Age related differences in mental health scale scores and depression diagnosis: adult responses to the CIDI-SF and MHI-5

The Association Between Pain and Physical Frailty Among Older Adults in India: Depression and Insomnia as Mediators

OBJECTIVES

To investigate the association between body pain and physical frailty among older adults in India and to examine whether this association is mediated by symptoms of depression and insomnia.

METHODS

Data were obtained from the Longitudinal Aging Study in India, comprising 31,464 adults aged 60 and older. Physical frailty was assessed using a modified version of the frailty phenotype developed by Fried and colleagues. Multivariable logistic regression was used to analyze associations, and the Karlson-Holm-Breen method was employed to evaluate mediation effects.

RESULTS

The prevalence of frailty was 30.65%, with women showing a higher prevalence than men (33.16% vs. 27.85%). Older adults experiencing body pain had increased odds of frailty (adjusted odds ratio [aOR]: 1.17, 95% CI: 1.06-1.35). Depression (aOR: 1.70, 95% CI: 1.44-2.01) and insomnia symptoms (aOR: 1.58, 95% CI: 1.38-1.81) were independently associated with higher odds of frailty. Mediation analysis showed that depression mediated 8.4% of the association between pain and frailty in men and 6.11% in women. Insomnia symptoms mediated 11.47% of the association in men and 14.54% in women.

CONCLUSION

Body pain was significantly associated with a higher likelihood of frailty among older adults in India. Symptoms of depression and insomnia partially mediated this association, with a stronger mediating effect observed for insomnia in women. Inclusive health care strategies addressing pain, depression, and insomnia could help mitigate the risk of frailty in this population.

Association between household air pollution due to unclean fuel use and depression among older adults in India: A cross-sectional study

Background

Depression is a major public concern among older adults. However, limited studies have examined the association of depression and household air pollution (HAP). Therefore, this study examines the association between HAP due to unclean fuel use and depression among older adults in India.

Methods

Data from Longitudinal Aging Study of India (LASI), wave-1 (2017-18) were used (N = 50,206, ≥50 years). Depression measured by CIDI-SF (Composite International Diagnostic Interview-Short Form) was the outcome variable. Household unclean fuel use was considered as proxy of HAP. Bivariate analyses and multivariate logistic regression were used to fulfil the study objectives.

Results

The prevalence of depression was greater among unclean fuel users than clean fuel users (9.6% vs 6.6%). Results showed that household unclean fuel use was associated with higher odds of depression. The interaction analyses showed that females and rural residents were at higher risk of depression due to HAP exposure. Furthermore, household cooking conditions also played an important role in the association between HAP exposure and depression. Unclean fuel use indoors without ventilation and with traditional chullah/stove was associated with higher odds of depression among older adults.

Conclusion

The study concludes that exposure to HAP due to unclean fuel use should be considered as a potential risk factor of depression among older adults. Therefore, the study suggests an urgent need to create awareness about negative effects of unclean fuel use on mental health and promote clean fuel usage in households to ensure healthy aging.

Treatment for Insomnia Symptoms is Associated with Reduced Depression Among Older Adults: A Propensity Score Matching Approach

OBJECTIVES

The study aimed to investigate the effect of utilization of treatment for insomnia symptoms on the prevalence of major depressive disorder among older adults in India.

METHODS

We used the data from the Longitudinal Ageing Study in India (LASI), 2017-18. The sample included 10,911 older individuals who reported insomnia symptoms. The propensity score matching (PSM) approach was used to compare the depressive disorder among those who received vs. not received treatment.

RESULTS

Only 5.7% of older adults reporting insomnia symptoms received treatment. On average, prevalence of depressive disorder among men and women who received treatment for insomnia symptoms was lesser by 0.79 and 0.33 points, respectively, than those who did not receive treatment. In the matched sample, treatment for insomnia symptoms was significantly associated with lesser prevalence of depression for both older men (β= -0.68, p < .001) and older women (β= -0.62, p < .001).

CONCLUSIONS

The current findings suggest that treatment for insomnia symptoms can reduce the risk of depressive disorder among older adults and the effects are higher among older men than women.

Interaction between depressive symptoms and obesity-related anthropometric measures on multimorbidity among community-dwelling older adults: evidence from India

BACKGROUND

This study aimed to examine the associations between depressive symptoms, body mass index (BMI), waist circumference, waist-hip ratio and multimorbidity among community-dwelling older adults. We also examine the interaction effects between depressive symptoms, BMI, waist circumference and waist-hip ratio on multimorbidity among older adults in India.

METHODS

A cross-sectional study was conducted, and the data were obtained from the Longitudinal Ageing Study in India (LASI) wave-1, with a sample of 31,464 older adults aged 60 years and above (men-15,098 and women-16,366). We used multinomial logistic regression to explore the independent associations between depressive symptoms, obesity-measures, and single and multimorbidity. We also estimated the interaction effects of depressive symptoms and obesity-measures on multimorbidity.

RESULTS

The prevalence of multimorbidity was higher among individuals with depressive symptoms (39.22%) than individuals with no depressive symptoms (29.94%). Adjusted models indicated that older adults with depressive symptoms had higher odds of single and multimorbidity [(AOR = 1.40, 95% CI: 1.17-1.68) and (AOR = 1.85, 95% CI: 1.58-2.16), respectively]. Similarly, in comparison to the normal BMI category, overweight and obese older adults were more likely to report single morbidity [(AOR = 1.62, 95% CI: 1.37-1.92 and (AOR = 2.14, 95% CI: 1.67-2.75), respectively] and multimorbidity [(AOR = 2.00, 95% CI: 1.72-2.33) and (AOR = 3.77, 95% CI: 2.94-4.82), respectively].

CONCLUSION

The findings revealed that the presence of depressive symptoms, overweight or obesity, and high-risk anthropometric measures such as high-risk waist circumference and high-risk waist to hip ratio significantly increased the risk of morbidity among older adults in India. Thus, it is suggested to adopt an integrated public health policy approach to control depressive symptoms and high-risk body composition to strategically prepare against the elevated risk of multimorbidity among ageing populations.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL IMPLICATIONS

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

Gender differences in the association between cardiovascular diseases and major depressive disorder among older adults in India

Background

Despite the global disease burden associated with the co-occurrence of cardiovascular diseases (CVDs) and depression, depression remains underdiagnosed and undertreated in the CVD population, especially among older adults in India. As such, this study examines (1) the association between single and multiple CVDs and major depressive disorder among older Indians; (2) whether this association is mediated by older adults' self-rated health and functional limitations; and (3) whether these associations vary for older men and women.

Methods

Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study in India. Multivariable logistic regression is used to explore the association between CVDs and major depressive disorder among older men and women. The Karlson-Holm-Breen (KHB) method is used to examine the mediation effects of self-rated health and functional difficulties in the observed associations.

Results

Overall, 5.08% of the older adults had multiple CVDs. Older women (9.71%) had a higher prevalence of major depressive disorder compared to men (7.50%). Multiple CVDs were associated with greater odds of major depressive disorder after adjusting the potential covariates (adjusted odds ratio [AOR]: 1.49; 95% confidence interval [CI]: 1.10-2.00). Older men with multiple CVDs had a greater risk of major depressive disorder (AOR: 1.64; 95% CI: 1.05-2.57) relative to women with CVDs (AOR: 1.39; 95% CI: 0.93-2.08). The association between multiple CVDs and depression was mediated by self-rated health (34.03% for men vs. 34.55% for women), ADL difficulty (22.25% vs. 15.42%), and IADL difficulty (22.90% vs. 19.10%).

Conclusions

One in five older Indians with multiple CVDs reports major depressive disorder, which is three times more common than the prevalence of depressive disorder in older adults without CVDs. This association is attenuated by self-rated health and functional limitations. Moreover, these associations are more pronounced in older men relative to older women. These findings depart from prior inferences that men with CVDs are less psychologically distressed than their female counterparts. Moreover, the findings underscore the importance of gender-specific approaches to interventions and therapeutics for CVD-related mental health.

Depression in Older Adults: Do Current DSM Diagnostic Criteria Really Fit?

OBJECTIVES

The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5.

METHODS

In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX.

RESULTS

Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue.

CONCLUSIONS

This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues.

CLINICAL IMPLICATIONS

Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.

Subjective social status and functional and mobility impairments among older adults: life satisfaction and depression as mediators and moderators

BACKGROUND

While functional and mobility impairments (FMIs) have garnered the attention of health researchers in low and middle-income countries (LMICs), including India, research has yet to explore whether and to what extent the perception of one's social status is associated with FMIs. We fill this gap in the literature by examining (1) the association between subjective social status (SSS) and FMIs among older adults in India and (2) whether this association between SSS and FMIs is mediated and moderated by life satisfaction and depression.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults aged 60 years and above. FMIs were assessed using established scales on impairments in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. SSS was assessed using the Macarthur scale. Life satisfaction was measured using responses to five statements gauging respondent's overall satisfaction with life. Depression was calculated using the shortened version of the Composite International Diagnostic Interview (CIDI-SF). Multivariable regression was employed to examine the association between variables, and the interaction terms and Karlson-Holm-Breen (KHB) method were used separately to test the mediation and moderation effects.

RESULTS

39.11% of the sample had a low SSS, 8.26% were depressed, and 32.07% reported low life satisfaction. A total of 8.74%, 10.91%, and 8.45% of the study population reported at least one impairment in ADL, IADL, and mobility, respectively. Older adults in the higher SSS group were less likely to have ADL impairment (beta: -0.017, CI: -0.030, -0.0032) and mobility impairment (beta: -0.044, CI: -0.076, -0.013). Depression moderated the association between SSS and mobility impairment (p-value: 0.025), and life satisfaction moderated the association between SSS and ADL impairments (p-value: 0.041) and SSS and IADL impairments (p-value: 0.037). Depression mediated 20.28%, 31.88%, and 18.39% of the associations of SSS with ADL, IADL, and mobility impairments, respectively. Similarly, life satisfaction mediated 23.24%, 52.69%, and 27.22% of the associations of SSS with ADL, IADL, and mobility impairments.

CONCLUSIONS

That SSS is associated with FMIs among older Indians, even after considering their objective socioeconomic status (SES), suggests that the use of SSS is relevant to the study of health inequalities in India. The finding that life satisfaction and depression mediate and moderate this association is crucial in pinpointing those older Indians at risk of the functional and mobility-related repercussions of lower SSS.

Depression by gender and associated factors among older adults in India: implications for age-friendly policies

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to examine our study objectives. Depression was reported in - 7.4% (95% CI 7.0, 7.8) of older men and 9.5% (CI 9.1, 10.0) of older women. Poor self-rated health, multimorbidity status, physical activity, difficulty in activities of daily living (ADL) and instrumental ADL (IADL) were the significant health-related factors associated with depression among older men and women. Not being satisfied with one's life, not being satisfied with their present living arrangement, receiving any type of ill-treatment, and being widowed were the significant factors associated with depression among older men and women. We found gender disparity in self-reported depression. Marital status contributed-to 36.7% of the gender gap in depression among older adults. Additionally, ADL and IADL difficulties among men and women contributed to 17.6% and 34.0%, gender gap, self-rated health contributed to 18.8% gap, whereas not having equal social participation (4.4%) and not satisfied in present living arrangements (8.1%) were other factors that contributed to gender gap for depression in India. Depression is a critical and persistent public health problem among-older females in India. Our findings provide a broader framework for policymakers and health practitioners to focus on gender-specific strategies to mitigate this highly emergent problem.

Prevalence of early and late onset of chronic diseases and multimorbidity and its association with physical, mental and functional health among older Indian adults

BACKGROUND

Identifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults.

METHODS

Cross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease).

RESULTS

Overall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06-1.67); while those with late onset of single (AOR: 1.34, CI: 1.17-1.53) and multimorbidity (AOR: 1.91, CI: 1.63-2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease.

CONCLUSIONS

The present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support.

Examining the Association of Pain and Pain Frequency With Self-Reported Difficulty in Activities of Daily Living and Instrumental Activities of Daily Living Among Community-Dwelling Older Adults: Findings From the Longitudinal Aging Study in India

OBJECTIVES

We examined the prevalence and associations of self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) with pain among community-dwelling older adults in India. We also explored the interaction effects of age and sex in these associations.

METHODS

We used the Longitudinal Ageing Study in India (LASI) Wave 1 data (2017-2018). Our unweighted sample included 31,464 older adults aged 60 years and above. Outcome measures were having difficulty in at least 1 ADL/IADL. We conducted multivariable logistic regression analyses to examine the association of pain with functional difficulties controlling for selected variables.

RESULTS

A total of 23.8% of older adults reported ADL and 48.4% reported IADL difficulty. Among older adults who reported pain, 33.1% reported difficulty in ADL and 57.1% reported difficulty in IADL. The adjusted odds ratio (aOR) for ADL was 1.83 (confidence interval [CI]: 1.70-1.96) and for IADL was 1.43 (CI: 1.35-1.51) when respondents reported pain compared with those without pain. Older adults who reported frequent pain had 2.28 and 1.67 times higher odds of ADL (aOR: 2.28; CI: 2.07-2.50) and IADL difficulty (aOR: 1.67; CI: 1.53-1.82) compared with those with no pain. Additionally, age and sex of the respondents significantly moderated the associations of pain and difficulty in ADL and IADL.

DISCUSSION

Given the higher prevalence and likelihood of functional difficulties among older Indian adults who experienced frequent pain, interventions to mitigate pain in this vulnerable population are needed to ensure active and healthy aging.

Life course rural/urban place of residence, depressive symptoms and cognitive impairment among older adults: findings from the Longitudinal Aging Study in India

BACKGROUND

Given the unique socioeconomic structures, and the rural/urban differentials in the prevalence of mental illnesses in the country, this study aimed to explore the associations of childhood, adulthood and late-life rural/urban place of residence with mental health outcomes, namely depressive symptoms and cognitive impairment, among older adults in India. The study also examined the relationship between older individuals' life-course rural/urban place of residence and late-life mental and cognitive health.

METHODS

Utilizing data from the Longitudinal Aging Study in India (n = 28,027 older adults age 60 years and above), the study employed multivariable logistic and linear regression models to examine the association between urban/rural residential status, life-course residence, depressive symptoms and cognitive impairment among older adults.

RESULTS

Childhood and adulthood place of residence was not associated with depressive symptoms in older men and women. Current rural place of residence was positively associated with depressive symptoms in older women [adjusted odds ratio (aOR): 1.37, confidence interval (CI): 1.05-1.80] but not men. Childhood [aOR: 1.88, CI: 1.16-3.04], adulthood [aOR: 2.00, CI: 1.26-3.16] and current rural residence [aOR: 1.93, CI: 1.27-2.91] was positively associated with cognitive impairment in men. Only current rural residence [aOR: 1.71, CI: 1.29-2.27] was associated with cognitive impairment in women. There was no significant association between life-course place of residence and depressive symptoms except in case of lifetime rural residence Respondents with urban-urban-urban (childhood-adulthood-current) place of residence were less likely to have depressive symptoms [adjusted coefficient (aCoef.): -0.14, CI: -0.21- -0.07] compared to those with rural-rural-rural place of residence. There were significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants, showing an urban advantage in cognitive function among older adults.

CONCLUSIONS

This study showed significant associations between life-course residence and depressive symptoms among permanent rural/urban residents. The study also showed significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants. Considering the rural disadvantage in mental and cognitive health among older adults, the government should continue to support policies that can improve access to education and healthcare among people residing in rural areas and women, in particular. The findings also urge social scientists and gerontologists in particular, to consider the importance of lifetime historical context while evaluating mental and cognitive health of older persons.

Mediation of the association between multi-morbidity and sleep problems by pain and depressive symptoms among older adults: Evidence from the Longitudinal Aging Study in India, wave- 1

BACKGROUND

There could be several possible mechanisms on how chronic conditions relate to sleep problems in older persons; for instance, pain and sleep have a strong link and depressive symptoms are similarly associated with sleep problems. The present study explored whether pain and depressive symptoms are mediators in the relationship between multi-morbidity and sleep problems among older adults.

METHODS

Study utilized data from the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults age 60 years and above. Multivariable logistic regression along with mediation analysis using Karlson-Holm-Breen (KHB) method was conducted.

RESULTS

A proportion of 14.8% of the participants suffered from sleep problems, whereas, 22.5% and 8.7% of older adults had multi-morbidity and had depressive symptoms, respectively. Also, around 10.3% of older adults reported pain and received no medication for the relief of pain, whereas 29.3% of older adults reported pain and received some type of medication for the relief of pain. Older adults with multi-morbidity had higher odds of suffering from sleep problems [adjusted odds ratio (aOR):1.26, confidence interval (CI):1.10-1.45] than those who had no multi-morbidity. Older adults who reported pain but received no medication for the relief of pain [aOR: 1.90, CI: 1.64-2.22] or reported pain and received medication for the relief of pain [aOR: 1.82, CI:1.62-2.04] and those who had depressive symptoms [aOR: 2.21, CI:1.89-2.57%] had higher odds of suffering from sleep problems compared to those who did not report pain and had no depressive symptoms, respectively. Around 11.2% of the association of multi-morbidity with sleep problems was mediated by pain and 4.3% of such association was mediated by depressive symptoms.

CONCLUSION

Pain and depressive symptoms were found to mediate the association between multi-morbidity and sleep problems; therefore, reducing pain and depressive symptoms may be considered to improve sleep in older multi-morbid patients.

Food insecurity and health outcomes among community-dwelling middle-aged and older adults in India

The study assessed associations between food insecurity and mental, physical, and behavioural health outcomes in India. The study analysed national cross-sectional population-based data (N = 72,262;  ≥ 45 years) from in India in 2017-2018. The overall prevalence of food insecurity was 9.7%. Food insecurity was significantly positively associated with poor mental health [low life satisfaction (AOR: 2.75, 95% CI 2.35-3.23), low self-reported health (AOR: 1.61, 95% CI 1.11-1.42), insomnia symptoms (AOR: 1.64, 95% CI 1.45-1.85), depressive symptoms (AOR: 2.21, 95% CI 1.97-2.48), major depressive disorder (AOR: 2.37, 95% CI 2.03-2.77), Alzheimer's/dementia (AOR: 1.75, 95% CI 1.13-2.69), and poorer cognitive functioning (AOR: 0.68, 95% CI 0.49-0.93)], poor physical health [bone or joint disease (AOR: 1.18, 95% CI 1.04-1.34), angina (AOR: 1.80, 95% CI 1.58-2.06), underweight (AOR: 1.28, 95% CI 1.16-1.40), chronic lung disease (AOR: 1.22, 95% CI 1.03-1.45), and functional disability (AOR: 1.68, 95% CI 1.47-1.92)], and health risk behaviour [tobacco use (AOR: 1.13, 95% CI 1.01-1.25), heavy episodic drinking (AOR: 1.45, 95% CI 1.10-1.91) and physical inactivity (AOR: 1.42, 95% CI 1.21-1.67)]. Furthermore, food insecurity was negatively associated with overweight/obesity (AOR: 0.80, 95% CI 0.73-0.88). Food insecurity was associated with seven poor mental health indicators, five poor physical health conditions, and three health risk behaviours. Programmes and policies that improve food availability may help improve mental and physical health among middle-aged and older adults in India.

Indigenous population and major depressive disorder in later life: a study based on the data from Longitudinal Ageing Study in India

BACKGROUND

Existing evidence suggests that the indigenous older population who live with their families and friends might experience lesser depressive symptoms due to better emotional support and well-being. The present study aimed to investigate the differentials in the prevalence of the major depressive disorder among tribal and non-tribal older populations in India and to explore the contribution of socio-demographic, health-related, and household factors in such disparities.

METHODS

A cross-sectional study was conducted using data from the Longitudinal Aging Study in India (2017-18). The analytical sample included 30,637 older adults, among whom 5,025 and 25,612 belonged to the Scheduled Tribe (ST) and non-Scheduled Tribe (non-ST) social groups, respectively. Major depressive disorder assessed by the Composite International Diagnostic Interview short-form (CIDI-SF) scale was the outcome variable. Descriptive statistics, bivariate and multivariable regression and, decomposition analyses were conducted.

RESULTS

About 4.8% and 8.9% of older adults from the ST and non-ST social groups had major depression. For both tribal and non-tribal groups, older adults who were unmarried, dissatisfied with living arrangements, and those who faced lifetime discrimination were at increased risk of major depression. Findings from differences due to characteristics (E) revealed that if the regional differences were minimized, it would decrease the ST-non-ST gap in major depression by about 19.6%. Similarly, equal self-rated health status and chronic conditions among ST and non-ST groups would decrease the gap in major depression by almost 9.6% and 7.9%, respectively. Additionally, an equal status of Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) among older adults would decrease the gap in major depression by about 3.8% and 3% respectively. Also, findings from differences due to coefficients (C) revealed that if older adults from the ST group had the same status of ADL as of older adults from the non-ST group, it would decrease the gap in major depression by about 11.8%.

CONCLUSION

The findings revealed a greater prevalence of major depression in older adults belonging to the non-ST group than the ST group. For both tribal and non-tribal groups, older adults who were unmarried, dissatisfied with living arrangements, and those who faced lifetime discrimination were at increased risk of major depression and these factors along with health-related variables contributed to significant ST-non-ST gap in depression, advantageous to tribal population; suggesting further research on the coping mechanisms of mental illnesses among indigenous population in India.

Relationship between handgrip strength, depression and cognitive functioning among older adults: Evidence from longitudinal ageing study in India

BACKGROUND

Handgrip strength (HGS) is a frequent and general indicator of muscle strength and it may affect several aspects of mental health among older people. This study explored the association of HGS with depression and cognitive impairment among community-dwelling older adults in resource-constrained setting of India.

METHOD

Data were drawn from the Longitudinal Ageing Study in India (LASI), and the analysis was conducted on 27,707 older adults aged 60 years and above. Outcome measures included depression (assessed by the Short Form Composite International Diagnostic Interview (CIDI-SF) and the Center for Epidemiological Studies-Depression (CES-D) scales) and cognitive impairment. Descriptive statistics and mean scores of HGS were reported and multivariable linear regression analyses were conducted to test the research hypotheses of the study.

RESULTS

Mean score of HGS was 24.33 (SD: 7.22) for males and 15.94 (SD: 5.14) for females. Mean age was 68.86 (SD: 7.19) and 68.40 (SD: 7.31) years among males and females respectively. Older participants who had weak HGS were significantly more likely to be depressed in CIDI-SF scale (B: 0.06, CI: 0.01-0.13) and CES-D scale (B: 0.02, CI: 0.01-0.03) in comparison to those who had strong HGS after adjusting for a large number of confounders. Older participants who had weak HGS were significantly more likely (B: 0.92, CI: 0.76-1.07) to have cognitive impairment compared to those who had strong HGS.

CONCLUSION

The findings highlight the independent association of HGS with major depression, depressive symptoms and cognitive impairment that have implications on promoting resistance-training programs among aged population.

Social support moderates the association of functional difficulty with major depression among community-dwelling older adults: evidence from LASI, 2017-18

BACKGROUND

This study aimed to examine the potential independent association of functional disability with major depression and moderating effects of social support variables including marital status, living arrangement and social participation in such associations.

METHODS

Data for the study were drawn from the Longitudinal Ageing Study in India (LASI) wave 1 that was collected during 2017-18 including a sample of 31,464 individuals aged 60 years and above. Descriptive statistics and results from bivariate analysis have been reported. Further, moderated multivariable logistic regression models were used to fulfil the study objective. Major depressive disorder was assessed using the scale of the Short Form Composite International Diagnostic Interview (CIDI-SF).

RESULTS

It was found that 8.67% of older participants were depressed in this study. Older adults who had difficulty in basic activities of daily living (BADL) (15.34%), difficulty in instrumental activities of daily living (IADL) (12.06%), unmarried (10.13%), separate living (9.67%) and socially inactive (10.09) were having higher prevalence of major depression compared to their respective counterparts. The adjusted model-1 revealed that older adults who had difficulty in BADL and IADL were 2.53 times [AOR: 2.53, CI: 2.17-2.95] and 2.27 times [AOR: 2.27, CI: 1.97-2.64] more likely to have major depression than those with no difficulty in BADL and IADL respectively. Further, interaction analyses found that currently unmarried status, separate living and being socially inactive have moderation effects in the observed associations and exacerbate the likelihood of major depression among older adults who are functionally impaired.

CONCLUSIONS

The findings highlight the importance of integrating social participation in the daily life of older adults and developing initiatives that promote a healthy surrounding such as social connectedness, co-residential living and special care for those who are physically disabled to protect against late-life depression.

Clinical Characteristics in Older, Middle-Aged and Young Adults Who Present With Suicide Attempts at Psychiatric Emergency Departments: A Multisite Study

OBJECTIVES

To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA).

DESIGN

Cross-sectional cohort study.

SETTING

3 Swedish university hospitals.

PARTICIPANTS

821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18-44 years, n = 423; 45-64 years, n = 164; 65+, n = 96).

MEASUREMENTS

Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS).

RESULTS

Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large.

CONCLUSIONS

While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians' assessments of the needs of older adults with intentional self-harm.

Prevalence and correlates of pain and associated depression among community-dwelling older adults: Cross-sectional findings from LASI, 2017-2018

BACKGROUND

Health practitioners often meet older persons suffering both from pain and depression. The study aimed to examine the factors associated with pain among older individuals and its association with major depression. In addition, the interaction between self-rated health (SRH), wealth status, and pain that is associated with depression are explored.

METHODS

We used data from the Longitudinal Aging Study in India (LASI). Participants included 15,098 male and 16,366 female adults aged 60 years or older. Univariate and bivariate analyses along with χ² tests were conducted in the initial stage. Binary logistic regression analyses were performed to fulfill the objectives. Major depression was calculated using Short Form Composite International Diagnostic Interview.

RESULTS

A proportion of 39.6% older individuals (n = 12,686) reported pain and 8.7% older adults (n = 2657) suffered from depression. Older adults who suffered from pain frequently were more likely to be depressed than those who never suffered from pain (adjusted odds ratio [AOR]: 1.70; confidence interval [CI]: 1.38-2.09). The interaction of pain, SRH, and household wealth status on depression found that older adults with pain who reported poor SRH (AOR: 4.18; CI: 3.50-5.00) or belonged to rich households (AOR: 2.27; CI: 1.84-2.80) had higher odds of suffering from depression, compared to older adults with no pain and good SRH or no pain and belonged to poor households.

CONCLUSION

It is highlighted that pain is quite common in older people, and is linked to depression especially among older people with poor SRH. Thus, routine evaluation of pain and associated symptoms of mental illnesses should be performed for ensuring healthy aging.

Risk and protective factors associated with grandparent kinship caregivers' psychological distress in COVID-19: Kinship license status as a moderator

COVID-19 and its related policy measures have increased the psychological distress of individuals, including grandparent kinship caregivers. Guided by the Resilience Model of Family Stress, Adjustment, and Adaptation, this study examines relationships between material hardship, parenting stress, social support, resilience and psychological distress of grandparent kinship caregivers during the COVID-19 pandemic, as well as the moderating role of kinship license status on these relationships. Kinship care licensing is a prerequisite to receiving financial assistance and other supporting services from the government. We administered a cross-sectional survey of grandparent kinship caregivers (N = 362) in the United States. Logistic regression results indicated that material hardship was associated with higher odds of experiencing psychological distress, whereas resilience and social support were associated with lower odds. Kinship license status moderated the relationships of social support and resilience with psychological distress. Results suggest that additional emergency funds and more tailored financial services should be provided to meet material needs, and interventions with a focus on resilience and social support are particularly needed. The moderating effects of license status indicate that some interventions should be specifically implemented among licensed kinship caregivers, whereas parallel services should be provided to kinship caregivers regardless of their license status.

The association between single and multiple chronic conditions and depression among older population in India: A comparative study between men and women

OBJECTIVE

The study aimed to estimate the prevalence of depression and to explore the association of specific chronic conditions as well as multi-morbidity with depression among the older population.

METHOD

The study utilized data from the Longitudinal Ageing Study in India Wave 1 (2017-2018). The total sample size for the present study was 31,464 older adults aged 60 and above, including 14,931 males and 16,533 females. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives.

RESULTS

The overall prevalence of depression among the elderly population in India was 8.7%. Older women had shown a greater prevalence rate of depression than older men. Among chronic conditions, hypertension, stroke, and bone-related diseases were found to be significantly associated with depression in the case of both men and women. The prevalence of depression among older adults with three or more chronic conditions was higher in males (14.5%) than in females (11.2%). The association between the number of chronic conditions and depression exhibited a linear trend with an increased odds ratio indicating a higher risk of depression among older adults with multiple chronic conditions.

CONCLUSION

Older individuals with a greater number of chronic illnesses have a higher risk of depression and the risk is proportional to the number of chronic conditions. This signifies the need for the identification of depressive symptoms at an early stage by focussing on the elderly suffering from chronic conditions and educating family members and the community about effective treatments and counselling.

Understanding the Relationships between Parenting Stress and Mental Health with Grandparent Kinship Caregivers' Risky Parenting Behaviors in the Time of COVID-19

Grandparent kinship caregivers may experience increased parenting stress and mental distress during the COVID-19 pandemic. It may lead to risky parenting behaviors, such as psychological aggression, corporal punishment, and neglectful behaviors towards their grandchildren. This study aims to examine (1) the relationships between parenting stress, mental health, and grandparent kinship caregivers' risky parenting practices, such as psychological aggression, corporal punishment, and neglectful behaviors towards their grandchildren during the COVID-19 pandemic, and (2) whether grandparent kinship caregivers' mental health is a potential mediator between parenting stress and caregivers' psychological aggression, corporal punishment, and neglectful behaviors. A cross-sectional survey among grandparent kinship caregivers (N = 362) was conducted in June 2020 in the United States. Descriptive analyses, negative binomial regression analyses, and mediation analyses were conducted using STATA 15.0. We found that (1) grandparent kinship caregivers' high parenting stress and low mental health were associated with more psychological aggression, corporal punishment, and neglectful parenting behaviors during COVID-19; and (2) grandparent kinship caregivers' mental health partially mediated the relationships between parenting stress and their psychological aggression, corporal punishment, and neglectful behaviors. Results suggest that decreasing grandparent kinship caregivers' parenting stress and improving their mental health are important for reducing child maltreatment risk during COVID-19.

Migration of adult male children and associated depression among community-dwelling older parents: A cross-sectional gender analysis from Longitudinal Ageing Study in India, 2017-2018

OBJECTIVES

This study empirically examines the association of migration of an adult male child (ren) on the mental health of the older parents left behind. It also examines the interaction effects of sex of older parents and male child migration on major depression to explore whether there is a gender differential in the possible association.

METHODS

The data for this study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). The total sample size for the present study was 27,248 older adults aged 60 years and above (male-12,624; female-14,624). Descriptive statistics along with cross-tabulation were presented. Proportion test was used to evaluate the significance level of differences in depression by sex. Additionally, binary logistic regression analysis was used to find out the associations. Major depression with symptoms of dysphoria, was calculated using the Short-Form Composite International Diagnostic Interview (CIDI-SF).

RESULTS

About 10.5% and 9.0% of older males and females had migrant sons. It was found that there was significant gender differential in depression in older age (male: 7.5% and female: 9.7%; p < 0.001). It was further found that the prevalence of depression was found among older men (9.3% vs. 7.3%) and women (12.5% vs. 9.4%) with migrant son. Older adults with migrant son had 26% significantly higher likelihood to be depressed in reference to older adults with non-migrant son (AOR: 1.26; CI: 1.02-1.56). Further, older women with a migrant son had 76% significantly higher likelihood to be depressed in reference to older men with migrant son (AOR: 1.76; CI: 1.32-2.39).

CONCLUSIONS

This study invites policymakers' attention towards migration of adult children and its potential effects on mental health of left-behind older parents in community-settings and in women in particular. Policies should focus on spreading awareness to migrant children of older adults on maintaining frequent contacts and visits to their ageing parents.

Covid-19: Repercussions on the mental health of higher education students

ABSTRACT This article aimed to assess the repercussions of Covid-19 and social isolation on the mental health of higher education students in Ceará, Brazil. The sample consisted of 3,691 higher education students taking online classes from June to September 2020, who answered to two instruments: a sociodemographic and situational profile questionnaire concerning the pandemic/social isolation, and the Mental Health Inventory. The results showed that 21.2% of the students had their activities canceled, with no expected return. The majority, 77.2%, reported concern about the death of relatives and acquittances by Covid-19. The overall state of mental health average measured by the inventory was 48.8. This result suggests that students had their mental health affected by the conditions imposed by the pandemic. Therefore, edu- cational institutions should promote strategies to protect the mental health of the student community.

Covid-19: repercussões na saúde mental de estudantes do ensino superior

RESUMO Este artigo teve como objetivo avaliar as repercussões da Covid-19 e do isolamento social na saúde mental de estudantes do ensino superior no Ceará, Brasil. A amostra foi composta por 3.691 alunos do ensino superior participando de aulas on-line no período de junho a setembro de 2020, que responderam a dois instrumentos: um questionário sociodemográfico e situacional referente à pandemia/isolamento social e o Inventário de Saúde Mental. Os resultados mostraram que 21,2% dos alunos tiveram suas atividades canceladas, sem expectativa de retorno. A maioria, 77,2%, relatou preocupação com a morte de parentes e conhecidos pela Covid-19. O estado geral de saúde mental médio, medido pelo inventário, foi de 48,8. Esse resultado sugere que os alunos tiveram sua saúde mental afetada pelas condições impostas pela pandemia. Assim, as instituições de ensino devem promover estratégias para proteger a saúde mental da comunidade estudantil.

Material hardship and child neglect risk amidst COVID-19 in grandparent-headed kinship families: The role of financial assistance

BACKGROUND

COVID-19 has exacerbated material hardship among grandparent-headed kinship families. Grandparent-headed kinship families receive financial assistance, which may mitigate material hardship and reduce child neglect risk.

OBJECTIVE

This study aims to examine (1) the association between material hardship and child neglect risk; and (2) whether financial assistance moderates this association in a sample of kinship grandparent-headed families during COVID-19.

PARTICIPANTS AND SETTING

Cross-sectional survey data were collected from a convenience sample of grandparent-headed kinship families (not necessarily child welfare involved) (N = 362) in the United States via Qualtrics Panels online survey.

METHODS

Descriptive, bivariate, and negative binomial regression were conducted using STATA 15.0.

RESULTS

Experiencing material hardship was found to be associated with an increased risk of child neglect, and receiving financial assistance was associated with a decreased risk of child neglect in the full sample and a subsample with household income > $30,000. Receiving financial assistance buffered the negative effect of material hardship on child neglect risk across analytic samples, and receiving SNAP was a significant moderator in the full sample. Among families with a household income ≤ $30,000, receiving SNAP and foster care payments was associated with a decreased risk of child neglect, while receiving TANF and unemployment insurance was associated with an increased risk of child neglect. Among families with household income > $30,000, only receiving SNAP was associated with a decreased risk of child neglect.

CONCLUSIONS

This study suggests the potential importance of providing concrete financial assistance, particularly SNAP and foster care payments, to grandparent-headed kinship families in efforts to decrease child neglect risk during COVID-19.

Associations of loneliness with poor physical health, poor mental health and health risk behaviours among a nationally representative community-dwelling sample of middle-aged and older adults in India

OBJECTIVES

Loneliness may negatively impact on health outcomes. The study aimed to estimate the associations between loneliness and poor physical health, poor mental health, and health risk behaviours in middle-aged and older adults in a national population survey in India.

METHODS

The sample included 72,262 middle-aged and older adults from a cross-sectional national community-dwelling survey in India in 2017-2018.

RESULTS

Results indicate that the prevalence of moderate loneliness was 20.5%, and severe loneliness was 13.3%. In the adjusted logistic regression analysis, moderate and/or severe loneliness was significantly positively associated with fair or poor self-rated health status, and significantly negatively associated with life satisfaction and cognitive functioning. Furthermore, loneliness was associated with stroke, angina, physical injury, difficulty of Activities of Daily Living, difficulties of Instrumental Activities of Daily Living and multi-morbidity. Loneliness increased the odds of major depressive disorder and insomnia symptoms. The associations between loneliness and current tobacco use and body mass index were negative and between loneliness and physical inactivity and underweight were positive.

CONCLUSIONS

Loneliness is associated with poor physical health, poor mental health and health risk behaviour (physical inactivity), emphasising the need to consider loneliness in various physical and mental health contexts.

The Relationship between Adherence to the Mediterranean Diet, Intake of Specific Foods and Depression in an Adult Population (45-75 Years) in Primary Health Care. A Cross-Sectional Descriptive Study

Background: The relationship between the quality of the diet and the adherence to the Mediterranean diet with the presence of persistent or recurrent depressive symptoms have been described. The objective of this study is to analyze the relationship between adherence to the Mediterranean diet and the intake of specific foods in primary care patients aged 45 to 75, having subclinical or major depression. The study also specifically analyzes this relationship in individuals suffering from chronic diseases. Methods: A cross-sectional descriptive study was conducted. 3062 subjects met the inclusion criteria from the EIRA study. Sociodemographic variables, clinical morbidity, depression symptomatology (PHQ-9) and adherence to Mediterranean diet (MEDAS) were collected. Results: Being female, younger, with a higher BMI, consuming more than 1 serving of red meat a day and drinking more than one carbonated or sugary drink daily, not consuming 3 servings of nuts a week and not eating 2 vegetables cooked in olive oil a week are predictors of having higher depressive symptomatology. Conclusions: Assessing the type of diet of patients presenting depressive symptoms and promoting adherence to a healthy diet is important, especially in patients with chronic diseases. However, depression is a very complex issue and the relationship between nutrition and depression must be further examined.

Maternal depression and loss of children under the one-child family planning policy in China: a cross-sectional study of 300 000 women

OBJECTIVES

This study aims to explore the association between maternal depression and the loss of the only child under the family-planning (FP) policy.

DESIGN

Cross-sectional data from a Chinese population-based study were analysed.

SETTING

Population from 10 (5 rural and 5 urban) areas in China.

PARTICIPANTS

Around 300 000 females were included in the study. The FP group was defined as women with one or two live births. Those with no surviving child were classified into the loss-of-only-child group. The non-FP group included women who had more than two live births. Logistic regression was used to assess the relationship between major depressive disorder (MDD) and family types, after stratification and adjustment.

OUTCOME

MDD was assessed using the Composite International Diagnostic Inventory.

RESULTS

The odds of MDD are 1.42 times higher in the FP group in general (OR=1.42, 95% CI: 1.28 to 1.57), as opposed to the non-FP group. In particular, the odds of MDD are 1.36 times greater in the non-loss-of-only-child group (OR=1.36, 95% CI: 1.21 to 1.51) and 2.80 (OR=2.80, 95% CI: 0.88 to 8.94) times greater in the loss-of-only-child group, compared with the non-FP group. The associations between FP groups and MDD appeared to be stronger in the elderly population, in those who were married, less educated and those with a higher household income. The association was found progressively stronger in those who lost their only child.

CONCLUSIONS

People in the FP group, especially those who lost their only child, are more susceptible to MDD than their counterparts in the non-FP group. Mental health programmes should give special care to those who lost their only child and take existing social policies and norms, such as FP policies, into consideration.

Association of late-life depression with cognitive impairment: evidence from a cross-sectional study among older adults in India

BACKGROUND

Late-life depression (LLD) is considered as a prodrome to dementia and plays a major role in the development of long-term cognitive disabilities. We aimed to estimate the prevalence and correlates of LLD and cognitive impairment and to explore their associations among older adults in India.

METHODS

Data for this study was derived from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-18). The total sample included 31,464 (15,098 male and 16,366 female) older individuals aged 60 years and above. Cognitive impairment measured from various domains derived from the cognitive module of the Health and Retirement Study (HRS), and major depression measured by the CIDI-SF (Composite International Diagnostic Interview- Short Form) were the outcome variables. Descriptive, bivariate, and multivariable analyses were performed to fulfill the objectives of the study.

RESULTS

The overall prevalence of LLD and cognitive impairment for the current sample was 8.7% and 13.7 % respectively. Among older individuals who have rated their health status as poor were 2.59 times more likely to suffer from LLD [OR: 2.59, CI: 2.24-2.99] as compared to their counterparts. The older adults who had difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) were 74% and 69 % more likely to suffer from LLD. Similarly, older adults who were depressed had higher odds of cognitive impairment [OR: 1.22, CI: 1.01-1.48] compared to their counterparts. Also, older adults who were depressed and belonged to rural areas were 2.58 times [AOR: 2.58, CI: 1.95-3.41] more likely to be cognitively impaired than those who were not depressed and resided in urban areas.

CONCLUSIONS

Depression is linked to an increased risk of cognitive decline and dementia; therefore, failing to diagnose and treat LLD in later life may have significant health implications. Moreover, treatment under the care of a cognitive neurologist or geriatric psychiatrist is recommended for people with LLD and cognitive disability due to both the disorders' complex existence.

Validation of brief screening measures for depression and anxiety in young people with substance use disorders

BACKGROUND

It is critical to promptly identify and monitor mood and anxiety symptoms in young people with SUD. The primary aim of this study was to conduct a psychometric validation of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) for depression and anxiety screening in young people seeking outpatient treatment for SUD. Our secondary aim was to compare the performance of the PHQ-9 and GAD-7 to their briefer two-item versions (PHQ-2 and GAD-2) in terms of detecting probable mood and anxiety disorders.

METHOD

Data were extracted from the electronic health records of patients (ages 14 to 26) who received a diagnostic evaluation following clinical implementation of the PHQ-9 and GAD-7 at a hospital-based outpatient SUD treatment program (N=121, average age 19.1 ± 3.1 years).

RESULTS

The PHQ-9 and GAD-7 showed excellent internal consistency. A PHQ-9 cut score of 7 or 8 (PHQ-2 cut score: 2) and GAD-7 cut score of 6 (GAD-2 cut score: 2) had the best balance of sensitivity, specificity, and positive and negative predictive power in these data. These measures also showed good convergent and acceptable discriminant validity.

LIMITATIONS

The sample was predominantly White and non-Hispanic, and a validated (semi-)structured diagnostic interview was not used to establish mood and anxiety disorder diagnoses.

CONCLUSIONS

Results suggest the PHQ-9 and GAD-7 are reliable and potentially clinically useful screening tools for depression and anxiety in young people with SUD, and that the two-item versions may have similar clinical utility as the full measures.

General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI-6), and Mental Health Index (MHI-5): psychometric and predictive properties in a Finnish population-based sample

The short versions of the General Health Questionnaire (GHQ-12), Beck's Depression Inventory (BDI-6), and Mental Health Index (MHI-5) are all valid and reliable measures of general psychological distress, depressive symptoms, and anxiety. We tested the psychometric properties of the scales, their overlap, and their ability to predict mental health service use using both regression and machine learning (ML, random forest) approaches. Data were from the population-based FinHealth-2017 Study of adults (N = 4270) with data on all of the evaluated instruments. Constructive validity, internal consistency, invariance, and optimal cut-off points in predicting mental health services were tested. Constructive validity was acceptable and all instruments measured their own distinct phenomenon. Some of the item scoring in BDI-6 was not optimal, and the sensitivity and specificity of all scales were relatively weak in predicting service use. Small gender differences emerged in optimal cut-off points. ML did not improve model predictions. GHQ-12, BDI-6, and MHI-5 may be interpreted to measure different constructs of psychological health symptoms, but are not particularly useful predictors of service use.

Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study

Introduction and Objective

The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care.

Methods

A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences (n = 101), in comparison with patients who had experienced a single major depression episode with no recurrence (n = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann-Whitney, chi-square, and Fisher's U statistics. A multivariate analysis (ordinary logistic regression) was performed.

Results

The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072).

Conclusion

These indicators should be considered by primary care physicians when attending patients suffering from major depression.

Does engagement in productive activities affect mental health and well-being in older adults with a chronic physical disability? Observational evidence from a Swiss cohort study

Objectives: To investigate type and load of productive activities as potential determinants of mental health and well-being in elderly persons with a physical disability.Methods: We used data from a Swiss population-based sample of 314 adults at or past the legal retirement age (65 for men, 64 for women) who live with a chronic physical disability, spinal cord injury. Engagement in housework, volunteering, and paid work were dichotomized (no; some engagement) and three groups of engagement types were constructed (none; housework only; volunteering and/or paid work). Load of engagement was appraised using a sumscore on the overall frequency as well as the total number of performed activities. We used regression modelling to draw causal inference regarding the associations of type and load of engagement with general mental health (Mental Health Inventory, SF-36), self-reported depression (Self-Administered Comorbidity Questionnaire, SCQ), and well-being (WHOQoL-BREF items).Results: Engagement in volunteering was positively related to well-being. Persons engaged only in housework reported better well-being and lower prevalence of depression than non-engaged persons, however, persons engaged in volunteering or paid work reported the highest well-being and the lowest prevalence of depression. The productivity sumscore tertiles and the number of performed activities were both positively linked to well-being and negatively linked to depression, while their association with general mental health was less pronounced.Conclusion: Strengthening the engagement in productive activities among the elderly with a chronic physical disability is suggested as a promising strategy to promote well-being and reduce the prevalence of depression.

Work Status, Financial Stress, Family Problems, and Gender Differences in the Prevalence of Depression in Chile

INTRODUCTION

It is widely known that women have a higher prevalence of depression than men. These differences may be explained by social differences between women and men due to gender roles. In Chile, as elsewhere, women have greater household responsibilities, lower job incomes, and especially low labor market participation. However, the incidence of these gender differences on the higher prevalence of depression in women requires further study in the Chilean context.

OBJECTIVE

To identify main social differences between women and men associated with gender differences in the prevalence of depression in middle-aged Chilean men and women.

DATA SOURCE

Data comes from the second Chilean National Health Survey (2009-2010), a cross-sectional, nationally representative sample (n = 2771) composed of 1103 men and 1668 women (39.8 and 60.2%, respectively), whose age range goes from 25 to 55 years old. This study was approved by the Ethics Committee of Pontificia Universidad Católica de Chile.

METHODS

Prevalence ratios were calculated through Poisson regression models to estimate associations between the prevalence of past episodes of depression and social stressful life events variables for men and women separately. Gender prevalence ratios of depression (Gender PR) adjusted for age and subsequently adjusted by the social and stressful life events variables. The analyses considered factors such as age, educational level, per-capita household income, work status, role as the head of household, marital status, events of violence, family problems, personal health problems or accidents, and self-reported financial stress.

RESULTS

This study finds that doing housework, reporting a serious family problem and having high financial stress were associated with a higher prevalence of depression in both genders. Whereas, health problems were only associated with prevalence in men. The age-adjusted gender PR was 2.84 [confidence interval (CI): 2.0-4.1], and when all selected variables were included attenuated to a PR of 1.86 (CI 1.3-2.7). The variable most strongly associated with depression in the fully-adjusted model was housework (PR: 5.3; CI: 1.3-21.0).

CONCLUSION

In conclusion, this study finds that depression in in Chile is associated with social factors such as participation in housework, family problems, and financial stress, all of which are more common in women. To make further progress in the study of this public health problem in Chile, it is essential to incorporate more detailed characterization of gender roles in surveys and other studies. Likewise, social policies and interventions that contribute to reduce gender social inequalities in the exposure to adverse life circumstances can contribute to reduce unnecessary and avoidable gender disparities in health.

Daily steps and diet, but not sleep, are related to mortality in older Australians

OBJECTIVES

Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55-85 years.

DESIGN

A prospective cohort study of adults in Newcastle, New South Wales, Australia.

METHOD

Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years).

RESULTS

Higher step count (HR: 0.93, 95%CI: 0.88-0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74-0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for ≥3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78-1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates.

CONCLUSIONS

Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.

Validation and psychometric evaluation of a brief screening questionnaire for psychological distress in patients with psoriasis

BACKGROUND

Patients with psoriasis are at risk of a co-morbid diagnosis of depression and/or anxiety. It is therefore essential for dermatologists to have valid and effective instruments that can screen and monitor depression and anxiety symptoms in psoriasis patients.

OBJECTIVE

The aim of this study was to validate the Mental Health Inventory (MHI-5) as a brief measure that can be used to evaluate psychological distress related to anxiety and depression in psoriasis patients.

METHODS

The sample included 76 adult dermatological outpatients diagnosed with psoriasis. Participants completed the MHI-5, the Hospital Anxiety and Depression Scale (HADS) and six subscales of the Self-Compassion Scale (SCS). Confirmatory factor analysis (CFA) was applied to examine the factor structure of MHI-5. Convergent validity was examined by applying correlations among all measures. Discriminant validity was examined by applying hierarchical regression models. Reliability was examined by calculating Cronbach's alpha coefficient.

RESULTS

Confirmatory factor analysis showed that the proposed one-factor model has a good fit to the data. The MHI-5 demonstrated satisfactory convergent validity by yielding significant moderate to strong correlations with the HADS and with the positive and negative subscales of the SCS. Discriminant validity was also evident with being at risk of anxiety predicting MHI-5 scores above and beyond the effect of gender and age. Hierarchical regressions were not performed because a very small number of participants (n = 3) were classified at risk of depression. The MHI-5 showed high internal consistency (α = 0.84).

CONCLUSION

This investigation provided evidence that MHI-5 is a reliable and valid instrument that can be used to effectively capture psychological distress in psoriasis patients.

Variability of the Prevalence of Depression in Function of Sociodemographic and Environmental Factors: Ecological Model

Major depression etiopathogenesis is related to a wide variety of genetics, demographic and psychosocial factors, as well as to environmental factors. The objective of this study is to analyze sociodemographic and environmental variables that are related to the prevalence of depression through correlation analysis and to develop a regression model that explains the behavior of this disease from an ecological perspective. This is an ecological, retrospective, cross-sectional study. The target population was 1,148,430 individuals over the age of 16 who were registered in Aragon (Spain) during 2010, with electronic medical records in the community’s primary health care centers. The spatial unit was the Basic Health Area (BHA). The dependent variable was the diagnosis of Depression and the ecological independent variables were: Demographic variables (gender and age), population distribution, typology of the entity, population structure by sex and age, by nationality, by education, by work, by salary, by marital status, structure of the household by number of members, and state of the buildings. The results show moderate and positive correlations with higher rates of depression in areas having a higher femininity index, higher population density, areas with a higher unemployment rate and higher average salary. The results of the linear regression show that aging +75 and rural entities act as protective factors for depression, while urban areas and deficient buildings act as risk factors. In conclusion, the ecological methodology may be a useful tool which, together with the statistical epidemiological analysis, can help in the political decision making process.

Obesity and depressive symptoms in mid-life: a population-based cohort study

BACKGROUND

Obesity and depression are both highly prevalent public health disorders and evidence on their relationship is inconsistent. This study examined whether depressive symptoms are associated with current obesity, and further, whether obesity in turn is associated with an increased odds of depressive symptoms five years later after accounting for potential lifestyle confounders and depressive symptoms at baseline.

METHODS

Data were obtained from the 1958 British birth cohort (N = 9217 for cross-sectional and 7340 for prospective analysis). Clinical Interview Schedule-Revised and Mental Health Inventory-5 were used for screening depressive symptoms at ages 45 and 50 years, respectively. General and central obesity were defined using measurements of body mass index (BMI) and waist circumference (WC) at 45 years, respectively.

RESULTS

There was a cross-sectional association between depressive symptoms and obesity: participants with ≥2 depressive symptoms had 31% (95%CI 11% to 55%) higher odds of general and 26% higher odds of central obesity (95%CI 8% to 47%). In prospective analyses, both general and central obesity were associated with higher odds of depressive symptoms five years later among women but not in men (P_interaction < 0.01). After adjustment for depressive symptoms at baseline, sociodemographic and lifestyle factors, women with general obesity had 38% (95% CI 7% to 77%) and women with central obesity 34% (95%CI 9% to 65%) higher odds of depression compared to others.

CONCLUSIONS

Depressive symptoms are associated with concurrent obesity and related lifestyle factors among women and men in mid-life. Our study suggests that obesity in turn affects long-term risk of depressive symptoms in women but not in men, independently of concurrent associations, providing an important target group for the implementation of preventative strategies.

Breast Cancer in Women Older Than 80 Years

Breast cancer is the most common cancer in women, with an incidence that rises dramatically with age. The average age at diagnosis of breast cancer is 61 years, and the majority of woman who die of breast cancer are age 65 years and older. Major improvements in public health and medical care have resulted in dramatic increases in longevity. The oldest old (those age 80 years and older) are a rapidly expanding group and now comprise 9 million members of the US population. The treatment of individuals who are age 80 years and older is complex and involves clearly defining the goals and value of treatment while also weighing risks, such as the potential effects of treatment on functional loss and quality of life. Limited evidence-based treatment guidelines exist for the caring of this older cohort of patients with breast cancer. Data from clinical trials that enroll primarily younger patients lack the information needed to estimate the likelihood of toxicities that can be life changing in older adults. Clinicians who make treatment recommendations should place the available evidence in the context of the patient's life expectancy and geriatric assessment results that include an evaluation of a patient's functional status, comorbidities, cognition, social support, nutritional status, and psychological state. Furthermore, these decisions should be placed in the context of the patient's goals for treatment, preferences, and values. This review summarizes the current literature and focuses on the role of geriatric assessment in treatment recommendations for patients age 80 years and older with early and metastatic breast cancer.

A phase II trial of bendamustine in combination with rituximab in older patients with previously untreated diffuse large B-cell lymphoma

Bendamustine in combination with rituximab (BR) has been associated with high response rates and acceptable toxicity in older patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Evaluation of BR is warranted in the front-line setting for DLBCL patients not eligible for anthracyclines or for the elderly. In this phase II study, we enrolled DLBCL patients aged ≥65 years who were poor candidates for R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) to determine the efficacy and safety of BR in previously untreated stage II-IV DLBCL. Twenty-three patients were enrolled with a median age of 80 years. 52% of patients presented with poor functional status (Eastern Cooperative Oncology Group performance score of ≥2). The overall response rate was 78% with 12 complete responses (52%). At a median follow up of 29 months, the median overall survival was 10·2 months and the median progression-free survival was 5·4 months. The most common grade 3/4 adverse events were haematological. Combination therapy with BR demonstrates high response rates as front-line therapy in frail older patients with DLBCL, but survival rates were low. BR should be used with caution in future clinical trials involving older DLBCL patients with poor functional status.

Alcohol screening for older adults in an acute general hospital: FAST v. MAST-G assessments

Aims and method Documented prevalence of alcohol misuse among older adult patients at Birmingham Heartlands Hospital is significantly lower than the national prevalence. We aimed to evaluate our alcohol misuse screening protocol for older adults to identify possible shortcomings. Hospital protocol is to screen all adults for alcohol misuse in the accident and emergency (A&E) department using the Fast Alcohol Screening Test (FAST). One hundred consecutive consenting in-patients aged 65-94 admitted via A&E subsequently undertook an additional alcohol screening test (Michigan Alcoholism Screening Test-Geriatric version; MAST-G). Results of the two tests were compared. Results FAST screening was completed for 71 patients and none were FAST-positive for alcohol misuse, yet using MAST-G, 18 patients scored positively for alcohol misuse. FAST screening failed to identify 8 patients with a documented history of alcohol misuse. Clinical implications Older adult alcohol misuse prevalence is significantly underreported using FAST. Screening older adults for alcohol problems requires a different approach to screening the general population.

Factors associated with mental health status of medical residents: a model-guided study

Residency is a stressful period in a physician's development, characterized by long work hours, time pressure, and excessive work load, that can exert negative effects on residents' mental health. Job burnout and negative work-home interference may play a major role in residents' mental health problems. The present study used the job demands-resources model as a theoretical framework to examine the way in which job demands (e.g., workload, emotional demands) and job resources (e.g., supervisor support, job autonomy) were associated with residents' mental health. From a pool of 290 medical residents, 264 (91 %) completed the questionnaires. Applying structural equation modeling techniques, the results showed that greater emotional exhaustion (β = -.65, SE = .09, p < .001) and more work-home interference (β = -.26, SE = .10, p < .05) were related to poor mental health. Specific job demands (i.e., high workload) and particular job resources (i.e., low opportunities for professional development and low supervisor support) were related to poor mental health not directly but only indirectly, via emotional exhaustion or work-home interference. Thus, through work-related emotional exhaustion, the impact of work conditions might be transmitted to and interfere with non-work related domains such as family life, as well as with domain-unspecific aspects of well-being, such as mental health and psychological distress. Implications of the results and suggestions for future research and practice are outlined.

Associations between fruit and vegetable consumption and psychological distress: results from a population-based study

BACKGROUND

Several studies observed associations of various aspects of diet with mental health, but little is known about the relationship between following the 5-a-day recommendation for fruit and vegetables consumption and mental health. Thus, we examined the associations of the Swiss daily recommended fruit and vegetable intake with psychological distress.

METHODS

Data from 20,220 individuals aged 15+ years from the 2012 Swiss Health Survey were analyzed. The recommended portions of fruit and vegetables per day were defined as 5-a-day (at least 2 portions of fruit and 3 of vegetables). The outcome was perceived psychological distress over the previous 4 weeks (measured by the 5-item mental health index [MHI-5]). High distress (MHI-5 score ≤ 52), moderate distress (MHI-5 > 52 and ≤ 72) and low distress (MHI-5 > 72 and ≤ 100) were differentiated and multinomial logistic regression analyses adjusted for known confounding factors were performed.

RESULTS

The 5-a-day recommendation was met by 11.6 % of the participants with low distress, 9.3 % of those with moderate distress, and 6.2 % of those with high distress. Consumers fulfilling the 5-a-day recommendation had lower odds of being highly or moderately distressed than individuals consuming less fruit and vegetables (moderate vs. low distress: OR = 0.82, 95 % confidence interval [CI] 0.69-0.97; high vs. low distress: OR = 0.55, 95 % CI 0.41-0.75).

CONCLUSIONS

Daily intake of 5 servings of fruit and vegetable was associated with lower psychological distress. Longitudinal studies are needed to further determine the causal nature of this relationship.

Geriatric assessment-identified deficits in older cancer patients with normal performance status

BACKGROUND

We investigated whether a brief geriatric assessment (GA) would identify important patient deficits that could affect treatment tolerance and care outcomes within a sample of older cancer patients rated as functionally normal (80%-100%) on the Karnofsky performance status (KPS) scale.

METHODS

Cancer patients aged ≥65 years were assessed using a brief GA that included both professionally and patient-scored KPS and measures of comorbidity, polypharmacy, cognition, function, nutrition, and psychosocial status. Data were analyzed using descriptive statistics and multivariable logistic regression.

RESULTS

The sample included 984 patients: mean age was 73 years (range: 65-99 years), 74% were female, and 89% were white. GA was conducted before (23%), during (41%), or after (36%) treatment. Overall, 54% had a breast cancer diagnosis (n = 528), and 46% (n = 456) had cancers at other sites. Moreover, 81% of participants (n = 796) had both professionally and self-rated KPS ≥80, defined as functionally normal, and those patients are the focus of analysis. In this subsample, 550 (69%) had at least 1 GA-identified deficit, 222 (28%) had 1 deficit, 140 (18%) had 2 deficits, and 188 (24%) had ≥3 deficits. Specifically, 43% reported taking ≥9 medications daily, 28% had decreased social activity, 25% had ≥4 comorbidities, 23% had ≥1 impairment in instrumental activities of daily living, 18% had a Timed Up and Go time ≥14 seconds, 18% had ≥5% unintentional weight loss, and 12% had a Mental Health Index score ≤76.

CONCLUSION

Within this sample of older cancer patients who were rated as functionally normal by KPS, GA identified important deficits that could affect treatment tolerance and outcomes.