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Nguyen NT, Nguyen T, Bui TD, Giang LT. Depression and associated factors among older people in Vietnam: Findings from a National Aging Survey. PLoS One 2024; 19:e0299791. [PMID: 38728261 PMCID: PMC11086836 DOI: 10.1371/journal.pone.0299791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/16/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Depression is one of the most common mental health disorders among older people. Depressive symptoms are often overlooked and untreated in primary care settings. This study aims to assess the prevalence of depressive symptoms and associated factors among older people in Vietnam. METHOD The study analyzed data from the Vietnam National Aging Survey (VNAS) conducted in 2022 with a nationally representative sample of 3,006 older people aged 60 and over in 12 provinces. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms. Bivariate and multiple logistic regression analyses were used to explore the association between depressive symptoms and other related factors such as sociodemographic and economic characteristics, social support, health status, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations, chronic diseases, cigarette smoking status, alcoholic drinking, and domestic violence. RESULTS The prevalence of depressive symptoms among older people was 20.2%. The associated factors that increase the odds of having depression among older people were female gender (OR = 2.21, 95% CI 1.34-3.62), living in rural areas (OR = 1.83, 95% CI 1.15-2.89), the poorest quintile (OR = 2.26, 95% CI 1.39-3.66), self-rated poor health (OR = 11.68, 95% CI 4.96-27.49), ADL limitations (OR = 2.12, 95% CI 1.51-2.99), IADL limitation (OR = 1.61 95% CI 1.16-2.25), and experiencing domestic violence in the last 12 months (OR = 6.66, 95% CI 4.00-11.05). CONCLUSION Depression symptoms were prevalent among older people in Vietnam. Depression screening for older people should be included in primary care settings for early identification and treatment of depression.
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Affiliation(s)
| | - Trang Nguyen
- Institute of Social and Medical Studies, Ha Noi, Vietnam
| | - Thu Dai Bui
- Institute of Social and Medical Studies, Ha Noi, Vietnam
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MacNeil A, Birk S, Villeneuve PJ, Jiang Y, de Groh M, Fuller-Thomson E. Incident and Recurrent Depression among Adults Aged 50 Years and Older during the COVID-19 Pandemic: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15032. [PMID: 36429749 PMCID: PMC9690838 DOI: 10.3390/ijerph192215032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic and accompanying public health measures have exacerbated many risk factors for depression in older adulthood. The objectives of the current study are: (1) to determine the risk of incident and recurrent depression during the COVID-19 pandemic among those with, or without, a history of depression; and (2) to identify factors that were predictive of depression in these two groups. The study population included 22,622 participants of the Canadian Longitudinal Study on Aging who provided data at baseline (2011-2015), follow-up (2015-2018), and twice during the pandemic (April-May 2020, September-December 2020). The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to classify individuals with depression. Logistic regression was used to estimate the odds of depression during COVID across a series of risk factors. Individuals with a history of depression had four times the risk of depression during the pandemic when compared to those without a history of depression, even after controlling for relevant covariates. Other factors associated with depression during the pandemic include being female, having fewer savings, and experiencing COVID-19 related stressors, such as health stressors, difficulties accessing resources, and family conflict. Clinicians working with older adults should consider interventions to support high-risk groups, such as those with recurrent depression.
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Affiliation(s)
- Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Sapriya Birk
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Paul J. Villeneuve
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- CHAIM Research Centre, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Ying Jiang
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
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Santos CJ, Paciência I, Ribeiro AI. Neighbourhood Socioeconomic Processes and Dynamics and Healthy Ageing: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116745. [PMID: 35682327 PMCID: PMC9180257 DOI: 10.3390/ijerph19116745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023]
Abstract
Elderly citizens are concentrated in urban areas and are particularly affected by the immediate residential environment. Cities are unequal and segregated places, where there is an intensification of urban change processes such as gentrification and displacement. We aimed to understand how neighbourhood socioeconomic processes and dynamics influence older people’s health. Three bibliographic databases—PubMed, Web of Science, and Scopus—were used to identify evidence of the influence of neighbourhood socioeconomic deprivation, socio-spatial segregation, urban renewal, and gentrification on healthy ageing. We followed the method of Arksey and O’Malley, Levac and colleagues, the Joanna Briggs Institute, and the PRISMA-ScR. The included studies (n = 122) were published between 2001 and 2021. Most evaluated neighbourhood deprivation (n = 114), followed by gentrification (n = 5), segregation (n = 2), and urban renewal (n = 1). Overall, older people living in deprived neighbourhoods had worse healthy ageing outcomes than their counterparts living in more advantaged neighbourhoods. Older adults pointed out more negative comments than positive ones for gentrification and urban renewal. As to segregation, the direction of the association was not entirely clear. In conclusion, the literature has not extensively analysed the effects of segregation, gentrification, and urban renewal on healthy ageing, and more quantitative and longitudinal studies should be conducted to draw better inferences.
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Affiliation(s)
- Cláudia Jardim Santos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Correspondence: ; Tel.: +351-222-061-820
| | - Inês Paciência
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90570 Oulu, Finland;
- Biocenter Oulu, University of Oulu, P.O. Box 5000, 90570 Oulu, Finland
| | - Ana Isabel Ribeiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
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Li LW, Cheng GJ, Xu H, Zhang Z, Liu J, Conwell Y. Depression Is Associated With Myocardial Infarction Within a 2-Year Period Among Adults in China. Asia Pac J Public Health 2022; 34:516-523. [PMID: 35485197 DOI: 10.1177/10105395221095331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined whether baseline depression is associated with myocardial infarction (MI) within a 2-year period among middle-age and older adults in China and whether the association varies by sociodemographic characteristics. Two-year longitudinal data from a nationally representative sample of people aged 45+ years in China were analyzed (N = 15 226). MI within the 2-year period was coded dichotomously. Baseline depression, assessed by the 10-item Center for Epidemiological Studies Depression scale, was used as a dichotomous and a continuous variable. After adjusting for medical conditions, lifestyle, and sociodemographic characteristics, the odds of having an MI within the 2-year period were 46% greater for respondents with clinically significant depression at baseline than those without. There was a dose-response relationship between symptom severity and the probability of having an MI. The association did not vary by sociodemographic characteristics. Findings suggest that depression screening and treatment may reduce MI cases in China and beyond.
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Affiliation(s)
- Lydia W Li
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Hongwei Xu
- Department of Sociology, Queens College-CUNY, Queens, NY, USA
| | - Zhenmei Zhang
- Department of Sociology, Michigan State University, East Lansing, MI, USA
| | - Jinyu Liu
- School of Social Work, Columbia University, New York, NY, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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5
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Liu Y, Liu Z, Liang R, Luo Y. The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China. BMC Psychiatry 2022; 22:297. [PMID: 35484534 PMCID: PMC9047288 DOI: 10.1186/s12888-022-03937-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship. METHODS Using data from the China Health and Retirement Longitudinal 2011-2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used. RESULTS Community SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents. CONCLUSIONS This study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.
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Affiliation(s)
- Yan Liu
- grid.11135.370000 0001 2256 9319Institute of Population Research, Peking University, Beijing, China
| | - Zhaorui Liu
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Beijing, China
| | - Richard Liang
- grid.168010.e0000000419368956School of Medicine, Stanford University, Palo Alto, California USA
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, 100191, Beijing, China.
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Holmgren JL, Carlson JA, Gallo LC, Doede AL, Jankowska MM, Sallis JF, Perreira KM, Andersson LM, Talavera GA, Castaneda SF, Garcia ML, Allison MA. Neighborhood Socioeconomic Deprivation and Depression Symptoms in Adults From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:427-439. [PMID: 34170007 PMCID: PMC8688277 DOI: 10.1002/ajcp.12525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Socioeconomic factors appear to impact mental health conditions such as depression, but little is known about the relative and combined role of neighborhood and personal socioeconomic deprivation among Hispanics/Latinos. This study examined cross-sectional associations of neighborhood and personal socioeconomic deprivation with depression symptoms in a US Hispanic/Latino population from the San Diego Field Center of the Hispanic Community Health Study/Study of Latinos (n = 3,851). Depression symptoms were assessed with the ten-item Centers for Epidemiological Studies in Depression Scale. Neighborhood socioeconomic deprivation was a composite of eleven variables (e.g., neighborhood income, education, employment, household crowding). Greater personal socioeconomic deprivation based on education, income, and employment was generally associated with higher depression symptoms, including after adjusting for neighborhood socioeconomic deprivation. Greater neighborhood socioeconomic deprivation was associated with higher depression symptoms in females but not males, but the association in females became non-significant when adjusting for personal socioeconomic deprivation. Neighborhood socioeconomic deprivation did not significantly interact with personal socioeconomic deprivation in relation to depression symptoms. The present findings support the association of personal socioeconomic status with mental health (indicated by depression symptoms) among Hispanic/Latino populations, whereas neighborhood socioeconomic deprivation did not relate to depression beyond the impact of personal indicators.
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Affiliation(s)
| | - Jordan A. Carlson
- Center for Children’s Healthy Lifestyles & Nutrition, Children’s Mercy Kansas City, MO, USA
- Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO, USA
| | | | | | | | - James F. Sallis
- University of California San Diego, La Jolla, CA, USA
- Mary MacKillop Institute of Health Research, Australian, Catholic University, Melbourne, Vic., Australia
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Jakobsen AL. Neighborhood socioeconomic deprivation and psychiatric medication purchases. Different neighborhood delineations, different results? A nationwide register-based multilevel study. Health Place 2021; 72:102675. [PMID: 34583189 DOI: 10.1016/j.healthplace.2021.102675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022]
Abstract
Previous studies of neighborhood socioeconomic deprivation and mental health treatment have shown mixed results. Multiple reviews have highlighted that the definition and measurement of neighborhoods can lead to different results, providing one explanation for these mixed findings. This study compares the use of micro-areas created using an automated redistricting algorithm and divided by physical barriers with the use of two administrative units, Danish parishes and postal codes. The geographical data are linked to Danish register data of the Danish population from age 16 in 2017, N = 4,347,001, to measure the association between the purchase of psychiatric medication and neighborhood socioeconomic deprivation using logistic multilevel models. Neighborhood socioeconomic deprivation is associated with a slightly increased probability of redeeming prescriptions for psychiatric medication after controlling for individual sociodemographic composition. However, this association was present only for micro-areas and not for parishes or postal codes. The results indicate that neighborhood effects on psychiatric medication purchases are affected by the neighborhood delineations used and that future studies should carefully consider how neighborhoods are defined and measured.
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Cheah YK, Azahadi M, Phang SN, Abd Manaf NH. Sociodemographic, Lifestyle, and Health Factors Associated With Depression and Generalized Anxiety Disorder Among Malaysian Adults. J Prim Care Community Health 2021; 11:2150132720921738. [PMID: 32450747 PMCID: PMC7252371 DOI: 10.1177/2150132720921738] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: Lowering the prevalence of mental health illness is one of the main public health concerns. The objective of the present study was to examine factors associated with depression and generalized anxiety disorder (GAD) among adults in Malaysia. Methods: Data were extracted from the National Health and Morbidity Survey 2011 (NHMS 2011), which is a nationally representative sample collected using a 2-stage stratified sampling method. A bivariate probit model was utilized to examine the influences of sociodemographic, lifestyle, and health factors on the likelihood of suffering from depression and GAD. Results: Age, gender, ethnicity, education, marital status, and self-rated health were significantly associated with depression and GAD. In particular, there were positive relationships between depression and GAD, and younger adults, females, Indian ethnic group, lower level of education, being unmarried, and self-rated poor health. Conclusions: Sociodemographic and health factors were associated with determining the risks of depression and GAD in Malaysia. With this information, future policies (eg, screening and treatment) could be targeted at those at most risk to develop depression and GAD.
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Affiliation(s)
- Yong Kang Cheah
- Universiti Utara Malaysia, Sintok, Kedah Darul Aman, Malaysia
| | - Mohd Azahadi
- National Institute of Health, Selangor, Malaysia
| | - Siew Nooi Phang
- Universiti Utara Malaysia, Sintok, Kedah Darul Aman, Malaysia
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Maston G, Franklin J, Hocking S, Swinbourne J, Gibson A, Manson E, Sainsbury A, Markovic T. Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration. PLoS One 2021; 16:e0253127. [PMID: 34138917 PMCID: PMC8211265 DOI: 10.1371/journal.pone.0253127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/01/2021] [Indexed: 12/27/2022] Open
Abstract
Meal replacement Severely Energy-Restricted Diets (SERDs) produce ≥ 10% loss of body mass when followed for 6 weeks or longer in people with class III obesity (BMI ≥ 40 kg/m2). The efficacy of SERDs continues to be questioned by healthcare professionals, with concerns about poor dietary adherence. This study explored facilitators and barriers to dietary adherence and program attrition among people with class III obesity who had attempted or completed a SERD in a specialised weight loss clinic. Participants who commenced a SERD between January 2016 to May 2018 were invited to participate. Semi-structured in-depth interviews were conducted from September to October 2018 with 20 participants (12 women and 8 men). Weight change and recounted events were validated using the participants' medical records. Data were analysed by thematic analysis using line-by-line inductive coding. The mean age ± SD of participants was 51.2 ± 11.3 years, with mean ± SD BMI at baseline 63.7 ± 12.6 kg/m2. Five themes emerged from participants' recounts that were perceived to facilitate dietary adherence: (1.1) SERD program group counselling and psychoeducation sessions, (1.2) emotionally supportive clinical staff and social networks that accommodated and championed change in dietary behaviours, (1.3) awareness of eating behaviours and the relationship between these and progression of disease, (1.4) a resilient mindset, and (1.5) dietary simplicity, planning and self-monitoring. There were five themes on factors perceived to be barriers to adherence, namely: (2.1) product unpalatability, (2.2) unrealistic weight loss expectations, (2.3) poor program accessibility, (2.4) unforeseeable circumstances and (2.5) externalised weight-related stigma. This study highlights opportunities where SERD programs can be optimised to facilitate dietary adherence and reduce barriers, thus potentially improving weight loss outcomes with such programs. Prior to the commencement of a SERD program, healthcare professionals facilitating such programs could benefit from reviewing participants to identify common barriers. This includes identifying the presence of product palatability issues, unrealistic weight loss expectations, socio-economic disadvantage, and behaviour impacting experiences of externalised weight-related stigma.
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Affiliation(s)
- Gabrielle Maston
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Samantha Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Swinbourne
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alice Gibson
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elisa Manson
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Tania Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Almeida OP, Patel H, Kelly R, Ford A, Flicker L, Robinson S, Araya R, Gilbody S, Thompson S. Preventing depression among older people living in rural areas: A randomised controlled trial of behavioural activation in collaborative care. Int J Geriatr Psychiatry 2021; 36:530-539. [PMID: 33098159 DOI: 10.1002/gps.5449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to test if a behavioural activation (BA) programme was more effective than usual care at reducing the risk of conversion to major depression over 52 weeks among adults aged 65 years or older living in rural Western Australia. Secondary aims were to test if participants assigned to the BA intervention experienced greater decline in the severity of depressive and anxiety symptoms than older adults treated with usual care over 26 and 52 weeks, as well as greater improvement in physical and mental health-related quality of life. METHODS Randomised controlled clinical trial that started recruitment in February 2016 in rural Western Australia. We used the electoral roll to invite adults aged 65 years or over living in suitable regions of Western Australia to take part in the study. We recruited those who consented and screened positive to at least one of the two Whooley questions: feeling down/depressed/hopeless or little interest or pleasure over the past month. Participants were randomly assigned to usual care or usual care plus a phone-delivered BA program (1:1). The intervention consisted of a self-managed BA program supported by three 45-min phone sessions delivered by a BA therapist over a period of 8 weeks. We used the DSM-5 criteria to establish the presence of a major depressive episode, and Patient Health Questionnaire, Generalised Anxiety Disorder Scale and SF-36 to assess symptoms of depression, anxiety and quality of life. RESULTS Of the 309 older adults randomised, 307 started the trial: 153 usual care and 154 BA (computer-generated random permuted even blocks ranging in size from 8 to 20). Six participants developed a major depressive episode during follow-up, four of them in the usual care group (odds ratio of depression associated with the intervention = 0.49, 95% CI = 0.04, 3.49-blind assessment). Seventy-three (23.8%) participants were lost over 52 weeks-there were no differences between usual care and intervention group. Intention-to-treat analyses using mixed regression models found modest non-significant effects of the BA intervention, while complete-case analyses showed that participants treated with BA compared with usual care experienced significant improvements in depression and anxiety symptoms over 52 weeks, as well as improved mental health quality of life. CONCLUSIONS Few participants developed a major depressive episode during follow-up. The BA intervention was associated with improved symptoms of depression and anxiety, although the clinical significance of these benefits remains unclear.
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Affiliation(s)
- Osvaldo P Almeida
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Hema Patel
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Rachael Kelly
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Andrew Ford
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | | | - Ricardo Araya
- Centre for Global Mental Health, King's College London, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Sandra Thompson
- WA Centre for Rural Health, School of Population and Global Health, University of Western Australia, Perth, Australia
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11
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Sirey JA, Woods A, Solomonov N, Evans L, Banerjee S, Zanotti P, Alexopoulos G, Kales HC. Treatment Adequacy and Adherence as Predictors of Depression Response in Primary Care. Am J Geriatr Psychiatry 2020; 28:1164-1171. [PMID: 32402523 PMCID: PMC8159366 DOI: 10.1016/j.jagp.2020.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Primary care is the de facto mental health system in the United States where physicians treat large numbers of depressed older adults with antidepressant medication. This study aimed to examine whether antidepressant dosage adequacy and patient adherence are associated with depression response among middle-aged and older adults prescribed with antidepressants by their primary care provider. DESIGN A secondary analysis was conducted on a sample drawn from a randomized controlled trial comparing Treatment as Usual to Treatment Initiation Program, an adherence intervention. Treatment Initiation Program improved adherence but not depression compared to Treatment as Usual (Sirey et al., 2017). For this analysis, we examined dosing adequacy and adherence at 6 and 12 weeks as predictors of depression response in both groups at 12 and 24 weeks. SETTING Primary care practices. PARTICIPANTS One hundred eighty-seven older adults with depression prescribed an antidepressant for depression by their primary care provider. MEASUREMENTS Depression response was defined as 50% reduction on the Hamilton Rating Scale for Depression. Adherence was defined as taking 80% of doses at follow-up interviews (6 and 12 weeks). Patient-reported dosage and duration of antidepressant therapy was collected using the Composite Antidepressant Score (adequacy score of >3) at follow-up. RESULTS Greater adherence, but not receipt of adequate dosage, was associated with higher likelihood of treatment response at both 12 (Odds ratio (OR) = 2.63; 95% Confidence Interval (CI), 1.19-5.84) and 24 weeks (OR = 3.09; 95% CI, 1.46-6.55). CONCLUSION As physicians prescribe antidepressants to the diverse group of adults seen in primary care, special attention to patients' views and approach to adherence may improve depression outcomes.
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Affiliation(s)
- Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College (JAS, AW, NS, PZ, GA).
| | - Alexandra Woods
- Department of Psychiatry, Weill Cornell Medical College (JAS, AW, NS, PZ, GA)
| | - Nili Solomonov
- Department of Psychiatry, Weill Cornell Medical College (JAS, AW, NS, PZ, GA)
| | - Lauren Evans
- Department of Healthcare Policy & Research, Weill Cornell Medicine (LE, SB)
| | - Samprit Banerjee
- Department of Healthcare Policy & Research, Weill Cornell Medicine (LE, SB)
| | - Paula Zanotti
- Department of Psychiatry, Weill Cornell Medical College (JAS, AW, NS, PZ, GA)
| | - George Alexopoulos
- Department of Psychiatry, Weill Cornell Medical College (JAS, AW, NS, PZ, GA)
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, University of California at Davis (HCK)
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12
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Elwadhi D, Cohen A. Social inequalities in antidepressant treatment outcomes: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1241-1259. [PMID: 32666210 DOI: 10.1007/s00127-020-01918-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify, review and synthesize evidence on whether social disadvantage moderates antidepressant treatment outcomes, even when access to treatment is not a consideration. METHODS The systematic review was done in accordance with PRIMSA guidelines. An a priori systematic search strategy was used to search databases (MEDLINE, PsychINFO, EMBASE, Global Health and Cochrane Trials Library) from their earliest entries through December 31, 2018. A two-step screening procedure was followed, and all experimental studies of antidepressant treatment in ICD/DSM diagnosed cases of depression were included. Studies with subjects < 18 years or investigating other modalities of treatment were excluded. RESULTS Thirteen papers reporting analyses from nine studies met inclusion criteria. There was heterogeneity in sample sizes, target populations, treatment settings, clinical outcomes and definition of SES indices. The primary outcome was the relative effect of socioeconomic status (SES) (as measured by income, employment status and level of education)-on antidepressant treatment outcomes. CONCLUSIONS The evidence from this review suggests that lower SES may lead to social inequalities in antidepressant treatment outcomes even in the context of clinical trials in which all participants have equal access to the same high-quality, standardized care. The review calls for more careful consideration of the choice and operationalization of SES indicators, and the need to "employ sampling methods that ensure ample representation of individuals from a wide range of social worlds". The review concludes with tentative suggestions about how to reduce social inequalities in antidepressant treatment outcomes at the level of individuals and populations.
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Affiliation(s)
- Deeksha Elwadhi
- Central Locality Team, Haringey Adult Mental Health Services, St Ann's Hospital, Barnet, Enfield and Haringey Mental Health Trust, London, UK.
| | - Alex Cohen
- Dept of Epidemiology, Harvard-TH Chan School of Public Health, Boston, MA, USA.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Tamura K, Langerman SD, Orstad SL, Neally SJ, Andrews MR, Ceasar JN, Sims M, Lee JE, Powell-Wiley TM. Physical activity-mediated associations between perceived neighborhood social environment and depressive symptoms among Jackson Heart Study participants. Int J Behav Nutr Phys Act 2020; 17:91. [PMID: 32650787 PMCID: PMC7350640 DOI: 10.1186/s12966-020-00991-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA. METHODS We used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates. RESULTS Our participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms. CONCLUSIONS We found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.
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Affiliation(s)
- Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA.
| | | | - Stephanie L Orstad
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jae E Lee
- Research Centers in Minority Institutions Translational Research Network Data Coordinating Center, Jackson State University, Jackson, MS, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Triolo F, Sjöberg L, Vetrano DL, Darin-Mattsson A, Bertolotti M, Fratiglioni L, Dekhtyar S. Social engagement in late life may attenuate the burden of depressive symptoms due to financial strain in childhood. J Affect Disord 2020; 263:336-343. [PMID: 31969263 DOI: 10.1016/j.jad.2019.11.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/22/2019] [Accepted: 11/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND It remains poorly understood if childhood financial strain is associated with old-age depression and if active social life may mitigate this relationship. AIMS To investigate the association between childhood financial strain and depressive symptoms during aging; to examine whether late-life social engagement modifies this association. METHOD 2884 dementia-free individuals (aged 60+) from the Swedish National study of Aging and Care-Kungsholmen were clinically examined over a 15-year follow-up. Presence of childhood financial strain was ascertained at baseline. Depressive symptoms were repeatedly assessed with the Montgomery-Åsberg Depression Rating Scale. Social engagement comprised information on baseline social network and leisure activities. Linear, logistic and mixed-effect models estimated baseline and longitudinal associations accounting for sociodemographic, clinical, and lifestyle factors. RESULTS Childhood financial strain was independently associated with a higher baseline level of depressive symptoms (β = 0.37, 95%CI 0.10-0.65), but not with symptom change over time. Relative to those without financial strain and with active social engagement, depressive burden was increased in those without financial strain but with inactive social engagement (β = 0.43, 95%CI: 0.15-0.71), and in those with both financial strain and inactive engagement (β = 0.99, 95%CI: 0.59-1.40). Individuals with financial strain and active social engagement exhibited similar depressive burden as those without financial strain and with active social engagement. LIMITATIONS Recall bias and reverse causality may affect study results, although sensitivity analyses suggest their limited effect. CONCLUSIONS Early-life financial strain may be of lasting importance for old-age depressive symptoms. Active social engagement in late-life may mitigate this association.
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Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Geriatric Medicine, Department di Biomedical, Metabolic e Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Darin-Mattsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Marco Bertolotti
- Division of Geriatric Medicine, Department di Biomedical, Metabolic e Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Terassi M, Rossetti ES, Luchesi BM, Gramani-Say K, Hortense P, Pavarini SCI. Factors associated with depressive symptoms in elderly caregivers with chronic pain. Rev Bras Enferm 2020; 73:e20170782. [PMID: 31994674 DOI: 10.1590/0034-7167-2017-0782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/08/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify factors associated with depressive symptoms in elderly caregivers with chronic pain. METHOD the study included people 60 years of age or older who reported chronic pain and cared for another elderly person living in the same household (n=186). Statistical analyzes were performed using the Mann-Whitney test, univariate and multiple logistic regression. RESULTS most participants had no depressive symptoms (70.4%), 24.2% had mild depressive symptoms and 5.4% had severe symptoms. Univariate analysis showed that the variables family income, number of diseases, number of medications in use, pain intensity, overload and perceived stress were associated with depressive symptoms. Multivariate analysis found an association with perceived stress (95% CI 1.101-1207) and number of medications (95% CI 1.139-1.540) in use. CONCLUSION factors associated with depressive symptoms in elderly caregivers with chronic pain were stress and the number of medications in use.
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Affiliation(s)
- Marielli Terassi
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
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Craike M, Bourke M, Hilland TA, Wiesner G, Pascoe MC, Bengoechea EG, Parker AG. Correlates of Physical Activity Among Disadvantaged Groups: A Systematic Review. Am J Prev Med 2019; 57:700-715. [PMID: 31630762 DOI: 10.1016/j.amepre.2019.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Socioeconomically disadvantaged adults have lower engagement in leisure-time physical activity than those who are more affluent. Identification of correlates of physical activity can inform the design of effective interventions. The aim of this systematic review was to identify consistent correlates of unspecified physical activity and leisure-time physical activity among socioeconomically disadvantaged adults. EVIDENCE ACQUISITION PubMed and Scopus were searched up to May 2018, and titles/abstracts and full texts were screened against eligibility criteria. Methodologic quality was assessed, and correlates were synthesized from July to September 2018. EVIDENCE SYNTHESIS Seventy-three studies were selected for synthesis; 48 examined unspecified physical activity and 31 examined leisure-time physical activity (6 examined both). Self-rated health, functional capacity, and physical activity self-efficacy were consistently, positively associated with unspecified physical activity. Mental health status and perceived benefits and enjoyment of physical activity were consistently, positively associated with leisure-time physical activity. Most studies were cross-sectional and used validated self-report measures of physical activity; few reported response rates >50%. CONCLUSIONS Few factors were consistently associated with either unspecified physical activity or leisure-time physical activity. Based on available evidence, strategies to increase physical activity should consider the needs of, and focus on, those with poor self-rated health and functional capacity and should use strategies to improve physical activity self-efficacy. Strategies to increase leisure-time physical activity should focus on simultaneously addressing leisure-time physical activity and mental health concerns and improving perceptions of physical activity benefits and enjoyment. It is recommended that future studies focus on leisure-time physical activity, focus on men, use longitudinal design, examine variables related to behavioral attributes and skills, and carefully consider and plan recruitment strategies.
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Affiliation(s)
- Melinda Craike
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia; Mitchell Institute, Victoria University, Melbourne, Victoria, Australia.
| | - Matthew Bourke
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Toni A Hilland
- School of Education, College of Design and Social Context, Bundoora, Victoria, Australia
| | - Glen Wiesner
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Michaela C Pascoe
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia; Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Enrique Garcia Bengoechea
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Alexandra G Parker
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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Baranyi G, Sieber S, Pearce J, Cheval B, Dibben C, Kliegel M, Cullati S. A longitudinal study of neighbourhood conditions and depression in ageing European adults: Do the associations vary by exposure to childhood stressors? Prev Med 2019; 126:105764. [PMID: 31269417 DOI: 10.1016/j.ypmed.2019.105764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
Abstract
Emerging literature emphasises the association between neighbourhood conditions and late life depression. Childhood experiences, crucial for life course development of mental health, may modify how neighbourhood affects subsequent depression. This study assessed the longitudinal associations of access to services and neighbourhood nuisance with depression among older adults, and tested whether these associations varied by exposure to childhood stressors. Data were drawn from the cross-national Survey of Health, Ageing and Retirement in Europe, a prospective cohort study between 2004/2005 and 2015, representative for European adults over the age of 50. Individual perceptions of neighbourhood were measured at baseline; childhood stressors, defined as socioeconomic conditions, adverse experiences and health problems, were collected retrospectively. Multilevel logistic regression estimated the risk of depression (n = 10,328). Access to services were negatively (OR = 0.78, 95% CI 0.68-0.90) and neighbourhood nuisance positively (OR = 1.36, 95% CI 1.18-1.56) associated with the probability of depression during follow-up. We found interactions between neighbourhood and childhood socioeconomic conditions, but not with adverse experiences and health problems. While older adults who grew up in better childhood socioeconomic conditions benefited more from living in a residential area with good access to services, they were at higher risk of developing depression when residing in areas with more neighbourhood nuisances. Older adults' mental health can benefit from better access to public transportation and neighbourhood amenities, while physical and social problems in the local area increase the risk of depression. Importantly, socioeconomic circumstances in early life may influence vulnerability to neighbourhood effects in older age.
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Affiliation(s)
- Gergő Baranyi
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Stefan Sieber
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland
| | - Jamie Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Boris Cheval
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland; Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
| | - Chris Dibben
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Kliegel
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland; Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Stéphane Cullati
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland; Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
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Persistent Depressive Symptoms in a Population With High Levels of Occupational Stress: Trajectories Offer Insights Into Both Chronicity and Resilience. J Psychiatr Pract 2018; 24:399-409. [PMID: 30395547 DOI: 10.1097/pra.0000000000000337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Religious participation and spirituality are linked to good mental health. However, clergy may experience more depression than is observed in the general population, which may be due in part to high job strain. The objectives of this study were to identify distinct longitudinal trajectories of depressive symptoms in clergy and to identify variables associated with each course. The sample was 1172 clergy who were followed for up to 66 months. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-8), which was administered approximately every 6 months. Latent class trajectory analysis was conducted for group identification, and a 3-class trajectory model fit the data best. Class 1 (38% of the sample) had minimal or no depressive symptoms over time, class 2 (47%) had chronic mild symptoms, and class 3 (15%) had persistent moderate/severe symptoms. Occupational distress was significantly associated with trajectory class. The odds of being in either the chronic mild or the persistent moderate/severe depressive symptom class were significantly higher for those who were female, for those with fair/poor self-rated health, for those with more perceived financial or occupational stress, for those with lower levels of perceived emotional support, and/or for those with lower levels of spiritual well-being. The class exhibiting resilience to depressive symptoms had higher levels of perceived support and spiritual well-being as well as lower levels of perceived financial and occupational stress. A substantial percentage of clergy, and possibly people in similar helping occupations, may experience significant levels of depressive symptoms that do not remit over time. These individuals may benefit from treatments that address work-related coping.
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Hu H, Cao Q, Shi Z, Lin W, Jiang H, Hou Y. Social support and depressive symptom disparity between urban and rural older adults in China. J Affect Disord 2018; 237:104-111. [PMID: 29803900 DOI: 10.1016/j.jad.2018.04.076] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/08/2018] [Accepted: 04/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Depressive symptom disparity between urban and rural older adults is an important public health issue in China. Social support is considered as an effective way to alleviate depression of older adults. This study aimed to investigate the extent to which social support could explain the depressive symptom disparity between urban and rural older adults in China. METHODS This study used data drawn from the 2011 China Health and Retirement Longitudinal Study with 6,772 observations. Multiple data analysis strategies were adopted, including descriptive analyses, bivariate analyses, regression analyses and decomposition analyses. RESULTS There were significant depressive symptom disparities between urban and rural older adults in China. Social support had significant association with depressive symptom of older adults while adjusting for covariates. About 25%-28% of the depressive symptom disparities could be attributed to urban-rural gaps in social support, in which community support contributed 21%-25%. Educational level and physical health status also contributed to the disparities. LIMITATION This study only established correlations between social support and depressive symptom disparity rather than casual relationships; and the self-reported measurement of depressive symptom and the unobservable cultural factors might cause limitations. CONCLUSIONS The urban-rural gap in social support, especially community support was a prime explanation for depressive symptom disparities between urban and rural older adults in China. To reduce the depressive symptom disparities, effective community construction in rural China should be put into place, including improving the infrastructure construction, strengthening the role of social organizations, and encouraging community interpersonal interactions for older adults.
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Affiliation(s)
- Hongwei Hu
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Street, Haidian District, Beijing 100872, PR China
| | - Qi Cao
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Street, Haidian District, Beijing 100872, PR China.
| | - Zhenzhen Shi
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Street, Haidian District, Beijing 100872, PR China
| | - Weixia Lin
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Street, Haidian District, Beijing 100872, PR China
| | - Haixia Jiang
- Institute of Population Research, Peking University, No.5, Yiheyuan Road, Haidian District, Beijing 100871, PR China
| | - Yucheng Hou
- Gerald R. Ford School of Public Policy, University of Michigan, Joan & Sanford Weill Hall, 735 S. State Street, Ann Arbor, MI 48109, US
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Chung SS, Joung KH. Demographics and Health Profiles of Depressive Symptoms in Korean Older Adults. Arch Psychiatr Nurs 2017; 31:164-170. [PMID: 28359428 DOI: 10.1016/j.apnu.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 12/28/2022]
Abstract
This study examined the demographics and health characteristics of depressive symptoms of Korean older adults. Data were from the 2014 survey of the Korean Longitudinal Study of Aging (KLoSA). Hierarchical logistic regression was conducted to identify risk factors of depressive symptoms. Model 2 including socio-demographics and health characteristics explained 19.2% of depressive symptoms. Significant risk factors of depressive symptoms were men, age of 53-60 years, mid-sized city and rural area residents, less than high-school education, adults without spouse, 1st (lowest) quintile of annual household income, body shape as underweight, ex-smokers, non-drinkers, no regular exercise, perceived health status as poor, limited activities of daily living, and the number of comorbidities. Interventions to reduce depressive symptoms in these populations should include strategies to change some of these modifiable risk factors.
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Affiliation(s)
- Sung Suk Chung
- Department of Statistics and Institute of Applied Statistics, Chonbuk National University, Jeonju, Republic of Korea.
| | - Kyoung Hwa Joung
- Department of Nursing, Jeonju University, Jeonju, Republic of Korea.
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Abstract
El objetivo del presente estudio fue evaluar la prevalencia de depresión, detectar el riesgo suicida e identificar los factores sociodemográficos y personales asociados a este trastorno. La muestra no aleatorizada estuvo conformada por 1525 hombres colombianos con edades entre 18 y 83 años procedentes de 22 departamentos y de distintos niveles educativos. Para evaluar la depresión se usó el Cuestionario de Depresión para Hombres (Álvarez y Londoño, 2012); para evaluar la comorbilidad con ansiedad se usó la Escala de Ansiedad HADS (Zigmond y Snaith, 1983) y el IMAFE (Lara, 1991); y para recolectar información acerca de los factores personales y sociodemográficos se usó una ficha de registro. Se analizaron los datos para calcular la prevalencia de corte, el riesgo suicida, la comorbilidad a través del uso del paquete estadístico SPSS. Se concluye que la prevalencia real reportada y el riesgo suicida en la población estudiada son más altos que los detectados usando un instrumento no sensible al género.
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When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-015-9313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim HJ, Fredriksen-Goldsen KI. Disparities in Mental Health Quality of Life Between Hispanic and Non-Hispanic White LGB Midlife and Older Adults and the Influence of Lifetime Discrimination, Social Connectedness, Socioeconomic Status, and Perceived Stress. Res Aging 2016; 39:991-1012. [PMID: 27193047 DOI: 10.1177/0164027516650003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed factors contributing to ethnic and racial disparities in mental health quality of life (MHQOL) among lesbian, gay, and bisexual (LGB) midlife and older adults. We utilized cross-sectional survey data from a sample of non-Hispanic White and Hispanic LGB adults aged 50 and older. Structural equation modeling was used to test the indirect effect of ethnicity/race on MHQOL via explanatory factors including social connectedness, lifetime discrimination, socioeconomic status (SES), and perceived stress. Hispanics reported significantly lower levels of MHQOL, compared to non-Hispanic Whites. In the final model, the association between ethnicity/race and MHQOL was explained by higher levels of perceived stress related to lower SES, higher frequency of lifetime discrimination, and lack of social connectedness among Hispanic LGB adults. This study suggests that perceived stress related to social disadvantage and marginalization plays an important role in MHQOL disparities among Hispanic LGB midlife and older adults.
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Affiliation(s)
- Hyun-Jun Kim
- 1 School of Social Work, University of Washington, Seattle, WA, USA
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Intakes of folate, vitamin B6 and B12 and risk of depression in community-dwelling older adults: the Quebec Longitudinal Study on Nutrition and Aging. Eur J Clin Nutr 2015; 70:380-5. [PMID: 26648330 DOI: 10.1038/ejcn.2015.202] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/09/2015] [Accepted: 11/06/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES Depression can decrease quality of life and affect health outcomes in older population. We investigated whether different intake levels of folate, vitamin B6 and B12 were associated with a 3-year depression incidence among generally healthy, community-dwelling older men and women. SUBJECTS/METHODS Participants in the Québec Longitudinal Study on Nutrition and Aging (NuAge), free of depression (that is, 30-item Geriatric Depression Scale (GDS) <11) at baseline (N=1368; 74 ± 4 years old; 50.5% women), were screened annually for incident depression (GDS ⩾ 11) or antidepressant medication. Tertiles of intakes (food only and food+supplements) were obtained from the mean of three non-consecutive 24-h recalls at baseline. Sex-stratified multiple logistic regression models were adjusted for age, physical activity, physical functioning, stressful life events and total energy intake. RESULTS Over 3 years, 170 participants were identified as depressed. Women in the highest tertile of B6 intake from food were 43% less likely to become depressed when adjusting for demographic and health factors (multivariate odds ratio (OR) 0.57, 95% confidence interval (CI) 0.39-0.96), but adjustment for energy intake attenuated the effect. Men in the highest tertile of dietary B12 intake had decreased risk of depression (energy-adjusted multivariate OR 0.42, 95% CI 0.20-0.90). No other association was observed. CONCLUSIONS This study provides some evidence of decreased depression risk among women with higher intakes of vitamin B6 from food, which was dependent on total energy intake, and among men with higher intakes of B12 from food, independently of energy intake.
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Richardson R, Westley T, Gariépy G, Austin N, Nandi A. Neighborhood socioeconomic conditions and depression: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1641-56. [PMID: 26164028 DOI: 10.1007/s00127-015-1092-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/29/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE The evidence linking neighborhood socioeconomic conditions (NSEC) with depression is mixed. We performed a systematic review of this literature, including a rigorous quality assessment that was used to explore if methodological or contextual factors explained heterogeneity across studies. METHODS A systematic literature search in three databases identified longitudinal studies among adolescents and adults living in high-income countries. Two independent reviewers screened studies for inclusion and performed data abstraction. We conducted a formal quality assessment and investigated sources of study heterogeneity. RESULTS Our database search identified 3711 articles, 84 of which were determined to be potentially relevant, and 14 articles were included in this review. About half of the studies found a significant association between NSEC and depression, and pooled estimates suggest poorer socioeconomic conditions were associated with higher odds of depression (OR = 1.14, 95% CI 1.01, 1.28). Study results varied by follow-up time. Among studies with less than 5 years of follow-up, there was a significant association between NSEC and depression (OR = 1.28, 95% CI 1.13, 1.44), although pooling of study results may not be warranted due to heterogeneity across studies. Among studies with at least 5 years of follow-up, which were homogeneous, there was no association (OR = 1.00, 95% CI 0.95, 1.06) between NSEC and depression. CONCLUSIONS We found inconsistent evidence in support of a longitudinal association between NSEC and depression, and heterogeneity according to the length of follow-up time might partly explain the mixed evidence observed in the literature on NSEC and depression.
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Affiliation(s)
- Robin Richardson
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave. West, Montreal, QC, H3A 1A2, Canada.
| | - Tracy Westley
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave. West, Montreal, QC, H3A 1A2, Canada
| | - Geneviève Gariépy
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave. West, Montreal, QC, H3A 1A2, Canada.,Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
| | - Nichole Austin
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave. West, Montreal, QC, H3A 1A2, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave. West, Montreal, QC, H3A 1A2, Canada.,Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
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Li LW, Liu J, Zhang Z, Xu H. Late-life depression in Rural China: do village infrastructure and availability of community resources matter? Int J Geriatr Psychiatry 2015; 30:729-36. [PMID: 25333218 PMCID: PMC4710465 DOI: 10.1002/gps.4217] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to examine whether physical infrastructure and availability of three types of community resources (old-age income support, healthcare facilities, and elder activity centers) in rural villages are associated with depressive symptoms among older adults in rural China. METHOD Data were from the 2011 baseline survey of the Chinese Health and Retirement Longitudinal Study (CHARLS). The sample included 3824 older adults aged 60 years or older residing in 301 rural villages across China. A score of 12 on the 10-item Center for Epidemiologic Studies Depression Scale was used as the cutoff for depressed versus not depressed. Village infrastructure was indicated by an index summing deficiency in six areas: drinking water, fuel, road, sewage, waste management, and toilet facilities. Three dichotomous variables indicated whether income support, healthcare facility, and elder activity center were available in the village. Respondents' demographic characteristics (age, gender, marital status, and living arrangements), health status (chronic conditions and physical disability), and socioeconomic status (education, support from children, health insurance, household luxury items, and housing quality) were covariates. Multilevel logistic regression was conducted. RESULTS Controlling for individuals' socioeconomic status, health status, and demographic characteristics, village infrastructure deficiency was positively associated with the odds of being depressed among rural older Chinese, whereas the provision of income support and healthcare facilities in rural villages was associated with lower odds. CONCLUSION Village infrastructure and availability of community resources matter for depressive symptoms in rural older adults. Improving infrastructure, providing old-age income support, and establishing healthcare facilities in villages could be effective strategies to prevent late-life depression in rural China.
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Affiliation(s)
- Lydia W. Li
- University of Michigan; School of Social Work; Ann Arbor MI USA
| | - Jinyu Liu
- University of Michigan; School of Social Work; Ann Arbor MI USA
| | - Zhenmei Zhang
- Michigan State University; Department of Sociology; East Lansing MI USA
| | - Hongwei Xu
- University of Michigan; Survey Research Center; Ann Arbor MI USA
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Meyer JM, McNamara JPH, Reid AM, Storch EA, Geffken GR, Mason DM, Murphy TK, Bussing R. Prospective relationship between obsessive-compulsive and depressive symptoms during multimodal treatment in pediatric obsessive-compulsive disorder. Child Psychiatry Hum Dev 2015; 45:163-72. [PMID: 23756717 DOI: 10.1007/s10578-013-0388-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study examined the prospective relationship between obsessive-compulsive and depressive symptoms during a multimodal treatment study involving youth with obsessive-compulsive disorder (OCD). Participants included fifty-six youth, aged 7-17 years (M = 12.16 years) who were enrolled in a two-site randomized controlled pharmacological and cognitive behavioral therapy treatment trial. Obsessive-compulsive severity was measured using the Children's Yale-Brown Obsessive-Compulsive Scale, and depressive symptoms were rated using the Children's Depression Rating Scale-Revised. Multi-level modeling analyses indicated that, on average over the course of treatment, variable and less severe obsessive-compulsive symptoms significantly predicted a decrease in depressive symptoms. Additionally, week-to-week fluctuations in OCD severity did not significantly predict weekly changes in depressive symptom severity. Level of baseline depressive symptom severity did not moderate these relationships. Findings suggest that when treating youth with OCD with co-occurring depression, therapists should begin by treating obsessive-compulsive symptoms, as when these are targeted effectively, depressive symptoms diminish as well.
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Affiliation(s)
- Johanna M Meyer
- Division of Medical Psychology, Department of Psychiatry, University of Florida, P.O. Box 100234, 1600 S Archer Rd, Gainesville, FL, 32611, USA,
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[Psychodynamic psychotherapy, lifestyle and prevention]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2014; 60:350-67. [PMID: 25528871 DOI: 10.13109/zptm.2014.60.4.350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Patients with mental disorders frequently manifest unhealthy behavior, which contributes to their increased risk for chronic mental and somatic diseases as well as excess mortality rates of 10 years and more. It also impairs their well-being and the course of mental disorders.We analyzed whether by addressing unhealthy behavior prevention can be integrated into psychodynamic psychotherapy. METHODS We reviewed the literature on the role of unhealthy behavior for mental disorders, on the role of lifestyle risk factors in psychodynamic theory, and on barriers to the integration of addressing lifestyle in psychodynamic psychotherapy. RESULTS Smoking, unhealthy dietary habits, and physical inactivity constitute dysfunctional behavior, resulting from maladaptive self-representations and an impairment of emotion-regulation capacities. In psychodynamic psychotherapy this maladaptive behavior can be addressed and treated as a kind of defensive behavior and resistance. CONCLUSION We believe that by addressing unhealthy behavior prevention can become a crucial task for psychodynamic psychotherapists today.
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Abstract
BACKGROUND In many countries, illiteracy rates among aged people are quite high. However, only few studies have specifically investigated the impact of illiteracy on depression. METHODS Data for 1,890 elderly individuals (aged ≥65 years) were obtained from a nationwide dementia epidemiological study conducted in South Korea. Based on their reading ability, the participants were divided into three groups: totally illiterate, partially illiterate, and literate. The Korean version of the Geriatric Depression Scale - Short Form (SGDS-K) was used to detect depression (cut-off score = 8). Multivariate logistic regression analyses were used to assess the association between illiteracy and depression. To explore clinical features of depression in illiterate people, we performed logistic regression to calculate odds ratios of positive responses (or negative responses to reverse-coded items) for each SGDS-K item using literate individuals as the reference group. RESULTS Totally illiterate participants had 2.41 times the odds and partially illiterate individuals had 1.59 times the odds of being depressed compared with literate participants after controlling for other variables. Compared with literate individuals, illiterate elderly persons were at increased odds for responding negatively to the majority of SGDS-K items, including "having memory problems," "others are better off than me," and "feeling worthless" even after controlling for various demographic and clinical factors. CONCLUSIONS Illiteracy in elderly individuals was associated with a higher rate and increased severity of depression. Illiteracy negatively affected depression symptomatology, especially factors associated with self-esteem. Therefore, clinicians should carefully monitor for the presence of depression in illiterate elderly adults.
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Kocalevent RD, Hinz A, Brähler E. Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry 2013; 35:551-5. [PMID: 23664569 DOI: 10.1016/j.genhosppsych.2013.04.006] [Citation(s) in RCA: 419] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The nine-item depression module from the Patient Health Questionnaire (PHQ-9) is widely used as an open access screening instrument for depression in different health care and community settings; thus far, normative data from the general population are still scarce. The objectives of the study were to generate normative data and to further investigate the construct validity and factor structure of the PHQ-9 in the general population. METHODS Nationally representative face-to face household surveys were conducted in Germany between 2003 and 2008 (n=5018). The survey questionnaires included the PHQ-9, the Satisfaction with Life Scale, the 12-item Short Form Health Survey (SF-12) for the measurement of health-related quality of life and demographic characteristics. RESULTS Normative data for the PHQ-9 were generated for both genders (53.6% female) and different age levels [mean age (S.D.) of 48.9 (18.1) years]. Women had significantly higher mean (S.D.) scores compared with men [3.1 (3.5) vs. 2.7 (3.5)]. A prevalence rate of moderate to high severity of depressive symptoms of 5.6% was identified. Intercorrelations with depression were highest for the Mental Component Scale of the SF-12, followed by the Physical Component Scale of health-related quality of life, and life satisfaction. Results supported a one-factor model of depression. CONCLUSIONS The normative data provide a framework for the interpretation and comparisons of depression with other populations. Evidence supports reliability and validity of the unidimensional PHQ-9 as a measure of depression in the general population.
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Affiliation(s)
- Rüya-Daniela Kocalevent
- Institute and Policlinic for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246 Hamburg, Germany.
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Borges LJ, Benedetti TRB, Xavier AJ, d'Orsi E. Fatores associados aos sintomas depressivos em idosos: estudo EpiFloripa. Rev Saude Publica 2013; 47:701-10. [DOI: 10.1590/s0034-8910.2013047003844] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 03/04/2013] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO Analisar a prevalência e fatores associados a sintomas depressivos em idosos. MÉTODOS Estudo epidemiológico transversal e de base domiciliar (inquérito EpiFloripa Idoso) com 1.656 idosos, realizado por conglomerados em dois estágios, setores censitários e domicílios, em Florianópolis, SC. A prevalência de sintomas depressivos (desfecho) foi obtida por meio da Geriatric Depression Scale (GDS-15), e testadas associações segundo variáveis sociodemográficas, de saúde, comportamentais e sociais. Foram calculadas razões de prevalências brutas e ajustadas com intervalo de 95% de confiança por regressão de Poisson. RESULTADOS A prevalência de sintomas depressivos foi de 23,9% (IC95% 21,84;26,01). Os fatores de risco associados no modelo final foram: escolaridade de cinco a oito anos (RP = 1,50; IC95% 1,08; 2,08), um a quatro anos (RP = 1,62; IC95% 1,18; 2,23) e nenhum ano de estudo (RP = 2,11; IC95% 1,46;3,05); situação econômica pior quando comparada com a que tinha aos 50 anos (RP = 1,33; IC95% 1,02;1,74); déficit cognitivo (RP = 1,45; IC95% 1,21;1,75); percepção de saúde regular (RP = 1,95; IC95% 1,47;2,60) e ruim (RP = 2,64; IC95% 1,82;3,83); dependência funcional (RP = 1,83; IC95% 1,43; 2,33); e dor crônica (RP = 1,35; IC95% 1,10;1,67). Grupo etário de 70 a 79 anos (RP = 0,77; IC95% 0,64;0,93); atividade física de lazer (RP = 0,75; IC95% 0,59;0,94); participação em grupos de convivência ou religiosos (RP = 0,80; IC95% 0,64;0,99); e ter relação sexual (RP = 0,70; IC95% 0,53;0,94) mostraram-se fatores protetores ao aparecimento dos sintomas depressivos. CONCLUSÕES Situação clínica adversa, desvantagem socioeconômica e pouca atividade social e sexual mostraram-se associadas aos sintomas depressivos em idosos.
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Butterworth P, Olesen SC, Leach LS. Socioeconomic differences in antidepressant use in the PATH Through Life Study: evidence of health inequalities, prescribing bias, or an effective social safety net? J Affect Disord 2013; 149:75-83. [PMID: 23394713 DOI: 10.1016/j.jad.2013.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 11/28/2012] [Accepted: 01/14/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Depression is more common amongst those who are economically disadvantaged. However there is inconsistent evidence concerning the relationship between socioeconomic position and antidepressant use. Moreover, evidence of greater antidepressant use amongst those of lower socioeconomic position may reflect their greater psychiatric morbidity, a prescribing bias towards pharmacological treatments, or provide evidence of an effective social safety net. This study investigates these issues whilst addressing methodological limitations of earlier studies. METHOD Data were from a large, random community survey of Australian adults (N=4493) with linked administrative data for primary-care service use. Depression was measured using the Patient Health Questionnaire, with other measures of current mental health and history of depression included in analysis. Multiple personal indicators and a combined measure of social disadvantage were considered. A series of analyses systematically examined competing explanations for socioeconomic differences in depression and antidepressant treatment. RESULTS Markers of socioeconomic disadvantage were associated with a greater likelihood of antidepressant use. This finding was not attributable to the higher rates of depression amongst the disadvantaged. A similar pattern of results was evident for non-pharmaceutical treatments (primary care consultations). Socioeconomic position was not associated with use of complementary medications for depression, not covered by Australia's social safety net. LIMITATIONS Analysis did not consider specialist mental health services. CONCLUSIONS Socially disadvantaged respondents reported greater antidepressant use and service use after controlling for current depression symptoms. This pattern of findings suggests Australia's universal health-care system and social safety net may help address potential inequalities in health care.
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Affiliation(s)
- Peter Butterworth
- Psychiatric Epidemiology and Social Issues Unit, Centre for Research on Ageing, Health and Wellbeing, The Australian National University, ACT, Australia.
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