female gender and functional limitations are also associated with diminished psychological well-being.

DISCUSSION

Our findings underscore the value of altruistic attitudes as important additional predictors, along with prosocial behaviors in fostering life satisfaction and positive affect in old age.

Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

BACKGROUND

Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.

METHOD

As part of a prospective, population-based study on a random sample of 5632 subjects aged 65-84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.

RESULTS

Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15-1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32-0.95; men MHR 0.59, 95% CI 0.37-0.93). Neither sociodemographic nor medical confounders significantly modified these associations.

CONCLUSIONS

Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

Course of depression and mortality among older primary care patients

CONTEXT

: Depression is a treatable illness that disproportionately places older adults at increased risk for mortality.

OBJECTIVE

: We sought to examine whether there are patterns of course of depression severity among older primary care patients that are associated with increased risk for mortality.

DESIGN AND SETTING

: Our study was a secondary analysis of data from a practice-based randomized controlled trial within 20 primary care practices located in greater New York City, Philadelphia, and Pittsburgh.

PARTICIPANTS

: The study sample consisted of 599 adults aged 60 years and older recruited from primary care settings. Participants were identified though a two-stage, age-stratified (60-74 years; older than 75 years) depression screening of randomly sampled patients. Severity of depression was assessed using the 24-item Hamilton Depression Rating Scale (HDRS).

MEASUREMENTS

: Longitudinal analysis via growth curve mixture modeling was carried out to classify patterns of course of depression severity across 12 months. Vital status at 5 years was ascertained via the National Death Index Plus.

RESULTS

: Three patterns of change in course of depression severity over 12 months were identified: 1) persistent depressive symptoms, 2) high but declining depressive symptoms, 3) low and declining depressive symptoms. After a median follow-up of 52.0 months, 114 patients had died. Patients with persistent depressive symptoms were more likely to have died compared with patients with a course of high but declining depressive symptoms (adjusted hazard ratio 2.32, 95% confidence interval [1.15-4.69]).

CONCLUSIONS

: Persistent depressive symptoms signaled increased risk of dying in older primary care patients, even after adjustment for potentially influential characteristics such as age, smoking status, and medical comorbidity.

The combination of depressive symptoms and smoking shorten life expectancy among the aged

BACKGROUND

Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors.

METHODS

A cohort of elderly people (N = 167) was followed-up for ten years. Information on socio-demographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality.

RESULTS

Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05-2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28-5.31), after controlling for potential confounders.

CONCLUSIONS

Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.

Relationship between the course of depression symptoms and the left ventricular mass index and left ventricular filling pressure in chronic haemodialysis patients

AIM

Multiple measurements of depression symptoms over time were more predictive of cardiovascular mortality than a single time measurement performed at baseline. The aim of this study is to evaluate the association of the course of depression symptoms, based on repeated assessments of depression symptoms over time, with left ventricular mass index (LVMI) and left ventricular filling pressure (LVFP) in patients on haemodialysis (HD).

METHODS

The level of depression symptoms in 61 patients on HD were prospectively assessed using the Beck Depression Inventory (BDI) at baseline and at three intervals (5, 10, 15 months). Doppler echocardiographic examinations were performed at the end of follow up.

RESULTS

At the end of follow up, the patients were divided into three groups according to their course of depression symptoms: non-depression (n = 21), intermittent depression (n = 23) and persistent depression (n = 17). LVMI and LVFP were significantly increased in the persistent depression symptoms group compared to those of the non-depression symptoms group and the intermittent depression symptoms group. Persistent depression symptoms were independently associated with LVMI (β-coefficient = 0.347, P = 0.017) and LVFP (β-coefficient = 0.274, P = 0.048) after adjustment for age, sex, systolic blood pressure, diastolic blood pressure, diabetes and interdialytic weight gain.

CONCLUSION

In our study, persistent depression symptoms were associated with left ventricular hypertrophy and diastolic dysfunction. Our data may provide a more complete understanding of cardiovascular risk associated with depression symptoms in patients on HD.

[Investigation of whether depressive status contributes to mortality and hospitalization in community-dwelling dependent older people]

AIM

In our aging society, the number of community-dwelling dependent elderly people is increasing. Many studies have shown that depression influences the health of older persons. In the present study, we examined whether depressive status is associated with mortality and hospitalization in community-dwelling dependent older people during a 3-year follow-up period.

METHODS

This study was a prospective cohort analysis of 1,409 community-dwelling disabled elderly (489 men, 920 women; average age 80.1, the Nagoya Longitudinal Study for Frail Elderly). Data included demographic characteristics, basic activities of daily living (ADL) scores, comorbidity, and depressive status as assessed by the short version of the Geriatric Depression Scale (GDS-15) at baseline. The participants were considered to have depression or severe depression if their GDS-15 score was 6-10 or above 10, respectively. The Cox proportional hazard model and the Kaplan-Meier method were used to assess any association with depressive status at baseline with mortality or hospitalization during a 3-year period.

RESULTS

During a 3-year observation, 284 participants died (53 at home, 231 at hospital), and 576 were admitted to hospitals. Univariate analysis revealed that the depressive status of participants was associated with mortality and hospitalization during a 3-year follow up. However, multivariate models used to adjust for potential confounders including gender, age, ADL status, and comorbidity, did not show any association between depressive status and mortality and hospitalization.

CONCLUSIONS

Depressive status among community-dwelling disabled elderly was not associated with mortality or hospitalization in the present series.