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Kim J, Kim JJ, Seok JH, Kim E, Park JY, Kim HE, Oh J. Association and interaction between clinician-rated measures of depression and anxiety with heart rate variability in elderly patients with psychiatric disorders. Heliyon 2023; 9:e20740. [PMID: 37860509 PMCID: PMC10582342 DOI: 10.1016/j.heliyon.2023.e20740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Background Older adults are vulnerable to comorbid depression and anxiety symptoms; however, these conditions are widely underrecognized and often untreated. Understanding their combined manifestation using objective measurements, such as clinician-rated scales and heart rate variability (HRV), can help refine the diagnosis and select a treatment strategy for geriatric patients. Methods This study included patients over 65 years who were mainly diagnosed with either category of depressive or anxiety disorders from the psychiatric outpatient clinic in a university hospital. A total of 114 patients met eligibility with a completed collection of electrocardiograms, the Hamilton Depression Rating Scale (HDRS; clinician-rated depression), and the Hamilton Anxiety Scale (HAS; clinician-rated anxiety) to assess the severity of symptoms. Both main and interaction effects between HDRS and HAS on HRV parameters were examined. Results Significant interaction effects between clinician-rated depression and anxiety (HDRS × HAS) on HRV reduction in frequency parameters (i.e., nuLF, nuHF, LF/HF ratio) were found, which consistently indicated autonomic nervous system dysregulation. Findings imply that HRV could reflect synergistic effects of comorbid depressive and anxiety symptoms, perhaps due to the amplification of individual symptoms in geriatric patients. Conclusions The results imply that using objective measurements can improve diagnostic accuracy, particularly in geriatric patients with comorbid status, and the normalization of the autonomic nervous system might be a candidate target for prevention and treatment.
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Affiliation(s)
- Joonbeom Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunjoo Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Hesun Erin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Oh
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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2
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Cheng Y, Thorpe L, Kabir R, Lim HJ. Latent class growth modeling of depression and anxiety in older adults: an 8-year follow-up of a population-based study. BMC Geriatr 2021; 21:550. [PMID: 34645416 PMCID: PMC8515663 DOI: 10.1186/s12877-021-02501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety are common mental health conditions in the older adult population. Understanding the trajectories of these will help implement treatments and interventions. AIMS This study aims to identify depression and anxiety trajectories in older adults, evaluate the interrelationship of these conditions, and recognize trajectory-predicting characteristics. METHODS Group-based dual trajectory modeling (GBDTM) was applied to the data of 3983 individuals, aged 65 years or older who participated in the Korean Health Panel Study between 2008 and 2015. Logistic regression was used to identify the association between characteristics and trajectory groups. RESULTS Four trajectory groups from GBDTM were identified within both depression and anxiety outcomes. Depression outcome fell into "low-flat (87.0%)", "low-to-middle (8.8%)", "low-to-high (1.3%)" and "high-stable (2.8%)" trajectory groups. Anxiety outcome fell into "low-flat (92.5%)", "low-to-middle (4.7%)", "high-to-low (2.2%)" and "high-curve (0.6%)" trajectory groups. Interrelationships between depression and anxiety were identified. Members of the high-stable depression group were more likely to have "high-to-low" or "high-curved" anxiety trajectories. Female sex, the presence of more than three chronic diseases, and being engaged in income-generating activity were significant predictors for depression and anxiety. CONCLUSIONS Dual trajectory analysis of depression and anxiety in older adults shows that when one condition is present, the probability of the other is increased. Sex, having more than three chronic diseases, and not being involved in income-generating activity might increase risks for both depression and anxiety. Health policy decision-makers may use our findings to develop strategies for preventing both depression and anxiety in older adults.
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Affiliation(s)
- Yanzhao Cheng
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Lilian Thorpe
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N2Z4, Canada
| | - Rasel Kabir
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Hyun Ja Lim
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada. .,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N2Z4, Canada.
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Mumba MN, Nacarrow AF, Cody S, Key BA, Wang H, Robb M, Jurczyk A, Ford C, Kelley MA, Allen RS. Intensity and type of physical activity predicts depression in older adults. Aging Ment Health 2021; 25:664-671. [PMID: 31948269 DOI: 10.1080/13607863.2020.1711861] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
UNLABELLED This study examined whether various levels of physical activity among older adults predicted levels of depression and whether there were racial differences in the levels and types of physical activities engaged in by adults aged 50 and older. METHOD Data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed for 2,474 adults aged 50 years and older. Variables of focus were demographics, physical activity and depression, assessed using the Physical Activity Questionnaire and the Mental Health - Depression Screener. RESULTS There was a significant positive relationship between income and depression; individuals with higher income had lower levels of depression. Simple linear regression revealed income significantly predicted depression scores, b = -.20, F(1, 2296) = 96.35, p < .001, explaining 4% of the variance, R2 = .04. As age increased, all levels of physical activity declined, regardless of the category. Vigorous recreation-related activity and moderate recreation-related activity each made significant, unique contributions to depression scores. CONCLUSION Findings from the current study suggest that physical activity interventions should be culturally appropriate and tailored to the needs and abilities of individual older adults to maximize benefits and minimize adverse events, particularly among community dwelling older adults.
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Affiliation(s)
- Mercy Ngosa Mumba
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Alexandra F Nacarrow
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA.,Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shameka Cody
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Betty A Key
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Hui Wang
- Institute for Rural Health Research, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - MacKenzie Robb
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Abigail Jurczyk
- Department of Biology, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Cassandra Ford
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Mary Ann Kelley
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Rebecca S Allen
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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van der Veen DC, Gulpers B, van Zelst W, Köhler S, Comijs HC, Schoevers RA, Oude Voshaar RC. Anxiety in Late-Life Depression: Determinants of the Course of Anxiety and Complete Remission. Am J Geriatr Psychiatry 2021; 29:336-347. [PMID: 33414001 DOI: 10.1016/j.jagp.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Studies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. We explored predictors of complete remission (no depression nor anxiety diagnoses at follow-up) and of the course of comorbid anxiety symptoms. We additionally tested the hypothesis that the course of anxiety disorders and symptoms in depressed patients is explained by negative life-events in the presence of high neuroticism or a low sense of mastery. METHODS An observational study of 270 patients (≥60 years) diagnosed with major depressive disorder and 2-year follow-up data, who participated in the Netherlands Study of Depression in Older persons (NESDO). Sociodemographic, somatic, psychiatric, and treatment variables were first explored as possible predictors. A multiple logistic regression analysis was used to examine their predictive value concerning complete remission. Subsequently, negative life-events, personality and their interaction were tested as potential predictors. Linear Mixed Models were used to assess whether the personality traits modified the effect of early and recent life-events, and time and their interactions on the course of the anxiety symptoms. RESULTS A total of 135 of 270 patients achieved complete remission. Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission: 38 of 103 (37.0%) versus 97 of 167 (58.1%). The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted nonremission. In line with our hypothesis, a less favorable course of self-reported anxiety symptoms was associated with more recent negative life-events, but only among patients with a high level of neuroticism or a low level of mastery. CONCLUSION Comorbid anxiety in depression as a negative impact on complete remission at 2-year follow-up. The course of anxiety severity seems dependent on the interaction of personality traits and life-events.
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Affiliation(s)
- Date C van der Veen
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands.
| | - Bernice Gulpers
- Regional Institute for Mental Health Care in Outpatients, RIAGG Maastricht (BG), Maastricht, The Netherlands; Department of Psychiatry and Psychology/MUMC, School for Mental Health and Neuroscience (MHeNS)/Alzheimer Centre Limburg (BG), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Willeke van Zelst
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience and Alzheimer Centre Limburg (SK), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry (HCC), Amsterdam Public Health Research Institute, GGZ inGeest/VU University Medical Centre, Amsterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands
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5
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Wang QQ, Fang YY, Huang HL, Lv WJ, Wang XX, Yang TT, Yuan JM, Gao Y, Qian RL, Zhang YH. Anxiety, depression and cognitive emotion regulation strategies in Chinese nurses during the COVID-19 outbreak. J Nurs Manag 2021; 29:1263-1274. [PMID: 33480056 PMCID: PMC8013387 DOI: 10.1111/jonm.13265] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 12/19/2022]
Abstract
AIMS To explore the association between cognitive emotion regulation strategies and anxiety and depression among nurses during the COVID-19 outbreak. BACKGROUND Nurses play a vital role in responding to the COVID-19 outbreak, but many of them suffer from psychological problems due to the excessive workload and stress. Understanding the correlation between cognitive emotion regulation strategies and anxiety and depression will promote targeted psychosocial interventions for these affected nurses. METHODS This cross-sectional study of 586 nurses was conducted in Eastern China. Participants completed online questionnaires that investigated anxiety, depression and cognitive emotion regulation strategies. RESULTS The prevalence of nurses' anxiety and depression was 27.6% and 32.8%, respectively. Lower self-blame, rumination and catastrophizing, as well as greater acceptance and positive refocusing, were related to fewer symptoms of anxiety or depression. CONCLUSION The cognitive emotion regulation strategies of acceptance and positive refocusing contribute to reducing anxiety or depression. These strategies should be considered when implementing psychotherapeutic interventions to improve nurses' adverse emotional symptoms. IMPLICATIONS FOR NURSING MANAGEMENT This study highlights the need to assess cognitive emotion regulation strategies use in screening for anxiety and depression. Nurse managers should develop psychosocial interventions including appropriate strategies to help nurses with adverse emotions during a pandemic.
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Affiliation(s)
- Qing-Qing Wang
- Department of Nursing, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yuan-Yuan Fang
- Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Hao-Lian Huang
- Department of Nursing, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Wen-Jun Lv
- Department of Nursing, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xiao-Xiao Wang
- Department of Nursing, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Tian-Ting Yang
- Department of Nursing, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jing-Mei Yuan
- Department of Nursing Research, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Ying Gao
- Department of Medical Psychology, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Rui-Lian Qian
- Department of Nursing, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yan-Hong Zhang
- Department of Nursing, Nanjing Brain Hospital, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
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6
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Ballesio A, Bacaro V, Vacca M, Chirico A, Lucidi F, Riemann D, Baglioni C, Lombardo C. Does cognitive behaviour therapy for insomnia reduce repetitive negative thinking and sleep-related worry beliefs? A systematic review and meta-analysis. Sleep Med Rev 2020; 55:101378. [PMID: 32992228 DOI: 10.1016/j.smrv.2020.101378] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022]
Abstract
Repetitive negative thinking (RNT), i.e., worry, rumination, and transdiagnostic repetitive thinking, is thought to exacerbate and perpetuate insomnia in cognitive models. Moreover, RNT is a longitudinal precursor of depression and anxiety, which are often co-present alongside insomnia. Whilst accumulating evidence supports the efficacy of cognitive behavioural therapy for insomnia (CBT-I) in reducing depression and anxiety symptoms, the literature on the effects of CBT-I on RNT has never been systematically appraised. Importantly, preliminary evidence suggests that reduction of RNT following CBT-I may be associated with reduction of depression and anxiety. Therefore, we aimed to conduct a systematic review and meta-analysis on the effects of CBT-I on RNT. Seven databases were searched, and 15 randomised controlled trials were included. Results showed moderate-to-large effects of CBT-I on worry (Hedge's g range: -0.41 to g = -0.71) but small and non-reliable effects on rumination (g = -0.13). No clear evidence was found for an association between post-treatment reduction in RNT and post-treatment reduction in depression and anxiety. Although the literature is small and still developing, CBT-I seems to have a stronger impact on sleep-related versus general measures of RNT. We discuss a research agenda aimed at advancing the study of RNT in CBT-I trials.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Italy; Department of Developmental and Social Psychology, Sapienza University of Rome, Italy.
| | - Valeria Bacaro
- Department of Human Sciences, University of Rome "G. Marconi"- Telematic, Italy
| | | | - Andrea Chirico
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Fabio Lucidi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Chiara Baglioni
- Department of Human Sciences, University of Rome "G. Marconi"- Telematic, Italy; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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7
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Ganda Mall JP, Löfvendahl L, Lindqvist CM, Brummer RJ, Keita ÅV, Schoultz I. Differential effects of dietary fibres on colonic barrier function in elderly individuals with gastrointestinal symptoms. Sci Rep 2018; 8:13404. [PMID: 30194322 PMCID: PMC6128877 DOI: 10.1038/s41598-018-31492-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/17/2018] [Indexed: 02/08/2023] Open
Abstract
Gastrointestinal problems are common in elderly and often associated with psychological distress and increased levels of corticotrophin-releasing hormone, a hormone known to cause mast cell (MC) degranulation and perturbed intestinal barrier function. We investigated if dietary fibres (non-digestible polysaccharides [NPS]) could attenuate MC-induced colonic hyperpermeability in elderly with gastrointestinal (GI) symptoms. Colonic biopsies from elderly with diarrhoea and/or constipation (n = 18) and healthy controls (n = 19) were mounted in Ussing chambers and pre-stimulated with a yeast-derived beta (β)-glucan (0.5 mg/ml) or wheat-derived arabinoxylan (0.1 mg/ml) before the addition of the MC-degranulator Compound (C) 48/80 (10 ng/ml). Permeability markers were compared pre and post exposure to C48/80 in both groups and revealed higher baseline permeability in elderly with GI symptoms. β-glucan significantly attenuated C48/80-induced hyperpermeability in elderly with GI symptoms but not in healthy controls. Arabinoxylan reduced MC-induced paracellular and transcellular hyperpermeability across the colonic mucosa of healthy controls, but did only attenuate transcellular permeability in elderly with GI symptoms. Our novel findings indicate that NPS affect the intestinal barrier differently depending on the presence of GI symptoms and could be important in the treatment of moderate constipation and/or diarrhoea in elderly.
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Affiliation(s)
- J P Ganda Mall
- Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Nutrition and physical activity research centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - L Löfvendahl
- Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - C M Lindqvist
- Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - R J Brummer
- Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Å V Keita
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - I Schoultz
- Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Nutrition and physical activity research centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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