Incremental decreases in quality-adjusted life years (QALY) associated with higher levels of depressive symptoms for U.S. Adults aged 65 years and older

The longitudinal association between physical health and depressive symptoms over eight years: Evidence from the health and retirement study

BACKGROUND

The bidirectional relationship between physical health (PH) and depressive symptoms (DS) remains unclear.

METHODS

Data were extracted from the Health and Retirement Study in the United States. PH was measured with a composite of chronic diseases, functional limitations and difficulties in basic and instrumental activities of daily living, and DS with a modified Center for Epidemiological Studies of Depression. Latent growth curve models (LGCM) were employed to examine how the change in PH or DS affected their mutual trajectories in later life. In addition, multilevel models were utilized.

RESULTS

There were 6144 participants included, with an average age of 69.82 ± 6.85 years at baseline, of whom 3686 (59.99 %) were women. PH scores increased from 5.65 in 2010 to 7.72 in 2018, while depression scores increased from 1.14 to 1.31. LGCM results showed that the initial levels of PH and DS were associated (β = 0.558, P < .001), and the initial level of PH could predict the trajectory of DS (β = 0.089, P < .001). Likewise, the initial level of DS was also related to initial PH (β = -0.563, P < .001) but couldn't predict the trajectory of PH. Furthermore, the slopes of PH and DS were predicted bidirectionally by each other. Two-level logistic models further demonstrated the bidirectional association between PH and DS.

CONCLUSION

There was a bidirectional association between physical health and depressive symptoms, which highlights the necessity of comprehensive health management for older adults with poor physical health or depression symptoms.

Incidence of depression among community-dwelling older adults: A systematic review

We aimed to synthesise information related to the incidence of depression and depressive symptoms (DDS) in a community-dwelling older adult population at a global level. In this systematic review, we included articles with a cohort study design that evaluated the incidence of depression or depressive symptoms in older adults aged 60 years or more in a community-dwelling environment. Six databases were used: Web of Science, PubMed, Scopus, LILACS, SciELO, and Cochrane, and the entire selection process was independently performed by peers. We divided the included articles into subgroups according to the DDS assessment instrument: (i) Geriatric Depression Scale; (ii) Center for Epidemiologic Studies Depression Scale; (iii) miscellaneous scales; and (iv) diagnostic interviews. Each cumulative incidence value obtained per item was adjusted for a 1-year follow-up period, which generated an annual cumulative incidence (AcI). From 46 articles, 42 used scales to evaluate the depressive variable, with an AcI estimate of around 4.5%. The articles that assessed depression categorically observed a variation in AcI between 0.2% and 7.0%. Among all the materials included, the group that used the Geriatric Depression Scale observed the lowest and the highest AcI, 1.3% and 26.6% respectively. Most of the productions were from countries in the Asian continent (52.2%), followed by Europe (30.4%), the Americas (13%), and Oceania (4.4%). Despite the variation of AcI, we found a frequent occurrence of DDS in older adults in the community-dwelling environment, which highlights the need for preventive actions and better-targeted early care, especially in terms of primary health care.

Psychological Health Among Older Adults During and After Quarantine: A Multi-Method Study

OBJECTIVE

Depression among older adults is a growing problem. With aging being a risk factor for COVID-19 infection, depression in this population may have been exacerbated. This study aimed to describe experiences and changes in depressive symptoms and well-being of older adults during and after the COVID-19 first wave in Spain.

METHODS

The study used a multi-method design. Participants self-reported depressive symptoms (Geriatric Depression Scale) and well-being (Cantril Ladder of Life). Participants were asked about changes in depressive symptoms or well-being during quarantine. If a change was perceived, they were asked to describe the change. In addition, the Patient Global Impression of Change scale was used. Both quantitative and qualitative analyses were performed on the data.

RESULTS

111 participants (mean age: 71±5 years; 76% women) completed the study. Sixty-three percent reported mild and 2% reported major depressive symptoms. Nearly half (47.7%) reported changes in depressive symptoms during the lockdown. While 37% reported feeling better during the lockdown, about 11% reported depressive symptoms were worse now compared with during the lockdown. 60% reported worsening well-being during the quarantining period. The qualitative analysis revealed 2 main themes: (1) psychological discomfort (mood deflection, fear/worries, and boredom/inactivity) and (2) social issues (inability to go out, missing family members and others).

CONCLUSIONS

Worsening depressive symptoms and lowering of well-being were noticed in this sample of older adults during and post-COVID lockdowns. Evaluation of mental health in the primary care setting and providing referrals for mental health services is essential for older adults who experienced COVID-19-related lockdowns.

A low-intensity behavioral intervention for depression in older adults delivered by lay coaches: proof-of-concept trial

OBJECTIVES

A broader workforce is necessary to expand U.S. geriatric mental health services. We examined (1) feasibility of training undergraduate students to deliver Do More, Feel Better (DMFB), an evidence-informed program for depression; and (2) feasibility, acceptability, and outcomes in a single-arm proof-of-concept trial.

METHOD

In Study 1, we taught DMFB to 18 upper-level undergraduate students and assessed fidelity using role plays. In Study 2, four students delivered six weekly DMFB sessions to 12 community-dwelling older adults (M = 66.83 years old, SD = 10.39) with depression (PHQ ≥ 10). Patient outcomes were change in pre- to post-treatment depressive symptoms, disability, and the target mechanism of increased activity.

RESULTS

Fidelity was high in the course (Study 1; 82.4% of role plays rated as 'passing') and the trial (Study 2; 100% of 24 sessions rated as 'passing'). The majority (83.3%) of patients were retained and evidenced statistically and clinically significant improvement in depressive symptoms (Hamilton Rating Scale for Depression [HAM-D]), disability (World Health Organization's Disability Assessment Schedule 2.0 [WHODAS 2.0], and activity (Behavioral Activation for Depression Scale [BADS]).

CONCLUSION

It is feasible to train bachelor's-level students to deliver a brief, structured intervention for depression. Future research should consider implementation strategies and stakeholder feedback.

Large improvement of mental health during in outpatient short-term group psychotherapy treatment-a naturalistic pre-/post-observational study

BACKGROUND

Group psychotherapy is an effective treatment for patients with mental health issues. This study aims to evaluate data on the effectiveness of a cost-free short-term outpatient group psychotherapy project for patients with mixed mental health issues in Tyrol, Austria.

METHODS

In this naturalistic observational study, outpatients taking part in the psychotherapeutic group treatment between spring 2018 and spring 2020 were included. Patients completed the patient health questionnaire (PHQ-D), an item of the working ability index (WAI) and single items on symptom burden, treatment expectation and perceived benefit before the first (T0) and/or last group session (T1). Mean changes were investigated using repeated measure analyses of variance (rANOVA).

RESULTS

A total of 98 patients were included in the study. Statistically significant improvements with medium to large effect sizes were observed for depression (η² = 0.22, p < 0.001), somatization (η² = 0.10, p = 0.008), anxiety (η² = 0.18, p < 0.001), and subjective working ability (η² = 0.22, p < 0.001). Neither age (p = 0.85), sex (p = 0.34), baseline symptoms (p = 0.29-0.77), nor previous experience with individual (p = 0.15) or group psychotherapy (p = 0.29) were associated with treatment outcome. However, treatment expectation at baseline was significantly associated with the patients' perception of the treatment benefit (r = 0.39, p < 0.001).

CONCLUSION

Our study highlights the benefit of outpatient short-term group psychotherapy for individuals with mental health issues. Group psychotherapy should be offered free of charge to individuals with mental health issues by social health providers.

Burden and preference-based quality of life associated with bullying in children

The objectives of this study are to assess the association between childhood bullying and preference-based health-related quality of life (QoL) in Australian school children and their parents and estimate quality-adjusted life years (QALYs) associated with bullying chronicity. Children aged 8-10 years completed the child health utilities (CHU-9D), while parents completed the Australian quality of life (AQoL-8D). Children were grouped into four categories of bullying involvement (no bullying, victim, perpetrator, or both perpetrator and victim) based on the Revised Olweus Bully/Victim Questionnaire. Parental data were compared across two bullying involvement groups (bullying vs. no bullying). QALYs were calculated for children over two years and comparisons made based on the number of assessments where bullying was reported (baseline, 1- and 2-year follow up). Children who were involved in bullying (victims and/or perpetrators) reported statistically significantly lower mean utility scores compared to children who were not involved in bullying. Parents whose child was involved in bullying had significantly lower mean utility scores compared to parents of children not involved with bullying. There appeared to be a dose-response relationship, with higher QALY losses associated with increasing frequency of reported bullying. Bullying among Australian school children was associated with significantly lower preference-based QoL for themselves and their parents. This study also confirmed the significant burden of disease for bullying among children measured by an incremental decrease in QALY with an increasing chronicity of bullying over time.

The Influence of Social Support on Depression among Elderly People in Serbia

Social factors such as social support, integration, and belonging to the community are positive resources against adverse events and living conditions. This study at examining the influence of social support on depression among elderly people in Serbia. The research was done according to the type of cross-sectional study, a mass survey of a random, representative stratified two-stage sample of the population of Serbia in 2013, which was conducted by the Ministry of Health of the Republic of Serbia. The target population consisted of 3540 respondents aged 65 and over. The Patient Health Questionnaire-8 (PHQ-8) was used to evaluate the presence of depressive symptoms and the social support score from the questionnaire Oslo-3 scale of social support. The relations between depression symptoms and social support were examined with univariate logistic regression analyses. In the univariate regression model, social support stood out as a strong predictor of depression. People with weak social support are three and a half times more likely (OR = 3.45) to have depression compared to those with strong social support. Men with small social support were more likely to have depression (OR = 5.08) than women (OR = 3.41). These results indicate the urgency of addressing depression as a public health priority to reduce the burden and disability and improve the overall health of the elderly population.

The Impact of ADHD on Maternal Quality of Life

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.

Protocol for a collaborative randomised effectiveness trial of lay-delivered versus clinician-delivered behavioural activation in senior centres

INTRODUCTION

Depression is common among community-dwelling older adults who make use of senior centre services yet remains undertreated due to a lack of acceptable and available treatments. Emerging evidence suggests that lay health providers can offer psychosocial interventions for mental health disorders experienced by older adults. We developed a streamlined Behavioural Activation intervention (called 'Do More, Feel Better'; DMFB) to be delivered by older adult volunteers and propose to compare its effectiveness to that of clinician-delivered behavioural activation (BA).

METHODS AND ANALYSIS

This study is a type I collaborative randomised effectiveness trial testing the effect of DMFB in comparison to BA among 288 senior centre clients (aged 60+). Participant clients will be recruited from 6 Seattle, 6 New York City and 6 Tampa area senior centres serving economically and ethnically diverse communities. Primary outcomes will be increased activity level (target) and decreased depressive symptoms. Secondary outcomes will be functioning and client satisfaction, and an exploratory outcome will be treatment fidelity.

ETHICS AND DISSEMINATION

The study received ethics approval from the University of Washington Institutional Review Board (STUDY00011434). Client, volunteer and clinician participants will all provide informed consent for study procedures through in-person or remote contact with investigators. Results of this study will be presented in peer-reviewed journals and at professional conferences.

TRIAL REGISTRATION NUMBER

NCT04621877; ClinicalTrials.gov.

Depression secondary to vision loss in old age and an effective rapid screening tool for undiagnosed cases

BACKGROUND

Zenebe et al. recently stated that despite depression being a common mental health problem in the elderly population, it is underdiagnosed in over half of the cases (Zenebe et al. in Ann Gen Psychiatry, 2021). They described an extensive list of risk factors associated with geriatric depression. However, we noted that they did not include ophthalmic conditions in this list which have previously been identified as an important risk factor for depression in the elderly.

MAIN BODY

To determine the extent of undiagnosed anxiety and depression in our elderly population with vision loss, we screened a cohort of our patients, over 60 years with vision loss secondary to macular disease for both conditions. Our cohort included 104 patients with mean best corrected visual acuity 0.58 LogMAR (Snellen equivalent 6/24). In this group, we identified 29.8% (31/104) and 28.8% (30/104) of patients with at least one depression or anxiety-related symptom, respectively, in the past 2 weeks. We identified 7.7% (8/104) and 3.8% (4/104) who had significant symptoms of depression and anxiety, respectively, that warranted further follow-up. Only two of these patients had previously been diagnosed with anxiety or depression with the majority having no previous history of either condition. Patients from our cohort who screened for depression or anxiety often cited frustration completing tasks and loss of independence secondary to declining vision. They also complained that the vision loss resulted in a lack of confidence which in turn resulted in social isolation and loneliness. Most of the patients welcomed referral to their GP for follow-up for input regarding their mental health and they also stated an interest in attending hospital optometry low vision services and counselling support.

CONCLUSIONS

With increasing time pressures on healthcare services and the rising use of virtual clinics especially during the COVID-19 pandemic, it is still essential to screen efficiently for depression in those elderly patients who are at significant risk. There is a considerable burden of major depressive disease in the geriatric population, and we would recommend that physicians (Geriatricians, GPs, Ophthalmologists etc.) screen elderly patients with vision loss for depression using the rapid screening tool which we suggest.

"Do More, Feel Better": Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients

This pilot randomized control trial (RCT) tested "Do More, Feel Better" (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and Weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (d_MSW = 0.16; 95% CI, -0.70 to 1.02) and depression (d_MSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. "Do More, Feel Better" shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.

Community delivery of brief therapy for depressed older adults impacted by Hurricane Sandy

Older adults frequently under-report depressive symptoms and often fail to access services after a disaster. To address unmet mental health needs, we developed a service delivery program (SMART-MH) that combines outreach, assessment, and therapy and implemented it in New York City after Hurricane Sandy. This study aimed to examine the feasibility, effectiveness, and patients' engagement of our brief psychotherapy ("Engage"). We predicted that Engage would result in reductions of depression, and that the benefits would be comparable to those of a historical comparison group who received Engage in a controlled experimental setting. A total of 2,831 adults (age ≥ 60) impacted by Hurricane Sandy were screened for depression. Assessments and therapy were conducted in English, Spanish, Cantonese, and Russian. Depressed individuals (PHQ-9 ≥ 10) who were not in treatment were offered Engage therapy in their native language at local senior center/nutrition sites. Twelve percent of the participants reported depression (N = 333). Of these 333 participants, 201 (60%) were not receiving treatment and 143 agreed to receive Engage therapy. Linear mixed-effects model showed that depression severity decreased significantly over time. More than two thirds had a five-point reduction in PHQ-9 scores and post-treatment scores ≤9. Post-hoc comparison of standardized slopes of change found patterns of depression reductions equivalent to Engage provided in a controlled setting. Partnerships to integrate mental health care into community settings can increase detection of mental-health needs and access to services in patients' native language. Brief reward exposure-based psychotherapy delivered in the community can provide comparable benefits to those achieved in research settings.

Overlap of Depressive Symptoms with Health-Related Quality-of-Life Measures

Because depressive symptoms are a part of health-related quality-of-life (HRQOL) measures, measures of depression will be empirically associated with HRQOL. We discuss examples of published research where authors ignored or did not fully account for overlap between depressive symptom and HRQOL measures. Future researchers need to recognize when their models include conceptually similar variables on the same side or both sides of the equation. This awareness will lead to more accurate conclusions about the prognostic value of depression and other HRQOL measures for health care utilization, mortality, and other outcomes. It will also result in fewer incorrect claims about the effect of depression on HRQOL.

Online Social Networking and Mental Health among Older Adults: A Scoping Review

As the number of older adults is expected to increase exponentially within the next few decades, loneliness, social isolation, and depression among seniors are growing public health concerns. Although formal treatment options, such as therapy and medication, can be helpful for depression, they can also be expensive and sometimes ineffective. It is therefore important to consider other potential treatment options and social interventions. Alternative methods for addressing mental health issues are especially important for older adults, as they may encounter barriers associated with aging such as limited mobility and decreased social networks. In these circumstances, online social networking may offer a potential "social cure" to alleviate loneliness, social isolation, and depression. The purpose of this scoping review was to gather and summarize the current literature on associations between online social networking and mental health outcomes (e.g., depression, life satisfaction, loneliness) among older adults. An initial search of 3,699 articles resulted in 52 articles that met criteria for inclusion. Five common themes were identified: (1) enhanced communication with family and friends, (2) greater independence and self-efficacy, (3) creation of online communities, (4) positive associations with well-being and life satisfaction, and (5) decreased depressive symptoms. Implications for older adults' mental health, social connectedness, programs and policies are discussed.

Acceptability of a lay-delivered intervention for depression in senior centers

OBJECTIVE

We examined: 1. depression rates among senior center clients; and 2. the acceptability of a lay-delivered intervention for depression ("Do More, Feel Better") from the perspective of key stakeholders prior to its implementation.

METHOD

We conducted cross-sectional surveys at four Seattle-area senior centers of 140 clients, 124 volunteers, and 12 administrators and staff. Client measures included the Patient Health Questionnaire-9 (PHQ-9) to determine depression severity, and items assessing depression treatment preferences. Following description of "Do More, Feel Better" as a lay-delivered intervention focused on increasing participation in rewarding activities, we used quantitative and qualitative items to assess acceptability to: 1. clients participating in; 2. volunteers administering; and 3. administrators and staff supporting the intervention.

RESULTS

25% of senior center clients (35/140) endorsed elevated depressive symptoms (PHQ-9 ≥ 10). 81% of clients (114/140) reported that they would consider participating in "Do More, Feel Better," and 59% percent of volunteers (73/123) expressed interest in learning how to assist others using the intervention. Administrators and staff reported high comfort levels with proposed volunteer training procedures, and they identified funding and staffing considerations as challenges to sustaining the intervention.

CONCLUSION

Findings indicate high depression rates among senior center clients and support the acceptability of lay-delivered behavioral interventions for depression from a variety of stakeholders. Further investigation of the feasibility, effectiveness, and implementation of "Do More, Feel Better" is warranted, particularly in the context of a lack of health care professionals available to meet the mental health needs of older adults.

Socio-Medical Aspects of Depression Among Elderly Adults in Serbia

Depression is the most frequent mental health problem in older age with serious consequences on personal, interpersonal and social level. The aim of this study was to determine the association of demographic factors, socio-economic factors and health status characteristics, with the presence of depressive symptoms in the elderly persons. The survey was conducted as a part of the national study “Health Survey of the Serbian population” in 2013. Data on the population aged 65 years and over were used for the purposes of this study (3540 respondents). PHQ-8 questionnaire was used to assess the presence of symptoms of depression. The relations between the presence of depressive symptoms, as a dependent variable, and a set of independent variables was examined by univariate and multivariate logistic regressions. Depression (PHQ-8 score≥10) was registered in 10% of the population aged 65 and above, wherein it was statistically significantly higher in women (12.7%) than in men (6.5%). Limitations in performing of daily activities showed to be the strongest predictor of depression in the elderly, while respondents who have had serious limitations had even six times more chanse to develop depression (OR=6.84). Respondents who rated their health as “bad or very bad” for 49.5% more frequently manifested depressive symptoms compared to those who evaluated their health as “very good or good” (OR=3.49). Respondents who have had two or more chronic diseases were three times more likely to have depression (OR=3.1) compared to people without chronic disease.

Lay-delivered behavioral activation for depressed senior center clients: Pilot RCT

OBJECTIVE

We describe the development of a lay-delivered behavioral intervention ("Do More, Feel Better") for depressed senior center clients, and we present preliminary data from a pilot randomized controlled trial (RCT) on (a) the feasibility of training lay volunteers to fidelity and (b) the acceptability, impact, and safety of the intervention.

METHODS

We trained 11 volunteers at two aging service settings in "Do More, Feel Better" and randomized 18 depressed clients to receive the intervention or referral to mental health services.

RESULTS

Pilot data indicated that we can successfully train and certify 64% of older volunteers and that depressed clients receiving the intervention reported high levels of session attendance and satisfaction. While there were no significant differences in 12-week reduction in Hamilton Depression Rating Scale scores between groups, intervention clients showed an 8-point reduction in comparison with a 0-point reduction among referral clients.

CONCLUSIONS

"Do More, Feel Better" has the potential of transferring evidence-based behavioral interventions to the hands of supervised lay volunteers and can address the insufficient workforce providing geriatric mental health services.

Neighborhood social reciprocity and mental health among older adults in China: the mediating effects of physical activity, social interaction, and volunteering

BACKGROUND

This study aims to investigate the mechanisms through which neighborhood social reciprocity influences older adults' mental health in China.

METHODS

This study used data from the 2011-2015 waves of the China Health and Retirement Longitudinal Study. It estimated the effects of neighborhood social reciprocity on older adults' mental health and tested the mediating effects of the frequencies of physical activity, social interaction with neighbors, and volunteering experience.

RESULTS

The results indicated that more neighborhood social reciprocity related to better mental health. The effects of the three mediators were statistically significant and enhanced mental health. In addition, the effects of the mediators were strengthened by neighborhood social reciprocity, and vice versa.

CONCLUSIONS

In China, neighborhood social reciprocity influenced older adults' mental health directly and through the mechanisms of the frequencies of physical activity, social interaction with neighbors, and volunteering experience.

Is clinician impression of depression symptom severity associated with incremental economic burden in privately insured US patients with treatment resistant depression?

BACKGROUND

Among patients with major depressive disorder (MDD), those with treatment-resistant depression (TRD) have a higher economic burden. However, the healthcare resource utilization (HRU) and costs may vary by severity status in TRD patients. This study quantified the incremental economic burden of severity status in TRD patients.

METHODS

In a US database of privately insured employees and dependents (07/01/2009-03/31/2015), a claims-based algorithm identified adult TRD patients who were stratified into mild, moderate, and severe cohorts based on the information in the last observed MDD ICD-9-CM code. HRU and costs of moderate and severe cohorts were compared to those of the mild cohort during the 2-year follow-up after the first antidepressant claim.

RESULTS

Among 6411 TRD patients, 455 (7.1%) were identified as mild, 2153 (33.6%) as moderate, and 1455 (22.7%) as severe. Moderate and severe patients compared to mild had 45% and 150% more inpatient admissions, 65% and 164% more inpatient days, 18% and 54% more emergency department visits and 8% and 10% more outpatient visits per-patient-per-year (PPPY), respectively (all-cause; all p < 0.05). Mean all-cause direct total healthcare costs were $12,123, $16,885, and $18,911 PPPY in mild, moderate, and severe patients, respectively. The all-cause total healthcare cost differences adjusted for baseline characteristics amounted to $3455 in moderate and $5150 in severe versus mild patients, respectively (PPPY; all p < 0.05).

LIMITATIONS

Not all TRD patients had a severity specifier; the severity specifier was not cross-validated against a depression scale.

CONCLUSIONS

Increased severity status is associated with incremental economic burden in TRD patients.

Factors associated with quality of life in patients with depression: A nationwide population-based study

Background

Depression, one of the most costly and common mental disorders, is reported to be associated with lower quality of life (QoL) in several studies. Improved understanding of the associated factors with QoL is necessary to optimize long-term outcomes and reduce disability in patients with depression. Therefore, the aim of this study was to identify factors that are associated with lower QoL among patients with depression.

Methods

The study was based on the Korea National Health and Nutrition Examination Survey, a cross-sectional health examination, years 2008 to 2014. The final analyzed sample consisted of a total of 1,502 study subjects who had been diagnosed by clinicians as having depression. A multivariate logistic regression model was performed to exam the association between the clinical characteristics (age, sex, demographic and health-related characteristics) and QoL. Analysis of covariance was also used to analyze EQ-5D according to mental health.

Results

Older age, lower level of education, lower income, worse subjective perception of health, unemployment, obesity and mental health struggles were found to be significantly associated with low QoL in depressive individuals after adjustment for multiple covariates.

Conclusions

This study has outlined grounding data in identifying patients who are at risk of QoL impairment. Policy makers should direct their interests to these individuals and provide appropriate management.

Randomized cost-effectiveness trial of group interpersonal psychotherapy (IPT) for prisoners with major depression

OBJECTIVE

This study tested the effectiveness and cost-effectiveness of interpersonal psychotherapy (IPT) for major depressive disorder (MDD) among prisoners. It is the first fully powered randomized trial of any treatment (pharmacological or psychosocial) targeting MDD among incarcerated individuals.

METHOD

One hundred eighty-one male (n = 117) and female (n = 64) prisoners from prison facilities in 2 states were randomized to group IPT (delivered by master's-level and nonspecialist prison counselors) for MDD plus prison treatment as usual (TAU) or to TAU alone. Participants' average age was 39 (range = 20-61); 20% were African American and 19% were Hispanic. Outcomes assessed at posttreatment and 3-month follow-up included depressive symptoms (primary; assessed using the Hamilton Rating Scale for Depression), suicidality (assessed with the Beck Scale for Suicide Ideation and Beck Hopelessness Scale), in-prison functioning (i.e., enrollment in correctional programs; discipline reports; aggression/victimization; and social support), remission from MDD, and posttraumatic stress disorder symptoms.

RESULTS

IPT reduced depressive symptoms, hopelessness, and posttraumatic stress disorder symptoms, and increased rates of MDD remission relative to prison TAU alone. Effects on hopelessness were particularly strong. Cost per patient was $2,054 including costs for IPT training and supervision or $575 without these costs. For providers running their second or subsequent IPT group, cost per additional week in remission from MDD (relative to TAU alone) was $524 ($148 excluding training and supervision costs, which would not be needed for established programs).

CONCLUSIONS

IPT is effective and cost-effective and we recommend its use for MDD among prisoners. It is currently the only treatment for MDD evaluated among incarcerated individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychological well-being and mortality: longitudinal findings from Lithuanian middle-aged and older adults study

BACKGROUND

The study aimed to examine whether after confounding by possible socio-demographic and other risk factors, psychological well-being is independently associated with reduced all-cause and cardiovascular mortality.

METHODS

Initial data were collected within the framework of the international project HAPIEE in 2006-2008. A random sample of 7115 individuals aged 45-72 years was screened. Deaths were evaluated by death register of Kaunas city (Lithuania) in a follow-up study till 2016. Psychological well-being was evaluated by a CASP-12 questionnaire. Socio-demographic, lifestyle, biologic factors and depressive symptoms were evaluated.

RESULTS

Age-adjusted survival curves revealed that psychological well-being predicts longevity in men and women (p < 0.001). After adjustment for many possible confounders psychological well-being was independently associated with all-cause mortality in men (HR 0.77; 95% CI 0.62-0.94) and women (HR 0.73; 95% CI 0.56-0.96). However, psychological well-being association with cardiovascular mortality attained statistical significance only in the women's group (HR 0.53; 95% CI 0.33-0.87), but not in men (HR 0.98; 95% CI 0.72-1.33).

CONCLUSIONS

Psychological well-being is an important predictor of longevity, controlling well-recognized risk factors such as age, education, cardiovascular diseases, social status, marital status, lifestyle and biological factors and depressive symptoms. Positive psychological well-being should be taken into account when screening older people to prevent negative health outcomes.

Overall survival in older patients with cancer

OBJECTIVES

A growing number of patients with cancer are older adults. We sought to identify the predictors for overall survival (OS) in older adults with solid tumour and haematological malignancies between January 2013 and December 2016.

METHODS

Retrospective cohort study. A comprehensive geriatric assessment was performed, with a median follow-up of 12.8 months.

ANALYSIS

univariate and multivariate Cox proportional hazards regression analysis.

RESULTS

In this study, among the 455 patients with last follow-up date or date of death, 152 (33.4%) died during the follow-up. The median follow-up is 12.8 months (range 0.2-51.1 months) and the median OS is 20.5 months (range 0.3-44.5 months). Among all older patients with cancer, predictors of OS included male gender, cancer stage, malnutrition, history of smoking, heavy alcohol use, frailty, weight loss, major depression, low body weight and nursing home residence. Traditional performance scores (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS)) were predictors of OS. Independent predictors included age >85 years and haematological malignancies. Among solid tumours (n=311) in addition to the above predictors, comorbidity, gait speed and vitamin D deficiency were associated with OS.

CONCLUSIONS

We identified specific geriatric factors associated with OS in older patients with cancer, and comparable in predictive ability to traditional performance scores such as KPS and ECOG. Prospective studies will be necessary to confirm our findings.

Well-being in major depression and social phobia with and without comorbidity

Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity.

Health behaviors influencing depressive symptoms in older Koreans living alone: secondary data analysis of the 2014 Korean longitudinal study of aging

BACKGROUND

Geriatric depression is a societal problem, specifically in those living alone in Korea. This study aims are to investigate (1) how sociodemographic factors, health status, and health behaviors are differently associated with depressive symptoms in older Koreans living alone compared to those living with others and (2) how living arrangements attenuated or strengthened the associations between four types of health behaviors and depressive symptoms.

METHODS

This secondary data analysis was conducted using data from the 2014 Korean Longitudinal Study of Aging. A structured survey assessing sociodemographic factors, health status, and health behaviors was conducted with people aged 65 or older who lived alone (n = 1359) and living with others (n = 2864). A multiple linear regression with interaction terms was conducted between mean-centered health behaviors and the status of living alone. All statistical analyses were performed using SPSS Statistics 23.0, and the two-tailed level of significance was set at 0.05.

RESULTS

Those living alone reported higher levels of depressive symptoms than those living with others (Mdiff = 2.129, SE = 0.005, p <  0.001). The variance of depressive symptoms explained by 13 variables was 18.1% for those living alone compared to 23.7% for those living with others. Compared to health behaviors, sociodemographic factors and health status more explained depressive symptoms, specifically with psychiatric disorders, pain, and impaired functionality as risk factors. Smoking, alcohol abstinence, physical inactivity, and social inactivity were associated with more depressive symptoms. Living arrangements moderated the association between depressive symptoms and each health behavior, except for physical inactivity (all p values < 0.001).

CONCLUSIONS

Older Koreans living alone were exposed to different risk factors for depressive symptoms compared to those living with others. Non-modifiable sociodemographic and health status factors were highly associated with depressive symptoms relative to health behaviors; thus, it is important to conduct early assessment and classification of vulnerable subgroups regarding geriatric depression. Specific assessment instruments should be prepared in practice according to living arrangements among older Koreans. Targeted interventions are essential to addressing living arrangements and modifying health behaviors to reduce smoking, alcohol consumption, and social inactivity, specifically in those living alone.

Quality of life independently predicts long-term mortality but not vascular events: the Northern Manhattan Study

PURPOSE

Cardiovascular disease is a major contributor to morbidity and mortality, and prevention relies on accurate identification of those at risk. Studies of the association between quality of life (QOL) and mortality and vascular events incompletely accounted for depression, cognitive status, social support, and functional status, all of which have an impact on vascular outcomes. We hypothesized that baseline QOL is independently associated with long-term mortality in a large, multi-ethnic urban cohort.

METHODS

In the prospective, population-based Northern Manhattan Study, Spitzer QOL index (SQI, range 0-10, with ten signifying the highest QOL) was assessed at baseline. Participants were followed over a median 11 years for stroke, myocardial infarction (MI), and vascular and non-vascular death. Multivariable Cox proportional hazards regression estimated hazard ratio and 95% confidence interval (HR, 95% CI) for each outcome, with SQI as the main predictor, dichotomized at 10, adjusting for baseline demographics, vascular risk factors, history of cancer, social support, cognitive status, depression, and functional status.

RESULTS

Among 3298 participants, mean age was 69.7 + 10.3 years; 1795 (54.5%) had SQI of 10. In fully adjusted models, SQI of 10 (compared to SQI <10) was associated with reduced risk of all-cause mortality (HR 0.80, 95% CI 0.72-0.90), vascular death (0.81, 0.69-0.97), non-vascular death (0.78, 0.67-0.91), and stroke or MI or death (0.82, 0.74-0.91). In fully adjusted competing risk models, there was no association with stroke (0.93, 0.74-1.17), MI (0.98, 0.75-1.28), and stroke or MI (1.03, 0.86-1.24). Results were consistent when SQI was analyzed continuously.

CONCLUSION

In this large population-based cohort, highest QOL was inversely associated with long-term mortality, vascular and non-vascular, independently of baseline primary vascular risk factors, social support, cognition, depression, and functional status. QOL was not associated with non-fatal vascular events.