1
|
Kim HK, Lenze EJ, Ainsworth NJ, Blumberger DM, Brown PJ, Flint AJ, Karp JF, Lavretsky H, Lenard E, Miller JP, Reynolds CF, Roose SP, Mulsant BH. Relationship between Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) total scores in older adults with major depressive disorder: An analysis of the OPTIMUM clinical trial. J Affect Disord 2024; 361:651-658. [PMID: 38925306 DOI: 10.1016/j.jad.2024.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) are commonly used scales to measure depression severity in older adults. METHODS We utilized data from the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) clinical trial to produce conversion tables relating PHQ-9 and MADRS total scores. We split the sample into training (N = 555) and validation samples (N = 187). Equipercentile linking was performed on the training sample to produce conversion tables for PHQ-9 and MADRS. We compared the original and estimated scores in the validation sample with Bland-Altman analysis. We compared the depression severity level using the original and estimated scores with Chi-square tests. RESULTS The Bland-Altman analysis confirmed that differences between the original and estimated scores for at least 95 % of the sample fit within 1.96 standard deviations of the mean difference. Chi-square tests showed a significant difference in the proportion of participants at each depression severity category determined using the original and estimated scores. LIMITATIONS The conversion tables should be used with caution when comparing depression severity at the individual level. CONCLUSIONS Our conversion tables relating PHQ-9 and MADRS scores can be used to compare treatment outcomes using aggregate data in studies that only used one of these scales.
Collapse
Affiliation(s)
- Helena K Kim
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Eric J Lenze
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, United States
| | - Nicholas J Ainsworth
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health and Department of Psychiatry, Toronto, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health and Department of Psychiatry, Toronto, Canada
| | - Patrick J Brown
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, United States
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, Tucson, United States
| | - Helen Lavretsky
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, United States
| | - Emily Lenard
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, United States
| | - J Philip Miller
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, United States; Division of Biostatistics, School of Medicine, Washington University in St. Louis, St. Louis, United States
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Steven P Roose
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, United States
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health and Department of Psychiatry, Toronto, Canada.
| |
Collapse
|
2
|
Taiwo Z, Tighe EL, Tone EB, Light SN, Dotson VM. Distinct latent symptom profiles in late-onset depressive symptoms in community-dwelling older adults. Aging Ment Health 2023; 27:2202-2210. [PMID: 37194465 PMCID: PMC10592582 DOI: 10.1080/13607863.2023.2211545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To examine the symptom profiles of late-onset depressive symptoms in a sample of older adults. METHOD The sample included 1,192 participants from the National Alzheimer's Coordinating Center Data Set. Participants were ≥65 years old, community-dwelling, and without cognitive impairment or a prior history of depression. Depressive symptoms were assessed using the Geriatric Depression Scale, 15-item (GDS-15). Latent class analysis (LCA) was used to identify and group participants based on profiles of depressive symptoms. RESULTS LCA revealed three distinct symptom profiles: (1) an Anhedonia/Amotivation profile with a higher probability of endorsing a combination of low positive emotion and amotivation (6%), (2) an Amotivation/Withdrawal profile with a high probability of endorsing only amotivational depressive symptoms (35%), and (3) an asymptomatic profile with no probability of endorsing any depressive symptoms (59%). Amotivational depressive symptoms were observed across both symptomatic profiles, while depressed mood (e.g. sadness) did not predominantly characterize any profile in this sample. There were also significant differences among symptom profiles in terms of demographic and clinical characteristics. CONCLUSIONS Findings highlight the importance of understanding depression at the symptom pattern level. A profile-based diagnostic approach may help improve the recognition of depressive symptoms in older adults.
Collapse
Affiliation(s)
- Zinat Taiwo
- Department of Rehabilitation Psychology and Neuropsychology, The Institute for Rehabilitation and Research (TIRR) Memorial Hermann, Houston, Texas, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | | | - Erin B. Tone
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Sharee N. Light
- LSU Health Shreveport School of Medicine, Shreveport, LA, USA
| | - Vonetta M. Dotson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
3
|
Liu Q, Ni W, Zhang L, Zhao M, Bai X, Zhang S, Ding Y, Yin H, Chen L. Comparative efficacy of various exercise interventions on depression in older adults with mild cognitive impairment: A systematic review and network meta-analysis. Ageing Res Rev 2023; 91:102071. [PMID: 37704052 DOI: 10.1016/j.arr.2023.102071] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Exercise is a promising nonpharmacological treatment for improving depression in older adults with MCI, but it is unclear which exercises are most effective. The objectives of this study were to compare and rank the effectiveness of various exercise interventions for depression in mild cognitive impairment (MCI) and to investigate the effects of exercise on depression. METHODS The PRISMA-NMA guidelines were applied to the development and reporting of review criteria. The Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus databases were systematically searched by combining search terms for randomized controlled trial studies (RCTs) published in English from individual databases with the earliest available date set to March 10, 2023. Two evaluators independently selected and evaluated eligible studies of changes in depression in older adults with MCI after an exercise intervention. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42022377052). RESULTS A network meta-analysis was conducted on 15 eligible RCTs consisting of 4271 subjects, including aerobic (n = 6), mind-body (n = 6) and multicomponent (n = 3) exercise trials. Compared to controls, mind-body exercise showed the strongest improvement in depressive symptoms (SMD = -0.63, 95% CI: -1.13, -0.14), followed by aerobic (SMD = -0.57, 95% CI: -0.88, -0.26) and multicomponent exercise (SMD = -0.53, 95% CI: -1.02, -0.03). Notably, there were no statistically significant differences between exercise types: aerobic vs. mind-body (SMD = 0.06, 95% PrI: -0.71, 0.84), multicomponent vs. mind-body (SMD = 0.11, 95% PrI: -0.75, 0.97), or multicomponent vs. aerobic (SMD = 0.04, 95% PrI: -0.771, 0.86). CONCLUSIONS In this review, we found that mind-body exercise was most effective when compared to conventional controls and that multiple exercise modalities (aerobic, mind-body, and multicomponent exercise) had beneficial and comparable effects in reducing depressive states in older adults with MCI. These findings may guide clinical geriatric stakeholders and allied health professionals in providing more scientifically optimal exercise prescriptions for older adults with MCI. In the future, more high-quality, long-term clinical trials are needed to support the exploration of longer-term dynamic effects.
Collapse
Affiliation(s)
- Qian Liu
- Jilin University School of Nursing, Changchun, China
| | - Weiguang Ni
- Jilin University Physical Education College, Changchun, China
| | - Lijia Zhang
- The First Hospital of Hebei Medicine University, Shijiazhuang, China
| | - Mingzhu Zhao
- Jilin University School of Nursing, Changchun, China
| | - Xuechun Bai
- Jilin University School of Nursing, Changchun, China
| | - Sitao Zhang
- Jilin University School of Nursing, Changchun, China
| | - Yiwen Ding
- Jilin University School of Nursing, Changchun, China
| | - Huiru Yin
- Jilin University School of Nursing, Changchun, China.
| | - Li Chen
- Jilin University School of Nursing, Changchun, China.
| |
Collapse
|
4
|
Al-Marwani S, Batieha A, Khader Y, El-Khateeb M, Jaddou H, Ajlouni K. Association between albumin and depression: a population-based study. BMC Psychiatry 2023; 23:780. [PMID: 37880606 PMCID: PMC10598913 DOI: 10.1186/s12888-023-05174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/09/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Albumin is the most prevalent plasma protein and is involved in a variety of critical physiological processes. Low serum albumin levels have been linked to depression symptoms in people who had recent suicide attempts and those suffering from several mental diseases such as acute episodes of mania, and schizophrenia. However, there has been little investigation into the relationship between depression and serum albumin levels in community-dwelling persons. This research aimed to examine the relationship between serum albumin and depression in a population-based sample and whether it differs depending on other possible confounders. METHODS Our data were derived from a national household population study conducted in 2017 with a sample size of 3,521 Jordanians aged > 17 years old. The Patient Health Questionnaire (PHQ-9) scale, a self-administered scale, was used to screen for depression. Concentrations of serum albumin and other medical biomarkers were measured by blood tests. Using descriptive statistics for depression distribution and multivariate logistic regression analysis, the connection between albumin levels and depression was investigated. RESULTS The odds ratios (ORs) for depression were significantly lower in the third and fourth quartiles of serum albumin concentration compared to the first quartile (OR = 0.64 and 0.66, respectively; P values = <0.001 and <0.001, respectively). This association was statistically significant even after controlling for variables such as gender, age, marital status, education, and occupation (OR = 0.67 and 0.75, respectively, and P values = 0.001 and 0.02, respectively), as well as after further controlling for other health status variables such as nutrition, comorbidity, body mass index, somking status, and biomedical markers such as serum calcium, phosphate, and magnesium (OR = 0.58 and 0.59, respectively, and P values = <0.001 and 0.001, respectively). Moreover, the unadjusted and adjusted odds ratios in the three regression models declined linearly with rising quartiles of serum albumin (P trend = <0.001, 0.009, and 0.001, respectively). CONCLUSIONS Our research found an inverse relationship between serum albumin and depression. Serum albumin could be a warning measure for depression. It is required for appropriate intervention measures to be implemented.
Collapse
Affiliation(s)
- Sabah Al-Marwani
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed El-Khateeb
- National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, P.O. Box 13165, Amman, Jordan
| | - Hashem Jaddou
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Kamel Ajlouni
- National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, P.O. Box 13165, Amman, Jordan
| |
Collapse
|
5
|
Janssen NP, Lucassen P, Huibers MJH, Ekers D, Broekman T, Bosmans JE, Van Marwijk H, Spijker J, Oude Voshaar R, Hendriks GJ. Behavioural Activation versus Treatment as Usual for Depressed Older Adults in Primary Care: A Pragmatic Cluster-Randomised Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:255-266. [PMID: 37385226 DOI: 10.1159/000531201] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Effective non-pharmacological treatment options for depression in older adults are lacking. OBJECTIVE The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated. METHODS In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up. RESULTS Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p < 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24). CONCLUSIONS BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.
Collapse
Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Marcus J H Huibers
- NPI Centre for Personality Disorders/Arkin Amsterdam, Amsterdam, The Netherlands
| | - David Ekers
- Mental Health and Addictions Research Group, Tees Esk and Wear Valleys NHS FT/University of York, York, UK
| | | | - Judith E Bosmans
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Richard Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Nicoletti VG, Fisicaro F, Aguglia E, Bella R, Calcagno D, Cantone M, Concerto C, Ferri R, Mineo L, Pennisi G, Ricceri R, Rodolico A, Saitta G, Torrisi G, Lanza G, Pennisi M. Challenging the Pleiotropic Effects of Repetitive Transcranial Magnetic Stimulation in Geriatric Depression: A Multimodal Case Series Study. Biomedicines 2023; 11:biomedicines11030958. [PMID: 36979937 PMCID: PMC10046045 DOI: 10.3390/biomedicines11030958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Although the antidepressant potential of repetitive transcranial magnetic stimulation (rTMS), the pleiotropic effects in geriatric depression (GD) are poorly investigated. We tested rTMS on depression, cognitive performance, growth/neurotrophic factors, cerebral blood flow (CBF) to transcranial Doppler sonography (TCD), and motor-evoked potentials (MEPs) to TMS in GD. METHODS In this case series study, six drug-resistant subjects (median age 68.0 years) underwent MEPs at baseline and after 3 weeks of 10 Hz rTMS on the left dorsolateral prefrontal cortex. The percentage change of serum nerve growth factor, vascular endothelial growth factor, brain-derived growth factor, insulin-like growth factor-1, and angiogenin was obtained. Assessments were performed at baseline, and at the end of rTMS; psychocognitive tests were also repeated after 1, 3, and 6 months. RESULTS Chronic cerebrovascular disease was evident in five patients. No adverse/undesirable effect was reported. An improvement in mood was observed after rTMS but not at follow-up. Electrophysiological data to TMS remained unchanged, except for an increase in the right median MEP amplitude. TCD and neurotrophic/growth factors did not change. CONCLUSIONS We were unable to detect a relevant impact of high-frequency rTMS on mood, cognition, cortical microcircuits, neurotrophic/growth factors, and CBF. Cerebrovascular disease and exposure to multiple pharmacological treatments might have contributed.
Collapse
Affiliation(s)
- Vincenzo G Nicoletti
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Eugenio Aguglia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, 95123 Catania, Italy
| | - Damiano Calcagno
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Mariagiovanna Cantone
- Neurology Unit, Policlinico University Hospital "G. Rodolico-San Marco", 95123 Catania, Italy
| | - Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Ludovico Mineo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giovanni Pennisi
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Riccardo Ricceri
- Stroke Unit, Neurology Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 41126 Modena, Italy
| | - Alessandro Rodolico
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giulia Saitta
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giulia Torrisi
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, 94018 Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| |
Collapse
|
7
|
Kelsall-Foreman I, Bucks RS, Weinborn M, Badcock JC. Loneliness and objective social isolation are differentially associated with anomalous perceptions in community-dwelling older adults. Cogn Neuropsychiatry 2023; 28:130-146. [PMID: 36744805 DOI: 10.1080/13546805.2023.2174841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anomalous perceptions are characterised by the subjective experience of a range of distorted and/or hallucinatory percepts. Whilst considerable attention has been paid to the neurocognitive processes contributing to anomalous perceptions amongst older adults, less is known about the social factors (e.g. social isolation, loneliness). Furthermore, it is unknown whether loneliness and social isolation are associated with different types of anomalous perceptions, including anomalous body-centred self-experiences and anomalous external experiences. METHODS This study examined the cross-sectional relationships between loneliness, objective social isolation, and anomalous perceptions in a sample of community-dwelling older adults (N = 242, Mage = 71.87 ± 7.73, range = 52-91, 67.8% female) using structural equation modelling. RESULTS Higher levels of loneliness were associated with more anomalous body-centred self-experiences and anomalous external experiences. Those reporting more loneliness also reported higher levels of anxiety and depression; however, the relationship between loneliness and anomalous perceptions was not mediated by these factors. Social disconnection from a religious group was associated with more anomalous external experiences and being married/living with a partner was associated with more anomalous body-centred self-experiences. CONCLUSIONS These findings suggest that loneliness and social isolation have differential associations with anomalous perceptions in older adults and provide additional evidence that attending to loneliness in older adults is important.
Collapse
Affiliation(s)
- India Kelsall-Foreman
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Johanna C Badcock
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- Perth Voices Clinic, Murdoch, Australia
| |
Collapse
|
8
|
Davies TL. Tailoring the mental health assessment to older adults. Nurse Pract 2023; 48:10-18. [PMID: 36573854 DOI: 10.1097/01.npr.0000902992.34389.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT This article discusses selected considerations for mental health assessment in older adults. Adopting a biopsychosocial model and trauma-informed approach to care creates a safe structure for a more comprehensive assessment. Selecting appropriate tools to improve diagnostic reasoning sets the foundation for further workup and tailored interventions.
Collapse
Affiliation(s)
- Tracy Lynn Davies
- Tracy Lynn Davies is Assistant Professor and Program Director of the Psychiatric Mental Health Nurse Practitioner Post-Graduate Certificate Program at Washburn University in Topeka, Kan
| |
Collapse
|
9
|
Whitsett MP, Goswami Banerjee A, Serper M. Assessment of mental health in patients with chronic liver disease. Clin Liver Dis (Hoboken) 2022; 20:52-56. [PMID: 36033429 PMCID: PMC9405502 DOI: 10.1002/cld.1214] [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] [Received: 08/31/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
Collapse
Affiliation(s)
| | | | - Marina Serper
- Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
10
|
Subjective Assessments of Quality of Life Are Independently Associated with Depressive Symptoms among Older Adults Enrolled in Primary Care in Chile. J Pers Med 2022; 12:jpm12071063. [PMID: 35887560 PMCID: PMC9322959 DOI: 10.3390/jpm12071063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
In Chile, depressive symptoms are highly prevalent among Chilean older adults, and research that examines the factors associated with them is scarce. This study aimed to determine if subjective assessments of quality of life are associated with positive screen for depressive symptoms among older adults enrolled in primary care in Chile. The participants of the study were people aged 70 years or more enrolled in primary care centers in three Chilean cities. The 15-item Geriatric Depression Scale was used to determine depressive symptoms. Multivariate logistic models were used to determine the associations. Overall, 17.28% men, and 26.47% women (p = 0.003) screened positive for depression. Subjective assessments of quality of life, including self-perceived health, memory, quality of life, and pain, were associated with a positive screen for depression. Only 17.65% of men and 43.55% of women who screened positive for depressive symptoms reported a diagnosis of depression. Assessments of quality of life in health checks of older adults in primary care could contribute to narrow the diagnosis and treatment gap by improving the ability to identify those who are more likely to experience depressive symptoms.
Collapse
|
11
|
Depressive Symptoms Feature-Based Machine Learning Approach to Predicting Depression Using Smartphone. Healthcare (Basel) 2022; 10:healthcare10071189. [PMID: 35885716 PMCID: PMC9318674 DOI: 10.3390/healthcare10071189] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
With the impact of the COVID-19 pandemic, the number of patients suffering from depression is rising around the world. It is important to diagnose depression early so that it may be treated as soon as possible. The self-response questionnaire, which has been used to diagnose depression in hospitals, is impractical since it requires active patient engagement. Therefore, it is vital to have a system that predicts depression automatically and recommends treatment. In this paper, we propose a smartphone-based depression prediction system. In addition, we propose depressive features based on multimodal sensor data for predicting depressive mood. The multimodal depressive features were designed based on depression symptoms defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The proposed system comprises a “Mental Health Protector” application that collects data from smartphones and a big data-based cloud platform that processes large amounts of data. We recruited 106 mental patients and collected smartphone sensor data and self-reported questionnaires from their smartphones using the proposed system. Finally, we evaluated the performance of the proposed system’s prediction of depression. As the test dataset, 27 out of 106 participants were selected randomly. The proposed system showed 76.92% on an f1-score for 16 patients with depression disease, and in particular, 15 patients, 93.75%, were successfully predicted. Unlike previous studies, the proposed method has high adaptability in that it uses only smartphones and has a distinction of evaluating prediction accuracy based on the diagnosis.
Collapse
|
12
|
Moreno X, Gajardo J, Monsalves MJ. Gender differences in positive screen for depression and diagnosis among older adults in Chile. BMC Geriatr 2022; 22:54. [PMID: 35031004 PMCID: PMC8760693 DOI: 10.1186/s12877-022-02751-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Different factors are associated with late life depression and diagnosis, including gender. It has also been reported that depression among older people is underdiagnosed. As a result, the mental health needs of this group are insufficiently met. The aim of this study was to explore gender differences in the factors associated with positive screens for depression and self-reported diagnosis among older adults in Chile. Methods Data from 3786 older adults who participated in the Social Protection Survey in 2016 were analysed. PHQ-9 was used to identify screen-positive cases. Self-reported diagnosis of depression was used to determine the proportion of people with a screen-positive result who had received a diagnosis of depression. Logistic regression models were used to determine sociodemographic and health factors associated with depression and underdiagnosis in older men and women. Results The prevalence of a screen-positive result was 20.91% (5.83% major depressive disorder) among men, and 36.38% (12.43% major depressive disorder) among women. 18.77% of men and 34.11% of women with a positive depression screening had received a diagnosis. More educated men were more likely to receive a diagnosis. Older age was associated with a lower probability of diagnosis among older women. Conclusions Our results suggest that depressive disorders are undiagnosed in a high proportion of older adults in Chile. Gender is a relevant factor in the underdiagnosis of depression in this group. Further research is needed to understand the factors involved in these gaps, to improve detection and provide timely support and treatment.
Collapse
Affiliation(s)
- Ximena Moreno
- Facultad de Psicología, Universidad San Sebastián, Lota 2465, Santiago, Chile.
| | - Jean Gajardo
- Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Lota 2465, Santiago, Chile.,Departamento de terapia ocupacional y ciencia de la ocupación, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - María José Monsalves
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Lota 2465, Santiago, Chile.,Area de Salud Pública, Instituto de Investigación en Ciencias Odontológicas, Facultad de Odontología, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Santiago, Chile
| |
Collapse
|
13
|
Passler JS, Sander A, Temkin NR, Barber J, Gardner RC. Depression in Older Adults 12 Months Following Traumatic Brain Injury: A TRACK-TBI Study. Arch Phys Med Rehabil 2021; 103:83-89. [PMID: 34587508 DOI: 10.1016/j.apmr.2021.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate depression at 12 months following traumatic brain injury (TBI) in older compared with younger adults. DESIGN Prospective longitudinal cohort study of persons with medically documented mild, moderate, and severe TBI at 12 months post-injury. SETTING Eighteen participating Level One trauma centers in the U.S. PARTICIPANTS 1,505 participants with TBI and primary outcome data at 12-month follow-up. INTERVENTION Not applicable. MAIN OUTCOME MEASURE Patient Health Questionnaire-9 (PHQ-9). RESULTS PHQ-9 total scores were significantly lower for older adults (age≥65)(M = 3.2) as compared with younger adults (age<65)(M = 5.0) (B = -1.63, p < .001), indicating less depressive symptoms in older adults. Age did not interact with education, sex, race/ethnicity, psychiatric history, substance use, or GCS severity to impact PHQ-9 scores. Of the 29% of older adults who endorsed symptoms consistent with depression, 14% were classified as minor depression and 15% as major depression. The odds of older adults falling in the major depression vs. no depression group was significantly lower (decreased by 56%) as compared with younger adults (OR = 0.44, p =.001). CONCLUSIONS At 12-months post-TBI, older adults endorse lower depressive symptoms than their younger counterparts and are less likely to experience major depression; however, over one-fourth of older adults endorsed symptoms consistent with depression, warranting evaluation and treatment.
Collapse
Affiliation(s)
- Jesse S Passler
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann. Houston, TX
| | - Angelle Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann. Houston, TX; Department of Physical Medicine and Rehabilitation, Harris Health System, Houston, TX
| | | | | | - Raquel C Gardner
- University of California San Francisco and San Francisco Veterans Affairs Medical Center
| | -
- Brain and Spinal Injury Center, San Francisco, CA; Department of Neurological Surgery, University of California, San Francisco, CA
| |
Collapse
|
14
|
Mehra A, Agarwal A, Bashar M, Grover S. Evaluation of Psychometric Properties of Hindi Versions of Geriatric Depression Scale and Patient Health Questionnaire in Older Adults. Indian J Psychol Med 2021; 43:319-324. [PMID: 34385725 PMCID: PMC8327872 DOI: 10.1177/02537176211022159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A limited number of studies have evaluated the psychometric properties of rating scales used to assess depression in the older adults. The present study aimed to assess the validity of the Hindi Geriatric Depression Scale (GDS, 30, 15, 10, 5, 4, and 1 item version) and Hindi Patient Health Questionnaire (nine and two items version) in a group of older adults residing in a rural community. METHODS The psychometric properties of these scales were assessed against the diagnosis of depression a qualified psychiatrist made by using a semistructured interview. RESULTS Total 125 older adults were recruited from a rural community, with a mean age of 65.5 (SD: 6.4) years. The prevalence of depression was 36.8% as per the evaluation by the psychiatrist. When the agreement of different scales with the clinicians' diagnosis was evaluated, it was seen that sensitivity, specificity, and Cohen Kappa value of GDS-30 and 15 were better than the other scales used to assess depression. When the sensitivity and specificity were evaluated using newer cutoffs, the specificity and sensitivity of GDS-30 were more than that of other scales. CONCLUSION Hindi version of GDS-30 with a cutoff of 13 has excellent psychometric properties.
Collapse
Affiliation(s)
- Aseem Mehra
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Agarwal
- Dept. of Community Medicine, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Mohammad Bashar
- Dept. of Community Medicine, Postgraduate institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
15
|
Adams DJ, Ndanzi T, Rweyunga AP, George J, Mhando L, Ngocho JS, Mboya IB. Depression and associated factors among geriatric population in Moshi district council, Northern Tanzania. Aging Ment Health 2021; 25:1035-1041. [PMID: 32252543 DOI: 10.1080/13607863.2020.1745147] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression in the elderly population has been identified as a significant public health problem associated with adverse outcomes such as decreased quality of life, cognitive decline, and increased rates of suicide. We aimed to determine the prevalence and factors associated with depressive symptoms among geriatric population in Moshi district council, northern Tanzania. METHODS This community-based cross-sectional study was conducted in Moshi rural district, northern Tanzania, between June and July 2019. A multi-stage sampling technique was used to recruit 304 elders aged 60 or more years. We used geriatric depression scale (GDS-15) to assess depression. Generalized linear model with Poisson family and log link function was used to estimate prevalence ratio (PR) and the corresponding 95% confidence intervals for factors associated with geriatric depressive symptoms. RESULTS A total of 304 participants were enrolled, the median age (interquartile range) 67 (62-75.5 years), and about half (51%) were females. The prevalence of geriatric depressive symptoms was 44.4%. Elders with a self-reported history of cognitive impairment had higher prevalence of depressive symptoms (PR = 1.66, 95%CI 1.16, 2.38) while elders with intermediate (PR = 0.56, 95%CI 0.38, 0.82) and strong social support (PR = 0.27, 95%CI 0.17, 0.44) were less likely to have depressive symptoms compared to those with no available social support. CONCLUSIONS Nearly one in every two elders had geriatric depressive symptoms. Depressive symptoms were associated with self-reported history of cognitive impairment and availability of social support. We recommend community screening, awareness creation, and social support interventions for early identification and management of depressive symptoms in this population.
Collapse
Affiliation(s)
- Diana J Adams
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Tunu Ndanzi
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Aminatha P Rweyunga
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Johnston George
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Lisbeth Mhando
- Department of Behavioral and Social Sciences, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - James S Ngocho
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Innocent B Mboya
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,School of Mathematics, Statistics & Computer Science, University of KwaZulu Natal, Pietermaritzburg, South Africa
| |
Collapse
|
16
|
Miller KJ, Areerob P, Hennessy D, Gonçalves-Bradley DC, Mesagno C, Grace F. Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. F1000Res 2020; 9:1325. [PMID: 34158928 PMCID: PMC8191520 DOI: 10.12688/f1000research.27123.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12
th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis (
n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’
g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’
g = -0.06,
PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’
g = -0.12,
PrI = -0.95, 0.72), mind-body versus resistance (Hedges’
g = -0.06,
PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO
CRD42018115866 (23/11/2018).
Collapse
Affiliation(s)
- Kyle J Miller
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Pinyadapat Areerob
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Declan Hennessy
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | | | - Christopher Mesagno
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Fergal Grace
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| |
Collapse
|
17
|
Miller KJ, Areerob P, Hennessy D, Gonçalves-Bradley DC, Mesagno C, Grace F. Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. F1000Res 2020; 9:1325. [PMID: 34158928 PMCID: PMC8191520 DOI: 10.12688/f1000research.27123.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 08/29/2023] Open
Abstract
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018).
Collapse
Affiliation(s)
- Kyle J. Miller
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Pinyadapat Areerob
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Declan Hennessy
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | | | - Christopher Mesagno
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Fergal Grace
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| |
Collapse
|
18
|
Dedeken P, Nickenig Vissoci JR, Sebera F, Boon PAJM, Rutembesa E, Teuwen DE. Validity, Reliability, and Diagnostic Cut-off of the Kinyarwandan Version of the Hamilton Depression Rating Scale in Rwanda. Front Psychol 2020; 11:1343. [PMID: 32719632 PMCID: PMC7350898 DOI: 10.3389/fpsyg.2020.01343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: In Rwanda, major depressive disorder affects 11.9% of the population and up to 35% of genocide survivors. Mental health services remain underutilized due to stigma and lack of awareness. Increasing the ability and capacity to diagnose and treat mental disorders is considered important to close this gap. We describe the translation, validity, and reliability assessment of the Hamilton Depression Rating Scale (HDRS) as a diagnostic tool for moderate to severe depression in Rwanda. Methods: The HDRS-21 was translated by a multi-group taskforce. We validated the translation against expert assessment in a comparative study on a sample of patients living with depression and of healthy volunteers. Psychometric properties, namely internal structure, reliability, and external validity were assessed using confirmatory factor analysis, three reliability calculations, and correlation analysis, respectively. Maximized Youden’s index was used for determining diagnostic cut-off. Results: The translated version demonstrated a kappa of 0.93. We enrolled 105 healthy volunteers and 105 patients with confirmed mild to severe depression. In the confirmatory factor analysis, HDRS had good factor loadings of 0.32–0.80. Reliability coefficients above 0.92 indicated strong internal consistency. External validity was shown by good sensitivity (0.95) and specificity (0.94) to differentiate depression from absence of depression. At a cut-off point of 17 for the diagnosis of depression, sensitivity and specificity were both 0.95 relative to gold standard. Conclusion: The validated HDRS in Kinyarwanda with diagnostic cut-off provides mental healthcare staff with an accurate tool to diagnose moderate to severe depression, enabling closure of the diagnosis and treatment gap.
Collapse
Affiliation(s)
- Peter Dedeken
- Department of Neurology, Heilig Hart Hospital, Lier, Belgium.,Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Fidele Sebera
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Neuropsychiatric Hospital, CARAES Ndera, Kigali, Rwanda.,Department of Neurology and Psychiatry, University of Rwanda, Kigali, Rwanda
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Eugene Rutembesa
- Department of Neurology and Psychiatry, University of Rwanda, Kigali, Rwanda
| | - Dirk E Teuwen
- Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium
| |
Collapse
|
19
|
Sebera F, Vissoci JRN, Umwiringirwa J, Teuwen DE, Boon PE, Dedeken P. Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda. PLoS One 2020; 15:e0234095. [PMID: 32530968 PMCID: PMC7292570 DOI: 10.1371/journal.pone.0234095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda. METHOD PHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ≥15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs. RESULTS Four hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (≥5) for mild and moderate depression and ≥7 for severe depression. CONCLUSION PHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ≥5 for mild or moderate and ≥7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.
Collapse
Affiliation(s)
- Fidèle Sebera
- CARAES Neuropsychiatric Hospital, Ndera, Kigali, Rwanda
- Centre Hospitalier Universitaire Kigali (CHUK), Kigali, Rwanda
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University Medical School, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | | | | | - Peter Dedeken
- UCB Pharma, Brussels, Belgium
- Ghent University Hospital, Ghent, Belgium
- Heilig Hart Hospitaal, Lier, Belgium
- * E-mail:
| |
Collapse
|
20
|
Khoury R, Chakkamparambil B, Chibnall J, Rajamanickam J, Kumar A, Grossberg GT. Diagnostic Accuracy of the SLU AMSAD Scale for Depression in Older Adults Without Dementia. J Am Med Dir Assoc 2020; 21:665-668. [PMID: 31704225 DOI: 10.1016/j.jamda.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of a short depression screening tool, the Saint Louis University (SLU) AMSAD depression scale, relative to the Geriatric Depression Scale-15 (GDS-15) and Montgomery-Asberg Depression Rating Scale (MADRS), and in relation to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for major depressive disorder, in cognitively intact older adults. DESIGN Cross-sectional. SETTING Outpatient geriatric psychiatry clinic. PARTICIPANTS Fifty older adults (aged ≥65 years) without dementia. MEASUREMENTS GDS-15, MADRS, SLU AMSAD, and DSM-5 criteria for major depressive disorder were administered. RESULTS Total scores (continuous variables) for the GDS-15, MADRS, and SLU AMSAD correlated significantly with the DMS-5 criteria for major depressive disorder (MDD) [area under the curve (AUC) ≥ 0.93, sensitivity = 0.93, and specificity ≥ 0.80]. Optimal cutoffs were 9+ for GDS-15, 18+ for MADRS, and 7+ for SLU AMSAD. When score results were categorized according to their known cutoffs for mild, moderate, and severe depression, AUC values were again high (range = 0.82-0.89), with adequate levels of sensitivity (0.87-0.93) and specificity (0.71-0.86), distinguishing no or mild depression from moderate or severe depression in relation to the DSM-5 diagnostic criteria for MDD. CONCLUSIONS AND IMPLICATIONS Strong diagnostic accuracy was shown for the 3 scales. The SLU AMSAD performed as well as the GDS-15 and slightly better than the MADRS. The superiority of the SLU AMSAD is supported by the fact that it encompasses only 5 simply worded, simply scaled items to be used in busy clinical settings.
Collapse
Affiliation(s)
- Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | - Binu Chakkamparambil
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - John Chibnall
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Jayashree Rajamanickam
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Aneel Kumar
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|
21
|
Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. Ageing Res Rev 2020; 58:100999. [PMID: 31837462 DOI: 10.1016/j.arr.2019.100999] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/08/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies have directly compared the effects of different exercise therapies on clinical depression in older adults. Thus, we conducted a systematic review and network meta-analysis of current evidence from randomised controlled trials (RCTs) to compare the effectiveness of three major exercise types (aerobic, resistance, and mind-body exercise) in clinically depressed older adults. METHODS We followed PRISMA-NMA guidelines and searched databases for eligible RCTs (inception - September 12th, 2019). RCTs were eligible if they included clinically depressed adults aged >65 years, implemented one or more exercise therapy arms using aerobic, resistance, or mind-body exercise, and assessed depressive symptoms at baseline and follow-up using a validated clinical questionnaire. RESULTS A network meta-analysis was performed on 15 eligible RCTs comprising 596 participants (321 treatment and 275 controls), including aerobic (n = 6), resistance (n = 5), and mind-body (n = 4) exercise trials. Compared with controls, mind-body exercise showed the largest improvement on depressive symptoms (g = -0.87 to -1.38), followed by aerobic exercise (g = -0.51 to -1.02), and resistance exercise (g = -0.41 to -0.92). Notably, there were no statistically significant differences between exercise types: aerobic versus resistance (g = -0.10, PrI = -2.23, 2.03), mind-body versus aerobic (g = -0.36, PrI = -2.69, 1.97), or mind-body versus resistance (g = -0.46, PrI = -2.75, 1.83). CONCLUSIONS These findings should guide optimal exercise prescription for allied health professionals and stakeholders in clinical geriatrics. Notably, clinically depressed older adults may be encouraged to self-select their preferred exercise type in order to achieve therapeutic benefit on symptoms of depression. In coalition with high levels of compliance, these data provide encouraging evidence for the antidepressant effect of either aerobic, resistance, or mind-body exercise as effective treatment adjucts for older adults presenting with clinical depression.
Collapse
|
22
|
Aslan J, Cova F, Saldivia S, Bustos C, Inostroza C, Rincón P, Ortiz C, Bühring V. Psychometric Properties of the Patient Health Questionnaire-9 in Elderly Chilean Primary Care Users. Front Psychiatry 2020; 11:555011. [PMID: 33312135 PMCID: PMC7704434 DOI: 10.3389/fpsyt.2020.555011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to assess the measurement properties (reliability, factor structure, and criterion validity) of the Patient Health Questionnaire (PHQ-9) as an instrument for screening major depressive disorder (MDD) in elderly primary care users in Chile. Method: About 582 participants aged between 65 and 80 years were enrolled from primary care centers. They completed the Composite International Diagnostic Interview (CIDI), a survey with sociodemographic characteristics and the PHQ-9. Results: The PHQ-9 revealed an acceptable internal consistency (ω = 0.79 [95% CI: 0.75-0.80] and α = 0.78 [95% CI: 0.75-0.81]); confirmatory factor analysis demonstrated a good fit for both 1- and 2-factor solutions. The chi-square difference test (χ2 = 0.61, gl = 1, p = 0.43) and correlation between the somatic and the cognitive-effective latent factors were very high (r = 0.97, p < 0.001), indicating that the 1 factor model was more parsimonious. Utilizing the CIDI as the gold standard, the area under the curve (AUC) was 0.88 (SE = 0.04, 95% CI: 0.84-0.90). The optimal cut-off score of ≥ 6 yielded good sensitivity and specificity for detecting MDD (0.95 and 0.76, respectively). However, considering the clinical utility index, the cut-off score of ≥9 proved to be a more effective marker for discarding cases of MDD. Conclusion: The PHQ-9 has adequate psychometric properties for elderly primary care users. In clinical settings, it showed its greatest utility in ruling out the presence of an MDD, however, its clinical value for identifying possible cases of MDD is limited. In cases above the cut-off point, it is recommended to perform a more thorough evaluation.
Collapse
Affiliation(s)
- Joseph Aslan
- Doctoral Program in Psychology, Universidad de Concepción, Concepción, Chile
| | - Félix Cova
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Claudio Bustos
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Carolina Inostroza
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Paulina Rincón
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Camila Ortiz
- Master Program in Politics and Government, Universidad de Concepción, Concepción, Chile
| | - Vasily Bühring
- Master Program in Psychology, Universidad de Concepción, Concepción, Chile
| |
Collapse
|
23
|
Ning H, Harrison TC, Zhao Y, Hu H, Chen H, Liao L, Yu R, Wu S, Feng H. Correlates of Depressive Symptoms Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study in China. Res Gerontol Nurs 2019; 12:133-146. [DOI: 10.3928/19404921-20190306-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
|
24
|
Schousboe JT, Vo TN, Kats AM, Langsetmo L, Diem SJ, Taylor BC, Strotmeyer ES, Ensrud KE. Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity. J Am Geriatr Soc 2019; 67:1596-1603. [PMID: 30903701 DOI: 10.1111/jgs.15881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity. DESIGN Prospective cohort study (Study of Osteoporotic Fractures [SOF]). SETTING Four US sites. PARTICIPANTS A total of 2508 community-dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data. MEASUREMENTS At Y10, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0-5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data. RESULTS Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0-1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2-5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self-reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14-1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99-1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms). CONCLUSION Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596-1603, 2019.
Collapse
Affiliation(s)
- John T Schousboe
- Department of Rheumatology, Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Tien N Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Allyson M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Susan J Diem
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| | - Brent C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| |
Collapse
|
25
|
Bessey LJ, Radue RM, Chapman EN, Boyle LL, Shah MN. Behavioral Health Needs of Older Adults in the Emergency Department. Clin Geriatr Med 2018; 34:469-489. [PMID: 30031428 DOI: 10.1016/j.cger.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Behavioral health disorders are common among older adults and, owing to limited access to resources for mental health care in the community, emergency department providers are often on the front lines of mental health crises. This article reviews the available literature regarding the care of behavioral health emergencies in older adults and provides a framework for navigating the evaluation and management of older adults presenting to the emergency department with behavioral health concerns.
Collapse
Affiliation(s)
- Laurel J Bessey
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Rebecca M Radue
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elizabeth N Chapman
- Department of Medicine, Division of Geriatrics, William S. Middleton Memorial VA Hospital, Geriatrics Research Education and Clinical Center, University of Wisconsin School of Medicine and Public Health, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Lisa L Boyle
- Department of Psychiatry, William S. Middleton Memorial VA Hospital, University of Wisconsin School of Medicine and Public Health, 2500 Overlook Terrace, Box 116A, Madison, WI 53705, USA.
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, MC9123, Madison, WI 53705, USA
| |
Collapse
|
26
|
Abstract
Geriatric patients present multiple age-related challenges and needs that must be taken into account during the rehabilitation process to achieve expected goals. This article examines the importance of identifying and managing psychosocial issues commonly observed in older adults and presents strategies to optimize their rehabilitation process. Depression, anxiety, fear of falling, adjustment issues, neurocognitive disorders, and caregiver support are discussed as a selection of factors that are relevant for geriatric patients undergoing rehabilitation. An argument is made for the importance of comprehensive geriatric assessment in older adults to identify salient issues that may impact rehabilitation and quality of life.
Collapse
Affiliation(s)
- Ricardo M Rodriguez
- Physical Medicine and Rehabilitation Service, VA Caribbean Health Care System, 10 Casia Street, San Juan, PR 00921, USA.
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the concept of anorexia of aging, including its complex pathophysiology and the multifaceted interventions required to prevent adverse health consequences from this geriatric syndrome. RECENT FINDINGS Anorexia of aging is extremely common, occurring in up to 30% of elderly individuals; however, this diagnosis is frequently missed or erroneously attributed to a normal part of the aging process. With aging, impairments in smell and taste can limit the desire to eat. Alterations in stress hormones and inflammatory mediators can lead to excess catabolism, cachexia, and reduced appetite. In addition, mood disorders, such as anxiety and depression, are powerful inhibitors of appetite. Anorexia of aging, with its negative consequences on weight and muscle mass, is a risk factor for the development of frailty and is important to screen for, as early intervention is key to reversing this debilitating condition. SUMMARY Anorexia of aging is a complex geriatric syndrome and a direct risk factor for frailty and thus should not be accepted as normal consequence of aging. Early diagnosis and formulating a plan for targeted interventions is critical to prevent disability and preserve function in elderly patients.
Collapse
Affiliation(s)
- Angela M Sanford
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|