Differential item functioning of the Geriatric Depression Scale in an Asian population

Assessing the measurement invariance of the 10-item Centre for Epidemiological Studies Depression Scale and Beck Anxiety Inventory questionnaires across people living with HIV/AIDS and healthy people

Background

Recently, extensive research has been reported the higher rate of depression and anxiety among people living with HIV/AIDS (PLWHAs) as compared to the general population. However, no single study has been carried out to investigate whether this disparity is a real difference or it happens due to lack of measurement invariance. This study aims to assess the measurement invariance of the Beck Anxiety Inventory (BAI) and 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) questionnaires across PLWHAs and healthy individuals.

Methods

One hundred and fifty PLWHAs and 500 healthy individuals filled out the Persian version of the BAI and CESD-10 questionnaires. Multi-group multiple-indicators multiple-causes model (MG-MIMIC) was used to assess measurement invariance across PLWHAs and healthy people.

Results

Our findings revealed that PLWHAs and healthy individuals perceived the meaning of all the items in the BAI and CESD-10 questionnaires similarly. In addition, although depression scores were significantly higher in PLWHAs as opposed to the healthy individuals, no significant difference was observed in anxiety scores of these two groups.

Conclusions

The current study suggests that the BAI and CESD-10 are invariant measures across PLWHAs and healthy people which can be used for meaningful cross-group comparison. Therefore, in comparison to healthy individuals, higher depression score of PLWHAs is a real difference. It is highly recommended that health professionals develop therapeutic interventions and psychological supports to promote the mental health of PLWHAs which alleviate their depressive symptoms.

Frailty and incident depressive symptoms in a Chinese sample: the Rugao Longevity and Ageing Study

BACKGROUND

To explore the cross-sectional and longitudinal associations between frailty and incident depressive symptoms in a Chinese elderly sample.

METHODS

We analysed data of 1264 older Chinese elders aged 70-87 years in the Rugao Longevity and Ageing Study. The frailty phenotype was assessed using the Fried criteria and depression symptoms was measured by the Geriatric Depression Scale.

RESULTS

At baseline, 10.6% of participants had depressive symptoms and 9.0% had frailty. In cross-sectional analysis, both pre-frailty (odds ratio (OR) = 2.18, 95% CI 1.35-3.51) and frailty (OR = 4.64, 95% CI 2.49-8.66) were associated with depressive symptoms. In longitudinal analyses, frailty (OR = 2.12, 95% CI 1.17-3.83), instead of pre-frailty, was associated with 1.5-year incident depressive symptoms in a full-adjusted model among participants free of baseline depressive symptoms. In the components of frailty, lower grip strength was associated with increased risk of depressive symptoms onset (OR = 1.56, 95% CI 1.06-2.29).

CONCLUSIONS

Frailty and lower grip strength were associated with incident depressive symptoms in a Chinese elderly sample. Interventions designed to prevent depressive symptoms may be useful by utilising physical aspects of the elderly population.

Evaluating hierarchical items of the geriatric depression scale through factor analysis and item response theory

Background

Geriatric depression scale (GDS) is a common screening tool for measuring depression among older adults. It employs a multi-factor structure and some differential item functioning (DIF) allowing different versions of GDS across cultures. The present study aimed to identify the short version of the hierarchical scale of GDS in which all items comprised the invariant item ordering, and items without DIF.

Methods

Participants and Measurement: A total of 803 participants, 70% female, with a mean age of 69.24 years (SD = 6.88) were enrolled from three geriatric units of tertiary care hospitals. All completed the 15-item GDS. Three methods of confirmatory factor analysis (CFA) with multiple indicators, multiple cause model, Mokken analysis and Rasch analysis were applied.

Results

Item 9 (prefer to stay at home) showed poor discriminatory power among all three methods. After removing DIF items due to sex and age, nine items remained suitable for the shortened version by CFA. When Mokken and Rasch analysis were applied, only six items remained for the hierarchical scale. Compared with other related shortened version of GDS, the new GDS-6 proved to have a comparable ability to detect depression as did the original 15-item GDS.

Limitation

The new GDS-6 needs to be investigated for test-retest reliability to ensure temporal stability of the scale. This cross-sectional analysis needs replication.

Conclusion

The GDS-6 derived from IRT had measurement properties and met criteria related to unidimensionality and ability to separate levels of depression. It was shown to be equal to or better in predicting performance compared with the original 15-item GDS.

Factor Structure and Measurement Invariance Across Gender Groups of the 15-Item Geriatric Depression Scale Among Chinese Elders

The 15-item Geriatric Depression Scale (GDS-15) is widely used to screen depression among elders. But the factor structure of the Chinese version GDS-15 remains unclear. This study was conducted to determine the best-fit factor structure of GDS-15 and to assess measurement invariance across gender groups in a sample of Chinese elders recruited from Mainland China (final sample N = 2428). The best-fit factor structure was examined by confirmatory factor analysis (CFA). Multigroup CFA was utilized to test the measurement invariance across genders of the factor structure. The results of CFA revealed that a three-factor model, including life satisfaction (four items), general depressive affect (seven items), and withdrawal (three items), fits the structure of the GDS-15 best. Measurement invariance across genders was supported, fully assuming different degrees of invariance.

Multimorbidity, depression and quality of life among elderly people assisted in the Family Health Strategy in Senador Guiomard, Acre, Brazil

This study analyzed the association between multimorbidity, depression and quality of life among the elderly in the Family Health Strategy (FHS). A cross-sectional study was conducted among the elderly in the FHS in Senador Guiomard (State of Acre). The study employed the Geriatric Depression Scale (GDS-15) and the Quality of Life Questionnaire (WHOQOL-BREF). Differences in descriptive variables in elderly people with and without multimorbidity were estimated using Pearson's chi-squared test, while the associations between multimorbidity and depression and quality of life were estimated using the logistic regression technique. It was seen that elderly people with depression represented 27% of the sample, this being more prevalent among elderly people with multimorbidity than those without, the former being twice as likely to be subject to depression. Likewise, individuals with multimorbidity had a greater chance of worse quality of life in the physical, social and total quality of life domains (all with p ≤ 0.010), though not in the environmental domain (p = 0.493). Thus, multimorbidity in the elderly is associated with the presence of depression and poor quality of life, which imposes the challenge on the FHS of guaranteeing the elderly living out their senescence without suffering and diminished quality of life.

Association of Frailty and Malnutrition With Long-term Functional and Mortality Outcomes Among Community-Dwelling Older Adults: Results From the Singapore Longitudinal Aging Study 1

IMPORTANCE

Physical frailty and malnutrition are prevalent among older adults and may be associated with functional and mortality outcomes.

OBJECTIVE

To assess the health outcomes associated with physical frailty and malnutrition singly and in combination among older adults.

DESIGN, SETTING, AND PARTICIPANTS

Population-based cohort study (Singapore Longitudinal Aging Study 1). Included were 2804 community-dwelling adults in Singapore aged 55 years or older at baseline (September 1, 2003, to December 23, 2005), with 2 follow-ups at 2- to 3-year intervals (from March 7, 2005, to September 10, 2007, and from November 13, 2007, to December 12, 2009) and a 12-year mortality follow-up to March 31, 2017. Data analysis was from July 1 to September 28, 2017.

MAIN OUTCOMES AND MEASURES

Baseline physical frailty (Fried criteria) with participants categorized according to the total score as frail (3-5 points), prefrail (1-2 points), or robust (0 point), and nutritional status (Nutrition Screening Initiative DETERMINE Your Nutritional Health Checklist and Mini Nutritional Assessment Short-Form [MNA-SF]). Baseline (prevalent) and follow-up (incident) instrumental/basic activities of daily living (IADL/ADL) disability, poor quality of life (QOL), and mortality were measured. Estimates of association were by odds ratios (ORs) and hazard ratios (HRs) and their 95% CIs.

RESULTS

The participants (mean [SD] age, 66.0 [7.7] years; 1033 [36.8%] male; 2611 [93.1%] Chinese) included 1021 (37.6%) categorized as robust with MNA-SF normal nutrition (R-NN), 330 (12.2%) robust with MNA-SF at risk/malnourished (R-ARM), 734 (27.0%) prefrail/frail with MNA-SF normal nutrition (PFF-NN), and 631 (23.2%) prefrail/frail with MNA-SF at risk/malnourished (PFF-ARM). Among these 2804 participants, 44 had missing frailty status, and 78 had missing MNA-SF nutritional status; therefore, 88 participants in total had missing frailty-nutritional status. In cross-sectional analyses, the prevalence of IADL/ADL disability was lowest among the R-NN group (169 [16.9%]) and increased substantially only among the PFF-ARM group (249 [40.2%]) (OR, 1.88; 95% CI, 1.40-2.53). Poor QOL prevalence was lowest among the R-NN group (142 [14.1%]), and the increase in other frailty and nutritional status groups was highest in the PFF-ARM group (255 [41.3%]) (OR, 2.61; 95% CI, 1.96-3.49). In longitudinal analyses, significant association with only incident poor QOL across frailty and nutritional status groups was highest in the PFF-ARM group (89 [34.8%]) compared with the R-NN group (132 [19.2%]) (OR, 1.70; 95% CI, 1.17-2.48). The mortality rate was lowest in the R-NN group (0.54 per 100 person-years) and highest in the PFF-ARM group (3.04 per 100 person-years) (HR, 1.72; 95% CI, 1.01-2.92). The results based on the Nutrition Screening Initiative measure of nutritional status were similar.

CONCLUSIONS AND RELEVANCE

Reported adverse health outcomes attributed to poor nutrition often appear more likely to be associated with physical frailty. Prefrail/frail older persons with poor nutrition might be targeted for interventions to prevent or delay adverse functional and mortality outcomes.

Chinese observational prospective study of ageing population with chronic kidney disease (C-OPTION): a study protocol

INTRODUCTION

The proportion of elderly people is steadily rising worldwide, especially in low-income and middle-income countries, including China. Chronic kidney disease (CKD) is a common disorder in older people. However, little is known about the epidemiology of CKD and its consequences among the elderly. Improvements on clinical guidelines and healthcare policies for this population are required. This study aims to examine the risk factors for progression of CKD among the elderly and develop models to identify subgroups who are at high risk.

METHODS AND ANALYSIS

This is a prospective, multicentre, cohort study. The study population comprises ~3000 patients with predialysis CKD, aged ≥65 years, recruited between March 2016 and December 2017. After the baseline assessments, these patients will be followed for 5 years or until the occurrence of primary outcomes. Assessments that include anthropomorphic measures, laboratory tests, questionnaires, and blood and urine specimen collection will be performed at baseline and at follow-ups. Data on demographic information, cognitive function, depression, risk of malnutrition, physical activity and quality of life will be collected. The primary outcomes are incidence of end-stage renal disease, loss of renal function (≥40% decline in glomerular filtration rate from baseline), and death. The secondary outcomes are acute coronary syndrome, hospitalisation for heart failure or unstable angina, cerebrovascular events, and peripheral arterial disease.

ETHICS AND DISSEMINATION

This study protocol has been approved by the ethics committees of the Chinese People's Liberation Army General Hospital and the participating centres. All the participants gave written informed consent before data collection. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conferences.

TRIAL REGISTRATION NUMBER

NCT03246204; Pre-results.

Is the 15-item Geriatric Depression Scale a Fair Screening Tool? A Differential Item Functioning Analysis Across Gender and Age

The 15-item version of the Geriatric Depression Scale (GDS-15) is widely employed to assess depression in old people, but it is unclear if there are biases in the total score depending on respondents' gender and age. In the current study, we investigated the measurement equivalence of the GDS-15 to provide evidence that the test is a fair screening tool when administered to young-old, old-old, and oldest-old men and women. Item Response Theory-based Differential Item Functioning analyses were applied on a large sample of Italian old people. One item exhibited Differential Item Functioning when comparing men and women, and one item showed Differential Item Functioning across different age-groups. Nonetheless, the magnitude of Differential Item Functioning was small and did not produce any differential test functioning. The gender and age measurement equivalence of the GDS-15 confirms that the test can be used for clinical and research screening purposes.

Anxiety symptoms bias memory assessment in older adults

BACKGROUND

Older adults with anxiety and/or depression experience additional memory dysfunction beyond that of the normal aging process. However, few studies have examined test bias in memory assessments due to anxiety and/or depressive symptoms. The current study investigated the influence of self-reported symptoms of anxiety and depression on the measurement equivalence of memory tests in older adults.

METHOD

This is a secondary analysis of the Advanced Cognitive Training for Independent and Vital Elderly dataset, a randomized controlled trial of community-dwelling older adults. Baseline data were included in this study (n = 2802). Multiple indicators multiple causes modeling was employed to assess for measurement equivalence, differential item functioning (DIF), in memory tests.

RESULTS

The DIF was present for anxiety symptoms but not for depressive symptoms, such that higher anxiety placed older adults at a disadvantage on measures of memory performance. Analysis of DIF impact showed that compared with participants scoring in the bottom quartile of anxious symptoms, participants in the upper quartile exhibited memory performance scores that were 0.26 standard deviation lower.

CONCLUSION

Anxious but not depressive symptoms introduce test bias into the measurement of memory in older adults. This indicates that memory models for research and clinical purposes should account for the direct relationship between anxiety symptoms and memory tests in addition to the true relationship between anxiety symptoms and memory construct. These findings support routine assessments of anxiety symptoms among older adults in settings in which cognitive testing is being conducted. Copyright © 2016 John Wiley & Sons, Ltd.

Physical Frailty, Cognitive Impairment, and the Risk of Neurocognitive Disorder in the Singapore Longitudinal Ageing Studies

Background

The independent and combined effects of physical and cognitive domains of frailty in predicting the development of mild cognitive impairment (MCI) or dementia are not firmly established.

Methods

This study included cross-sectional and longitudinal analyses of physical frailty (Cardiovascular Health Study criteria), cognitive impairment (Mini-Mental State Examination [MMSE]), and neurocognitive disorder (DSM-5 criteria) among 1,575 community-living Chinese older adults from the Singapore Longitudinal Ageing Studies.

Results

At baseline, 2% were frail, 32% were prefrail, and 9% had cognitive impairment (MMSE score < 23). Frailty at baseline was significantly associated with prevalent cognitive impairment. Physical frailty categories were not significantly associated with incident NCD, but continuous physical frailty score and MMSE score showed significant individual and joint associations with incident mild NCD and dementia. Compared with those who were robust and cognitively normal, prefrail or frail old adults without cognitive impairment had no increased risk of incident NCD, but elevated odds of association with incident NCD were observed for robust with cognitive impairment (odds ratio [OR] = 4.04, p < .001), prefrail with cognitive impairment (OR = 2.22, p = .044), and especially for frail with cognitive impairment (OR = 6.37, p = .005). The prevalence of co-existing frailty and cognitive impairment (cognitive frailty) was 1% (95% confidence interval [CI]: 0.5-1.4), but was higher among participants aged 75 and older at 5.0% (95% CI: 1.8-8.1).

Conclusions

Physical frailty is associated with increased prevalence and incidence of cognitive impairment, and co-existing physical frailty and cognitive impairment confers additionally greater risk of incident NCD.

Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community-Dwelling Older Adults: Singapore Longitudinal Ageing Studies

OBJECTIVE

The association between frailty and malnutrition is widely noted, but the common and distinct aspects of this relationship are not well understood. We investigated the prevalence of prefrailty/frailty and malnutrition/nutritional risk; their overlapping prevalence; compared their sociodemographic, physical, and mental health risk factors; and assessed their association, independently of other risk factors.

METHODS

Cross-sectional study of population-based cohort (Singapore Longitudinal Ageing Study [SLAS]-1 [enrolled 2003-2005] and SLAS-2 [enrolled 2010-2013]) of community-dwelling older Singaporeans aged ≥55 (n = 6045).

MEASUREMENTS

Mini Nutritional Assessment (MNA)-Short Form (SF), Nutritional Screening Initiative (NSI) Determine Checklist, Fried physical frailty phenotype.

RESULTS

The overall prevalence of MNA malnutrition was 2.8%, and at risk of malnutrition was 27.6%; the prevalence of frailty and prefrailty were 4.5%, and 46.0% respectively. Only 26.5% of participants who were malnourished were frail, but 64.2% were prefrail (totally 90.7% prefrail or frail). The prevalence of malnutrition among frail participants was 16.1%, higher than in other studies (10%); nearly one-third of the whole population sample had normal nutrition while being prefrail (27.7%) or frail (1.5%). The prevalence of risk factors for prefrailty/frailty and malnutrition/nutritional risk were remarkably similar. MNA at risk of malnutrition and malnutrition were highly significantly associated with prefrailty (odds ratio [OR] 2.11 and 6.71) and frailty (OR 2.72 and 17.4), after adjusting for many other risk factors. The OR estimates were substantially lower with NSI moderate and high nutritional risk for prefrailty (OR 1.39 and 1.74) and frailty (OR 1.27 and 1.93), but remain significantly elevated.

CONCLUSION

Frailty and malnutrition are related but distinct conditions in community-dwelling older adults. The contribution of poor nutrition to frailty in this population is notably greater. Both frail/prefrail elderly and those who are malnourished/at nutritional risk should be identified early and offered suitable interventions.

Development of the psychometric property of a Minimum Data-Set-Based Depression Rating Scale for use in long-term care facilities in Taiwan

OBJECTIVES

Our aim is to develop the psychometric property of the Minimum Data-Set-Based Depression Rating Scale (MDS-DRS) to ensure its use to assess service needs and guide care plans for institutionalized residents.

METHODS

378 residents were recruited from the Haoran Senior Citizen Home in northern Taiwan. The MDS-DRS and GDS-SF were used to identify observable features of depression symptoms in the elderly residents.

RESULTS

A total of 378 residents participated in this study. The receiver operating characteristic (ROC) curve indicated that the MDS-DRS has a 43.3% sensitivity and a 90.6% specificity when screening for depression symptoms. The total variance, explained by the two factors 'sadness' and 'distress,' was 58.1% based on the factor analysis.

CONCLUSIONS

Reliable assessment tools for nurses are important because they allow the early detection of depression symptoms. The MDS-DRS items perform as well as the GDS-SF items in detecting depression symptoms. Furthermore, the MDS-DRS has the advantage of providing information to staff about care process implementation, which can facilitate the identification of areas that need improvement. Further research is needed to validate the use of the MDS-DRS in long-term care facilities.

Validation of the Tamil version of short form Geriatric Depression Scale-15

Background:

Local language screening instruments can be helpful in early assessment of depression in the elderly in the community and primary care population. This study describes the validation of a Tamil version of Geriatric Depression Scale (short form 15 [GDS-15] item) in a rural population.

Materials and Methods:

A Tamil version of GDS-15 was developed using standardized procedures. The questionnaire was applied in a sample of elderly (aged 60 years and above) from a village in South India. All the participants were also assessed for depression by a clinical interview by a psychiatrist.

Results:

A total of 242 participants were enrolled, 64.9% of them being females. The mean score on GDS-15 was 7.4 (±3.4), while the point prevalence of depression was 6.2% by clinical interview. The area under the receiver-operator curve was 0.659. The optimal cut-off for the GDS in this sample was found at 7/8 with sensitivity and specificity being 80% and 47.6%, respectively.

Conclusion:

The Tamil version of GDS-15 can be a useful screening instrument for assessment of depression in the elderly population.

Differential reporting of depressive symptoms across distinct clinical subpopulations: what DIFference does it make?

OBJECTIVE

To investigate the impact of differences in depressive symptom reporting across clinical groups (healthcare setting, chronic illness, depression diagnosis and anxiety diagnosis) on clinical interpretability and comparability of depression scores.

METHODS

Participants from the Netherlands Study of Depression and Anxiety (n=2981) completed the self-report Inventory of Depressive Symptomatology (IDS-SR). Differences in depressive symptom reporting between distinct clinical subpopulations were assessed using a Differential Item Functioning (DIF) analysis. The effects of DIF on symptom level were evaluated by examining whether DIF-adjustment had clinically relevant effects.

RESULTS

Significant DIF was detected across all tested clinical subpopulation groupings. Clinically relevant DIF was found on the symptom level for 13 IDS-SR items. However, impact of DIF on the aggregate level ranged from small to negligible: adjustment for DIF only led to salient changes in aggregate scores for 0.2-12.7% of individuals across tested sources of DIF.

CONCLUSION

Differences in endorsement patterns of depressive symptoms were observed across clinical populations, challenging the assumptions regarding the measurement properties of self-reported depression. However, effects of DIF on the aggregate level of IDS-SR total scores were found to be minimal and not clinically important. The IDS-SR thus seems robust against DIF across clinical populations.

Demographic characteristics do not decrease the utility of depressive symptoms assessments: examining the practical impact of item bias in four heterogeneous samples of older adults

OBJECTIVE

Previous studies have identified differential item function (DIF) in depressive symptoms measures, but the impact of DIF has been rarely reported. Given the critical importance of depressive symptoms assessment among older adults, we examined whether DIF due to demographic characteristics resulted in salient score changes in commonly used measures.

METHODS

Four longitudinal studies of cognitive aging provided a sample size of 3754 older adults and included individuals both with and without a clinical diagnosis of major depression. Each study administered at least one of the following measures: the Center for Epidemiologic Studies Depression scale (20-item ordinal response or 10-item dichotomous response versions), the Geriatric Depression Scale, and the Montgomery-Åsberg Depression Rating Scale. Hybrid logistic regression-item response theory methods were used to examine the presence and impact of DIF due to age, sex, race/ethnicity, and years of education on the depressive symptoms items.

RESULTS

Although statistically significant DIF due to demographic factors was present on several items, its cumulative impact on depressive symptoms scores was practically negligible.

CONCLUSIONS

The findings support substantive meaningfulness of previously reported demographic differences in depressive symptoms among older adults, showing that these individual differences were unlikely to have resulted from item bias attributable to demographic characteristics we examined.

Building a new Rasch-based self-report inventory of depression

This paper illustrates a sequential item development process to create a new self-report instrument of depression refined with Rasch analysis from a larger pool of potential diagnostic items elicited through a consensus approach by clinical experts according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders criteria for major depression. A 51-item pool was administered to a sample of 529 subjects (300 healthy community-dwelling adults and 229 psychiatric outpatients). Item selection resulted in a 21-item set, named the Teate Depression Inventory, with an excellent Person Separation Index and no evidence of bias due to an item-trait interaction (χ (2)=147.71; df =168; P=0.48). Additional support for the unidimensionality, local independence, appropriateness of the response format, and discrimination ability between clinical and nonclinical subjects was provided. No substantial differential item functioning by sex was observed. The Teate Depression Inventory shows considerable promise as a unidimensional tool for the screening of depression. Finally, advantages and disadvantages of this methodology will be discussed in terms of subsequent possible mathematical analyses, statistical tests, and implications for clinical investigations.

Tea consumption and physical function in older adults: a cross-sectional study

BACKGROUND

Tea consumption has been reported to be associated with lowered risk of cardiovascular disease, stroke and osteoporosis that cause functional disability, but its association with physical function has not been investigated directly.

OBJECTIVE

We examined the association between tea consumption and performance in gait and balance, instrumental and basic activities of daily living (IADL and BADL) in a cross-sectional study of community-living older persons.

METHOD

Baseline data of 2398 adults aged ≥ 55 years in the Singapore Longitudinal Ageing Studies who completed self-reported current tea consumption, Performance Oriented Mobility Assessment (POMA) of gait and balance, and self reports of BADL and IADL were analyzed.

RESULTS

In multivariate analyses controlling for age, gender, education, housing type, co-morbidities, hospitalization, arthritis and hip fracture, GDS depression score, MMSE cognitive score, body mass index, creatinine, serum albumin, haemoglobin, physical activities score and coffee consumption, tea consumption was positively associated with better balance (β=0.06, p<0.01), gait (β=0.01, p=0.02), IADL (β=0.03, p=0.01) and BADL (β=0.01, p=0.05). Strongly positive associations were observed for black/oolong tea in multivariate analyses, and for green tea consumption only in univariate analysis, whereas coffee consumption was not associated at all.

CONCLUSIONS

Tea consumption was associated with better physical functional performances in community-living older adults.

Examining the validity and reliability of the Taita symptom checklist using Rasch analysis

BACKGROUND/PURPOSE

The Taita symptom checklist (TSCL) is a standardized self-rating psychiatric symptom scale for outpatients with mental illness in Taiwan. This study aimed to examine the validity and reliability of the TSCL using Rasch analysis.

METHODS

The TSCL was given to 583 healthy people and 479 people with mental illness. Rasch analysis was used to examine the appropriateness of the rating scale, the unidimensionality of the scale, the differential item functioning across sex and diagnosis, and the Rasch cut-off score of the scale.

RESULTS

Rasch analysis confirmed that the revised 37 items with a three-point rating scale of the TSCL demonstrated good internal consistency and met criteria for unidimensionality. The person and item reliability indices were high. The TSCL could reliably measure healthy participants and patients with mental illness. Differential item functioning due to sex or psychiatric diagnosis was evident for three items. A Rasch cut-off score for TSCL was produced for detecting participants' psychiatric symptoms based on an eight-level classification.

CONCLUSION

The TSCL is a reliable and valid assessment to evaluate the participants' perceived disturbance of psychiatric symptoms based on Rasch analysis.

Depressive symptoms in older adults with chronic kidney disease: mortality, quality of life outcomes, and correlates

OBJECTIVE

Among patients with chronic kidney disease (CKD), we investigated the prevalence of depressive symptoms, their impact on mortality and quality of life, and correlates of depressive symptoms.

DESIGN

Prospective cohort study, followed up to 4 years.

SETTING

General community.

PARTICIPANTS

A total of 362 older adults with CKD (Stages 3 and 4 assessed from estimated glomerular filtration rate [eGFR]) drawn from the Singapore Longitudinal Aging Study cohort.

MEASUREMENTS

Scores on the Geriatric Depression Scale (GDS) and the prevalence of depressive symptoms (GDS ≥5) and other variables were assessed at baseline, and SF-12 quality of life (QOL) (at 2 years) and mortality determined from 4 years of follow-up.

RESULTS

Depressive symptoms were present in 13% of the participants at baseline, and were associated with poorer SF-12 QOL scores (up to 30 percentage point differences). There was a significant association between depressive symptoms and increased mortality risk (odds ratio: 3.17; 95% confidence interval: 1.17-8.61; χ(2) = 5.11; df = 1; p = 0.023), which was statistically significant in unadjusted analysis, but not in multivariate analysis that accounted for covariates (odds ratio: 2.62; 95% confidence interval: 0.77-8.89; χ(2) = 2.37; df = 1; p = 0.13). Baseline cognitive impairment, functional disability, and other chronic illness were significantly associated with both increasing GDS scores and depressive symptoms. No relationship between eGFR and depressive symptoms was observed.

CONCLUSION

Depression among individuals with CKD was significantly associated with poorer quality of life, but not with increased mortality in predialysis CKD patients. More prospective studies are needed to establish the effects of depression on adverse CKD outcomes in predialysis CKD patients.

The Use of GDS-15 in Detecting MDD: A Comparison Between Residents in a Thai Long-Term Care Home and Geriatric Outpatients

Background

To assess the psychometric properties of the Thai version of the 15-item Geriatric Depression Scale (TGDS-15) when screening for major depression (MDD) among geriatric outpatients (GOs) and long-term care (LTC) home residents in Thailand.

Methods

This was a cross-sectional study of 156 geriatric outpatients and 81 LTC home residents. All 237 participants were given a Mini-Mental State Examination, a MDD diagnosis according to the Mini-International Neuropsychiatric Interview, and completed a TGDS-15 questionnaire. Sensitivity, specificity, overall accuracy, and positive and negative predictive values were calculated. A comparison between the two groups was carried out. Differential Item Functioning (DIF) using logistic regression and factor analytic study were also applied.

Results

Overall, 38.4% of the participants were found to have MDD. The TGDS-15 was found to perform better when used with the GOs than with the LTC home residents, revealing a sensitivity of 0.92 and a specificity of 0.87 in the GOs (cut-off score of ≥ 5), but a sensitivity of 100% and a specificity of 49% with the LTC home group (cut-off score of ≥ 8), when comparing only cognitively intact subjects. The negative predictive value (NPV) was very good for both groups, but the positive predictive value (PPV) for the GO group was much better than for those in the LTC group (83.3% vs. 31.2%). Seven uniform DIF items were found - 2 by gender and 4 by age. Cronbach’s alpha was higher for the GO group than for the LTC home residents. Factor analysis supported a two-factor solution, using the ‘depressed mood’ and ‘positive mood’ factors, which accounted for 46.55% of the total variance.

Conclusions

The TGDS-15 scale was effective at screening for MDD in elderly cognitively intact Thais, those in both GO and LTC settings, as the sensitivity and NPV were shown to be very good in both groups. However, in the LTC setting, the low specificity and PPV found leads to the need for a further assessment to be carried among the potentially depressed individuals, based on the GDS results. Taking the factor analytic study into account, a more suitable version of the GDS should be developed.

Positive affect as a predictor of lower risk of functional decline in community-dwelling elderly in Japan

AIM

To investigate whether positive affect independently predicts a lower risk of functional decline among community-dwelling older Japanese.

METHODS

A 2-year prospective study was carried out among 505 residents of Tosa Town aged 65 years and older without disability in carrying out basic activities of daily living (BADL) at baseline. Positive and negative affect was measured using the 15-item Geriatric Depression Scale, which includes items that reflect positive affect, as well as items that reflect negative affect. Information on functional ability, sociodemographic factors and medical conditions was obtained using a self-administered questionnaire.

RESULTS

A total of 72 (14.3%) participants reported a decline in BADL at the 2-year follow up. The sum-score of the positive items was significantly associated with a lower risk of functional decline (OR 0.78, 95% CI 0.64-0.97), after controlling for potential confounding factors. Of the five positive items, three items (feeling satisfied with life OR 0.49, 95% CI 0.25-0.95; feeling happy most of the time OR 0.50, 95% CI 0.25-0.99; and feeling full of energy OR 0.46, 95% CI 0.22-0.95) were significantly associated with functional decline after adjusting for confounders. These associations were also independent of negative affect. In contrast, none of the negative items predicted functional decline after controlling for confounding factors.

CONCLUSIONS

Positive psychological well-being, specifically the feeling of satisfaction with life, happiness and energy, might have a favorable effect on the maintenance of functional ability, regardless of negative affect.

Homocysteine, folate, vitamin B-12, and physical function in older adults: cross-sectional findings from the Singapore Longitudinal Ageing Study

BACKGROUND

There is a paucity of studies, as well as inconsistent findings, on the associations of homocysteine, folate, and vitamin B-12 with physical function and decline in older persons.

OBJECTIVE

We investigated the independent associations of homocysteine, folate, and vitamin B-12 with gait and balance performance and Instrumental Activities of Daily Living (IADL) in community-living older persons.

DESIGN

We performed cross-sectional analyses on baseline data of 796 respondents in the Singapore Longitudinal Ageing Study who had laboratory measurements of fasting homocysteine folate and vitamin B-12 and completed Performance Oriented Mobility Assessment (POMA) of gait and balance and self-reports of IADLs.

RESULTS

In multivariate analyses in which sex, age, education, housing type, comorbidities, hospitalization, depression and global cognitive scores, BMI, creatinine, arthritis and hip fracture, serum albumin and hemoglobin, and physical activities were controlled for, we showed that homocysteine, independently of folate and vitamin B-12, showed significant negative associations with POMA balance (P = 0.02), POMA gait scores (P < 0.01), and IADL (P < 0.01). Serum folate showed a significant positive association only with POMA balance scores (P < 0.045). No significant independent associations for vitamin B-12 were observed.

CONCLUSIONS

The independent association of elevated homocysteine and low folate, but not vitamin B-12, on physical and functional decline was supported in this study. Interventional studies of the physical functional effects of folate and vitamin B-12 status in different populations are needed.

Modifying measures based on differential item functioning (DIF) impact analyses

OBJECTIVE

Measure modification can impact comparability of scores across groups and settings. Changes in items can affect the percent admitting to a symptom.

METHODS

Using item response theory (IRT) methods, well-calibrated items can be used interchangeably, and the exact same item does not have to be administered to each respondent, theoretically permitting wider latitude in terms of modification.

RESULTS

Recommendations regarding modifications vary, depending on the use of the measure. In the context of research, adjustments can be made at the analytic level by freeing and fixing parameters based on findings of differential item functioning (DIF). The consequences of DIF for clinical decision making depend on whether or not the patient's performance level approaches the scale decision cutpoint. High-stakes testing may require item removal or separate calibrations to ensure accurate assessment.

DISCUSSION

Guidelines for modification based on DIF analyses and illustrations of the impact of adjustments are presented.

Kidney function and cognitive and functional decline in elderly adults: findings from the Singapore longitudinal aging study

OBJECTIVES

To investigate whether lower estimated glomerular filtration rate (eGFR) or chronic kidney disease (CKD) was associated with subsequent cognitive and instrumental activity of daily living (IADL) decline in a prospective cohort study.

DESIGN

Prospective cohort study, followed for up to 4 years.

SETTING

General community.

PARTICIPANTS

One thousand three hundred fifteen adults aged 55 and older from the Singapore Longitudinal Aging Study.

MEASUREMENTS

Baseline data included eGFR levels, presence of CKD (eGFR < 60 mL/min per 1.73 m(2) ), and known confounders. Cognitive decline was defined as a drop of 2 or more points on the Mini-Mental State Examination (MMSE) and functional decline as a drop of 2 or more points in IADL score.

RESULTS

Decreasing levels of eGFR and the presence of CKD were associated with greater odds of cognitive decline at follow-up independent of confounding risk factors in multivariate analyses: estimated 14% increment in odds of cognitive decline per 10 mL/min/1.73 m(2) decrease in eGFR (odds ratio = 1.94, 95% confidence interval = 1.23-3.05; P = .004 for CKD vs non-CKD). Similar associations were found in a cognitively normal subgroup (MMSE > 23) at baseline. In the whole sample, CKD, but not eGFR, was found to be significantly associated with higher risk of IADL decline.

CONCLUSION

CKD in older persons was significantly associated with cognitive and functional decline. Future research should target the development and evaluation of strategies to delay or prevent cognitive decline and physical disability in elderly adults with impaired kidney function.

Sintomas depressivos em idosos: análise dos itens da Escala de Depressão Geriátrica

OBJETIVOS: Verificar a estrutura fatorial da Escala de Depressão Geriátrica de 15 itens em uma amostra de idosos assistidos pela Estratégia Saúde da Família, descrever o perfil social e analisar as respostas aos itens da Escala de Depressão Geriátrica. MÉTODOS: Estudo de delineamento transversal com 503 idosos assistidos pela Estratégia Saúde da Família, em Dourados, MS. Para analisar as respostas da EDG 15, utilizou-se o teste de Qui-quadrado de Mantel-Haenzsel (p <0,05). A análise fatorial, a consistência interna e a generalidade dos resultados para a população foram realizadas. RESULTADOS: Dos 503 idosos pesquisados 69,0% eram mulheres, 53,1% não letrados, 53,7% tinham 70 anos ou mais e 34,4% apresentavam depressão. A análise fatorial identificou quatro fatores (apatia, desesperança, desmotivação e isolamento). A estrutura da EDG 15 não se mostrou apropriada para a generalização de resultados. CONCLUSÃO: Dentre os idosos com depressão, predominaram a apatia e o isolamento. Cabe às equipes de saúde promover atividades físicas, recreativas e culturais para minimizar esse quadro. Novas pesquisas serão necessárias, sobretudo para análise da estrutura fatorial.

Serum albumin and hemoglobin are associated with physical function in community-living older persons in Singapore

OBJECTIVES

Albumin and hemoglobin are viewed as markers of nutritional and inflammatory status. This study examined the associations of serum albumin and hemoglobin with physical function in community-living older adults.

DESIGN

Population-based cross-sectional and longitudinal study.

SETTING

The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban Singapore.

PARTICIPANTS

2762 older adults aged 55 and above assessed at baseline, and 1829 at follow up 1-2 years later.

MEASUREMENTS

Serum albumin and hemoglobin, Performance Oriented Mobility Assessment (POMA), knee extension strength at baseline, and Instrumental Activities of Daily Living (IADL) at baseline and follow up.

RESULTS

In cross-sectional multivariate analyses that adjusted for haemoglobin and other confounders, albumin showed a significant linear association (p<0.001) with POMA balance score (b=0.06, SE=0.02) and knee extension strength (b=0.70, SE=0.10). Independently of albumin, hemoglobin also showed a significant linear association with POMA balance score (b=0.09, SE=0.04). In longitudinal analyses, albumin was significantly associated with IADL decline (IADL total score drop>=1 during follow-up), OR= 0.92 (0.87 - 0.97), p=<0.01.

CONCLUSION

The findings suggest that low levels of albumin and hemoglobin are potentially useful risk markers of physical functional decline in older adults. Further research should investigate whether improvements in the levels of albumin and hemoglobin alter the level of functional disability and risk of functional decline.

Validation of a brief seven-item response bias-free geriatric depression scale

OBJECTIVE

Shortened versions of various depression scales have typically been based on conventional techniques such as factor analysis, without simultaneously considering the removal of culturally biased items that show differential item functioning (DIF). The authors recently showed that eight items in the 15-item Geriatric Depression Scale (GDS-15) evidenced DIF, associated with gender, age, ethnicity, and chronic illnesses. By selecting out these items, the authors derived a shortened 7-item GDS and compared it with derivations based on conventional factor analysis and logistic regression techniques and validated its test performance in Asian elderly.

METHODS

The GDS-15 and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depressive disorder (MDD) was independently administered by interviewers to 4,253 noninstitutionalized community-living elderly subjects aged 60 years and older. Concurrent methods of data reduction and item selection included factor analyses and logistic regression modeling. The GDS-7 was compared with GDS-15 test performance using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders diagnosis of MDD as gold standard criterion and receiver operating characteristics analysis.

RESULTS

After removal of eight DIF items, the derivation was consistent with and complements the results from factor analysis and logistic regression analyses. The short GDS-7 fit a unidimensional model with high explained total variance and demonstrated high sensitivity (0.93) and specificity (0.91) at a cutoff of one-half that was comparable with GDS-15.

CONCLUSIONS

By removing items with culturally based response bias, the GDS-7 showed excellent scaling and test performance for screening MDD in an Asian elderly population.

Gender Effect According to Item Directionality on the Perceived Stress Scale for Adults With Multiple Sclerosis

Assessment is critical to rehabilitation practice and research, and self-reports are a commonly used form of assessment. This study examines a gender effect according to item wording on the Perceived Stress Scale for adults with multiple sclerosis. Past studies have demonstrated two-factor solutions on this scale and other scales measuring stress-related constructs with factor loadings being determined by item wording. Moreover, women have typically scored higher on these measured constructs. However, a literature review reveals that this gender difference often manifests only on the factor composed of negatively worded items. This study extends this line of research by examining gender differences on the Perceived Stress Scale on the negatively worded items at both the item and bundle levels after controlling for responses on the positively worded items. Implications of this study on the field of rehabilitation are discussed.

Preliminary evidence for the development of a stroke specific geriatric depression scale

Measuring depression among persons with stroke faces many challenges; diagnostic tools are lengthy and do not measure the extent of depression; screening tools are not stroke-specific; and metrics from the available indices do not provide a value that is mathematically or clinically meaningful.

PURPOSE

To provide evidence for the development of a stroke specific Geriatric Depression Scale screening measure (SS-GDS) through Rasch methodology.

METHODS

Secondary analyses of a randomized controlled trial post-stroke. Interviews from 91 subjects aged 71 (SD 10) over three time points or 240 interviews were analyzed. Rasch Analysis helped transform the 30-item GDS onto a logit scale. Unidimensionality, item fit, redundancy, and differential item functioning (DIF) were assessed.

RESULTS

Seventeen items fit the model to form a hierarchical measure ranging in difficulty from +1.2 to -1.8 logits. Preliminary psychometric properties of reliability, validity, and responsiveness were adequate. Two items that demonstrated DIF, one for language and one for gender, were split.

CONCLUSION

The 17-item SS-GDS Rasch measure was developed to screen for post-stroke depression (PSD) and provide an important step toward quantifying PSD. If revalidated in a larger sample, the SS-GDS could provide a mathematically valid index to screen for depression in stroke survivors.

Validation of the Rasch-based Depression Screening in a large scale German general population sample

Background

The study aimed at presenting normative data for both parallel forms of the "Rasch-based Depression Screening (DESC)", to examine its Rasch model conformity and convergent and divergent validity based on a representative sample of the German general population.

Methods

The sample was selected with the assistance of a demographic consulting company applying a face to face interview (N = 2509; mean age = 49.4, SD = 18.2; 55.8% women). Adherence to Rasch model assumptions was determined with analysis of Rasch model fit (infit and outfit), unidimensionality, local independence (principal component factor analysis of the residuals, PCFAR) and differential item functioning (DIF) with regard to participants' age and gender. Norm values were calculated. Convergent and divergent validity was determined through intercorrelations with the depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS-D and HADS-A).

Results

Fit statistics were below critical values (< 1.3). There were no signs of DIF. The PCFAR revealed that the Rasch dimension "depression" explained 68.5% (DESC-I) and 69.3% (DESC-II) of the variance, respectively which suggests unidimensionality and local independence of the DESC. Correlations with HADS-D were r_DESC-I = .61 and r_DESC-II = .60, whereas correlations with HADS-A were r_DESC-I = .62 and r_DESC-II = .60.

Conclusions

This study provided further support for the psychometric quality of the DESC. Both forms of the DESC adhered to Rasch model assumptions and showed intercorrelations with HADS subscales that are in line with the literature. The presented normative data offer important advancements for the interpretation of the questionnaire scores and enhance its usefulness for clinical and research applications.

Diagnostic validity and added value of the Geriatric Depression Scale for depression in primary care: a meta-analysis of GDS30 and GDS15

BACKGROUND

The Geriatric Depression Scale (GDS) has been evaluated in hospital settings but its validity and added value in primary care is uncertain. We therefore conducted a meta-analysis analysing the diagnostic accuracy, clinical utility and added value of the GDS in primary care.

METHODS

A comprehensive search identified 69 studies that measured the diagnostic validity of the GDS against a semi-structured psychiatric interview and of these 17 analyses (in 14 publications) took place in primary care. Seven studies examined the GDS(30) and 10 studies examined the GDS(15). Heterogeneity was moderate to high, therefore random effects meta-analysis was used.

RESULTS

Diagnostic accuracy of the GDS(30) after meta-analytic weighting was given by a sensitivity of 77.4% (95% CI=66.3% to 86.8%) and a specificity=65.4% (95% CI=44.2% to 83.8%). For the GDS(15) the sensitivity was 81.3% (95% CI=77.2% to 85.2%) and specificity=78.4% (95% CI=71.2% to 84.8%). The fraction correctly identified (also known as efficiency) by the GDS(15) was significantly higher than the GDS(30) (77.6% vs 71.2%, Chi(2)=24.8 P<0.0001). The clinical utility of both the GDS(30) and GDS(15) was "poor" for case-finding (UI+ 0.29, UI+ 0.32 respectively). However the GDS(15) was rated as "good" for screening (UI- 0.75) whereas the GDS(30) was "adequate" (UI- 0.60). Concerning added value, when identification using the GDS was compared with general practitioners' ability to diagnose late-life depressions unassisted by tools, at a prevalence of 15% the GDS(30) had no added benefit whereas the GDS(15) helped identify an additional 4 cases per 100 primary care attendees and also helped rule-out an additional 4 non-cases per 100 attendees. Thus we estimate the potential gain of the GDS(15) in primary care to be 8% over unassisted clinical detection but at a cost of 3-4 minutes of extra time per appointment.

CONCLUSION

The GDS yields potential added value in primary care. We recommend the GDS(15) but not the GDS(30) in the diagnosis of late-life depression in primary care.

Cognitive function and tea consumption in community dwelling older Chinese in Singapore

OBJECTIVES

We aimed to examine the relationship between tea consumption and cognitive function in older adults.

DESIGN

Cross-sectional study.

SETTING

The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban Singapore.

PARTICIPANTS

716 Chinese adults aged > or = 55 years.

MEASUREMENT

Self-reported current tea consumption habits (frequency and type). Cognitive performance was assessed by a battery of neuropsychological tests; composite domain scores on attention, memory, executive function, and information processing speed were computed using raw test scores. The Mini-Mental State Examination (MMSE) total score was used as a measure of global cognitive function.

RESULTS

After adjusting for potential confounders, total tea consumption was independently associated with better performances on global cognition (B=0.055, SE=0.026, p=0.03), memory (B=0.031, SE=0.012, p=0.01), executive function (B=0.032, SE=0.012, p=0.009), and information processing speed (B=0.04, SE=0.014, p=0.001). Both black/oolong tea and green tea consumption were associated with better cognitive performance. There was no association between coffee consumption and cognitive function.

CONCLUSIONS

Tea consumption was associated with better cognitive performance in community-living Chinese older adults. The protective effect of tea consumption on cognitive function was not limited to particular type of tea.

Screening for depression: Rasch analysis of the dimensional structure of the PHQ-9 and the HADS-D

BACKGROUND

Both the depression modules of the Hospital Anxiety and Depression Scale (HADS-D) and the Patient Health Questionnaire (PHQ-9) are widely used for the screening of depression. We analyzed the dimensionality and the item fit of both scales individually and across the scales. Moreover, we sought to identify items which evidenced item response bias associated with age and gender.

METHODS

The depression subscales HADS-D and the PHQ-9 were administered to 1271 patients (mean age 67.2; 22.5% women) undergoing coronary artery bypass graft surgery (CABG). Rasch analyses were performed to assess the overall fit of the model, individual item fit and differential item functioning (DIF).

RESULTS

Rasch analysis revealed that the HADS-D and the PHQ-9 feature a common core construct containing six items of the HADS-D and three items of the PHQ-9. Two of these items are identical with the 2-item short form of the PHQ-9. In addition, fatigability was the only somatic item that fitted the model. No substantial DIF was observed.

LIMITATIONS

The generalizability of these results might be restricted to patients awaiting CABG.

CONCLUSIONS

The short form of the PHQ-9 seems to be an economic and valid instrument for the screening of depression, which indicates the same latent construct that is captured by six items of the HADS-D. Further studies are needed to evaluate whether the addition of fatigability might enhance the validity of the PHQ-2 in this patient population.

Comorbid cognitive impairment and depression is a significant predictor of poor outcomes in hip fracture rehabilitation

BACKGROUND

The effects of depression and cognitive impairment on hip fracture rehabilitation outcomes are not well established. We aimed to evaluate the associations of depressive symptoms and cognitive impairment (individually and combined) with ambulatory, living activities and quality of life outcomes in hip fracture rehabilitation patients.

METHODS

A cohort of 146 patients were assessed on depressive symptoms (Geriatric Depression Scale, GDS > or = 5), cognitive impairment (Mini-mental State Examination, MMSE < or = 23), and other variables at baseline, and on ambulatory status, Modified Barthel Index (MBI), and SF-12 PCS and MCS quality of life on follow ups at discharge, 6 months and 12 months post fracture.

RESULTS

In these patients (mean age 70.8 years, SD 10.8), 7.5% had depressive symptoms alone, 28.8% had cognitive impairment alone, 50% had both, and 13.7% had neither (reference). Ambulatory status showed improvement over time in all mood and cognition groups ((beta = 0.008, P = 0.0001). Patients who had cognitive impairment alone (beta = -0.060, P = 0.001) and patients who had combined cognitive impairment with depressive symptoms beta = -0.62, P = 0.0003), showed significantly less improvement in ambulatory status than reference patients. In the latter group, the relative differences in ambulatory scores from the reference group were disproportionately greater over time (beta = -0.003, SE = 0.001, P = 0.021). Patients with combined depressive symptoms and cognitive impairment also showed a significantly lower MBI score, (beta = -10.92, SE = 4.01, P = 0.007) and SF-12 MCS (beta = -8.35, SE = 2.37, P = 0.0006). Mood and cognition status did not significantly predict mortality during the follow-up.

CONCLUSION

Depression and cognitive impairment comorbidity is common in hip fracture rehabilitation patients and significantly predicts poor functional and quality of life outcomes.

Association between depressive symptoms and use of HMG-CoA reductase inhibitors (statins), corticosteroids and histamine H(2) receptor antagonists in community-dwelling older persons: cross-sectional analysis of a population-based cohort

BACKGROUND

Strong evidence supporting the existence of causal associations of drug use with depression is often lacking from empirical studies. Limited evidence suggests an inverse association of use of HMG-CoA reductase inhibitors (statins) with depressive symptoms. Sparse and sometimes conflicting data in this respect have also been reported for corticosteroids, histamine H(2) receptor antagonists and antihypertensive agents.

OBJECTIVE

To identify associations between use of different drug classes and depressive symptoms in community-dwelling older patients and to determine whether any such associations varied between young-old and old-old patients.

METHOD

We analysed cross-sectional data from a population-based cohort of 2804 older adults aged > or =55 years, in whom specific drug use was systematically identified from self-reports and physical inspection of medication labels. Depressive symptoms were determined using the 15-item Geriatric Depression Scale (GDS), with a GDS score > or =5 defining the presence of depressive symptoms.

RESULTS

Multivariate analysis controlling for the confounding effects of risk factors and correlates of depression revealed significant associations between depressive symptoms and use of statins (odds ratio [OR] 0.71; 95% CI 0.52, 0.97), histamine H(2) receptor antagonists for patients aged <65 years (OR 4.67; 95% CI 1.59, 13.74) and, in participants aged > or =65 years, systemic corticosteroids (OR 4.02; 95% CI 1.12, 14.42). No convincing associations between the presence of depressive symptoms and use of antihypertensives, antiparkinsonism drugs, NSAIDs and tranquilizers/hypnotic/sedatives were demonstrated.

CONCLUSION

The evidence in this study suggests a possible protective effect of statin use on depressive symptoms, and affirms a positive association between depressive symptoms and corticosteroid use, especially in the older elderly. Use of H(2) receptor antagonists was also associated with depressive symptoms, probably through their link with underlying dyspeptic syndromes.