Global prevalence of depression in older adults: A systematic review and meta-analysis of epidemiological surveys

Associations between sarcopenia and depression in middle-aged and older adults: the moderating effect of smoking

The aim of this study were to estimate associations of sarcopenic status with depressive symptoms. We used mixed-effects linear model to estimate longitudinal association between sarcopenic status and rate of change in 10-item Center for Epidemiologic Studies Depression (CES-D) scores, and used Cox regression model to estimate the association between sarcopenic status and incident depression (CES-D ≥ 10). Stratification analyses were performed when the interactions between sarcopenic status and covariates were significant. A total of 6522 participants were ultimately included. After adjusting for covariates, participants with possible sarcopenia (β = 0.117; 95% CI 0.067 to 0.166; P < 0.001) and sarcopenia (β: 0.093; 95% CI 0.027-0.159; P < 0.001) had a faster increase in CES-D scores compared with normal individuals. Interactions between smoking and sarcopenic status were significant (Pinteraction < 0.05). We found significantly positive associations of sarcopenic status with CES-D scores in nonsmokers, but not in current and past smokers. Besides, compared with normal participants, those with possible sarcopenia (HR 1.15; 95% CI 1.05 to 1.27) and sarcopenia (HR 1.28; 95% CI 1.12 to 1.46) (Ptrend < 0.001) had elevated risks of incident depression. Sarcopenia is associated with a faster increase in CES-D scores and increased risks of depression among Chinese middle-aged and older adults. Stronger associations between sarcopenia and trajectory of CES-D scores were found in nonsmokers than in smokers.

Complement C1q/C3-CR3 signaling pathway mediates abnormal microglial phagocytosis of synapses in a mouse model of depression

BACKGROUND

Both functional brain imaging studies and autopsy reports have indicated the presence of synaptic loss in the brains of depressed patients. The activated microglia may dysfunctionally engulf neuronal synapses, leading to synaptic loss and behavioral impairments in depression. However, the mechanisms of microglial-synaptic interaction under depressive conditions remain unclear.

METHODS

We utilized lipopolysaccharide (LPS) to induce a mouse model of depression, examining the effects of LPS on behaviors, synapses, microglia, microglial phagocytosis of synapses, and the C1q/C3-CR3 complement signaling pathway. Additionally, a C1q neutralizing antibody was employed to inhibit the C1q/C3-CR3 signaling pathway and assess its impact on microglial phagocytosis of synapses and behaviors in the mice.

RESULTS

LPS administration resulted in depressive and anxiety-like behaviors, synaptic loss, and abnormal microglial phagocytosis of synapses in the hippocampal dentate gyrus (DG) of mice. We found that the C1q/C3-CR3 signaling pathway plays a crucial role in this abnormal microglial activity. Treatment with the C1q neutralizing antibody moderated the C1q/C3-CR3 pathway, leading to a decrease in abnormal microglial phagocytosis, reduced synaptic loss, and improved behavioral impairments in the mice.

CONCLUSIONS

The study suggests that the C1q/C3-CR3 complement signaling pathway, which mediates abnormal microglial phagocytosis of synapses, presents a novel potential therapeutic target for depression treatment.

Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study

BACKGROUND

To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data.

METHODS

Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression.

RESULTS

Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14).

CONCLUSION

About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.

Adherence to Mediterranean diet is inversely associated with depressive symptoms in older women: findings from the NutBrain Study

Data on the association of the Mediterranean diet (MD) with depressive symptoms in older people at high risk of depression are scarce. This study aimed to investigate the cross-sectional association of the adherence to the MD and its components with depressive symptoms in an Italian cohort of older men and women. A total of 325 men and 473 women aged 65–97 years (2019–2023) answered a 102-item semi-quantitative FFQ, which was used to calculate the Mediterranean diet score (MDS). Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale; subjects with a score of 16 or more were considered to have depression. Multivariable logistic regression was used for statistical analysis. The occurrence of depressive symptoms was 19·8 % (8·0 % men, 27·9 % women). High adherence to MDS (highest tertile) significantly reduced the odds of having depressive symptoms by 54·6 % (OR 0·454, 95 % CI 0·266, 0·776). In sex-stratified analysis, the reduction was evident in women (OR 0·385, 95 % CI 0·206, 0·719) but not in men (OR 0·828, 95 % CI 0·254, 2·705). Looking at the association of MDS components with depressive symptoms, we found an inverse significant association with fish consumption and the MUFA:SFA ratio above the median only in women (OR 0·444, 95 % CI 0·283, 0·697 and OR 0·579, 95 % CI 0·345, 0·971, respectively). High adherence to the MDS, and a high fish intake and MUFA:SFA ratio were associated with lower depressive symptoms in women only. Future longitudinal studies are needed to confirm these findings and to explore the underlying biological mechanisms.

24-hour movement behaviors time allocation and depression among Chinese community-dwelling older adults: A latent profile analysis

This study explored the combination characteristics of physical activity, sedentary behavior, and sleep among older adults during a 24-hour time allocation and analyzed the correlations between different combinations and depression. We recruited 648 older adults (mean age 72.65±7.03) from three communities in urban areas of central China and measured their physical activity, sedentary behavior, sleep quality, and depression. We used latent profile analysis to classify the time allocation of 24 h of movement behavior and binary logistic regression to analyze associations between different subgroups and depression. We found four classes of 24-hour movement behavior: moderately active-moderate sleepers (32.9 %), active-sedentary-short sleepers (17.8 %), sedentary-long sleepers (8.6 %), and active-short sleepers (40.7 %). Compared with moderately active-moderate sleepers, active-sedentary-short and sedentary-long sleepers were 2.953 and 4.813 times more likely to have depression, respectively. There was no statistically significant difference between active-short and moderately active-moderate sleepers. The results can inform preventive measures for depression in older adults.

Inter- and intrapopulation differences in the association between physical multimorbidity and depressive symptoms

BACKGROUND

The association between physical multimorbidity and depression differs by populations. However, no direct inter- or intrapopulation comparison of the association has been conducted. Thus, this study aims to estimate the association in China and the United States and reveal inter- and intrapopulation differences in the association.

METHODS

Middle-aged and older adults from the China Health and Retirement Longitudinal Study and the Health and Retirement Study were included. Physical multimorbidity was defined as the simultaneous presence of two or more chronic physical conditions and depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Generalized estimating equation model and stratification multilevel method were the main statistical models.

RESULTS

The presence of physical multimorbidity was associated with a higher risk of depression in both China (RR = 1.360 [95 % CI: 1.325-1.395]) and the US (RR = 1.613 [95 % CI: 1.529-1.701]). For individuals at a low risk of multimorbidity, multimorbidity was associated with 47.4 % (95 % CI: 1.377-1.579) and 71.1 % (95 % CI: 1.412-2.074) increases in the likelihood of depression in China and the US. The effect size was smaller for individuals at a moderate or high risk. However, the cross-national differences were greater for those with a high risk of multimorbidity.

LIMITATIONS

The self-report measures, attribution bias.

CONCLUSIONS

Compared to Chinese adults, the presence of physical multimorbidity led to an additional increase in depressive symptoms for American counterparts. The association was stronger for individuals at a low risk of multimorbidity, but cross-national differences were observed mostly among individuals at a high risk.

Abuse and other factors related to depression in older Ecuadorian adults

Objective

To identify abuse and other risk factors associated with depression in older Ecuadorian adults using data from the 2012 Ecuador's Survey of Health, Welfare, and Aging (SABE).

Methods

This cross-sectional study analyzed data from the 2012 SABE survey, which included 5235 adults aged 60 and above. The study evaluated residence, education level, ethnic self-identification, self-perceived health and memory, loneliness, cognitive status, and abuse. Depression was assessed using the Yesavage Depression Scale, short version (YDS-SV). Categorical variables were analyzed with the Chi-square test, differences between groups were calculated with the Kruskal-Wallis test, and multiple linear regression analysis was performed. A p-value of ≤0.05 was considered statistically significant.

Results

The mean age was 71.39 ± 8.59 years and 55.10% of the sample were women. Abuse was absent in 72.1% (3.773) of the population. The Chi-square test indicated significant associations between depression and poor self-reported health (P = 0.000) and indigenous ethnicity (P = 0.000). Multiple linear regression analysis revealed that age (P < 0.001), abuse (p < 0.001), cognitive status (P = 0.002), and living alone (P = 0.034) significantly contributed to mood as assessed by the YDS-SV. No statistically significant association was found for perceived health status or place of residence (urban or rural).

Conclusions

Risk factors associated with depression in older Ecuadorian adults include advanced age, living alone, cognitive decline, poor self-perception of health and cognition, and abuse.

Decoding emotional resilience in aging: unveiling the interplay between daily functioning and emotional health

Background

EPs pose significant challenges to individual health and quality of life, attracting attention in public health as a risk factor for diminished quality of life and healthy life expectancy in middle-aged and older adult populations. Therefore, in the context of global aging, meticulous exploration of the factors behind emotional issues becomes paramount. Whether ADL can serve as a potential marker for EPs remains unclear. This study aims to provide new evidence for ADL as an early predictor of EPs through statistical analysis and validation using machine learning algorithms.

Methods

Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) national baseline survey, comprising 9,766 samples aged 45 and above, were utilized. ADL was assessed using the BI, while the presence of EPs was evaluated based on the record of "Diagnosed with Emotional Problems by a Doctor" in CHARLS data. Statistical analyses including independent samples t-test, chi-square test, Pearson correlation analysis, and multiple linear regression were conducted using SPSS 25.0. Machine learning algorithms, including Support Vector Machine (SVM), Decision Tree (DT), and Logistic Regression (LR), were implemented using Python 3.10.2.

Results

Population demographic analysis revealed a significantly lower average BI score of 65.044 in the "Diagnosed with Emotional Problems by a Doctor" group compared to 85.128 in the "Not diagnosed with Emotional Problems by a Doctor" group. Pearson correlation analysis indicated a significant negative correlation between ADL and EPs (r = -0.165, p < 0.001). Iterative analysis using stratified multiple linear regression across three different models demonstrated the persistent statistical significance of the negative correlation between ADL and EPs (B = -0.002, β = -0.186, t = -16.476, 95% CI = -0.002, -0.001, p = 0.000), confirming its stability. Machine learning algorithms validated our findings from statistical analysis, confirming the predictive accuracy of ADL for EPs. The area under the curve (AUC) for the three models were SVM-AUC = 0.700, DT-AUC = 0.742, and LR-AUC = 0.711. In experiments using other covariates and other covariates + BI, the overall prediction level of machine learning algorithms improved after adding BI, emphasizing the positive effect of ADL on EPs prediction.

Conclusion

This study, employing various statistical methods, identified a negative correlation between ADL and EPs, with machine learning algorithms confirming this finding. Impaired ADL increases susceptibility to EPs.

When Movement Therapy Meets Spirituality: A Quasi-Experiment

Depression is a public health issue in older adults. This study followed a participatory train-the-trainer approach to develop the Movement-based x 'Elderspirituality-Fu Le Man Xin' intervention. Additionally, a quasi-experimental design was followed to evaluate the effectiveness of the intervention. Data were collected from pre-and post-intervention assessments. A total of 135 older adults with depressive symptoms were recruited, 77 received the intervention and 58 received an active control intervention. Repeated measures ANCOVA showed that the 'Movement-based x 'Elderspirituality-Fu Le Man Xin' intervention significantly reduced depression in cognitively sound participants (F(1, 73) = 62.346, p < .001).

Personality traits and depressive symptoms among Chinese older people: A network approach

BACKGROUND

The present study aims to investigate the network structure of depressive symptoms, the interrelationships between individual personality traits and depressive symptoms, and gender differences among Chinese older people aged 60 and above.

METHOD

We performed network analyses with a regularized Graphical Gaussian Model and a case-dropping bootstrap approach. A sample of 4876 older Chinese people aged 60+ was included in the analyses. We investigated the central symptoms in the depression network and the bridge nodes that connect personality facets and depressive symptoms. Gender differences were investigated by testing the global strength, network invariance, and edge weights.

RESULTS

Sadness and depressed mood were the most central depressive symptoms, while somatic symptoms such as restless sleep were the least central. Neurotic facets, particularly "worry a lot" and "get nervous easily", played significant bridging roles in the web of personality traits and depressive symptoms. Gender differences were observed in three edges among different personality traits (rude-worried, original-worried, and forgiving-nervous).

LIMITATION

The study adopts a cross-sectional dataset, and therefore, cannot track the network changes over time or conclude a causal relationship.

DISCUSSION

The study calls for more focus and prioritization on sadness, depressed mood and neurotic traits in the identification of depression among older Chinese people. Future researchers and practitioners should better understand of older Chinese adults' worry and nervousness to develop appropriate practices and policies.

The Effects of a Healthy Lifestyle on Depressive Symptoms in Older Chinese Adults: The Mediating Role of Psychological Resilience

Objectives This study aimed to validate the interrelationships and potential pathways of influence between healthy lifestyles, psychological resilience, and depressive symptoms in the Chinese elderly population. Methods We utilized data from the Chinese Elderly Health Influential Factors Tracking Survey 2018 and included 9448 samples for the study after screening according to the qualifying conditions. The interrelationships among healthy lifestyles, psychological resilience and depressive symptoms were analyzed using stepwise regression, and the robustness of mediation effects was assessed using Sobel and Bootstrap test. Results Among Chinese older adults, healthy lifestyles were negatively associated with depressive symptoms (β = -0.310, 95% CI: -0.405, -0.215), positively associated with psychological resilience (β = 0.137, 95% CI:0.071, 0.023), and psychological resilience was negatively associated with depressive symptoms (β = -1.014, 95% CI: -1.037, -0.990). Conclusions Psychological resilience partially mediated the association between healthy lifestyles and depressive symptoms, with the mediating effect accounting for 44.8% of the total effect. Our study contributes to the understanding of the relationship between healthy lifestyles and depressive symptoms in the elderly population and emphasizes the important role of psychological resilience. It is recommended that the government and policymakers improve depressive symptoms among older adults through comprehensive measures such as promoting healthy lifestyles and education, providing psychological support services, and creating a favorable environment.

The effect of spiritual reminiscence therapy on depression and hope among Iranian older adults: a quasi-experimental study

This quasi-experimental study aimed to evaluate the impact of spiritual reminiscence therapy (SRT) on depression and hope among older adults living in Shahroud, northeast of Iran. One hundred fifty-six older adults were selected through convenience sampling and assigned non-randomly to the intervention (n= 78) and control (n= 78) groups. The data collection tools included the Geriatric Depression Scale and Adult Hope Scale. For the intervention group, SRT was conducted in six weekly sessions, each lasting 60 to 90 min, over six weeks. The data were analyzed utilizing descriptive statistics and inferential tests (independent t-test, Chi-square test, and analysis of covariance). The two groups' post-intervention mean scores on depression (t= 11.63 and P< 0.001), and hope (t= 4.41 and P< 0.001) were statistically different, suggesting that SRT positively affected older adults by alleviating despair and boosting hope. The findings indicate that engaging in SRT can be beneficial in reducing depression and fostering hope among older adults.

The Level of Expectations Regarding Aging Among Older Adults: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the level of expectations regarding aging (ERA) among older adults.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults aged 60 years and older in any setting.

METHODS

We searched 11 databases for cross-sectional studies that reported ERA scores among older adults using the ERA survey from inception to May 1, 2022, without language restrictions. Two researchers independently selected studies, extracted data, and assessed quality. The mean scores and standard deviations of the ERA survey and its subscales were pooled using the Stata software (version 17.0).

RESULTS

Twelve studies with 3664 participants were included in this study. The pooled mean scores of overall ERA were 37.85 (95% CI, 33.54-42.16). Specifically, the pooled scores for expectations regarding physical health, mental health, and cognitive function were 31.67 (95% CI, 27.42-35.92), 43.69 (95% CI, 38.99-48.39), and 33.28 (95% CI, 29.56-37.00), respectively. No statistically significant differences between groups were observed in any subgroup analysis.

CONCLUSIONS AND IMPLICATIONS

The level of ERA among older adults is relatively low, particularly concerning cognitive function and physical health dimensions. These findings may provide a valuable reference for public health professionals and policymakers to intervene and manage the health problems of older adults.

Association between residential greenness and depression symptoms in Chinese community-dwelling older adults

BACKGROUND

Studies of residential greenness and depression symptoms among community-dwelling older adults in China are limited. However, understanding the role of greenness in depression symptoms among older adults can inform depression prevention and interventions.

OBJECTIVE

This study explored the relationship between residential greenness and depression symptoms among community-dwelling older adults in China.

METHODS

A cluster random sampling method was used to survey 7512 community-dwelling adults aged 60 and above from three towns in Shanghai. Depression symptoms were assessed using the Geriatric Depression Scale (GDS30). Residential greenness was measured using the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI). Long-term greenspace exposure was defined as the mean NDVI and EVI in the three years prior to the baseline survey. Controlling for the covariates, the relationship between greenness and depression symptoms was assessed using binomial logistic regression and mixed-effects linear regression. Interaction analysis was conducted to explore which covariates potentially alter the association. We also assessed the mediating role of physical activity.

RESULTS

The prevalence of depression symptoms among the participants was 13.72%. Higher residential greenness was associated with lower odds of depression symptoms, after adjusting for covariates. In the logistic regression analysis, the odds of depression symptoms decreased with increasing NDVI and EVI. In linear regression analysis, GDS30 scores decreased with increasing NDVI and EVI. Interaction analyses revealed that higher NDVI and EVI were more protective against depression among male individuals and older adults living with others than among female individuals and older adults living alone. Additionally, physical activity had a masking effect on residential greenness and depression symptoms.

CONCLUSION

Higher residential greenness is associated with lower odds of depression symptoms in community-dwelling Chinese older adults. Increasing urban and neighborhood green spaces may contribute to the prevention and intervention of depression symptoms in community-dwelling older adults.

Cognitive decline among older adults with depressive symptoms before and during the COVID-19 pandemic

BACKGROUND

Whether the COVID-19 pandemic would induce accelerated cognitive decline in individuals with depressive symptoms is undetermined.

OBJECTIVE

To investigate the impact of the COVID-19 pandemic on cognitive function among older adults with depressive symptoms.

METHODS

Data were from the Health and Retirement Study. The interval between wave 13 and wave 14 was defined as the prepandemic period, and the interval between wave 14 and wave 15 was defined as the pandemic period. Linear mixed models and modified Poisson regression models were employed to compare the differences in cognitive decline and incident dementia between participants with and without depressive symptoms before and during the pandemic.

RESULTS

A total of 9304 participants were included. During the prepandemic period, no significant difference was observed in changes in cognitive scores between participants with and without depressive symptoms. During the pandemic period, an accelerated decline in cognitive scores was found between the two groups (global cognition: -0.25, 95 % CI: -0.41 to -0.08, P = 0.004; memory: -0.16, 95 % CI: -0.31 to -0.02, P = 0.030; executive function: -0.08, 95 % CI: -0.15 to -0.02, P = 0.014). Participants with depressive symptoms had a higher risk of developing dementia during the pandemic (RR: 1.48, 95 % CI: 1.17 to 1.88, P < 0.001).

LIMITATIONS

Causal relationship cannot be concluded due to the observational study design.

CONCLUSIONS

Older adults with depressive symptoms suffered more severe cognitive deterioration and had a higher risk of incident dementia during the pandemic, underscoring the need to provide cognitive monitoring and interventions for those with depressive symptoms during the COVID-19 pandemic.

Psychological aspects of rehabilitation nutrition: A position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication)

Psychological aspects of rehabilitation nutrition affect physical, cognitive, and social rehabilitation nutrition. When depression is recognized, not only pharmacotherapy and psychotherapy, but also non-pharmacological therapies such as exercise, nutrition, psychosocial, and other interventions can be expected to improve depression. Therefore, accurate diagnosis and intervention without overlooking depression is important. Psychological aspects of preventive rehabilitation nutrition is also important because depression can be partially prevented by appropriate exercise and nutritional management. Even in the absence of psychological negatives, increasing more psychological positives from a positive psychology perspective can be useful for both patients and healthcare professionals. Positive rehabilitation nutrition interventions can increase more psychological positives, such as well-being, through cognitive-behavioral therapy and mindfulness on their own, as well as through interventions on environmental factors. Consequently, physical, cognitive, and social positives are also expected to be enhanced.

Explaining the Urban-Rural Difference in Late-Life Depression in India: Evidence from a Multivariate Decomposition Analysis Based on Longitudinal Aging Study in India, Wave 2017-18

OBJECTIVES

The study explored the associated factors of depression among older Indian adults and the influences of individual and socio-environmental factors in explaining the rural-urban difference in the prevalence of late-life depression.

METHODS

Data come from the Longitudinal Aging Study in India, with a sample of 30,637 older adults aged 60 and above. Multivariable logistic regression and nonlinear multivariate decomposition analyses were conducted to fulfill the objectives.

RESULTS

About 6.2% older adults in urban areas and 9.5% in rural areas were depressed. Older adults in rural areas had significantly higher likelihood to be depressed than those in urban areas. Poor self-rated health, multiple chronic conditions, functional difficulty, low life satisfaction, social inactivity, low satisfaction with living arrangement, ill-treatment and being widowed increased the risk of depression. Additionally, work status similar to urban older adults, physical activity, living arrangement satisfaction, self-rated health and ill-treatment would decrease the urban-rural difference in depression.

CONCLUSIONS

The study showed significant rural-urban difference in late-life depression, with a rural disadvantage.

CLINICAL IMPLICATIONS

The findings suggest the need for identifying at-risk populations and developing a framework of targeted policy interventions for mitigating the increased risk of late-life depression among older Indians and in rural areas in particular.

Association between activities of daily living and depressive symptoms among older adults in China: evidence from the CHARLS

Objective

The limitation of activities of daily living (ADL) affects the mental health of older adults. We distinguished activities of daily living into basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and aimed to explore the relationship between the two limitations and depressive symptoms among Chinese older adults by using nationally representative cross-sectional data.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS, wave 4) were used, and 9,789 older adults aged 60 years and above were screened. The 10-item Center for Epidemiologic Studies Depression (CES-D-10) scale was used to measure the depressive symptoms of older adults, and a 12-item scale for ADL was used to estimate functional limitations. Generalized linear mixed-effect models were employed to examine the relationship between BADL/IADL and depressive symptoms among older adults.

Results

The prevalence of high-risk depression among older adults was 43.5%, and the rates of limitation in BADL and IADL were 19.02 and 25.29%, respectively. The prevalence of high-risk depression significantly differed among subgroups of smoking, drinking, chronic diseases, duration of sleep, having social activities or not, and the type of medical insurance. Older adults with limited BADL or IADL were at a higher risk of depression than those without limitations of BADL or IADL; BADL (OR-adjusted = 2.71; 95% CI: 2.40-3.06) and IADL (OR-adjusted = 2.68; 95% CI: 2.41-2.98) had various influences on the risk of depression in older adults.

Conclusion

ADL was a related factor in the risk of depression among older adults in China. BADL and IADL had different effects on the risk of depression, suggesting that older adults with physical function limitations might be more likely to suffer from depression.

Depression and risk of sarcopenia: a national cohort and Mendelian randomization study

Background

Depression and the increased risk of sarcopenia are prevalent among the elderly population. However, the causal associations between these factors remain unclear. To investigate the potential association between depression and the risk of sarcopenia in older adults, this study was performed.

Methods

In the baseline survey, a total of 14,258 individuals aged 40 and above from the China Health and Retirement Longitudinal Study (2015) participated. We initially described the baseline prevalence of the disease. Then, logistic regression and restricted cubic spline (RCS) regression were conducted to assess the relationship between depression and sarcopenia. Subgroup analysis was performed to validate the robustness of the findings. Additionally, we conducted Mendelian randomization analysis using the inverse variance weighting estimator to assess the causal relationship between depression and sarcopenia. Furthermore, we adopted six methods, including MR-Egger, simple median, weighted median, maximum likelihood, robust adjusted profile score (RAPS), and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO), for sensitivity analyses.

Results

Depression patients exhibited higher risks of sarcopenia in all five models adjusting for different covariates (P < 0.05). The RCS analysis demonstrated a linear relationship between depression and sarcopenia (P < 0.05). In the subgroup analysis, increased risk was observed among participants aged 60-70, married or cohabiting individuals, non-smokers, non-drinkers, those with less than 8 h of sleep, BMI below 24, and individuals with hypertension (all P < 0.05). Mendelian randomization results revealed that genetically proxied depression led to a reduction in appendicular skeletal muscle mass (all P < 0.05).

Conclusion

Our study provides observational and causal evidences that depression can lead to sarcopenia. This finding emphasizes the importance of timely identification and management of depression, as well as implementing targeted educational programs as part of comprehensive strategies to prevent sarcopenia.

Depressive Disorders, Cognitive and Physical Function of Older People in Early Dementia Detection

BACKGROUND

Aging is associated with cognitive decline, leading to cognitive and physical impairments, which are risk factors for loss of independence and dementia development. Early diagnosis is beneficial for both, the patient and their family, to avoid long-term consequences. The aim of this study was to analyze the frequency of depressive disorders and their influence on cognitive and physical function of older people in early dementia detection.

METHODS

There were 852 patients, aged at least 60 years, from the Central Teaching Hospital. The study was conducted between September 2022 and June 2023. The qualified participants were examined using four tools: Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Timed Up and Go (TUG) and Schulman's Clock-Drawing Test.

RESULTS

Over one-third had depressive disorders. A relationship with p < 0.05 was observed between GDS and IADL: r = -0.61. A relationship with p > 0.05 was observed between GDS and TUG: r = -024. A relationship with p < 0.05 was observed between GDS and CDT: r = 0.74.

CONCLUSIONS

The first signs of depressive disorders in older people may be considered an indication for further diagnosis of dementia.

Relationships among oral hygiene behavior, toothache, and depressive symptoms in Chinese older adults

OBJECTIVES

The study aims to investigate the relationships among oral hygiene behavior, toothache, and depression among Chinese older adults.

METHODS

We used data came from the 2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The Center for Epidemiologic Studies Depression Scale was used to evaluate depression. Binary logistic regression was performed to analyze the relationships among oral hygiene behavior, toothache, and depression.

RESULTS

A total of 12,172 older adults were included in the study, of whom 27.2% had depression. Compared with those who did not brush their teeth daily, those who brushed their teeth at least once daily exhibited lower odds of having depressive symptoms (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.77-0.97 versus OR = 0.81, 95% CI = 0.71-0.93). Compared with those who did not have toothache, those who had toothache over the past 6 months exhibited higher odds of having depression (OR = 1.49, 95% CI = 1.33-1.68). Living arrangement had a significant effect on the correlation between toothache and depression (p = 0.049), who lived alone and had toothache exhibited higher odds of having depressive symptoms.

CONCLUSIONS

Oral hygiene behavior and toothache are associated with depression. Taking effective measures to maintain a daily toothbrushing pattern and reduce the occurrence of toothache may mitigate the risk of depression among older adults, especially among those living alone.

CLINICAL RELEVANCE

The present study reports that the potential relationship between different oral hygiene behavior, toothache, and depressive symptoms.

Social activities and long-term depressive-symptoms trajectories among middle-aged and older adults in China: a population-based cohort study

Background

The association between social activities and depressive symptoms remains unclear. This study aimed to explore the relationship between social activities at baseline and the long-term depressive-symptoms trajectories among a cohort of middle-aged and older adults in China.

Methods

This study included 13,258 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms across four waves from 2011 to 2018 were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Four types of social activities were assessed at baseline by self-report: (1) interacting with friends; (2) playing Mahjong, chess, and cards or attending a community club; (3) providing help to family, friends, or neighbors; and (4) attending a sporting or social event or club. Group-based trajectory modeling (GBTM) was used to map depressive-symptoms trajectories during the follow-up period.

Results

Not interacting with friends at baseline was associated with an increased risk of increasing (adjusted odds ratio [aOR]: 1.21, 95% confidence interval [CI]: 1.03, 1.41) and severe-stable (aOR: 1.35, 95% CI: 1.10, 1.65) depressive-symptoms trajectories. Participants who did not play Mahjong, cards, or chess and did not attend a sporting or social event or club at baseline were more likely to have mild-stable, decreasing, increasing, and severe-stable depressive-symptoms trajectories.

Conclusion

Social activities play an important role in long-term depressive-symptoms trajectories in middle-aged and older Chinese adults. Interacting with friends, attending sports, or social clubs may prevent depressive symptoms.

Increased vigorous exercise and decreased sedentary activities are associated with decreased depressive symptoms in United States adults: Analysis of The National Health and Nutrition Examination Survey (NHANES) 2017-2020

Background and aims

Depression is a major public health concern that affects over 4% of the global population. Identification of new nonpharmacologic recommendations will help decrease the burden of disease. The overarching of this study was to examine the association between physical activity and depressive symptoms in a large sample of adults in the United States.

Methods

Presently, researchers utilized data from the National Health and Nutrition Examination Surveys (NHANES 2017-2020), which is a retrospective, complex, multistage, representative, and modern cohort of the United States. Adult patients ( > 18 years; N = 8091) with complete 9-item Patient Health Questionnaire (PHQ-9) information were included in the study. The PHQ-9 is a well-validated survey, per literature, scores ≥10 are considered to have clinically relevant depression. Univariable and multivariable logistic regression was fit for active and sedentary activities on clinical depression (PHQ-9 ≥ 10). The acquisition and analysis of the data within this study were approved by the National Center for Health Statistics Ethics Review Board.

Results

After adjusting for potential confounders like age, race, sex, and income, we found that increased vigorous exercise was associated with lower rates of depressive symptoms. Each extra day of vigorous exercise was associated with 11% decreased odds of depression (odd ratio [OR]: 0.89, confidence interval [CI]: 0.83-0.96, p < 0.01). Increased sedentary activity was associated with increased depression. Each extra hour per day of sedentary activity was associated with a 6% increase in odds of depression (OR: 1.06, (1.02-1.10, p < 0.01).

Conclusion

To conclude, exercise appears to be protective against depressive symptoms; however, further prospective studies are required to ascertain whether exercise causes decreased depressive symptoms.

Wearable and Mobile Technologies for the Evaluation and Treatment of Obsessive-Compulsive Disorder: Scoping Review

BACKGROUND

Smartphones and wearable biosensors can continuously and passively measure aspects of behavior and physiology while also collecting data that require user input. These devices can potentially be used to monitor symptom burden; estimate diagnosis and risk for relapse; predict treatment response; and deliver digital interventions in patients with obsessive-compulsive disorder (OCD), a prevalent and disabling psychiatric condition that often follows a chronic and fluctuating course and may uniquely benefit from these technologies.

OBJECTIVE

Given the speed at which mobile and wearable technologies are being developed and implemented in clinical settings, a continual reappraisal of this field is needed. In this scoping review, we map the literature on the use of wearable devices and smartphone-based devices or apps in the assessment, monitoring, or treatment of OCD.

METHODS

In July 2022 and April 2023, we conducted an initial search and an updated search, respectively, of multiple databases, including PubMed, Embase, APA PsycINFO, and Web of Science, with no restriction on publication period, using the following search strategy: ("OCD" OR "obsessive" OR "obsessive-compulsive") AND ("smartphone" OR "phone" OR "wearable" OR "sensing" OR "biofeedback" OR "neurofeedback" OR "neuro feedback" OR "digital" OR "phenotyping" OR "mobile" OR "heart rate variability" OR "actigraphy" OR "actimetry" OR "biosignals" OR "biomarker" OR "signals" OR "mobile health").

RESULTS

We analyzed 2748 articles, reviewed the full text of 77 articles, and extracted data from the 25 articles included in this review. We divided our review into the following three parts: studies without digital or mobile intervention and with passive data collection, studies without digital or mobile intervention and with active or mixed data collection, and studies with a digital or mobile intervention.

CONCLUSIONS

Use of mobile and wearable technologies for OCD has developed primarily in the past 15 years, with an increasing pace of related publications. Passive measures from actigraphy generally match subjective reports. Ecological momentary assessment is well tolerated for the naturalistic assessment of symptoms, may capture novel OCD symptoms, and may also document lower symptom burden than retrospective recall. Digital or mobile treatments are diverse; however, they generally provide some improvement in OCD symptom burden. Finally, ongoing work is needed for a safe and trusted uptake of technology by patients and providers.

Relationships between Physical Activity and Selected Chronic Diseases among Functionally Independent Long-Term Care Residents during the Post-Lockdown Period in Croatia

The aim of this observational study was to investigate the level and association of physical activity and selected chronic diseases in functionally independent LTC residents after prolonged physical and social isolation during COVID-19 in Croatia. Adhering to the inclusion criteria, 180 functionally independent residents were included in the study. Assessment of physical activity was carried out by 7-day motor monitoring. Prolonged physical and social isolation negatively affected the achieved level of physical activity of LTC residents (x¯ = 5058.74). Major depressive disorder resulted in significantly lower residents' physical activity scores, demonstrating a shrinking effect ranging from 0.42 to 0.45. A significant negative impact on the residents' physical activity was also found in the presence of osteoarthritis and iron deficiency anemia, where a downward effect was present in the range from 0.66-0.72 and 0.64 to 0.66. The presence of comorbidities has a significant negative impact on the residents' physical activity, where a downward effect is present in the range from 0.91-0.92.

Bidirectional causal relationship between depression and frailty: a univariate and multivariate Mendelian randomisation study

BACKGROUND

cumulative evidence from cohort studies suggested that there were inconsistent conclusions as to whether there was a bidirectional association between depression and frailty. Therefore, this study used a bidirectional two-sample Mendelian randomisation (MR) study to investigate the causal relationship between depression and frailty.

METHODS

we performed univariate and multivariate bidirectional MR analyses to assess the causal association between depression and frailty. Independent genetic variants associated with depression and frailty were selected as instrumental variables. Inverse variance weighted (IVW), MR-Egger, weighted median and weighted mode were mainly used in univariate MR analysis. Multivariate MR (MVMR) analyses used multivariable inverse variance-weighted methods to individually and jointly adjust for three potential confounders, body mass index (BMI), age at menarche (AAM) and waist-to-hip ratio (WHR, adjusted for BMI).

RESULTS

univariate MR analysis showed a positive causal relationship between depression and risk of frailty (IVW, odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.23-1.37, P = 6.54E-22). Causal relationship between frailty and risk of depression (IVW, OR = 1.69, 95% CI = 1.33-2.16, P = 2.09E-05). MVMR analysis revealed that the bidirectional causal association between depression and frailty remained after adjusting for three potential confounders, BMI, AAM and WHR (adjusted for BMI), individually and in combination.

CONCLUSIONS

our findings supported a causal relationship between genetically predicted depression and frailty in both directions.

Association between depression and macrovascular disease: a mini review

Depression and macrovascular diseases are globally recognized as significant disorders that pose a substantial socioeconomic burden because of their associated disability and mortality. In addition, comorbidities between depression and macrovascular diseases have been widely reported in clinical settings. Patients afflicted with coronary artery disease, cerebrovascular disease or peripheral artery disease exhibit an elevated propensity for depressive symptoms. These symptoms, in turn, augment the risk of macrovascular diseases, thereby reflecting a bidirectional relationship. This review examines the physiological and pathological mechanisms behind comorbidity while also examining the intricate connection between depression and macrovascular diseases. The present mechanisms are significantly impacted by atypical activity in the hypothalamic-pituitary-adrenal axis. Elevated levels of cortisol and other hormones may disrupt normal endothelial cell function, resulting in vascular narrowing. At the same time, proinflammatory cytokines like interleukin-1 and C-reactive protein have been shown to disrupt the normal function of neurons and microglia by affecting blood-brain barrier permeability in the brain, exacerbating depressive symptoms. In addition, platelet hyperactivation or aggregation, endothelial dysfunction, and autonomic nervous system dysfunction are important comorbidity mechanisms. Collectively, these mechanisms provide a plausible physiological basis for the interplay between these two diseases. Interdisciplinary collaboration is crucial for future research aiming to reveal the pathogenesis of comorbidity and develop customised prevention and treatment strategies.

Predicting depressive symptom by cardiometabolic indicators in mid-aged and older adults in China: a population-based cross-sectional study

Objective

Depressive symptom is a serious mental illness often accompanied by physical and emotional problems. The prevalence of depressive symptom in older adults has become an increasingly important public health priority. Our study used cardiometabolic indicators to predict depressive symptom in middle-aged and older adults in China.

Methods

The data came from the China Health and Retirement Longitudinal Study 2011 (CHARLS2011), which was a cross-sectional study. The analytic sample included 8,942 participants aged 45 years or above. The study evaluated the relationship between cardiometabolic indicators and depression by measuring 13 indicators, including body mass index (BMI), waist circumference, waist-height ratio (WHtR), conicity index, visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-waist circumference, TyG-WHtR). Binary logistic regression analysis was used to examine the association between thirteen cardiometabolic indicators and depressive symptom. In addition, the receiver operating characteristic (ROC) curve analysis and area under curve (AUC) were used to evaluate the predictive anthropometric index and to determine the optimum cut-off value.

Results

The study included 8,942 participants, of whom 4,146 (46.37%) and 4,796 (53.63%) were male and female. The prevalence of depressive symptom in mid-aged and older adults in China was 41.12% in males and 55.05% in females. The results revealed that BMI [AUC = 0.440, 95%CI: 0.422-0.457], waist circumference [AUC = 0.443, 95%CI: 0.425-0.460], WHtR [AUC = 0.459, 95%CI: 0.441-0.476], LAP [AUC = 0.455, 95%CI: 0.437-0.472], BRI [AUC = 0.459, 95%CI: 0.441-0.476], CVAI [AUC = 0.449, 95%CI: 0.432-0.467], TyG-BMI [AUC = 0.447, 95%CI: 0.429-0.465], and TyG-waist circumference [AUC =0.452, 95%CI: 0.434-0.470] were weak predictors of depressive symptom (p < 0.05) in males. In females, BMI [AUC = 0.470, 95%CI: 0.453-0.486], LAP [AUC = 0.484, 95%CI: 0.467-0.500], TyG-BMI [AUC = 0.470, 95%CI: 0.454-0.487], and TyG-waist circumference [AUC =0.481, 95%CI: 0.465-0.498] were weak predictors of depressive symptom (p < 0.05). On the other side, VAI, ABSI, conicity index and TyG index could not predict depressive symptom in middle-aged and older adults.

Conclusion

Most cardiometabolic indicators have important value in predicting depressive symptom. Our results can provide measures for the early identification of depressive symptom in middle-aged and older adults in China to reduce the prevalence of depressive symptom and improve health.

Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis

Background

This study was designed to investigate the prevalence and predictors of depression in patients after pacemaker implantation during the COVID-19 pandemic in addition to identifying specific depressive symptoms associated with quality of life (QOL) using network analysis (NA).

Methods

This cross-sectional, observational study was conducted in China between July 1, 2021, and May 17, 2022. Descriptive analysis was used to calculate depression prevalence. Univariate analyses were used to compare differences in demographic and clinical characteristics between depressed and non-depressed patients following pacemaker implantation. Binary logistic regression analysis was used to assess factors independently associated with depression. Network analysis “expected influence,” and flow function indexes were used to identify symptoms central to the depression network of the sample and depressive symptoms that were directly associated with QOL, respectively. Network stability was examined using a case-dropping bootstrap procedure.

Results

In total, 206 patients implanted with a pacemaker met the study entry criteria and completed the assessment. The overall prevalence of depression (PHQ-9 total score ≥ 5) was 39.92% [95% confidence interval (CI) = 29.37−42.47%]. A binary logistic regression analysis revealed that patients with depression were more likely to report a poor health status (p = 0.031), severe anxiety symptoms (p &lt; 0.001), and fatigue (p &lt; 0.001). In the network model for depression, “Sad mood,” “Poor Energy,” and “Guilt” were the most influential symptoms. “Fatigue” had the strongest negative association with QOL, followed by “Sad mood” and “Appetite”.

Conclusion

Depression is common among patients having undergone pacemaker implantation during the COVID-19 pandemic. Anxiety, central symptoms of depression (i.e., “Sad mood”, “Poor Energy”, and “Guilt”) and depressive symptoms linked to QOL (i.e., “Sad mood”, “Appetite”, and “Fatigue”) identified in this study are promising targets for interventions and preventive measures for depression in patients who have undergone pacemaker implants.