Symptoms of depression in older home-care patients: patient and informant reports

What factors determine disclosure of suicide ideation in adults 60 and older to a treatment provider?

Correlates of patient disclosure of suicide ideation to a primary care or mental health provider were identified. Secondary analyses of IMPACT trial data were conducted. Of the 107 patients 60 years of age or older who endorsed thoughts of ending their life at least "a little bit" during the past month, 53 indicated they had disclosed these thoughts to a mental health or primary care provider during this period. Multiple logistic regression was used to identify predictors of disclosure to a provider. Significant predictors included poorer quality of life and prior mental health specialty treatment. Among participants endorsing thoughts of suicide, the likelihood of disclosing these thoughts to a provider was 2.96 times higher if they had a prior history of mental health specialty treatment and 1.56 times higher for every one-unit decrease in quality of life. Variation in disclosure of thoughts of suicide to a mental health or primary care provider depends, in part, on patient characteristics. Although the provision of evidence-based suicide risk assessment and guidelines could minimize unwanted variation and enhance disclosure, efforts to routinize the process of suicide risk assessment should also consider effective ways to lessen potential unintended consequences.

What do network members know? Network members as reporters of depression among Caucasian-American and African-American older women

OBJECTIVE

To determine whether family members and friends can be accurate reporters of depression in older women and whether their reports predict diagnostic depression concurrently and across a one-year time interval.

METHOD

African-American and Caucasian older women (N = 153; mean age = 75) previously screened for depression nominated network members (NMs) who could be contacted as informants. NMs completed an informant version of the CES-D, described their closeness to the participant, the extent of the participant's support from family and friends, and their assessment of the participant's typical coping strategies. These reports were then used to predict participant CES-D, Hamilton depression scores, and Structured Clinical Interview (SCID) depression diagnoses concurrently and at six-month and one-year intervals.

RESULTS

NMs' estimates of participants CES-D status were highly correlated with participants own CES-D scores, and also predicted Hamilton depression scores and SCID diagnoses concurrently and at six months and one year later. NMs' ratings of participants' use of positive coping also predicted depression at six months and one year.

CONCLUSION

NMs knew when elderly women were depressed and their reports were accurate predictors of depression even one year later, which implies that elderly depression does not abate spontaneously. Future research should test the possibility that family and friends might be recruited as allies in encouraging earlier treatment and in providing support to older adults through difficult life transitions.

Linking concurrent self-reports and retrospective proxy reports about the last year of life: a prevailing picture of life satisfaction decline

OBJECTIVE

We examined the extent to which retrospective proxy reports of well-being mirror participant self-reports at 12-24 months before death and how proxy reports of well-being change over the last year of life. We also explored the role of sociodemographic, cognitive, and health factors of both participants and proxies in moderating such associations.

METHOD

We used retrospective proxy ratings obtained in the German Socio-Economic Panel Study (N = 164; age at death = 19-99 years).

RESULTS

Results revealed moderate agreement between self- and proxy reports (r = .42), but proxies, on average, overestimated participants' life satisfaction by two thirds of a scale point on a 0-10 scale (or 0.4 SD). Discrepancies were particularly pronounced when proxies themselves reported low life satisfaction. Over the last year of life, participants were viewed to have experienced declines in life satisfaction (-0.54 SD). Declines were stronger for ill participants and proxies who reported low life satisfaction.

DISCUSSION

Results qualify theoretical expectations and empirical results based on self-report data that are typically available 1 or 2 years before death. We discuss that retrospective proxy reports in panel surveys can be used as a hypothesis-generating tool to gather insights into late life.

Agreement between informant and self-reported personality in depressed older adults: what are the roles of medical illness and cognitive function?

In a sample of 77 dyads, involving depressed patients at least 50 years of age and their family or friends (informants), patient illness burden and cognitive decline were associated with self-informant rating discrepancies for facets of Revised NEO Personality Inventory (NEO-PI-R) Openness and Extraversion. Informant judgments about Neuroticism and Conscientiousness were not associated with illness burden or cognitive function, underscoring the potential utility of risk-detection strategies that rely on informant-report in these two domains. Findings suggest the need for research on how patient illness severity and cognitive function affect how friends and family use or misuse information when making judgments about older depressed patients.

Concordance of self- and proxy-reported suicide ideation in depressed adults 50 years of age or older

OBJECTIVE

To assess whether social supports (proxies) can detect the presence of suicide ideation in a clinical sample of depressed adults 50 years of age or older, and to additionally assess the potential impact of depression symptom severity on patient-proxy concordance in reports of patient suicide ideation.

METHOD

Cross-sectional data were collected regarding Axis I diagnoses, severity of depressive symptoms, and suicide ideation in a clinical sample of 109 patients 50 years of age and older. Patients were administered study measures by trained interviewers. Patients' social supports completed proxy measures of these same variables. We assessed concordance in self- and proxy-reported suicide ideation, employing global suicide ideation items derived from depression scales and more fine-grained suicide ideation items drawn from multi-item suicide ideation measures. We investigated patient-proxy concordance regarding the presence of patient suicide ideation.

RESULTS

Patients who endorsed suicide ideation and were concordantly seen by their social supports to be suicidal reported significantly greater depressive symptom severity than patients concordantly reported to be nonsuicidal. Patients' social supports reported significantly less depressive symptom severity in patients who endorsed suicide ideation yet who did not appear to be suicidal to them.

CONCLUSIONS

Our findings suggest that family and friends can broadly ascertain the presence of suicide ideation in depressed middle-aged and older adults, yet in doing so may largely be responding to their broad perceptions of depressive symptom severity in patients and not specifically to the presence of suicidal thoughts.

The effect of symptom visibility on informant reporting

Informant reporting is important in the assessment of depression and anxiety among individuals with cognitive impairment. The authors examined the influence of the visibility effect on the ease of rating depression and anxiety symptoms. Fifty-three family members of dementia patients and 65 staff members working with cognitively impaired adults judged the ratability of the Inventory of Depression and Anxiety Symptoms item pool. Results indicated that Appetite Loss, Lassitude, and Insomnia scales were easiest to rate; Suicidality and Traumatic Intrusions scales were most difficult to rate. Findings support the visibility effect and emphasize the importance of selecting easy to rate items for informants.