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Walker J, Burke K, Wanat M, Fisher R, Fielding J, Mulick A, Puntis S, Sharpe J, Esposti MD, Harriss E, Frost C, Sharpe M. The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies. Psychol Med 2018; 48:2285-2298. [PMID: 29576041 DOI: 10.1017/s0033291718000624] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comorbid depression in the medically ill is clinically important. Admission to a general hospital offers an opportunity to identify and initiate treatment for depression. However, we first need to know how common depression is in general hospital inpatients. We aimed to address this question by systematically reviewing the relevant literature. METHODS We reviewed published prevalence studies in any language which had used diagnostic interviews of general hospital inpatients and met basic methodological quality criteria. We focussed on interview-based studies in order to estimate the proportion of patients with a diagnosis of depressive illness. RESULTS Of 158 relevant articles, 65 (41%) describing 60 separate studies met our inclusion criteria. The 31 studies that focussed on general medical and surgical inpatients reported prevalence estimates ranging from 5% to 34%. There was substantial, highly statistically significant, heterogeneity between studies which was not materially explained by the covariates we were able to consider. The average of the reported prevalences was 12% (95% CI 10-15), with a 95% prediction interval of 4-32%. The remaining 29 studies, of a variety of specific clinical populations, are described. CONCLUSIONS The available evidence suggests a likely prevalence high enough to make it worthwhile screening hospital inpatients for depression and initiating treatment where appropriate. Further, higher quality, research is needed to clarify the prevalence of depression in specific settings and to further explore the reasons for the observed heterogeneity in estimates.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Katy Burke
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Marta Wanat
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Rebecca Fisher
- Department of Primary Care Health Sciences,University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Amy Mulick
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Puntis
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Joseph Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Michelle Degli Esposti
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford,Oxford,UK
| | - Chris Frost
- Department of Medical Statistics,London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Psychological Medicine Research,University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
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Mousavi B, Khateri S, Soroush M, Ganjparvar Z. Sulfur mustard exposure and mental health in survivors of Iran–Iraq war with severe lung injuries. TOXIN REV 2017. [DOI: 10.1080/15569543.2017.1303779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Batool Mousavi
- Janbazan Medical and Engineering Research Center, Tehran, Iran
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Wald HL, Leykum LK, Mattison MLP, Vasilevskis EE, Meltzer DO. A patient-centered research agenda for the care of the acutely ill older patient. J Hosp Med 2015; 10:318-27. [PMID: 25877486 PMCID: PMC4422835 DOI: 10.1002/jhm.2356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/28/2015] [Accepted: 03/09/2015] [Indexed: 12/11/2022]
Abstract
Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training.
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Affiliation(s)
- Heidi L. Wald
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO
| | - Luci K. Leykum
- South Texas Veterans Health Care System and Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio TX
| | - Melissa L. P. Mattison
- Department of Medicine, Division of General Medicine and Primary Care, Section of Hospital Medicine Beth Israel Deaconess Medical Center, Boston, MA
| | - Eduard E. Vasilevskis
- Division of General Internal Medicine and Public Health and Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center, Nashville, TN
| | - David O. Meltzer
- Section of Hospital Medicine, University of Chicago Department of Medicine, Chicago, IL
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Cancino RS, Culpepper L, Sadikova E, Martin J, Jack BW, Mitchell SE. Dose-response relationship between depressive symptoms and hospital readmission. J Hosp Med 2014; 9:358-64. [PMID: 24604881 DOI: 10.1002/jhm.2180] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/02/2014] [Accepted: 02/05/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Evidence suggests depression increases hospital readmission risk. OBJECTIVE Determine whether depressive symptoms are associated with unplanned readmission within 30 days of discharge of general medical patients. DESIGN Secondary analysis of the Project Re-Engineered Discharge (RED) randomized controlled trials. SETTING Urban academic safety-net hospital. PATIENTS A total of 1418 hospitalized adult English-speaking patients. INTERVENTION The 9-Item Patient Health Questionnaire (PHQ-9) was used to screen patients for depressive symptoms. MEASUREMENTS Hospital readmission within 30 days of discharge. Poisson regression was used to control for confounding variables. RESULTS There were 225 (16%) patients who screened positive for mild depressive symptoms (5 ≤PHQ-9 ≤ 9) and 336 (24%) for moderate or severe depressive symptoms (PHQ-9 ≥ 10). After controlling for confounders, a higher rate of readmission was observed in subjects with mild depressive symptoms compared to subjects with PHQ-9 <5, incidence rate ratio (IRR) 1.49 (95% confidence interval [CI]: 1.11-2.00). The adjusted IRR of readmission for those with moderate-to-severe symptoms was 1.96 (95% CI: 1.51-2.49) compared to those with no depression. CONCLUSIONS Screening positive for mild and moderate-to-severe depressive symptoms during a hospitalization on a general medical service is associated with an increased dose-dependent readmission rate within 30 days of discharge in an urban, academic, safety-net hospital. Further research is needed to determine whether treatments targeting the reduction of depressive symptoms reduce the risk of readmission.
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Affiliation(s)
- Ramon S Cancino
- Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
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5
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Sociodemographic correlates of depression and anxiety disorders among physically ill elderly patients. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000427044.15345.7b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Day HR, Morgan DJ, Himelhoch S, Young A, Perencevich EN. Association between depression and contact precautions in veterans at hospital admission. Am J Infect Control 2011; 39:163-5. [PMID: 21356434 DOI: 10.1016/j.ajic.2010.06.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/18/2010] [Accepted: 06/22/2010] [Indexed: 10/18/2022]
Abstract
Contact Precautions (CP) have been associated with depression and anxiety. We enrolled 103 patients on admission to a VA hospital and administered the Hospital Depression and Anxiety Scale (HADS). The mean unadjusted HADS score was 10% higher in patients on CP (14.3 vs 13.0; P = .47), and the association was stronger after adjusting for other variables (mean difference, 2.2; P = .21). Although underpowered, in the largest study to date, patients on CP tended toward more depression and anxiety.
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Meeks T, Vahia I, Lavretsky H, Kulkarni G, Jeste D. A tune in "a minor" can "b major": a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011; 129:126-42. [PMID: 20926139 PMCID: PMC3036776 DOI: 10.1016/j.jad.2010.09.015] [Citation(s) in RCA: 341] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/15/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. METHODS We searched PubMed (1980-Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression. RESULTS In older adults subthreshold depression was generally at least 2-3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8-10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. LIMITATIONS Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. CONCLUSIONS The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.
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Affiliation(s)
- Thomas Meeks
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Ipsit Vahia
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Helen Lavretsky
- Department of Psychiatry, University of California, Los Angeles
| | | | - Dilip Jeste
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
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8
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Kessler RC, Birnbaum H, Shahly V, Bromet E, Hwang I, McLaughlin KA, Sampson N, Andrade LH, de Girolamo G, Demyttenaere K, Haro JM, Karam AN, Kostyuchenko S, Kovess V, Lara C, Levinson D, Matschinger H, Nakane Y, Browne MO, Ormel J, Posada-Villa J, Sagar R, Stein DJ. Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO World Mental Health Survey Initiative. Depress Anxiety 2010; 27:351-64. [PMID: 20037917 PMCID: PMC3139270 DOI: 10.1002/da.20634] [Citation(s) in RCA: 281] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although depression appears to decrease in late life, this could be due to misattribution of depressive symptoms to physical disorders that increase in late life. METHODS We investigated this issue by studying age differences in co-morbidity of DSM-IV major depressive episodes (MDE) with chronic physical conditions in the WHO World Mental Health (WMH) surveys, a series of community epidemiological surveys of respondents in 10 developed countries (n=52,485) and 8 developing countries (n=37,265). MDE and other mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). Organic exclusion rules were not used to avoid inappropriate exclusion of cases with physical co-morbidity. Physical conditions were assessed with a standard chronic conditions checklist. RESULTS Twelve-month DSM-IV/CIDI MDE was significantly less prevalent among respondents ages 65+ than younger respondents in developed but not developing countries. Prevalence of co-morbid mental disorders generally either decreased or remained stable with age, while co-morbidity of MDE with mental disorders generally increased with age. Prevalence of physical conditions, in comparison, generally increased with age, while co-morbidity of MDE with physical conditions generally decreased with age. Depression treatment was lowest among the elderly in developed and developing countries. CONCLUSIONS The weakening associations between MDE and physical conditions with increasing age argue against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders. Future study is needed to investigate processes that might lead to a decreasing impact of physical illness on depression among the elderly.
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Affiliation(s)
- Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Victoria Shahly
- Boston Psychoanalytic Society and Institute, Boston, Massachusetts
| | - Evelyn Bromet
- Department of Psychiatry, State University of New York at Stony Brook
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Katie A. McLaughlin
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology- LIM 23 Department and Institute of Psychiatry School of Medicine University of São Paulo São Paulo, Brazil
| | | | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
| | - Josep Maria Haro
- Sant Joan de Deu-SSM, Barcelona; Ciber en Salud Mental (CIBERSAM), ISCIII Barcelona, Spain
| | - Aimee N. Karam
- Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | | | | | - Carmen Lara
- Autonomous University of Puebla, Puebla, Mexico
| | - Daphna Levinson
- Research & Planning, Mental Health Services Ministry of Health, Jerusalem, Israel
| | | | | | | | - Johan Ormel
- Department of Psychiatry & Department of Epidemiology and Bioinformatics, University Medical Center Groningen; Graduate School of Behavioural and Cognitive Neurosciences & Graduate School for Experimental Psychopathology, University of Groningen, the Netherlands
| | - Jose Posada-Villa
- Ministry of Social Protection, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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9
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Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36:828-35. [PMID: 20232042 DOI: 10.1007/s00134-010-1842-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 01/02/2010] [Indexed: 12/18/2022]
Abstract
PURPOSE Patients who require mechanical ventilation are at risk of emotional stress because of total dependence on a machine for breathing. The stress may negatively impact ventilator weaning and survival. The purpose of this study was to determine whether depressive disorders in patients being weaned from prolonged mechanical ventilation are linked to weaning failure and decreased survival. METHODS A prospective study of 478 consecutive patients transferred to a long-term acute care hospital for weaning from prolonged ventilation was undertaken. A clinical psychologist conducted a psychiatric interview to assess for the presence of depressive disorders. RESULTS Of the 478 patients, 142 had persistent coma or delirium and were unable to be evaluated for depressive disorders. Of the remaining 336 patients, 142 (42%) were diagnosed with depressive disorders. In multivariate analysis, co-morbidity score [odds ratio (OR), 1.23; P = 0.007], functional dependence before the acute illness (OR, 1.70, P = 0.03) and history of psychiatric disorders (OR, 3.04, P = 0.0001) were independent predictors of depressive disorders. The rate of weaning failure was higher in patients with depressive disorders than in those without such disorders (61 vs. 33%, P = 0.0001), as was mortality (24 vs. 10%, P = 0.0008). The presence of depressive disorders was independently associated with mortality (OR, 4.3; P = 0.0002); age (OR, 1.06; P = 0.001) and co-morbidity score (OR, 1.24; P = 0.02) also predicted mortality. CONCLUSION Depressive disorders were diagnosed in 42% of patients who were being weaned from prolonged ventilation. Patients with depressive disorders were more likely to experience weaning failure and death.
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10
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Helvik AS, Skancke RH, Selbaek G. Screening for depression in elderly medical inpatients from rural area of Norway: prevalence and associated factors. Int J Geriatr Psychiatry 2010; 25:150-9. [PMID: 19551706 DOI: 10.1002/gps.2312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The present investigation screened for depression in order to assess the prevalence of depression and to study the associated factors with depression in elderly medically hospitalised patients from a rural area in Norway. METHODS A cross-sectional study evaluated 484 (243 women) elderly medical inpatients with age range 65-101 (mean 80.7) years between September 2006 and August 2008 and used the Hospital Anxiety and Depression scale (HAD), Montgomery and Asberg Depression Rating Scale, the Mini-Mental State Examination, Lawton and Brody's scale for self-maintaining and instrumental activities of daily living. RESULTS The prevalence of current depression, depression score > or =8 at HAD, was for the total sample 10% of whom 78% was previously not diagnosed as having depression. The odds for depression were decreased for women aged 80 years or more while for men at the same age strata it was increased threefold. Age adjusted logistic regression analyses demonstrated an increased odds for depression for those who were in need of nursing assistance before hospitalisation, had lower level of physical functioning, had clinical anxiety symptoms and had higher number of medicaments at inclusion time. CONCLUSION The prevalence of depression in medical hospitalised elderly from rural areas was lower than in most other hospital studies. However, most patients with depression were not previously recognised as being depressed.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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11
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Kessler RC, Birnbaum H, Bromet E, Hwang I, Sampson N, Shahly V. Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R). Psychol Med 2010; 40:225-37. [PMID: 19531277 PMCID: PMC2813515 DOI: 10.1017/s0033291709990213] [Citation(s) in RCA: 335] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life. METHOD We studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0. RESULTS Lifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged 65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly. CONCLUSIONS Given that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders.
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Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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12
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Pinho MX, Custódio O, Makdisse M. Incidência de depressão e fatores associados em idosos residentes na comunidade: revisão de literatura. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2009. [DOI: 10.1590/1809-9823.2009120111] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Depressão geriátrica ocorre com frequência, mesmo na população residente na comunidade. Vários fatores de risco associados estão descritos na literatura. O objetivo deste estudo é realizar uma revisão da literatura sobre a incidência de depressão geriátrica e os fatores de risco associados em idosos residentes na comunidade. Para este fim, realizou-se revisão bibliográfica da literatura sobre o tema, sendo efetuada consulta às bases de dados MEDLINE, PUBMED, LILACS e SCIELO, utilizando-se das palavras chaves "idoso", "fator de risco", "depressão" e "incidência". A incidência de depressão na população idosa residente na comunidade é de 13,23%, em média. Os preditores de depressão identificados foram: sexo feminino, idade avançada, condição marital, baixa escolaridade, condição socioeconômica desfavorável, condições de moradia, baixo suporte social, eventos estressores, depressão prévia, co-morbidades psiquiátricas, características de personalidade, distúrbios do sono, déficits cognitivos, condições de saúde adversas, limitação funcional e dor. Depressão ocorre com frequência na população idosa e constitui problema grave. A identificação dos fatores de risco associados com sua incidência pode ajudar os profissionais que atuam na área a diagnosticar e propor intervenções mais precoces e adequadas.
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Morgan DJ, Diekema DJ, Sepkowitz K, Perencevich EN. Adverse outcomes associated with Contact Precautions: a review of the literature. Am J Infect Control 2009; 37:85-93. [PMID: 19249637 DOI: 10.1016/j.ajic.2008.04.257] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contact Precautions (CP) are a standard method for preventing patient-to-patient transmission of multiple drug-resistant organisms (MDROs) in hospital settings. With the ongoing worldwide concern for MDROs including methicillin-resistant Staphylococcus aureus (MRSA) and broadened use of active surveillance programs, an increasing number of patients are being placed on CP. Whereas few would argue that CP are an important tool in infection control, many reports and small studies have observed worse noninfectious outcomes in patients on CP. However, no review of this literature exists. METHODS We systematically reviewed the literature describing adverse outcomes associated with CP. We identified 15 studies published between 1989 and 2008 relating to adverse outcomes from CP. Nine were higher quality based on standardized collection of data and/or inclusion of control groups. RESULTS Four main adverse outcomes related to CP were identified in this review. These included less patient-health care worker contact, changes in systems of care that produce delays and more noninfectious adverse events, increased symptoms of depression and anxiety, and decreased patient satisfaction with care. CONCLUSION Although CP are recommended by the Centers for Disease Control and Prevention as an intervention to control spread of MDROs, our review of the literature demonstrates that this approach has unintended consequences that are potentially deleterious to the patient. Measures to ameliorate these deleterious consequences of CP are urgently needed.
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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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Prakash O, Gupta LN, Singh VB, Singhal AK, Verma KK. Profile of psychiatric disorders and life events in medically ill elderly: experiences from geriatric clinic in Northern India. Int J Geriatr Psychiatry 2007; 22:1101-5. [PMID: 17357180 DOI: 10.1002/gps.1793] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Morbidity among elderly people has an important influence on their psychological well-being. Evaluation of the morbidity profile and its determinants, which have implications for management of medical problems of elderly people, are scarce in developing countries. Even the physicians' detection rate of mental distress in elderly populations is low in medical outpatient clinics. This could be due to the large caseloads and also, importantly, underestimation of psychological concerns of the elderly. The objective of this study was to study the psychiatric co-morbidity and life events among elderly medical outpatients. METHODS One hundred medically ill elderly (>60 years) patients attending the Geriatric Clinic at Bikaner (North India) constituted the study population. The physical diagnosis was made by a physician based on reported illness, clinical examination and medical records. Psychiatric diagnosis was made by detailed clinical psychiatric interview using ICD-10 guidelines. Life events were assessed by the Indian adaptation of Presumptive Stressful Life Events Scale. RESULTS Hypertension was the most commonly reported physical diagnosis (50%), other specific medical illnesses were osteoarthritis (15%), diabetes (13%) and constipation (8%). The study found 18% subjects had depression and 11% had other mental disorders. Patients with mental disorders had suffered more recent stressful life events. Among life events, conflicts in family (16%); unemployment of self or children (9%) was reported by elderly psychiatric patients. Other reported life events in psychiatric diagnosed elderly were conflict in family (7%), illness of self (6%) or family members (5%) and death of family members (5%) or close relatives (4%). CONCLUSION Mental disorders are common among medically ill elderly patients, but they are poorly recognized and treated. Assessment of the psychiatric morbidity will help in strengthening psycho-geriatric services and thus, improve the quality of life of the elderly.
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Affiliation(s)
- Om Prakash
- Geriatric Clinic and services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Abstract
Depression frequently is comorbid with a variety of medical illnesses; individuals who have such comorbidities may have increased morbidity and lower functional status. Usual antidepressant treatments can be effective in depressed patients who have comorbid medical illness. These patients, however, experience lower rates of recovery and remission of depressive symptoms and higher rates of relapse during follow-up than seen in patients who have MDD with no medical comorbidity. Comorbid medical illness therefore is a marker of treatment resistance in MDD. Collaborative treatments combining antidepressants, psychotherapy, education, and case management may be effective and could overcome the risk of treatment resistance. Two clinical strategies seem warranted in light of the studies presented here: (1) an increased index of suspicion for depression in medically ill patients, and (2) more intensive antidepressant treatment in depressed patients who have medical comorbidity.
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Affiliation(s)
- Dan V Iosifescu
- Depression Clinical and Research Program, Massachusetts General Hospital, 50 Staniford Street, Suite 401, Boston, MA 02114, USA.
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Abstract
OBJECTIVE Baseline patient characteristics and depression treatments were examined as predictors of speed of depression remission in hospitalized medical patients with chronic pulmonary disease (CPD). METHODS Consecutively admitted patients over age 50 years with CPD were screened for major and minor depression using the Structured Clinical Interview for Depression. Patients with minor depression were followed up over 12-24 weeks with the Longitudinal Interview Follow-up Evaluation. Course of depression and predictors of remission were examined. RESULTS Seven hundred eleven depressed patients with CPD (410 with minor, 301 with major depression) were identified and assessed over time. Two-thirds with minor depression had remitted by 12 weeks compared with 26.9% with major depression at 12 weeks and 49.2% at 24 weeks. Predictors of faster remission for minor depression were black race, community hospital admission, less severe depression, less medical comorbidity, less severe CPD, more social support, and no antidepressant treatment. For major depression, less severe depression, no past antidepressant drug treatment, and less intense current antidepressant treatment predicted faster remission. CONCLUSIONS The course of depressive disorder after discharge in patients hospitalized with CPD can be predicted by characteristics during admission. Although patients with minor depression may be followed and treatment initiated only if depression persists, those with major depression need more aggressive treatment and psychiatric consultation if improvement does not occur.
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Affiliation(s)
- Harold G Koenig
- Departments of Psychiatry & Behavioral Sciences and Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Koenig HG. Comparison of older depressed hospitalized patients with and without heart failure/pulmonary disease. Aging Ment Health 2006; 10:335-42. [PMID: 16798625 DOI: 10.1080/13607860500409716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Test the hypothesis that depressed hospitalized patients with congestive heart failure (CHF) and/or chronic pulmonary disease (CPD) are no different from depressed patients with other medical disorders, and so can be treated similarly. Consenting patients aged 50 or over consecutively admitted to the medical services at Duke University Medical Center and three community hospitals were screened for depressive disorder using the Structured Clinical Interview for Depression (SCID-IV). Characteristics of patients reflecting vulnerability, stressors, and coping resources were assessed. CHF/CPD patients with major (n = 413) and minor (n = 587) depression were compared to depressed patients with other medical disorders (n = 63). Among those with major depression, patients with CHF/CPD differed from those with other medical disorders in having less severe depression and less severe cognitive impairment, but greater physical illness severity. Among those with minor depression, CHF/CPD patients tended to be older and, as with major depression, had less severe depression and more severe medical illness. These findings were largely confirmed when CHF and CPD patients were examined separately. Depressive disorders in CHF/CPD patients are similar to those in patients with other medical disorders. However, they may be associated with less severe depressive symptoms and more severe physical illness than depressed patients with other medical disorders. These findings help to identify the unique ways in which depressive disorder manifests itself in hospitalized patients with chronic heart and lung disease that may impact their management.
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Affiliation(s)
- H G Koenig
- Duke University Medical Center, Durham, NC 27710, USA.
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Koenig HG, Vandermeer J, Chambers A, Burr-Crutchfield L, Johnson JL. Comparison of Major and Minor Depression in Older Medical Inpatients With Chronic Heart and Pulmonary Disease. PSYCHOSOMATICS 2006; 47:296-303. [PMID: 16844887 DOI: 10.1176/appi.psy.47.4.296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depressed medical inpatients with congestive heart failure (CHF) and/or chronic pulmonary disease (CPD) were examined to determine characteristics distinguishing major depression (N=413) from minor depression (N=587). Consecutively admitted patients age 50 or over were screened for depressive disorder with the Structured Clinical Interview for Depression (SCID-IV). CHF/CPD patients with major depression differed from those with minor depression not only on number and severity of depressive symptoms but also on race/ethnicity, comorbid psychiatric illnesses, dyspnea, life stressors, social support, and previous antidepressant therapy. CHF/CPD patients with major and minor depression have distinct psychosocial and physical characteristics that distinguish one from another.
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Affiliation(s)
- Harold G Koenig
- Duke Univ. Medical Center and the GRECC VA Medical Center, Durham, NC 27710, USA.
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20
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Abstract
BACKGROUND Older people with depression make greater use of healthcare services, but the detection of the disorder is poor. The National Service Framework for Older People recommended screening for depression in acute healthcare settings to improve health outcomes of older people. Previous studies, mainly outside the UK, report widely differing rates for depression that do not usefully inform UK practice. Thus the aim of this study is to estimate, in a large representative sample of older medical inpatients in a UK hospital setting, the prevalence of depressive symptoms and ICD-10 depressive disorder and to examine the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15) as a screening instrument. METHODS A two-phase prevalence study of depressive disorder was carried out in acute wards of a district general hospital. Six hundred and eighteen (61%) of 1,009 eligible older medical inpatients were screened using the GDS-15. A stratified sample (n = 223) was further assessed using the Geriatric Mental State, from which ICD-10 diagnoses were determined. RESULTS The weighted prevalence estimate of ICD-10 depressive disorder was 17.7% (95%CI: 12.9-22.5). Forty-four percent of participants scored above the normally recommended cut-point of >or=5 on the GDS-15. However, on the basis of ROC, the optimal cut-point of the GDS-15 for screening for depressive disorder in this hospitalised population is two points higher at >or=7 (sensitivity 0.74, specificity 0.81). CONCLUSIONS This study confirms that depression is common amongst older UK medical inpatients with 1 in 6 suffering from clinical depression. The cut-point for GDS-15 for this population is >or=7.
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Affiliation(s)
- Sarah Cullum
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK.
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Milisen K, Braes T, Fick DM, Foreman MD. Cognitive assessment and differentiating the 3 Ds (dementia, depression, delirium). Nurs Clin North Am 2006; 41:1-22, v. [PMID: 16492451 DOI: 10.1016/j.cnur.2005.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Differentiation between a diminished or altered cognitive functioning asa consequence of aging and one resulting from serious health problems is critical in the elderly. An unrecognized cognitive disorder or the worsening of the impairment may hamper the effectiveness and appropriateness of care and treatment; therefore, standardized assessment procedures and systematic monitoring of cognition and behavior are important aspects of the nursing care. of older adults. In this article, current notions for accurate and comprehensive cognitive assessment in older persons are delineated. Further, an overview of epidemiological screening and diagnostic dilemmas of dementia, depression, and deliriumare provided.
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Affiliation(s)
- Koen Milisen
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium.
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Koenig HG, Vandermeer J, Chambers A, Burr-Crutchfield L, Johnson JL. Minor depression and physical outcome trajectories in heart failure and pulmonary disease. J Nerv Ment Dis 2006; 194:209-17. [PMID: 16534439 DOI: 10.1097/01.nmd.0000202492.47003.74] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We examined conjoint trajectories of depression-physical illness outcomes in elderly inpatients with minor depression and heart failure or pulmonary disease, and identified demographic, psychosocial, physical, and treatment predictors of trajectory. Consecutively admitted patients over age 50 with heart failure and/or chronic pulmonary disease were screened for minor depression using the Structured Clinical Interview for Depression. Follow-up evaluations were performed at 6 and 12 weeks using the Longitudinal Interview Follow-Up Evaluation, Hamilton Depression Scale, and Chronic Heart Failure-Chronic Respiratory Disease Questionnaire. Patients were placed into four depression-physical illness outcome trajectories: (T#1) depression better, illness better; (T#2) depression better, illness same; (T#3) depression same, illness better; and (T#4) depression same, illness same. Bivariate and multivariate predictors were examined. Minor depression was identified in 587 patients. Of these, 487 were evaluated at 6 weeks and 444 at 12 weeks. By 6 weeks, 39.4% of patients improved both on depression and physical illness (T#1), and 27.3% improved on neither (T#4). By 12 weeks, 49.6% had improved on both and 20.5% on neither. Race, admitting hospital, past psychiatric history, family psychiatric history, comorbid physical illnesses, and antidepressant drug treatment independently predicted outcome trajectory. Improvements in depression and physical illness track closely together in elderly inpatients with heart failure or pulmonary disease. Baseline patient characteristics predict which outcome trajectory they are likely to follow after hospital discharge, and may be useful in diagnosis and management.
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Affiliation(s)
- Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA
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Old age medical patients screening positive for depression. Ir J Psychol Med 2005; 22:124-127. [PMID: 30308785 DOI: 10.1017/s0790966700009228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim was to observe whether medical inpatients screening positive for depression using the Geriatric Depression Scale (GDS) continue to screen positive following hospital discharge. METHOD Participants aged 65 or over, were recruited from consecutive admissions to a city teaching hospital. Subjects had an Abbreviated Mental Test Score (AMTS) of seven or above and a GDS-15 score of five or above. Information was collected on past psychiatric history and living arrangements. Subjects were followed-up three months later and the GDS repeated. RESULTS Thirty subjects were recruited and 26 (87%) followed-up. Ten (38%) no longer scored positive on the GDS, and overall the mean GDS score decreased by two points (Z = 2.235 p < 0.05). Patients with a past psychiatric history or living alone were more likely to be depressed at follow-up. No participants were referred to the psychiatric service or started on antidepressant medication during the course of the study. CONCLUSION Depressive symptoms are likely to persist following hospital discharge, especially in those patients with a past psychiatric history. An understanding of the risk factors associated with persistent depressive symptoms is necessary if the patients appropriate for treatment are to be identified.
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Trentini CM, Xavier FMDF, Chachamovich E, Rocha NSD, Hirakata VN, Fleck MPDA. The influence of somatic symptoms on the performance of elders in the Beck Depression Inventory (BDI). BRAZILIAN JOURNAL OF PSYCHIATRY 2005; 27:119-23. [PMID: 15962136 DOI: 10.1590/s1516-44462005000200009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: The Beck Depression Inventory (BDI) has been widely used to assess the prevalence of depressive symptomatology in clinical and non-clinical samples. On elders, however, the Beck Depression Inventory total score can be influenced by the increased scores on somatic and performance subscale due to the impact of ageing process itself and clinical diseases. PURPOSE: To verify if there are differences between answers of adults and elders for the BDI Somatic and Performance subscale. METHODS: Five hundred and fifty six subjects were interviewed. Two hundred and seventeen were adults (between 18 and 59 years old) and 339 were elders (> 60 years). Adults and elders with terminal diseases or dementia were excluded. The convenience sampling method was used. RESULTS: Elders answered significantly with higher scores in the Somatic and Performance subscale compared to adults (p < 0.001). Female gender and educational level were also associated to higher scores in the Somatic subscale. No differences between both age groups were found in the Cognitive-Affective subscale (p = 0.332). CONCLUSIONS: Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.
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Iosifescu DV, Nierenberg AA, Alpert JE, Papakostas GI, Perlis RH, Sonawalla S, Fava M. Comorbid medical illness and relapse of major depressive disorder in the continuation phase of treatment. PSYCHOSOMATICS 2004; 45:419-25. [PMID: 15345787 DOI: 10.1176/appi.psy.45.5.419] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examined the impact of comorbid medical illness on the rate of relapse of major depressive disorder during continuation therapy. Subjects (N = 128) with major depressive disorder (according to DSM-III-R criteria) achieved clinical remission (a 17-item Hamilton Depression Rating Scale score < or = 7) after 8 weeks of treatment with fluoxetine and entered the continuation phase of antidepressant treatment. They used the Cumulative Illness Rating Scale to measure the severity of comorbid medical illness. Eight patients (6.3%) relapsed during the 28-week continuation phase. With logistic regression, the total burden and the severity of comorbid medical illness significantly predicted the relapse of major depressive disorder during continuation therapy with fluoxetine. Greater medical comorbidity was also associated with higher increases in self-reported symptoms of depression, anxiety, and anger during the follow-up.
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Affiliation(s)
- Dan V Iosifescu
- Depression Clinical and Research Program, Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Iosifescu DV, Bankier B, Fava M. Impact of medical comorbid disease on antidepressant treatment of major depressive disorder. Curr Psychiatry Rep 2004; 6:193-201. [PMID: 15142472 DOI: 10.1007/s11920-004-0064-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A major factor in evaluating and treating depression is the presence of comorbid medical problems. In this paper, the authors will first evaluate studies showing that medical illness is a risk factor for depression. The authors will review a series of randomized, controlled studies of antidepressant treatment in subjects with major depressive disorder (MDD) and comorbid medical illnesses (myocardial infarction, stroke, diabetes, cancer, and rheumatoid arthritis). Most of these studies report an advantage for an active antidepressant over placebo in improvement of depressive symptoms. The authors also will review a series of studies in which the outcome of antidepressant treatment is compared between subjects with MDD with and without comorbid medical illness. In these studies, subjects with medical illness tend to have lower improvement of depressive symptoms and higher rates of depressive relapse with antidepressant treatment compared with MDD subjects with no medical comorbidity. In addition, the authors will review hypotheses on the mechanism of the interaction between medical illness and clinical response in MDD. The paper will conclude that medical comorbidity is a predictor of treatment resistance in MDD.
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Affiliation(s)
- Dan V Iosifescu
- Massachusetts General Hospital, 50 Staniford Street, Suite 401, Boston, MA 02114, USA.
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Goldberg JH, Breckenridge JN, Sheikh JI. Age differences in symptoms of depression and anxiety: examining behavioral medicine outpatients. J Behav Med 2003; 26:119-32. [PMID: 12776382 DOI: 10.1023/a:1023030605390] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined whether symptoms of depression and concomitant anxiety differed between older and younger medical outpatients referred to a behavioral medicine clinic. In a sample of 178 male veterans aged 21-83 years, older adults (> or = 60 years) reported lower overall depressive symptoms on the Beck Depression Inventory (BDI) and anxiety symptoms on the State-Trait Anxiety Inventory than did younger adults ( < 60 years). Depressive symptoms were highly prevalent. Among older adults, 60.0% scored 10 or higher on BDI and 33.8% scored 16 or higher. Among younger adults, 70.8% scored 10 or higher on BDI, and 48.7% scored 16 or higher. The age difference in overall depressive symptoms was driven by cognitive-affective symptoms. While older adults had lower cognitive-affective symptoms than did younger adults, the two groups did not differ on somatic-performance symptoms. these results suggest the importance of assessing cognitive-affective depressive symptoms in both older and younger male medical outpatients.
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Affiliation(s)
- Jennifer H Goldberg
- Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California, 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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Huffman J, Stern TA. Acute psychiatric manifestations of stroke: a clinical case conference. PSYCHOSOMATICS 2003; 44:65-75. [PMID: 12515840 DOI: 10.1176/appi.psy.44.1.65] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jeff Huffman
- Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02114, USA
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Saks K, Tiit E, Käärik E, Jaanson K. Depressive symptoms in older Estonians: prevalence and models. J Am Geriatr Soc 2002; 50:1164-5. [PMID: 12110085 DOI: 10.1046/j.1532-5415.2002.50280.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE We report a case of severe depression in an elderly and critically ill patient with multiple medical complications who was treated with a combination of methylphenidate and sertraline. The objective of this report is to outline the usefulness of methylphenidate as an antidepressant in a patient with respiratory insufficiency. METHOD Case description. RESULTS The patient had a positive clinical response with initial mental confusion due to methylphenidate. An initial dose of 2.5 mg/day allowed antidepressant response and improvement of respiratory function permitting the removal of mechanical ventilation. CONCLUSION Methylphenidate may be useful for patients with severe medical conditions including ventilatory insufficiency.
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Affiliation(s)
- D C Ayache
- Department and Institute of Psychiatry, Faculty of Medicine University of São Paulo, Brazil
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Blank K, Robison J, Prigerson H, Schwartz HI. Instability of attitudes about euthanasia and physician assisted suicide in depressed older hospitalized patients. Gen Hosp Psychiatry 2001; 23:326-32. [PMID: 11738463 DOI: 10.1016/s0163-8343(01)00160-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to examine the interest of non-terminally ill hospitalized elderly patients in euthanasia and physician assisted suicide (PAS) and to determine the stability of these interests over time. Patients age 60 or older (n=158), including both a depressed sample and non-depressed control sample, underwent a structured interview evaluating their interest in euthanasia and PAS in the event of a series of hypothetical outcome scenarios. Substantial proportions of subjects (varying from 13.3%-42% depending on the scenario) expressed hypothetical acceptance of euthanasia and PAS. After six months a subset of patients changed their minds about euthanasia and PAS (8% - 26% depending on the scenario), most often in the direction of initial acceptance to later rejection. Patients depressed in the hospital and interested in PAS for the outcome of their current (non-terminal) condition were significantly more likely express unstable opinions, with most rejecting it six months later. Other correlations of instability, in specific scenarios, included being male, experiencing higher baseline suffering, poorer subjective health and lower instrumental support. Because euthanasia and PAS actions are irreversible, findings of instability have important implications both clinically and for design of PAS legislation.
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Affiliation(s)
- K Blank
- Braceland Center for Mental Health and Aging, Institute of Living, University of Connecticut School of Medicine, Hartford, CT 06106, USA.
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Weinert CR. Epidemiology of psychiatric medication use in patients recovering from critical illness at a long-term acute-care facility. Chest 2001; 119:547-53. [PMID: 11171736 DOI: 10.1378/chest.119.2.547] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY OBJECTIVES To describe the pharmacoepidemiology of psychotropic medication prescription in patients recovering from life-threatening medical and surgical illness. DESIGN Retrospective analysis of a random sample of medical records. SETTING Regional referral center. PATIENTS Eighty-nine randomly selected patients transferred from an ICU to the study facility. INTERVENTIONS None. MEASUREMENTS AND RESULTS Patients had been treated at the referring ICU for 33 +/- 24 days (mean +/- SD) and remained at the study hospital for 64 +/- 52 days. Most of the patients had prolonged respiratory failure. Nearly half of the patients (47%) received an antidepressant medication while at the facility, and 48% received at least one dose of a benzodiazepine on the first day after transfer. In the sample of 75 patients not prescribed an antidepressant before transfer, 37% were started on therapy with an agent, usually within 3 weeks and predominantly in the selective serotonin reuptake inhibitor or psychostimulant class. Younger patients and those evaluated by a mental health specialist were more likely to be prescribed an antidepressant, compared to other patients. Forty percent of patients were still receiving at least one dose of a benzodiazepine in a 24-h period after their third week at the facility. CONCLUSION Although the efficacy of antidepressant pharmacotherapy in patients with comparable severity of medical illness has not been established, a substantial proportion of patients recovering from critical illness at a specialized facility are prescribed antidepressant medications. Benzodiazepine exposure is frequent after transfer, and the prevalence in patients who remain at the facility minimally decreases over time.
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Affiliation(s)
- C R Weinert
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
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Ostbye T, Steenhuis R, Walton R, Cairney J. Correlates of dysphoria in Canadian seniors: the Canadian Study of Health and Aging. Canadian Journal of Public Health 2000. [PMID: 10986793 DOI: 10.1007/bf03404296] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the correlates of dysphoria in elderly Canadians. METHOD Randomly sampled elderly underwent screening in 1992 (CSHA-1) and in 1997 (CSHA-2). Community-living subjects without dementia at CSHA-1 were re-interviewed at CSHA-2 (n = 5234). A score < 53 on the mental health component of the Medical Outcomes Study Questionnaire (SF-36) was used to measure dysphoria. Sociodemographic, functional, social support, disease and lifestyle correlates of dysphoria were examined. RESULTS 4.76% of men, and 8.59% of women were classified as dysphoric. The occurrence declined with age. In multivariate analyses, chronic pain, poor self-rated health, functional dependency and, in men only, being married, were significantly related to dysphoria. Perceived social support remained significant after controlling for sociodemographic, functional and disease variables. CONCLUSION Dysphoria is common among the elderly, especially elderly women. Given the interrelationships and number of correlates of dysphoria, elderly Canadians require broad programs promoting health and social support as well as functional and economic independence.
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Affiliation(s)
- T Ostbye
- Department of Epidemiology and Biostatistics, University of Western Ontario, London.
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Abstract
Neuropsychiatric conditions, such as Alzheimer's dementia, and complications, such as delirium, are common in elderly patients with heart failure. Persistent alcohol abuse and cigarette smoking sometimes contribute to the onset and progression of heart failure. Major depression and other depressive disorders are common in this population and have adverse effects on functional status, quality of life, and prognosis. Anxiety and social isolation are clinically significant problems in many cases. These problems often are treatable and deserve more clinical attention than they typically receive.
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Affiliation(s)
- K E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63108, USA
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Pouget R, Yersin B, Wietlisbach V, Bumand B, Büla CJ. Depressed mood in a cohort of elderly medical inpatients: prevalence, clinical correlates and recognition rate. AGING (MILAN, ITALY) 2000; 12:301-7. [PMID: 11073350 DOI: 10.1007/bf03339851] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objectives of this prospective cohort study were to 1) determine the prevalence of depressed mood, 2) identify the characteristics associated with it, and 3) evaluate the recognition rate of depressed mood by clinicians. The study population was a cohort of 401 elderly patients, aged 75 years and older, admitted to the internal medicine service of a tertiary care academic medical center in Western Switzerland over six months. We excluded patients with severe cognitive impairment, terminal disease or those living in a nursing home. Data on demographics, medical, physical, social and mental status were collected upon admission. Presence of depressed mood was defined as a score > or = 6 on the Geriatric Depression Scale (GDS), short form (15-item). An independent reviewer performed a discharge summary abstraction to assess recognition rate. Subjects' mean age was 82.4 years, 60.9% were women. Overall, 90 patients (22.40%) had an abnormal GDS score (> or =6). Compared to those without a depressed mood, these subjects were (all p<0.05) older (83.5 vs 82.0 years), more frequently living alone (66.7 vs 55.0%), dependent in both basic activities of daily living (BADL) and instrumental ADL (48.9 vs 36.0%, and 91.1 vs 84.9%, respectively), and cognitively impaired (47.8 vs 27.7% with MMSE score<24). In addition, they had more comorbidities (Charlson index 1.6 vs 1.2). In multivariate analysis, an independent association remains for subjects living alone (OR 1.8, 95%CI 1.1-3.0), with cognitive impairment (OR 1.9, 95%CI 1.1-3.2), and comorbidities (OR 1.3 per point, 95%CI 1.1-1.5). Detection rate during the index hospitalization was only 16.7% (15/90). In conclusion, depressed mood was frequent but rarely detected in this population. These findings emphasize the need to improve screening efforts, and to develop additional strategies such as using a pre-screening question to enhance clinical recognition.
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Affiliation(s)
- R Pouget
- Division of Geriatric Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Fischer EP, Marder SR, Smith GR, Owen RR, Rubenstein L, Hedrick SC, Curran GM. Quality Enhancement Research Initiative in Mental Health. Med Care 2000; 38:I70-81. [PMID: 10843272 DOI: 10.1097/00005650-200006001-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Veterans Administration (VA) recently introduced its Quality Enhancement Research Initiative (QUERI) to facilitate the translation of best practices into usual clinical care. The Mental Health QUERI (MHQ) was charged with developing strategic plans for major depressive disorder (MDD) and schizophrenia. Twenty percent or more of VA service users are affected by 1 of these 2 disorders, disorders that often have a devastating impact on affected individuals. Despite the increasing availability of efficacious treatments for each disorder, substantial gaps remain between best practices and routine care. In this context, the MHQ identified steps critical to the success of a sustained process of rapid-cycle health care improvement for MDD and schizophrenia, including research initiatives to close gaps in knowledge of best treatment practices, demonstration projects to close gaps in practice and to expand understanding of effective strategies for implementing clinical guidelines, targeted enhancements of the VA information system, and research and dissemination initiatives to increase the availability of resources to support the accelerated incorporation of best practices into routine care. This article presents an overview of the elements in the initial MHQ strategic plans and the rationale behind them.
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Affiliation(s)
- E P Fischer
- VA HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and the Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock 72114, USA
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Weatherall M. A randomized controlled trial of the Geriatric Depression Scale in an inpatient ward for older adults. Clin Rehabil 2000; 14:186-91. [PMID: 10763796 DOI: 10.1191/026921500672596145] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To measure the prevalence of high scores on the Geriatric Depression Scale in an inpatient unit for older people and assess whether administration of this instrument increased the use of antidepressant medication. DESIGN Randomized controlled trial. SETTING Inpatient unit for assessment, treatment and rehabilitation of older adults in a district hospital. SUBJECTS Consecutive admissions to the inpatient unit were approached. Of 198 people, 100 gave consent and were randomized to receive the intervention. INTERVENTIONS The Geriatric Depression Scale and the Folstein Mini-mental State Examination were administered to the intervention group. The Nottingham Instrumental Activities of Daily Living questionnaire and the Folstein Mini-mental State Examination were administered to the placebo group. The scores of these instruments and a copy of the completed instrument were placed in the subject's case notes. For those subjects randomized to receive the Geriatric Depression Scale an interpretation of the score was written in the case notes. MAIN OUTCOME MEASURES The primary outcome measure was whether antidepressant medication was listed on the discharge summary for the admission. Other outcome measures were death, readmission and use of antidepressant medication three months after administration of the instruments. RESULTS There was a prevalence of Geriatric Depression Scale scores greater than 10 of 52% in the 50 people administered this instrument. Six out of 46 people administered the Geriatric Depression Scale, who were discharged in the study period, were on antidepressant medication at discharge. Three out of 47 people administered the placebo instrument were on antidepressant medication at discharge. The absolute difference in proportions was 6.7%, 95% confidence interval 19 to -5.3%. CONCLUSIONS A high proportion of patients admitted to an inpatient unit for assessment, treatment and rehabilitation scored in the depressed range on the Geriatric Depression Scale; however, use of the Geriatric Depression Scale in this clinical setting did not increase the use of antidepressant medication. This may be because the instrument is too nonspecific.
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Affiliation(s)
- M Weatherall
- Department of Medicine, Wellington School of Medicine, New Zealand.
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Beausang P, Syyed R. Screening for anxiety and depression in adult general medical in-patients in a Scottish District General Hospital. Scott Med J 1998; 43:177-80. [PMID: 9924755 DOI: 10.1177/003693309804300606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We prospectively screened for anxiety and depression by administering the HAD scale to consecutive general medical patients admitted to a Scottish District General Hospital (DGH) over a calendar month. Age, gender, and use of psychotropic medications were also recorded. Of 119 patients (49 male) aged 16 to 92 years, "Probable presence of anxiety" was recorded in 23%, and "Probable presence of depression" in 19%. There was no significant difference between male and female patients or between different age groups. Formal psychological management was not available on site. Sixty-seven per cent of patients with "Probable presence of anxiety" and 61% with "Probable presence of depression" received no psychotropic medications. Despite a high prevalence of psychological distress amongst general medical in-patients, anxiety and depression are consistently under-diagnosed and under-treated. Screening for psychological distress, followed, where indicated, by psychological and/or pharmacological intervention, should be a fundamental element of holistic, patient-centred care in general medicine.
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Affiliation(s)
- P Beausang
- Department of Medicine for the Elderly, Gartnavel General Hospital, Glasgow
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Abstract
Studies have consistently shown high prevalence rates of depression associated with negative medical, functional, and psychosocial outcomes in hospitalized, medically ill, older adults. Several issues pose challenges to measurement of depression in this population. In particular, symptoms simultaneously attributable to both medical illness and psychiatric problems may confound measurement of depression, and there is no distinct boundary between normal and abnormal symptoms. This article critiques prevalence research methods used to measure depression in hospitalized, medically ill, older adults and makes recommendations regarding future measurement approaches in both research and clinical practice. Through the identification of appropriate methods for measurement of depression in this population, psychiatric nurses can make a valuable contribution in this area of research as well as enhance effective case-finding and evaluation of depression in older, hospitalized, medically ill patients in the clinical setting.
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Affiliation(s)
- L H Kurlowicz
- School of Nursing, University of Pennsylvania, Philadelphia 19104-6096, USA
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Kurlowicz LH. Perceived self-efficacy, functional ability, and depressive symptoms in older elective surgery patients. Nurs Res 1998; 47:219-26. [PMID: 9683117 DOI: 10.1097/00006199-199807000-00007] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decline in functional ability as a consequence of medical illness or surgery has been associated with the development of depressive symptoms in older patients. Little is known about the influence of psychological variables on the relationship between postoperative functional ability and depressive symptoms in older adults. Inclusion of perceived self-efficacy in a theoretical model of the relationship of functional ability and depressive symptoms would extend knowledge and inform health care providers about specific risk factors for the development of postoperative depressive symptoms in older elective surgery patients. OBJECTIVES The purpose of this longitudinal study was to test a theoretical path model of the effects of perceived self-efficacy and functional ability on depressive symptoms in older adults after major elective surgery. METHOD Seventy-six older adult inpatients (60% women; mean age = 72.3 years, SD = 5.06) who had undergone elective total hip replacement surgery participated in a face-to-face interview 4 to 5 days after surgery (Time 1) and a telephone interview 6 weeks after surgery (Time 2). Perceived self-efficacy was measured by the Self-Efficacy Expectation Scale, functional ability by the Functional Status Index, and depressive symptoms by the Geriatric Depression Scale. RESULTS Path analysis revealed that Time 1 perceived self-efficacy had a direct, negative effect on Time 2 depressive symptoms. Time 1 perceived self-efficacy also had an indirect effect on Time 2 depressive symptoms through its positive effect on Time 2 functional ability. CONCLUSIONS The findings suggest that interventions to enhance older patients' perceived self-efficacy while hospitalized after elective total hip replacement surgery may enhance functional ability, which in turn may decrease the likelihood of depressive symptoms postoperatively.
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Affiliation(s)
- L H Kurlowicz
- School of Nursing, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia 19104-6096, USA
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Conn DK, Steingart AB. Diagnosis and management of late life depression: a guide for the primary care physician. Int J Psychiatry Med 1998; 27:269-81. [PMID: 9565728 DOI: 10.2190/j309-ejmx-whrm-4uyg] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this article is to provide a brief and practical approach for the primary care physician regarding the recognition, diagnosis, and management of depression in elderly patients. METHOD Empirical evidence and current recommendations regarding the recognition, diagnosis, and treatment of depression are reviewed as the basis for this approach. Appropriate modifications for geriatric depression are added where indicated. RESULTS The recommendations are listed by category and briefly explained. CONCLUSIONS It is important to be vigilant for the variety of depressive presentations that occur in older primary care patients. Neurological causes of depression (such as stroke), suicide, and a longer time to recovery are all more frequent concerns in older depressed patients.
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Affiliation(s)
- D K Conn
- Department of Psychiatry, Baycrest Center for Geriatric Care, Toronto, Ontario, Canada
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Abstract
Depression is a common clinical problem in the elderly. Risk factors in this population include genetic vulnerability, psychosocial losses, medical comorbidity, cerebrovascular disease, and neurodegenerative disorders. Depression in the elderly may have severe consequences, including high rates of suicide, malnutrition or dehydration, high utilization of medical services, impaired recovery from medical illnesses, and inappropriate placement in residential care facilities. A significant number of older depressed patients may not respond to anti-depressant medications, suffer intolerable medication side effects, or have illnesses with symptoms or consequences so severe that it is not feasible to wait the time required for one or more antidepressant trials to work. For many of these patients ECT can be a dramatically effective treatment. With appropriate evaluation and monitoring, ECT can be performed with relative safety even for patients with serious concurrent medical illnesses. Serious adverse effects are rare, and cognitive consequences of ECT are generally circumscribed and of limited duration; there is no evidence of "brain damage" or permanent change in cognitive ability from ECT. After a recovery period memory function is often better than it was during the episode of depression. For patients who have been refractory to or intolerant of medication, maintenance ECT can be an effective strategy for preventing early relapse. Further research is needed, however, to clarify the optimum use of MECT schedules and pharmacotherapy combinations to most effectively and safely prevent relapse of depression in different elderly populations and to help predict who will best respond to which treatment modalities.
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Affiliation(s)
- R M Greenberg
- ECT Service, Franciscan-Parkside Center, Saint Francis Hospital, Jersey City, USA
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Raue PJ, Meyers BS. An overview of mental health services for the elderly. NEW DIRECTIONS FOR MENTAL HEALTH SERVICES 1998:3-12. [PMID: 9520522 DOI: 10.1002/yd.2330247603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychiatric distress is substantially prevalent among elderly individuals, particularly in the primary care and institutional settings, where most older persons receive mental health care. Barriers to care from providers include negative attitudes and stigmatization and poor recognition by general health care professionals. When psychiatric disorders are recognized, the intensity and duration of treatment provided is generally below standards for adequacy. Further research can determine the impact of patient, caregiver, and provider factors on treatment provision and on patient adherence to treatment. Assessment of factors influencing the treatment process are needed to ensure that treatments provided in the real world approximate the efficacy established in controlled clinical trials.
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Affiliation(s)
- P J Raue
- New York Hospital-Cornell Medical Center, Westchester Division, USA
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Wright GE, Parker JC, Smarr KL, Johnson JC, Hewett JE, Walker SE. Age, depressive symptoms, and rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 1998; 41:298-305. [PMID: 9485088 DOI: 10.1002/1529-0131(199802)41:2<298::aid-art14>3.0.co;2-g] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the relationship between age and depression in persons with rheumatoid arthritis (RA). METHODS Two separate outpatient cohorts of persons with RA were studied. In both studies, the Center for Epidemiological Studies Depression Scale was administered to all subjects, and the prevalence of depressive symptoms was determined by age group. In the second study, data on additional measures of disease activity, pain, life stress, and coping were collected for use in multiple linear regression analyses. RESULTS In both samples, a significant correlation between age and depression was found; younger persons (age < or = 45 years) with RA were significantly more depressed, even after controlling for potentially confounding variables such as sex, marital status, antidepressant medication, arthritis medication, functional class, and disease duration. CONCLUSION The findings show that younger persons with RA are at higher risk for depressive symptoms than their older counterparts.
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Affiliation(s)
- G E Wright
- Harry S. Truman Memorial Veterans' Hospital, and University of Missouri-Columbia School of Medicine, 65201, USA
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Abstract
This paper reviews research on the relationship between age and depression in adulthood, with a focus on depression in late life. Age differences in prevalence rates of major depression and depressive symptomatology raise questions about presentation and measurement of depression across adulthood, and suggest a changing salience of risk factors for depression from young adulthood through old age as well as to cohort differences in risk for depression. Applying a developmental perspective on biological change, psychological adaptation, and stress processes throughout adulthood shows that risk for depression onset in young adults is typified more through psychological vulnerability and stress, as well as genetic factors, while risk for depression in older adults typified more through comorbid medical and neurological disorder. Implications for research and clinical practice are discussed. This review of the relationship of age to depression shows that the study of psychopathology and adult development can inform each other.
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Affiliation(s)
- M J Karel
- Brockton/West Roxbury VA Medical Center, MA 02401, USA
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Koenig HG. Differences in psychosocial and health correlates of major and minor depression in medically ill older adults. J Am Geriatr Soc 1997; 45:1487-95. [PMID: 9400559 DOI: 10.1111/j.1532-5415.1997.tb03200.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the differences in correlates of different levels of depression in medically ill hospitalized older adults. DESIGN, SETTING, AND PARTICIPANTS A consecutive series of 542 patients aged 60 or older admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. MEASUREMENT A wide range of demographic, social, psychiatric, and physical health data were collected, and associations with major and minor depression were assessed. RESULTS Compared with patients without depression, those with major depression were more likely to have a history of prior episodes of depression, higher dysfunctional attitude scores, greater overall severity of medical illness, cognitive impairment, and symptoms of pain or other somatic complaints. Specific medical diagnosis was less important a predictor of major depression than overall severity of medical illness. Compared with patients without depression, those with minor depression were more likely to report non-health-related stressors during the year before hospital admission, have a diagnosis of immune system disorder, and have greater severity of medical illness. When major and minor depression were compared directly, on the other hand, no significant differences were observed except for history of depression, and that relationship was weak and present only when the etiologic approach to diagnosis was used. CONCLUSION During hospital admission, certain psychosocial, psychiatric, and physical health characteristics of older medical patients place them at high risk for different levels of depression. Patients with major and minor depression resemble each other more than they do patients without depression. These findings may help clinicians better understand the causes of different types of depression in this setting and lead to improved diagnosis and treatment.
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Affiliation(s)
- H G Koenig
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA
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Hooper SC, Vaughan KJ, Tennant CC, Perz JM. Preferences for voluntary euthanasia during major depression and following improvement in an elderly population. AUSTRALIAN JOURNAL ON AGEING 1997; 16:3-7. [PMID: 11655255 DOI: 10.1111/j.1741-6612.1997.tb01012.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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