A rating scale for anxiety states

The longitudinal association between loneliness and depressive symptoms in the elderly: a systematic review

OBJECTIVE

Loneliness and the onset of depression in old age are growing problems related to the greater life expectancy nowadays. This review investigated the longitudinal association between loneliness and depressive symptoms in the elderly.

DESIGN

A comprehensive search was conducted using three databases (Scopus, PsycInfo, and PubMed) combing for empirical studies published up until July 2020. A total of 4.549 abstracts and 221 full-text articles were assessed. Three authors independently reviewed titles and abstracts; disagreements were resolved by consensus.

RESULTS

Ten studies were included in the final review. We identified two categories of studies based on the outcome considered in each article: 1) the longitudinal effect of loneliness on depressive symptoms and 2) the clinical course of depression and its association with loneliness. All the articles reported a significant and positive association between loneliness and depressive symptoms in their longitudinal design research, ranging from an odds ratio of 0.41 to 17.76. The heterogeneity regarding the effect size in the analyses can be explained by the multifactorial design implemented by most of the studies included.

CONCLUSIONS

Future research should investigate the moderators' role and how it may influence the longitudinal association between loneliness and depression over the years.

Secular changes in the relation between social factors and depression: a study of two birth cohorts of Swedish septuagenarians followed for 5 years

BACKGROUND

Rapid societal changes occurred in the Western world during the 20(th) century. It is not clear whether this has changed the relation between social factors and depression in older people.

METHODS

Representative samples of 70-year-olds from Gothenburg, Sweden, were examined with identical psychiatric examinations in 1971-72 (N=392; 226 women and 166 men) and 2000-01 (N=499; 270 women and 229 men). Follow-up studies were conducted after five years. Social factors were obtained by self-report and depression was diagnosed according to DSM-IV-TR.

RESULTS

Feelings of loneliness were related to both concurrent depression at baseline and new depression at follow-up in both birth cohorts. Visits with others than children and neighbours once per month or less, compared to having more visits, and the perception of having too little contact with others, were related to both concurrent and new depression in 70-year-olds examined 1971-72, but not in those examined 30 years later.

LIMITATIONS

The response rate declined from 85.2% in 1971-72 to 65.8% in 2000-01. Participation bias may have resulted in an underestimation of depression in the later-born cohort.

CONCLUSIONS

Social contacts with others were related to depression in 70-year-olds examined in the 1970s, but not in those examined in the 2000s. This may reflect period changes in the ways of socialising, communicating and entertaining, e.g. due to technological development and expansion of mass media. Findings may be useful when developing modern and effective programs for the prevention of mental ill-health in older people.

Prevalence of mental disorders in an urban sample examined at 70, 75 and 79 years of age

The prevalence of mental disorders in a representative sample of old people in Gothenburg, Sweden, was studied at 70, 75 and 79. The study comprised 392 subjects at 70, 302 subjects at 75 and 203 at 79. A case was defined by cut-off points on symptom and sign rating scales, and diagnoses were defined operationally as closely as possible to the ICD-classification. The total psychiatric morbidity was 21.9, 24.2 and 31.0% in the three age groups. The prevalence of schizophrenic and paranoid syndromes was 0.5, 1.7 and 2.5% and of affective disorders 1.0, 2.3 and 0.5%. The prevalence of dementias of psychotic degree was 1.3, 2.3 and 6.9% and of asthenic neuroses corresponding to dementias of mild-moderate degree 2.3, 4.0 and 9.4%. The prevalence of anxiety, depressive and obsessive-compulsive neuroses of moderate-severe degree was 6.6, 4.6 and 3.9% and of mild degree 7.9, 6.0 and 5.9%. The prevalence of active alcoholism in men was 4.2, 3.4 and 3.0% and in women 0.0% in all age groups. Current treatment was reported by 67-85% of subjects with psychoses, about one half of them in psychiatric services, and by 35-65% of subjects with neuroses, about one fifth of them in psychiatric services.

A rating scale of phobic disorders

Scales were constructed for the rating of phobic disorders, taking into account both behaviour therapeutic and psychodynamic aspects. The scales rate phobic behaviour with regard to anxiety (situational and anticipatory) and coping (avoidance and escape). The target phobia as well as seven common phobias are rated, the former being divided into: fairly easy, moderately difficult, and very difficult situations. The scales also include free anxiety (10 items), ego-restriction (11 items), and social function (six items with regard to interpersonal relations, and one each for capacity to work and leisure activities), and finally, a global rating. The inter-rater reliability was good (mostly around 0.90). Construct validity was supported by the result in effect studies of short-term psychotherapy.

Prevalence of mental disorders in a 70-year-old urban population

The prevelance of mental diseases and abnormalities in a representative, systematic sample of 70-year-olds in Gothenburg, Sweden, is presented. Out of 460 selected subjects, 392 (85.2%) took part and the responders and non-responders were similar in several respects. A case was defined by cut-off points on symptom and/or sign rating scales and diagnoses were defined operationally but as closely as possible to the ICD-classification. The total psychiatric morbidity, excluding personality deviations, was 16.9% in men and 26.1% in women, and excluding also mild neuroses 12.7% in men and 15.5% in women. The prevalence of psychoses was 3.0% in men and 3.5% in women, of neuroses of moderate-severe degree 6.6% in men and 11.5% in women, of neuroses of mild degree 4.2% in men and 10.6% in women, of alcoholism 3.0% in men and 0.0% in women and of oligophrenia 0.0% in men and 0.4% in women. The prevalence of demential syndromes of a psychotic degree was 2.4% in men and 1.3% in women, of a neurotic degree 4.2% in men and 1.8% in women and the total prevalence of demential syndromes was thus 6.6% in men and 3.1% in women. Indications of previous alcohol problems and no or a low current consumption of alcohol were noted among 18.1% of the men.

Interprofessional communicability and reliability of the Comprehensive Psychopathological Rating Scale (CPRS) as assessed by video-taped interviews

Five raters: two experienced psychiatrists, two psychologists (one acquainted with the use of the scale and one new to it) and an untrained social worker, participated in training sessions in the use of the CPRS. Videotaped interviews were used for assessing the level of inter-rater reliability and the communicability of the CPRS to unexperienced raters. As in previous studies, it was found that the CPRS is easily communicable and that a very satisfactory level of agreement among raters can be achieved.

Factors related to drug compliance and attrition in neurotic outpatients treated with anxiolytics

Forty-six outpatients with anxiety-tension states took part in a study on the effects of anxiolytic drugs. At the first interview ratings were performed and the patients answered a questionnaire as to their experience of the consultation (n = 42). Based on follow-up examinations after 2, 4 and 8 weeks, three groups were formed: completers, who did not experience side-effects to be of such intensity that they changed the recommended dose (n = 15); deviators, who due to side-effects changed the recommended dose temporarily or permanently (n = 20); and attritors (n = 7). One to two years after the end of the drug study a personality inventory was sent out by post. It was returned by 35 patients. 1) Completers, deviators and attritors were similar with regard to age, education and social class. 2) They were also similar with regard to initial distress level. 3) Completers had the highest scores on scales measuring the personality traits defence of status and guilt-feelings and on the factor inex neurotic self-assertiveness, while attritors had the lowest scores. 4) Completers, deviators and attritors were similar with regard to experience of the first consultation. 5) Patients with a more favourable experience of the first consultation reported taking lower doses of the drugs.

Non-pharmacological factors in drug treatment of anxiety states

Forty-six outpatients with anxiety tension states took part in a study on the effects of anxiolytic drugs. After the first interview the subjects also filled in a questionnaire as to their expectations of treatment outcome (n=41) and their experience of the first consultation (n=42), and the doctors made a prognostic evaluation (n=46). The relations between these three factors and background variables as well as initial ratings and outcome as rated by the doctors at follow-up examinations after 2, 4, and 8 weeks were investigated. Expectations, experience, and prognosis were not related to each other. Less hopeful patients more often considered conflicts to be the exclusive cause of their disorder and they were rated higher on signs and on the variable difficulties in being with people. Patients with less favourable experience more often considered practical and economic difficulties to be a cause of their disorder. Single or divorced patients were more often judged to have a less favourable prognosis. More positive expectations and a favourable prognosis. More positive expectations and a favourable prognosis were to some extent related to a better outcome after 2 and 4 weeks and a favourable experience was to some extent related to a better outcome after 4 and 8 weeks.