1
|
Triolo F, Vetrano DL, Trevisan C, Sjöberg L, Calderón-Larrañaga A, Belvederi Murri M, Fratiglioni L, Dekhtyar S. Mapping 15-year depressive symptom transitions in late life: population-based cohort study. Br J Psychiatry 2024:1-7. [PMID: 38812455 DOI: 10.1192/bjp.2024.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND The longitudinal course of late-life depression remains under-studied. AIMS To describe transitions along the depression continuum in old age and to identify factors associated with specific transition patterns. METHOD We analysed 15-year longitudinal data on 2745 dementia-free persons aged 60+ from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression (minor and major) was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; subsyndromal depression (SSD) was operationalised as the presence of ≥2 symptoms without depression. Multistate survival models were used to map depression transitions, including death, and to examine the association of psychosocial (social network, connection and support), lifestyle (smoking, alcohol consumption and physical activity) and clinical (somatic disease count) factors with transition patterns. RESULTS Over the follow-up, 19.1% had ≥1 transitions across depressive states, while 6.5% had ≥2. Each additional somatic disease was associated with a higher hazard of progression from no depression (No Dep) to SSD (hazard ratio 1.09; 1.07-1.10) and depression (Dep) (hazard ratio 1.06; 1.04-1.08), but also with a lower recovery (HRSSD-No Dep 0.95; 0.93-0.97 [where 'HR' refers to 'hazard ratio']; HRDep-No Dep 0.96; 0.93-0.99). Physical activity was associated with an increased hazard of recovery to no depression from SSD (hazard ratio 1.49; 1.28-1.73) and depression (hazard ratio 1.20; 1.00-1.44), while a richer social network was associated with both higher recovery from (HRSSD-No Dep 1.44; 1.26-1.66; HRDep-No Dep 1.51; 1.34-1.71) and lower progression hazards to a worse depressive state (HRNo Dep-SSD 0.81; 0.70-0.94; HRNo Dep-Dep 0.58; 0.46-0.73; HRSSD-Dep 0.66; 0.44-0.98). CONCLUSIONS Older people may present with heterogeneous depressive trajectories. Targeting the accumulation of somatic diseases and enhancing social interactions may be appropriate for both depression prevention and burden reduction, while promoting physical activity may primarily benefit recovery from depressive disorders.
Collapse
Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Caterina Trevisan
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Department of Medical Sciences, University of Ferrara, Italy
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| |
Collapse
|
2
|
Cui L, Li S, Wang S, Wu X, Liu Y, Yu W, Wang Y, Tang Y, Xia M, Li B. Major depressive disorder: hypothesis, mechanism, prevention and treatment. Signal Transduct Target Ther 2024; 9:30. [PMID: 38331979 PMCID: PMC10853571 DOI: 10.1038/s41392-024-01738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024] Open
Abstract
Worldwide, the incidence of major depressive disorder (MDD) is increasing annually, resulting in greater economic and social burdens. Moreover, the pathological mechanisms of MDD and the mechanisms underlying the effects of pharmacological treatments for MDD are complex and unclear, and additional diagnostic and therapeutic strategies for MDD still are needed. The currently widely accepted theories of MDD pathogenesis include the neurotransmitter and receptor hypothesis, hypothalamic-pituitary-adrenal (HPA) axis hypothesis, cytokine hypothesis, neuroplasticity hypothesis and systemic influence hypothesis, but these hypothesis cannot completely explain the pathological mechanism of MDD. Even it is still hard to adopt only one hypothesis to completely reveal the pathogenesis of MDD, thus in recent years, great progress has been made in elucidating the roles of multiple organ interactions in the pathogenesis MDD and identifying novel therapeutic approaches and multitarget modulatory strategies, further revealing the disease features of MDD. Furthermore, some newly discovered potential pharmacological targets and newly studied antidepressants have attracted widespread attention, some reagents have even been approved for clinical treatment and some novel therapeutic methods such as phototherapy and acupuncture have been discovered to have effective improvement for the depressive symptoms. In this work, we comprehensively summarize the latest research on the pathogenesis and diagnosis of MDD, preventive approaches and therapeutic medicines, as well as the related clinical trials.
Collapse
Affiliation(s)
- Lulu Cui
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China
- China Medical University Centre of Forensic Investigation, Shenyang, China
| | - Shu Li
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China
- China Medical University Centre of Forensic Investigation, Shenyang, China
| | - Siman Wang
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China
- China Medical University Centre of Forensic Investigation, Shenyang, China
| | - Xiafang Wu
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China
- China Medical University Centre of Forensic Investigation, Shenyang, China
| | - Yingyu Liu
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China
- China Medical University Centre of Forensic Investigation, Shenyang, China
| | - Weiyang Yu
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China
- China Medical University Centre of Forensic Investigation, Shenyang, China
| | - Yijun Wang
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China
- China Medical University Centre of Forensic Investigation, Shenyang, China
| | - Yong Tang
- International Joint Research Centre on Purinergic Signalling/Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education/School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine/Acupuncture and Chronobiology Key Laboratory of Sichuan Province, Chengdu, China
| | - Maosheng Xia
- Department of Orthopaedics, The First Hospital, China Medical University, Shenyang, China.
| | - Baoman Li
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang, China.
- Liaoning Province Key Laboratory of Forensic Bio-evidence Sciences, Shenyang, China.
- China Medical University Centre of Forensic Investigation, Shenyang, China.
| |
Collapse
|
3
|
Fan Y, Shen BJ, Tay HY. Depression, anxiety, perceived stress, and their changes predicted medical adherence over 9 months among patients with coronary heart disease. Br J Health Psychol 2021; 26:748-766. [PMID: 33382184 DOI: 10.1111/bjhp.12496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although effective medical treatments have proved to successfully improve prognoses and outcomes of patients with coronary heart disease (CHD), low adherence to treatments is still common among patients. Deleterious impact of psychological distress on medical adherence has been recognized; however, few studies examined the influence of change in psychological distress on attenuation in adherence. This study investigated whether three common manifestations of distress (depression, anxiety, and perceived stress) and their changes predicted decline in medical adherence among CHD patient over 9 months. DESIGN A three-wave longitudinal study. METHODS Participants were 255 CHD patients with a mean age of 63 years. Psychological distress, medication adherence, and specific treatment adherence were assessed at baseline, 3 months, and 9 months. Hierarchical regression analyses were conducted to examine the influences of psychological distress on medical adherence over 9 months. All models were adjusted for baseline medication or specific adherence, demographic, and medical covariates. RESULTS Baseline depression and its changes over time significantly predicted greater decline in both medication adherence (βs = .15-.20, ps < .05) and specific adherence (βs = -.21 to -.15, ps < .05). Anxiety showed a similar trend. For perceived stress, baseline and its change significantly predicted specific adherence over 9 months (βs = -.30 to -.23, ps < .01), but did not predict medication adherence at 3 and 9 months. CONCLUSIONS Findings underline the necessity of tracking various forms of psychological distress over time for CHD patients to promote medical adherence and further improve the disease prognosis.
Collapse
Affiliation(s)
- Yunge Fan
- Psychology Program, Nanyang Technological University, Singapore City, Singapore
| | - Biing-Jiun Shen
- Psychology Program, Nanyang Technological University, Singapore City, Singapore
| | - Hung Yong Tay
- Heart Wellness Center, Singapore Heart Foundation, Singapore City, Singapore
| |
Collapse
|
4
|
Lim HJ, Cheng Y, Kabir R, Thorpe L. Trajectories of Depression and Their Predictors in a Population-Based Study of Korean Older Adults. Int J Aging Hum Dev 2020; 93:834-853. [PMID: 32830531 DOI: 10.1177/0091415020944405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to determine trajectories of depression in older adults and to identify predictors of membership in the different trajectory groups. A total of 3983 individuals aged 65 or older were included. Latent class growth models were used to identify trajectory groups. Of 3983 individuals, 2269 (57%) were females, with a mean baseline age of 72.4 years (SD = 6 years). Four depression trajectories were identified across 8 years of follow-up: "low-flat" (n = 3636; 86.6%), "low-to-middle" (n = 214; 9.2%), "low-to-high" (n = 31; 1.3%), and "high-stable" (n = 102; 2.9%). Compared to the low-flat depression group, high-stable depression group members were more likely to be female, have three or more chronic diseases, and were more likely not to own a home. Our findings will assist health policy decision-makers in planning intervention programs targeting those most likely to experience persistent depression in order to improve psychological well-being in the elderly.
Collapse
Affiliation(s)
- Hyun Ja Lim
- 12371 Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,248223 Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yanzhao Cheng
- 248223 Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rasel Kabir
- 248223 Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lilian Thorpe
- 12371 Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
5
|
Roh HW, Hong CH, Lim HK, Chang KJ, Kim H, Kim NR, Choi JW, Lee KS, Cho SM, Park B, Son SJ. A 12-week multidomain intervention for late-life depression: a community-based randomized controlled trial. J Affect Disord 2020; 263:437-444. [PMID: 31969275 DOI: 10.1016/j.jad.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/08/2019] [Accepted: 12/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given that current unimodal strategies for treating late-life depression are insufficient, the awareness of the necessity and importance of multidomain intervention has increased. We assessed the efficacy of multidomain intervention in reducing symptoms of late-life depression. METHODS This was a 12-week community-based randomized controlled trial in 78 older adults diagnosed with major depressive disorder. Participants were randomly assigned to the multidomain intervention or supportive therapy group. We provided four home visits and 12 telephone calls over 12 weeks. Four therapeutic approaches (physical activity, healthy diet, social activity, and brief cognitive restructuring) were incorporated into the multidomain intervention. The primary outcome was the change in depressive symptoms, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). Secondarily, we investigated changes in resting-state functional connectivity. RESULTS The MADRS total score was reduced more in the multidomain intervention group than in the supportive therapy group during the 12 weeks (intervention × time interaction, P = =0.007). After correction for multiple comparisons, the multidomain intervention group exhibited a lower MADRS total score at week 12 (score difference 5.117; P = =0.029). At follow-up, the multidomain intervention group also exhibited less functional connectivity between the posterior cingulate cortex and left inferior parietal lobule within the default mode network (FDR < 0.1). LIMITATIONS Caution is needed in the interpretation of the results, considering the small sample size and high percentage of female participants. CONCLUSIONS A 12-week multidomain intervention resulted in a greater reduction of depressive symptoms among the elderly with major depressive disorder than their counterparts who received supportive therapy.
Collapse
Affiliation(s)
- Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Yeouido St. Mary's Hospital, Seoul, Republic of Korea
| | - Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Haena Kim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Na-Rae Kim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kang Soo Lee
- Department of Psychiatry, CHA University School of Medicine, CHA Bundang Medical Center, Bundang, Republic of Korea
| | - Sun-Mi Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea; Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
| |
Collapse
|
6
|
Wassink-Vossen S, Collard RM, Wardenaar KJ, Verhaak PF, Rhebergen D, Naarding P, Voshaar RCO. Trajectories and determinants of functional limitations in late-life
depression: A 2-year prospective cohort study. Eur Psychiatry 2020; 62:90-96. [DOI: 10.1016/j.eurpsy.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background:
In mental health research, functional recovery is increasingly
valued as an important outcome in addition to symptomatic
remission.
Methods:
Course types of functional limitations among depressed older
patients and its relation with symptomatic remission were explored in a
naturalistic cohort study (Netherlands Study of Depression in Older
persons). 378 depressed older patients (≥60 years) and 132 non-depressed
persons were included. Depressive disorders were assessed with Composite
International Diagnostic Interview at baseline and two-year follow-up.
Functional limitations were assessed every 6 months with the World
Health Organization Disability Assessment II.
Results:
Depressed patients had more functional limitations compared to their
non-depressed counterparts. Growth Mixture Modeling among depressed
patients identified two trajectories of functional limitations, both
starting at a high disability level. The largest subgroup (81.2%) was
characterized by a course of high disability levels over time. The
smaller subgroup (18.8%) had an improving course (functional recovery).
After two years, the main predictor of functional recovery was the
remission of depression. Among symptomatic remitted patients, female
sex, higher level of education, higher gait speed, and less severe
depression were associated with no functional recovery. Non-remitted
patients without functional recovery were characterized by the presence
of more chronic somatic diseases, a lower sense of mastery, and a higher
level of anxiety.
Conclusions:
1 in 5 depressed older patients have a course with functional
recovery. Combining functional and symptomatic recovery points to a
subgroup of older patients that might profit from more rigorous
psychiatric treatment targeted at psychiatric comorbidity and a group of
frail depressed older patients that might profit from integrated
geriatric rehabilitation.
Collapse
|
7
|
Visted E, Sørensen L, Vøllestad J, Osnes B, Svendsen JL, Jentschke S, Binder PE, Schanche E. The Association Between Juvenile Onset of Depression and Emotion Regulation Difficulties. Front Psychol 2019; 10:2262. [PMID: 31695636 PMCID: PMC6816416 DOI: 10.3389/fpsyg.2019.02262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/23/2019] [Indexed: 01/04/2023] Open
Abstract
Juvenile onset of Major Depressive Disorder (MDD) is associated with increased likelihood of recurrent episodes of depression and more detrimental clinical trajectories. The aim of the current study was to investigate the effect of juvenile onset of MDD on emotion regulation as measured by self-report and Heart Rate Variability (HRV). Furthermore, we wanted to assess whether juvenile onset impacted the association between rumination and depressive symptoms. Sixty-four individuals with at least three prior episodes of MDD were recruited and filled out self-report questionnaires measuring rumination and emotion regulation abilities. In addition, electrocardiographic assessments were used to calculate HRV. Based on self-reported age of MDD onset, individuals were divided in two groups: Juvenile onset of MDD (first MDD episode before the age of 18, n = 30) and adult onset of MDD (first MDD episode after the age of 18, n = 34). Results showed that individuals whose first depressive episode occurred in childhood and adolescence reported more rumination and less emotional clarity compared to individuals who had their first episode of MDD in adulthood. Moreover, the tendency to ruminate was strongly associated with depressive symptoms in the juvenile onset of MDD group, whereas no such association was found in the adult onset group. There was no significant group difference for HRV. The findings are discussed in light of existing literature, in addition to suggesting how our findings may inform clinical practice and future research. We conclude that juvenile onset of MDD may lead to difficulties in emotion regulation and that these difficulties may increase depressive symptoms and vulnerability for relapse in this particular subgroup.
Collapse
Affiliation(s)
- Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Solli District Psychiatric Center (DPS), Nesttun, Norway
| | - Berge Osnes
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Bjørgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway
| | - Julie Lillebostad Svendsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Per-Einar Binder
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | |
Collapse
|
8
|
Xiang X, Cheng J. Trajectories of major depression in middle-aged and older adults: A population-based study. Int J Geriatr Psychiatry 2019; 34:1506-1514. [PMID: 31179582 PMCID: PMC6742519 DOI: 10.1002/gps.5161] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to examine depression trajectories and correlates in a nationally representative sample of middle-aged and older adults in the United States. METHODS The study sample consisted of 15 661 participants aged over 50 years from the US Health and Retirement Study. Major depression was assessed using the Composite International Diagnostic Interview (CIDI-SF). Depression trajectories were identified using a group-based trajectory modeling enhanced to account for nonrandom attrition. Multinomial logistic regression was conducted to investigate predictors of depression trajectories. RESULTS Four depression trajectory groups were identified: "never" (85.8%), "increasing" (6.3%), "decreasing" (3.2%), and "persistently moderate/high" (4.7%). Baseline depressive symptom severity was a strong predictor of depression trajectories. Older age, male sex, and non-Hispanic African American race were associated with a lower risk of the three trajectories with small to high depression burden, whereas chronic disease count was associated with a higher risk of these trajectories. The risk of being on the increasing trajectory increased with mobility difficulties. Difficulties in household activities predicted membership in the persistently moderate/high group. CONCLUSIONS A small but nonignorable proportion of middle-aged and older adults have chronic major depression. Initial symptom severity and chronic disease burden are consistent risk factors for unfavorable depression trajectories and potential targets for screening and intervention.
Collapse
Affiliation(s)
- Xiaoling Xiang
- School of Social WorkUniversity of Michigan Ann Arbor MI
| | - Jianjia Cheng
- School of Social WorkUniversity of Michigan Ann Arbor MI
| |
Collapse
|
9
|
Persistent Depressive Symptoms in a Population With High Levels of Occupational Stress: Trajectories Offer Insights Into Both Chronicity and Resilience. J Psychiatr Pract 2018; 24:399-409. [PMID: 30395547 DOI: 10.1097/pra.0000000000000337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Religious participation and spirituality are linked to good mental health. However, clergy may experience more depression than is observed in the general population, which may be due in part to high job strain. The objectives of this study were to identify distinct longitudinal trajectories of depressive symptoms in clergy and to identify variables associated with each course. The sample was 1172 clergy who were followed for up to 66 months. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-8), which was administered approximately every 6 months. Latent class trajectory analysis was conducted for group identification, and a 3-class trajectory model fit the data best. Class 1 (38% of the sample) had minimal or no depressive symptoms over time, class 2 (47%) had chronic mild symptoms, and class 3 (15%) had persistent moderate/severe symptoms. Occupational distress was significantly associated with trajectory class. The odds of being in either the chronic mild or the persistent moderate/severe depressive symptom class were significantly higher for those who were female, for those with fair/poor self-rated health, for those with more perceived financial or occupational stress, for those with lower levels of perceived emotional support, and/or for those with lower levels of spiritual well-being. The class exhibiting resilience to depressive symptoms had higher levels of perceived support and spiritual well-being as well as lower levels of perceived financial and occupational stress. A substantial percentage of clergy, and possibly people in similar helping occupations, may experience significant levels of depressive symptoms that do not remit over time. These individuals may benefit from treatments that address work-related coping.
Collapse
|
10
|
Jeuring HW, Stek ML, Huisman M, Oude Voshaar RC, Naarding P, Collard RM, van der Mast RC, Kok RM, Beekman ATF, Comijs HC. A Six-Year Prospective Study of the Prognosis and Predictors in Patients With Late-Life Depression. Am J Geriatr Psychiatry 2018; 26:985-997. [PMID: 29910018 DOI: 10.1016/j.jagp.2018.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/20/2018] [Accepted: 05/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the six-year prognosis of patients with late-life depression and to identify prognostic factors of an unfavorable course. DESIGN AND SETTING The Netherlands Study of Depression in Older Persons (NESDO) is a multisite naturalistic prospective cohort study with six-year follow-up. PARTICIPANTS Three hundred seventy-eight clinically depressed patients (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria) and 132 nondepressed comparisons were included at baseline between 2007 and 2010. MEASUREMENTS Depression was measured by the Inventory of Depressive Symptomatology at 6-month intervals and a diagnostic interview at 2- and 6-year follow-up. Multinomial regression and mixed model analyses were both used to identify depression-related clinical, health, and psychosocial prognostic factors of an unfavorable course. RESULTS Among depressed patients at baseline, 46.8% were lost to follow-up; 15.9% had an unfavorable course, i.e., chronic or recurrent; 24.6% had partial remission; and 12.7% had full remission at six-year follow-up. The relative risk of mortality in depressed patients was 2.5 (95% confidence interval 1.26-4.81) versus nondepressed comparisons. An unfavorable course of depression was associated with a younger age at depression onset; higher symptom severity of depression, pain, and neuroticism; and loneliness at baseline. Additionally, partial remission was associated with chronic diseases and loneliness at baseline when compared with full remission. CONCLUSIONS The long-term prognosis of late-life depression is poor with regard to mortality and course of depression. Chronic diseases, loneliness, and pain may be used as putative targets for optimizing prevention and treatment strategies for relapse and chronicity.
Collapse
Affiliation(s)
- Hans W Jeuring
- Department of Psychiatry, GGZ in Geest, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Max L Stek
- Department of Psychiatry, GGZ in Geest, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard C Oude Voshaar
- University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul Naarding
- GGNet, Department of Old Age Psychiatry, Apeldoorn, The Netherlands
| | - Rose M Collard
- Radboud University Medical Center, Department of Psychiatry, Nijmegen, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Rob M Kok
- Parnassia Psychiatric Institute, Hague, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, GGZ in Geest, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, GGZ in Geest, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S. Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry 2018; 18:156. [PMID: 29843662 PMCID: PMC5975705 DOI: 10.1186/s12888-018-1736-5] [Citation(s) in RCA: 596] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/11/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The adverse effects of loneliness and of poor perceived social support on physical health and mortality are established, but no systematic synthesis is available of their relationship with the outcomes of mental health problems over time. In this systematic review, we aim to examine the evidence on whether loneliness and closely related concepts predict poor outcomes among adults with mental health problems. METHODS We searched six databases and reference lists for longitudinal quantitative studies that examined the relationship between baseline measures of loneliness and poor perceived social support and outcomes at follow up. Thirty-four eligible papers were retrieved. Due to heterogeneity among included studies in clinical populations, predictor measures and outcomes, a narrative synthesis was conducted. RESULTS We found substantial evidence from prospective studies that people with depression who perceive their social support as poorer have worse outcomes in terms of symptoms, recovery and social functioning. Loneliness has been investigated much less than perceived social support, but there is some evidence that greater loneliness predicts poorer depression outcome. There is also some preliminary evidence of associations between perceived social support and outcomes in schizophrenia, bipolar disorder and anxiety disorders. CONCLUSIONS Loneliness and quality of social support in depression are potential targets for development and testing of interventions, while for other conditions further evidence is needed regarding relationships with outcomes.
Collapse
Affiliation(s)
- Jingyi Wang
- Division of Psychiatry – University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF England
| | - Farhana Mann
- Division of Psychiatry – University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF England
| | - Brynmor Lloyd-Evans
- Division of Psychiatry – University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF England
| | - Ruimin Ma
- Division of Psychiatry – University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF England
| | - Sonia Johnson
- Division of Psychiatry – University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF England
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE England
| |
Collapse
|
12
|
Correlation between Motor Cortex Excitability Changes and Cognitive Impairment in Vascular Depression: Pathophysiological Insights from a Longitudinal TMS Study. Neural Plast 2016. [PMID: 27525127 DOI: 10.1155/2016/8154969.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Transcranial magnetic stimulation (TMS) highlighted functional changes in dementia, whereas there are few data in patients with vascular cognitive impairment-no dementia (VCI-ND). Similarly, little is known about the neurophysiological impact of vascular depression (VD) on deterioration of cognitive functions. We test whether depression might affect not only cognition but also specific cortical circuits in subcortical vascular disease. Methods. Sixteen VCI-ND and 11 VD patients, age-matched with 15 controls, underwent a clinical-cognitive, neuroimaging, and TMS assessment. After approximately two years, all participants were prospectively reevaluated. Results. At baseline, a significant more pronounced intracortical facilitation (ICF) was found in VCI-ND patients. Reevaluation revealed an increase of the global excitability in both VCI-ND and VD subjects. At follow-up, the ICF of VCI-ND becomes similar to the other groups. Only VD patients showed cognitive deterioration. Conclusions. Unlike VD, the hyperfacilitation found at baseline in VCI-ND patients suggests enhanced glutamatergic neurotransmission that might contribute to the preservation of cognitive functioning. The hyperexcitability observed at follow-up in both groups of patients also indicates functional changes in glutamatergic neurotransmission. The mechanisms enhancing the risk of dementia in VD might be related either to subcortical vascular lesions or to the lack of compensatory functional cortical changes.
Collapse
|
13
|
Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
Collapse
Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| |
Collapse
|
14
|
Pennisi M, Lanza G, Cantone M, Ricceri R, Spampinato C, Pennisi G, Di Lazzaro V, Bella R. Correlation between Motor Cortex Excitability Changes and Cognitive Impairment in Vascular Depression: Pathophysiological Insights from a Longitudinal TMS Study. Neural Plast 2016; 2016:8154969. [PMID: 27525127 PMCID: PMC4971324 DOI: 10.1155/2016/8154969] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 05/30/2016] [Indexed: 02/07/2023] Open
Abstract
Background. Transcranial magnetic stimulation (TMS) highlighted functional changes in dementia, whereas there are few data in patients with vascular cognitive impairment-no dementia (VCI-ND). Similarly, little is known about the neurophysiological impact of vascular depression (VD) on deterioration of cognitive functions. We test whether depression might affect not only cognition but also specific cortical circuits in subcortical vascular disease. Methods. Sixteen VCI-ND and 11 VD patients, age-matched with 15 controls, underwent a clinical-cognitive, neuroimaging, and TMS assessment. After approximately two years, all participants were prospectively reevaluated. Results. At baseline, a significant more pronounced intracortical facilitation (ICF) was found in VCI-ND patients. Reevaluation revealed an increase of the global excitability in both VCI-ND and VD subjects. At follow-up, the ICF of VCI-ND becomes similar to the other groups. Only VD patients showed cognitive deterioration. Conclusions. Unlike VD, the hyperfacilitation found at baseline in VCI-ND patients suggests enhanced glutamatergic neurotransmission that might contribute to the preservation of cognitive functioning. The hyperexcitability observed at follow-up in both groups of patients also indicates functional changes in glutamatergic neurotransmission. The mechanisms enhancing the risk of dementia in VD might be related either to subcortical vascular lesions or to the lack of compensatory functional cortical changes.
Collapse
Affiliation(s)
- Manuela Pennisi
- 1Spinal Unit, Emergency Hospital “Cannizzaro”, 95126 Catania, Italy
| | - Giuseppe Lanza
- 2Department of Neurology I.C., “Oasi” Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), 94018 Troina, Italy
| | - Mariagiovanna Cantone
- 2Department of Neurology I.C., “Oasi” Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), 94018 Troina, Italy
| | - Riccardo Ricceri
- 3Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, 95125 Catania, Italy
| | - Concetto Spampinato
- 4Department of Electrical, Electronics and Informatics Engineering, University of Catania, 95125 Catania, Italy
| | - Giovanni Pennisi
- 5Department of Surgery and Medical-Surgical Specialties, University of Catania, 95125 Catania, Italy
| | - Vincenzo Di Lazzaro
- 6Department of Medicine, Unit of Neurology, Neurophysiology, Neurobiology, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Rita Bella
- 3Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, 95125 Catania, Italy
- *Rita Bella:
| |
Collapse
|