Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey

Self-Concept and Temporality in Institutionalized Elders

The current investigation examined the self-concept and temporality in institutionalized and non-institutionalized elderly. Sixty-two participants divided into two groups according to their place of residence participated in the study. The analysis focused on psychopathological scales, on self-concept assessment, its positive or negative valence, its development and the time perspective. The results showed that the institutionalized group was defined more with descriptive evaluations, emotional states, and peripheral information. The non-institutionalized group described themselves more with traits and specific attributes. For some identity statements, the emotional valence between the two groups was significantly different. The institutionalized group is not turned towards a particular temporal perspective, unlike the non-institutionalized who is more forward-looking. Findings suggest that there are differences in self-expression and temporality in our sample. This exploratory study emphasizes the importance of taking into account the self of institutionalized elderly and the temporality in which they are projected upon entering an institution.

The association between multiple sclerosis and early psychiatric background

BACKGROUND

The exact cause of Multiple Sclerosis (MS) is unclear. Since its definition in the late 19th century, researchers have repeatedly suggested a connection between the disease and mental state. Studies have shown that mental symptoms tend to precede the initiation of the disease by up to ten years. However, the hypothesis that psychiatric issues might precede MS onset by longer periods has not been empirically established. This study seeks to fill this research gap. The current matched cohort study investigated the possibility that psychiatric conditions may precede the initiation of multiple sclerosis by 15 years or more METHODS: A retrospective analysis utilizing the electronic database of Clalit Health Services (CHS), Israel's largest HMO, compared a group of 9,533 MS-diagnosed female and male individuals with 28,599 non-MS matched controls RESULTS: Logistic regression analysis revealed a significant association (p < 0.001) between MS diagnosis and prior psychiatric conditions, indicating a 93% increased likelihood of psychiatric history among those later diagnosed with MS compared with those who were not CONCLUSIONS: The heightened probability of mental health issues preceding the onset of MS by extended durations suggests a potential etiological role in the development of MS, rather than solely representing a component of the prodromal stage of the disease. Limitations include the retrospective design and the need for prospective studies to validate these associations.

Acute Exercise Improves Large-Scale Brain Network Segregation in Healthy Older Adults

Introduction: Age-related cognitive decline and mental health problems are accompanied by changes in resting-state functional connectivity (rsFC) indices, such as reduced brain network segregation. Meanwhile, exercise can improve cognition, mood, and neural network function in older adults. Studies on effects of exercise on rsFC outcomes in older adults have chiefly focused on changes after exercise training and suggest improved network segregation through enhanced within-network connectivity. However, effects of acute exercise on rsFC measures of neural network integrity in older adults, which presumably underlie changes observed after exercise training, have received less attention. In this study, we hypothesized that acute exercise in older adults would improve functional segregation of major cognition and affect-related brain networks. Methods: To test this, we analyzed rsFC data from 37 healthy and physically active older adults after they completed 30 min of moderate-to-vigorous intensity cycling and after they completed a seated rest control condition. Conditions were performed in a counterbalanced order across separate days in a within-subject crossover design. We considered large-scale brain networks associated with cognition and affect, including the frontoparietal network (FPN), salience network (SAL), default mode network (DMN), and affect-reward network (ARN). Results: We observed that after acute exercise, there was greater segregation between SAL and DMN, as well as greater segregation between SAL and ARN. Conclusion: These findings indicate that acute exercise in active older adults alters rsFC measures in key cognition and affect-related networks in a manner that opposes age-related dedifferentiation of neural networks that may be detrimental to cognition and mental health.

Symptom patterns of comorbid depression and anxiety among older adults in China and their predictors

Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross-sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10-item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7-item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual- and social-level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, "difficult to relax" is prominent in profiles high in anxiety. In addition to individual-level variables, social-level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.

Clinical Staging for Personality Disorders in Older Adults

OBJECTIVE

This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults.

METHODS/DESIGN

The study employed an international Delphi methodology with three rounds and involved 21 experts.

RESULTS

Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD.

CONCLUSION

The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.

Group schema therapy combined with psychomotor therapy for older adults with a personality disorder: an open-label, multicentre, randomised controlled trial

BACKGROUND

Although several types of psychotherapy effectively reduce psychological distress associated with personality disorders, randomised controlled trials (RCT) have systematically excluded older patients. We aimed to examine the effectiveness of group schema therapy combined with psychomotor therapy (GST + PMT) in later life compared with treatment as usual (TAU).

METHODS

We did an open-label, multicentre, RCT in eight outpatient clinics for geriatric psychiatry in the Netherlands. Adults aged 60 years or older with a full or subthreshold cluster B or C personality disorder according to DSM criteria were included and randomly assigned 1:1 to GST + PMT or TAU by an independent researcher applying a computer-generated sequence per study site when 8 to 16 patients had given informed consent; investigators and interviewers were kept blinded until end of follow-up. Included individuals received 20 weekly sessions of GST + PMT or TAU with 1 year of follow-up. The primary outcome was psychological distress, measured with the 53-item Brief Symptom Inventory. The trial was registered with International Clinical Trials Registry Platform, NTR6621.

FINDINGS

Of the 145 study participants recruited between Feb 21, 2018, and Jan 21, 2020, 102 patients (median age of 69 years [IQR 63-71], 62 [61%] female) who concluded therapy before the COVID-19 pandemic (cutoff March 20, 2020) were included in the intention-to-treat analysis (51 in each study group), because COVID-19 measures substantially disrupted delivery of group therapy. GST + PMT significantly improved psychological distress compared with TAU over the 6-month treatment period (Cohen's d 0·42, 95% CI 0·16 to 0·68; p=0·0016). The pre-post effect of GST + PMT remained stable during follow-up, whereas patients receiving TAU further improved, resulting in a non-significant difference between groups at 1 year (Cohen's d 0·21, 95% CI -0·07 to 0·48; p=0·14). No patients reported adverse events.

INTERPRETATION

Psychotherapy focused on personality disorders is effective in later life, resulting in a faster improvement in psychopathology than TAU. Future studies should focus on increasing effectiveness by intensifying or prolonging treatment.

FUNDING

Netherlands Organization for Health Research and Development.

TRANSLATION

For the Dutch translation of the abstract see Supplementary Materials section.

Development of a Needs Assessment for Low-income Seniors in Cleveland Ohio: A student-driven Interprofessional Approach

BACKGROUND AND OBJECTIVE

Older persons with low socioeconomic status in the United States have different and unique health needs compared to younger persons. As part of a student-led, interprofessional partnership, we performed a needs assessment of community dwelling older persons with low socioeconomic status in an urban location within Ohio, USA.

METHODS

Three entities participated in the needs assessment: a student-run health clinic, a Federally Qualified Health Center, and an apartment complex of the study population. Health professional students from medical, dental, nursing, social work, nutrition, and physician assistant programs led the needs assessment process. The process consisted of multiple phases, which included preliminary literature review, survey development, data collection, and analysis. The final survey was multidisciplinary, with six content areas covered in 37 items.

RESULTS

One hundred nineteen survey responses were received, and multiple areas of need were identified including food insecurity, dental care access, and mental health. 93% of participants had at least one unmet health need and 39% of respondents met our classification for high need. The needs of the local study population had key differences from previously published data in more generalized populations of older community-dwelling individuals in the United States, notably lower utilization of dental care (43% vs. 66%), increased prevalence of possible food insecurity (30% vs. 17%), and increased use of age-appropriate preventive cancer screening services.

CONCLUSIONS

Multiple areas of need were successfully identified through a student-led interprofessional needs assessment. Future student teams can address the identified needs, again through interprofessional collaborations. This process may have unique benefits to help build robust community-academic partnerships, while fostering interprofessional collaborative opportunities among healthcare students.

Posttraumatic stress disorder in people with dementia: study protocol

Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.

Can personality disorder be accurately assessed in older age? A differential item functioning analysis of ICD-11 inventories

OBJECTIVES

The contested categorical personality disorder (PD) criteria are not well suited to inform PD diagnoses in older adults. Yet, the classification of PDs is undergoing a critical transition phase with a paradigm shift to a dimensional approach for diagnosing PDs. No special attention was given to the expression of PDs in older age when the dimensional ICD-11 model was developed. Given that PDs are highly prevalent in older adults, there is an urgent need to examine if ICD-11 related instruments are able to adequately assess for PDs in older adults.

METHODS

The age-neutrality of ICD-11 measures was examined in a sample of 208 Dutch community-dwelling adults (N = 208, M age = 54.96, SD = 21.65), matched on sex into 104 younger (age range 18-64) and 104 older (age range 65-93) adults. An instrument is considered not to be age-neutral if a collective large level of differential item functioning (DIF) exists in a group of items of an instrument (i.e., 25% or more with DIF). We therefore set out to detect possible DIF in the following ICD-11 self-report measures: the Standardized Assessment of Severity of Personality Disorder (SASPD), the Personality Inventory for ICD-11 (PiCD), and the Borderline Pattern Scale (BPS).

RESULTS

DIF analyses using a non-parametric odds ratio approach demonstrated that SASPD, PiCD, and BPS were age-neutral with less than 25% of items showing DIF. Yet, impact of DIF at scale level, examined by way of differential test functioning (DTF), indicated a DTF effect on the SASPD total score.

CONCLUSIONS

These results of age-neutrality of the PiCD and BPS are promising for measuring ICD-11 traits and the borderline pattern. Yet, the age-neutral measurement of PD severity requires further research. With a rapidly aging population, its accurate assessment across the entire adult life span, including older age, is a prerequisite for an adequate detection of PDs.

Aging and Emotional Well-Being After Disasters: Vulnerability and Resilience

BACKGROUND AND OBJECTIVES

Climate change threatens well-being and has increased the prevalence of weather-related disasters. We investigated age differences in emotional well-being among adults who had experienced hurricane-related, unavoidable stressors. Socioemotional selectivity theory (SST) posits that age-related motivational shifts buffer older adults against psychological distress, whereas the strength and vulnerability integration model (SAVI) posits that unavoidable stressors are more detrimental to older adults' well-being compared to younger adults.

RESEARCH DESIGN AND METHODS

We used existing self-report data from a life-span sample of adults (N = 618, M age = 58.44 years, standard deviation = 16.03, 18-96 years) who resided in the U.S. Gulf Coast region. The sample was recruited in 2016 to examine the sequelae of the Deepwater Horizon oil spill and contacted again after the 2017 and 2018 hurricane seasons. In 2016, participants reported their depression, anxiety, and trauma history. After the 2017-2018 hurricane seasons, participants reported their depression, post-traumatic stress, exposure to hurricane-related adversities, injuries and casualties, self-efficacy, and perceived health.

RESULTS

In line with SST, older age was associated with reporting significantly fewer depression and post-traumatic stress disorder symptoms, even after controlling for exposure to hurricane-related adversities, injuries and casualties, health, self-efficacy, pre-hurricane depression, anxiety, and trauma. The association between older age and fewer depression symptoms was stronger among those who experienced hurricane-related adversities compared to those who had not, in contrast to predictions based on SAVI.

DISCUSSION AND IMPLICATIONS

We discuss the implications of age-related strengths in emotional well-being for policy and practice in the context of the ongoing climate crisis.

The dhikr and the mental health of the elderly in Aceh, Indonesia

Background

The ageing population in Indonesia is increasing. However, biological and social changes and declines may trigger mental health problems among the elderly. Existing data show that the prevalence of mental health problems (depression) among the elderly in Indonesia is above 15%.

Aim

This study aims to investigate the relationship between the Majelis Zikir (dhikr assembly) and the mental health of the elderly.

Setting

The research was conducted in Aceh Barat District, Aceh Province, Indonesia.

Methods

This study uses a retrospective cohort design. The study sample consists of individuals aged 60 years or older. The total sample size was 114 (57 exposed and 57 unexposed groups). The research instrument was in the form of a questionnaire.

Results

The respondents had an average age of 67.61 years, with more females (63.2%), more educated (67.5%), more unemployed (71.1%) and 61.4% felt that their income was sufficient. The analysis showed that the relative risk value of members of the dhikr assembly was 1.857 (95% CI: 1.266-2.724) and showed a significant relationship between the dhikr assembly and mental health.

Conclusion

Dhikr, as one of the forms of religious activities in Islam, has a positive role in older people's mental health. Elderly members of the dhikr assembly are likelier to achieve better mental health.

Contribution

The findings in this study can assist healthcare professionals and policymakers in their efforts to maintain and improve the mental health of the elderly through dhikr.

Personality disorders in older adults: Differences in self-informant ratings

Previous research on self-informant reports in assessing personality disorders (PDs) has been mainly focused on adults, leaving older adults under-studied. We examined self-informant agreement in PD screening among older adults (≥60 years) using the Gerontological Personality disorders Scale (GPS). Potential differences such as who reports more personality pathology on a PD screener (i.e., GPS), item accessibility and the effect of relational aspects were studied as well. Data of 326 older adult-informant dyads, of which the older adults were sampled from five general practices in the Netherlands, were used. Results indicate that self-informant agreement ranged from r = 0.26-0.73, with lower concordance on the GPS-subscale measuring intrapersonal aspects of personality pathology. Informants were more sensitive to habitual pathological personality features than older adults. Two GPS items showed differential item functioning across self- and informant-report. Of relational aspects, only congeniality affected the GPS-iv scores; lower ratings on congeniality were associated with higher GPS-iv scores (i.e., higher reporting of personality problems).

Resilience of racial and ethnic minority older adults during the COVID-19 pandemic: The role of a prior disability prevention intervention

Older adults from racially and ethnically diverse backgrounds and with preexisting mental illness have been disproportionately vulnerable to severe illness, disability, and death due to the adverse impacts of the COVID-19 pandemic. This study used a sample of older adults (60 +; N = 307) from a randomized clinical trial (Positive Minds-Strong Bodies [PMSB]) conducted between May 25, 2015, and March 5, 2019. Participants were recontacted to assess symptoms of anxiety, depression, general distress, and physical functioning during the COVID-19 pandemic between March 2, 2021, and July 18, 2022 (62.7% recontacting rate excluding ineligible participants; N = 165). We estimated an analysis of covariance model to evaluate whether or not prior differences between the PMSB intervention and enhanced usual care (EUC) groups continued to be observed at the COVID-19 follow-up. Results showed that, compared to EUC, participants who received the PMSB intervention reported fewer depression symptoms (Geriatric Depression Scale-15 scores) and greater physical functioning (Late-Life Functioning and Disability Instrument scores) at the COVID-19 follow-up. No significant differences were observed between the PMSB intervention and EUC groups on anxiety symptoms (Generalized Anxiety Disorder-7 scores) during the pandemic. Last, findings suggested that the lower depression symptoms and greater physical functioning observed after treatment completion were sustained, though not further improved, over time. These findings provide evidence that the PMSB intervention is a powerful intervention to promote resilience and prevent disability associated with major life stressors, such as the COVID-19 pandemic. Future research is needed to examine the underlying mechanisms of psychosocial and exercise training interventions that lead to lasting resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Frailty and Other Factors Associated With Early Outcomes in Middle-to Older Age Trauma Patients: A Prospective Cohort Study

OBJECTIVES

To prospectively investigate associations of frailty and other predictor variables with functional recovery and health outcomes in middle-aged and older patients with trauma.

DESIGN

Single-center prospective cohort study.

SETTING

Emergency department of Wan Fang Hospital in Taiwan.

PARTICIPANTS

Trauma patients aged 45 and older.

MEASUREMENTS

Frailty was assessed with the Clinical Frailty Scale (CFS). Injury mechanisms, pre-existing diseases, and fracture locations were recorded at baseline. The primary outcome was functional recovery assessed using the Barthel Index (BI). Secondary outcomes were new care needs, unscheduled return visits, and falls 3 months postinjury.

RESULTS

A total of 588 participants were included in the final analysis. For every one-point increase in the CFS, the multivariable-adjusted odds ratio (OR, 95% confidence interval [CI]) of failure to retain the preinjury BI was 1.34 (1.16-1.55); associations were consistent across levels of age and injury severities. Significant joint associations of frailty and age with poor functional recovery were observed. CFS was also associated with new care needs (OR for every one-point increase, 1.36, 95% CI, 1.17-1.58), unscheduled return visits (OR 1.26, 95% CI, 1.04-1.51), and falls (OR 1.23, 95% CI, 1.01-1.51). Other variables associated with failure to retain preinjury BI included road traffic accident and presence of hip fracture.

CONCLUSION

Frailty was significantly associated with poor functional and health outcomes regardless of injury severity in middle-aged and older patients with trauma. Injury mechanisms and fracture locations were also significant predictors of functional recovery postinjury.

Electrophysiological signatures of anxiety in Parkinson's disease

Anxiety is a common non-motor symptom in Parkinson's disease (PD) occurring in up to 31% of the patients and affecting their quality of life. Despite the high prevalence, anxiety symptoms in PD are often underdiagnosed and, therefore, undertreated. To date, functional and structural neuroimaging studies have contributed to our understanding of the motor and cognitive symptomatology of PD. Yet, the underlying pathophysiology of anxiety symptoms in PD remains largely unknown and studies on their neural correlates are missing. Here, we used resting-state electroencephalography (RS-EEG) of 68 non-demented PD patients with or without clinically-defined anxiety and 25 healthy controls (HC) to assess spectral and functional connectivity fingerprints characterizing the PD-related anxiety. When comparing the brain activity of the PD anxious group (PD-A, N = 18) to both PD non-anxious (PD-NA, N = 50) and HC groups (N = 25) at baseline, our results showed increased fronto-parietal delta power and decreased frontal beta power depicting the PD-A group. Results also revealed hyper-connectivity networks predominating in delta, theta and gamma bands against prominent hypo-connectivity networks in alpha and beta bands as network signatures of anxiety in PD where the frontal, temporal, limbic and insular lobes exhibited the majority of significant connections. Moreover, the revealed EEG-based electrophysiological signatures were strongly associated with the clinical scores of anxiety and followed their progression trend over the course of the disease. We believe that the identification of the electrophysiological correlates of anxiety in PD using EEG is conducive toward more accurate prognosis and can ultimately support personalized psychiatric follow-up and the development of new therapeutic strategies.

Aging Makes the Heart Grow Fonder: Age Influences Hearing Ability and Interactions between Psychological Phenomena in Patients with Chronic Tinnitus

(1) Background: Risk factors for chronic tinnitus comprise interactions of individuals' hearing difficulties and psychological distress-including anxiety, depression, and perceived stress levels. Both groups of factors likely become more pronounced with age, although mixed literature has also suggested increases in psychological resilience over time. To this end, only a few studies have delineated direct and indirect effects of age on audiological and psychological variables that might influence tinnitus-related distress in patients with chronic tinnitus. (2) Methods: N = 678 patients with chronic tinnitus completed audiological assessments alongside self-report measures of psychological and tinnitus-related distress. Path analyses investigated the effect of age on patients' tinnitus-related distress via both audiological and psychological variables. (3) Results: Age was significantly associated with both hearing ability and psychological distress indices, with perceived stress and anxiety decreasing with aging. Different mediation models revealed that the association between age and tinnitus-related distress was mediated completely by hearing ability and partly by perceived stress and anxiety. (4) Conclusions: Whilst interactions of individuals' hearing ability and psychological distress levels maintain tinnitus-related distress across the age span, the weighting of these factors may shift with age. Treatment approaches should consider hearing ability across the lifespan. Psychological factors should be individually conceptualized, considering both distress-related and potential resilience factors in old age.

Multilayer perceptron modeling for social dysfunction prediction based on general health factors in an Iranian women sample

In the year 2022, this research conducted an in-person study involving 780 single or widowed women, aged between 20 and 70, falling within the bottom three economic deciles and possessing varying levels of education. All participants held educational qualifications below a high school diploma and were beneficiaries of charitable financial support in Khorasan province, Iran. The study aimed to investigate the predictive factors of social dysfunction in this specific demographic. Data collection spanned a 12-month period throughout 2022, with participants completing the GHQ-28 questionnaire during their visits to the charity office. Clinical in-person interviews were also conducted to gather comprehensive data. Data analysis was carried out using IBM SPSS version 27. The research employed a Multilayer Perceptron (MLP) neural network model, considering an extensive set of input factors and covariates. These factors included cognitive functioning, anxiety, depression, age, and education levels. The MLP model exhibited robust performance, achieving high overall accuracy and sensitivity in identifying cases of high social dysfunction. The findings emphasized the significance of cognitive functioning, anxiety, and depression as pivotal predictors of social dysfunction within this specific demographic, while education and age displayed relatively lower importance. The normalized importance scores provided a relative measure of each covariate's impact on the model's predictions. These results furnish valuable insights for the development of targeted interventions and evidence-based policies aimed at addressing social dysfunction and promoting societal well-being among economically disadvantaged, single or widowed women. Notably, the research underscores the potential of MLP modeling in social science research and suggests avenues for further research and refinement to enhance the model's predictive accuracy, particularly for cases of low social dysfunction.

Assessment of Personality Disorders in Older Adults. A Practice Guide

Assessment of personality disorders (PDs) in older adults is a nuanced trade of its own. The aim of this practice guide is to illustrate gerontological assessment challenges using 3 case vignettes. We argue that it is important to pay extra attention to the influence of cognitive and medical (somatic) disorders on personality functioning in older adults during personality assessment. We also note that information provided by informants contributes added value to personality assessment. Personality assessment should be sufficiently age-specific to prevent overdiagnosis or underdiagnosis in older adults. Furthermore, given the reduced psychological or somatic capacity of some older adults, phased or sequential personality assessment is recommended. This should be focused on the assessment questions to be answered, for example starting with short general screening of personality functioning, followed by more in-depth exploration. Personality assessment should be kept as brief and simple as possible in terms of formulation of the items.

Emotional processing and positive affect after acute exercise in healthy older adults

The well-elucidated improvement of mood immediately after exercise in older adults presumably involves adaptations in emotion-processing brain networks. However, little is known about effects of acute exercise on appetitive and aversive emotion-related network recruitment in older adults. The purpose of this study was to determine the effect of acute exercise, compared to a seated rest control condition, on pleasant and unpleasant emotion-related regional activation in healthy older adults. Functional MRI data were acquired from 32 active older adults during blocked presentations of pleasant, neutral and unpleasant images from the International Affective Pictures System. fMRI data were collected after participants completed 30 min of moderate to vigorous intensity cycling or seated rest, performed in a counterbalanced order across separate days in a within-subject design. The findings suggest three ways that emotional processing in the brain may be different immediately after exercise (relative to immediately after rest): First, reduced demands on emotional regulation during pleasant emotional processing as indicated by lower precuneus activation for pleasant stimuli; second, reduced processing of negative emotional stimuli in visual association areas as indicated by lower activation for unpleasant stimuli in the bilateral fusiform and ITG; third, an increased recruitment in activation associated with regulating/inhibiting unpleasant emotional processing in the bilateral medial superior frontal gyrus (dorsomedial prefrontal cortex), angular gyri, supramarginal gyri, left cerebellar crus I/II and a portion of right dorsolateral prefrontal cortex. Overall, these findings support that acute exercise in active older adults alters activation in key emotional processing and regulating brain regions.

Pre-pandemic mental health and coping strategy usage during the COVID-19 pandemic: a cross-sectional analysis of the Southern Cities Study

BACKGROUND

Little is known about the usage of coping strategies recommended by the World Health Organization and the Centers for Disease Control and Prevention during the COVID-19 pandemic and whether coping strategy usage varies by pre-pandemic mental health. This study examined the prevalence of different coping strategies and associations of their usage with pre-pandemic mental health.

METHODS

Data were collected from adults residing in metropolitan areas of the U.S. South in May/June 2020 using random-digit-dialing and web-based surveys (n = 1,644). We estimated the prevalence of each coping strategy: (1) keeping up-to-date about COVID-19; (2) taking breaks from the news or social media; (3) taking care of physical health; (4) engaging in relaxing activities; (5) reaching out to and spending time with others; and (6) trying to find comfort in religious or spiritual beliefs. We examined the association between the use of each strategy and pre-pandemic mental health using modified Poisson regression, adjusting for covariates. We also analyzed the association between pre-pandemic mental health and the number of coping strategies employed using ordered logistic regression.

RESULTS

The most prevalent strategies were: "keeping up-to-date about COVID-19" (53%), "taking care of physical health" (52%), and "reaching out to and spending time with others" (52%). Good pre-pandemic mental health was associated with an increased prevalence of "reaching out to and spending time with others" (adjusted prevalence ratio, 1.43; 95% confidence interval, 1.07-1.91). The use of other coping strategies and the number of coping strategies used during the pandemic did not vary by pre-pandemic mental health.

CONCLUSIONS

Our findings suggest that people who had good pre-pandemic mental health were more likely to connect with other people during the COVID-19 pandemic. Given the well-documented impact of social support on mental health in disaster contexts, efforts to promote safe social connections for those with pre-existing mental health concerns are needed.

Sleep quality is a predictor of muscle mass, strength, quality of life, anxiety and depression in older adults with obesity

We aimed to investigate associations between sleep quality with selected quantitative and qualitative parameters of health in older individuals with obesity. Cross-sectional assessment (n = 95 men/women; ≥ 65 years; BMI ≥ 30 kg/m²) of sleep quality, body composition, handgrip strength, quality-of-life, anxiety/depression. Mean PSQI score was 6.3. Poor sleepers (n = 49) presented lower appendicular lean mass (ALM) (16.2 vs 17.8 kg; p = 0.0273), ALM/BMI (0.47 vs 0.53 kg/BMI; p = 0.0085), fat mass (48.6 vs 46.6%; p = 0.0464), handgrip strength (19.7 vs 22.0 kgf; p = 0.0542) and handgrip/BMI (0.57 vs 0.66 kgf/BMI; p = 0.0242) than good sleepers. They also had higher anxiety (8.6 vs 5.6; p = 0.0100) and depression (4.8 vs 3.2; p = 0.0197) scores, worse health-related quality-of-life and lower scores in mental (62.8 vs 73.0; p = 0.0223) and physical (52.9 vs 67.3; p = 0.0015) domains. Adjusted models showed that PSQI was negatively associated with ALM (β = - 0.13, 95% CI - 0.25; - 0.01) and health-related quality of life on physical (β = - 2.76, 95% CI - 3.82; - 1.70) and mental (β = - 2.25, 95% CI - 3.38; - 1.12) domains, and positively associated with anxiety (β = 0.57; 95% CI 0.26; 0.87) and depression (β = 0.31; 95% CI 0.13; 0.49). Poor sleep quality associates with impaired selected quantitative and qualitative parameters of health. Additionally, sleep quality was shown as an independent predictor of ALM, health-related quality-of-life, anxiety and depression in older individuals with obesity.

Substance Use Disorders in Older Adults

Although substance misuse (primarily alcohol and prescribed benzodiazepines and opioids) among Americans aged ≥60 years is becoming an escalating health concern, substance use disorder (SUD) is often underestimated and/or undiagnosed, preventing older adults from receiving needed treatment. Chronic medical conditions, mental health issues, and psychosocial stressors increase older adults' risks for developing SUD. Racial/ethnic minority groups (e.g., American Indian, Alaska Native) experiencing health care inequities and limited resources are more vulnerable to developing SUD. It is recommended that SUD screening be included in annual check-ups using tools adapted to older adults. Clinicians should consider older adults' comorbidities to differentiate symptoms of substance use from neurocognitive disorders, depression, anxiety, and metabolic disorders. To ensure successful outcomes, interventions must be tailored to the specific needs of older adults. Building on the current federal government administration's support, SUD practice guidelines should be updated with older adults in mind. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 15-19.].

Prevalence and trends of common mental disorders from 2007-2009 to 2019-2022: results from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs. during the COVID-19 pandemic

Up-to-date information on the prevalence and trends of common mental disorders is relevant to health care policy and planning, owing to the high burden associated with these disorders. In the first wave of the third Netherlands Mental Health Survey and Incidence Study (NEMESIS-3), a nationally representative sample was interviewed face-to-face from November 2019 to March 2022 (6,194 subjects; 1,576 interviewed before and 4,618 during the COVID-19 pandemic; age range: 18-75 years). A slightly modified version of the Composite International Diagnostic Interview 3.0 was used to assess DSM-IV and DSM-5 diagnoses. Trends in 12-month prevalence rates of DSM-IV mental disorders were examined by comparing these rates between NEMESIS-3 and NEMESIS-2 (6,646 subjects; age range: 18-64 years; interviewed from November 2007 to July 2009). Lifetime DSM-5 prevalence estimates in NEMESIS-3 were 28.6% for anxiety disorders, 27.6% for mood disorders, 16.7% for substance use disorders, and 3.6% for attention-deficit/hyperactivity disorder. Over the last 12 months, prevalence rates were 15.2%, 9.8%, 7.1%, and 3.2%, respectively. No differences in 12-month prevalence rates before vs. during the COVID-19 pandemic were found (26.7% pre-pandemic vs. 25.7% during the pandemic), even after controlling for differences in socio-demographic characteristics of the respondents interviewed in these two periods. This was the case for all four disorder categories. From 2007-2009 to 2019-2022, the 12-month prevalence rate of any DSM-IV disorder significantly increased from 17.4% to 26.1%. A stronger increase in prevalence was found for students, younger adults (18-34 years) and city dwellers. These data suggest that the prevalence of mental disorders has increased in the past decade, but this is not explained by the COVID-19 pandemic. The already high mental disorder risk of young adults has particularly further increased in recent years.

The role of physical and cognitive/emotional functioning in the associations between common health conditions and working

The degree to which functional abilities explain the negative associations between chronic disease and employment is not well understood. If functional limitations play an important role, then increasing access to accommodations and rehabilitation could facilitate employment among people with chronic illness. If not, other barriers related to living with chronic illness may be at play, calling for other interventions. The goal of this study was to 1) assess how health conditions were associated with employment for adults ages 30-69, and 2) test how much of these illness-employment associations was explained by physical and cognitive/emotional functioning. We fielded the state-of-the-art Work Disability Functional Assessment Battery (WD-FAB) in the nationally-representative RAND American Life Panel (N = 1774) in 2020, stratifying the sample by age and educational attainment. We found that mental health conditions, nervous system/sensory conditions, and cardiovascular conditions were significantly associated with large reductions in the probability of working, at -8, -10, and -19 percentage points (pp) respectively, while there were no significant associations for other conditions. Functional abilities were positively associated with employment to different degrees depending on education. Among those without college degrees, physical functioning (+16 pp) but not cognitive/emotional functioning was significantly associated with working. Among those with college degrees, both physical (+6 pp) and cognitive/emotional (+4 pp) functioning were associated with working. Older workers (ages 51-69) showed a larger association between physical functioning and work with no association between cognitive/emotional functioning and work. Importantly, accounting for functioning reduced the negative associations with employment for mental health and nervous system/sensory conditions but not for cardiovascular conditions. This implies that, for the former conditions, accommodating functional limitations could promote greater employment. However, broader accommodations, such as paid sick leave, increased control over work schedules, and other improvements to working conditions may be necessary to reduce work exits due to cardiovascular conditions.

Prevalence of psychiatric disorders in the aging population in the northeastern of Iran

Background

The prevalence of psychiatric disorders by demographic characteristics in elderly people is poorly understood, at least in the northwest of Iran. We aimed to estimate the prevalence of various psychiatric disorders in the elderly population in East Azerbaijan Province, Tabriz. A total of 1000 aging people were randomly selected from the general population. Data were collected using valid structured instruments and face-to-face interviews by trained psychologists. The Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Abbreviated Mental Test Questionnaire were used. Chi-square (χ2) test was used for categorized variables, and an independent T-test was carried out for quantitative variables.

Results

Overall, 38.5% of the elderly had at least one mental disorder (47.2% women, 27.3% men). The prevalence of major depressive disorder (MDD) and any anxiety disorders was 16.6% (22.4% female and 9.3% male) and 16.7% (23.1% female and 8.6% male), respectively. Likewise, the overall prevalence of any depressive symptoms, post-traumatic stress disorder (PTSD), general anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and panic disorders were 21.6%, 7%, 5.3%, and 5.9%, respectively. The prevalence of any mental disorder in the first, second, and third quartiles of the socio-economic level was 54.3%, 37%, and 17.8%, respectively. The prevalence of any mental disorders among the marginalized and the non-marginalized population is 55.3 and 31.5%, respectively.

Conclusions

We found 38.5% (47.2% women, 27.3% men) of the elderly people had any mental disorders, and 21.6% of them had any depressive disorders. The prevalence of mental disorders in elders was almost like adults and middle-aged people in this study. However, the prevalence of mental disorders was higher than in marginalized population and low socio-economic status.

Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment

OBJECTIVE

Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes.

METHOD

Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results.

RESULTS

We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments.

CONCLUSION

This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.

The Need for a Diagnostic Instrument to Assess Post-Traumatic Stress Disorder in People with Dementia: Findings from a Delphi Study

Cognitive and behavioral aspects may mask posttraumatic stress disorder (PTSD) in people with dementia. PTSD severely lowers quality of life in people with dementia. Proper recognition of PTSD is essential to ensure adequate treatment. However, a valid diagnostic tool for PTSD in dementia is lacking. A Delphi study was conducted among 20 Dutch and 6 international experts in the field of PTSD and dementia care or research. The aim was to reach consensus in 3 rounds on the added value, form, content, and application for developing such an instrument. The first round confirmed the need for a new diagnostic tool for research and clinical practice. Consensus was reached on 23 statements regarding the support base and 19 related to content of the instrument. In the third round, opinions on several conceptual problems were gathered. Based on the experts' opinions, a draft version of an instrument, the TRAuma and DEmentia-interview (TRADE-interview), was developed. Clinical and research implications of this new measure are discussed.

Age Matters: The Moderating Effect of Age on Styles and Strategies of Coping with Stress and Self-Esteem in Patients with Neoplastic Prostate Hyperplasia

The aim of this study was to analyze coping mechanisms and their psychological aspects during the treatment of neoplastic prostate hyperplasia. We have analyzed strategies and styles of coping with stress and self-esteem of patients diagnosed with neoplastic prostate hyperplasia. A total of 126 patients were included in the study. Standardized psychological questionnaires were used to determine the type of coping strategy by using the Stress Coping Inventory MINI-COPE, while a coping style questionnaire was used to assess the type of coping style by using the Convergence Insufficiency Symptom Survey (CISS). The SES Self-Assessment Scale was used to measure the level of self-esteem. Patients using adaptive strategies of coping with stress in the form of active coping, seeking support and planning had higher self-esteem. However, the use of maladaptive coping strategies in the form of self-blame was found to cause a significant decrease in patients' self-esteem. The study has also shown the choice of a task-based coping style to positively influence one's self-esteem. An analysis related to patients' age and coping methods revealed younger patients, up to 65 years of age, using adaptive strategies of coping with stress to have a higher level of self-esteem than older patients using similar strategies. The results of this study show that older patients, despite the use of adaptation strategies, have lower self-esteem. This group of patients should receive special care both from family and medical staff. The obtained results support the implementation of holistic care for patients, using psychological interventions to improve patients' quality of life. Early psychological consultation and mobilization of patients' personal resources may allow patients to change stress coping methods towards more adaptive forms.

Age-Dependent Differences in Frequent Mental Distress (FMD) of US Older Adults Living in Multigenerational Families versus Living Alone

Frequent mental distress (FMD) is prevalent among older Americans, but less is known about disparities in FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared FMD (≥14 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (≥65 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, findings indicate 23% lower odds of FMD among older adults living in multigenerational households compared to counterparts living alone (adjusted odds ratio (AOR): 0.77; 95% confidence interval (CI): 0.60, 0.99). Findings also show that the reduction in the odds of FMD with each 5 year increase in age was larger among older adults living in multigenerational families by 18% (AOR: 0.56; 95% CI: 0.46, 0.70) compared to older adults living alone (AOR: 0.74; 95% CI: 0.71, 0.77), and this difference was significant at the 5% significance level. Multigenerational living may have a protective association with FMD among older adults. Further research is needed to identify multigenerational family and non-kin factors that translate into mental health advantages for older adults.

The effect of web-based Hatha yoga on psychological distress and sleep quality in older adults: A randomized controlled trial

BACKGROUND

To date, there has been very limited experimental research on the impact of Yoga on older adults' mental health during the COVID-19 crisis. We aimed to explore the effect of a web-based Hatha yoga program on psychological and quality of sleep in older adults who self-isolated at home during the initial stage of the COVID-19 outbreak.

METHODS

Two hundred volunteers of both sexes were split into experimental (Yoga group, YG) and control (Control group, CG) groups, in a web-based randomized controlled study. All participants were administered the Depression, Anxiety and Stress Scales (DASS-21) and the Pittsburgh sleep quality index (PSQI); at baseline and following an eight-week online Hatha yoga intervention.

RESULTS

The YG showed significant reductions in depression (-56.1%; Z = 5.67, p < 0.01, r = 0.70) anxiety (-64.3%; Z = 5.27, p < 0.01, r = 0.65) and stress (-68.2%; Z = 5.86, r = 0.73) scores, while the CG showed a significant increase in depression. In addition, the total PSQI score of the YG was considerably lower during follow-up (3.38 ± 2.02, p < 0.05) than at baseline (4.8 ± 32, p < 0.05), which indicates an improvement of the quality of sleep. The proportion of individuals experiencing good sleep from the YG increased from 63% to 85% after the Hatha yoga intervention.

CONCLUSION

The use of a web-based Hatha Yoga intervention program was associated with a beneficial effect on the mental health and quality of sleep in older adults.

Psychiatric Morbidity Among Older Hospitalized Patients

Background

Globally, life expectancy is increasing, leading to an equal proportion of elderly and young individuals, which carries extensive implications. In Bosnia and Herzegovina (BiH), the average age at death in 2021 was 77 years, positioning BiH in the middle of the global list of average life expectancy. Current studiesinvestigate whether the prevalence of psychiatric disorders increases or decreases with age, but results are inconsistent regarding the role of age.There is no prior research on mental disorders in the elderly population in BiH. The experience of the previous war in BiH and the post-war complex "transitional period" have been associated with specific challenges to the mental health of this population, inspiring our research topic.

Objective

The aim of this study was to investigate the psychiatric morbidity in hospitalized individuals aged≥55 years.

Methods

The sample consisted of all patients over age 55 treated at the Department of Psychiatry in Tuzla between January 2018 and December 2020 (N=637), divided into four age categories. Data were obtained from medical records, and for research purposes, a specific questionnaire was constructed.

Results

The predominant psychiatric morbidity stemmed from the category of affective disorders, most common within the "55-64 years" age group, while organic mental disorders were more prevalent in other age groups.Substance use disorders were present in patients aged "55-64 years", with a sharp decline in their prevalence in older age. Female participants had a significantly higher prevalence of affective, psychotic, neurotic, and stress-related disorders, whereas male participants exhibited an increased prevalence of organic mental and substance use disorders.

Conclusion

In total sample, the most prevalent diagnoses belong to the category of affective disorders. Female were most frequently diagnosed with affective disorders, whereas organic mental disorders and substance use disorders prevail in male.

Coverage Parity And Racial And Ethnic Disparities In Mental Health And Substance Use Care Among Medicare Beneficiaries

Many older Americans do not receive needed care for mental health and substance use disorders (MHSUD), and there are substantial racial and ethnic disparities in receipt of this care across the lifespan. Medicare introduced cost-sharing parity for outpatient MHSUD care during the period 2010-14, reducing beneficiaries' out-of-pocket share of MHSUD spending from 50 percent to 20 percent. Among traditional Medicare beneficiaries ages sixty-five and older, we examined changes in MHSUD use and spending during the period 2008-18 for low-income beneficiaries with the cost-sharing reduction versus a control group of beneficiaries with free care throughout the study period among Black, Hispanic, Asian, and American Indian/Alaska Native versus White beneficiaries. Among older Medicare beneficiaries, overall use of MHSUD services increased during this period. For White beneficiaries, MHSUD cost-sharing parity was associated with an increased likelihood of having specialty MHSUD visits and medication use and a reduced likelihood of having unmonitored MHSUD medication use and MHSUD emergency department visits and hospitalizations. However, cost-sharing parity was associated with smaller or no gains in MHSUD services use for racial and ethnic minority beneficiaries compared with White beneficiaries, thus widening racial and ethnic disparities in MHSUD care.

The epidemiology and clinical features of personality disorders in later life; a study of secondary care data

OBJECTIVES

Personality disorders (PDs) are often conceptualised as impacting individuals throughout their life. However, there has been limited study of the disorders in those over the age of 65. We have used the psychiatric secondary care medical records of 21,971 individuals over the age of 65 from Cambridgeshire, UK, who received care between 2014 and 2021 to characterise older patients with a PD diagnosis.

METHODS

The data from all patients >65 with a diagnosis of personality disorder (PD) was extracted (n = 217) along with two comparison groups (n = 2170); patients <65 with a diagnosis of PD and patients >65 with a psychiatric diagnosis other than PD or dementia.

RESULTS

Compared to younger patients with PD, older patients were more likely to be male, married, suffering from a mixed PD and live in less deprived areas. Compared to patients >65 with diagnoses other than PD, older patients were more likely to be female, single or divorced and had a higher level of social deprivation. Our most striking finding was that older patients with PDs were more likely to experience polypharmacy. A mean of 18.48 different drugs had been prescribed over their lifetime, compared to 9.51 for patients >65 with other mental health diagnoses.

CONCLUSION

Here we present the largest ever description of this group of patients and provide insights that could inform clinical practice and future research.

SEROPREVALENCE OF HBsAg, Anti-HBs, Anti-HCV, and Anti-HIV IN PATIENTS WITH ALCOHOL AND SUBSTANCE ABUSE IN AN AMATEM CLINIC IN EASTERN TURKIYE: A SIX-YEAR RETROSPECTIVE EVALUATION

Aim Substance abuse and concomitant infections are important causes of morbidity and mortality. Yet, the number of epidemiological studies regarding infectious diseases in people with substance abuse are limited in our country. In this study, the aim was to investigate the frequency of illegal alcohol and substance use in an Alcohol and Drug Research, Treatment and Training Centres (AMATEM) clinic in Turkey as well as the HBsAg, anti-HBs, anti-HCV, and anti-HIV parameters between the years of 2016-2021. Material and Method HBsAg, anti-HBs, anti-HCV, and anti-HIV tests were conducted using the ELISA technique in 6881 alcohol and substance use disorder (ASUD). Urine samples from ASUD’s were analyzed for alcohol, cannabis, and cocaine metabolites. The results were evaluated retrospectively. Results All of the 6881 ASUD’s were male with a mean age of 32.18±9.66 years. Of the 6881 ASUD’s included in the study, 4107 (59.7%) were opioid addicts; 1479 (21.5%) were mixed drug addicts; 897 (13%) were alcohol addicts; and the rest were addicts with other types of substance use. The mean age of the alcohol users was 45.33±13.03 and the mean age of opioid users was 29.90±7.13. The percentage of opioid addiction in 2016 was 71.2% which dropped to 28.7% in 2021. Meanwhile, the percentage of alcohol addiction was 13.6% in 2016 and increased to 21.4% in 2021; and the percentage of mixed drug use was 8.7% in 2016 and increased to 36.8% in 2021. HBsAg-positivity in opioid users (56.7%) was higher compared to cannabis users (2.6%) and mixed drug users (22.3%). Anti-HCV positivity of opioid users (69.4%) was found to be higher compared to alcohol (9.4%), cannabis (2%), and mixed drug (16.2%) users, and this finding was statistically significant (p=0.0001). Anti-HBs positivity of opioid users (63.1%) was found to be higher compared to alcohol (9.9%), cannabis (3%), and mixed drug (21%) users, and this finding was statistically significant (p=0.0001). Anti-HIV was determined negative in all ASUD’s. The highest rates of HBsAg, anti-HCV and anti-HBs positivity were found in the 26-30 years of age. Conclusion These findings indicate a high prevalence of intravenous substance abuse in the 26-30 years age group in our region as well as the high HBV and HCV rates in this patient group.

The effects of mindfulness meditation versus CBT for anxiety on emotional distress and attitudes toward seeking mental health treatment: a semi-randomized trial

Older adults often avoid seeking psychological treatment, thus challenging their ability to cope effectively with anxiety, stress, and depression. The current study aimed to compare the effects of a mindfulness intervention with cognitive behavioral therapy (CBT) on measures of emotional distress and attitudes toward seeking mental health treatment among older adults. Twenty-four seniors were assigned to three groups: (1) Mindfulness-based intervention for seniors (MBIS), (2) CBT for anxiety, or (3) a care-as-usual control group. Participants in the two intervention groups of eight weekly sessions were randomly assigned. Results showed that attitudes toward seeking psychological treatment and depression, anxiety, and worry levels were evaluated before and after the interventions. Following both interventions, participants considered the prospect of utilizing psychological treatment more positively, whereas no changes were observed in the control group. Interestingly, worry levels were eased only in the MBIS group, and anxiety levels were eased only in the CBT group. Our findings support the understanding that cognitive group interventions can effectively achieve their intended aim (decreasing worry or anxiety) and positively impact attitudes toward psychological treatment.Trial registration: clinicaltrials, NCT04165005, 15/11/19.

Risk Factors for Substance Use across the Lifespan

Substance use is a perennial public health concern with associated health risks and economic impacts on society. In this article, we present a selective review of the epidemiological and clinical literatures on alcohol and substance use from a lifespan developmental perspective. We compare and contrast risk factors for the initiation of use and the development of a substance use disorder in adolescence, young adulthood, middle-age and later life. During adolescence, alcohol use experimentation is at its peak. Specific risk factors have been identified including trauma and parenting style that can increase the risk of substance use for teenagers. Emerging adults and college students are likely to experiment with other substances in addition to alcohol such as nicotine, marijuana, cocaine, and prescription medication such as Adderall. Middle-age and older adults with alcohol and substance use in their developmental histories may have an undiagnosed alcohol use disorder. Others will develop a late-onset substance use disorder in older age, possibly due to a dearth of social support, coping with bereavement, and medical complication. Based on Social Cognitive Theory, the roles of expectancies and self-efficacy are hypothesized to impact substance use and the risk of substance use disorder across the lifespan. Implications of the present review for future research on age-specific risk factors in alcohol use in relation to underlying developmental processes are considered.

The dose-effect relationships of cigarette and alcohol consumption with depressive symptoms: a multiple-center, cross-sectional study in 5965 Chinese middle-aged and elderly men

BACKGROUND

Although association of depressive symptoms with cigarette or alcohol is well documented, the dose-response relationship between them is rarely studied. This study aims to evaluate dose-response relationships of cigarette and alcohol consumption with depressive symptoms in Chinese middle-aged and elderly men, providing evidence to guide cigarette and alcohol control.

METHODS

This multiple-center, cross-sectional study including 5965 Chinese men aged 40-79 years was conducted in 2013-2016 in China. Depressive symptoms were evaluated by Beck Depression Inventory-Short Form. History of cigarette smoking and alcohol drinking were collected with a structured questionnaire. Prevalence of depressive symptoms was compared depending on cigarette and alcohol consumption. Adjusted odds ratios (OR) and 95% confidence interval (CI) were estimated by binary logistic regression. Interpolation analysis was applied to test dose-effect relationships.

RESULTS

A parabolic-shaped relationship was observed between cigarette consumption and depressive symptoms. Compared to never smokers, 59.0% (OR = 1.59, 95% CI 1.30-1.94) and 29.0% (OR = 1.29, 95% CI 1.08-1.54) higher odds of depressive symptoms were observed in men smoking < 10 cigarettes/day and 10-20 cigarettes/day, whereas, similar odds of depressive symptoms among men smoking > 20 cigarettes/day (P = 0.092). An inverted J-shaped relationship was observed between alcohol consumption and depressive symptoms. Compared to never drinkers, a tendency of higher prevalence of depressive symptoms (OR = 1.16, 95% CI 0.99-1.36) was observed in men drinking < 140 g/week, and similar prevalence was observed in those drinking 140-280 g/week (P = 0.920), whereas, 29.4% (OR = 0.71, 95% CI 0.57-0.88) lower odds in men drinking > 280 g/week.

CONCLUSIONS

Associations of cigarette smoking and alcohol drinking with depressive symptoms differ with consumption in middle-aged and elderly men. Health-care providers should exercise great caution on depressive symptoms in conducting cigarette and alcohol control.

Soluble Epoxide Hydrolase Is Associated with Postprandial Anxiety Decrease in Healthy Adult Women

The metabolism of bioactive oxylipins by soluble epoxide hydrolase (sEH) plays an important role in inflammation, and sEH may be a risk modifier in various human diseases and disorders. The relationships that sEH has with the risk factors of these diseases remain elusive. Herein, sEH protein expression and activity in white blood cells were characterized before and after a high-fat meal in healthy women (HW) and women with anorexia nervosa (AN). sEH expression and sEH activity were significantly correlated and increased in both groups two hours after consumption of the study meal. Fasting sEH expression and activity were positively associated with body mass index (BMI) in both groups, while an inverse association with age was found in AN only (p value < 0.05). sEH was not associated with anxiety or depression in either group at the fasting timepoint. While the anxiety score decreased after eating in both groups, a higher fasting sEH was associated with a lower postprandial anxiety decrease in HW (p value < 0.05). sEH characterization using direct measurements verified the relationship between the protein expression and in vivo activity of this important oxylipin modulator, while a well-controlled food challenge study design using HW and a clinical control group of women with disordered eating elucidated sEH’s role in the health of adult women.

Association between quality of life, sleep quality and mental disorders in Iranian older adults

Aging as a major challenge can affect the development and growth of countries all around the world. This study aimed to identify the subgroups of the elderly based on the quality of life (Qol), sleep quality, and common mental disorders and assess the role of demographic characteristics on the membership of participants in each latent class. This cross-sectional study was conducted on 1064 people over the age of 60 years. The sample was selected through cluster sampling in northern Iran. All participants completed six sets of checklists and questionnaires. Data analysis was performed using latent class analysis. Three latent classes were identified; namely, (1) healthy (66.8%), (2) anxious and with poor sleep quality (28.6%), and unhealthy (4.6%). Being Female significantly increased the odds of membership in classes 2 and 3 compared to class 1. Furthermore, living in urban areas increased the odds of belonging to class 2 and class 3 compared to class 1. Illiteracy was also shown to increase the odds of being in class 3 in comparison to class 1. Results from the present indicate that the co-occurrence of health problems in 33.2% of the elderly was observed in various forms. The results of this study can be used in prioritizing health programs for the elderly and emphasizing high-risk groups.

Using Evidence: A Nursing Assessment Protocol for Acute Geropsychiatric Patients

INTRODUCTION

The Centers for Disease Control and Prevention estimates that approximately 20% of the United States population lives with at least one mental health issue. The most common mental illnesses affecting older Americans include anxiety, cognitive, and mood disorders. These patients may exhibit behaviors indicating agitation or anxiety during necessary hospital stays that warrant de-escalation techniques and appropriate medications to help manage emergent symptoms.

AIMS

This quality improvement intervention was intended to demonstrate enhancement of the nursing assessment and reassessment of patients demonstrating symptoms of agitation and anxiety requiring intervention.

METHODS

Assessment of the established nursing practice demonstrated compromised patient safety and led to planning and implementation of a new practice standard that incorporated an evidence-based tool. Nurses utilized a protocol that employed the Pittsburgh Agitation Scale to augment documentation of the nursing assessment for patients exhibiting symptoms of marked anxiety and agitation.

RESULTS

Following a 3-month trial, chart audits were completed to assess results of the protocol's implementation. Significant improvement was noted in the nursing assessment process as evidenced in required documentation of nursing assessment and reassessment including use of the protocol.

CONCLUSIONS

Implementing standards to guide nursing care can support both patient safety and professional practice.

Relationship of stigmatization and social support with depression and anxiety among cognitively intact older adults

Aims and objectives

This study aimed to assess depression and anxiety symptoms among older adult residents of long-term care facilities (LTCFs) in Jordan and to examine the relationships between stigmatization and social support with depression and anxiety.

Methods

Data was collected between December 2019 and March 2020 using a cross-sectional design. A total of 90 LTCF residents responded to measures of cognition, anxiety, depression, stigmatization, and social support. Descriptive statistics and multiple regression analyses were used in this study.

Results

The average scores of depression and anxiety were high among the participants, with 81.1% of the participants found to be at risk of developing clinical depression. Stigmatization was positively correlated with depression and anxiety, whereas social support was negatively correlated with depression. Stigmatization was a significant predictor of both anxiety and depression scores (β = .19, p = .03; β = .32, p = .001, respectively).

Conclusions

Older adults residing in LTCFs in Jordan suffer from many psychological distress symptoms, which place them at risk of serious mental problems. Reducing stigmatization would improve the psychological well-being of LTCF residents.

Relevance to clinical practice

Caregivers working at LTCFs should be aware that with the longer stay, older adult residents are expected to complain of psychological distress symptoms. Thus, frequent assessment of the residents is highly recommended. In addition, caregivers should provide the residents with appropriate social support to mitigate the negative impact of a lengthy stay.

Disrupted development from head to tail: Pervasive effects of postnatal restricted resources on neurobiological, behavioral, and morphometric outcomes

When a maternal rat nurtures her pups, she relies on adequate resources to provide optimal care for her offspring. Accordingly, limited environmental resources may result in atypical maternal care, disrupting various developmental outcomes. In the current study, maternal Long-Evans rats were randomly assigned to either a standard resource (SR) group, provided with four cups of bedding and two paper towels for nesting material or a limited resource (LR) group, provided with a quarter of the bedding and nesting material provided for the SR group. Offspring were monitored at various developmental phases throughout the study. After weaning, pups were housed in same-sex dyads in environments with SRs for continued observations. Subsequent behavioral tests revealed a sex × resource interaction in play behavior on PND 28; specifically, LR reduced play attacks in males while LR increased play attacks in females. A sex × resource interaction was also observed in anxiety-related responses in the open field task with an increase in thigmotaxis in LR females and, in the social interaction task, females exhibited more external rears oriented away from the social target. Focusing on morphological variables, tail length measurements of LR males and females were shorter on PND 9, 16, and 21; however, differences in tail length were no longer present at PND 35. Following the behavioral assessments, animals were perfused at 56 days of age and subsequent immunohistochemical assays indicated increased glucocorticoid receptors in the lateral habenula of LR offspring and higher c-Fos immunoreactivity in the basolateral amygdala of SR offspring. Further, when tail vertebrae and tail tendons were assessed via micro-CT and hydroxyproline assays, results indicated increased trabecular separation, decreased bone volume fraction, and decreased connectivity density in bones, along with reduced collagen concentration in tendons in the LR animals. In sum, although the restricted resources only persisted for a brief duration, the effects appear to be far-reaching and pervasive in this early life stress animal model.

Strategies for Maintaining Brain Health: The Role of Stroke Risk Factors Unique to Elderly Women

Stroke risk and prevalence increase with advanced age and women tend to be older than men at the time of their first stroke. Advanced age in women confers unique stroke risks that are beyond reproductive factors. Previous reviews and guidelines have largely focused on risk factors specific to women, with a predominant focus on reproductive factors and, therefore, younger to middle-aged women. This review aims to specifically describe stroke risk factors in elderly women, the population of women where the majority of strokes occur, with a focus on atrial fibrillation, hormone therapy, psychosocial risk factors, and cognitive impairment. Our review suggests that prevention and management of stroke risks that are unique or more prevalent in elderly women needs a coordinated system of care from general physicians, general neurologists, vascular and cognitive neurologists, psychologists, cardiologists, patients, and their caretakers. Early identification and management of the elderly woman-specific and traditional stroke risk factors is key for decreasing stroke burden in elderly women. Increased education among elderly women regarding stroke risk factors and their identification should be considered, and an update to the guidelines for prevention of stroke in women is strongly encouraged.

Age-neutrality of the SCID-II: Differential Item Functioning in Younger Outpatients (Aged 20-45) and Older Outpatients (Aged 65+)

OBJECTIVES

Measurements are often developed for the assessment of personality disorders (PDs) in younger adults and seldom evaluated on the applicability in older adults. Remarkably, research has not yet been conducted into age-group appropriateness of the gold standard for the assessment of PDs, known as Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Therefore, the current study empirically investigated the age-neutrality of the PDs assessed by the SCID-II.

METHODS

Age-neutrality was examined in 84 younger adults (aged 20-45 years) and 68 older adults (aged 65-85) by Differential Item Functioning (DIF). The impact of DIF on scale level was further examined using Differential Test Functioning analyzes to examine the impact of the amount of DIF variance in the items on scale level.

RESULTS

Overall, the great majority, 95.8% of the categorically measured items and 87.5% of the dimensionally measured items, was endorsed in the same way by younger adults and older adults with equal scores on the PD scale. Subsequent analyzes revealed no large DTF for PD scales.

CONCLUSIONS

Overall the SCID-II in an outpatient population is age-neutral for both categorically and dimensionally scored PD scales.

CLINICAL IMPLICATIONS

The SCID-II can be used for the assessment of PDs in older adults.

Psychotherapy with older adults: Ageism and the therapeutic process

Objective This study explores how ageism in therapists is manifested in psychotherapy with older adults and how therapists deal with its impact on their therapeutic work. Method: Semi-structured interviews were conducted with 14 therapists and analyzed using grounded theory methodology. Results: Findings clustered around two themes: (i) maintaining openness to change while acknowledging limitations; (ii) dealing with manifestations of ageism inside therapy by going beyond relating to older patients only in terms of their chronological age. Conclusions: Our findings indicate that while therapists maintain an optimistic view regarding the possibility of therapeutic change, the therapeutic encounter with older patients triggers certain ageist therapeutic biases and behaviors in therapists, even in experienced therapists who have competency in working with older adults. Our findings also indicate that dealing with therapists' ageism in psychotherapy with older patients requires therapists not only to be aware in advance of their ageist attitudes but also to continuously engage in the management of the manifestations of ageism inside treatment. We use the conceptual framework of countertransference to suggest an understanding of the relationship between therapists' ageism and the therapeutic process. Implications for training and practice are discussed.

Antipsychotic prescription patterns and associated factors among the elderly with psychiatric illnesses

Prescribing rate of antipsychotics in elderly patients with psychiatric illnesses has been increasing all over the world. However, there is a lack of research examining the use of antipsychotics at psychiatric hospitals. We aim to find out long-term trends in antipsychotic prescriptions and factors associated with the use of antipsychotics in the elderly population. All outpatient visits with patients aged over 65 years between 2006 and 2015 in a psychiatric hospital were included in the analysis. Demographic and clinical data, including patient age, sex, National Health Insurance status, psychiatric diagnosis and antipsychotic prescription, were retrieved through the electronic medical information system. In this study, we found that prescribing rate of antipsychotics has increased around 5.07% through the study period (from 57.25% in 2006 to 60.15% in 2015, P < 0.001). Among all antipsychotics, there was an increase in the use of second-generation antipsychotics with a simultaneous decline in the use of first-generation antipsychotics. Logistic regression analysis showed advanced age, female gender and certification for catastrophic illnesses were positively associated with the use of antipsychotics. Furthermore, patients most likely to be prescribed an antipsychotic were those with psychotic disorders, followed by dementia, and then affective or neurotic disorders. The results of this study were consistent with the worldwide trend of increasing prescriptions of second-generation antipsychotics among elderly patients with psychiatric illnesses. Despite the potential benefits of these medications on certain psychiatric symptoms, clinicians need to exercise due caution as they may also cause potentially serious side effects among the elderly population.

Early life adversity drives sex-specific anhedonia and meningeal immune gene expression through mast cell activation

Exposure to early life adversity (ELA) in the form of physical and/or psychological abuse or neglect increases the risk of developing psychiatric and inflammatory disorders later in life. It has been hypothesized that exposure to ELA results in persistent, low grade inflammation that leads to increased disease susceptibility by amplifying the crosstalk between stress-processing brain networks and the immune system, but the mechanisms remain largely unexplored. The meninges, a layer of three overlapping membranes that surround the central nervous system (CNS)- dura mater, arachnoid, and piamater - possess unique features that allow them to play a key role in coordinating immune trafficking between the brain and the peripheral immune system. These include a network of lymphatic vessels that carry cerebrospinal fluid from the brain to the deep cervical lymph nodes, fenestrated blood vessels that allow the passage of molecules from blood to the CNS, and a rich population of resident mast cells, master regulators of the immune system. Using a mouse model of ELA consisting of neonatal maternal separation plus early weaning (NMSEW), we sought to explore the effects of ELA on sucrose preference behavior, dura mater expression of inflammatory markers and mast cell histology in adult male and female C57Bl/6 mice. We found that NMSEW alone does not affect sucrose preference behavior in males or females, but it increases the dura mater expression of the genes coding for mast cell protease CMA1 (cma1) and the inflammatory cytokine TNF alpha (tnf alpha) in females. When NMSEW is combined with an adult mild stress (that does not affect behavior or gene expression in NH animals) females show reduced sucrose preference and even greater increases in meningeal cma1 levels. Interestingly, systemic administration of the mast cell stabilizer Ketotifen before exposure to adult stress prevents both, reduction in sucrose preference an increases in cma1 expression in NMSEW females, but facilitates stress-induced sucrose anhedonia in NMSEW males and NH females. Finally, histological analyses showed that, compared to males, females have increased baseline activation levels of mast cells located in the transverse sinus of the dura mater, where the meningeal lymphatics run along, and that, in males and females exposed to adult stress, NMSEW increases the number of mast cells in the interparietal region of the dura mater and the levels of mast cell activation in the sagittal sinus regions of the dura mater. Together, our results indicate that ELA induces long-term meningeal immune gene changes and heightened sensitivity to adult stress-induced behavioral and meningeal immune responses and that these effects could mediated via mast cells.

Subjective life expectancy of middle-aged and older adult cancer survivors: A cross-sectional study in Korea using age-specific subgroup analysis

OBJECTIVE

As the population ages and the survival rate of cancer patients increases, long-term management of older adult cancer survivors has become important. Subjective life expectancy (SLE) is a concept that refers to an individual's particular predicted lifespan, which enables individuals to live an active life with hopeful expectations for the extension of a healthy life. Therefore, this study aims to identify the factors related to SLE according to age group, to help enable middle-aged and older adult cancer survivors to actively live out their lives with a sense of control.

DESIGN

A descriptive, cross-sectional study was used.

METHODS

This study included 538 participants in the fifth to seventh survey data of the Korean Longitudinal Study of Aging dataset. Moreover, we conducted multivariable regression analyses.

RESULTS

The participants of this study were 137 middle-aged (under 64 years), 196 young-old (65-74 years), 164 old-old (75-84 years) and 41 oldest-old (over 85 years) cancer survivors. The mean age of the participants was 71.22 ± 9.4 years. The factors related to SLE were employment status (β = 7.43, p = 0.018) and quality of life (QOL) (β = 0.25, p = 0.010) for the middle-aged group and age (β = -1.50, p = 0.002) and employment status (β = 10.44, p = 0.003), and QOL (β = 0.31, p < 0.001) in the young-old group; in the old-old group and oldest-old group, the predictors of SLE were QOL (β = 0.35, p = 0.004) and social network (β = 2.76, p = 0.018).

CONCLUSION

The SLE of middle-aged and older adult cancer survivors was different by age group, and related factors also varied by it. Therefore, an individual approach for each age group is required to effectively promote SLE.

IMPLICATIONS FOR PRACTICE

By developing and applying differentiated nursing interventions suitable for each age group for middle-aged and older adult cancer survivors, it should be possible to help them make a healthy transition with positive expectations for life extension.

Psychiatric Comorbidity in Prurigo Nodularis and the Impact of Socioeconomic Status

OBJECTIVE

We sought to investigate the relationship between psychiatric comorbidity, socioeconomic status (SES), and mental health utilization among patients with prurigo nodularis (PN).

METHODS

We conducted a retrospective cohort study of patients with PN from 2007 to 2019. SES was approximated using zip codes; per capita income data was compared to the Livable Income Threshold.

RESULTS

288 patients were included. Patients were predominantly female (57%) and significantly more likely to have a psychiatric disorder than men (p=0.001). 44.1 percent of patients had at least one psychiatric comorbidity, with mood (74.8%) and anxiety (63.0%) disorders being most common. Patients with PN in lower SES groups had a higher incidence of psychiatric disorder (p=0.566) and utilization of mental health services (p=0.617). 40.9 percent of patients with a diagnosed psychiatric disorder had no record of seeing a psychiatrist or psychologist.

LIMITATIONS

Patient records were retrospectively reviewed for encounters with a psychiatrist or psychologist, but did not account for other forms of mental health services. Per capita income used to determine SES may not be an accurate representation of an individual's income, nor did it account for the number of people within a household.

CONCLUSION

Psychiatric comorbidity was common among patients with PN and many went without receiving mental health services. Further studies with larger sample sizes are needed to better understand the impact of SES on these factors.