Trends in depressive symptom burden among older adults in the United States from 1998 to 2008

Social Engagement and Happiness in Older Adults With and Without Cognitive Impairment

This study investigated the associations between in-person and remote engagement and self-rated happiness in older adults aged 50 years and above in three cognitive function subgroups: Normal Cognition, Cognitive Impairment not Dementia (CIND), and Dementia. Data were obtained from the 2014 Health and Retirement Study. Results showed that remote engagement was significantly associated with higher self-rated happiness, particularly in the CIND group. However, its association with in-person engagement was less consistent. No significant association was observed among individuals with dementia. However, the direction of the relationship between the two types of social engagement and self-rated happiness was positive. Instrumental activities of daily living, depression, and social capital were identified as potential factors influencing the relationship between social engagement and self-rated happiness. These findings emphasize promotion of both in-person and remote social engagement opportunities to enhance the well-being of older adults across different cognitive function subgroups.

Psychosocial Well-Being Differences Between the Young Old, Old-Old, and Oldest Old: A Global Comparison

OBJECTIVES

We investigate global differences in psychosocial well-being between older adult age groups.

METHODS

Using multinomial logistic regression, we analyzed 2018 data (n = 93,663) from 9 countries/regions in the Health and Retirement Study international family of studies to compare age group differences in depression, loneliness, and happiness.

RESULTS

Compared to the young old, the old-old reported more depression in Southern Europe, while the oldest old had higher risk in India and Southern Europe but lower risk in the United States. The old-old reported less loneliness in the United States but more in Southern Europe, while the oldest old had greater risk in Southern Europe. The old-old reported less happiness in Korea, while the oldest old had lower reports in Korea but higher reports in the United States.

DISCUSSION

The psychosocial well-being of the oldest old is exceptionally good in the United States but exceptionally poor in Southern Europe.

The network structures of depressive and insomnia symptoms among cancer patients using propensity score matching: Findings from the Health and Retirement Study (HRS)

OBJECTIVE

Both depression and insomnia are found to be more prevalent in cancer patients compared to the general population. This study compared the network structures of depression and insomnia among cancer patients versus cancer-free participants (controls hereafter).

METHOD

The 8-item Center for Epidemiological Studies Depression Scale (CESD-8) and the 4-item Jenkins Sleep Scale (JSS-4) were used to measure depressive and insomnia symptoms, respectively. Propensity score matching (PSM) was used to construct the control group using data from the Health and Retirement Study (HRS). In total, a sample consisting of 2216 cancer patients and 2216 controls was constructed. Central (influential) and bridge symptoms were estimated using the expected influence (EI) and bridge expected influence (bridge EI), respectively. Network stability was assessed using the case-dropping bootstrap method.

RESULT

The prevalence of depression (CESD-8 total score ≥ 4) in cancer patients was significantly higher compared to the control group (28.56 % vs. 24.73 %; P = 0.004). Cancer patients also had more severe depressive symptoms relative to controls, but there was no significant group difference for insomnia symptoms. The network structures of depressive and insomnia symptoms were comparable between cancer patients and controls. "Felt sadness" (EI: 6.866 in cancer patients; EI: 5.861 in controls), "Felt unhappy" (EI: 6.371 in cancer patients; EI: 5.720 in controls) and "Felt depressed" (EI: 6.003 in cancer patients; EI: 5.880 in controls) emerged as the key central symptoms, and "Felt tired in morning" (bridge EI: 1.870 in cancer patients; EI: 1.266 in controls) and "Everything was an effort" (bridge EI: 1.046 in cancer patients; EI: 0.921 in controls) were the key bridge symptoms across both groups.

CONCLUSION

Although cancer patients had more frequent and severe depressive symptoms compared to controls, no significant difference was observed in the network structure or strength of the depressive and insomnia symptoms. Consequently, psychosocial interventions for treating depression and insomnia in the general population could be equally applicable for cancer patients who experience depression and insomnia.

Spousal concordance in adverse childhood experiences and the association with depressive symptoms in middle-aged and older adults: findings across China, the US, and Europe

Background

Adverse childhood experiences (ACEs) are associated with higher depressive risks in adulthood. Whether respondents' ACEs are associated with their own depressive symptoms in adulthood and whether this association extends to their spouses' depressive symptoms remain unexplored.

Methods

Data were from China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE). ACEs were categorized into overall, intra-familial, and extra-familial ACEs. Correlations of couples' ACEs were calculated using Cramer's V and partial Spearman's correlation. Associations of respondents' ACEs with spousal depressive symptoms were assessed using logistic regression, and mediation analyses were conducted to explore the mediating role of respondents' depressive symptoms.

Results

Significant associations between husbands' ACEs and wives' depressive symptoms, with odds ratios (ORs) and 95% confidence intervals (CIs) of 2.09 (1.36-3.22) for 4 or more ACEs in CHARLS, and 1.25 (1.06-1.48) and 1.38 (1.06-1.79) for 2 or more ACEs in HRS and SHARE. However, wives' ACEs were associated with husbands' depressive symptoms only in CHARLS and SHARE. Findings in intra-familial and extra-familial ACEs were consistent with our main results. Additionally, respondents' depressive symptoms mediated more than 20% of the effect of respondents' ACEs on spousal depressive symptoms.

Conclusion

We found that ACEs were significantly correlated between couples. Respondents' ACEs were associated with spousal depressive symptoms, with respondents' depressive symptoms mediating the association. The bidirectional implications of ACEs on depressive symptoms should be considered within household and effective interventions are warranted.

Time trends in depression prevalence among Swedish 85-year-olds: repeated cross-sectional population-based studies in 1986, 2008, and 2015

BACKGROUND

Octogenarians of today are better educated, and physically and cognitively healthier, than earlier born cohorts. Less is known about time trends in mental health in this age group. We aimed to study time trends in the prevalence of depression and psychotropic drug use among Swedish 85-year-olds.

METHODS

We derived data from interviews with 85-year-olds in 1986-1987 (N = 348), 2008-2010 (N = 433) and 2015-17 (N = 321). Depression diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders. Symptom burden was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). Information on psychotropic drug use, sociodemographic, and health-related factors were collected during the interviews.

RESULTS

The prevalence of major depression was lower in 2015-2017 (4.7%, p < 0.001) and 2008-2010 (6.9%, p = 0.010) compared to 1986-1987 (12.4%). The prevalence of minor depression was lower in 2015-2017 (8.1%) compared to 2008-2010 (16.2%, p = 0.001) and 1986-1987 (17.8%, p < 0.001). Mean MADRS score decreased from 8.0 in 1986-1987 to 6.5 in 2008-2010, and 5.1 in 2015-2017 (p < 0.001). The reduced prevalence of depression was not explained by changes in sociodemographic and health-related risk factors for depression. While psychoactive drug use was observed in a third of the participants in each cohort, drug type changed over time (increased use of antidepressants and decreased use of anxiolytics and antipsychotics).

CONCLUSIONS

The prevalence of depression in octogenarians has declined during the past decades. The decline was not explained by changes in known risk factors for depression. The present study cannot answer whether changed prescription patterns of psychoactive drugs have contributed to the decline.

Trends in major depressive episodes and mental health treatment among older adults in the United States, 2010-2019

BACKGROUND

Despite concerns about increasing trends in depression over the past two decades, little is known about recent trends in depression and mental health (MH) treatment among older adults and whether these trends differ by demographic characteristics.

METHODS

We examined data from a US representative sample of noninstitutionalized adults aged ≥65 from the 2010-2019 National Survey on Drug Use and Health (N = 31,502). We estimated trends in the prevalence of past-year major depressive episode (MDE) overall and by demographic characteristics. We also estimated trends in MH treatment among those with past-year MDE.

RESULTS

From 2010/11 to 2018/19, the estimated prevalence of past-year MDE among older adults increased from 2.0 % (95 % CI: 1.6-2.6) to 3.2 % (95 % CI: 2.7 to 3.7), a 60.0 % increase (p = 0.013). Increases were detected among men (p = 0.038), White individuals (p = 0.018), those who are widowed (p = 0.003), those with an annual household income of <$20,000 (p = 0.020) or $20,000-$49,000 (p = 0.016), and those with some college degree (p = 0.014). Among those with MDE, there were no significant changes detected in any form of past-year MH treatment.

LIMITATIONS

NSDUH does not assess individuals who are institutionalized, incarcerated, or experiencing homelessness, and thus the prevalence of MDE may be underestimated.

CONCLUSIONS

Although the estimated prevalence of depression is increasing among older adults, there has not been a proportional increase in MH treatment among those with depression. These findings call for urgent expansion of treatment services and training of MH professionals with expertise in older adults to meet the needs of this growing, vulnerable population.

Age-period-cohort analysis of depression trends: are depressive symptoms increasing across generations in Germany?

Several studies have examined trends in depression, but only few have explicitly considered possible generational differences. I examined changes in the burden of depressive symptoms between 2002 and 2017 according to age, time period and birth cohort in Germany. I used population-based data drawn from the German Aging Survey (N = 33,723, 54% female, ages 40 +) from 2002, 2008, 2011, 2014, and 2017. Depressive symptoms were measured via the CES-D 15. Hierarchical age-period-cohort models were used to examine trends in depression. I found that depressive symptoms changed across age, time period and birth cohorts. While there was a general decrease across time periods, strong evidence for a U-shaped cohort effect was also found: Younger generations, beginning with cohorts born after the World War II, increasingly report more depressive symptoms than older generations. This U-shaped cohort trend appeared most pronounced for the somatic symptoms subscale. Contrarily, only minimal cohort differences were found regarding the positive affect subscale. Therefore, depressive symptoms, and especially somatic symptoms, seem to increase in more recent birth cohorts in Germany, who might thus be at risk to experience more mental health problems in the future. Potential reasons for these trends and the generalizability of the results to other countries should be investigated by future studies.

Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway

OBJECTIVES

Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes.

DESIGN

Repeated population-based health surveys to monitor decennial changes.

SETTING

Data from three cross-sectional surveys in 1995-1997, 2006-2008 and 2017-2019 in the population-based HUNT Study in Norway were used.

PARTICIPANTS

The general population in a Norwegian county covering participants aged 13-79 years, ranging from 48 000 to 62 000 000 in each survey.

MAIN OUTCOME MEASURES

Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults.

RESULTS

Adolescents' and young adults' mental distress increased sharply, especially between 2006-2008 and 2017-2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups.

CONCLUSIONS

Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people's living conditions and behaviour, including the increased influence of screen-based media.

Responding to Disability Onset in the Late Working Years: What do Older Workers do?

This study uses occupational data from the Health and Retirement Study to document the link between disability onset and occupational transitions among older adults who are working and do not report a disabling condition at age 55. We find that one-quarter of workers go on to experience new disabilities before full-retirement age. Relative to their peers who do not report disabilities, stopping work and significant occupational changes are more common among workers who experience new disabilities. Our results suggest that policies to support labor force attachment might consider the importance of new disability onset and whether employer accommodations might help workers with new disabling conditions remain in the jobs they held when their health began to limit their work.

Sex differences in mental health among older adults: investigating time trends and possible risk groups with regard to age, educational level and ethnicity

OBJECTIVES

Older women report lower mental health compared to men, yet little is known about the nature of this sex difference. Therefore, this study investigates time trends and possible risk groups.

METHOD

Data from the Doetinchem Cohort Study (DCS) and the Longitudinal Aging Study Amsterdam (LASA) were used. General mental health was assessed every 5 years, from 1995 to 1998 onwards (DCS, n = 1412, 20-year follow-up, baseline age 55-64 years). Depressive and anxiety symptoms were assessed for two birth cohorts, from 1992/1993 onwards (LASA cohort 1, n = 967, 24-year follow-up, age 55-65 years,) and 2002/2003 onwards (LASA cohort 2, n = 1002, 12-year follow-up, age 55-65 years) with follow-up measurements every 3-4 years.

RESULTS

Mixed model analyses showed that older women had a worse general mental health (-6.95; -8.36 to 5.53; range 0-100, ∼10% lower), more depressive symptoms (2.09; 1.53-2.63; range 0-60, ∼30% more) and more anxiety symptoms (0.86; 0.54-1.18; range 0-11, ∼30% more) compared to men. These sex differences remained stable until the age of 75 years, where after they decreased due to an accelerated decline in mental health for men compared to women. Sex differences and their course by age were consistent over successive birth cohorts, educational levels and ethnic groups (Caucasian vs. Turkish/Moroccan).

CONCLUSION

There is a consistent female disadvantage in mental health across different sociodemographic groups and over decennia (1992 vs. 2002) with no specific risk groups.

Age and sex trends in depressive symptoms across middle and older adulthood: Comparison of the Canadian Longitudinal Study on Aging to American and European cohorts

BACKGROUND

The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear.

METHODS

Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort.

RESULTS

Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60.

LIMITATIONS

Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts.

CONCLUSIONS

Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources.

Lower Socio-Economic Position Associated With Higher Odds Of Diabetes-Depression Comorbidity

Diabetes-depression comorbidity (DDC) adversely affects the quality of life of diabetic patients, complicates the clinical treatment and makes diabetes management very challenging. Therefore, early identification and diagnosis of DDC is crucial to prevent complications and improve the health outcomes among the diabetic patients. This work explores the association between demographic, lifestyle, social economic factors and DDC. The analysis is based on data obtained from the Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention (CDC), USA. Logistic Regression was used to explore this association. Women were found to have higher odds of DDC as compared to men [OR 1.30, 95%CI(1.17-1.44), p <0.001]. Additionally, sedentary behaviour and lower socio-economic position was found to be associated with higher odds of DDC. Moreover, a gradient association was observed between socio-economic position (SEP) and DDC. The odds of DDC tend to reduce with improvement in SEP. Our findings underscore the importance of examining and addressing the disproportionate burden of DDC among the lower socio-economic groups.

The role of social communication technologies in cognition and affect in older adults

Affect and cognition have both been associated with communication across one's social network during ageing. Thus, it is important to consider how communication varies by different aspects of one's social network, and by communication mode, including phone, email and social media. This study aimed to investigate the relationship between technology-mediated communication, depression and an executive function-related fluid-reasoning measure among older adults. Data were drawn from the Health and Retirement dataset's 2016 wave. Hierarchical regression analyses were conducted to examine the link between communication modes (phone, email and social media) with children, family and friends with a fluid-reasoning cognition measure and Center for Epidemiologic Studies Depression Scale, controlling for demographic covariates, among 3,798 older American adults. Phone and email communication, but not social media, were significantly related to depression and cognition. The model fit was considerably stronger for the analyses with cognition than depression. Curvilinear associations were found for communication via phone and email with cognition, suggesting moderate amounts of communication by phone and email across social groups were most closely linked with higher scores on fluid reasoning. For depression, curvilinear relationships were found for talking on the phone with family and friends, and emailing for children and family, indicating that moderate communication levels revealed the lowest depression levels. Implications for how older adults’ social support may contribute to depression and cognition status are discussed.

Decline of depressive symptoms in Europe: differential trends across the lifespan

PURPOSE

We examined changes in the burden of depressive symptoms between 2006 and 2014 in 18 European countries across different age groups.

METHODS

We used population-based data drawn from the European Social Survey (N = 64.683, 54% female, age 14-90 years) covering 18 countries (Austria, Belgium, Denmark, Estonia, Finland, France, Germany, Great Britain, Hungary, Ireland, The Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland) from 2006 to 2014. Depressive symptoms were measured via the CES-D 8. Generalized additive models, multilevel regression, and linear regression analyses were conducted.

RESULTS

We found a general decline in CES-D 8 scale scores in 2014 as compared with 2006, with only few exceptions in some countries. This decline was most strongly pronounced in older adults, less strongly in middle-aged adults, and least in young adults. Including education, health and income partially explained the decline in older but not younger or middle-aged adults.

CONCLUSIONS

Burden of depressive symptoms decreased in most European countries between 2006 and 2014. However, the decline in depressive symptoms differed across age groups and was most strongly pronounced in older adults and least in younger adults. Future studies should investigate the mechanisms that contribute to these overall and differential changes over time in depressive symptoms.

Changes in depressive symptoms of older adults in the Czech Republic

BACKGROUND

It is unclear whether the rising burden of depression is due to its increasing prevalence or better detection. We aimed to study trends in depressive symptoms in older individuals from the Czech Republic.

METHODS

We used data from the Survey on Health, Aging and Retirement in Europe. Depressive symptoms, defined by 4 or more points on the EURO-D scale, alone or in combination with pharmacological treatment, were compared between participants in 2006/2007 (cohort 1) and in 2015 (cohort 2). Binary logistic regression assessed the association of cohort 2 with depressive symptoms, step-wise adjusting for sociodemographic and clinical covariates.

RESULTS

The prevalence of depressive symptoms (defined by EURO-D) was 28% in cohort 1 and 22% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for all covariates (OR 0.77; 95% CI 0.63-0.94). Defined by EURO-D scale or pharmacological treatment, the prevalence was 30% in cohort 1 and 26% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for age and sex, but not in the fully adjusted model (OR 0.88; 95% CI 0.73-1.07). The difference in depressive symptoms between cohorts was associated in particular with increased length of education and higher household net worth.

LIMITATIONS

Information about pharmacological treatment has been reported inaccurately.

CONCLUSIONS

The prevalence of depressive symptoms has decreased in older adults in the Czech Republic. Additional increase in education and socioeconomic resources of the population could further reduce the depressive symptoms in the population.

Is the global prevalence rate of adult mental illness increasing? Systematic review and meta-analysis

OBJECTIVES

The question whether mental illness prevalence rates are increasing is a controversially debated topic. Epidemiological articles and review publications that look into this research issue are often compromised by methodological problems. The present study aimed at using a meta-analysis technique that is usually applied for the analysis of intervention studies to achieve more transparency and statistical precision.

METHODS

We searched PubMed, PsycINFO, CINAHL, Google Scholar and reference lists for repeated cross-sectional population studies on prevalence rates of adult mental illness based on ICD- or DSM-based diagnoses, symptom scales and distress scales that used the same methodological approach at least twice in the same geographical region. The study is registered with PROSPERO (CRD42018090959).

RESULTS

We included 44 samples from 42 publications, representing 1 035 697 primary observations for the first time point and 783 897 primary observations for the second and last time point. Studies were conducted between 1978 and 2015. Controlling for a hierarchical data structure, we found an overall global prevalence increase in odds ratio of 1.179 (95%-CI: 1.065-1.305). A multivariate meta-regression suggested relevant associations with methodological characteristics of included studies.

CONCLUSIONS

We conclude that the prevalence increase in adult mental illness is small, and we assume that this increase is mainly related to demographic changes.

Depression and alcohol misuse among older adults: exploring mechanisms and policy impacts using agent-based modelling

PURPOSE

To: (1) explore how multi-level factors impact the longitudinal prevalence of depression and alcohol misuse among urban older adults (≥ 65 years), and (2) simulate the impact of alcohol taxation policies and targeted interventions that increase social connectedness among excessive drinkers, socially isolated and depressed older adults; both alone and in combination.

METHODS

An agent-based model was developed to explore the temporal co-evolution of depression and alcohol misuse prevalence among older adults nested in a spatial network. The model was based on Los Angeles and calibrated longitudinally using data from the Multi-Ethnic Study of Atherosclerosis.

RESULTS

Interventions with a social component targeting depressed and socially isolated older adults appeared more effective in curbing depression prevalence than those focused on excessive drinkers. Targeting had similar impacts on alcohol misuse, though the effects were marginal compared to those on depression. Alcohol taxation alone had little impact on either depression or alcohol misuse trajectories.

CONCLUSIONS

Interventions that improve social connectedness may reduce the prevalence of depression among older adults. Targeting considerations could play an important role in determining the success of such efforts.

The Impacts of Service Related Exposures on Trajectories of Mental Health Among Aging Veterans

Objectives

Drawing on life-course perspective and cumulative advantage theory, we examined whether service related exposures (SREs)-combat and exposure to death-have lasting impacts on depressive symptom and psychiatric problem trajectories of aging veterans.

Methods

The Health and Retirement Study and linked 2013 Veterans Mail Survey were used to examine SREs and mental health among older veterans between 2002 and 2012 (N = 1,662). Latent growth curves were used to measure how individuals vary from average mental health trajectories based on SREs and other important covariates.

Results

Exposure to death had a significant and lasting effect on depressive symptoms for veterans in late life but was reduced to nonsignificance when physical health trajectories were included. Combat and exposure to death had independent and robust impacts on psychiatric problems, which were robust in final models.

Discussion

SREs presented varied and significant impacts, suggesting that combat does not work alone in driving poor mental health trajectories, and that exposure to death is a more robust risk marker for later outcomes.

Patterns of Social Engagement Among Older Adults With Mild Cognitive Impairment

Objectives

Promoting engagement in social activities may be an intervention that prevents or delays cognitive impairment. Nevertheless, little is known about social engagement among people with mild cognitive impairment (MCI). We aim to examine patterns of social engagement among people with MCI and to assess whether factors under 4 domains of the WHO’s ICF model (personal factors, environmental factors, body functions and structure, and health condition) associate with different patterns of social engagement.

Method

Data were drawn from the 2010 Health and Retirement Study. The final sample comprised 1,227 people with cognitive impairment no dementia (CIND). Latent class analysis and multinomial logistic regression were utilized.

Results

Three patterns of social engagement were identified: informal social engagement only, formal and informal social engagement, and low social engagement. Factors in each of the 4 ICF model domains were associated with the probability of class membership.

Discussion

Our findings suggest that social engagement is heterogeneous among people with CIND and that some groups of people with CIND have possibilities of engaging in more social activities, especially in formal social activities. Results also indicate that providing informal social resources may be essential for social programs designed specifically for people with CIND to promote their formal social engagement. Future study is needed to examine possible differences in outcomes across groups with similar patterns of social engagement.

The Brazilian Longitudinal Study of Aging (ELSI-Brazil): Objectives and Design

Brazil is experiencing among the world’s fastest demographic aging worldwide. This demographic transition is occurring in a context of few resources and great social inequalities. The Brazilian Longitudinal Study of Aging (ELSI-Brazil) is a nationally representative study of 9,412 people aged 50 years or older, residing in 70 municipalities across the 5 Brazilian regions. ELSI-Brazil allows investigations of the aging process, its health, psychosocial and economic determinants, and societal consequences. The baseline examination (2015–2016) included detailed household and individual interviews and physical measurements (blood pressure, anthropometry, grip strength, and timed walk and balance tests). Blood tests and sample storage were performed in a subsample of study participants. Subsequent waves are planned for every 3 years. The study adopts a conceptual framework common to other large-scale longitudinal studies of aging in the world, such as the Health and Retirement Study, allowing cross-national comparisons. The goal of ELSI-Brazil is not only to build an understanding of aging in a large, Western, middle-income country in a rapid demographic transition but also to provide scientific data to support and study policy changes that may affect older adults. We describe the methodology of the study and some descriptive results of the baseline survey.

The Mental Health Benefits of Acquiring a Home in Older Age: A Fixed-Effects Analysis of Older US Adults

Homeownership is consistently associated with better mental health, but whether becoming a homeowner in later in life has positive psychological benefits has not, to our knowledge, been examined. We assessed whether acquiring a home after age 50 years was associated with depression in a representative sample of older US adults. We used individual fixed-effects models based on data from 20,524 respondents aged ≥50 years from the Health and Retirement Study, who were interviewed biennially during 1993-2010. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale. Controlling for confounders, becoming a homeowner in later life predicted a decline in depressive symptoms in the same year (β = -0.0768, 95% confidence interval (CI): -0.152, -0.007). The association remained significant after 2 years (β = -0.0556, 95% CI: -0.134, -0.001) but weakened afterward. Buying a home for reasons associated with positive characteristics of the new house or neighborhood drove this association (β = -0.426, 95% CI: -0.786, -0.066), while acquiring a home for reasons associated with characteristics of the previous home or neighborhood, the desire to be closer to relatives, downsizing, or upsizing did not predict mental health improvements. Findings suggest that there are small but significant benefits for mental health associated with acquiring a home in older age.

Longitudinal Changes in Depression Symptoms and Survival Among Patients With Lung Cancer: A National Cohort Assessment

Purpose Depression symptoms are common among patients with lung cancer; however, longitudinal changes and their impact on survival are understudied. Methods This was a prospective, observational study from the Cancer Care Outcomes Research and Surveillance Consortium from five US geographically defined regions from September 2003 through December 2005. Patients enrolled within 3 months of their lung cancer diagnosis were eligible. The eight-item Center for Epidemiologic Studies Depression scale was administered at diagnosis and 12 months' follow-up. The main outcome was survival, which was evaluated using Kaplan-Meyer curves and adjusted Cox proportional hazards modeling. Results Among 1,790 participants, 681 (38%) had depression symptoms at baseline and an additional 105 (14%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.17; 95% CI, 1.03 to 1.32; P = .01). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n = 640), new-onset depression symptoms (n = 105), depression symptom remission (n = 156), and persistent depression symptoms (n = 254) and HRs were calculated. Using the never-depression symptoms group as a reference group, HRs were as follows: new-onset depression symptoms, 1.50 (95% CI, 1.12 to 2.01; P = .006); depression symptom remission, 1.02 (95% CI, 0.79 to 1.31; P = .89), and persistent depression symptoms, 1.42 (95% CI, 1.15 to 1.75; P = .001). At baseline, depression symptoms were associated with increased mortality among participants with early-stage disease (stages I and II; HR, 1.61; 95% CI, 1.26 to 2.04), but not late-stage disease (stages III and IV; HR, 1.05; 95% CI, 0.91 to 1.22). At follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease (HR, 1.71; 95% CI, 1.27 to 2.31) and those with late-stage disease (HR, 1.32; 95% CI, 1.04 to 1.69). Conclusion Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality, particularly among patients with early-stage disease. Symptom remission is associated with a similar mortality rate as never having had depression.

Depression symptom trends and health domains among lung cancer patients in the CanCORS study

OBJECTIVES

Among lung cancer patients depression symptoms are common and impact outcomes. The aims of this study were to determine risk factors that contribute to persistent or new onset depression symptoms during lung cancer treatment, and examine interactions between depression symptoms and health domains that influence mortality.

MATERIALS AND METHODS

Prospective observational study in five healthcare systems and 15 Veterans Affairs medical centers. Patients in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium with lung cancer were eligible. The 8-item Center for Epidemiologic Studies Depression (CES-D) scale was administered at baseline and follow-up. Scores ≥4 indicated elevated depressive symptoms. Health domains were measured using validated instruments. We applied logistic regression and Cox proportional hazards modeling to explore the association between depression symptoms, health domains, and mortality.

RESULTS

Of 1790 participants, 38% had depression symptoms at baseline and among those still alive, 31% at follow-up. Risk factors for depression symptoms at follow-up included younger age (OR=2.81), female sex (OR=1.59), low income (OR=1.45), not being married (OR=1.74) and current smoking status (OR=1.80); high school education was associated with reduced odds of depression symptoms at follow-up, compared with lesser educational attainment (OR=0.74) (all p values <0.05). Patients with depression symptoms had worse health-related quality of life, vitality, cancer-specific symptoms, and social support than patients without depression symptoms (all p<0.001). The association between depression symptoms and increased mortality is greater among patients with more lung cancer symptoms (p=0.008) or less social support (p=0.04).

CONCLUSIONS

Patient risk factors for depression symptoms at follow-up were identified and these subgroups should be targeted for enhanced surveillance. Patients with depression symptoms suffer across all health domains; however, only more lung cancer symptoms or less social support are associated with worse mortality among these patients. These potentially modifiable health domains suggest targets for possible intervention in future studies.

Paradoxical Trend for Improvement in Mental Health With Aging: A Community-Based Study of 1,546 Adults Aged 21-100 Years

OBJECTIVE

Studies of aging usually focus on trajectories of physical and cognitive function, with far less emphasis on overall mental health, despite its impact on general health and mortality. This study examined linear and nonlinear trends of physical, cognitive, and mental health over the entire adult lifespan.

METHODS

Cross-sectional data were obtained from 1,546 individuals aged 21-100 years, selected using random digit dialing for the Successful AGing Evaluation (SAGE) study, a structured multicohort investigation that included telephone interviews and in-home surveys of community-based adults without dementia. Data were collected from 1/26/2010 to 10/07/2011 targeting participants aged 50-100 years and from 6/25/2012 to 7/15/2013 targeting participants aged 21-100 years with an emphasis on adding younger individuals. Data included self-report measures of physical health, measures of both positive and negative attributes of mental health, and a phone interview-based measure of cognition.

RESULTS

Comparison of age cohorts using polynomial regression suggested a possible accelerated deterioration in physical and cognitive functioning, averaging 1.5 to 2 standard deviations over the adult lifespan. In contrast, there appeared to be a linear improvement of about 1 standard deviation in various attributes of mental health over the same life period.

CONCLUSIONS

These cross-sectional findings suggest the possibility of a linear improvement in mental health beginning in young adulthood rather than a U-shaped curve reported in some prior studies. Lifespan research combining psychosocial and biological markers may improve our understanding of resilience to mental disability in older age and lead to broad-based interventions promoting mental health in all age groups.

The relationships among perceived discrimination, self-perceptions of aging, and depressive symptoms: a longitudinal examination of age discrimination

OBJECTIVES

This study examined the relationship between changes in perceived discrimination and changes in depressive symptoms among older people. The association between perceived age discrimination and depressive symptoms was also analyzed longitudinally along with tests to determine whether self-perception of aging mediates this association.

METHOD

Data from two waves (2008 and 2012) of the Health and Retirement Study were used. Longitudinal models were tested using a nationally representative sample of 3921 participants who responded to psychosocial questionnaires in both waves and answered questions about perceived everyday discrimination and attributions of discrimination in 2008.

RESULTS

Changes in perceived discrimination was significantly associated with changes in depressive symptoms over time. Perceived age discrimination was significantly related to a change in depressive symptoms over four years and self-perceptions of aging mediated the relationship between perceived age discrimination and depressive symptoms.

CONCLUSION

Findings demonstrate the importance of recognizing perceived discrimination and negative self-perceptions of aging as well as how the negative effects of age discrimination on self-perceptions of aging can be risk factors for the development of depressive symptoms in late life.

Perception of Exercise Lifestyle as a Valid Tool for Prevention and Treatment of Depression in Rural Communities

BACKGROUND

This study examines perception of exercise lifestyle prescription as a valid treatment for depression among rural patients at a primary care clinic in Texas.

METHODS

The researchers created a depression and exercise survey completed by 104 patients ages 18 and up living in central, economically disadvantaged rural Texas. Logistic regression was used to analyze data obtained.

RESULTS

There was a significant difference (p = 0.01) in perception of exercise as a valid treatment for depression as a function of demographic variables, however not as a function of exercise duration (p = 0.12) in the rural primary care clinic's patients. Even though it was not a statistically significant finding, there was a positive correlation found between the amount of exercise engaged in per day and the likelihood to have a positive perception of exercise prescription as a tool in depression prevention and treatment.

CONCLUSION

Participants between ages 40 to 59 years old, female, and of Hispanic ethnicity independently are most likely to perceive exercise lifestyle as a valid treatment for depression. This is the first study to look specifically at patient perception of exercise as a valid treatment tool for depression not only in rural areas, but also in the nation. Findings from this pilot study may help healthcare service providers learn how to best incorporate exercise prescription into depression prevention and treatment in rural areas, leading to reducing depression epidemics.

Ten-year trends in the prevalence and correlates of major depressive disorder in Korean near-elderly adults: a comparison of repeated nationwide cross-sectional studies from 2001 and 2011

PURPOSE

Near-elderly adults go through many changes in socioeconomic status, such as retirement, which may affect their mental health differently according to when they live. We aimed to compare the prevalence of major depressive disorder (MDD) and its changes according to sociodemographic factors using nationally representative surveys of Korean near-elderly adults conducted 10 years apart.

METHODS

Nationwide community samples of individuals aged 55-64 years living in 2001 (n = 1256) and 2011 (n = 1066) were compared. Face-to-face interviews were conducted using the Korean version of the Composite International Diagnostic Interview to diagnose MDD. Sociodemographic data were collected using self-reported questionnaires including questions on employment and economic status. We examined differences in MDD prevalence and its association with sociodemographic factors over time by calculating 2011-to-2001 odds ratios (ORs) using multivariable logistic regression models.

RESULTS

Among near-elderly people, MDD tended to be more prevalent in 2011 than in 2001. However, only near-elderly men in 2011 showed a higher risk of MDD compared with those in 2001 (2011-to-2001 OR 4.19), while women did not. The prevalence ratio by gender decreased from 7.04 in 2001 to 2.34 in 2011. Among vulnerable sociodemographic groups, a significant increase in MDD was observed in unemployed men (adjusted OR 8.35), but not in unemployed women or other vulnerable groups.

CONCLUSION

This study provides evidence of a substantial increase in MDD in Korean near-elderly men and suggests that unemployment should be considered as an important correlate of MDD in this group.

Stressors, Coping Resources, and Depressive Symptoms among Rural American Indian Older Adults

The purpose of this study was to examine the associations of physical health stressors and coping resources with depressive symptoms among American Indian older adults age 50 years or older. The study used a convenience sample of 227 rural American Indian older adults. A hierarchical multiple regression tested three sets of predictors on depressive symptoms: (a) sociodemographics, (b) physical health stressors (functional disability and chronic medical conditions), and (c) coping resources (social support and spirituality). Most participants reported little difficulty in performing daily activities (e.g., eating, dressing, traveling, and managing money), while presenting over two types of chronic medical conditions. Depressive symptoms were predicted by higher scores on perceived social support and lower scores on functional disability; women and those having no health insurance also had higher levels of depressive symptoms. Findings suggest that social work practitioners should engage family and community support, advocate for access to adequate health care, and attend to women's unique circumstances and needs when working with American Indian older adults.

The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: a cohort study

OBJECTIVE

To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations.

METHODS

This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to their Medicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses.

RESULTS

After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics.

CONCLUSIONS

CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.

Mediators of the impact of a home-based intervention (beat the blues) on depressive symptoms among older African Americans

Older African Americans (N = 208) with depressive symptoms were randomly assigned to a home-based nonpharmacologic intervention (Beat the Blues, or BTB) or wait-list control group. BTB was delivered by licensed social workers and involved up to 10 home visits focused on care management, referral and linkage, depression knowledge and efficacy in symptom recognition, instruction in stress reduction techniques, and behavioral activation through identification of personal goals and action plans for achieving them. Structured interviews by assessors masked to study assignment were used to assess changes in depressive symptoms (main trial endpoint), behavioral activation, depression knowledge, formal care service utilization, and anxiety (mediators) at baseline and 4 months. At 4 months, the intervention had a positive effect on depressive symptoms and all mediators except formal care service utilization. Structural equation models indicated that increased activation, enhanced depression knowledge, and decreased anxiety each independently mediated a significant proportion of the intervention's impact on depressive symptoms as assessed with 2 different measures (PHQ-9 and CES-D). These 3 factors also jointly explained over 60% of the intervention's total effect on both indicators of depressive symptoms. Our findings suggest that most of the impact of BTB on depressive symptoms is driven by enhancing activation or becoming active, reducing anxiety, and improving depression knowledge/efficacy. The intervention components appear to work in concert and may be mutually necessary for maximal benefits from treatment to occur. Implications for designing tailored interventions to address depressive symptoms among older African Americans are discussed.

Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans

BACKGROUND

The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.

OBJECTIVE(S)

To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).

DESIGN

Prospective cohort study.

PARTICIPANTS

Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).

MAIN MEASURES

The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

KEY RESULTS

All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95% Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

CONCLUSIONS

Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.

Social inequalities in suicide: the role of selective serotonin reuptake inhibitors

We aimed to examine the relationship between socioeconomic status (SES) and suicide associated with the introduction and diffusion of selective serotonin reuptake inhibitors (SSRIs). Negative binomial regression was used to estimate county-level suicide rates among persons aged 25 years or older using death certificate data collated by the National Center for Health Statistics from 1968 to 2009; SES was measured using the decennial US Census. The National Health and Nutrition Examination Survey and the Medical Expenditure Panel Survey were used to measure SSRI use. Once SSRIs became available in 1988, a 1% increase in SSRI usage was associated with a 0.5% lower suicide rate. Prior to the introduction of SSRIs, SES was not related to suicide. However, with each 1% increase in SSRI use, a 1-standard deviation (SD) higher SES was associated with a 0.6% lower suicide rate. In 2009, persons living in counties with SES 1 SD above the national average were 13.6% less likely to commit suicide than those living in counties with SES 1 SD below the national average--a difference of 1.9/100,000 adults aged ≥25 years. Higher SSRI use was associated with lower suicide rates among US residents aged ≥25 years; however, SES inequalities modified the association between SSRI use and suicide.

Hospitalization, depression and dementia in community-dwelling older Americans: findings from the national health and aging trends study

OBJECTIVE

The objective was to estimate the prevalence of both dementia and depression among community-dwelling older Americans and to determine if hospitalization is independently associated with dementia or depression in this population.

METHOD

This cross-sectional study utilized data from a nationally representative, population-based sample of 7197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self- or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2.

RESULTS

An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval [95% CI]: 1.16-1.73) and substantial depressive symptoms (OR: 1.60, 95% CI: 1.29-1.99).

CONCLUSIONS

Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bidirectional relationship between hospitalizations, dementia and depression, along with targeted interventions to reduce hospitalizations, is needed.