Prevalence and predictors of depression in populations of elderly: a review

The role of spousal loss in the development of depressive symptoms in the elderly - implications for diagnostic systems

BACKGROUND

In the revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the Mood Disorder Workgroup for DSM-V the bereavement exclusion criterion for the diagnosis of major depression has been eliminated.

AIM

To investigate the impact of bereavement on the incidence of depression and depressive symptoms in the elderly.

METHOD

Participants over 75 years from the longitudinal German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) that were still married at baseline were investigated (n=1,193). Data from four follow-ups (time frame: 6 years) were investigated. The response rate at baseline was 50.3%. Three clinical endpoints were analyzed: depressive symptoms according to Geriatric Depression Scale (1) GDS≥6, (2) GDS≥10, and (3) Major Depression (MD). The effect of loss was investigated using random-effects regression models.

RESULTS

Experiencing a loss of spouse was predictive of a higher incidence in GDS≥6 (OR 4.52, 95% CI 2.6-7.9) and 10 (OR 5.59, 95% CI 1.8-17.0) even after adjusting for age, gender, impairment at baseline, and GDS score at baseline. Associations with MD were not significant (OR 1.77, 96% CI 0.9-3.5).

CONCLUSIONS

Older adults experiencing the loss of their spouse are more likely to display elevated levels of depressive symptoms, that may reach a concerning level of severity.

Depression and dementia: cause, consequence or coincidence?

The relationship between depression and dementia is complex and still not well understood. A number of different views exist regarding how the two conditions are linked as well as the underlying neurobiological mechanisms at work. This narrative review examined longitudinal and cross sectional studies in the existing literature and determined the evidence supporting depression being a risk factor, a prodrome, a consequence, or an independent comorbidity in dementia. Overall there is convincing evidence to support both the notion that early life depression can act as a risk factor for later life dementia, and that later life depression can be seen as a prodrome to dementia. There is also evidence to support both conditions showing similar neurobiological changes, particularly white matter disease, either indicating shared risk factors or a shared pattern of neuronal damage. These findings highlight the need to examine if effective treatment of depressive episodes has any effect in reducing the prevalence of dementia, as well as clinicians being vigilant for late life depression indicating the incipient development of dementia, and therefore carefully following up these individuals for future cognitive impairment.

Adapting manualized Behavioural Activation treatment for older adults with depression

There is growing evidence that Behavioural Activation is an effective treatment for older adults with depression. However, there is a lack of detail given in studies about any adaptations made to interventions or efforts made to remove treatment barriers. Factors such as co-morbid physical health problems, cognitive impairment and problems with social support suggest there may be specific treatment considerations when developing interventions for this group. This article aims to describe adaptations made to a general adult Behavioural Activation manual using literature on treatment factors for older adults as an organizational framework. This information may be of use to mental health workers delivering behavioural interventions to older adults with depression and documents the initial phase of developing a complex intervention.

Functional limitations and depressive symptoms: a longitudinal analysis of older Mexican American couples

OBJECTIVES

This study extends previous work on longitudinal patterns of spousal associations between functional impairments and psychological well-being in older couples in 3 important ways: By examining Mexican Americans, by considering a broader range of functional limitations, and by assessing the role of health status, social integration, and socioeconomic resources in these associations.

METHOD

Drawing on data from 6 waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993-2007), we employed growth curve models to investigate the implications of the spouse's functional limitations for the respondent's age trajectories of depressive symptoms in older Mexican American couples. Models were run separately for husbands and wives.

RESULTS

The spouse's functional limitations were associated with higher levels of depressive symptoms in the respondent. Personal resources can both ameliorate and intensify the adverse implications of the spouse's functional limitations for the respondent's depressive symptomatology. The interplay among these factors can vary by gender and the type of the spouse's functional impairment.

DISCUSSION

Future studies would benefit by examining caregiving patterns in older couples, by distinguishing between different dimensions of social support available to them, and by considering changes in couples' marital quality and social ties over time.

An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

Background

Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.

Methods

A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation.

Results

Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.

Conclusions

Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.

Trial registration

Clinicaltrials.gov identifier: NCT01407926.

Prevalence and risk factors of depression among community dwelling elderly

Depression in the elderly is associated with increased morbidity and mortality. The purpose of this study was to determine the prevalence and risk factors of depression among community-dwelling older population in an urban setting in Turkey. This cross-sectional study was conducted among 482 elderly individuals 65 years and over in an urban area. Cluster sampling method was used for sample size. Depression in the elderly had been diagnosed by a clinical interview and Geriatric Depression Scale. Data were collected by door-to-door survey. Chi square test was used for statistical analysis. P value, which was calculated by the results of chi square test and coefficient of phi (φ), below 0.05 was included in the analysis of logistic regression. Depression was significantly associated with female gender, being single or divorced, lower educational status, low income, unemployment, and lack of health insurance. However, logistic regression analysis revealed higher depression rates in the elderly with chronic obstructive pulmonary disease, psychiatric disease, cerebrovascular disease, low income and being dependent. Depression is common among community-dwelling older people in an urban area of Izmir, Turkey. Older adults living in community should be cautiously screened to prevent or manage depression.

Depressive symptoms and suicide risk in older adults: value placed on autonomy as a moderator for men but not women

Risk for suicide is elevated among older men. We examined whether value placed on autonomy amplifies the relation between depressive symptoms and suicide risk differently for older men and women. Participants were 98 community-dwelling older adults, M age 73.6 (SD = 8.6), 65.1% female, 93.1% White. Questionnaires measured suicide risk (SBQ-R), depressive symptoms (CESD), and value placed on autonomy (PSI-II autonomy). Among men, depressive symptoms were associated with suicide risk only when PSI-II autonomy was elevated. Among women, greater depressive symptoms were associated with suicide risk at all levels of PSI-II autonomy. Further research on attitudes toward autonomy is warranted.

Prevalence and gender differences in late-life depression: a population-based study

OBJECTIVE

The worldwide phenomenon of an aging population combined with the increasing prevalence of depression in late life are issues that need to be addressed. This study aims to estimate the frequency of depression and subthreshold depression occurring in a sample of cognitively well-functioning, community-dwelling, older Italian adults and to investigate sociodemographic and clinical correlates of depression, exploring gender differences.

METHODS

We used a cross-sectional analyses of survivors in a population-based study (the Faenza Project) that included 359 subjects aged 74 years and older (49.3% women). A modified version of Cambridge Examination for Mental Disorders of Elderly Persons-Revised was administered to all participants. Prevalence rates of depression and 95% confidence intervals (CIs) were estimated according to International Classification of Diseases, Tenth Revision criteria. Statistical analyses were implemented to describe sociodemographic and clinical features associated with depression. Odds ratios were estimated by multivariate logistic regression, and the dependant variable was any type of depression.

RESULTS

Overall prevalence of depression was 25.1% (95% CI: 20.6-29.6), with no evidence of gender difference. Prevalence of mild, moderate, and severe depression was 16.4% (95% CI: 12.6-20.2), 7.5% (95% CI: 4.8-10.2), and 1.1 (95% CI: -0.4-2.6), respectively. A rate of 5.6% of the population complained of subthreshold depressive symptoms. After age 81, depression occurrence decreased as age increased. The association between depression and functional measures, such as primary activity, mobility, and disability in performing household chores, were stronger in men than in women. Similarly, severely disabling conditions like stroke were more strongly associated with depression in men than in women.

CONCLUSION

Our data suggest a disparity between men and women regarding the impact of depression on everyday life. Specific gender differences need to be taken into account for the evaluation of the depression-related burden in late life.

Prevalence of depression and its associated factors among patients attending primary care settings in the post-conflict Northern Province in Sri Lanka: a cross-sectional study

BACKGROUND

In Sri Lanka, civilians in the Northern Province were affected by a long-term armed conflict that ended in 2009. This study aims to describe the prevalence of depression and its associated factors among adult patients attending primary care settings in the Northern Province in Sri Lanka.

METHODS

We report data from a cross-sectional patient morbidity registry established in 16 primary care facilities (12 Divisional Hospitals and 4 Primary Medical Care Units) in four districts of the Northern Province. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression among all patients aged ≥ 18 years, between March and May 2013. A sample of 12,841 patient records was included in the analysis. A total score of ≥ 10 in the PHQ-9 was considered as major depression. Factors associated with major depression were tested using multivariable logistic regression analysis.

RESULTS

The prevalence of major depression was 4.5% (95% CI: 4.1-4.9) and mild depression was 13.3% (95% CI: 12.7-13.9). The major depression was significantly higher in females than males (5.1% vs. 3.6%) and among unpaid family workers (6.0%) than any other category who earned an income (varied between 1.2% and 3.2%). The prevalence was rising significantly with advancing age, and ranged from 0.3% in the youngest to 11.6% in the elderly.Multivariable regression analysis revealed that the females have a higher risk for major depression than males (OR = 1.4; 95% CI: 1.1-1.7). Older patients were more likely to be depressed than younger patients, OR (95% CI) were 4.9 (1.9-12.5), 5.6 (2.2-14.0), 5.7 (2.3-14.2) and 4.7 (1.8-11.9) for the age groups 25-34, 35-49, 50-64, and ≥ 65 years respectively, in contrast to 18-24 year group. Disability in walking (OR = 7.5; 95% CI: 5.8-9.8), cognition (OR = 4.5; 95% CI: 3.6-5.6), self-care (OR = 2.6; 95% CI: 1.7-4.0), seeing (OR = 2.3; 95% CI: 1.8-3.0), and hearing (OR = 2.0; 95% CI: 1.5-2.5) showed significant associations with depression.

CONCLUSIONS

Depression is a common issue at primary care settings in a post-conflict population, and the elders, women and persons with disability are at a greater risk. Strengthening capacity of primary care facilities and community mental health services is necessary for early detection and management.

Prevalence and risk factors of depression in the elderly nursing home residents in Singapore

OBJECTIVES

Depression is a common health problem in elderly nursing home (NH) residents and is often under-recognized and under-treated. This study aimed to determine the prevalence rates of depression and identify the risk factors associated with depression in the elderly NH population in Singapore.

METHODS

A sample of 375 residents in six NHs in Singapore, aged 55 years and above, was assessed with the Structural Clinical Interview (SCID), based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The association of demographic, functional and health-related characteristics with depression was examined using multivariate logistic regression analyses.

RESULTS

Overall point prevalence for depression in the elderly NH residents was found to be 21.1% (95% confidence intervals (CI): 17.1%-25.6%). The prevalence rate for minor depression in the elderly NH residents was 14.4% (95% CI: 11.1%-18.5%) and 6.7% (95% CI: 4.5%-9.8%) for major depression. Significant risk factors that were found to be associated with depression were length of stay for more than 2 years, known history of depression, pain, and no or lack of social contact.

CONCLUSION

The prevalence rates for depression were high among NH residents in Singapore. More attention is needed to care for the psychosocial needs of elderly NH residents in Singapore.

Gene-behavior interaction of depressive symptoms and the apolipoprotein E {varepsilon}4 allele on cognitive decline

OBJECTIVE

Depressive symptoms and the apolipoprotein E (APOE) ε4 allele are independent risk factors for cognitive decline. However, it is not clear whether the presence of both depressive symptoms and the APOE ε4 allele increases cognitive decline.

METHODS

A prospective study of a population-based sample of 4150 (70% African American and 63% women) participants 65 years and older who were interviewed at 3-year intervals was conducted. Depressive symptoms were measured using the 10-item version of the Center for Epidemiologic Studies Depression scale, with each item coded as presence or absence of a symptom. The APOE genotype was ascertained by DNA samples collected during follow-up. Cognitive function was assessed at the initial and follow-up interviews (average follow-up of 9.2 years), using a standardized global cognitive score.

RESULTS

There were 1405 (34%) participants with one or more copies of the APOE ε4 allele. In participants with no depressive symptoms, cognitive function decreased by 0.0412 unit per year among those with no copies and 0.0704 unit per year among those with one or more copies of the APOE ε4 allele. For each additional symptom of depression, cognitive decline increased by 0.0021 unit per year among those with no copies and 0.0051 unit per year among those with one or more copies of the APOE ε4 allele. The three-way interaction of depressive symptoms, APOE ε4 allele, and time was significant (p = .021).

CONCLUSIONS

The association of depressive symptoms on cognitive decline was increased among participants with one or more copies of the APOE ε4 allele compared with those without the allele.

Duloxetine: a review of its use in the management of major depressive disorder in older adults

Duloxetine (Cymbalta(®)) is a selective serotonin norepinephrine reuptake inhibitor indicated for the treatment of major depressive disorder (MDD). This article reviews the therapeutic efficacy and tolerability of duloxetine in older adults with MDD and summarizes its pharmacological properties. Treatment with duloxetine significantly improved several measures of cognition, depression, anxiety, pain and health-related quality-of-life (HR-QOL) in older adults with MDD in two 8-week, double-blind, placebo-controlled trials. However, no significant improvements in measures of depression were observed at week 12 (primary endpoint) of a 24-week, double-blind trial, although symptoms of depression did improve significantly at earlier timepoints. Benefit of treatment was also observed during continued therapy in the 24-week study (i.e. after the 12-week primary endpoint) and in an open-label, 52-week study, with improvements being observed in some measures of depression, pain and HR-QOL. Duloxetine was generally well tolerated in these studies, with nausea, dizziness and adverse events reflecting noradrenergic activity (e.g. dry mouth, constipation) being the most common treatment-emergent adverse events during treatment for up to 52 weeks. Duloxetine therapy had little effect on cardiovascular parameters and bodyweight. Although further well designed and long-term studies in this patient population are required to confirm the efficacy of duloxetine and to compare it with that of other antidepressants, current evidence suggests that treatment with duloxetine may be beneficial in older adults with MDD.

Social relations and depression in late life-a systematic review

OBJECTIVE

Social relations have become the focus of much research attention when studying depressive symptoms in older adults. Research indicates that social support and being embedded in a network may reduce the risk for depression. The aim of the review was to analyze the association of social relations and depression in older adults.

METHODS

Electronic databases were searched systematically for potentially relevant articles published from January 2000 to December 2012. Thirty-seven studies met the inclusion criteria for this review.

RESULTS

Factors of social relations were categorized into 12 domains. Factors regarding the qualitative aspects of social relations seem to be more consistent among studies and therefore provide more explicit results. Thus, social support, quality of relations, and presence of confidants were identified as factors of social relations significantly associated with depression. The quantitative aspects of social relations seem to be more inconsistent. Cultural differences become most obvious in terms of the quantitative aspects of social relations.

CONCLUSION

Despite the inconsistent results and the methodological limitations of the studies, this review identified a number of factors of social relations that are significantly associated with depression. The review indicates that it is needful to investigate social relations in all their complexity and not reduce them to one dimension. Simultaneously, it is important to conduct longitudinal studies because studies with cross-sectional design do not allow us to draw conclusions on causality. Beyond that, cultural differences need to be considered.

Voluntary wheel running does not affect lipopolysaccharide-induced depressive-like behavior in young adult and aged mice

OBJECTIVE(S)

Peripheral stimulation of the innate immune system with lipopolysaccharide (LPS) causes prolonged depressive-like behavior in aged mice that is dependent on indoleamine 2,3 dioxygenase (IDO) activation. Regular moderate-intensity exercise training has been shown to exert neuroprotective effects that might reduce depressive-like behavior in aged mice. The purpose of this study was to test the hypothesis that voluntary wheel running (VWR) would attenuate LPS-induced depressive-like behavior and brain IDO gene expression in 4- and 22-month-old C57BL/6J mice.

METHODS

Mice were housed with a running wheel (VWR) or no wheel (standard) for 30 (young adult mice) or 70 days (aged mice), after which they were intraperitoneally injected with LPS (young adult mice: 0.83 mg/kg; aged mice: 0.33 mg/kg).

RESULTS

Young adult VWR mice ran on average 6.9 km/day, while aged VWR mice ran on average 3.4 km/day. Both young adult and aged VWR mice increased their forced exercise tolerance compared to their respective standard control groups. VWR had no effect on LPS-induced anorexia, weight loss, increased immobility in the tail suspension test and decreased sucrose preference in either young adult or aged mice. Four (young adult mice) and 24 h (aged mice) after injection of LPS, mRNA transcripts for TNF-α, IL-1β, IL-6, and IDO were upregulated in the whole brain independently of VWR.

CONCLUSION

Prolonged physical exercise has no effect on the neuroinflammatory response to LPS and its behavioral consequences in young adult and aged mice.

Mental health service utilization among Korean elders in Korean churches: preliminary findings from the Memory and Aging Study of Koreans in Maryland (MASK-MD)

BACKGROUND

Korean Americans (KA) comprise the fourth largest Asian-American subgroup, with a population estimated at nearly 1.7 million, and the vast majority (up to 85%) of KA elders attends ethnic churches. Despite the rapid increase of the KA elderly population, data on mental health service utilization among KA elders are scarce.

METHOD

Based on a cluster sampling method, the Memory and Aging Study among Koreans in Maryland (MASK-MD) recruited and assessed 630 KA elders (mean age: 70.9 ± 6.1 years; 68.9% female) in KA churches for depression, dementia, and level of mental health service utilization. The Korean versions of the Patient Health Questionnaire (PHQ-9K) and Mini-mental Status Examination (MMSE-KC) were administered by trained community health workers.

RESULTS

Of the 630 participants, 23.2% and 7.3% had PHQ-9 scores of 5 ('mild depression') or above and 10 or above ('clinical depression'), respectively. In addition, 7.0% scored below the age- and education-specific cutoff values for probable dementia based on the MMSE-KC. Of the 92 participants with 'clinical depression' or having thoughts of death or self-injury, only 16 (17%) reported utilizing mental health services. Likewise, of 56 participants with probable dementia, only 3 (7.3%) sought treatment from a health care provider.

CONCLUSION

The prevalence of depression and cognitive impairment are high in community-dwelling KA elders attending KA churches, but the rate of mental health service utilization among depressed or cognitively impaired Korean elders is low. Further research is warranted to identify barriers to and strategies for adequate mental health care for Korean immigrant elders.

Age-related response to redeemed antidepressants measured by completed suicide in older adults: a nationwide cohort study

OBJECTIVE

To examine if the suicide rate of older adults prescribed antidepressants varies with age and to assess the proportion of older adults who died by suicide that had recently been prescribed antidepressants.

METHODS

A population-based cohort study using a nationwide linkage of individual-level records was conducted on all persons aged 50+ living in Denmark during 1996-2006 (1,215,524 men and 1,343,568 women). Suicide rates by treatment status were calculated using data on all antidepressant prescriptions redeemed at pharmacies.

RESULTS

Individual-level data covered 9,354,620 and 10,720,639 person-years for men and women, respectively. Men aged 50-59 who received antidepressants had a mean suicide rate of 185 (95% confidence interval [CI]: 160-211) per 100,000, whereas for those aged 80+ the rate was 119 (95% CI: 91-146). For women, the corresponding values were 82 (95% CI: 70-94) and 28 (95% CI: 20-35). Logistic regression showed a 2% and 3% decline in the rate for men and women, respectively, considered in treatment with antidepressants, with each additional year of age. An opposite trend was found for persons not in treatment. Fewer persons aged 80+ dying by suicide had received antidepressant prescriptions during the last months of life than younger persons.

CONCLUSION

An age-dependent decline in suicide rate for antidepressant recipients was identified. One reason could be that older adults respond better to antidepressants than younger age groups. Still, the increasing gap with age between estimated prevalence of depression and antidepressant prescription rate in persons dying by suicide underscores the need for assessment of depression in the oldest old.

Assessment of Nutritional and Depression Status in Free-Living El-derly in Tabriz, Northwest Iran

BACKGROUND

Malnutrition and depression are the common health problems in elderly population. Poor nutrition might have a strong effect on the incidence of depression. The aims of this study were to assess the nutritional and depression status and the possibly relationship between these variables in the urban free-liv-ing elderly in Tabriz, northwestern Iran.

METHODS

This cross-sectional study was carried out on 184 elderly people (male=97; female=87) with age 60 years or elder in 2012. All subjects entered to the study voluntarily from those attending to daily care centers for elderly peo-ple. Mini Nutritional Assessment (MNA) tool and Geriatric Depression Score (GDS) were used to evaluate nutritional status and depression scores, respec-tively. Con-tinuous variables were expressed as mean ± standard deviation (SD) and qualita-tive data were presented as frequency (percent). Spearman's correla-tion was em-ployed to determine the relationship between variables.

RESULTS

Up to 50% of subjects had poor nutrition status. About 14% of elderly people had serve depression and 28.3% had mild depression. There was a posi-tive significant correlation between MNA and GDS tests in both gender (r=0.416; P<0.001).

CONCLUSION

There was no acceptable level of nutritional status and mental health in the elderly people. Further studies are needed to evaluate the other factors that can effect on the quality of life in this population.

Effects of Buddhism walking meditation on depression, functional fitness, and endothelium-dependent vasodilation in depressed elderly

OBJECTIVES

The objectives of this study were to determine the effects of the novel Buddhism-based walking meditation (BWM) and the traditional walking exercise (TWE) on depression, functional fitness, and vascular reactivity.

DESIGN

This was a randomized exercise intervention study.

SETTINGS/LOCATION

The study was conducted in a university hospital setting.

SUBJECTS

Forty-five elderly participants aged 60-90 years with mild-to-moderate depressive symptoms were randomly allocated to the sedentary control, TWE, and BWM groups.

INTERVENTIONS

The BWM program was based on aerobic walking exercise incorporating the Buddhist meditations performed 3 times/week for 12 weeks.

OUTCOME MEASURES

Depression score, functional fitness, and endothelium-dependent vasodilation as measured by the flow-mediated dilation (FMD) were the outcome measures used.

RESULTS

Muscle strength, flexibility, agility, dynamic balance, and cardiorespiratory endurance increased in both exercise groups (p<0.05). Depression score decreased (p<0.05) only in the BWM group. FMD improved (p<0.05) in both exercise groups. Significant reduction in plasma cholesterol, triglyceride, high-density lipoprotein cholesterol, and C-reactive protein were found in both exercise groups, whereas low-density lipoprotein cholesterol, cortisol, and interleukin-6 concentrations decreased only in the BWM group.

CONCLUSIONS

Buddhist walking meditation was effective in reducing depression, improving functional fitness and vascular reactivity, and appears to confer greater overall improvements than the traditional walking program.

Meaning-in-life in nursing-home patients: a correlate with physical and emotional symptoms

AIMS AND OBJECTIVES

To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population.

BACKGROUND

Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health.

DESIGN AND METHODS

The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended.

RESULTS

The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed.

CONCLUSIONS

The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being.

RELEVANCE TO CLINICAL PRACTICE

Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes.

Risk factors for onset of depression after heart failure hospitalization

BACKGROUND

Depression is common in chronic heart failure (CHF) and associated with adverse outcomes. Knowing the risk factors for the development of depression at the early post-hospitalization phase may be a key factor of successful disease management programs. The aim of this study was therefore to identify the risk factors related to the onset of depression after heart failure hospitalization in patients with CHF.

METHODS

The study population included participants with an admission diagnosis of acute heart failure or exacerbation of CHF from a multicenter prospective cohort study. Patients completed clinical evaluation at discharge and functional and social status assessment at 1 month after discharge, and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) at discharge and 1-year later.

RESULTS

Of the 131 patients without depression at discharge, 29 (22.1%) had developed significant depressive symptoms (HADS-D ≥ 8) at 1-year follow-up. Multiple logistic regression demonstrated that previous ischemic heart disease [odds ratio (OR) 3.09, 95% confidence interval (CI) 1.15-8.33], participation restrictions (OR 0.43, 95% CI 0.26-0.70), and lack of satisfaction with social support (OR 0.48, 95% CI 0.29-0.79) were independent predictors of developing depression.

CONCLUSIONS

The three clinically accessible variables and targets for interventions identified as predictors in this study may help to guide the optimal post-discharge disease management planning for these patients who are at high risk for depression.

Age and sex differences in prevalence and clinical correlates of depression: first results from the Irish Longitudinal Study on Ageing

OBJECTIVE

The risk of depression is increased by physical illness; however, the nature of this relationship is complex and unclear. Here, we explore the prevalence and clinical correlates of depression, with particular emphasis on factors representing consequences or physical manifestations of disease and identify age and gender differences in their effects.

METHODS

A population-representative sample of 8175 community-dwelling adults aged 50 years and over participated in the first wave of The Irish Longitudinal Study on Ageing. The primary outcome measure was clinically significant depressive symptoms defined by a score of 16 or greater on the 20-item Centre for Epidemiologic Studies Depression scale.

RESULTS

Overall, 10% (95% CI: 9-11%) of adults reported clinically significant depressive symptoms. Physical illness is associated with depressive symptoms only in adults 65 years and older; in adults aged 50-64 years, the association is mediated by medication use, and this age difference is statistically significant (p < 0.00). Irrespective of age, chronic pain and incontinence were stronger predictors of depression in men (interaction effects p < 0.00) CONCLUSIONS: Our findings identify age-specific and gender-specific clinical markers for depression risk among the older population, which may identify those more likely to present with depression in community settings.

Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study

OBJECTIVE

Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms.

METHODS

A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health.

RESULTS

A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant.

CONCLUSIONS

Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.

Assessment of the person with late-life depression

This article discusses characteristic factors in the presentation of depressive disorders in persons older than age 65 years. Clinical presentation is discussed along with risk and protective factors. Detailed descriptions of tests useful for screening and diagnosis of depression in the elderly are presented. Each test is reviewed according to time to administer, sensitivity and specificity, outcomes, advantages, and disadvantages. The importance of clinical history and the diagnostic interview, as well as the role of laboratory studies and neuroimaging in the clinical evaluation are discussed.

Computerised cognitive behavioural therapy for depression and anxiety with older people: a pilot study to examine patient acceptability and treatment outcome

OBJECTIVE

The study objective was to determine the acceptability and treatment outcome of using Beating the Blues (BTB) with older people (6 + years). Specific aims included identifying the treatment uptake and drop-out rate, and describing the role of basic demographics in therapy uptake.

METHOD

Fifty-eight participants, experiencing symptoms of depression, were given a free choice of receiving treatment as usual (TAU) plus BTB (TAU + BTB) or TAU alone. All participants completed demographic questionnaires and a range of outcome measures at baseline, 2 months after baseline (end of treatment) and 3 months after baseline (follow-up).

RESULTS

Thirty-three participants (56.9%) opted to receive BTB and reported having more experience and confidence using a computer than those who declined BTB. Twenty-four participants (72.7%) went on to complete all eight BTB sessions. Statistical analysis found significant differences between the two treatment groups, with the TAU + BTB group showing greater improvements in their symptoms of depression and anxiety than the TAU group by the end of treatment and at follow-up. Furthermore, the TAU+ BTB group had a significantly higher percentage of participants who met criteria for clinically significant improvement in their symptoms of depression by the end of treatment and at follow-up.

CONCLUSION

Although further research is required, including a randomised controlled trial, the results of this initial pilot study provide evidence that BTB may offer an acceptable and effective treatment option for older people.

Age related differences in mental health scale scores and depression diagnosis: adult responses to the CIDI-SF and MHI-5

Inconsistencies surrounding the prevalence levels of depression in later life suggest that the measurement of depression in older people may be problematic. The current study aimed to map responses to a depressive symptom scale, the Mental Health Index-5 (MHI-5) which is part of the Short form 36 (SF-36, Ware et al., 1993) against the diagnostic screening items of the Composite International Diagnostic Instrument-Short Form (CIDI-SF, Kessler et al., 1998) to examine disagreement rates across age groups. The study examined data from a national random sample of 10,641 participants living in Ireland, 58.8% were female and 19% were over 65 (SLÁN, 2007). CIDI-SF depression screening endorsement was lower in older groups, whereas mean MHI-5 depressive symptoms showed less change across age groups. Results showed that the odds of MHI-5 endorsers aged 18-44 endorsing CIDI-SF screening questions were 5 times and 4.5 times (dysphoria and anhedonia, respectively) greater than the odds of people aged 75 or more endorsing these items. Findings suggest that although the risk of depressive disorder may decrease with age, complex diagnostic screening questions may exaggerate lower rates of depression among older people.

Oscillometric measure of blood pressure detects association between orthostatic hypotension and depression in population based study of older adults

BACKGROUND

White matter hyperintensities may contribute to depression by disrupting neural connections among brain regions that regulate mood. Orthostatic hypotension (OH) may be a risk factor for white matter hyperintensities and accumulating evidence, although limited suggests it may play a role in the development of late-life depression. The aim of this study was to examine the relationship between an oscillometric measure of orthostatic hypotension and depression in population based sample of older adults.

METHODS

We analysed data on adults aged 60 and over from the first wave of The Irish Longitudinal Study on Ageing (TILDA). Depression was assessed using the Center for Epidemiologic Studies--Depression (CES-D) scale and OH was assessed by a sit-to-stand orthostatic stress test; two seated blood pressure measurements were followed by a single standing blood pressure measurement. Participants self reported whether they felt dizzy, light-headed or unsteady on standing.

RESULTS

Participants with symptomatic OH (SOH, n=20) had the highest mean CES-D score (mean 8.6, SE 1.6) when compared to participants with asymptomatic OH (AOH) (mean 5.6, SE .48) and participants with no OH (mean 5.2, SE .14) and this difference was significant for both comparisons (p<0.001). Linear regression analysis adjusted for socio-demographic and clinical characteristics showed that SOH was associated with higher CES-D scores (unstandardised B coefficient = 2.24; 95% CI .301 - 4.79; p =0.05) compared to participants without OH. AOH was not associated with higher CES-D scores (unstandardised B coefficient =.162; 95% CI -.681, 1.00; p= 0.70).

CONCLUSIONS

Symptomatic orthostatic hypotension is associated with depression in older adults and needs to be considered in studies examining the relationship between vascular disease and depression in older adults.

Physical activity and depressive symptoms in older adults

OBJECTIVES

Depressive symptoms are prevalent in older adults, and physical activity (PA) may have beneficial effects on depression. The purpose of this study was to explore the association between physical activity and depressive symptoms, taking into account demographic factors, and the associations between selected demographic factors and physical activity levels in community-dwelling older adults (age ≥ 60 years).

METHODS

Data were drawn from the National Health and Nutrition Examination Survey 2005-2006. Descriptive statistics and logistic models were used in data analysis.

RESULTS

Four percent of participants reported moderate depressive symptoms, and 24% of subjects exhibited sedentary PA. Factors associated with increased risk of moderate depression included age, sedentary PA, and chronic medical conditions (ps < 0.05). Sedentary PA was significantly associated with age, race, education, BMI, smoking status, alcohol use, and taking psychotropics (ps < 0.05).

DISCUSSION

PA is a protective factor for depression in older adults, and clinical implications to encourage PA are discussed.

What characterizes late-life depression?

This article analyzes late-life depression, looking carefully at what defines a person as elderly, the incidence of late-life depression, complications and differences in symptoms between young and old patients with depression, subsyndromal depression, bipolar depression in the elderly, the relationship between grief and depression, along with sleep disturbances and suicidal ideation.

Depression Treatment Non-adherence and its Psychosocial Predictors: Differences between Young and Older Adults?

Depression is a common disease among young and older adults. Although it can be treated, non-adherence is very common among individuals of different ages. The aim of the present paper is to review and summarize research findings regarding depression among young and older adults, with a special focus on the phenomenon of treatment non-adherence among young and older adults with depression. The first section of the review focuses on describing the characteristics of depression in young and older adults. The second section focuses on treatment non-adherence of young and older adults, the prevalence of this phenomenon, and its consequences. The third section focuses on several factors (illness beliefs, treatment beliefs, self-stigma, and self-esteem) that were identified as having a significant association with treatment non-adherence of individuals with depression, with special attention focused on age differences. Results of the review of the literature reveal that research in the area of depression treatment non-adherence and its predictors among young and older adults has received, to date, very minor and limited attention. Thus, there is a need to expand the current body of knowledge and promote future interventions geared towards the unique characteristics of depression among young and older adults, in order to increase their treatment adherence.

Factor structure of the CES-D scale among older adults in Chennai, India

To examine the psychometric properties of the 20-item Centre for Epidemiological Studies - Depression scale (CES-D). Data were collected from 400 community-dwelling older adults aged 65 years and above, residing in Chennai, India. The instruments including the CES-D scale were translated into Tamil language. The sample was randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. EFA on a subsample (n = 200) yielded two factors, depressed affect and positive affect. CFA with another subsample (n = 200) indicated a good fit for the two-factor structure. In addition, the two-factor model evinced a superior fit to one-, three- and four-factor models. The internal consistency was high for the total scale and its subscales. The convergent validity of the scale was supported by significant correlations with theoretically related measures. The results indicate acceptable measurement properties of the CES-D scale. However, some items appear to be problematic for Indian older adults. Therefore, there is a need for further studies among Indian older adults.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Fatores associados aos sintomas depressivos em idosos: estudo EpiFloripa

OBJETIVO Analisar a prevalência e fatores associados a sintomas depressivos em idosos. MÉTODOS Estudo epidemiológico transversal e de base domiciliar (inquérito EpiFloripa Idoso) com 1.656 idosos, realizado por conglomerados em dois estágios, setores censitários e domicílios, em Florianópolis, SC. A prevalência de sintomas depressivos (desfecho) foi obtida por meio da Geriatric Depression Scale (GDS-15), e testadas associações segundo variáveis sociodemográficas, de saúde, comportamentais e sociais. Foram calculadas razões de prevalências brutas e ajustadas com intervalo de 95% de confiança por regressão de Poisson. RESULTADOS A prevalência de sintomas depressivos foi de 23,9% (IC95% 21,84;26,01). Os fatores de risco associados no modelo final foram: escolaridade de cinco a oito anos (RP = 1,50; IC95% 1,08; 2,08), um a quatro anos (RP = 1,62; IC95% 1,18; 2,23) e nenhum ano de estudo (RP = 2,11; IC95% 1,46;3,05); situação econômica pior quando comparada com a que tinha aos 50 anos (RP = 1,33; IC95% 1,02;1,74); déficit cognitivo (RP = 1,45; IC95% 1,21;1,75); percepção de saúde regular (RP = 1,95; IC95% 1,47;2,60) e ruim (RP = 2,64; IC95% 1,82;3,83); dependência funcional (RP = 1,83; IC95% 1,43; 2,33); e dor crônica (RP = 1,35; IC95% 1,10;1,67). Grupo etário de 70 a 79 anos (RP = 0,77; IC95% 0,64;0,93); atividade física de lazer (RP = 0,75; IC95% 0,59;0,94); participação em grupos de convivência ou religiosos (RP = 0,80; IC95% 0,64;0,99); e ter relação sexual (RP = 0,70; IC95% 0,53;0,94) mostraram-se fatores protetores ao aparecimento dos sintomas depressivos. CONCLUSÕES Situação clínica adversa, desvantagem socioeconômica e pouca atividade social e sexual mostraram-se associadas aos sintomas depressivos em idosos.

Dimensional assessment of depressive severity in the elderly general population: psychometric evaluation of the PHQ-9 using Rasch Analysis

BACKGROUND

The depression module of the Patient Health questionnaire (PHQ-9) is a wide-spread self-report instrument for the assessment of depression with compelling psychometric characteristics when relying on classical test theory assumptions. This study aimed at evaluating whether the PHQ-9 may be interpreted as a dimensional scale measuring depression severity in the elderly general population using Rasch analysis with special emphasis on its unidimensional structure and differential item functioning (DIF) due to gender, age, and the presence of somatic multimorbidity.

METHODS

A representative sample of the elderly German general population (N=1631; age 60-85 years, 53.5% female) filled in the PHQ-9, a questionnaire about chronic medical conditions and a demographic data sheet. Unidimensionality and psychometric properties of the PHQ-9 were ascertained applying confirmatory factor analysis (CFA) and Rasch analysis.

RESULTS

Results revealed substantial violations of the unidimensionality of the scale: item 8 (retardation or agitation) had to be eliminated and multiple residual correlations were added. Gender-related DIF emerged for two items, and three items showed insufficient Rasch model fit.

LIMITATIONS

The large sample leads to high statistical power that might technically increase the probability of detecting model misfit or DIF. The sampling procedure leads to a possible underestimation of morbidity due to the exclusion of those elderly patients living in nursing homes.

CONCLUSIONS

Results suggest that - when applied in the elderly general population - the PHQ-9 should be interpreted in terms of a diagnostic algorithm for classificatory decisions about a DSM-IV based probable diagnosis of depression rather than as a dimensional scale.

Atypical depressive symptoms and obesity in a national sample of older adults with major depressive disorder

BACKGROUND

The objectives of this study are to present findings on the rate of obesity associated with classic, atypical, and undifferentiated depression by comparing with those without depression in a nationally representative sample of United States older adults.

METHODS

The authors used data from the 2001 to 2002 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), which included 10,557 adults 60 years of age and older. Chi-square tests were used to compare classic, atypical, and undifferentiated as well as nondepressed control in sociodemographic characteristics. Then, logistic regressions adjusting for sociodemographic characteristics were used to evaluate associations of rate of current obesity (defined as Body Mass Index (BMI) > 30) across the three depressive groups (classic, atypical, and undifferentiated depression) and nondepressed control. Lifetime, current, and past depression were examined.

RESULTS

Significant differences were found between atypical and classic depression in sex, age, marital status, race, and personal income. After adjusting for sex, age, marital status, race, and personal income, the rate of obesity was significantly greater for respondents with atypical depression than respondents with classic, undifferentiated depression, or without depression. Same results were found in lifetime, current, and past depression.

CONCLUSION

Our findings suggest that the heterogeneity of depression should be considered when examining the effect of depression on obesity in old age. Prevention measures should be designed and delivered to older adults with atypical depression.

Depressive symptoms in older adults with chronic kidney disease: mortality, quality of life outcomes, and correlates

OBJECTIVE

Among patients with chronic kidney disease (CKD), we investigated the prevalence of depressive symptoms, their impact on mortality and quality of life, and correlates of depressive symptoms.

DESIGN

Prospective cohort study, followed up to 4 years.

SETTING

General community.

PARTICIPANTS

A total of 362 older adults with CKD (Stages 3 and 4 assessed from estimated glomerular filtration rate [eGFR]) drawn from the Singapore Longitudinal Aging Study cohort.

MEASUREMENTS

Scores on the Geriatric Depression Scale (GDS) and the prevalence of depressive symptoms (GDS ≥5) and other variables were assessed at baseline, and SF-12 quality of life (QOL) (at 2 years) and mortality determined from 4 years of follow-up.

RESULTS

Depressive symptoms were present in 13% of the participants at baseline, and were associated with poorer SF-12 QOL scores (up to 30 percentage point differences). There was a significant association between depressive symptoms and increased mortality risk (odds ratio: 3.17; 95% confidence interval: 1.17-8.61; χ(2) = 5.11; df = 1; p = 0.023), which was statistically significant in unadjusted analysis, but not in multivariate analysis that accounted for covariates (odds ratio: 2.62; 95% confidence interval: 0.77-8.89; χ(2) = 2.37; df = 1; p = 0.13). Baseline cognitive impairment, functional disability, and other chronic illness were significantly associated with both increasing GDS scores and depressive symptoms. No relationship between eGFR and depressive symptoms was observed.

CONCLUSION

Depression among individuals with CKD was significantly associated with poorer quality of life, but not with increased mortality in predialysis CKD patients. More prospective studies are needed to establish the effects of depression on adverse CKD outcomes in predialysis CKD patients.

The economic burden of depression in Switzerland

BACKGROUND

Despite the high prevalence of depression, information about the burden of this disease in Switzerland is scarce. A better knowledge of the costs of depression may provide important information for future national preventive programmes, optimizing cost-effective budgeting. The estimates of national costs may improve the public's awareness of depression and depression-related costs, breaking down the taboo of depression as an illness.

OBJECTIVES

The aims of this study were to analyse the annual cost for different levels of depression and to investigate the annual economic burden of depression in Switzerland.

METHODS

A retrospective, multicentre, non-interventional study in psychiatrist practices was carried out. Outpatients who had been diagnosed with depression in the last 3 years were included. Patient demographics and information on clinical characteristics and resource utilization in the first 12 months after diagnosis were collected. Costs analysis, subdivided into direct and indirect costs, was performed for three depression severity classes (mild, moderate and severe), according to the 17-item Hamilton Depression Rating Scale (HDRS-17). Costs were also extrapolated to a national level. Regression analysis was performed to control for factors that may have an impact on the cost of depression.

RESULTS

A total of 556 patients were included. Hospitalization and hospitalization days were directly correlated with disease severity (p < 0.001). Medical resource utilization linked to depression and antidepressant treatments was also correlated to the disease status. Severely depressed patients reported a significantly higher number of workdays lost and were significantly more often on disability insurance. The mean total direct costs per person per year, mainly due to hospitalization costs, were <euro>3,561 for mild, <euro>9,744 for moderate and <euro>16,240 for severe depression. The mean indirect costs per person per year, mainly due to workdays lost, were <euro>8,730 for mild, <euro>12,675 for moderate and <euro>16,669 for severe depression (year 2007/2008 values). Regression analysis showed that hospitalization days, psychiatrist visits in hospital, disability insurance, workdays lost and the HDRS-17 score were significantly correlated to the total costs. Extrapolation at a national level resulted in a total burden of about <euro>8.1-8.3 billion per year.

CONCLUSIONS

The burden of depression in Switzerland was estimated to be about <euro>8 billion per year. The costs of depression were directly related to disease severity. However, since many cases of depression remain unreported and since this analysis only included individuals between 18 and 65 years of age, it is reasonable to suppose that the total burden of depression may be even higher.

[Depressive symptoms in elderly women. The influence of gender]

OBJECTIVE

To examine gender differences in depressive symptoms in people over 75 years of age in the community.

METHODS

This is a descriptive cross-sectional study. The data was obtained from the study of frailty in Lleida (FRALLE survey). Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). Logistic regression were used to analyse the relationship of gender with depressive symptoms.

RESULTS

The prevalence of depressive symptoms was 33.1%; 22.8% for men and 40.3% for women. In the total population, gender was statistically significant in all three models constructed. Thus, women have nearly double the prevalence rates for depression compared to men, even after adjusting for social and demographic factors and the health status.

CONCLUSIONS

The results suggest that women have a higher risk of depressive symptoms than men, and the protective factors of depressive symptoms are higher education in women, and the presence of a partner in men.

Dealing with missing data in the Center for Epidemiologic Studies Depression self-report scale: a study based on the French E3N cohort

BACKGROUND

The Center for Epidemiologic Studies - Depression scale (CES-D) is a validated tool commonly used to screen depressive symptoms. As with any self-administered questionnaire, missing data are frequently observed and can strongly bias any inference. The objective of this study was to investigate the best approach for handling missing data in the CES-D scale.

METHODS

Among the 71,412 women from the French E3N prospective cohort (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale) who returned the questionnaire comprising the CES-D scale in 2005, 45% had missing values in the scale. The reasons for failure to complete certain items were investigated by semi-directive interviews on a random sample of 204 participants. The prevalence of high depressive symptoms (score ≥ 16, hDS) was estimated after applying various methods for ignorable missing data including multiple imputation using imputation models with CES-D items with or without covariates. The accuracy of imputation models was investigated. Various scenarios of nonignorable missing data mechanisms were investigated by a sensitivity analysis based on the mixture modelling approach.

RESULTS

The interviews showed that participants were not reluctant to answer the CES-D scale. Possible reasons for nonresponse were identified. The prevalence of hDS among complete responders was 26.1%. After multiple imputation, the prevalence was 28.6%, 29.8% and 31.7% for women presenting up to 4, 10 and 20 missing values, respectively. The estimates were robust to the various imputation models investigated and to the scenarios of nonignorable missing data.

CONCLUSIONS

The CES-D scale can easily be used in large cohorts even in the presence of missing data. Based on the results from both a qualitative study and a sensitivity analysis under various scenarios of missing data mechanism in a population of women, missing data mechanism does not appear to be nonignorable and estimates are robust to departures from ignorability. Multiple imputation is recommended to reliably handle missing data in the CES-D scale.

The relationship between social integration and depression in non-demented primary care patients aged 75 years and older

BACKGROUND

Social integration seems to be associated with depression in late life. But the measurement of social integration still lacks a strong consensus. To date in most studies the different domains of social integration have been examined separately.

AIMS

In order to improve comparability among studies, we used the social integration index (SII), which covers all domains of social integration, to examine the association of social integration and depression in non-demented primary care patients aged 75 years and older.

METHOD

Data were derived from the longitudinal German study on Aging, Cognition and Dementia in primary care patients. Included in the cross-sectional survey were 1028 non-demented subjects aged 75 years and older. The GDS-15 Geriatric Depression Scale was used to measure depression with a threshold of ≥6. Associations of the SII and further potential risk factors and depression were analysed using multivariate logistic regression models.

RESULTS

The SII was significantly associated with depression in the elderly. After full adjustment for all variables, odds of depression were significantly higher for lower levels of the SII, having a care level, impaired vision and mobility and subjective memory complaints.

CONCLUSION

Because the social integration index covers several aspects of social integration, the results seem to be more significant than considering only one of these domains alone. Further research is needed to prove the practicability of the social integration index and to supply the literature with consistent results regarding the association of social integration and depression. Elderly with depression could benefit from increased social networks and enhanced social integration, which points to the development of social programs and social policies that maximize the engagement of older adults in social activities and volunteer roles.