Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study

Depression Treatment Trajectories and Associated Social Determinants: A Three-Year Follow-Up Study in 66,540 Older Adults Undergoing First-Time Depression Treatment in Denmark

OBJECTIVE

This study aimed to describe depression treatment patterns, identify unique trajectory groups using a group-based trajectory approach, and explore associated social determinants in older adults undergoing first-time depression treatment during a 3-year follow-up.

METHODS

This Danish register-based cohort study included all adults aged ≥ 65 who initiated depression treatment by redeeming first-time antidepressant prescriptions (no prescriptions in the last 10 years) between 2006 and 2015. The outcome of interest during the 2-year follow-up was depression treatment, assessed as antidepressant prescriptions redemptions and psychiatric hospital contacts for depression. Latent class growth analyses were applied to model treatment trajectories during 3 years. Multinomial logistic regression analyses were used to analyze adjusted associations between social determinates and trajectory group membership.

RESULTS

Among the 66,540 older adults (55.2% females, mean age: 77.3 years), we identified three distinct groups with unique patterns of depression treatment trajectories: 'brief-treatment' where individuals stopped depression treatment within 6 months (33.7%); 'gradual-withdrawal' (26.5%) where treatment was gradually stopped over 2 years; and 'persistent-treatment' where individuals continued depression treatment for the entire 3 years (39.8%). Females, single-person households, and residents of less-urbanized regions were associated with higher odds of membership in the 'persistent-treatment' group, while older age, widowhood or separation, and non-Danish ethnicities were associated with lower odds.

CONCLUSIONS

Three distinct patterns of depression treatment trajectories were identified in older adults, indicating differential clinical courses of depression-potentially influenced by social determinants, including sex, marital status, urban residence, and ethnicity. Early patient stratification and targeted interventions are crucial in depression care for older adults.

Association Between Gallstones and Depressive Symptoms: Results from NHANES and Mendelian Randomization Study

Purpose

Prior research has suggested a correlation between gallstones and depressive symptoms, yet the specifics of this relationship remain unclear. This study aims to explore the association between gallstones and depressive symptoms among adults.

Patients and Methods

Initially, we conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017 - March 2020. After propensity score matching (PSM) for participants with gallstones and those without gallstones, multivariate logistic regression analysis was used to explore the potential association between gallstones and depressive symptoms. This was followed by Mendelian randomization (MR) analysis to further elucidate the causal relationship between them. Using the genome-wide association study database, we extracted instrumental variables and performed bidirectional univariate and multivariate MR analyses.

Results

In the cross-sectional study of NHANES 2017 - March 2020, 835 pairs of participants with comparable characteristics, both with and without gallstones, were identified after PSM. The multivariate adjusted logistic regression analyses revealed a significant association between gallstones and depressive symptoms [fully adjusted model: OR=1.821 (95% CI, 1.181-2.808), P=0.007]. Subsequent MR analyses further clarified the causal relationship, indicating that genetically determined gallstones significantly increase the risk of developing depressive symptoms [forward univariate MR analysis: OR=1.04 (95% CI, 1.01-1.06), P=0.002; multivariate MR analysis: OR=1.03 (95% CI, 1.01-1.05), P=0.009], with no evidence of reverse causation [inverse univariate MR analysis: OR=1.28 (95% CI, 0.90-1.83), P=0.17].

Conclusion

Gallstones are a risk factor for depressive symptoms among adults. Hence, we recommend timely depression screening for patients diagnosed with gallstones, facilitating early detection and effective treatment of depressive symptoms, thus alleviating its impact on both individuals and society.

Mental Health Literacy Among Urban and Rural Residents of Guangdong Province, China

Purpose

The study aims to understanding the mental health literacy level of urban and rural residents in Guangdong Province, the first major province in China, and its influencing factors is crucial.

Methods

A multi-stage stratified equal-volume random sampling method was adopted in October-December 2022 to select permanent residents aged 18 years and above in Guangdong Province for the questionnaire survey, which consisted of a general demographic information questionnaire and a national mental health literacy questionnaire. Rao-Scott χ²-test with correction based on sampling design, independent samples t-test and binary multivariate logistic regression analysis were performed.

Results

A total of 51744 individuals completed the questionnaire, including 31822 urban residents and 19200 rural residents. The rate of achievement of mental health literacy was 13.6% among urban residents, which was significantly higher compared to the rate of 8.6% among rural residents. Logistic regression analysis showed that female, higher education, being mental worker, being a retiree, having a higher monthly household income, maintaining a regular diet, and using electronic products for 2-6 hours per day were protective factors for mental health literacy attainment in urban residents, while having chronic diseases, being a smoker and having a history of drinking were identified as risk factors in urban residents. Among in rural residents, married, younger, higher education, being mental worker and using electronic products for 2-6 hours per day, maintaining a regular diet, and engaging in regular exercise were protective factors for achieving mental health literacy, while previous smoking was a risk factor.

Conclusion

The study revealed a low level of mental health literacy among urban and rural residents of Guangdong Province, with a significant disparity between the two areas. These findings highlight the need for continuing efforts to increase the dissemination of mental health knowledge in rural communities and improve levels of mental health literacy.

Association between chronic conditions, multimorbidity, and dependence levels in Chinese community-dwelling older adults with functional dependence: a cross-sectional study in south-central China

Background

The rising prevalence of multimorbidity and functional dependence in community-dwelling older adults contribute to the demand for home care services. Evidence on how chronic conditions, especially multimorbidity, affect dependence levels among older adults with functional dependence in a socio-cultural context is much needed to inform policy, workforce, aged care service development to meet the care needs of this population.

Objectives

This study aimed to determine the association between chronic conditions, multimorbidity and dependence levels among Chinese community-dwelling older adults with functional dependence.

Methods

A cross-sectional study was conducted with 1,235 community-dwelling older adults with functional dependence in Hunan province, China, from June to October 2018. Data on socio-demographic factors, cognitive function, vision and hearing conditions, activities of daily living (ADLs), and health conditions were collected, and binary logistic regression analyses were used to determine the association between chronic conditions, multimorbidity and dependence levels, with adjustments for relevant covariates.

Results

Among the participants, 62.9% had multimorbidity. Parkinson's disease, stroke, COPD, hypertension, mood and psychotic disorders (Anx/Sch/Dep) were significantly associated with high levels of functional dependence. After adjusting for demographic variables, cognitive function, vision, and hearing conditions, we observed a significant relationship between multimorbidity and higher functional dependence, but this association became insignificant when including certain chronic diseases closely associated with high-level dependence. Study revealed that Parkinson's disease and stroke notably increase dependency risk across seven ADL domains, demonstrating their extensive impact on daily functioning.

Conclusion

The prevalence of multimorbidity among Chinese community-dwelling older adults with functional dependence is very high. The association of multimorbidity with functional dependence is mediated by specific chronic conditions. These findings highlight the necessity of adopting an integrated care model that combines medical and social care, with a particular emphasis on managing multimorbidity and critical chronic conditions that lead to severe functional dependence to preventing and diminish the onset of disabilities.

The impact of internet device diversity on depressive symptoms among middle-aged and older adults in China: A cross-lagged model of social participation as the mediating role

BACKGROUND

Depressive symptoms is more prevalent in middle-aged and older populations, and the development of Internet technology has brought new challenges and opportunities for the mental health of this group. This study aims to explore the bidirectional relationship between Internet device diversity and levels of depressive symptoms through longitudinal data analysis, as well as investigate the mediating role of social participation.

METHODS

Data for the analysis was retrieved from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, 2018, and 2020, which included 9259 middle-aged and older adults. The sum of the number of devices mentioned by each participant was calculated to assess the diversity of internet device use, a weighted total score of how frequently and to what extent individuals had participated in various social activities in the past month was calculated to measure the social engagement, and the Center for Epidemiological Studies Depression Scale was used to calculate depressive symptoms. A cross-lagged mediation model and bivariate correlation analysis were employed to examine the longitudinal relationships among depressive symptoms, internet device diversity, and social participation. Age, gender, highest education level, marital status, drinking status, smoking history, self-rated health, sleep duration, and chronic health conditions were adjusted as covariates.

RESULTS

The results from the three waves of longitudinal data revealed mutual predictive relationships among internet device diversity, social participation, and depressive symptoms. The mediating effect was significant (β = -0.612, 95 % CI -0.796 to -0.429), with significant gender differences observed. Furthermore, our findings indicated that social participation functioned as a protective factor against depressive symptoms, and the association between social participation and depressive symptoms was not a straightforward linear relationship. This suggests that participation in social activities (either high or low) is associated with a lower risk of depressive symptoms compared to no social participation, with no gender differences.

CONCLUSIONS

This study suggests that there is a relationship between internet device diversity and lower levels of depressive symptoms among middle-aged and older adults in China. Social participation mediates the relationship between internet device diversity and depressive symptoms, and different levels of social engagement have different effects on depressive symptoms. It is recommended to increase support for social participation among middle-aged and older adults, strengthen structural social capital, and better leverage the use of the internet to reduce depressive symptoms levels and promote the physical and mental well-being of this population.

Depressive disorders in Chinese left-behind children and adolescents from Yunnan province: prevalence and association with self-harm behaviors

BACKGROUND

The prevalence of clinically diagnosed depressive disorders (DD) in Chinese left-behind children (LBC) remains unknown. We aim to estimate the prevalence of DD, discuss the associations between DD and self-harm (SH) behaviors in a large representative sample of Chinese LBCs chosen from Yunnan province.

METHODS

A total of 5462 LBCs were selected from the most recent datasets of the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a mega population-based two-phase cross-sectional survey. Weighted prevalence rates and designed Logistic regression were adopted to estimate the prevalence of DD and the association between DD and SH.

RESULTS

The weighted prevalence of lifetime and current DD were 4.22% (95% CI: 3.13-6.00%) and 3.84% (95% CI: 2.85-5.00%) in Chinese LBCs. Higher lifetime and current DD prevalence rates were observed in girls and those reported adverse parental marital status and SH behaviors. The absence of DD was associated with significantly decreased odds of SH behavior (OR = 0.06), repetitive SH (OR = 0.09), using multiple SH methods (OR = 0.09), and severe SH (OR = 0.15). Subsequently performed stratified analyses identified prominent effect modification by sex and age, as a stronger association between DD and SH was found in girls (OR = 0.02 versus OR = 0.07 in boys) and younger adolescents (OR = 0.08 versus OR = 0.22 in older adolescents).

CONCLUSION

The prevalence of DD was high in Chinese LBCs. DD was associated with prominently increased risk of SH behaviors in LBCs. Attention and intervention are needed in this vulnerable population.

Assessment of psychometric properties of the union physio-psycho-social assessment questionnaire (UPPSAQ-70) in a large sample of general hospital psychiatric outpatients

OBJECTIVE

To evaluate the psychometric properties of the Union Physio-Psycho-Social Assessment Questionnaire (UPPSAQ-70) among general hospital psychiatric outpatients.

METHODS

A total of 2000 participants responded to the survey. Factor analyses were used to test the construct validity of the scale. Convergent validity was evaluated by the correlation between UPPSAQ-70 and symptoms measured using the Chinese versions of Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Patient Health Questionnaire-15 (PHQ-15), Somatic Symptom Disorder - B Criteria Scale (SSD-12) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The nine-factor model was supported (χ2 = 8816.395, df = 2309, χ2/df = 3.818, RMSEA = 0.053, CFI = 0.929). The UPPSAQ-70 showed significant correlation with the SAS (r = 0.396, P < .001), SDS (r = 0.451, P < .001), PHQ-15 (r = 0.381, P < .001), SSD-12 (r = 0.324, P < .001) and PSQI (r = 0.220, P < .001). UPPSAQ-70 and its subscales showed good internal consistency with Cronbach's alpha coefficients ranging from 0.79 to 0.96.

CONCLUSIONS

The UPPSAQ-70 was a rating scale with good construct validity and reliability, which can measure overall health in the biological, psychological, and social domains for Chinese psychiatric outpatients, but its convergent validity still requires further empirical research.

Childhood maltreatment associated suicidal risk in Chinese children and adolescents: a mediation of resilience

BACKGROUND

Existing evidence suggests that children and adolescents who had experienced childhood maltreatment (CM) are at higher suicidal risk. However, the mediation role of resilience in this association remains unclear. We aim to investigate the mediation via resilience in the associations between CM and three suicidal risk indicators (suicidal ideation, SI; suicidal plan, SP; suicidal attempt, SA) among a large sample of Chinese children and adolescents.

METHODS

A population-based cross-sectional survey was conducted in southwestern China Yunnan province. A total of 9723 children and adolescents were included and analyzed by using a multi-stage stratified cluster sampling design. Univariate and multivariate logistic regression models were fitted to explore the associations between CM, resilience, and the three suicidal risk indicators, dose-response trends further elucidated by using the restricted cubic splines. Path models were adopted to estimate the mediation of resilience.

RESULTS

The estimated prevalence rates for one-year SI, SP and SA were 32.86% (95% CI: 31.93-33.80%), 19.36% (95% CI: 18.57-20.16%) and 9.07% (95% CI: 8.51-9.66%). After adjustment, CM significantly associated with all 3 suicidal risk indicators, and the odds ratios (ORs) were 2.13 (95% CI: 1.91-2.37), 2.45 (95% CI: 2.13-2.81), and 3.61 (95% CI: 2.90-4.52) for one-year SI, SP, and SA, respectively. Path models revealed that resilience significantly mediated the associations between CM and the three suicidal risk indicators, and among all dimensions of resilience, family support presented the strongest mediation consistently.

CONCLUSIONS

Our study results suggest that intervention measures which focusing on improving psychological resilience might be effective in reducing suicidal risk for children and adolescents who had experienced maltreatment. Prospective studies should be done to corroborate our findings.

Association of Non-Suicidal Self-Injury with Tryptophan Hydroxylase 2 Gene Polymorphism and Negative Life Events Among Adolescents with Depression in Northern China

Objective

To investigate the association between single nucleotide polymorphisms (SNPs) of tryptophan hydroxylase 2 (TPH2) (rs11178997, rs11178998, and rs120074175) and negative life events in adolescent depression with Non-suicidal self-injury (NSSI).

Methods

Genomic DNA was extracted from 197 adolescents with depression (participants group, including NSSI group and non-NSSI group), as well as from 100 healthy controls (control group), in northern China. PCR technology was utilized to amplify DNA fragments and detect genotypes in both groups. The Adolescent Life Event Scale (ASLEC) was employed to conduct a questionnaire survey among the participants and control groups. Differences in allele and genotype frequency distribution between the two groups were analyzed using the X^2 test, while generalized multifactor dimensionality reduction (GMDR) was used to analyze gene-environment interactions.

Results

Significant differences were observed in ASLEC scores between the control group and both the NSSI group and non-NSSI group (P<0.05). Additionally, significant differences were found in the interpersonal relationship factor and punishment factor between the NSSI group and non-NSSI group (P < 0.05). Moreover, a significant difference was identified in SNP genotype of rs11178997 between the depression group (NSSI group + non-NSSI group) and control group (P<0.05). GMDR analysis revealed an interaction among rs11178997, rs11178998, and ASLEC.

Conclusion

Adolescents with depression, particularly females, may exhibit a tendency to employ NSSI as an emotional coping mechanism when confronted with greater family and interpersonal challenges. The AT genotype of TPH2 gene locus rs11178997 is more prevalent among adolescents with depression. Furthermore, the occurrence of NSSI may be associated with an interaction involving polymorphic sites rs11178997 and rs11178998 along with life events.

Negative life events, sleep quality, and depression among older adults in Shandong Province, China: A conditional process analysis based on economic income

AIM

Negative life events have been reported as a risk factor for depression. However, the mechanism between negative life events and depression is still unclear. This study aimed to explore the mediating role of sleep quality and the moderating role of economic income in the association between negative life events and depression among older adults aged 60 years and over.

METHODS

A multi-stage stratified sampling method was used to select elderly individuals over 60 years old in Shandong, China, making use of the Household Health Interview Survey (2020). In total, 3868 older adults completed the measures of negative life events, sleep quality, depression, and economic income.

RESULTS

Negative life events positively predicted depression among the elderly (proportion of direct effect, 55.12%), and poor sleep quality could mediate this association (proportion of indirect effect, 44.87%). Economic income played a moderating role in the relationship between negative life events, sleep quality, and depression (the first and second half of the mediating effect, the direct effect of negative life events on depression). Both effects were weaker among the elderly with higher economic incomes.

CONCLUSIONS

Negative life events had positive effects on depression in older adults. Economic income moderated the direct effect of negative life events and the mediating effect (first and second half) of sleep quality on depression. When the elderly experience negative life events, interventions for improving their sleep quality and financial support could effectively prevent depression. Geriatr Gerontol Int 2024; 24: 751-757.

Parent-Child Relationships: A Shield Against Maternal Depression in the Midst of Household Chaos

Background

Depression, a severe mental disorder, not only jeopardizes the health of mothers but also significantly negative impacts on families and their children. This study investigates the correlation between household chaos and maternal depression.

Methods

This study adopted a cross-sectional design and used the Confusion, Hubbub, and Order Scale, Dyadic Adjustment Scale, Parent-Child Relationship Scale, and Beck Depression Inventory to assess 1947 mothers of children in seven kindergartens in Shanghai, China.

Results

The findings revealed a significant positive correlation between household chaos, marital conflict, and maternal depression. Marital conflict also showed a significantly positively correlated with maternal depression. Marital conflict mediates the relationship between household chaos and maternal depression. Parent-child relationships moderated the direct effect of household chaos on maternal depression. When parent-child relationships were low, household chaos had a greater predictive effect on maternal depression. Conversely, when parent-child relationships were high, the predictive effect of household chaos on maternal depression was reduced.

Conclusion

This study reveals that parent-child relationships play a protective role in the impact of household chaos on maternal depression. This study significantly contributes to enriching the social support buffering model.

Psychological resilience and related factors among primary care workers in Wuhan, China: A cross-sectional study

Purpose

Primary medical workers constitute a high-risk group for mental health problems, and psychological resilience might protect them from the negative psychological impacts of their work. Therefore, this study aimed to investigate the current situation of psychological resilience among primary care workers in Wuhan, China, as well as related factors.

Methods

In this cross-sectional study, a total of 417 primary care workers (30.0 % men; 38.5 ± 8.5 years old) were randomly selected to complete a questionnaire. The brief version of the National Mental Health Literacy Questionnaire and the Psychological Resilience Scale were used to assess participants' mental health literacy and psychological resilience, respectively. Multiple linear regression was performed to identify factors associated with the psychological resilience of primary care workers.

Results

More than four-fifths of the primary care workers included in this study exhibited appropriate levels of mental health knowledge. In terms of mental health skills, participants' attainment rates, ranging from high to low, were 60.9 % for distracting attention, 45.3 % for interpersonal support and 43.9 % for cognitive reappraisal. The average psychological resilience score obtained by primary care workers was 27.81 ± 5.71, and the factors associated with increased psychological resilience included being male, being older, and possessing higher mental health skills, including skills pertaining to interpersonal support and distracting attention.

Conclusion

The psychological resilience of primary care workers in Wuhan is at a moderate level and thus requires further improvement. Although these medical staff exhibit appropriate levels of mental health knowledge, their mental health skills are relatively poor, despite the fact that interpersonal support and distracting attention are significantly associated with psychological resilience. Hence, interventions targeting mental health skills are recommended to promote psychological resilience among primary care workers.

Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases

Introduction

It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality.

Results

Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]).

Conclusion

Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.

The effect of spiritual reminiscence therapy on depression and hope among Iranian older adults: a quasi-experimental study

This quasi-experimental study aimed to evaluate the impact of spiritual reminiscence therapy (SRT) on depression and hope among older adults living in Shahroud, northeast of Iran. One hundred fifty-six older adults were selected through convenience sampling and assigned non-randomly to the intervention (n= 78) and control (n= 78) groups. The data collection tools included the Geriatric Depression Scale and Adult Hope Scale. For the intervention group, SRT was conducted in six weekly sessions, each lasting 60 to 90 min, over six weeks. The data were analyzed utilizing descriptive statistics and inferential tests (independent t-test, Chi-square test, and analysis of covariance). The two groups' post-intervention mean scores on depression (t= 11.63 and P< 0.001), and hope (t= 4.41 and P< 0.001) were statistically different, suggesting that SRT positively affected older adults by alleviating despair and boosting hope. The findings indicate that engaging in SRT can be beneficial in reducing depression and fostering hope among older adults.

Solid fuel use, socioeconomic status and depression: a cross-study of older adults in China

BACKGROUND

Indoor air pollution causes severe psychological stress and promotes depression. A better understanding of the impact of solid fuel consumption and socioeconomic indicators on mental health is critical to promote successful aging. In this study, we analyzed the relationship of depression with socioeconomic status (SES) and solid fuel use, and illustrated the mediating role of solid fuel use in the relationship between SES and depression.

METHODS

9250 participants from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey were included in this study. A logistic regression analysis was used to calculate odds ratio (OR) and 95% confidence interval (CI) of depression for different types of fuel consumption. The stepwise approach and the Sobel test were used to test the mediation effect.

RESULTS

Older people who reported the consumption of solid fuels showed higher odds of having depressive symptoms (OR = 1.16, 95% CI:1.03, 1.31). In model with depression as the outcome variable, the ORs of low education level and low annual household income level were 1.30 (95% CI: 1.15, 1.47) and 1.43 (95% CI: 1.28, 1.59) respectively. Solid fuel consumption accounted for 38.40% of the effect of a low education level and 54.73% of the effect of low income on depression.

CONCLUSIONS

Solid fuel use and SES are associated with depression, and solid fuel use may act as a potential mediator connecting socioeconomic indicators and depression.

Association between suicide attempts and anemia in late-life depression inpatients

BACKGROUND

Anemia is strongly associated with late-life depression (LLD), however, few studies have investigated the relationship between anemia and suicide attempts in LLD patients. It is still challenging to predict suicide risk in patients with depression. Therefore, there is growing interest in potential biomarkers of depressive disorders and suicidal behavior, which may play a significant role in the early diagnosis and treatment of depression. This study aimed to compare serum ferritin, folate, vitamin B12, and erythrocyte parameter levels in patients with LLD with those in healthy older adults, and the relationship between serum ferritin, folate, vitamin B12, and suicide attempts in patients.

METHODS

Serum ferritin, folate, vitamin B12, and erythrocyte parameter levels were measured in 66 hospitalized LLD patients (30 without suicide attempt, 36 with suicide attempt) and 47 healthy individuals. All participants were surveyed for basic conditions and suicide attempts, and depression was assessed in LLD patients.

RESULTS

Serum ferritin, folate, vitamin B12, red blood cell count, hemoglobin, hematocrit, mean platelet volume and plateletcrit levels were significantly lower in LLD patients compared with healthy older adults (P < 0.05). Further analysis of the relationship between serum ferritin, folate, and vitamin B12 levels and LLD patients' suicide attempts and showed a significant negative association between serum folate and vitamin B12 and suicide attempts (P < 0.05).

CONCLUSIONS

Serum ferritin, folate, vitamin B12, red blood cell count, hemoglobin, hematocrit, mean platelet volume and plateletcrit levels were significantly lower in LLD patients than in healthy older adults. In addition, reduced serum folate and vitamin B12 levels in patients may have some effect on suicide attempts. More mechanistic studies are needed to further explain this association.

Effects of group reminiscence interventions on depressive symptoms and life satisfaction in older adults with intact cognition and mild cognitive impairment: A systematic review

OBJECTIVE

Reminiscence interventions have been extensively used to improve the psychological health of people with dementia. However, there is uncertainty about the effectiveness of group reminiscence interventions for older adults with intact cognition and mild cognitive impairment. Based on the large number of older adults and strained health care resources in China, we conducted a systematic review of the evidence on the effectiveness of group reminiscence interventions for older adults with intact cognition or mild cognitive impairment.

MATERIALS AND METHODS

Five English databases were searched from inception to 21 August 2022. The quality of the included articles was assessed by using the Cochrane Risk of Bias Scale or Criteria (2020) and the Australian Evidence-Based Health Care Centre (2020). Data related to study and intervention characteristics were extracted.

RESULTS

Twenty-four articles were included, of which eight were quasiexperimental studies and sixteen were randomized controlled studies. The overall study quality was high, but most studies did not blind the participants. Group reminiscence interventions were beneficial in improving depressive symptoms and life satisfaction in older adults with intact cognition or mild cognitive impairment, but no valid conclusions could be drawn about the effect on quality of life.

CONCLUSIONS

Group reminiscence interventions are an effective type of psychological intervention to improve the psychological health of older people. In addition, group reminiscence interventions are simple and easy to implement and can be considered a routine care activity to meet the spiritual needs of cognitively intact and mildly cognitively impaired older people.

Gender differences in depressive symptoms among Chinese older adults based on fairlie decomposition analysis

This study aimed to investigate the factors influencing depressive symptoms among Chinese older adults based on gender differences. Data from the eighth wave of Chinese Longitudinal Health Longevity Survey were used. We analyzed the influencing factors of depressive symptoms reported by older adults using the chi-squared test and logistic model. Fairlie decomposition analysis was performed to quantify the contribution level of each influencing factor. We found that 11.71 % of older adults met the CES-D-10 criteria for depressive symptoms. Females (13.89 %) reported a significantly higher level of depressive symptoms than males (9.24 %). Age, residence, sleeping time, exercise, activities of daily living functional disability, instrumental activity of daily living functional disability, and living status influenced depressive symptoms in older adults. Higher education and lower body mass index were only significant in male, whereas middle annual income and exercising were significant only in female. The Fairlie decomposition model explained the reasons for 75.64 % of the gender differences in depressive symptoms, with instrumental activity of daily living functional disability (33.60 %), age (-17.79 %), and education level (17.41 %) being major factors affecting gender differences in depressive symptoms. This is the first nationwide study to examine gender differences in depressive symptoms among older adults. These results provide a basis for relevant Chinese government departments to formulate policies to prevent and control depressive symptoms.

The mechanisms underlying the negative effect of socioeconomic status on depressive symptoms among older adults: The roles of social support and living arrangement

OBJECTIVES

Previous studies have found an association between socioeconomic status (SES) and depressive symptoms among older adults, however the mechanisms underlying this association remained unclear. This study aimed to examine the mediating role of social support and the moderating role of living arrangement in the association between SES and depressive symptoms.

METHODS

Data was collected from the 2020 Household Health Interview Survey in Taian city, Shandong Province, China. A total of 3896 older adults aged 60 and above were included in this study. Depressive symptoms was measured by the Patient health Questionnaire-9 (PHQ-9), Social support by the Multidimensional Scale of Perceived Social Support (MSPSS), and other variables by related demographic scales. The moderated mediation model was examined using HAYES PROCESS 3.5.

RESULTS

SES negatively predicted depressive symptoms among older adults, and social support could mediate this association. Living arrangement played a moderating role in the relationship between social support and depressive symptoms (the second half of the mediating effect), and the effect was stronger among older adults who lived alone.

CONCLUSIONS

Social support partially mediated the relationship between SES and depressive symptoms among older adults, and living alone strengthened the effect of social support on depressive symptoms. Interventions that address older adults' social support and living arrangement may ameliorate depressive symptoms among older adults.

Stigma toward mental disorders and associated factors among community mental health workers in Wuhan, China

BACKGROUND

Stigma toward mental disorders (STMD) is a significant barrier to mental health service delivery. To improve the provision of mental health services for community-dwelling residents in China, this study investigated STMD and its associated factors in community mental health workers (CMHWs) in Wuhan, China.

METHODS

In this cross-sectional study, a total of 3869 CMHWs (22.9% men and 37.1 ± 8.4 years old) were randomly selected through multistage sampling and invited to participate in this survey. The perceived devaluation-discrimination scale (PDD) and the National Mental Health Literacy Questionnaire (NMHLQ) were used to assess STMD and mental health knowledge, respectively. The presence of STMD was indicated by a mean item score of 3.0 or higher on the PDD. Multiple logistic regression was used to identify factors associated with STMD.

RESULTS

Of the CMHWs, 41.9% had poor mental health knowledge (NMHLQ score < 80), and 18.5% exhibited STMD. In multiple regression analysis, factors significantly associated with STMD were social workers (vs. primary care physicians, OR = 1.44, p < .001), poor self-rated capacity to handle common mental health problems (vs. good, OR = 1.57, p < .001), and poor mental health knowledge (vs. NMHLQ score ≥ 80, OR = 1.46, p < .001).

CONCLUSION

STMD is common among Chinese CMHWs. To reduce STMD among CMHWs, training programs in mental health care skills and mental health education may be necessary.

The role of anxiety and depressive symptoms in mediating the relationship between subjective sleep quality and cognitive function among older adults in China

BACKGROUND

Deterioration of cognitive function has a significant impact on the unavoidable burden on individuals, families, and society. This study aimed to examine the serial multiple mediating effects of anxiety and depressive symptoms on the relationship between subjective sleep quality and cognitive function among older adults in China.

METHODS

We selected 6442 Chinese older adults aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey. The SPSS PROCESS macro was employed to perform simple and serial multiple mediation analyses.

RESULTS

Subjective sleep quality, depressive symptoms, anxiety symptoms, and cognitive function were significantly related (P < 0.01). Poor sleep quality can have a direct negative influence on cognitive function among older adults (effect = -0.110; 95 % CI = [-0.166, -0.053]), but it can also have an indirect negative impact via three pathways: the independent mediation of anxiety symptoms (effect = -0.028; 95 % CI = [-0.048, -0.011]), the independent mediation of depressive symptoms (effect = -0.014; 95 % CI = [-0.026, -0.002]), and the serial mediation of anxiety and depressive symptoms (effect = -0.009; 95 % CI = [-0.017, -0.001]).

LIMITATIONS

This study used a cross-sectional design, which restricts the ability to infer causal relationships.

CONCLUSIONS

The effect of subjective sleep quality on cognitive function was serially mediated by anxiety and depressive symptoms among older adults. Diverse therapies targeted at improving sleep quality in older adults may improve mood and cognitive functioning.

Prevalence of depressive disorders in a primary care setting in Ho Chi Minh City, Vietnam: A cross-sectional epidemiological study

OBJECTIVE

This research was conducted to identify the prevalence and associated factors of depressive disorders, as well as evaluate the recognition rate of general practitioners in detecting these mental health issues in primary care.

METHOD

Five hundred and twelve participants (55.3% female, mean age = 46.35 years) were assessed by psychiatrists based on the DSM-5 clinical procedures over a two-month survey in a primary care facility in Ho Chi Minh City, Vietnam.

RESULTS

There were 15.8% (95% confidence interval [CI] 12.9-19.2) of the population having depressive disorders, with major depressive disorder being the most prevalent subtype at 8% (95% CI 5.9-10.6). General practitioners could detect depressive disorders in 2.5% of all cases (95% CI .5-7.7). Significantly linked with depressive disorders in multivariable analysis were Chinese ethnic or other minority races (adjusted odds ratios [aOR] = 4.10, 95% CI 1.04-16.12), and low economic status (aOR = 5.41, 95% CI 1.29-22.59).

CONCLUSIONS

The high prevalence of depressive disorders in outpatients of primary care clinics may raise the awareness of the practitioners about screening and other appropriate actions to tackle the issue.

Change in prevalence over time and factors associated with depression among Bangladeshi older adults during the COVID-19 pandemic

BACKGROUND

Globally, the COVID-19 pandemic seriously affected both physical and mental health conditions. This study aims to assess changes in the prevalence of depression among older adults during the COVID-19 pandemic in Bangladesh and explore the correlates of depression in pooled data.

METHODS

This study followed a repeated cross-sectional design and was conducted through telephone interviews on two successive occasions during the COVID-19 pandemic (October 2020 and September 2021) among 2077 (1032 in 2020-survey and 1045 in 2021-survey) older Bangladeshi adults aged 60 years and above. Depression was measured using the 15-item Geriatric Depression Scale (GDS-15). The binary logistic regression model was used to identify the factors associated with depression in pooled data.

RESULTS

A significant increase in the prevalence of depression was noted in the 2021 survey compared to the 2020 survey (47.2% versus 40.3%; adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.11-1.75). Depression was significantly higher among participants without a partner (aOR 1.92, 95% CI 1.45-2.53), with a monthly family income of <5000 BDT (aOR: 2.65, 95% CI 1.82-3.86) or 5000-10 000 BDT (aOR: 1.30, 95% CI 1.03-1.65), living alone (aOR 2.24, 95% CI 1.40-3.61), feeling isolated (aOR 3.15, 95% CI 2.49-3.98), with poor memory/concentration (aOR 2.02, 95% CI 1.58-2.57), with non-communicable chronic conditions (aOR 1.34, 95% CI 1.06-1.69), overwhelmed by COVID-19 (aOR 1.54, 95% CI 1.18-2.00), having difficulty earning (aOR 1.49, 95% CI 1.15-1.92) or obtaining food (aOR 1.56, 95% CI 1.17-2.09) during COVID-19 pandemic, communicating less frequently (aOR 1.35, 95% CI 1.07-1.70) and needing extra care (aOR 2.28, 95% CI 1.75-2.96) during the pandemic.

CONCLUSIONS

Policymakers and public health practitioners should provide immediate mental health support initiatives for this vulnerable population during the COVID-19 pandemic and beyond. Policymakers should also invest in creating safe places to practise mindful eating, exercise, or other refuelling activities as a means of preventing and managing depression.

Predictive potential of somatic symptoms for the identification of subthreshold depression and major depressive disorder in primary care settings

BACKGROUND

The presence of heterogenous somatic symptoms frequently obscures the recognition of depression in primary care. We aimed to explore the association between somatic symptoms and subthreshold depression (SD) and Major Depressive Disorder (MDD), as well as to determine the predictive potential of somatic symptoms in identifying SD and MDD in primary care.

METHODS

Data were derived from the Depression Cohort in China study (ChiCTR registry number: 1900022145). The Patient Health Questionnaire-9 (PHQ-9) was used to assess SD by trained general practitioners (GPs), and the Mini International Neuropsychiatric Interview depression module was used to diagnose MDD by professional psychiatrists. Somatic symptoms were assessed using the 28-item Somatic Symptoms Inventory (SSI).

RESULTS

In total of 4,139 participants aged 18-64 years recruited from 34 primary health care settings were included. The prevalence of all 28 somatic symptoms increased in a dose-dependent manner from non-depressed controls to SD, and to MDD (P for trend <0.001). Hierarchical clustering analysis grouped the 28 heterogeneous somatic symptoms into three clusters (Cluster 1: energy-related symptoms, Cluster 2: vegetative symptoms, and Cluster 3: muscle, joint, and central nervous symptoms). Following adjustment for potential confounders and the other two clusters of symptoms, per 1 increase of energy-related symptoms exhibited significant association with SD (OR = 1.24, 95% CI, 1.18-1.31) and MDD (OR = 1.50, 95% CI, 1.41-1.60) The predictive performance of energy-related symptoms in identifying individuals with SD (AUC = 0.715, 95% CI, 0.697-0.732) and MDD (AUC = 0.941, 95% CI, 0.926-0.963) was superior to the performance of total SSI and the other two clusters (P < 0.05).

CONCLUSIONS

Somatic symptoms were associated with the presence of SD and MDD. In addition, somatic symptoms, notably those related to energy, showed good predictive potential in identifying SD and MDD in primary care. The clinical implication of the present study is that GPs should consider the closely related somatic symptoms for early recognition for depression in practice.

Oral health and depressive symptoms among older adults in urban China: a moderated mediation model analysis

BACKGROUND

This study explored the association between oral health and depression occurs via daily dietary satisfaction as a mediator, and that body mass index could moderate the path between daily dietary satisfaction and depression.

METHODS

Data for this research were derived from a community survey adopting quota sampling in the cities of Tianjin and Shijiazhuang in mainland China in 2020 (N = 781). The moderated mediation model was tested by using bootstrapping with resampling strategies, and the Johnson-Neyman technique was used to visualize the moderating effect of body mass index.

RESULTS

A significant negative association between oral health and depression has been indicated (B = -0.22, SE = 0.11, 95%CI [- 0.44, - 0.01]), and dietary satisfaction partially mediated the relationship between oral health and depression (B = -0.04, SE = 0.02, 95%CI [- 0.09, - 0.002]). The path was moderated by body mass index, and the effect of dietary satisfaction on depression was much greater in people with relatively low body mass index.

CONCLUSIONS

This study present evidence for policymakers and researchers that strategies to enhance oral health and daily dietary satisfaction could be important for preventing depression in Chinese older adults, and especially for the relatively fitter older groups with lower body mass index.

Clinical insomnia among elderly primary care attenders in Wuhan, China: A multicenter cross-sectional epidemiological study

Background and objectives

Integrating sleep health into primary care is a promising approach to narrow the treatment gap for insomnia in older adults but data regarding the epidemiological characteristics of insomnia among elderly primary care attenders (EPCAs) are very limited. This study examined the prevalence and correlates of clinical insomnia among Chinese EPCAs.

Methods

By using two-stage consecutive sampling method, a total of 757 EPCAs were recruited from seven urban and six rural primary care centers in Wuhan, China. The Insomnia Severity Index (ISI) and the Geriatric Depression Scale (15 item version) were administered to assess insomnia severity and depressive symptoms, respectively.

Results

The two-week prevalence of clinical insomnia (ISI score ≥ 15) was 28.9%. Significant correlates of clinical insomnia were: female sex (vs. male, OR = 2.13, P < 0.001), fair and poor family relationship (vs. good, OR = 1.59, P = 0.028), hypertension (OR = 1.67, P = 0.004), heart disease (OR = 1.73, P = 0.048), arthritis (OR = 2.72, P = 0.001), and depressive symptoms (OR = 4.53, P < 0.001).

Conclusion

The high prevalence of clinical insomnia among Chinese EPCAs suggests a high level of sleep health need in older patients in China's primary care settings. Considering the many negative outcomes associated with insomnia, it is necessary to integrate sleep health into primary care in China.

Training needs and curriculum of continuing medical education among general practitioners in Tibet, China: A cross-sectional survey

Background

Uneven distribution of health resources is higher in Tibet than in other regions. The development of core professional capability for general practitioners (GPs) is the main goal of continuing medical education (CME) training programs.

Aim

This study aimed to explore the needs of CME for GPs and provide advice for the development of policy, practice, and CME curriculums.

Methods

We conducted a cross-sectional online survey among GPs in Tibet Autonomous Region, China. We designed an online questionnaire including the demographic section, training contents, and training formats about CME.

Results

A total of 108 questionnaires were included in this study. Notably, 79 (73.15%) were women and 56 participants (51.85%) were working in primary care settings. We developed a curriculum priority: first-choice, major alternatives, and secondary considerations. The topics identified as first-choice for CME were related to "cardiovascular disease" (85.19%), "respiratory disease" (81.48%), and "digestive disease" (80.56%). Major alternatives included two essential knowledge and eight clinical skill items. We rated 10 items as secondary considerations. Only 39.81% ranked mental health as an essential priority; bedside teaching (51.85%) was the first choice.

Conclusion

We presented priority areas identified in this study to focus on CME for GPs in Tibet. The 23 topics may reflect the features of general practice, which increasingly require common disease management skills, while a demand-oriented curriculum and staged training plans should be adopted. CME programs should be adapted dynamically to respond to evolving needs.

Depressive disorders in older Chinese adults with essential hypertension: A classification tree analysis

Background

Although there has been accumulating evidence on the elevated risk of depression in hypertensive patients, data regarding depressive disorders in older adults with hypertension and the interplay between factors associated with depression in this population are very limited. Disentangling the mutual influences between factors may help illuminate the pathways involved in the pathogenesis of the comorbidity of depression in hypertension. This study investigated the prevalence of depressive disorders in older Chinese adults with hypertension and examined major correlates of depressive disorders and the interactions between correlates by using classification tree analysis (CTA).

Methods

In total, 374 older adults with essential hypertension were enrolled from seven urban and six rural primary care centers in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. Family relationship and feelings of loneliness were assessed with standardized questions. A checklist was used to assess the presence of six major medical conditions: diabetes mellitus, heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, chronic gastric ulcer, and arthritis.

Results

The 1-month prevalence rate of depressive disorders was 25.7%. The CTA model identified four major correlates of depressive disorders: loneliness was the most salient, followed by arthritis, family relationship, and heart disease. There were statistically significant interactions between loneliness and arthritis, loneliness and family relationship, and arthritis and heart disease.

Conclusion

Over one out of every four older Chinese adults with hypertension suffer from depressive disorders. Collaborative multidisciplinary management services are needed to reduce the burden of depression in hypertensive older adults, which may include social work outreach services to promote family relationship, mental health services to relive loneliness, and primary care services to manage arthritis and heart disease.

Prevalence and correlates of suspected dementia in older adults receiving primary healthcare in Wuhan, China: A multicenter cross-sectional survey

Background

Integrating the management of dementia into primary healthcare is a cost-effective way to reduce the burden of dementia but the clinical epidemiology of dementia in primary healthcare settings remains unclear. This study investigated the prevalence and correlates of suspected dementia in Chinese older adults receiving primary healthcare.

Methods

In this multicenter cross-sectional survey, a total of 773 older adults (≥65 years) were consecutively recruited from seven urban and six rural primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the Brief Community Screening Instrument for Dementia (BCSI-D). Participants with suspected dementia were those who were screened positive on the BCSI-D.

Results

The prevalence of suspected dementia in older primary healthcare adults was 26.8%. Factors significantly associated with suspected dementia were female sex (OR = 1.95, P < 0.001), age-group of 75+ (OR = 1.68, P = 0.004), poor financial status (OR = 4.79, P < 0.001), rural residence (OR = 1.47, P = 0.032), no regular physical exercise (OR = 1.74, P = 0.002), and stroke and other cerebrovascular diseases (OR = 1.97, P = 0.015).

Conclusions

Chinese older adults receiving primary healthcare are at high risk of suspected dementia. Screening and intervention efforts for dementia in primary healthcare settings may be more useful to target older adults who are women, are 75 years and above, have poor economic status, are rural residents, have no exercise habit, and suffer from cerebrovascular diseases.

Anxiety symptoms in older Chinese adults in primary care settings: Prevalence and correlates

Background

Integrating mental health services into primary care is a potentially cost-effective way to decrease the treatment gap for anxiety in older adults but data on the epidemiology of anxiety symptoms in older Chinese adults in primary care settings have been very limited. This study investigated the prevalence and correlates of anxiety symptoms in Chinese older primary care patients.

Methods

A total of 753 older primary care patients (≥65 years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the short form of the Geriatric Anxiety Inventory (GAI-SF).

Results

The prevalence of anxiety symptoms (GAI-SF ≥ 3) in older primary care patients was 21.1%. Statistically significant correlates of anxiety symptoms were female sex (vs. male, OR = 1.85, P = 0.002), poor economic status (vs. good, OR = 2.31, P = 0.013), fair and poor family relationship (vs. good, OR = 1.85, P = 0.006), hypertension (OR = 2.01, P < 0.001), chronic gastric ulcer (OR = 6.82, P < 0.001), and Parkinson's disease (OR = 7.83, P = 0.031).

Conclusions

Anxiety symptoms are prevalent among older adults attending primary care clinics. Efforts for preventing or reducing anxiety symptoms in older primary care patients may be more useful to target those who are women, have poor financial status, don't have a good family relationship, suffer from hypertension, have chronic gastric ulcer, and suffer from Parkinson's disease.

Effectiveness of integrated care for older adults with depression and hypertension in rural China: A cluster randomized controlled trial

BACKGROUND

Effectiveness of integrated care management for common, comorbid physical and mental disorders has been insufficiently examined in low- and middle-income countries (LMICs). We tested hypotheses that older adults treated in rural Chinese primary care clinics with integrated care management of comorbid depression and hypertension (HTN) would show greater improvements in depression symptom severity and HTN control than those who received usual care.

METHODS AND FINDINGS

The study, registered with ClinicalTrials.gov as Identifier NCT01938963, was a cluster randomized controlled trial with 12-month follow-up conducted from January 1, 2014 through September 30, 2018, with analyses conducted in 2020 to 2021. Participants were residents of 218 rural villages located in 10 randomly selected townships of Zhejiang Province, China. Each village hosts 1 primary care clinic that serves all residents. Ten townships, each containing approximately 20 villages, were randomly selected to deliver either the Chinese Older Adult Collaborations in Health (COACH) intervention or enhanced care-as-usual (eCAU) to eligible village clinic patients. The COACH intervention consisted of algorithm-driven treatment of depression and HTN by village primary care doctors supported by village lay workers with telephone consultation from centrally located psychiatrists. Participants included clinic patients aged ≥60 years with a diagnosis of HTN and clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10). Of 2,899 eligible village residents, 2,365 (82%) agreed to participate. They had a mean age of 74.5 years, 67% were women, 55% had no schooling, 59% were married, and 20% lived alone. Observers, older adult participants, and their primary care providers (PCPs) were blinded to study hypotheses but not to group assignment. Primary outcomes were change in depression symptom severity as measured by the Hamilton Depression Rating Scale (HDRS) total score and the proportion with controlled HTN, defined as systolic blood pressure (BP) <130 mm Hg or diastolic BP <80 for participants with diabetes mellitus, coronary heart disease, or renal disease, and systolic BP <140 or diastolic BP <90 for all others. Analyses were conducted using generalized linear mixed effect models with intention to treat. Sixty-seven of 1,133 participants assigned to eCAU and 85 of 1,232 COACH participants were lost to follow-up over 12 months. Thirty-six participants died of natural causes, 22 in the COACH arm and 14 receiving eCAU. Forty COACH participants discontinued antidepressant medication due to side effects. Compared with participants who received eCAU, COACH participants showed greater reduction in depressive symptoms (Cohen's d [±SD] = -1.43 [-1.71, -1.15]; p < 0.001) and greater likelihood of achieving HTN control (odds ratio [OR] [95% CI] = 18.24 [8.40, 39.63]; p < 0.001). Limitations of the study include the inability to mask research assessors and participants to which condition a village was assigned, and lack of information about participants' adherence to recommendations for lifestyle and medication management of HTN and depression. Generalizability of the model to other regions of China or other LMICs may be limited.

CONCLUSIONS

The COACH model of integrated care management resulted in greater improvement in both depression symptom severity and HTN control among older adult residents of rural Chinese villages who had both conditions than did eCAU.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT01938963 https://clinicaltrials.gov/ct2/show/NCT01938963.

Association of blood mercury exposure with depressive symptoms in the Chinese oldest old

Depressive symptoms have a significant impact on the quality-of-life among the oldest old (aged ≥ 80 years) in the population. Current research on the association of blood mercury with depressive symptoms has mainly targeted the general population. However, it is unclear whether this association is present in the oldest old. We used data from the Healthy Aging and Biomarker Cohort Study carried out in 2017-2018, with 1154 participants aged ≥ 80 years eligible for analysis. Inductively coupled plasma mass spectrometry (ICP-MS) was employed to detect blood mercury (Hg) levels, while the CES-D10 depression scale was used to assess depressive symptoms. The association between blood mercury levels and depressive symptoms was investigated using log-binomial and Poisson regression models. We also used restricted cubic splines (RCS) to assess the linear or nonlinear association of blood mercury with depressive symptoms scores. The 1154 participants ranged in age from 80 to 120 years, while the geometric mean of blood mercury concentration was 1.01 μg/L. After adjustment for covariates, log-binomial and Poisson regression analyses revealed a statistically significant, positive association of blood mercury with depressive symptoms. In comparison to the first tertile, the adjusted relative risks of blood mercury and the presence of depressive symptoms in the second and third tertiles were 1.55 (1.20-1.99) and 1.45 (1.11-1.90), respectively. The RCS model showed a linear association between blood mercury level and depressive symptoms scores. In conclusion, among the oldest old, we demonstrated that blood mercury levels were positively associated with depressive symptoms. Further surveys, especially cohort studies and clinical trials are needed to confirm these results.

Prevalence and correlates of suicidal ideation among older adults attending primary care clinics in Wuhan, China: A multicenter cross-sectional study

Background

Primary care represents an ideal setting for screening for and managing suicidal older adults but the clinical epidemiology of suicidal ideation in Chinese older primary care patients remains unclear. This study investigated the prevalence and correlates of suicidal ideation in older Chinese adults receiving primary care.

Methods

This multicenter cross-sectional survey included a total of 769 older adults (≥65 years) from seven urban and six rural primary care clinics in Wuhan, China. The presence of depressive symptoms and suicidal ideation was assessed with the Geriatric Depression Scale and a single-item question "In the past 12 months, did you think about ending your life?," respectively.

Results

The 12-month prevalence of suicidal ideation in older primary care patients was 16.6%. Significant correlates of suicidal ideation were poor economic status (vs. good, OR = 2.80, P = 0.008), heart disease (OR = 2.48, P = 0.005), chronic gastric ulcer (OR = 3.55, P = 0.012), arthritis (OR = 2.10, P = 0.042), and depressive symptoms (OR = 11.29, P < 0.001).

Conclusions

Suicidal ideation is common among older adults attending Chinese primary care clinics. It is necessary to integrate psychological crisis intervention into primary care to prevent late-life suicide.

Associations of Smoking and Alcohol Consumption with Loneliness, Depression, and Loss of Interest Among Chinese Older Males and Females

As China experiences a rapidly aging population, the prevalence of Chinese older adults suffering from mental health issues also increases. Because cigarette smoking and alcohol consumption are two major public health concerns in China, we examined smoking and alcohol consumption status with loneliness, depression, and loss of interest among Chinese older adults. Panel data were extracted from the Chinese Longitudinal Healthy Longevity Survey, and older adults were selected as the final study sample (age ≥ 65) from two different time points (the 2011-2012 and 2014 waves). We analyzed Chinese older men and women with the adoption of panel logistic regression models to study mental health measurements of loneliness, depression, and loss of interest. Among males, compared with non-alcohol users, former alcohol users had higher odds of reporting depression (adjusted odds ratio [AOR] = 1.39, 95% CI: 1.01, 1.91; p < 0.05), while current alcohol users did not. Current and former smoking statuses were positively associated with depression (all p < 0.05). However, only current smoking status was positively associated with loss of interest (p < 0.05). Among females, former alcohol consumption was positively associated with loneliness, and current alcohol consumption was positively associated with depression. Health practitioners should evaluate the roles of smoking and alcohol consumption on Chinese older adults' mental health measurements in the long term.

Predictors of Depression Level among Community-Dwelling Elderly Persons

Elderly people in the community have difficulty taking care of themselves because of their inability to care for themselves in daily life as well as their poor social support system, which leads to loneliness, resulting in depression. The primary objective was to investigate the level of depression and related factors among community-dwelling elderly persons (CDEP). This was a cross-sectional study, and 150 participants were interviewed. The questionnaires included demographics, the Functional Independence Measure, the Interpersonal Support Evaluation List, the UCLA Loneliness Scale, and the Geriatric Depression Scale Short Form. It was found that participants with different levels of depression accounted for 26%, and education level, living status, chronic disease, daily life function, social support, and loneliness were all significant factors influencing the depression level among the CDEP that could significantly predict 63.4% of the variation in depression level. Nursing staff must understand the level of depression and its influencing factors, encourage the elderly in the community to increase social networks, and integrate leisure into their lives, thereby enhancing the sense of value and meaning of life and reducing feelings of loneliness and depression.

Prevalence and Unmet Need for Mental Healthcare of Major Depressive Disorder in Community-Dwelling Chinese People Living With Vision Disability

Objective

Mental health services have been recognized as an essential part of the comprehensive eye care services, but data regarding the mental health of people living with vision disability (PLwVD) remain very limited. This study examined the epidemiology of major depressive disorder (MDD) among Chinese PLwVD, as well as their perceived needs for and utilization of mental health services.

Methods

By using stratified cluster sampling method, a total of 1,753 PLwVD were successfully recruited from 73 urban communities and 169 rural villages in Wuhan, China, and interviewed with the Mini-international Neuropsychiatric Interview 5.0. Standardized questions were used to measure perceived mental healthcare needs and use of mental health services of PLwVD with MDD.

Results

The one-month prevalence of MDD was 24.4%. Among the PLwVD with MDD, 26.0% perceived needs for mental healthcare and only 1.2% sought treatment from mental health specialists for their emotional problems. Factors associated with MDD were middle age [vs. young adulthood, odds ratio (OR) = 1.96, P < 0.001], older adulthood (vs. young adulthood, OR = 1.79, P = 0.004), being never-married (vs. married, remarried, and cohabiting, OR = 1.96, P < 0.001), being separated, divorced, and widowed (vs. married, remarried, and cohabiting, OR = 12.30, P < 0.001), a low level of objective social support (vs. high, OR = 1.83, P < 0.001), currently drinking (OR = 1.81, P < 0.001), having childhood-onset eye conditions (OR = 1.89, P = 0.005), and having difficulties in performing daily activities (OR = 2.78, P < 0.001).

Conclusions

Chinese PLwVD are at high risk for MDD and have a high level of unmet need for mental healthcare. Public strategies are warranted to improve the mental health literacy of PLwVD and make the mental health services available, accessible, and affordable for PLwVD.

Depression Is Associated With Myocardial Infarction Within a 2-Year Period Among Adults in China

We examined whether baseline depression is associated with myocardial infarction (MI) within a 2-year period among middle-age and older adults in China and whether the association varies by sociodemographic characteristics. Two-year longitudinal data from a nationally representative sample of people aged 45+ years in China were analyzed (N = 15 226). MI within the 2-year period was coded dichotomously. Baseline depression, assessed by the 10-item Center for Epidemiological Studies Depression scale, was used as a dichotomous and a continuous variable. After adjusting for medical conditions, lifestyle, and sociodemographic characteristics, the odds of having an MI within the 2-year period were 46% greater for respondents with clinically significant depression at baseline than those without. There was a dose-response relationship between symptom severity and the probability of having an MI. The association did not vary by sociodemographic characteristics. Findings suggest that depression screening and treatment may reduce MI cases in China and beyond.

The Incidence and Burden of Risk Factors for Mild Cognitive Impairment in Older Rural Chinese Persons

Objective: The study investigated the prevalence of mild cognitive impairment (MCI), a common cognitive disorder in late life, among rural older residents in China. The associated risk factors were also analyzed. Methods: Two thousand one hundred forty-six older adults aged 60 or more in a rural town of Zhejiang Province, China, were recruited and analyzed. Demographic characteristics were collected by a self-designed questionnaire. Diagnosis of MCI was made by well-trained primary care physicians according to the Petersen criteria. Results: 23.16% of the analyzed sample were diagnosed with MCI, while the prevalence was significantly higher in women, those never married, not employed, and with older age, lower education, diabetes, coronary heart disease and stroke. Stepwise logistic regression indicated that age, education, diabetes, coronary heart disease, and stroke were significant predictive factors of MCI. Conclusion: The prevalence of MCI in rural older residents in China is high, and those with specific demographic characteristics like women, never married, not employed, and with older age, lower education and chronic physical conditions should be more concerned in primary care management. Integrated care approaches managing MCI and comorbid chronic conditions are recommended in future management practices.

Sense of Alienation and Its Associations With Depressive Symptoms and Poor Sleep Quality in Older Adults Who Experienced the Lockdown in Wuhan, China, During the COVID-19 Pandemic

OBJECTIVE

To examine the epidemiology of sense of alienation (SoA) and its associations with depressive symptoms and poor sleep quality (PSQ) in Chinese older adults who experienced lockdown during the COVID-19 pandemic.

BACKGROUND

There is a dearth of data on SoA in older adults during the COVID-19 pandemic.

METHODS

Altogether, 543 community-dwelling older adults (50+ years) were recruited via the three-tier mental health network in Wuhan, China, and completed an online questionnaire in April 2020, the first month after the reopening of Wuhan. SoA, depressive symptoms, and sleep quality were measured by using the General Social Alienation Scale, Depression Anxiety and Stress Scale, and a single standardized question, respectively.

RESULTS

The prevalence of SoA was 52.3% (95% confidence interval: 48.1-56.5%). Factors associated with higher levels of SoA were religious belief (β = 1.960, P = .024), monthly family income<4000 RMB (β = 1.405, P = .022), unemployment (β = 1.217, P = .039), fair or poor physical health (β = 2.202, P = .002), never and sometimes receiving community support (β = 2.297, P < .001 and β = 3.417, P < .001), perceiving a low possibility of a cure for COVID-19 (β = 2.379, P < .001), and affirmative and unsure fear of COVID-19 patients (β = 2.025, P = .007 and β = 1.101, P = .027). After adjusting for sociodemographic and pandemic-related variables, a one-SD increment in the SoA score was significantly associated with depressive symptoms (Odd Ratio [OR] = 5.59, P < .001) and poor sleep quality (Odd Ratio = 2.00, P < .001).

CONCLUSION

Over half of the older adults who experienced lockdown felt alienated, and SoA was independently associated with their depressive symptoms and PSQ. Efforts are warranted to address SoA in older adults who experienced lockdown during the pandemic.

Comorbid anxiety and depression, depression, and anxiety in comparison in multi-ethnic community of west China: prevalence, metabolic profile, and related factors

OBJECTIVES

To identify the prevalence, lifestyle factors, chronic disease status, and assessing the metabolic profile, comparing key differences in a cohort of subjects aged at least 50 years old among depression combined anxiety, depression and anxiety in a multi-ethnic population in west China.

METHODS

A large multi-ethnic sample of 6838 participants aged 50 years old (mean age 62.4 ± 8.3 years) from West China Health and Aging Trend (WCHAT) study was analyzed. We categorized all participants into four groups: (a) comorbid anxiety and depression symptomology (CAD), (b) anxiety only, (c) depression only, or (d) neither depression nor anxiety. Different variables like anthropometry measures, life styles, chronic disease and blood test were collected. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). GDS-15 scores ≥5 indicate depression. Anxiety status was assessed using Generalized Anxiety Disorder (GAD-7) instrument and the scores ≥5 was considered as having anxiety. Different variables like anthropometry measures, life styles, cognitive function and chronic disease comorbidities were collected and serum parameters were tested. Multivariable logistic regression adjusted for age, sex, and ethnicity was done to compare between those with the mental outcomes and without.

RESULTS

The proportions of CAD, anxiety and depression were 9.0%, 12.8% and 10.6% respectively with ethnic diversity. The 'comorbid' group shown greater frequency of being female, having a lower educational level, higher prevalence of being single/divorced/widowed, drinking alcohol and smoking, more chronic disease profile and cognitive decline compared with individuals with only one disorder. And the metabolic profile showed differences in albumin, total protein, creatinine, uric acid, thyroid hormones in comparing CAD symptomology and the 'neither symptomology'.

CONCLUSIONS

Yi, Qiang and Uyghur ethnic groups have a higher prevalence of mental disease compared with Han in west China. And these mental disease had a distinct risk factor profile in age, sex, educational level, chronic disease and cognitive function. Vitamin D levels were lower among those with mental disease compared to those without.

The Protective Effect of Caring for Grandchildren on the Mental Health of the Elderly: A Structural Equation Modeling Analysis

Population aging has become a common problem all over the world, and the process of China’s population aging is developing rapidly. China has made active aging a national development strategy, giving full attention to the physical and mental health of the elderly. Bloodline and family continuity make the Chinese elderly attach great importance to the responsibility of caring for grandchildren. This study takes the elderly as the research center, and aims to investigate the relationship between caring for grandchildren and the mental health of the elderly in China, and whether participation in social activities mediates such an association. Adopting the data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a Chi-squared test and multiple regression results showed that caring for grandchildren significantly improved the mental health level of the elderly in China, and the results were still valid after the use of the Propensity Score Matching (PSM) to solve the endogenous problems. Analysis of the mediating effects using the Structural Equation Model (SEM) showed that caring for grandchildren indirectly contributed to the reduction of depression by increasing the diversity and frequency of participation in social activities. The constant adjustment of China’s fertility policy increases the possibility of the elderly caring for multiple grandchildren, and prolongs their time of caring for grandchildren. The elderly caring for grandchildren is a proactive choice, which continuously relieves the child-rearing stress, and highlights the family value and social value of the elderly. At the same time, raising and accompanying grandchildren makes the elderly’s lives more fulfilling and positive, which in turn promotes participation in social activities, and the mental health of the elderly.

Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = -.750, 95% CI = -.834 to -.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

The prevalence of depressive symptoms and associated factors in middle-aged and elderly Chinese people

BACKGROUND

This study aimed to evaluate the prevalence of depressive symptoms and associated factors in middle-aged and elderly people in China.

METHODS

Data were obtained from the China Family Panel Studies (CFPS) 2018. We selected 16,767 respondents over the age of 45 as samples for research and analysis. A short version of the Center for Epidemiological Research Depression Scale (CES-D) was used to assess depressive symptoms. Chi-square test and multiple logistic regression analysis were used to explore the related factors of depressive symptoms. Back Propagation neural network model was established to examine the ranking of influencing factors of depressive symptoms.

RESULTS

There was 24.1% prevalence of depressive symptoms among the respondents. The 14 important variables affecting depressive symptoms were screened out with the multivariable logistic regression. Based on the BP neural network to rank the degree of importance, the top five important variables were determined, which were subjective well-being (100.0%), self-reported health (92.0%), life satisfaction (83.4%), ADL disability (74.0%), and marital status (69.7%).

LIMITATIONS

This study was a cross-sectional study, and causality cannot be determined.

CONCLUSIONS

The prevalence of depressive symptoms in middle-aged and elderly Chinese people was high. Subjective quality of life evaluation, health condition and marital status were important factors that have an impact on depressive symptoms.

Prevalence of depressive symptoms and its related factors among China's older adults in 2016

BACKGROUND

Depression seriously threatens Chinese elderly. This study analysis the prevalence of depressive symptoms (DS) and its related factors among China's aging population.

METHODS

All participants were from the PINDEC project. Multi-stage clustered sampling was conducted. A total of 20,019 participants aged 60 or above completed the DS screening in 2016, and among them, 19,420 were taken into analysis. Univariate and multivariate logistic regression analysis were performed to explore the related factors of DS.

RESULTS

Of the 19,420 adults, 9,444 were male (48.63%) and 9,976 were female (51.37%). The prevalence of DS was 15.94%. The risk factors of DS were: female gender (OR=1.198, 1.097-1.308), daily alcohol consumption (OR=1.480, 1.284-1.705), disturbed sleep (OR=1.864, 1.716-2.024), chronic diseases (OR=1.214, 1.181-1.249), greater age (OR=1.012, 1.077-1.018), impaired cognition (OR=2.567,2.202-2.993), poor ADL performance (OR=1.545, 1.380-1.729), and insufficient social communication (OR=1.241, 1.134-1.358). Protective factors of DS included: higher education level, greater BMI (OR=0.986, 0.975-0.997), living in urban areas (OR=0.677, 0.611-0.749), and leisure activities such as playing cards or mahjong (OR=0.816, 0.730-0.912). For the DS risk factors, multiplicative interaction was found between cognition and ADL performance, in addition to cognition and social communication.

LIMITATIONS

Causality cannot be drawn from this cross-sectional survey. And the elderly who were looked after by nannies or living in nursing homes were not taken into analysis.

CONCLUSIONS

DS is prevalent among older adults in China. It is recommended that periodic screening for DS should be conducted for elderly individuals. Furthermore, it is suggested that the elderly adopt healthy lifestyles to prevent DS.

Investigation of the mental health status of frontier-line and non-frontier-line medical staff during a stress period

The Coronavirus Disease 2019 (COVID-19) epidemic has become a global public health event. Medical staff around the world are nervously responding to the crisis, and their mental health problems deserve attention. To better know the differences in the mental health status between frontier-line and non-frontier-line medical staff. This study used the Child PTSD Symptom Scale, the Self-Rating Depression Scale, the Self-Rating Anxiety Scale and the Connor-Davidson Resilience Scale to examine the PTSD, depression, anxiety and resilience among 162 frontier-line medical workers and 163 non-frontier-line medical workers in China. The results showed that all negative factor scores of non-frontier-line medical staff seemed to be worse than those of frontier-line medical staff, and the positive factor scores were the opposite through descriptive analysis, independent sample t-test and Chi-square test. Some psychological effects and theories were used to explain this phenomenon. Intervention suggestions for medical staff and future research directions were discussed.

Reliability and Validity of the Quick Inventory of Depressive Symptomatology-Self-Report Scale in Older Adults With Depressive Symptoms

Background: Depressive symptoms are common in older adults. Developing rapid self-report tools is essential to measure the presence and severity of depressive symptoms in older adults. This study evaluated the psychometric properties of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) scale for use in depressed older adults. Methods: A total of 238 depressed older adults were included in the study. The Montgomery-Asberg Depression Rating Scale (MADRS) and the QIDS-SR were administered to assess the severity of depressive symptoms. Cronbach's alpha coefficient, Spearman rank correlations, and principal component analysis were performed to estimate the internal consistency, convergent validity, and factorial structure of the QIDS-SR, respectively. Results: The Cronbach's alpha for the QIDS-SR was acceptable (α = 0.64). Item-total correlation analyses showed that the items of concentration/decision-making, involvement, energy level, and agitation/retardation had high correlation with the QIDS-SR total score (all correlation coefficients ≥0.60). The QIDS-SR total score was significantly correlated with the MADRS total score (r = 0.53, p < 0.001), demonstrating acceptable convergent validity. Factor analysis revealed the unidimensional structure of the QIDS-SR. Conclusions: The QIDS-SR appears to be a reliable and valid self-report scale for estimating the severity of depressive symptoms in depressed older adults.

Mental health problems, needs, and service use among people living within and outside Wuhan during the COVID-19 epidemic in China

BACKGROUND

Crisis mental health services for the general population are an essential component in combating the COVID-19 epidemic. To facilitate planning of mental health services, empirical data on mental health problems and service utilization of populations affected by the epidemic are urgently needed. This study investigated the prevalence of mental health problems of residents within and outside Wuhan, China, as well as their patterns of mental health service utilization.

METHODS

From January 27 to February 2, 2020, an online cross-sectional survey recruited residents from 4 subpopulations: Wuhan residents (n=2,617), migrants from Wuhan (those who left Wuhan before lockdown, n=930), other Hubei residents (n=633), and residents of other provinces of China ("other residents", n=3,561). Participants' mental health problems and patterns of utilization of mental health services in recent days were assessed with standardized assessments.

RESULTS

Among the 4 groups, Wuhan residents had the highest rate of any type of mental health problem (i.e., psychological distress: 41.9%), followed by migrants from Wuhan (34.2%), other Hubei residents (24.8%), and other residents (21.1%). Rates of perceived mental health needs and utilization of mental health services during recent days were 10.2% and 1.9% for Wuhan residents, 8.4% and 1.8% for migrants from Wuhan, 6.2% and 1.1% for other Hubei residents, and 6.4% and 1.0% for other residents, respectively. Overall, 63.0% mental health service users received services via internet and telephone, and 83.1% participants with perceived mental health needs ascribed their lack of help-seeking to barriers to accessibility and availability.

CONCLUSIONS

The COVID-19 epidemic is associated with unprecedented levels of mental health problems and needs in affected residents. To address the unmet mental health needs, internet- and telephone-based mental health services should be widely provided to residents, especially those in the worst-affected regions.

Association between social capital and depression among older people: evidence from Anhui Province, China

BACKGROUND

To examine the relationship between social capital and depression among community-dwelling older adults in Anhui Province, China.

METHODS

A cross-sectional study was conducted among older people selected from three cities of Anhui Province, China using a multi-stage stratified cluster random sampling method. Data were collected through questionnaire interviews and information on demographic characteristics, social capital, and depression was collected. The generalized linear model and classification and regression tree model were employed to assess the association between social capital and depression.

RESULTS

Totally, 1810 older people aged ≥60 years were included in the final analysis. Overall, all of the social capital dimensions were positively associated with depression: social participation (coefficient: 0.35, 95% CI: 0.22-0.48), social support (coefficient:0.18, 95% CI:0.07-0.28), social connection (coefficient: 0.76, 95% CI:0.53-1.00), trust (coefficient:0.62, 95% CI:0.33-0.92), cohesion (coefficient:0.31, 95% CI:0.17-0.44) and reciprocity (coefficient:0.30, 95% CI:0.11-0.48), which suggested that older people with higher social capital had a smaller chance to develop depression. A complex joint effect of certain social capital dimensions on depression was also observed. The association with depression and the combinative effect of social capital varied among older adults across the cities.

CONCLUSIONS

Our study suggests that improving social capital could aid in the prevention of depression among older adults.