Sociodemographic and clinical correlates of number of previous depressive episodes in the depressed elderly

Association of social network factors with weight status and weight loss intentions among hispanic adults

Hispanic adults have the highest obesity prevalence in the United States, but little is known about weight-related social network influences. A community-based sample of 610 Hispanic participants completed height/weight and a survey. The proportion of overweight or obese (OW/OB) network members was higher for OW/OB respondents compared to normal weight respondents. Participants with high weight loss intentions reported more positive social norms for weight control, social support, and social cohesion. If most or all of OW/OB participant's social contacts were trying to lose weight, the odds that they were likely to try to lose weight was four times higher than other participants. The relationship between weight loss intentions and number of social contacts trying to lose weight was strongly mediated by social norms for weight control and social support. These results suggest that social contacts and functional network characteristics may impact weight status and weight control intentions among Hispanic adults.

Reconsidering residential mobility: Differential effects on child wellbeing by race and ethnicity

Residential mobility is a common experience among Americans, especially children. Most previous research finds residential mobility has negative effects on children's educational attainment, delinquency, substance abuse, and physical and mental health. Previous research, however, does not fully explore whether the effect of mobility differs by child race/ethnicity, in part because many of the samples used for these studies were majority white or exclusively non-white or disadvantaged. In addition, previous research rarely fully accounts for factors that predict selection into mobility and that may also be related to the outcome of interest. This study simultaneously addresses both of these limitations by estimating the effect of moving homes on children's emotional and behavioral wellbeing using first difference models and a diverse longitudinal sample from the Project on Human Development in Chicago Neighborhoods. I find that, after controlling for a wide range of individual, caregiver, household and neighborhood characteristics, the effects of moving among African American and Latino children are significantly worse than among white children.

The Effectiveness and Efficiency of Home-Based Nursing Health Promotion for Older People: A Review of the Literature

Despite the large potential role that community nurses have in providing individualized health promotion to older people, there is a lack of consensus in the literature regarding this role's effectiveness and efficiency. This article presents a literature review and synthesis of 12 randomized controlled trials selected from 344 published studies on preventive home visitation programs for older people. The findings suggest that a diversity of home visiting interventions carried out by nurses can favorably affect health and functional status, mortality rates, use of hospitalization and nursing homes, and costs. Further research is needed that focuses on the outcomes of quality of life, mental health, social support, caregiver burden, the acceptability of intervention, and specific subgroups of clients who benefit most. Findings also indicate the need for a theoretical foundation, increased emphasis on health-promotion strategies, and more research using a more complete economic evaluation to establish efficiency.

When perceptions defy reality: The relationships between depression and actual and perceived Facebook social support

BACKGROUND

Although the relationship between depression and "offline" social support is well established, numerous questions surround the relationship between "online" social support and depression. We explored this issue by examining the social support dynamics that characterize the way individuals with varying levels of depression (Study 1) and SCID-diagnosed clinically depressed and non-depressed individuals (Study 2) interact with Facebook, the world's largest online social network.

METHOD

Using a novel methodology, we examined how disclosing positive or negative information on Facebook influences the amount of social support depressed individuals (a) actually receive (based on actual social support transactions recorded on Facebook walls) and (b) think they receive (based on subjective assessments) from their Facebook network.

RESULTS

Contrary to prior research indicating that depression correlates with less actual social support from "offline" networks, across both studies depression was positively correlated with social support from Facebook networks when participants disclosed negative information (p=.02 in Study 1 and p=.06 in Study 2). Yet, depression was negatively correlated with how much social support participants thought they received from their Facebook networks (p=.005 in Study 1 and p=.001 in Study 2).

LIMITATIONS

The sample size was relatively small in Study 2, reflecting difficulties of recruiting individuals with Major Depressive Disorder.

CONCLUSIONS

These results demonstrate that an asymmetry characterizes the relationship between depression and different types of Facebook social support and further identify perceptions of Facebook social support as a potential intervention target. (243 words; 250 max).

Social support in late life mania: GERI-BD

OBJECTIVE

Using the database of the National Institute of Mental Health-sponsored acute treatment of late life mania study (GERI-BD), we assessed the role of social support in the presentation of late life bipolar mania.

METHODS

In the first 100 subjects randomized in geriatric BD, we explored the demographic, clinical, and social support characteristics (assessed using the Duke Social Support Index) and aspects of manic presentation. We selected two dependent variables: symptom severity, as determined by the Young Mania Rating Scale (YMRS) at baseline, and duration of episode. We selected nine potential independent variables on the basis of Pearson correlation coefficients. We derived two final models using multiple regression analysis employing an iterative process.

RESULTS

In our severity model, being married was associated with a higher YMRS score (p = 0.05), whereas higher social interaction scores with non-family members were associated with a lower YMRS score (p = 0.011). In the episode duration model, longer duration was associated with a higher Hamilton Depression Rating Scale score (p = 0.03) and higher social interaction scores with non-family members (p = 0.0003), younger age (p = 0.04), higher number of persons in one's family social network (p = 0.017), and higher instrumental support scores (p = 0.0062).

CONCLUSIONS

In late life mania, more social interaction with one's community appears to be associated with less severe symptoms at presentation for treatment, however, it can also be associated with slightly longer the duration of episode. Two aspects of the Duke Social Support Index are associated with a shorter episode duration prior to seeking treatment: being part of a larger family network and a having a higher level of instrumental support prior to treatment. The Instrumental Support Subscale measures the degree of assistance that is available for the respondent in performing daily tasks. These findings suggest that in older adults with BD, close social interactions and support are important in limiting the length of the illness episode prior to treatment. Social interactions involving non-family members may be less important in moderating the intensity of the symptoms at presentation.

A model predicting suicidal ideation and hopelessness in depressed older adults: the impact of emotion inhibition and affect intensity

The purpose of this study was to begin a preliminary examination of constructs theorized to be related to suicidal behavior by testing a model of the influence of both temperament and emotion regulation on suicidal ideation and hopelessness in a sample of depressed older adults. The model was evaluated using structural equation modeling procedures in a sample of depressed, older adults. Findings supported a temporally predictive model in which negative affect intensity and reactivity lead to emotion inhibition, operationalized as ambivalence over emotional expression and thought suppression, which in turn lead to increased presence of suicidal predictors, operationalized as hopelessness and suicidal ideation. These results suggest that suicide prevention efforts in older adults may be improved by targeting emotion inhibition in treatment, especially among affectively intense and reactive older adults.

Social support in elderly patients with bipolar disorder

OBJECTIVE

The role of social support in bipolar disorder is poorly understood. It is known that young and middle-aged patients with impaired social support are more likely to be treatment resistant and have increased hospitalization. However, the role of social support in elderly patients with bipolar disorder has not been studied. Our purpose was to evaluate social support in older adults with bipolar disorder compared with peer controls and younger bipolar patients. In addition, we looked at the role of social support in the age of illness onset.

METHODS

We evaluated social support of 29 older subjects with bipolar disorder (age 50 or older) and 56 younger subjects with bipolar disorder using the Duke Social Support Index, comparing them to non-psychiatric, peer controls. Using logistic regression we then examined the relationship of demographic, social support factors, and age of onset.

RESULTS

Both older and younger bipolar subjects perceived their social support as inadequate (OR = 14.98; OR = 9.05) compared with similar aged controls. Younger bipolar subjects also had less social interactions than younger controls (OR = 4.63). These findings remained significant when controlled for gender, marital status, race, and education. No significant differences were noted between early-onset and late-onset bipolar subjects.

CONCLUSIONS

Older and younger bipolar patients have decreased perceptions of social support than older controls. No effect was found based on the age of illness onset. In addition, younger subjects had less social interactions than peer controls.

Psychosocial and clinical predictors of unipolar depression outcome in older adults

BACKGROUND

This study examined psychosocial and clinical predictors of depression non-remittance among a sample of initially clinically depressed elders.

METHODS

Incident and prevalent unipolar depression cases (n = 166) were enrolled into the MHCRC for the Study of Depression in Late Life and followed for 12 months while undergoing treatment using a standardized algorithm. The outcome was remission vs non-remission (<6 vs > 7 on the Montgomery-Asberg Depression Rating Scale (MADRS)) at one-year follow-up. Baseline predictor variables included psychosocial factors, such as four domains of social support, basic and instrumental activities of daily living (ADLs), and clinical factors, which included use of ECT, past history of depression, comorbidities, and antidepressant treatment.

RESULTS

At one-year follow-up, 45% of the sample was in remission based upon MADRS scores. In bivariate analyses, non-remitted patients were more likely at baseline to use benzodiazepines, anxiolytic/sedatives, and/or MAO inhibitors than patients in remission, and have more depressive episodes. Among psychosocial factors, non-remitted patients had at baseline, more ADL and IADL problems and decreased subjective social support as compared to patients in remission. In logistic regression analyses more depression episodes, using anxiolytic/sedatives, more IADL problems and decreased subjective social support predicted poor depression outcome after one-year.

CONCLUSIONS

While clinical and diagnostic variables were related to improvement, baseline psychosocial factors were also important.

Distinction of early- and late-onset depression in the elderly by their lifetime symptomatology

OBJECTIVE

It has been proposed that early-onset depression (EOD) and late-onset depression (LOD) differ etiologically and phenomenologically. To validate the phenomenological distinction, the affective symptoms of elderly subjects with EOD and LOD were compared.

METHODS

Seventy-one patients with age-at-onset of depression below 60 years (EOD) and 67 age-matched patients with age-at-onset above 60 years (LOD) were consecutively recruited from the Departments of Psychiatry of the University of Mainz and the University of Bonn. To reduce the effect of interepisode variance of symptoms, we focused on the lifetime prevalence of different affective symptoms which were evaluated using the Composite International Diagnostic Interview (CIDI). Logistic regression analysis was performed to identify particular depressive symptoms which might discriminate EOD and LOD, and to account for possible sociodemographic differences between the two groups.

RESULTS AND CONCLUSION

Low spirits and feelings of worthlessness were more frequently found in EOD, they were sufficient discriminators to distinguish elderly subjects with EOD and LOD. This study provides further evidence for a phenomenological distinction between early- and late-onset depression in the elderly.

The impact of the organisation of mental health services on the quality of assessment provided to older patients with depression

OBJECTIVE

The objective of this study was to examine the impact of the organisation of mental health services on the quality of medical and psychiatric assessment provided to patients with depression over 50 years of age.

METHOD

A retrospective clinical audit of 99 patients with primary depressive disorders who were over 50 years of age was used. These patients were assessed initially by specialised psychogeriatric outpatient and community services (44%), community-based adult mental health services (35%) or an inpatient service (21%). At 2-3 years follow up, clinical outcomes were rated by treating physicians and included current depression status, cognitive and medical status, course of illness since initial assessment and current living circumstances.

RESULTS

Patients who were assessed by the community-based adult mental health service received the least comprehensive assessment. Although these patients were more likely to be living independently, they tended to have the poorest depression outcome. Patients who were assessed by the specialised or inpatient services received more comprehensive initial assessment and better coordinated long-term care. Although these patients had more medical and cognitive comorbidity they had better overall depression outcomes.

CONCLUSIONS

Within a service system that determines access according to an arbitrary age of onset, patients with depression receive the best assessment from specialised psychogeriatric services. However, patients with an early age of onset, more chronic disorders and poor outcomes are treated largely within community-based adult services. Psychiatric services need to ensure that all older patients with depression receive appropriate biomedical and psychosocial assessment, as well as continuity of medical and psychological treatment.

Depressive symptoms in the frail elderly: physical and psycho-social correlates

The elderly who suffer from chronic illness are at unusually high risk of depression and depressive symptoms. This study was conducted to describe the prevalence of depressive symptoms in a sample of chronically-ill elders and to examine the relationship between physical illness and depression, both as it is illuminated in a regression model and as it is understood by the respondents themselves. Interviews were conducted with a random sample of 100 clients in a community-based care program for low-income elderly at risk of nursing home placement. Over one-third of the sample (36%) reported significant depressive symptoms, as measured by the CES-D. Multiple regression analysis identified functional limitations, cognitive impairment and self-perception as significant correlates of depression in a model that explained 30 percent of the variance in CES-D scores.

Correlates of suicidal ideation among an elderly depressed sample

BACKGROUND

Suicidal ideation has been shown to be strongly associated with suicide completion and elders take their own lives more than any other age group.

METHODS

The present study examined clinical and phenomenological correlates of suicidal ideation among an elderly sample (n = 167) derived from subjects enrolled in the Duke Clinical Research Center for the Study of Depression in Late Life.

RESULTS

Bivariate results indicated that clinical variables associated with psychomotor retardation, a history of dysthymia, a previous psychiatric in-patient stay, and being a 'younger' elder were related to greater suicidal ideation. Multivariate analyses indicated that feeling guilty, sinful, or worthless was associated with over six times greater odds of having suicidal thoughts.

LIMITATIONS

Findings are based on correlational analyses, and thus, the direction of causality cannot be inferred.

CONCLUSIONS

This study provides evidence for clinicians of some of the 'red flags' associated with the presence of suicidal ideation among depressed older adults.

Perceived social support among depressed elderly, middle-aged, and young-adult samples: cross-sectional and longitudinal analyses

BACKGROUND

A number of studies have concluded that the perceived quality of support is more strongly associated with mental health than with the actual structure of personal networks. This study examined clinical, historical, and phenomenological variables associated cross-sectionally and longitudinally with perceived social support.

METHODS

Participants included elderly, middle-aged, and young-adult depressed samples derived from the Duke Clinical Research Center for the Study of Depression in Late Life.

RESULTS

Cross-sectional multivariate analyses revealed that perceived social support was: (1) for the elderly associated with pessimistic thinking, being divorced, having strange ideas, the degree of social interaction, and instrumental support; (2) for middle-age associated with dysthymia, divorce, pessimistic thoughts, social interaction, and instrumental support; and (3) among young adults with instrumental support only. Longitudinal multivariate analyses indicated that only perceived social support at Time 1 predicted perceived social support 1 year later among elderly and middle-aged subjects, whereas only instrumental support predicted perceived social support 1 year later among the young-adult sample.

LIMITATIONS

The small number of subjects among the young-adult sample limit conclusions regarding this group. In addition, only patients provided data. Future studies should consider using multiple informants to enhance the accuracy of reported social support.

CONCLUSIONS

Our findings indicate that in addition to whatever else they do for depressed patients, clinicians must endeavor to address relationship or social support difficulties, especially in the elderly.

Differences in geriatric psychiatry outpatients with early- vs late-onset depression

This study assessed clinical and demographic differences between 74 geriatric psychiatry outpatients with early-onset vs late-onset depression. The following data were considered: age, gender, marital status, years of education, number of prescription medications and active medical diagnoses (including presence of various categories of medical disorder), presence of any comorbid dementia or other psychiatric disorder, age of depression onset, number of depressive episodes and MMSE score. Fifteen patients (20.3%) had an early onset of depression (before age 60 years) and 59 (79.7%) had a late onset of depression. Early-onset patients had significantly more episodes of depression than late-onset patients (4.2 vs 1.9, t = 4.74, p < 0.001). Patients with early-onset depression also had a higher mean number of prescribed medications (5.3 vs 3.5, t = 2.29, p = 0.025) and active medical disorders (4.6 vs 3.1, t = 2.89, p = 0.005). Specifically, early onset of depression was associated with an elevated prevalence of cardiac disease (53.3% vs 23.7%, chi 2 = 5.0, df = 1, p = 0.025), diabetes (46.7% vs 16.9%, chi 2 = 6.0, df = 1, p = 0.015), gastrointestinal disorder (40.0% vs 12.0%, chi 2 = 6.5, df = 1, p = 0.011) and arthritis (26.7% vs 6.8%, chi 2 = 4.9, df = 1, p = 0.027). These findings support previous reports that people with a history of depression experience greater medical morbidity than those without a history of depression. The study groups did not differ with respect to MMSE score or presence of a concurrent dementia disorder. These results were unexpected given previous studies that indicate greater cognitive impairment in late- vs early-onset depression. The potential contribution of increased vascular risk factors among the early-onset depression group may have partly contributed to the finding of no difference in cognition between groups in the present study.

Psychosocial and physical correlates of chronic depression

This study used a case-control design to address differences in psychosocial, physical and clinical profiles between subjects who presented with a chronic index episode of major depression and those who presented with a non-chronic index episode. Subjects were adult patients participating in the Duke University Mental Health Clinical Research Center (MHCRC) for the Study of Depression in Later Life. Cases (N = 88) who reported duration of depressive symptoms lasting > or = 24 months at enrollment were compared to controls (N = 354) who reported symptoms lasting 1-12 months. The groups were compared with respect to selected demographic and clinical variables, physical function deficits, medical comorbidity, social support constructs and number of recent stressful life events. Social support and physical health were more relevant to chronicity of major depressive illness than were severity of illness or family history. Older age (> 60 years) intensified the deleterious effect of recent negative life events and reduced the deleterious effect of functional impairment on chronic major depression. These findings require special emphasis where treatment for chronic major depression is divorced from considerations of the social environment and functional capacity.