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Bartels C, Abdel-Hamid M, Wiltfang J, Schneider A, Belz M. Antidepressant Effects of a Multimodal Group Therapy Program for Mild Dementia: A Retrospective Evaluation of Clinical Routine Data. J Alzheimers Dis 2022; 90:1725-1737. [PMID: 36336930 DOI: 10.3233/jad-220578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The multimodal CORDIAL treatment concept for mild dementia, combining cognitive rehabilitation, cognitive behavioral and humanistic psychology interventions, has proven its feasibility and demonstrated a reduction of depressive symptoms in individual dyadic/triadic settings. OBJECTIVE We investigate antidepressant effects of an adapted group-based CORDIAL program in clinical routine care. METHODS During 2013 and 2017, 51 outpatients with mild dementia (45% female, mean age 72.4 years, 67% Alzheimer's dementia, mean MMST 24.8) periodically received a modified CORDIAL group treatment as part of our regular outpatient care. Treatment comprised 10 bi-weekly sessions, partly involving caregivers. Systematic pre- and post-treatment assessments of clinical routine data were evaluated retrospectively (median time-interval of 6.6 months). RESULTS Depressive symptoms as measured by the Geriatric Depression Scale significantly decreased over time (p = 0.007, Cohen's d = 0.39), and irrespective of gender. Patients with longer disease duration before treatment start showed significantly higher initial levels of depressive symptoms (p = 0.044), followed by a reduction to a level of those with shorter disease duration (ns). Most secondary outcomes (cognitive symptoms, disease severity, quality of life, caregiver burden) remained unchanged (ns), while competence in activities of daily living declined from pre- to post-measurement (p = 0.033). CONCLUSION A group-based CORDIAL treatment is feasible in a clinical routine setting and demonstrated antidepressant effects comparable to those of the individual treatment design, further suggesting its implementation in regular care. Future trials might also investigate its potentially preventive effects by reducing depressive symptoms in pre-dementia stages, even at a subsyndromal level.
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Affiliation(s)
- Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.,Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, LVR-Hospital Essen, Essen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany.,Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Michael Belz
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
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Abstract
AIMS Retirement is a major life transition that may improve or worsen mental health, including depression. Existing studies provide contradictory results. We conducted a systematic review with meta-analysis to quantitatively pool available evidence on the association of retirement and depressive symptoms. METHODS We applied PRISMA guidelines to conduct a systematic review and meta-analysis to retrieve, quantitatively pool and critically evaluate the association between retirement and both incident and prevalent depression and to understand better the potential role of individual and contextual-level determinants. Relevant original studies were identified by searching PubMed, Embase, PsycINFO and the Cochrane Library, through 4 March 2021. Subgroup and sensitivity meta-analyses were conducted by gender, study design (longitudinal v. cross-sectional studies), study quality score (QS) and considering studies using validated scales to diagnose depression. Heterogeneity between studies was evaluated with I2 statistics. RESULTS Forty-one original studies met our a priori defined inclusion criteria. Meta-analysis on more than half a million subjects (n = 557 111) from 60 datasets suggested a protective effect of retirement on the risk of depression [effect size (ES) = 0.83, 95% confidence interval (CI) = 0.74-0.93], although with high statistical heterogeneity between risk estimates (χ2 = 895.19, df = 59, I2 = 93.41%, p-value < 0.0001). Funnel plot asymmetry and trim and fill method suggested a minor potential publication bias. Results were consistent, confirm their robustness and suggest stronger protective effects when progressively restricting the included studies based on quality criteria: (i) studies with the highest QS [55 datasets, 407 086 subjects, ES = 0.81, 95% CI = 0.71-0.91], (ii) studies with a high QS and using validated assessment tools to diagnose depression (44 datasets, 239 453 subjects, ES = 0.76, 95% CI = 0.65-0.88) and (iii) studies of high quality, using a validated tool and with a longitudinal design (24 datasets, 162 004 subjects, ES = 0.76, 95% CI = 0.64-0.90). We observed a progressive reduction in funnel plot asymmetry. About gender, no statistically significant difference was found (females ES = 0.79, 95% CI = 0.61-1.02 v. men ES = 0.87, 95% CI = 0.68-1.11). CONCLUSIONS Pooled data suggested that retirement reduces by nearly 20% the risk of depression; such estimates got stronger when limiting the analysis to longitudinal and high-quality studies, even if results are affected by high heterogeneity.As retirement seems to have an independent and protective effect on mental health and depressive symptoms, greater flexibility in retirement timing should be granted to older workers to reduce their mental burden and avoid the development of severe depression. Retirement may also be identified as a target moment for preventive interventions, particularly primary and secondary prevention, to promote health and wellbeing in older ages, boosting the observed impact.
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3
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Alabdulgader A, Mobarki AO, AlDuwayrij A, Albadran A, Almulhim MI, Almulhim A. Depression Screening for the Geriatric Population Visiting Primary Healthcare Centers in the Eastern Region of Saudi Arabia. Cureus 2021; 13:e17971. [PMID: 34667660 PMCID: PMC8516422 DOI: 10.7759/cureus.17971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/05/2022] Open
Abstract
Background Depression is considered one of the most common psychiatric disorders that affects more than 260 million people in all age groups worldwide. Yet, among the geriatric population, in which it can show nonspecific symptoms, depression can be easily underdiagnosed. The objectives of this study are to assess the prevalence of depression among the geriatric population in primary healthcare centers and to estimate the effects of different sociodemographic and medical factors. Methodology A total of 408 patients aged 60 years or older were approached in the primary healthcare centers of the eastern region of Saudi Arabia. Using the Patient Health Questionnaire-9, patients were either interviewed or filled the questionnaire by themselves. Questions about sociodemographic data and medical and medication histories were included in the questionnaire. Results Of the 408 participants, 173 (42.4%) reported depressive symptoms; 115 (28.2%) of the participants had mild depression, 50 (12.3%) had moderate depression, and 8 (2%) reported moderately severe depression. Correlates of depression included elderly patients aged 75 years or more, of whom 78.9% showed depression compared to 39.3% of those who were 60-65 years old (P = 0.001). Furthermore, the female elderly showed higher rates of depression compared to males (52.8% vs. 35.7%; P = 0.001). A reported 81.1% of the elderly were diagnosed with chronic diseases; approximately half of them were depressed, while only 32.9% of the elderly free of diseases were depressed (P = 0.001). Conclusions The prevalence of depression is high among the elderly in the eastern province of Saudi Arabia, especially in those who complain of chronic diseases, older patients, and females. Screening for depression must be employed early to manage depressive symptoms and prevent further complications.
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Affiliation(s)
- Abdulrhman Alabdulgader
- Internal Medicine, King Abdulaziz Medical City Riyadh, Ministry of the National Guard-Health Affairs, Riyadh, SAU
| | - Ali O Mobarki
- Medicine and Surgery, King Faisal University, Al Ahsa, SAU
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Resnick B, Boltz M, Galik E, Zhu S. The Impact of Cognitive impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings. Clin Nurs Res 2021; 31:310-319. [PMID: 34472369 DOI: 10.1177/10547738211040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to describe differences in pain, behavioral symptoms, quality of staff-resident interactions, participation in function focused care and physical activity among residents with and without cognitive impairment in assisted living. This was a secondary data analysis using baseline data from an ongoing trial testing Function Focused Care for Assisted Living using the Evidence Integration Triangle (FFC-AL-EIT). A total of 550 residents were recruited from 59 communities. The average age of participants was 89.30 (SD = 7.63), the majority were white (98%), female (69%), had evidence of cognitive impairment (75%), and 5.16 (SD = 1.86) comorbidities. Those with cognitive impairment had more pain, were more sedentary and less likely to engage in function focused care activities. Addressing pain and implementing interventions for those with cognitive impairment to participate in function focused care may help optimize function and physical activity in assisted living residents.
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Affiliation(s)
| | - Marie Boltz
- Pennsylvania State University, University Park, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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5
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Subjective memory complaints and future depression in primary care patients: A four-year follow-up study. Gen Hosp Psychiatry 2018; 55:4-9. [PMID: 30176576 DOI: 10.1016/j.genhosppsych.2018.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the predictive value of subjective memory complaints (SMCs) for having a hospital-based diagnosis of a single depressive episode over a four-year follow-up period. METHODS A prospective register-based cohort study in general practice. All 17 practices in Inner city Copenhagen participated in the study. They had 40,865 registered patients, 2934 aged 65 years or older. Information on SMCs and socio-demographics was collected during two months at enrolment in primary care. Diagnoses of single depressive episodes were retrieved from the Danish Psychiatric Central Research Register. Cox proportional hazard regression models were used to examine risk factors for a hospital-based diagnosis of a single depressive episode. RESULTS 758 patients aged 65 years or older consulted their GP in October and November 2002. According to our definition, 177 (23%) had SMCs at enrolment, 12 (6.9%) of whom received a diagnosis of a single depressive episode within the follow-up period. In three multivariate models, SMCs were significantly associated with single depressive episodes. In the fully controlled model SMCs had a hazard ratio (HR) of 2.59 for receiving a subsequent depression diagnosis. CONCLUSIONS In an older general practice population, SMCs are associated with increased risk of receiving a hospital-based diagnosis of a single depressive episode.
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Tranah GJ, Maglione JE, Yaffe K, Katzman SM, Manini TM, Kritchevsky S, Newman AB, Harris TB, Cummings SR. Mitochondrial DNA m.13514G>A heteroplasmy is associated with depressive symptoms in the elderly. Int J Geriatr Psychiatry 2018; 33:1319-1326. [PMID: 29984425 DOI: 10.1002/gps.4928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Mitochondrial DNA (mtDNA) heteroplasmy is a mixture of normal and mutated mtDNA molecules in a cell. High levels of heteroplasmy at several mtDNA sites in complex I lead to inherited neurological neurologic diseases and brain magnetic resonance imaging (MRI) abnormalities. Here, we test the hypothesis that mtDNA heteroplasmy at these complex I sites is associated with depressive symptoms in the elderly. METHODS We examined platelet mtDNA heteroplasmy for associations with depressive symptoms among 137 participants over age 70 from the community-based Health, Aging and Body Composition Study. Depressive symptoms were assessed using the 10-point version of the Center for Epidemiologic Studies Depression Scale (CES-D 10). Complete mtDNA sequencing was performed and heteroplasmy derived for 5 mtDNA sites associated with neurologic mitochondrial diseases and tested for associations with depressive symptoms. RESULTS Of 5 candidate complex I mtDNA mutations examined for effects on depressive symptoms, increased heteroplasmy at m.13514A>G, ND5, was significantly associated with higher CES-D score (P = .01). A statistically significant interaction between m.13514A > G heteroplasmy and sex was detected (P = .04); in sex-stratified analyses, the impact of m.13514A>G heteroplasmy was stronger in male (P = .003) than in female (P = .98) participants. Men in highest tertile of mtDNA heteroplasmy exhibited significantly higher (P = .0001) mean ± SE CES-D 10 scores, 5.37 ± 0.58, when compared with those in the middle, 2.13 ± 0.52, and lowest tertiles, 2.47 ± 0.58. No associations between the 4 other candidate sites and depressive symptoms were observed. CONCLUSIONS Increased mtDNA heteroplasmy at m.13514A>G is associated with depressive symptoms in older men. Heteroplasmy may represent a novel biological risk factor for depression.
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Affiliation(s)
- Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, San Francisco, CA, USA
| | - Jeanne E Maglione
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Kristine Yaffe
- University of California, San Francisco, Departments of Psychiatry, Neurology, and Epidemiology, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | | | - Todd M Manini
- University of Florida, Department of Aging and Geriatric Research, Gainesville, FL, USA
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Sticht Center on Aging, Winston-Salem, NC, USA
| | - Anne B Newman
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
| | - Tamara B Harris
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, San Francisco, CA, USA
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Avila-Funes JA, Zamudio-Rodríguez A, Muñoz-Nevárez LA, Belaunzarán-Zamudio PF, Díaz-Ramos JA, Alcala-Zermeno JL, Ouvrard C, Sierra-Madero J, Amieva H. Correlates of depressive symptoms among older adults living with HIV. Int J Geriatr Psychiatry 2018; 33:1260-1264. [PMID: 29896759 DOI: 10.1002/gps.4922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/04/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To establish the correlates of depressive symptoms among Mexican community-dwelling older people living with HIV (PLWHIV). METHODS Cross-sectional, 2-center study of 328 participants aged 50 or older being followed in the outpatient HIV clinics of 2 tertiary care hospitals in Mexico. Data were obtained through a comprehensive geriatric assessment. Multivariate logistic regression analyses were performed to identify the correlates of depressive symptoms. RESULTS Mean age of participants was 58.4 years (SD = 7.2), and 82.9% were men. Depressive symptoms were present in 15.9% of participants. The multivariate logistic regression models showed that frailty and disability for activities of daily living were both independently associated with depressive symptoms. CONCLUSION Frailty and disability were independent correlates of depressive symptoms in older PLWHIV. Future studies should attempt to explore the role of physical frailty and disability on psychosocial morbidity among older PLWHIV.
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Affiliation(s)
- José Alberto Avila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, Inserm, Bordeaux, France
| | | | - Luis Arnoldo Muñoz-Nevárez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Julio Alberto Díaz-Ramos
- Department of Geriatrics, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - Juan Luis Alcala-Zermeno
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Camille Ouvrard
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, Inserm, Bordeaux, France
| | - Juan Sierra-Madero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hélène Amieva
- Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, Inserm, Bordeaux, France
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Chaddha A, Kline-Rogers E, Braverman AC, Erickson SR, Jackson EA, Franklin BA, Woznicki EM, Jabara JT, Montgomery DG, Eagle KA. Survivors of Aortic Dissection: Activity, Mental Health, and Sexual Function. Clin Cardiol 2016; 38:652-9. [PMID: 26769699 DOI: 10.1002/clc.22418] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/28/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Currently no research exists assessing lifestyle modifications and emotional state of acute aortic dissection (AAD) survivors. We sought to assess activity, mental health, and sexual function in AAD survivors. HYPOTHESIS Physical and sexual activity will decrease in AAD survivors compared to pre-dissection. Incidence of anxiety and depression will be significant after AAD. METHODS A cross sectional survey was mailed to 197 subjects from a single academic medical center (part of larger IRAD database). Subjects were ≥18 years of age surviving a type A or B AAD between 1996 and 2011. 82 surveys were returned (overall response rate 42%). RESULTS Mean age ± SD was 59.5 ± 13.7 years, with 54.9% type A and 43.9% type B patients. Walking remained the most prevalent form of physical activity (49 (60%) pre-dissection and 47 (57%) post-dissection). Physical inactivity increased from 14 (17%) before AAD to 20 (24%) after AAD; sexual activity decreased from 31 (38%) to 9 (11%) mostly due to fear. Most patients (66.7%) were not exerting themselves physically or emotionally at AAD onset. Systolic blood pressure (SBP) at 36 months post-discharge for patients engaging in ≥2 sessions of aerobic activity/week was 126.67 ± 10.30 vs. 141.10 ± 11.87 (p-value 0.012) in those who did not. Self-reported new-onset depression after AAD was 32% and also 32% for new-onset anxiety. CONCLUSIONS Alterations in lifestyle and emotional state are frequent in AAD survivors. Clinicians should screen for unfounded fears or beliefs after dissection that may reduce function and/or quality of life for AAD survivors.
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Affiliation(s)
- Ashish Chaddha
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Eva Kline-Rogers
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Alan C Braverman
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | | | | | - Barry A Franklin
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Elise M Woznicki
- Preventive Cardiology and Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan
| | - Justin T Jabara
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
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Pérodeau GM, du Fort GG. Psychotropic Drug Use and the Relation Between Social Support, Life Events, and Mental Health in the Elderly. J Appl Gerontol 2016. [DOI: 10.1177/073346480001900102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to determine if self-reported social support and life events explained differences in levels of anxiety and depression among 109 elderly psychotropic drug users compared to 90 nonusers (aged 62 to 98). Two thirds of the respondents were French-speaking, mostly female (82.1%) and widowed (57.4%), and recipients of a home care program in Montreal, Canada. The life event and social support scales, broken down by item value, did not differentiate users from nonusers, except for feelings of loneliness reported by 40% of users compared to only 16% of nonusers (p < .001). Analysis of the relation between psychiatric symptomatology and psychosocial variables, broken down by item value, showed greater sensitivity among users to perceived (subjective) lack in social support. In contrast, only “feelings of loneliness” had an effect on the level of mental health of nonusers. There was no effect with regard to objective items of social support.
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Maglione JE, Nievergelt CM, Parimi N, Evans DS, Ancoli-Israel S, Stone KL, Yaffe K, Redline S, Tranah GJ. Associations of PER3 and RORA Circadian Gene Polymorphisms and Depressive Symptoms in Older Adults. Am J Geriatr Psychiatry 2015; 23:1075-87. [PMID: 25892098 PMCID: PMC4568170 DOI: 10.1016/j.jagp.2015.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 01/23/2015] [Accepted: 03/04/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depressive symptoms are common in older adults and associated with poor outcomes. Although circadian genes have been implicated in depression, the relationship between circadian genes and depressive symptoms in older adults is unclear. METHODS A cross-sectional genetic association study of 529 single nucleotide polymorphisms (SNPs) representing 30 candidate circadian genes was performed in two population-based cohorts: the Osteoporotic Fractures in Men Study (MrOS; N=270, age: 76.58±5.61 years) and the Study of Osteoporotic Fractures (SOF) in women (N=1740, 84.05±3.53 years) and a meta-analysis was performed. Depressive symptoms were assessed with the Geriatric Depression Scale categorizing participants as having none-few symptoms (0-2), some depressive symptoms (>2 to <6), or many depressive symptoms (≥6). RESULTS We found associations meeting multiple testing criteria for significance between the PER3 intronic SNP rs12137927 and decreased odds of reporting "some depressive symptoms" in the SOF sample (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.48-0.78, df=1, Wald χ2=-4.04, p=0.000054) and the meta-analysis (OR: 0.61, CI: 0.48-0.78, z=-4.04, p=0.000054) and between the PER3 intronic SNPs rs228644 (OR: 0.74, CI: 0.63-0.86, z=3.82, p=0.00013) and rs228682 (OR: 0.74, CI: 0.86-0.63, z=3.81, p=0.00014) and decreased odds of reporting "some depressive symptoms" in the meta-analysis compared to endorsing none-few depressive symptoms. The RORA intronic SNP rs11632098 was associated with greater odds of reporting "many depressive symptoms" (OR: 2.16, CI: 1.45-3.23, df=1, Wald χ2=3.76, p=0.000168) in the men. In the meta-analysis the association was attenuated and nominally significant (OR: 1.63, CI: 1.24-2.16, z=3.45, p=0.00056). CONCLUSION PER3 and RORA may play important roles in the development of depressive symptoms in older adults.
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Affiliation(s)
- Jeanne E. Maglione
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | | | - Neeta Parimi
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA
| | - Susan Redline
- Departments of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Gregory J. Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA
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12
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Maglione JE, Ancoli-Israel S, Peters KW, Paudel ML, Yaffe K, Ensrud KE, Stone KL. Subjective and objective sleep disturbance and longitudinal risk of depression in a cohort of older women. Sleep 2014; 37:1179-87. [PMID: 25061246 DOI: 10.5665/sleep.3834] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the longitudinal relationship between subjective and objective sleep disturbance and depressive symptoms. DESIGN Longitudinal. SETTING Three US clinical centers. PARTICIPANTS Nine hundred fifty-two community-dwelling older women (70 y or older). MEASUREMENTS At baseline, subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measures were assessed with wrist actigraphy. Depressive symptoms were assessed with the Geriatric Depression Scale (GDS) at baseline and approximately 5 y later. The analysis was restricted to women with few (GDS 0-2) depressive symptoms at baseline. RESULTS There was an independent association between greater PSQI score (per standard deviation increase, indicating worse subjective sleep quality) at baseline and greater odds of worsening depressive symptoms (≥ 2-point increase in GDS) (Multivariate Odds Ratio [MOR] 1.19, confidence interval [CI] 1.01-1.40, P = 0.036). Higher scores specifically on the sleep quality (MOR 1.41, CI 1.13-1.77, P < 0.003) and sleep latency (MOR 1.21, CI 1.03-1.41, P = 0.018) PSQI subscales were also associated with greater odds for worsening depressive symptoms. Objective assessments revealed an association between baseline prolonged wake after sleep onset (WASO ≥ 60 min) and worsening depressive symptoms at follow-up (MOR 1.36, CI 1.01-1.84, P = 0.046). There were no associations between other objectively assessed sleep measures and worsening depressive symptoms. CONCLUSIONS In older women with few or no depressive symptoms at baseline, those with more subjectively reported sleep disturbance and more objectively assessed fragmentation of sleep at baseline had greater odds of worsening depressive symptoms 5 y later. Future studies investigating this relationship in more detail are indicated. CITATION Maglione JE, Ancoli-Israel S, Peters KW, Paudel ML, Yaffe K, Ensrud KE, Stone KL, Study of Osteoporotic Fractures Research Group. Subjective and objective sleep disturbance and longitudinal risk of depression in a cohort of older women.
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Affiliation(s)
- Jeanne E Maglione
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, La Jolla, CA ; Department of Medicine, University of California, San Diego, La Jolla, CA
| | | | - Misti L Paudel
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis MN
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis MN ; Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN ; Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
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Depressive symptoms and circadian activity rhythm disturbances in community-dwelling older women. Am J Geriatr Psychiatry 2014; 22:349-61. [PMID: 23567424 PMCID: PMC4109690 DOI: 10.1016/j.jagp.2012.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 09/13/2012] [Accepted: 09/26/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Aging is associated with changes in circadian rhythms. Current evidence supports a role for circadian rhythms in the pathophysiology of depression. However, little is known about the relationship between depressive symptoms and circadian activity rhythms in older adults. We examined this association in community-dwelling older women. METHODS We performed a cross-sectional analysis of 3,020 women (mean age: 83.55 ± 3.79 years) enrolled in the Study of Osteoporotic Fractures. Depressive symptoms were assessed with the Geriatric Depression Scale categorizing participants as "normal" (0-2; referent group, N = 1,961), "some depressive symptoms" (3-5, N = 704), or "depressed" (≥6, N = 355). Circadian activity rhythm variables were measured using wrist actigraphy. RESULTS In age-adjusted and Study of Osteoporotic Fractures site-adjusted models, greater levels of depressive symptoms were associated with decreased amplitude (height; df = 3,014, t = -11.31, p for linear trend <0.001), pseudo F-statistic (robustness; df = 3,014, t = -8.07, p for linear trend <0.001), and mesor (mean modeled activity; df = 3014, t = -10.36, p for linear trend <0.001) of circadian activity rhythms. Greater levels of depressive symptoms were also associated with increased odds of being in the lowest quartile for amplitude (df = 1, χ(2) = 9240, p for linear trend <0.001), pseudo F-statistic (df = 1, χ(2) = 49.73, p for linear trend <0.001), and mesor (df = 1, χ(2) = 81.12, p for linear trend <0.001). These associations remained significant in multivariate models. Post-hoc analyses comparing mean amplitude, mesor, and pseudo F-statistic values pair-wise between depression-level groups revealed significant differences between women with "some depressive symptoms" and the "normal" group. CONCLUSION These data suggest a graded association between greater levels of depressive symptoms and more desynchronization of circadian activity rhythms in community-dwelling older women. This association was observed even for women endorsing subthreshold levels of depressive symptoms.
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Moyle W, Evans K. Models of mental health care for older adults: a review of the literature. Int J Older People Nurs 2013; 2:132-40. [PMID: 20925790 DOI: 10.1111/j.1748-3743.2007.00062.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aim. This paper reviews literature that draws on models of mental health care for older adults. Background. It is predicted that as a consequence of the aging of the population the incidence of mental health disorders, common in older populations, will also rise. Many such disorders can be successfully managed if detected early. Assessment and management requires collaboration between health professionals who are skilled and educated in the management of older adults with mental illness and the use of models of care appropriate to this population. Results. The paucity of research in this area is demonstrated. Conclusion. The need for mental health nurses to challenge current models of mental health care for older adults is identified so that they take on an expanded and developed specialist role in care of older adults with mental illness.
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Affiliation(s)
- Wendy Moyle
- Professor of Nursing, Research Centre for Clinical Practice Innovation, Griffith University, Nathan, Brisbane, AustraliaPostgraduate Mental Health Program Coordinator, School of Nursing and Midwifery, Griffith University, Nathan, Brisbane, Australia
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Cho J, Lee WJ, Moon KT, Suh M, Sohn J, Ha KH, Kim C, Shin DC, Jung SH. Medical care utilization during 1 year prior to death in suicides motivated by physical illnesses. J Prev Med Public Health 2013; 46:147-54. [PMID: 23766873 PMCID: PMC3677068 DOI: 10.3961/jpmph.2013.46.3.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/29/2013] [Indexed: 11/26/2022] Open
Abstract
Objectives Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. Methods Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. Results Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity. Conclusions Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.
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Affiliation(s)
- Jaelim Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Pei Y, Smith AK, Wang Y, Pan Y, Yang J, Chen Q, Pan W, Bao F, Zhao L, Tie C, Wang Y, Wang J, Zhen W, Zhou J, Ma X. The brain-derived neurotrophic-factor (BDNF) val66met polymorphism is associated with geriatric depression: a meta-analysis. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:560-6. [PMID: 22610920 PMCID: PMC3549636 DOI: 10.1002/ajmg.b.32062] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 04/25/2012] [Indexed: 11/08/2022]
Abstract
Depression has been associated with reduced expression of brain-derived neurotrophic factor (BDNF) in the hippocampus. Genetic association studies of the BDNF Val66Met polymorphism (rs6265) in geriatric depression have produced inconsistent results. A meta-analysis of studies was conducted to compare the frequency of the BDNF Val66Met variant between cases with geriatric depression and age-matched controls. A total of five studies involving 523 cases with geriatric depression and 1,220 psychiatrically healthy controls was included. Met allele carriers had an increased risk for geriatric depression when compared to Val/Val homozygotes (P = 0.004, OR = 1.48, 95% CI = 1.13-1.93). Our findings suggest the BDNF Met allele may confer increased risk for depression as individual age.
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Affiliation(s)
- Yu Pei
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Yongjun Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yanli Pan
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jian Yang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Qi Chen
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Weigang Pan
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Feng Bao
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Lisha Zhao
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Changle Tie
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yizheng Wang
- Department of Neurobiology, Capital Medical University, Beijing, China
| | - Jian Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Wenfeng Zhen
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jinxia Zhou
- Neuroscience Research Australia and the University of New South Wales, Sydney, New South Wales 2031, Australia
| | - Xin Ma
- Beijing Anding Hospital, Capital Medical University, Beijing, China,Correspondence to: Prof. Xin Ma, M.D., Beijing Anding Hospital, Capital Medical University, Xicheng District, Beijing 100088, China.
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Maglione JE, Ancoli-Israel S, Peters KW, Paudel ML, Yaffe K, Ensrud KE, Stone KL. Depressive symptoms and subjective and objective sleep in community-dwelling older women. J Am Geriatr Soc 2012; 60:635-43. [PMID: 22428562 PMCID: PMC3517685 DOI: 10.1111/j.1532-5415.2012.03908.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the relationship between depressive symptoms and subjective and objective sleep in older women. DESIGN Cross-sectional. SETTING Four U.S. clinical centers. PARTICIPANTS Three thousand forty-five community-dwelling women aged 70 and older. MEASUREMENTS Depressive symptoms were assessed using the Geriatric Depression Scale, categorizing participants as normal (0-2, reference), some depressive symptoms (3-5), or depressed (≥ 6). Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Objective sleep measures were assessed using wrist actigraphy. RESULTS In multivariable-adjusted models, there were graded associations between greater level of depressive symptoms and worse subjective sleep quality and more subjective daytime sleepiness (P-trends < .001). Women with some depressive symptoms (odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.48-2.24) and depressed (OR = 2.84, 95% CI = 2.08-3.86) women had greater odds of reporting poor sleep (PSQI>5). Women with some depressive symptoms (OR = 1.97, 95% CI = 1.47-2.64) and depressed women (OR = 1.70, 95% CI = 1.12-2.58) had greater odds of reporting excessive daytime sleepiness (ESS>10). There were also graded associations between greater level of depressive symptoms and objectively measured wake after sleep onset (WASO) (P-trend = .03) and wake episodes longer than 5 minutes (P-trend = .006). Depressed women had modestly higher odds of WASO of 1 hour or longer (OR = 1.37, 95% CI = 1.03-1.83). Women with some depressive symptoms (OR = 1.49, 95% CI = 1.19-1.86) and depressed women (OR = 2.04, 95% CI = 1.52-2.74) had greater odds of being in the highest quartile for number of nap episodes longer than 5 minutes. No associations between depressive symptom level and prolonged sleep latency, poor sleep efficiency, or short or long total sleep time were found. CONCLUSION Greater depressive symptom levels were associated with more subjective sleep disturbance and objective evidence of sleep fragmentation and napping.
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Affiliation(s)
- Jeanne E Maglione
- Department of Psychiatry, University of California at San Diego, La Jolla, California, USA.
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Halabi S, Collins EG, Thorevska N, Tobin MJ, Laghi F. Relationship between depressive symptoms and hypogonadism in men with COPD. COPD 2011; 8:346-53. [PMID: 21774576 DOI: 10.3109/15412555.2011.594465] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prevalence of depression in chronic obstructive pulmonary disease (COPD) is greater than in the general population, but the mechanism is unknown. Depression has been linked mechanistically to testosterone deficiency, and testosterone deficiency (hypogonadism) affects many men with COPD. Accordingly, we hypothesized that significant depressive symptoms would be associated with hypogonadism in men with COPD. The hypothesis was tested in a prospective cross-sectional investigation of 104 men (FEV1 = 43 ± 1% predicted (± SE)), 36 of whom had significant depressive symptoms (Geriatric Depression Scale score or GDS ≥ 11). Hypogonadism was present in 14 patients with GDS ≥ 11 (39%) and in 21 with GDS < 11 (31%; p = 0.41). The independent association between depressive symptoms and gonadal state was evaluated after adjusting for potential confounders: combined severity of lung disease and functional impairment (BODE-index), co-morbidities (Charlson co-morbidity-Index), age, active smoking, education, and marital status. After controlling for confounding variables, multivariable logistic-regression analysis revealed that only BODE-index (odds ratio 1.40; p = 0.003), lack of companion (2.73; p = 0.045) and younger age (0.93; p = 0.021) were independently associated with depressive symptoms. In a secondary analysis, patients were stratified into those with severe depressive symptoms (GDS ≥ 19) and those with mild depressive symptoms (GDS 11-18). Prevalence of hypogonadism was greater in first group than in the second (62% vs. 26%; p = 0.036). After controlling for confounders, however, gonadal state was not associated with severe depressive symptoms. Similarly, gonadal state was not associated with mood and motivation subscale scores of the GDS. In conclusion, presence of significant depressive symptoms was not associated with hypogonadism in men with COPD.
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Affiliation(s)
- Sahar Halabi
- Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois 60141, USA
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Press Y, Tandeter H, Romem P, Hazzan R, Farkash M. Depressive symptomatology as a risk factor for increased health service utilization among elderly patients in primary care. Arch Gerontol Geriatr 2011; 54:127-30. [PMID: 21377223 DOI: 10.1016/j.archger.2011.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 02/04/2011] [Accepted: 02/05/2011] [Indexed: 11/17/2022]
Abstract
Depression may play an important role in determining frequent physician visits in the older population. Our aim is to examine the relationships between socio-demographic variables, co-morbidity, memory complaints, functional status, depressive symptomatology, and health care utilization among community dwelling older patients. The study was conducted in urban primary health care clinics in Beer-Sheva, Israel. Two groups were identified: low care utilizers (LCU), with ≤ 6 visits to family physicians (FP)/year and high care utilizers (HCU) with ≥ 16 visits to FP/year. Data were collected during a structured face-to-face individual interview. The study population included 180 patients, of them 86 (47.7%) were LCU and 94 (52.2%) were HCU. In all clinical measurements the HCU group indicators were statistically significant worse off than the LCU group: average depressive symptoms (5.6 vs. 2.5, p<0.01), memory complaints (57.5% vs. 23.3%, p<0.01), Barthel Index (BI) (89.9 vs. 96.0, p<0.001), OARS (10.8 vs. 12.5, p<0.01), and co-morbidity: total cumulative score (TCS) of Charlson comorbidity index (CCI) (2.2 vs. 1.3, p<0.01). Our study raises the possibility that at least one of the reasons for over-utilization of health services by older residents in the community is depressive symptomatology.
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Affiliation(s)
- Yan Press
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva 84105, Israel.
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Helmich I, Latini A, Sigwalt A, Carta MG, Machado S, Velasques B, Ribeiro P, Budde H. Neurobiological alterations induced by exercise and their impact on depressive disorders [corrected]. Clin Pract Epidemiol Ment Health 2010; 6:115-25. [PMID: 21283646 PMCID: PMC3026330 DOI: 10.2174/1745017901006010115] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 08/09/2010] [Accepted: 08/13/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND The impact of physical activity on brain metabolic functions has been investigated in different studies and there is growing evidence that exercise can be used as a preventive and rehabilitative intervention in the treatment of depressive disorders. However, the exact neuronal mechanisms underlying the latter phenomenon have not been clearly elucidated. The present article summarises key results derived from studies that focussed on the neurobiological impact of exercise on brain metabolic functions associated with depressive disorders. Since major depressive disorder (MDD) is a life threatening disease it is of great significance to find reliable strategies to prevent or to cure this illness. Therefore, the aim of this paper is to review (1) the physiological relationship between physical activity and depressive disorders and (2) the potential neurobiological alterations induced by exercise that might lead to the relief of mental disorders like depression. METHODS We searched electronic databases for literature concerning the relationship between exercise and depression from 1963 until 2009. RESULTS The data suggests an association between physical inactivity and higher levels of depressive symptoms. Properly designed studies could show that exercise training can be as effective as antidepressive medications. CONCLUSION The exact mechanisms how exercise affects the brain are not fully understood and the literature lacks of well designed studies concerning the effects of exercise training on depressive disorders. But the observed antidepressant actions of exercise are strong enough that it already can be used as an alternative to current medications in the treatment of depressive disorders.
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Affiliation(s)
- Ingo Helmich
- Department of Neurology, Psychosomatic Medicine, and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sports University Cologne, Germany
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Abstract
AbstractThis article reevaluates the issue of the prevalence of depressive conditions (clinical depressions and depressive symptoms) in the elderly with the help of recent epidemiological data. It then underlines several key aspects of the etiology of depressive conditions of older adults. The perspective is a psychosocial analysis, which considers the etiological contributions of three types of factors: the socio-demographic status of the person, life events, and the resources of the person. The article concludes by delineating the implications for research in this area.
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Quelques considérations sur la prévalence et l'étiologie des états dépressifs de la personne âgée. Can J Aging 2010. [DOI: 10.1017/s0714980800014926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉCet article réévalue la question de la prévalence des états dépressifs (dépressions cliniques et symptômes dépressifs) dans le groupe des personnes ágées à la lumière des études épidémiologiques récentes. Il se propose ensuite de souligner quelques aspects particuliers de l'étiologie des états dépressifs de la personne âgée. La perspective choisie est celle d'une analyse psychosociale qui examine les contributions étiologiques de trois types de facteurs: le statut socio-démographique, les événements de l'existence, et les ressources de la personne. L'article conclut en dégageant quelques implications de cette analyse pour les recherches qui s'adressent aux états dépressifs de la personne âgée.
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Préville M, Boyer R, Vasiliadis HM, Grenier S, Voyer P, Hudon C, Streiner DL, Cairney J, Brassard J. One-year incidence of psychiatric disorders in Quebec's older adult population. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:449-57. [PMID: 20704772 DOI: 10.1177/070674371005500708] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the incidence of psychiatric disorders in the Quebec older adult population. METHOD Data from the Enquête sur la Santé des Aînés (ESA) study conducted in 2005 to 2008 using a representative sample (n = 2784) of community-dwelling adults aged 65 years and older were used. RESULTS The ESA study's results indicate that 12.0% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. Our results also indicate that the 12-month rate of incident cases of DSM-IV disorders was 6.2%. The proportion of incident cases was higher for the depression group (3.4%) than for the anxiety disorders group (2.3%). The results showed that the probability to develop an incident psychiatric condition after 1 year of follow-up, compared with the noncases group, varied according to sex (OR 2.18; 95% CI 1.39 to 3.44). Our results also showed that the number of chronic health problems (OR 1.20; 95% CI 1.09 to 1.33) and the change in the number of chronic health problems reported between the baseline and the second interview (OR 1.14; 95% CI 1.01 to 1.30) increased the probability to be an incident case at Time 2. The results indicated that social support did not influence the probability to develop a psychiatric disorder. CONCLUSION These results indicate that sex and physical health status have an impact on the incidence of DSM-IV disorders in the elderly. This finding underscores the need for improved recognition and treatment of psychiatric disorders associated with physical illness in the older population.
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Affiliation(s)
- Michel Préville
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
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Predisposing and Facilitating Factors of Severe Psychological Distress among Frail Elderly Adults. Can J Aging 2010. [DOI: 10.1017/s071498080000146x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
ABSTRACTA sample of frail older adults (65 years and over) living at home or institutionalized (n = 664) with a significant functional limitation was used to document predisposing and facilitating factors of severe psychological distress among frail elderly adults. Our results indicated that 48.2 per cent of the older adults living at home presented severe psychological distress symptoms, compared to 34.3 per cent of elderly adults living in institutions. The probability of reporting a severe level of psychological distress was associated with the respondents' social support, cognitive and functional status. When the respondents' cognitive and functional status were controlled, no evidence of a significant association was found between the respondents' age, gender, marital status, education or income and the level of their psychological distress symptoms. Our results showed that 77.9 per cent of the respondents with severe psychological distress symptoms were still severely distressed 12 months after their first interview. Findings suggest that severe psychological distress represents an important challenge for practitioners in gerontology and geriatrics. It is suggested that other studies focusing on the consequences of psychological distress on older adults' quality of life, functional decline, institutionalization and mortality may help document the gravity of this symptomatology in the elderly population.
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Abstract
OBJECTIVES Most older persons in primary care suffering clinically significant depressive symptoms do not meet criteria for major or minor depression. The authors tested the hypothesis that patients with subsyndromal depression (SSD) would have poorer psychiatric, medical, and functional outcomes at follow-up than nondepressed patients but not as poor as those with minor or major depression. The authors also explored the relative outcomes of three definitions of SSD to determine their relative prognostic value. DESIGN Prospective observational cohort study. SETTING Primary care practices in Monroe County, NY. PARTICIPANTS Four hundred eighty-one primary care patients aged 65 years and older who completed research assessments at intake and at least 1 year of follow-up evaluation. MEASUREMENTS Depression diagnoses and three definitions of SSD were determined by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the 24-item Hamilton Depression Rating Scale. Other validated measures assessed anxiety, cognition, medical burden, and functional status. RESULTS Patients with SSD had poorer 1-year lagged outcomes than nondepressed subjects in terms of psychiatric symptoms and functional status, often not significantly different than major or minor depression. Two of the SSD definitions identified subjects with poorer psychiatric and functional outcomes than the third SSD definition. CONCLUSIONS Clinicians should be vigilant in caring for patients with SSD, monitoring for persistent, or worsening depressive symptoms including suicidality, anxiety, cognitive impairment, and functional decline. Researchers may use particular SSD definitions to identify individuals at higher risk of poor outcomes, to better understand the relationships of SSD to functional disability, and to test innovative preventive and therapeutic interventions.
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Suárez-Linares M, Cobo-Gómez JV, Suárez-García FM, García-Carreño E, Alvarez-Alvarez A. [Current and lifetime depression as a risk factor for hospital admission in patients older than 74 years attended in an emergency department]. Rev Esp Geriatr Gerontol 2009; 44:305-10. [PMID: 19864048 DOI: 10.1016/j.regg.2009.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 07/20/2009] [Accepted: 07/20/2009] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Depression is especially frequent in the elderly. In addition to impairing quality of life, this disorder can affect the outcome of medical diseases. The objective is to analyze whether depressive disorders in elderly individuals attending an emergency room for medical complaints constitute a risk factor for admission. MATERIAL AND METHODS All patients aged more than 74 years old attending the Emergency Department of the Hospital Universitario Central de Asturias who required comprehensive geriatric assessment from 2004 to 2005 were included in this study. Sociodemographic variables and data on functional, cognitive and emotional status before attendance at the emergency department were collected. A logistic regression analysis was performed to determine whether there was an independent association between depression and admission to the Geriatric Service. RESULTS A total of 1016 patients (62.32% women) were evaluated. The mean age was 87.4 years. The Barthel index before admission to the emergency department was 71.8 (95% confidence interval [CI]: Depression was diagnosed in 17.4% of the patients (75.7% women). Of the whole sample, 721 patients (71.0%) were admitted to a geriatric service, while 79.7% of patients with depression were admitted (p=0.002). After multivariate regression analysis adjusted by age, sex, marital status, institutionalization, living arrangements, Barthel index and cognitive status before admission, depression was independently associated with a greater risk for admission to a geriatric service (odds ratio: 1.83, 95% CI: 1.20-2.78). CONCLUSIONS Depression and mood disorders constitute an independent risk factor for admission to a geriatric service in patients aged more than 74 years assessed by comprehensive geriatric methodology in an emergency department.
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Lundmark PO, Trope GE, Shapiro CM, Flanagan JG. Depressive symptomatology in tertiary-care glaucoma patients. Can J Ophthalmol 2009; 44:198-204. [PMID: 19491956 DOI: 10.3129/i09-041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate depressive symptomatology among patients with glaucoma and to relate the findings to disease stability. DESIGN Cross-sectional postal survey. PARTICIPANTS The study sample consisted of 258 patients out of a pool of 884 respondents to a survey on health and sleep sent to 1809 glaucoma patients registered in a major tertiary glaucoma centre at the Toronto Western Hospital, Toronto, Ont. METHODS The Center for Epidemiologic Studies Depression Scale questionnaire was mailed along with questions related to demographic information, general health, and sleep quality. Respondents were included if (i) their diagnosis was either primary open-angle glaucoma, normal tension glaucoma, or primary angle-closure glaucoma; (ii) the disease duration was 3 years or more; (iii) clinical examinations were obtained annually; and (iv) perimetric results were reliable. Each patient's condition was classified as stable or progressive on the basis of pointwise decline in visual fields (VFs). RESULTS The unadjusted odds ratio for depressive symptoms was found to be 0.4 times less (95% CI 0.19-0.88) in patients with progressive VFs (n = 79) than in patients with stable VFs (n = 179). Adjusting for demographic characteristics, general health, psychiatric comorbidity, and ocular factors did not weaken this association. However, it was reduced by the increased severity of VF defects (moderate and severe). CONCLUSIONS In this sample of tertiary-care patients, depressive symptoms were found to be less common in patients with progressive than with stable VFs when defects were classified as early, but not when they were classified as moderate or severe.
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Affiliation(s)
- Per O Lundmark
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
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Pahkala K, Kivelä SL, Laippala P. Relationships between social and health factors and major depression in old age in a multivariate analysis. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/08039489109103299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Anttila S. Depressive symptoms and general hospital care in the elderly A population-based study. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/08039489109101983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aggarwal A, Freund K, Sato A, Adams-Campbell LL, Lopez AM, Lessin LS, Ockene J, Wallace RB, Williams CD, Bonds DE. Are depressive symptoms associated with cancer screening and cancer stage at diagnosis among postmenopausal women? The Women's Health Initiative observational cohort. J Womens Health (Larchmt) 2009; 17:1353-61. [PMID: 18788983 DOI: 10.1089/jwh.2007.0544] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with depressive symptoms may use preventive services less frequently and experience poorer health outcomes. We investigated the association of depressive symptoms with breast and colorectal cancer screening rates and stage of cancer among a cohort of postmenopausal women. METHODS In The Women's Health Initiative Observational Study, 93,676 women were followed on average for 7.6 years. Depressive symptoms were measured at baseline and at 3 years using the 6-item scale from the Center for Epidemiological Studies Depression scale (CES-D). We calculated a cancer screening rate expressed as a proportion of the years that women were current with recommended cancer screening over the number of follow-up visits in the study. Breast and colorectal cancers were staged based on Surveillance, Epidemiology and End Results (SEER) classification. RESULTS At baseline, 15.8% (12,621) women were positive for depressive symptoms, and 6.9% (4,777) were positive at both baseline screening and at 3 years. The overall average screening rate was 71% for breast cancer and 53% for colorectal cancer. The breast cancer screening rate was 1.5% (CI 0.9%-2.0%) lower among women who reported depressive symptoms at baseline than among those who did not. Depressive symptoms were not a predictor for colorectal cancer screening. Stage of breast and colorectal cancer was not found to be associated with depressive symptoms after adjusting for covariates. CONCLUSIONS Among a healthy and self-motivated cohort of women, self-reported depressive symptoms were associated with lower rates of screening mammography but not with colorectal cancer screening.
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Affiliation(s)
- Arpita Aggarwal
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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Préville M, Boyer R, Grenier S, Dubé M, Voyer P, Punti R, Baril MC, Streiner DL, Cairney J, Brassard J. The epidemiology of psychiatric disorders in Quebec's older adult population. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:822-32. [PMID: 19087480 DOI: 10.1177/070674370805301208] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To document the prevalence of psychiatric disorders in Quebec's older adult population. METHOD Data came from the Enquête sur la santé des aînés study conducted in 2005--2006 using a representative sample (n = 2798) of community-dwelling older adults. RESULTS Our results indicate that 12.7% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine dependency. The 12-month prevalence rate of major depression was 1.1% and the prevalence of minor depression 5.7%. A total of 5.6% of the respondents reported an anxiety disorder. The most prevalent anxiety disorders were specific phobia (2.0%), obsessive-compulsive disorder (OCD) (1.5%), and generalized anxiety disorder (GAD) (1.2%). Agoraphobia without panic disorder and panic disorder were reported by 0.3% and 0.6% of the respondents, respectively. The prevalence rate of benzodiazepine dependency was 2.3%. The 12-month comorbidity prevalence rate between any psychiatric disorders was 2.2%. Among those with depressive disorder, the most frequent comorbidity was observed between minor depression and specific phobia (4.3%), GAD (4.3%), OCD (3.7%), and mania (1.3%). Further, only 39% of those having at least one active DSM-IV diagnosis reported having used health services for their psychological distress symptoms during the previous 12 months. Among those who consulted health services, 85% visited a general practitioner. CONCLUSIONS Our results indicate that a large proportion of the elderly population in Quebec presents mental health needs. Longitudinal research focusing on the individual and social consequences of mental health problems reported by older adults is needed to avoid misinterpretation of this finding.
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Affiliation(s)
- Michel Préville
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
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Jiang W, O'Connor C, Silva SG, Kuchibhatla M, Cuffe MS, Callwood DD, Zakhary B, Henke E, Arias RM, Krishnan R. Safety and efficacy of sertraline for depression in patients with CHF (SADHART-CHF): a randomized, double-blind, placebo-controlled trial of sertraline for major depression with congestive heart failure. Am Heart J 2008; 156:437-44. [PMID: 18760123 PMCID: PMC2659472 DOI: 10.1016/j.ahj.2008.05.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 05/06/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sertraline, a selective serotonin-reuptake inhibitor, has demonstrated substantial mood improvement in patients with post myocardial infarction or with unstable angina. The impact of sertraline on the prognosis and depression of patients with chronic heart failure (HF) and comorbid major depressive disorder (MDD) is unknown. METHOD This is a prospective, randomized, double-blind, placebo-controlled study designed to assess the safety and efficacy of sertraline in the treatment of MDD in patients with HF. The study is designed also to examine the effects of treating depression on cardiac events and morbidity/mortality in patients with HF. Approximately 500 men and women who are >or=45 years of age with current MDD and chronic systolic HF, characterized by left ventricular ejection fraction or=II, comprise the study population. Eligible participants are randomized to either sertraline or placebo for a 12-week acute treatment phase. All patients, regardless of acute treatment phase completion, are followed routinely until the last subject completes 6-month follow-up. Quality of life and certain physiologic parameters, as well as pro-inflammatory and HF biomarkers, that may reflect the impact of sertraline in this particular population are measured at baseline and at the end of the acute treatment phase. CONCLUSION Because of the high prevalence of depression and its significant adverse impact on prognosis of patients with ischemic heart disease (IHD) and HF, the Safety and Efficacy of Sertraline for Depression in Patients with Chronic Heart Failure (SADHART-CHF) trial aims to assess the effects of sertraline on response of depression as well as on the cardiac prognosis of patients with HF.
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Affiliation(s)
- Wei Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Abstract
OBJECTIVES To delineate the differences between older persons with and without a diagnosis of major depression. METHODS Participants were recruited from three outpatient clinics serving older patients at St Michael's Hospital. To be included in the study, participants had to speak English and have no evidence of significant sensory deficits that would interfere with neuropsychological testing. Participants were excluded if they had active delirium, active CNS disease (including dementia), active substance abuse, unstable medical disease, recent ECT treatment and a current/past diagnosis of a psychotic disorder. The diagnosis of major depression was made by qualified professionals in accordance with established guidelines. Participants were administered structured measures assessing global cognition, medical co-morbidity, subjective memory complaints, mood and detailed neurocognitive testing evaluating working memory, attention and speed of processing. Differences between depressed and non-depressed subjects with respect to these measures were analyzed using analysis of variance (ANOVA). RESULTS Thirty-six participants were included in this study. The depressed (n = 17) and non-depressed (n = 19) groups were well matched in terms of age, education, medical co-morbidity and mini-mental state exam (MMSE) score. While the depressed subgroup had significantly higher subjective memory, language and cognitive complaints, there were no significant differences observed between the two subgroups on measures of memory and learning, attention and speed of information processing, fine motor dexterity and verbal fluency. CONCLUSION This study suggests that while significant depressive symptoms are strongly associated with increased cognitive complaints, they are not associated necessarily with objective cognitive impairment.
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Naturalistic outcomes of minor and subsyndromal depression in older primary care patients. Int J Geriatr Psychiatry 2008; 23:773-81. [PMID: 18200611 DOI: 10.1002/gps.1982] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review the literature regarding the naturalistic outcomes of minor and subsyndromal depression ('Min/SSD') in older primary care patients, synthesizing and critiquing findings and discussing avenues for future research. DESIGN The author obtained relevant articles from repeated computer-assisted literature searches over the past 15 years, and by reviewing the reference citations of the articles so obtained. RESULTS A variety of relevant outcome domains were identified, as were important putative predictors, moderators, and mediators of outcome. In general, minor and subsyndromal depression each have comparable outcomes, outcomes that are clearly worse than non-depressed subjects, with substantially elevated risk of worsening into major depression, albeit not as poor as those with major depression. CONCLUSIONS Min/SSD is common and of real clinical importance in primary care seniors. Several definitions of SSD may be used, each with overlapping but distinguishable utility in identifying patients. While the evidence base has expanded greatly in the past decade, considerable work remains to be done. Naturalistic studies of several outcome domains are needed, focusing on the predictive, moderating, and mediating roles of a wide range of psychopathological, medical, functional, and psychosocial factors. Such work will complement interventions and biomarker research approaches.
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Abstract
Failure to recognize psychiatric conditions in any age group particularly in the elderly could lead to a very complicated clinical picture and may lead to increased health expenditures. Psychiatric emergencies can be secondary to numerous factors: geriatric depression and suicide, behavioral disturbance secondary to underlying organic conditions, substance abuse, elder abuse, and medication-induced adverse events. This article discusses mainly geriatric depression, elder abuse, and conditions emanating from iatrogenic causes.
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Affiliation(s)
- Ben Borja
- University of Maryland School of Medicine, Department of Psychiatry, 22 S. Greene Street, Baltimore, MD 21201, USA
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Abstract
Individuals with COPD have a higher prevalence of co-morbid depression than either the general population or patients with other chronic illnesses. The best estimates report a prevalence of approximately 40% in COPD patients, compared to 15% in the general population. Depression in COPD patients leads to a lower quality of life, greater objective impairment in function, and decreased adherence to therapeutic interventions. While many depressed COPD patients have been treated empirically with antidepressants--subjecting them to antidepressant side effects, toxicities, and costs--there is a surprising lack of evidence supporting or directing that treatment. We review the current literature regarding the management of depression in COPD, suggest strategies for management, and future research needs.
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Affiliation(s)
- Rachel Norwood
- National Jewish Medical and Research Center, 1400 Jackson Street, Denver, Colorado 80206, USA.
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Watson LC, Lehmann S, Mayer L, Samus Q, Baker A, Brandt J, Steele C, Rabins P, Rosenblatt A, Lyketsos C. Depression in assisted living is common and related to physical burden. Am J Geriatr Psychiatry 2006; 14:876-83. [PMID: 17001027 DOI: 10.1097/01.jgp.0000218698.80152.79] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to obtain a direct estimate of the prevalence of depression, its associated factors, and rates of treatment among residents of assisted living (AL) facilities in central Maryland. METHOD One hundred ninety-six AL residents were recruited from 22 (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. Chart review, staff and family history, comprehensive in-person resident evaluation, and the Cornell Scale for Depression in Dementia (CSDD) were administered by an experienced team of geriatric psychiatry clinicians. Those scoring >7 on the CSDD, a cut point repeatedly associated with poor outcomes, were considered clinically depressed. RESULTS Participants had an average age of 86 years, most were female and widowed, and 68% met consensus criteria for dementia. Twenty-four percent (47 of 196) of the sample was depressed. In bivariate analyses, depression was significantly related to medical comorbidity, need for activities of daily living (ADLs) assistance, more days spent in bed, and less participation in organized activities. After controlling for pertinent covariates in a regression model, only need for ADL assistance remained significantly associated with depression. Forty-three percent of those currently depressed were receiving antidepressants and were more likely to receive them if they lived in a large AL facility. Sixty percent of depressed residents had no regular source of psychiatric care. CONCLUSIONS In the first clinical study implemented by geriatric psychiatry professionals in AL, depression was found to be common, undertreated, and related to physical burden. AL is a rapidly growing segment of long-term care and represents an important setting in which to find and treat serious depression.
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Affiliation(s)
- Lea C Watson
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Cook S, Marsiske M. Subjective memory beliefs and cognitive performance in normal and mildly impaired older adults. Aging Ment Health 2006; 10:413-23. [PMID: 16798634 PMCID: PMC2905785 DOI: 10.1080/13607860600638487] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Previous research suggests that subjective perceptions of memory may be related to objective memory performance. In the present study, healthy community-dwelling elders (N = 73, mean age = 75.25 years, education = 16.2 years) completed a neuropsychological assessment, including two questionnaires of subjective memory beliefs. Each participant was identified, via consensus conference, as belonging to either an amnestic mild cognitive impairment (MCI, n = 16) or no mild cognitive impairment (noMCI, n = 57) group. Results indicated that subjective memory capacity beliefs were significantly related to verbal memory performance in the MCI group, but not in the noMCI group. This differential relationship persisted even after controlling for depressive symptoms, and was not reflective of unequal variances in the two groups. Thus, results indicate that subjective memory beliefs may be better indicators of performance in those with possible incipient cognitive impairment than normal older adults, perhaps because persons with MCI have heightened insight into their memory functioning, and that this relationship is not due to group differences in depressive symptoms.
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Affiliation(s)
- S Cook
- Department of Clinical and Health Psychology, University of Florida, Gainesville, 32610-0165, USA.
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Abstract
This article reviews the most common behavioral emergencies in the geriatric population. Psychiatric emergencies are seen frequently by emergency physicians who face the challenge of assessing and managing patients presenting with psychosis, severe depression, agitation, suicidal intent, and substance abuse in the emergency department. The evaluation is frequently complicated by the necessity to investigate numerous domains such as underlying medical conditions, prior psychiatric disorders and substance abuse, as well as psychosocial factors. It is crucial to rule out organic causes for what appears to be psychiatric disease in the elderly. The assessment might be further complicated by the patient's limited ability to recall pertinent aspects of the history due to either cognitive impairment or acute distress. Emergency department personnel might have inadequate expertise in assessing emergencies in elderly persons, further impeding the ability to appropriately manage behavioral complications in geriatric patients. Availability of high-quality emergency care and tight collaboration with primary care providers, psychiatric consultants, and social services is crucial to optimal outcomes from acute psychiatric decompensations in the elderly.
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Affiliation(s)
- Joanna Piechniczek-Buczek
- Division of Psychiatry, Boston University School of Medicine, Robinson Building B-410, 88 East Newton Street, Boston, MA 02118, USA.
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Hankin CS, Spiro A, Mansell D, Miller DR, Kazis LE. Mental Disorders and Medical Care Utilization of VA Ambulatory Care Patients. J Ambul Care Manage 2006; 29:51-60. [PMID: 16340619 DOI: 10.1097/00004479-200601000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this article, the authors examine patterns of medical services use among the Department of Veterans Affairs (VA) ambulatory care patients who screened positive for posttraumatic stress, depression, or alcohol-related disorders. On the basis of research linking mental disorders with increased use of medical services, the authors hypothesize that even after controlling for age and medical disease comorbidity, patients in VA ambulatory care who screen positive for targeted mental disorders would be more likely to use VA medical services and have higher rates of such use than those who did not screen positive. Baseline data were obtained from the Veterans Health Study, a longitudinal investigation of veterans' health. Four Boston-area VA ambulatory care facilities were used as study sites. A random sample of 2425 participants (mean age = 62) was drawn from male VA ambulatory care patients screened for eligibility during specified periods. Screening measures were Center for Epidemiological Studies-Depression Scale for depression, Posttraumatic Stress Disorder Checklist for posttraumatic stress disorder, and CAGE Questionnaire for alcohol-related disorders with endorsement of prior year consumption for alcohol-related disorders. Prior medical services use was assessed by self-report. Although unadjusted analyses of medical services use revealed clear effects of the screening presence of mental disorders on most outcomes, after adjusting for age and medical comorbidity, almost all these effects were reduced, and some previously nonsignificant results became significant. Findings suggest that healthcare policy and risk adjustment predicated upon the presumed relationship between mental disorders in the aggregate and medical services use should reconsider the important contributions of age, comorbid medical disorders, and specific mental disorder diagnoses.
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Affiliation(s)
- Cheryl S Hankin
- Center for Health Quality, Outcomes, and Economic Research (CHQOER), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
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Barbour KA, Blumenthal JA. Exercise training and depression in older adults. Neurobiol Aging 2005; 26 Suppl 1:119-23. [PMID: 16223547 DOI: 10.1016/j.neurobiolaging.2005.09.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 09/05/2005] [Indexed: 11/27/2022]
Abstract
This article provides a review of the evidence supporting exercise as an effective treatment of depression in older adults. Depression is prevalent among older adults and is associated with significant morbidity, increased risk of mortality, and economic burden. Although effective treatments for depression exist (e.g., antidepressant medication, cognitive-behavioral therapy), the disorder remains inadequately treated for many older individuals. Recently, the use of exercise as a treatment for depression has received increased attention. Results of these studies suggest that exercise leads to a reduction in depressive symptoms when compared to wait list, social contact controls, and antidepressant medication. However, many studies have significant methodological limitations. In the present article, we include discussion of these limitations and provide suggestions for future research.
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Affiliation(s)
- Krista A Barbour
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3119, Durham, NC 27710, USA.
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Awad N, Gagnon M, Messier C. The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. J Clin Exp Neuropsychol 2005; 26:1044-80. [PMID: 15590460 DOI: 10.1080/13803390490514875] [Citation(s) in RCA: 304] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present review integrates findings of published studies that have evaluated the cognitive function of treated and untreated type 2 diabetic patients and provides a detailed overview of the neuropsychological assessments conducted. Cognitive deficits are observed in older people with glucose intolerance or untreated diabetes but these deficits appear to be attenuated by treatments that improve glycemic control. Cognitive decrements in treated type 2 diabetic patients are most consistently observed on measures of verbal memory (35% of the measures) and processing speed (45% of the measures) while preserved function is observed on measures of visuospatial, attention, semantic and language function. Some studies suggest that deficits in cognitive functions are associated with poorer glycemic control. A number of other factors, such as depression, cardiovascular and cerebrovascular disease, increase these deficits. We conclude that, in diabetic patients who achieve and maintain good glycemic control, type 2 diabetes only has a small impact on cognitive functions before the age of 70 years. However, early onset of type 2 diabetes, poor glycemic control and the presence of micro- and macrovascular disease may interact to produce early cognitive deficits. In older adults (70 years and over), diabetes likely interacts with other dementing processes such as vascular disease and Alzheimer's disease to hasten cognitive decline.
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Affiliation(s)
- Nesrine Awad
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
Several studies have reported that psychiatric disorders, mainly depression and anxiety disorders, were masked and undiagnosed among older adults, particularly frail elderly. This phenomenon could have a significant impact on elderly quality of life. In this study, we assessed the utility of three measures for detecting mental health disorders among frail elderly receiving home care services: (1) the PRIME-MD; (2) a standard psychological distress measure (PDI-29), and (3) the health care case manager'sa priori judgment on the subject's mental health status. Results obtained by home care nurses were compared to those obtained by clinical psychologists using a structured diagnostic interview (SCID for DSM-IV). The study was conducted in two community health service centres. During the study's period, all patients in the health care workers' caseload without cognitive impairment and not reporting significant stressful life events during the six-week period preceding the interview (n = 315) were asked to participate in the study. Results showed that 42.9% of the volunteers that agreed to meet a psychologist at home (n = 177) had a current SCID-IV diagnosis. The specificity of the PRIME-MD test performed by nurses was 83.8% and its sensitivity was 41.7%. The correct classification rate was 66.7%. Results indicated that the PDI-29 items showed better performance characteristics than the PRIME-MD in identifying current cases. The specificity of the PDI-29 was 59.0% and its sensitivity was 73.6%. These results lead us to the conclusion that the PRIME-MD, previously proposed by Spitzer, R.L., Williams, J.B., Kroenke, K., Linzer, M., DeGruy, F.V. 3rd, Hahn, S.R., et al. (1994, Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. Journal of the American Medical Association, 272 (22), 1749-1756.) to help physicians in primary care clinics, could be less appropriate than the PDI-29 when used by home care nurses in identifying undiagnosed mental health disorders in frail older adults living at home. Moreover, this study showed that the health care case manager'sa priori judgment on the care receiver's mental health status is not sufficient in identifying frail elderly mental health services needs. A two-stage screening procedure is proposed to help home care nurses.
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Affiliation(s)
- M Préville
- University of Sherbrooke & Research Centre on Aging, Sherbrooke Geriatric University Institute, 1036 Belvédère South, Sherbrooke, Québec, Canada, J1H 4C4.
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Rossi A, Barraco A, Donda P. Fluoxetine: a review on evidence based medicine. ANNALS OF GENERAL HOSPITAL PSYCHIATRY 2004; 3:2. [PMID: 14962351 PMCID: PMC356924 DOI: 10.1186/1475-2832-3-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2003] [Accepted: 02/12/2004] [Indexed: 11/10/2022]
Abstract
Background Fluoxetine was the first molecule of a new generation of antidepressants, the Selective Serotonin Re-uptake Inhibitors (SSRIs). It is recurrently the paradigm for the development of any new therapy in the treatment of depression. Many controlled studies and meta-analyses were performed on Fluoxetine, to improve the understanding of its real impact in the psychiatric area. The main objective of this review is to assess the quality and the results reported in the meta-analyses published on Fluoxetine. Methods Published articles on Medline, Embase and Cochrane databases reporting meta-analyses were used as data sources for this review. Articles found in the searches were reviewed by 2 independent authors, to assess if these were original meta-analyses. Only data belonging to the most recent and comprehensive meta-analytic studies were included in this review. Results Data, based on a group of 9087 patients, who were included in 87 different randomized clinical trials, confirms that fluoxetine is safe and effective in the treatment of depression from the first week of therapy. Fluoxetine's main advantage over previously available antidepressants (TCAs) was its favorable safety profile, that reduced the incidence of early drop-outs and improved patient's compliance, associated with a comparable efficacy on depressive symptoms. In these patients, Fluoxetine has proven to be more effective than placebo from the first week of therapy. Fluoxetine has shown to be safe and effective in the elderly population, as well as during pregnancy. Furthermore, it was not associated with an increased risk of suicide in the overall evaluation of controlled clinical trials. The meta-analysis available on the use of Fluoxetine in the treatment of bulimia nervosa shows that the drug is as effective as other agents with fewer patients dropping out of treatment. Fluoxetine has demonstrated to be as effective as chlomipramine in the treatment of Obsessive-Compulsive-Disorder (OCD). Conclusion Fluoxetine can be considered a drug successfully used in several diseases for its favorable safety/efficacy ratio. As the response rate of mentally ill patients is strictly related to each patient's personal characteristics, any new drug in this area, will have to be developed under these considerations.
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Affiliation(s)
- Andrea Rossi
- Medical Dept. Eli Lilly Italia S.p.A. via Gramsci, 731, Sesto fiorentino (Florence), Italy
| | - Alessandra Barraco
- Medical Dept. Eli Lilly Italia S.p.A. via Gramsci, 731, Sesto fiorentino (Florence), Italy
| | - Pietro Donda
- Medical Dept. Eli Lilly Italia S.p.A. via Gramsci, 731, Sesto fiorentino (Florence), Italy
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Bisschop MI, Kriegsman DMW, Deeg DJH, Beekman ATF, van Tilburg W. The longitudinal relation between chronic diseases and depression in older persons in the community: the Longitudinal Aging Study Amsterdam. J Clin Epidemiol 2004; 57:187-94. [PMID: 15125629 DOI: 10.1016/j.jclinepi.2003.01.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2003] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purposes of this study were to examine the differences in influence of various chronic diseases on depressive symptomatology over time and to determine whether there were differences in such influence depending on physical limitations and time of onset of disease. STUDY DESIGN AND SETTING Data for this study were obtained from the Longitudinal Aging Study Amsterdam. Two thousand two hundred eighty-eight respondents (age 55-85) were included and followed for a maximum of 6 years. Depressive symptoms (using the CES-D scale), the presence of seven frequently occurring chronic diseases, physical limitations, and sociodemographic variables were assessed by structured interviews. Generalized estimating equation models were estimated for each disease and compared with each other. RESULTS Lung disease, arthritis, cardiac disease, and cancer were all positively associated with increased depressive symptoms over time. Stroke was associated with depressive symptoms, but these associations were not found when adjusted for physical limitations. For atherosclerosis and diabetes mellitus only weak or no associations with depressive symptoms were found. Recent onset of disease resulted in less strong associations for in cancer, lung disease, and arthritis. CONCLUSION The results demonstrate that the level of depressive symptoms varies across type of chronic disease. In cardiac disease, arthritis, cancer, and lung disease increased depressive symptoms could not be attributed to physical limitations, but in stroke the association found with depressive symptoms was to a large extent attributable to physical limitations.
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Affiliation(s)
- M Isabella Bisschop
- Institute for Research in Extramural Medicine, Vrije Universiteit Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Abstract
This article reviews the impact of depressive and anxiety disorders on quality of life (QOL), disability, and economic burden in the lives of older individuals. Distinctions between the terms QOL, disability, and burden are important in understanding the extent of improvement needed in treatment for elderly patients with depression or anxiety. Treatment efforts should be extended to remediate not only signs and symptoms of psychiatric syndromes but QOL and disability as well; increased understanding toward this end is evolving, yet it is clear that these issues need to be the focus of more investigation.
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Affiliation(s)
- Rachel E Maddux
- Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, California 90048, USA
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Kales HC, Valenstein M. Complexity in late-life depression: impact of confounding factors on diagnosis, treatment, and outcomes. J Geriatr Psychiatry Neurol 2003; 15:147-55. [PMID: 12230085 DOI: 10.1177/089198870201500306] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Late-life depression is a heterogeneous syndrome. Although depression in elderly patients is highly treatable, a number of factors or confounds create complexity in its overall management. Patient factors, such as medical illness, neuropsychiatric comorbidity, and race, may interact with provider factors to make management more complex. Outcomes and services research indicate that these factors, particularly medical illness, affect whether late-life depression is appropriately detected, diagnosed, and treated. Attention to such factors must be included in an agenda for mental health services research, with emphasis on the delivery of effective treatment to elderly patients with depression and improved outcomes in clinical settings.
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Affiliation(s)
- Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor Veterans Affairs Medical Center 48105, USA
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