Late-life depressive symptoms: prediction models of change

Spontaneous miscarriage and social support in predicting risks of depression and anxiety: a cohort study in UK Biobank

BACKGROUND

It is still unclear whether social support can moderate the high risk of depression and anxiety due to spontaneous miscarriage.

OBJECTIVE

This study prospectively investigated the associations of spontaneous miscarriage with risks of depression and anxiety, and evaluated the interactions between spontaneous miscarriage and the degree of social support in relation to depression and anxiety risks.

STUDY DESIGN

A total of 179,000 participants from the UK Biobank with pregnancy experience and without depression or anxiety at baseline were included. Spontaneous miscarriage was defined by self-report from participants at enrollment or by International Classification of Diseases codes. The degree of social support was defined as the number of social support factors including living with a spouse or partner, participation in social activities, and confiding. Cox proportional hazards models were used to evaluate the joint association of spontaneous miscarriage and social support with the risks of depression and anxiety.

RESULTS

During a median follow-up of 12.3 years, 4939 depression incidents and 5742 anxiety incidents were documented. For participants with 1, 2, and ≥3 spontaneous miscarriages, hazard ratios (95% confidence intervals) for depression were 1.10 (1.02-1.19), 1.31 (1.14-1.50), and 1.40 (1.18-1.67), respectively (P trend <.001), compared with participants without a history of spontaneous miscarriage, after adjustment for covariates. For anxiety, the hazard ratios (95% confidence intervals) were 1.07 (1.00-1.15), 1.04 (0.90-1.19), and 1.21 (1.02-1.44), respectively (P trend=.01). Moreover, we found that the risk of depression associated with a combination of spontaneous miscarriage and low degree of social support in later life was greater than the sum of the risks associated with each individual factor, indicating significant interactions on an additive scale (P interaction=.03).

CONCLUSION

Spontaneous miscarriage is associated with higher risks of depression and anxiety, and the risk of depression is further increased when there is also low degree of social support.

Gender differences in social networks and physical and mental health: are social relationships more health protective in women than in men?

Background

Individuals' relationships are characterized by multidimensional aspects and the unique make-up of different features is more or less supportive of physical and mental health. The current study derived social network types based on an extended set of indicators reflecting the structure, function, and quality of relationships, then examined their associations with diverse physical and mental health outcomes separately for men and women.

Methods

Using samples of 620 South Korean adults (Mage = 53.52), Latent Profile Analysis (LPA) was used to uncover distinct social network types, and multiple regression analyses were conducted to examine the link between network types and health outcomes.

Results

LPA analysis derived four network types: diversified, family-(un)supported, friend- based, and restricted. The prevalence and configuration of network types differed between men and women: the family-unsupported type was more prevalent in women than in men whereas the restricted type was more prevalent in men than in women. An individual's network type membership was significantly associated with one's physical and mental health and the positive effects of an optimal network type and the negative effects of a non-optimal network type on mental health were much greater for women than they were for men.

Discussion

The findings suggest that women benefit more from supportive networks but that they are also more vulnerable to a lack of supportive (or the presence of conflict-filled) relationships, and highlight that having diversified and greater quality relationships, and avoiding conflicts are critical for women to have enhanced health.

A happy home? Socio-economic inequalities in depressive symptoms and the role of housing quality in nine European countries

BACKGROUND

This study examines the prevalence of and socio-economic inequalities in depressive symptoms in nine high-income European countries, focusing in particular on the role of housing quality.

METHODS

Using the European Social Survey, a concentration index of depressive symptoms in each country is estimated. The role of housing quality is assessed by examining the risk factors associated with the concentration index, using the Recentred Influence Function method. To contextualise the housing quality results, other predictors of inequalities in depressive symptoms inequalities are also quantified and discussed.

RESULTS

Our results indicate that inequalities in depressive symptoms are concentrated among poorer respondents both in each country and in total. Austria and Belgium have the lowest inequalities and France has the highest. No geographic pattern is evident. Housing problems are associated with higher inequalities in six of the nine countries in the sample. While no association is evident for indicators of socio-economic status such as years of education and income, financial strain is significant.

CONCLUSIONS

This study is the first to estimate the degree of socio-economic inequality in depressive symptoms across European countries. The association between poor housing and poorer inequalities suggests that housing has a role to play lowering depressive symptoms inequalities.

Social network typologies moderate the association of loneliness with depressive symptomatology in middle-aged and older adults

Background

Depression remains among the most prevalent mental disorders, and it severely affects daily functioning and quality of life. There has been extensive research reporting on the impact of social relationships on depression, but much of this research has only considered isolated aspects of relationships. This study derived social network types based on the multiple components of social relationships, and then investigated their effects on depressive symptoms.

Methods

Using samples of 620 adults (M_age = 53.52), Latent Profile Analysis (LPA) was conducted to uncover network types based on the structural (network size, contact frequency, marital status, and social engagement), functional (levels of support and conflict), and qualitative (satisfaction with relationships) aspects of social relationships. Multiple regressions were used to test if distinct network types directly impact on depressive symptoms and whether network types moderate the association of loneliness (perceived social isolation) with depressive symptoms.

Results

LPA identified four distinct network types (diverse, family-focused, friend-focused, and restricted) and there were significant differences in depressive symptoms among four network types. Analysis using the BCH method showed that individuals in the restricted network type had the highest depressive symptoms, followed in order by individuals in the friend-focused, family-focused, and diverse network types. Regression results further indicated that an individual's network network type membership was significantly associated with depressive symptoms, and being in the diverse and family-focused network types alleviated the negative effect of loneliness on depressive symptoms.

Conclusion

The results suggest that both quantitative and qualitative aspects of social relationships are important in buffering against the adverse effect of loneliness on depressive symptoms. These findings underscore the utility of taking a multi-dimensional approach to uncover heterogeneity in the social networks of adults and their implications on depression.

The sociodemographic characteristics and clinical features of the late-life depression patients: results from the Beijing Anding Hospital mental health big data platform

BACKGROUND

The sociodemographic characteristics and clinical features of the Late-life depression (LLD) patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of LLD patients at a psychiatric hospital in China, with a subgroup analysis, such as with or without anxiety, gender differences.

METHODS

This retrospective study examined outpatients with LLD from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records.

RESULTS

In a sample of 47,334 unipolar depression patients, 31,854 (67.30%) were women, and 15,480 (32.70%) were men. The main comorbidities of LDD are generalized anxiety disorder (GAD) (83.62%) and insomnia (74.52%).Among patients with unipolar depression, of which benzodiazepines accounted for the largest proportion (77.77%), Selective serotonin reuptake inhibitors (SSRIs) accounted for 59.00%, a noradrenergic and specific serotonergic antidepressant (NaSSAs) accounted for 36.20%. The average cost of each visit was approximately 646.27 yuan, and the cost of each visit was primarily attributed to Western medicine (22.97%) and Chinese herbal medicine (19.38%). For the cost of outpatient visits, depression comorbid anxiety group had a higher average cost than the non-anxiety group (p < 0.05). There are gender differences in outpatient costs, men spend more than women, for western medicine, men spend more than women, for Chinese herbal medicine, women spend more than men (all p < 0.05). The utilization rate of SSRIs and benzodiazepines in female patients is significantly higher than that in male patients (p < 0.05).

CONCLUSION

LLD patients are more commonly women than men and more commonly used SSRIs and NaSSAs. Elderly patients with depression often have comorbid generalized anxiety. LLD patients spend most of their visits on medicines, and while the examination costs are lower.

A retrospective case series of electroconvulsive therapy in the management of depression and suicidal symptoms in adolescents

OBJECTIVE

Major depressive disorder (MDD) with suicidal symptoms is common in adolescents. Electroconvulsive therapy (ECT) is highly effective in the treatment of MDD. We have described its use and outcome in a case series of adolescents with depression and suicidal symptoms receiving ECT.

METHODS

We analyzed 362 adolescents aged from 12 to 17 who had received ECT between year 2015 and 2021. A total of 278 subjects were found to meet the inclusion criteria, where depressive symptoms were assessed by HDRS and suicidal symptoms were assessed by HDRS item 3. Their sociodemographic, clinical, and treatment information were retrieved through these records for this study.

RESULTS

The mean ± SD age of subjects was 15.41 ± 1.50 years and male sex was 14.7% (n = 41). Comorbid diagnoses were present in 104 patients (37.4%). The ECT sessions ranged from 6 to 12 times. All the patients took antidepressants, with sertraline (n = 182; 65.5%) being the most widely used. Majority of patients also received benzodiazepines. ECT was significantly effective in adolescents with depression and suicidal symptoms in evaluation by HDRS, HDRS item 3, CGI-S (p &lt; .001) pre/post-ECT. The response rate of MDD patients was 52%, with suicidal ideation (SI) at 49%, and 54% in MDD with suicide attempt (SA). The change of CGI-S scores showed no significant differences between various subgroups of sex and comorbid (p&gt;.05), but there were significant differences between subgroups of suicidal symptoms (p &lt; .001). ECT was generally safe with subjective memory complaint (n = 189, 68.0%), headache (n = 150, 54.0%), body pain (n = 28, 10.1%), delirium (n = 95, 34.2%), and nausea (n = 31, 11.2%) as possible side effects following ECT.

CONCLUSION

In this study, ECT was found to decrease depressive and suicidal symptoms in adolescents, and the side effect was acceptable. ECT showed better outcome for MDD with SA compared to MDD with SI.

Soy product consumption and the risk of major depressive disorder in older adults: Evidence from a cohort study

Background

To explore the association between soy product consumption and the risk of depression in the community.

Methods

In 2014, a total of 10,901 older people were recruited from Zhejiang province, China, and completed food frequency interviews. Participants were followed up over the next 6 years, and depression was assessed at each visit. Finally, 6,253 participants were included in the present study. Mixed effects models were performed to analyze the association by multivariate adjustments for potential confounders.

Results

Over four-fifths of the eligible participants took soy food at least one day per week. The mixed effects model has shown the adjusted odds ratios (95% CI) of high-frequency consumers (4-7 days per week) were 0.46 (0.39-0.54) for depression with a cut-off score of 5, compared with non-consumers.

Conclusions

More frequent soy product consumption was associated with a lower risk of depression.

Subjective Assessments of Quality of Life Are Independently Associated with Depressive Symptoms among Older Adults Enrolled in Primary Care in Chile

In Chile, depressive symptoms are highly prevalent among Chilean older adults, and research that examines the factors associated with them is scarce. This study aimed to determine if subjective assessments of quality of life are associated with positive screen for depressive symptoms among older adults enrolled in primary care in Chile. The participants of the study were people aged 70 years or more enrolled in primary care centers in three Chilean cities. The 15-item Geriatric Depression Scale was used to determine depressive symptoms. Multivariate logistic models were used to determine the associations. Overall, 17.28% men, and 26.47% women (p = 0.003) screened positive for depression. Subjective assessments of quality of life, including self-perceived health, memory, quality of life, and pain, were associated with a positive screen for depression. Only 17.65% of men and 43.55% of women who screened positive for depressive symptoms reported a diagnosis of depression. Assessments of quality of life in health checks of older adults in primary care could contribute to narrow the diagnosis and treatment gap by improving the ability to identify those who are more likely to experience depressive symptoms.

Psychometric Properties of the Short-Form Geriatric Depression Scale (GDS-SF) and Its Associated Factors among the Elderly in Bangladesh

Background: This study aimed to (1) evaluate the psychometric properties of a Comprehensive Short-Form Geriatric Depression Scale (GDS-SF) and (2) examine the associated factors of GDS-SF among the elderly. Methods: A cross-sectional study was conducted from November 2019 to April 2020 in Dhaka City Corporation, Bangladesh. Data of 377 elderly were collected, including socio-demographic characteristics, social supports, comorbidities, sleep behaviours, and depression (as measured by the GDS-SF). We used the principal component analysis, correlation analysis, and logistic regression analysis to validate GDS-SF, and explore its associations. Results: The GDS-SF was reliable and homogeneous with Cronbach’s alpha = 0.836, and McDonald’s Omega = 0.841, with no floor/ceiling effects. The questionnaire demonstrated a good construct validity with item-scale convergent validity and KMO measure of sampling adequacy (0.869 for the total sample, 0.838 for the community subsample, and 0.851 for the slum subsample). In the multivariate model, older people had a higher likelihood of moderate and severe depression (OR, 1.06; 95% CI, 1.00, 1.12; p = 0.048). The likelihood of having moderate and severe depression was lower in men (OR, 0.48; 95% CI, 0.28, 0.85; p = 0.011) and those satisfied with their children’s support (OR, 0.17; 95% CI, 0.08, 0.35; p < 0.001), compared with their counterparts, respectively. Conclusions: The GDS-SF is a reliable and valid survey tool for evaluating depression in Bangladeshi older adults. Age, gender, and satisfaction with children’s support were predictors of depression.

Prevalence and factors associated with anxiety and depression in older adults: Gender differences in psychosocial indicators

BACKGROUND

With increasing numbers of people living into old age, health functioning and good quality of life are central to public health policy in aging. However, quality of life for many elders is undermined by anxiety and depression. Understanding gender differences in the determinants of anxiety and depression symptoms is crucial to policy and practice.

OBJECTIVE

To examine gender-specific symptom subtypes of later-life anxiety and depression, in relation to their socio-demographic, social and health context.

METHOD

Cross-sectional study using data from The Irish Longitudinal Study on Ageing (TILDA, 2009-2011). Latent class analysis defined gender-specific symptom profiles for anxiety and depression. Correlates of latent classes were analysed using logistic regression, assessing associations between socio-demographic factors; social indicators and health indicators.

RESULTS

Four classes of self-reported anxiety and depression were derived: 'low', 'comorbidity', 'anxiety and subthreshold depression' and 'anxiety' only. With males 8% were comorbid, 26% subthreshold and 26% with anxiety only. With female 12% were comorbid, 27% subthreshold and 29% with anxiety only. While symptom expression may relate to stress from common ageing, our findings show clear gradations of symptoms associated with a range of social and health indicators.

CONCLUSION

Our findings support the actuality of comorbid depression and anxiety with further evidence for anxiety and subthreshold depression. A sizeable subgroup confirms that many older people experience anxiety only. Our study indicates the need for a more sensitive recognition of needs and a more nuanced policy agenda for older people towards improving the quality of their social life.

Relationship of zinc status with depression and anxiety among elderly population

BACKGROUND & AIMS

Population aging is a global challenge. Old populations are prone to zinc deficiency. This study aimed to determine the association of zinc status with depression and anxiety among men and women aged 60+ years old.

METHODS

In this cross-sectional study, 297 elderly participants (144 males and 153 females) were studied. The dietary and serum zinc were assessed using a three-day dietary record and an auto-analyzer, respectively. Depression and anxiety were measured using Geriatric Depression Scale and Hamilton Anxiety Rating Scale, respectively. Chi-squared test was used to compare qualitative variables. Multiple logistic regression analysis was conducted to assess relationship between zinc status and depression/anxiety.

RESULTS

The total zinc deficiency based on serum values was 23.2%. Dietary intake of zinc in 72.4%of participants was less than of the Estimated Average Requirement (EAR). The total depression prevalence was 42.2%. Moreover, 52.5% of the participants suffered from anxiety. The odds of depression among participants in the third tertile of serum zinc concentration was 51% lower than those in the first tertile (OR = 0.49, CI = 0.25-0.96, p = 0.03). No significant relationship was found between zinc intake and depression. Furthermore, serum or dietary zinc levels were not related to anxiety.

CONCLUSIONS

This study showed a considerable zinc deficiency and depression/anxiety in the old population. A significant relation was found between serum zinc concentration and depression. Further surveys, especially cohort studies and clinical trials are needed to confirm these results.

Prevalence and related factors of depression and falls among the elderly living in rural communities of Guangzhou

Few studies have concentrated on the prevalence and related factors of depression and falls among the elderly living in rural communities of Guangzhou. A total of 335 participants aged ≥60 years were recruited by simple random sampling method. A structural equation model was applied to determine interrelationships between depression, falls and other variables. As high as 27.5% and 23.3% participants had reported depressive symptoms and falls, respectively. The path analysis showed the total effect (β = -0.58) of depression on quality of life (QOL) consisted of a direct effect (β = -0.51) and an indirect effect (β = -0.07), which was mediated by family function and number of falls, and the R ² was 0.36. The model fit indices were χ ² /df = 1.096, P > 0.05, Root Mean Square Error of Approximation (RMSEA) = 0.017, Tucker-Lewis Index (TLI) = 0.998 and Comparative Fit Index (CFI) = 0.999. Depression and falls were prevalent among the elderly living in rural communities of Guangzhou city. Pay attention to strengthen family function and prevent falls may prevent depression and improve the QOL among the elderly.

Social isolation, cognitive reserve, and cognition in older people with depression and anxiety

Objectives: Poor social connections may be associated with poor cognition in older people who are not experiencing mental health problems, and the trajectory of this association may be moderated by cognitive reserve. However, it is unclear whether this relationship is the same for older people with symptoms of depression and anxiety. This paper aims to explore social relationships and cognitive function in older people with depression and anxiety. Method: Baseline and two-year follow-up data were analysed from the Cognitive Function and Ageing Study-Wales (CFAS-Wales). We compared levels of social isolation, loneliness, social contact, cognitive function, and cognitive reserve at baseline amongst older people with and without depression or anxiety. Linear regression was used to assess the relationship between isolation and cognition at baseline and two-year follow-up in a subgroup of older people meeting pre-defined criteria for depression or anxiety. A moderation analysis tested for the moderating effect of cognitive reserve. Results: Older people with depression or anxiety perceived themselves as more isolated and lonely than those without depression or anxiety, despite having an equivalent level of social contact with friends and family. In people with depression or anxiety, social isolation was associated with poor cognitive function at baseline, but not with cognitive change at two-year follow-up. Cognitive reserve did not moderate this association. Conclusion: Social isolation was associated with poor cognitive function at baseline, but not two-year follow-up. This may be attributed to a reduction in mood-related symptoms at follow-up, linked to improved cognitive function.

Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings

PURPOSE

The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors.

PATIENTS AND METHODS

This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis.

RESULTS

Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive-compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated.

CONCLUSION

The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.

Illness and intelligence are comparatively strong predictors of individual differences in depressive symptoms following middle age

OBJECTIVE

We compared the importance of socio-demographic, lifestyle, health, and multiple cognitive measures for predicting individual differences in depressive symptoms in later adulthood.

METHOD

Data came from 6203 community-dwelling older adults (age 41-93 years at study entry) from the United Kingdom. Predictors (36 in total) were assessed up to four times across a period of approximately 12 years. Depressive symptoms were measured with the Geriatric Depression Scale. Statistical methods included multiple imputation (for missing data), random forest analysis (a machine learning approach), and multivariate regression.

RESULTS

On average, depressive symptoms increased gradually following middle age and appeared to accelerate in later life. Individual differences in depressive symptoms were most strongly associated with differences in combined symptoms of physical illness (positive relation) and fluid intelligence (negative relation). The strength of association between depressive symptoms and fluid intelligence was unaffected by differences in health status within a subsample of chronically depressed individuals.

CONCLUSION

Joint consideration of general health status and fluid intelligence may facilitate prediction of depressive symptoms severity during later life and may also serve to identify sub-populations of community-dwelling elders at risk for chronic depression.

What a difference a year makes: comparing relationships between stressful life events, mood and life satisfaction among older adults, and their working-age counterparts

OBJECTIVES

Stressful life events (SLEs) have been linked to depression, anxiety, and reduced life satisfaction. The inoculation hypothesis of aging suggests older adults may be less vulnerable to poor psychological outcomes following SLEs than working-age adults. The current study compared relationships between SLEs, mood and life satisfaction among older adults (65+), and adults aged 50-64, and investigated whether group identification and loneliness moderate these relationships.

METHOD

A community-based sample of 121 Scottish participants responded to measures of SLEs (modified Social Readjustment Rating Scale), symptoms of depression and anxiety (Hospital Anxiety and Depression Scale), life satisfaction (Life Satisfaction Index A), group identification (Group Identification Scale), and loneliness (UCLA Loneliness Scale).

RESULTS

In the 50-64 age group, the number of SLEs was significantly associated with greater symptoms of depression and anxiety, and reduced life satisfaction. Group identification and loneliness did not moderate these relationships. There were no significant relationships in the older adult group.

CONCLUSION

The finding of relationships in working-age, but not older adults, supports the inoculation hypothesis of aging. Further research to better understand changes across the lifespan, and inter-relationships with related variables, would be valuable from both theoretical and clinical perspectives.

Associations of physical activity and depression: Results from the Irish Longitudinal Study on Ageing

Physical activity (PA) can protect against depression, but few studies have assessed whether meeting PA guidelines is sufficient, or if benefits can be derived from greater volumes of PA. The present study examines cross-sectional and prospective associations between different volumes of moderate-to-vigorous PA (MVPA) and walking, and depressive symptoms and status. Participants (n = 4556; 56.7% female) aged ≥ 50 years completed the International PA Questionnaire (IPAQ) at baseline and the Center for Epidemiological Studies Depression Scale at baseline and two years later. Prevalence and incidence of depression were 9.0% (n = 410) and 5.0% (n = 207), respectively. After full adjustment, odds of prevalent depression were: 40% (OR = 0.60, 95%CI: 0.48-0.76) lower among those meeting PA guidelines; 23% (OR = 0.77, 0.49-1.21) and 43% (OR = 0.57, 0.45-0.73) lower among those in moderate and high categories, respectively; and, 22% (OR = 0.78, 0.61-1.01) and 44.0% (OR = 0.56, 0.42-0.74) lower among those in moderate and high walking tertiles, respectively. Odds of incident depression were: 23% (OR = 0.77, 0.58-1.04) lower among those meeting PA guidelines; 37% (OR = 0.63, 0.32-1.22) and 20.0% (OR = 0.80, 0.59-1.09) lower among those in moderate and high categories, respectively; and, 21% (OR = 0.79, 0.56-1.12) and 25% (OR = 0.75, 0.52-1.07) lower among those in moderate and high walking tertiles, respectively. Moderate and high volumes of MVPA were significantly associated with lower odds of concurrent depression, and significantly and non-significantly associated with reduced odds of incident depression, respectively. Meeting recommended levels of MVPA and walking were associated with significantly lower odds of concurrent depression, and non-significantly reduced odds of the development of depression over two years.

Lifetime Socioeconomic Status and Late-life Health Trajectories: Longitudinal Results From the Mexican Health and Aging Study

Objective

This article examines the association between childhood and adult socioeconomic status (SES) and late-life health trajectories for older adults in Mexico.

Method

Data are from the Mexican Health and Aging Study, a panel survey that began with a nationally representative sample of Mexican adults 50 years and older at baseline (2001), with follow-up in 2003 and 2012. We use a hierarchical repeated measures model to estimate the relationship between SES and depressive symptoms, functional limitations, and self-rated health, respectively. We tested both discrete measures of SES in childhood and adulthood, as well as a combined indicator of lifetime SES.

Results

Childhood SES was significantly associated with later-life health trajectories net of adulthood SES indicators. Adult SES was significantly associated with late-life health trajectories, with some differences by gender and outcome. There were significant SES disparities in health outcomes over the 11-year study period. However, there were no significant multiplicative interactions between SES and age, which would have indicated either diminishing or widening SES health disparities with age.

Discussion

Socioeconomic disparities in health appear to persist into old age in the Mexican context. Efforts to reduce late-life health disparities in Mexico should target socioeconomic and material conditions across the life course.

Corpus callosum macro and microstructure in late-life depression

BACKGROUND

Differences in corpus callosum (CC) morphology and microstructure have been implicated in late-life depression and may distinguish between late and early-onset forms of the illness. However, a multimodal approach using complementary imaging techniques is required to disentangle microstructural alterations from macrostructural partial volume effects.

METHODS

107 older adults were assessed: 55 currently-depressed patients without dementia and 52 controls without cognitive impairment. We investigated group differences and clinical associations in 7 sub-regions of the mid-sagittal corpus callosum using T1 anatomical data, white matter hyperintensity (WMH) quantification and two different diffusion MRI (dMRI) models (multi-tissue constrained spherical deconvolution, yielding apparent fibre density, AFD; and diffusion tensor imaging, yielding fractional anisotropy, FA and radial diffusivity, RD).

RESULTS

Callosal AFD was lower in patients compared to controls. There were no group differences in CC thickness, surface area, FA, RD, nor whole brain or WMH volume. Late-onset of depression was associated with lower FA, higher RD and lower AFD. There were no associations between any imaging measures and psychotic features or depression severity as assessed by the geriatric depression scale. WMH volume was associated with lower FA and AFD, and higher RD in patients.

LIMITATIONS

Patients were predominantly treatment-resistant. Measurements were limited to the mid-sagittal CC. dMRI analysis was performed on a smaller cohort, n=77. AFD was derived from low b-value data.

CONCLUSIONS

Callosal structure is largely preserved in LLD. WMH burden may impact on CC microstructure in late-onset depression suggesting vascular pathology has additional deleterious effects in these patients.

Zinc Deficiency Is associated With Depressive Symptoms-Results From the Berlin Aging Study II

Background

Zinc plays an important role for behavioral and mental function, maintaining the correct functions of intracellular signal transduction, cellular and trans-membrane transport, protein synthesis, and antioxidant system. We investigated both dietary zinc intake and plasma zinc levels and the correlation with depressive symptoms in a large sample of community-dwelling old.

Design

One thousand five hundred fourteen older people (aged 60-84 years, 772 women) from the Berlin Aging Study II were included. Zinc intake was assessed by the EPIC Food Frequency Questionnaire. Plasma zinc levels were assessed with atomic-absorption spectrophotometry. Depressive symptoms were assessed with the "Center for Epidemiological Studies Depression Scale" and the "Geriatric Depression Scale."

Results

Zinc deficiency in blood plasma was found in 18.7% of participants, and depressive symptoms in 15.7%. Participants with depressive symptoms had lower energy-adjusted zinc intake (median 11.1 vs 11.6 µmol/L; p = .048) and lower plasma zinc levels (median 12.2 vs12.3 mg/dL; p = .037). Even after adjustment for known predictors of depression, plasma zinc deficiency remained significantly associated with depressive symptoms (odds ratio: 1.490, 95% confidence interval: 1.027-2.164; p = .036). In the multiple logistic regression model stratified by sex, we found that plasma zinc deficiency was strongly associated with a higher risk for depressive symptoms in women (odds ratio: 1.739, 95% confidence interval: 1.068-2.833; p = .026).

Conclusions

Plasma zinc deficiency was common in our old study population. An increase in dietary zinc and higher plasma zinc levels may reduce the risk of depressive symptoms. A screening for reduced dietary zinc intake or plasma zinc deficiency might be beneficial in older people at risk of depressive symptoms.

Cardiovascular risk factors and risk of incident depression throughout adulthood among men: The Johns Hopkins Precursors Study

BACKGROUND

Modifiable cardiovascular risk factors elevate risk of subsequent depression in older adults, but the effect of their onset before or after age 65 on incident depression is unclear.

METHODS

Participants were 1190 male medical students without a diagnosis of depression, who matriculated in 1948-1964 and followed through 2011. Cox proportional hazards models were used to assess associations of vascular risk-factor burden, diabetes, hypertension, hyperlipidemia, smoking status, and overweight/obese status with onset of incident depression. Adjustment covariates were race, enrollment wave, baseline age, physical activity, and heavy alcohol use.

RESULTS

The analysis included 44,175 person-years of follow-up. Among participants depression-free until age 65, vascular risk-factor burden after age 65 (Hazard Ratio, [HR]: 2.13, 95% Confidence Interval, [CI]: 1.17, 3.90) was associated with incident depression risk after age 65. The magnitude of vascular risk-factor burden after age 65 on depression risk after age 65 is comparable to the effect of 8.2 additional years of age. Diabetes (HR: 2.79, 95% CI: 1.25, 6.26), hypertension (HR: 2.72, 95% CI: 1.52, 4.88), and hyperlipidemia (HR: 1.88, 95% CI: 1.05, 3.35) before age 65 were associated with incident depression risk after age 65. Men diagnosed with diabetes after age 65 had 2.87 times the risk of incident depression after age 65 (95% CI: 1.24, 6.62).

LIMITATIONS

Our findings are restricted to male former medical students, which may affect study generalizability.

CONCLUSIONS

Results support the vascular depression hypothesis. Depression screening in older adults with vascular risk-factor burden may provide an avenue for prevention of late-onset depression.

Collective violence and the health of the elderly: a cross-sectional analysis of a population-based national survey in Mexico

OBJECTIVE

To describe the association between collective violence and the health of older adults in Mexico.

METHODS

The data analyzed were taken from a Mexican population-based national survey of health and nutrition that included a representative sample of adults over 60 years of age and from an index of violence for each of the states of Mexico that was compiled by a major research center. Five of the most common geriatric ailments (weight loss, depressive symptoms, falls, positive affectivity, and disability) were crossed with the violence index score assigned to each state.

RESULTS

A total of 7 108 older adults were included in the analysis. Among the five geriatric health problems, weight loss had the strongest association with violence, even when an adjusted model was used. For weight loss, that association increased as the level of collective violence rose. With the adjusted model, there was also an association of severe collective violence with disability and with low positive affectivity.

CONCLUSIONS

Our results show that there is an association of collective violence with weight loss and other geriatric problems. Collective violence could indirectly affect individuals' health, especially older persons and other vulnerable groups.

Social relationships, loneliness, and mental health among older men and women in Ireland: A prospective community-based study

BACKGROUND

Data is lacking on the association of interpersonal stressors and social isolation with mental disorders and the mediating role of loneliness. Thus, we examined this association prospectively using community-based data.

METHODS

Data on 6105 adults aged ≥50 years from the Irish Longitudinal Study on Ageing (TILDA) was analyzed. Mental health outcomes were assessed 2 years after baseline. Depressive and anxiety symptoms were evaluated with validated scales. Multivariable linear regression and mediation analyses were conducted.

RESULTS

Higher levels of spousal support, less strain from spouse and better social network integration were protective against depressive symptoms in men. Social support from friends and children was protective against depressive symptoms in both genders. Higher levels of social strain from children were positively associated with depressive symptoms in women. Loneliness was a significant mediator in the majority of these associations.

CONCLUSION

Interventions aimed at increasing relationship quality and strengthening existing social network structures, with a specific focus on reducing feelings of loneliness, may be beneficial in the prevention of depressive symptoms among older adults.

Is low positive emotionality a specific risk factor for depression? A meta-analysis of longitudinal studies

Depression is well known to share a negative cross-sectional relationship with personality constructs defined by positive emotion (positive affect, extraversion, behavioral activation). These Positive Emotionality (PE) constructs have been proposed to represent stable temperamental risk factors for depression, not merely current mood state. These constructs have also been proposed to increase risk specifically for depression, relative to anxiety. We performed a meta-analysis of longitudinal studies to examine the relationship of PE to depression (59 effect sizes) and anxiety (26 effect sizes). In cross-sectional analyses, PE constructs were negatively associated with depression (r = -.34) and anxiety (r = -.24). PE constructs also prospectively predicted depression (r = -.26) and anxiety (r = -.19). These relationships remained statistically significant, but were markedly attenuated, when baseline levels of depression (β = -.08) and anxiety (β = -.06) were controlled. Moreover, depression and anxiety were equally strong predictors of subsequent changes in PE (β = -.07 and -.09, respectively). These findings are consistent with theoretical accounts of low PE as a temperamental vulnerability for depression, but suggest that the prospective relationship of PE to depression may be weaker and less specific than previously assumed. (PsycINFO Database Record

Depression and Quality of Life in Older Persons: A Review

BACKGROUND

Depression is a prevalent and disabling condition in older persons (≥ 60 years) that increases the risk of mortality and negatively influences quality of life (QOL). The relationship between depression, or depressive symptoms, and QOL has been increasingly addressed by research in recent years, but a review that can contribute to a better understanding of this relationship in older persons is lacking. Against this background, we undertook a literature review to assess the relationship between depression and QOL in older persons.

SUMMARY

Extensive electronic database searches revealed 953 studies. Of these, 74 studies fulfilled our criteria for inclusion, of which 52 were cross-sectional studies and 22 were longitudinal studies. Thirty-five studies were conducted in a clinical setting, while 39 were community-based epidemiological studies. A clear definition of the QOL concept was described in 25 studies, and 24 different assessment instruments were employed to assess QOL. Depressed older persons had poorer global and generic health-related QOL than nondepressed individuals. An increase in depression severity was associated with a poorer global and generic health-related QOL. The associations appeared to be stable over time and independent of how QOL was assessed.

KEY MESSAGES

This review found a significant association between severity of depression and poorer QOL in older persons, and the association was found to be stable over time, regardless which assessment instruments for QOL were applied. The lack of a definition of the multidimensional and multilevel concept QOL was common, and the large variety of QOL instruments in various studies make a direct comparison between the studies difficult.

White Matter Hyperintensity Accumulation During Treatment of Late-Life Depression

White matter hyperintensities (WMHs) have been shown to be associated with the development of late-life depression (LLD) and eventual treatment outcomes. This study sought to investigate longitudinal WMH changes in patients with LLD during a 12-week antidepressant treatment course. Forty-seven depressed elderly patients were included in this analysis. All depressed subjects started pharmacological treatment for depression shortly after a baseline magnetic resonance imaging (MRI) scan. At 12 weeks, patients underwent a follow-up MRI scan, and were categorized as either treatment remitters (n=23) or non-remitters (n=24). Among all patients, there was as a significant increase in WMHs over 12 weeks (t(46)=2.36, P=0.02). When patients were stratified by remission status, non-remitters demonstrated a significant increase in WMHs (t(23)=2.17, P=0.04), but this was not observed in remitters (t(22)=1.09, P=0.29). Other markers of brain integrity were also investigated including whole brain gray matter volume, hippocampal volume, and fractional anisotropy. No significant differences were observed in any of these markers during treatment, including when patients were stratified based on remission status. These results add to existing literature showing the association between WMH accumulation and LLD treatment outcomes. Moreover, this is the first study to demonstrate similar findings over a short interval (ie 12 weeks), which corresponds to the typical length of an antidepressant trial. These findings serve to highlight the acute interplay of cerebrovascular ischemic disease and LLD.

The association of relationship quality and social networks with depression, anxiety, and suicidal ideation among older married adults: Findings from a cross-sectional analysis of the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Important associations have been found between social relationships and various mental health outcomes. However, limited data exists for these associations among older adults especially in terms of relationship quality in partnerships. This study aimed to examine the associations of positive and negative partner interactions and social networks with depression, anxiety and suicidal ideation.

METHODS

Nationally-representative, cross-sectional data of the Irish Longitudinal Study on Ageing (TILDA) was analyzed. The analytical sample consisted of 4988 community dwelling adults aged >50 years in spouse/partner relationships. Information on sociodemographics and social relationships were assessed using standard questions. Validated scales for depression and anxiety, and a single-item question for suicidal ideation were used to assess mental health outcomes. Multivariable logistic regression was used to assess the association between social relationships and depression, anxiety, and suicidal ideation.

RESULTS

After adjusting for confounders, negative partner interactions were significantly associated with increased likelihood of depression, anxiety, and suicidal ideation, while positive partner interactions were significantly and inversely related to anxiety and suicidal ideation. Higher levels of social integration were significantly associated with lower odds for depression.

LIMITATIONS

Given the cross-sectional nature of the research, no firm conclusions can be made in terms of directions of causality.

CONCLUSION

By assessing the available social network of older adults, as well as the areas in their social relationships that need to be addressed, it may be possible for practitioners and policy makers to maximize the benefits of network integration and minimize the potentially harmful aspects of social relationships, thereby improving overall mental health and emotional well-being.

Plasma and platelet clusterin ratio is altered in Alzheimer's disease patients with distinct neuropsychiatric symptoms: findings from a pilot study

BACKGROUND

Clusterin protein in plasma has been found to differentiate between people with and without cognitive changes. However, these findings are not conclusive, despite the clusterin gene variations repeatedly being linked to increased risk for dementia, in particular Alzheimer's disease (AD).

METHOD

We analysed the level of clusterin in platelet and plasma in 25 subjects with a clinical diagnosis of AD and 26 subjects with no cognitive impairment.

RESULTS

In the current study, we report that the levels of both plasma and platelet clusterin are similar between AD and cognitively intact individuals. Clusterin plasma and platelet levels, as well as the plasma/platelet clusterin ratio, were not affected by age, gender, cognitive impairment and/or overt behavioural symptomatology, including presence of hallucinations and delusions, as well as depression. However, the plasma/platelet clusterin ratio was positively associated in with the Neuropsychiatric Inventory measures of agitation, apathy, irritability and motor aberrant behaviour in AD subjects.

CONCLUSION

Previous inconsistencies in reported blood clusterin levels may be a result of underlying non-cognitive symptoms in people with AD. Our findings need now to be replicated in larger group of dementia subjects.

The association between social relationships and depression: a systematic review

BACKGROUND

Depression is one of the most prevalent mental disorders globally and has implications for various aspects of everyday-life. To date, studies assessing the association between social relationships and depression have provided conflicting results. The aim of this paper was to review the evidence on associations between social relationships and depression in the general population.

METHODS

Studies investigating the association of social support, social networks, or social connectedness with depression were retrieved and summarized (searches using Pubmed, ScienceDirect, PsycNet were conducted in May 2014).

RESULTS

Fifty-one studies were included in this review. The strongest and most consistent findings were significant protective effects of perceived emotional support, perceived instrumental support, and large, diverse social networks. Little evidence was found on whether social connectedness is related to depression, as was also the case for negative interactions.

LIMITATIONS

Due to the strict inclusion criteria relating to study quality and the availability of papers in the domain of interest, the review did not capture 'gray literature' and qualitative studies.

CONCLUSION

Future research is warranted to account for potential bias introduced by the use of subjective measures as compared to objective measures of received support and actual networks. Due to the heterogeneity between available studies on the measure of social relationships, the inclusion of comparable measures across studies would allow for more valid comparisons. In addition, well-designed prospective studies will provide more insight into causality. Future research should address how social support and networks interact and together affect risks for depression. Social connectedness and negative interactions appear to be underutilized as measures in population-based studies.

Magnetic resonance imaging predictors of treatment response in late-life depression

In older adults, depression not only results in more years lived with disability than any other disease but it also carries additional risks of suicide, medical comorbidities, and family caregiving burden. Because it can take many months to identify an effective treatment regimen, it is of utmost importance to shorten the window of time and identify early on what medications and dosages will work effectively for individuals having depression. Late-life depression (LLD) has been associated with greater burden of age-related changes (eg, atrophy, white matter ischemic changes, and functional connectivity). Depression in midlife has been shown to alter affective reactivity and regulation, and functional magnetic resonance imaging (fMRI) studies in LLD have replicated the same abnormalities. Effective treatment can normalize these alterations. This article provides a review of the current literature using structural and functional neuroimaging to identify MRI predictors of treatment response in LLD. The majority of the literature on structural MRI has focused on the vascular depression hypothesis, and studies support the view that loss of brain volume and white matter integrity was associated with poorer treatment outcomes. Studies using fMRI have reported that lower task-based activity in the prefrontal cortex and limbic regions was associated with poorer outcome. These imaging markers may be integrated into clinical decision making to attain better treatment outcomes in the future.