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Roy JC, Hédouin R, Desmidt T, Dam S, Mirea-Grivel I, Weyl L, Bannier E, Barantin L, Drapier D, Batail JM, David R, Coloigner J, Robert GH. Quantifying Apathy in Late-Life Depression: Unraveling Neurobehavioral Links Through Daily Activity Patterns and Brain Connectivity Analysis. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:639-649. [PMID: 38615911 DOI: 10.1016/j.bpsc.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Better understanding apathy in late-life depression would help improve prediction of poor prognosis of diseases such as dementia. Actimetry provides an objective and ecological measure of apathy from patients' daily motor activity. We aimed to determine whether patterns of motor activity were associated with apathy and brain connectivity in networks that underlie goal-directed behaviors. METHODS Resting-state functional magnetic resonance imaging and diffusion magnetic resonance imaging were collected from 38 nondemented participants with late-life depression. Apathy was evaluated using the diagnostic criteria for apathy, Apathy Evaluation Scale, and Apathy Motivation Index. Functional principal components (fPCs) of motor activity were derived from actimetry recordings taken for 72 hours. Associations between fPCs and apathy were estimated by linear regression. Subnetworks whose connectivity was significantly associated with fPCs were identified via threshold-free network-based statistics. The relationship between apathy and microstructure metrics was estimated along fibers by diffusion tensor imaging and a multicompartment model called neurite orientation dispersion and density imaging via tractometry. RESULTS We found 2 fPCs associated with apathy: mean diurnal activity, negatively associated with Apathy Evaluation Scale scores, and an early chronotype, negatively associated with Apathy Motivation Index scores. Mean diurnal activity was associated with increased connectivity in the default mode, cingulo-opercular, and frontoparietal networks, while chronotype was associated with a more heterogeneous connectivity pattern in the same networks. We did not find significant associations between microstructural metrics and fPCs. CONCLUSIONS Our findings suggest that mean diurnal activity and chronotype could provide indirect ambulatory measures of apathy in late-life depression, associated with modified functional connectivity of brain networks that underlie goal-directed behaviors.
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Affiliation(s)
- Jean-Charles Roy
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France; Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Institut National de la Santé et de la Recherche Médicale (INSERM), Rennes, France; Université de Rennes, Inria, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France.
| | - Renaud Hédouin
- Université de Rennes, Inria, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France
| | - Thomas Desmidt
- CHU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; Centre d'Investigation Clinique 1415, CHU de Tours, INSERM, Tours, France
| | - Sébastien Dam
- Université de Rennes, Inria, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France
| | - Iris Mirea-Grivel
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France
| | - Louise Weyl
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France
| | - Elise Bannier
- Université de Rennes, Inria, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France; CHU de Rennes, Service de Radiologie, Rennes, France
| | - Laurent Barantin
- CHU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
| | - Dominique Drapier
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France; Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Institut National de la Santé et de la Recherche Médicale (INSERM), Rennes, France; Faculté de Médecine, Rennes Université, Rennes, France
| | - Jean-Marie Batail
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France; Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Institut National de la Santé et de la Recherche Médicale (INSERM), Rennes, France; Faculté de Médecine, Rennes Université, Rennes, France
| | - Renaud David
- CHU de Nice, Université Côte d'Azur, Nice, France
| | - Julie Coloigner
- Université de Rennes, Inria, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France
| | - Gabriel H Robert
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Rennes, France; Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Institut National de la Santé et de la Recherche Médicale (INSERM), Rennes, France; Université de Rennes, Inria, Centre National de la Recherche Scientifique, IRISA, INSERM, Empenn U1228 ERL, Rennes, France; Faculté de Médecine, Rennes Université, Rennes, France
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Wang S, Rossheim ME, Nandy RR, Nguyen US. Interaction between sleep duration and trouble sleeping on depressive symptoms among U.S. adults, NHANES 2015-2018. J Affect Disord 2024; 351:285-292. [PMID: 38302062 DOI: 10.1016/j.jad.2024.01.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study aims to examine the associations and interaction effects of sleep duration and trouble sleeping on depressive symptoms among U.S. adults. METHODS National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018 were analyzed (N = 10,044). Trouble sleeping and sleep duration were self-reported. Sleep duration was defined as short (≤6 h) or long (≥9 h), compared with normal (>6 and < 9 h). Depressive symptoms were determined by the Patient Health Questionnaire-9 score ≥ 10. Both multiplicative interaction and additive interaction were reported. RESULTS There was a significant positive additive interaction between short sleep duration and trouble sleeping on depressive symptoms in the fully adjusted model (Relative excess risk due to interaction, RERIOR = 4.42, 95 % CI: 1.12, 7.73), with 43 % of the association with depressive symptoms attributed to the interaction (attributable proportion of interaction, AP = 0.43, 95 % CI: 0.22, 0.64). Similarly, a significant positive additive interaction between long sleep duration and trouble sleeping on depressive symptoms was found (RERIOR = 4.17, 95 % CI: 0.96, 7.38), with 41 % of the association with depressive symptoms attributed to the interaction (AP = 0.41, 95 % CI: 0.21, 0.60). No multiplicative interaction was detected between short or long sleep duration and trouble sleeping. LIMITATIONS The cross-sectional design limits the ability to draw causal inferences. CONCLUSIONS Findings suggest that different aspects of sleep health interact synergistically, accounting for a substantial portion of the association with depressive symptoms. This underscores the importance of simultaneously considering multiple dimensions of sleep health in relation to depressive symptoms.
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Affiliation(s)
- Shanshan Wang
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Matthew E Rossheim
- Department of Health Administration & Health Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rajesh R Nandy
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Uyen-Sa Nguyen
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Janssen NP, Hendriks GJ, Sens R, Lucassen P, Oude Voshaar RC, Ekers D, van Marwijk H, Spijker J, Bosmans JE. Cost-effectiveness of behavioral activation compared to treatment as usual for depressed older adults in primary care: A cluster randomized controlled trial. J Affect Disord 2024; 350:665-672. [PMID: 38244792 DOI: 10.1016/j.jad.2024.01.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Depression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown. METHODS An economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥ 10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios. RESULTS Societal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95 % CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95 % CI -0.015 to 0.19), and QALYs (MD 0.026, 95 % CI -0.0037 to 0.055). On average, BA was dominant over TAU (i.e., more effective and less expensive), although the probability of dominance was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs. DISCUSSION Although the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands.
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Renate Sens
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, Department of Psychiatry, University Medical Centre Groningen, 9713 GZ Groningen, the Netherlands
| | - David Ekers
- Mental Health and Addictions Research Group, Tees Esk and Wear Valleys NHS FT/University of York, TS60SZ York, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, BN1 9PH Brighton, United Kingdom
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, VU University, 1081 HV Amsterdam, the Netherlands
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Elefante C, Brancati GE, Pistolesi G, Amadori S, Torrigiani S, Baldacci F, Ceravolo R, Ismail Z, Lattanzi L, Perugi G. The impact of mild behavioral impairment on the prognosis of geriatric depression: preliminary results. Int Clin Psychopharmacol 2023:00004850-990000000-00105. [PMID: 37966156 DOI: 10.1097/yic.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Our study aimed to examine how the presence of Mild Behavioral Impairment (MBI) symptoms influenced the outcome of late-life depression (LLD). Twenty-nine elderly (≥ 60 years) depressive patients, including eleven (37.9%) with MBI, were recruited and followed-up on average for 33.41 ± 8.24 weeks. Psychiatric symptoms severity and global functioning were assessed, respectively, using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) scale. BPRS total score significantly decreased from baseline to follow-up (P < 0.001, d = 1.33). The presence of MBI had no significant effect on mood and cognitive symptoms improvement. On the contrary, while a significant increase in GAF score was observed in patients without MBI (P = 0.001, d = 1.01), no significant improvement of global functioning was detected in those with MBI (P = 0.154, d = 0.34) after 6-month follow-up. The presence of MBI in patients with LLD may negatively affect long-term outcome, slowing or preventing functional improvement.
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Affiliation(s)
- Camilla Elefante
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | | | - Gabriele Pistolesi
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | - Salvatore Amadori
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | - Samuele Torrigiani
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
| | - Filippo Baldacci
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology and Laboratory Medicine, Hotchkiss Brain Institute & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- College of Health and Medicine, University of Exeter, Exeter, UK
| | | | - Giulio Perugi
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa
- G. De Lisio Institute of Behavioral Sciences, Pisa, Italy
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A'Azman S, Sung P, Malhotra R. Engagement in Physical Activity and Quality of Life Among Informal Caregivers of Older Adults. J Aging Health 2023:8982643231209086. [PMID: 37936406 DOI: 10.1177/08982643231209086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVES This study examined (1) the association of caregiver engagement in physical activity (PA) with their quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between several caregiving stressors and their QoL, among informal caregivers of older adults. METHODS Multivariable regression was applied to data from 278 adult caregivers, aged 23-90 years, in Singapore. RESULTS Engagement in PA by caregivers was positively associated with psychological, social relationships, and environment domains of their QoL. Caregiver engagement in PA also mitigated the negative association between care-recipient mood impairment and QoL of caregivers in the physical health and social relationships domains. DISCUSSION QoL of caregivers may be improved or protected by their regular engagement in PA, especially when their care-recipients have mood impairment. Policymakers and practitioners should encourage caregivers to engage in PA and provide them with the necessary support to do so.
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Affiliation(s)
| | - Pildoo Sung
- Department of Sociology, Hong Kong Baptist University, Hong Kong
| | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Solomonov N. Improving social reward responsivity and social connectedness in psychotherapies for late-life depression: Engage & Connect as an example. Psychiatry Res 2023; 329:115469. [PMID: 37783093 PMCID: PMC10841452 DOI: 10.1016/j.psychres.2023.115469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Abstract
Psychotherapies are effective in reducing late-life depression. Yet, about half of patients remain depressed at treatment end. Advances in neuroscience can inform simplified interventions that target key brain networks impacted by depression. Behavioral activation therapies that increase social connectedness may improve social reward responsivity and alter abnormalities of the Positive Valence System (PVS). Engage & Connect is an example for a scalable and simple neuroscience-informed psychotherapy, aimed to improve PVS functions and social reward responsivity by increasing engagement in rewarding social activities. Interventions that improve social reward responsivity can be promising first-line treatments for late-life depression in the community.
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Affiliation(s)
- Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA.
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7
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Steinman L, Xing J, Court B, Coe NB, Yip A, Hill C, Rector B, Baquero B, Weiner BJ, Snowden M. Can a Home-Based Collaborative Care Model Reduce Health Services Utilization for Older Medicaid Beneficiaries Living with Depression and Co-occurring Chronic Conditions? A Quasi-experimental Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:712-724. [PMID: 37233831 DOI: 10.1007/s10488-023-01271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
Depression remains a major public health issue for older adults, increasing risk of costly health services utilization. While home-based collaborative care models (CCM) like PEARLS have been shown to effectively treat depression in low-income older adults living with multiple chronic conditions, their economic impact is unclear. We conducted a quasi-experimental study to estimate PEARLS effect on health service utilization among low-income older adults. Our secondary data analysis merged de-identified PEARLS program data (N = 1106), home and community-based services (HCBS) administrative data (N = 16,096), and Medicaid claims and encounters data (N = 164) from 2011 to 2016 in Washington State. We used nearest neighbor propensity matching to create a comparison group of social service recipients similar to PEARLS participants on key determinants of utilization guided by Andersen's Model. Primary outcomes were inpatient hospitalizations, emergency room (ER) visits, and nursing home days; secondary outcomes were long-term supports and services (LTSS), mortality, depression and health. We used an event study difference-in-difference (DID) approach to compare outcomes. Our final dataset included 164 older adults (74% female, 39% people of color, mean PHQ-9 12.2). One-year post-enrollment, PEARLS participants had statistically significant improvements in inpatient hospitalizations (69 fewer hospitalizations per 1000 member months, p = 0.02) and 37 fewer nursing home days (p < 0.01) than comparison group participants; there were no significant improvements in ER visits. PEARLS participants also experienced lower mortality. This study shows the potential value of home-based CCM for participants, organizations and policymakers. Future research is needed to examine potential cost savings.
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Affiliation(s)
- Lesley Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
- Hans Rosling Center, University of Washington, 3980 15th Avenue NE, UW Mailbox 351621, Seattle, WA, 98195, USA.
| | - Jingping Xing
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Beverly Court
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Norma B Coe
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Andrea Yip
- Seattle-King County Aging and Disability Services, Seattle, USA
| | - Clara Hill
- Department of Human Development, Washington State University, Pullman, USA
| | - Bea Rector
- Washington State Department of Social and Health Services, Aging and Long-Term Support Administration, Lacey, USA
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, USA
| | - Mark Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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Subramanian S, Oughli HA, Gebara MA, Palanca BJA, Lenze EJ. Treatment-Resistant Late-Life Depression: A Review of Clinical Features, Neuropsychology, Neurobiology, and Treatment. Psychiatr Clin North Am 2023; 46:371-389. [PMID: 37149351 DOI: 10.1016/j.psc.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Major depression is common in older adults (≥ 60 years of age), termed late-life depression (LLD). Up to 30% of these patients will have treatment-resistant late-life depression (TRLLD), defined as depression that persists despite two adequate antidepressant trials. TRLLD is challenging for clinicians, given several etiological factors (eg, neurocognitive conditions, medical comorbidities, anxiety, and sleep disruption). Proper assessment and management is critical, as individuals with TRLLD often present in medical settings and suffer from cognitive decline and other marks of accelerated aging. This article serves as an evidence-based guide for medical practitioners who encounter TRLLD in their practice.
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Affiliation(s)
- Subha Subramanian
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Hanadi A Oughli
- Department of Psychiatry, Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ben Julian A Palanca
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine in St. Louis, St Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis; Department of Biomedical Engineering, Washington University in St. Louis, St Louis, MO, USA; Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, USA; Neuroimaging Labs Research Center, Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St Louis, MO, USA
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C H, R Rao S, K B, Yeturu SS, MP R, Krishnan M. Fingerprint patterns in neuropsychological disorder depression among south Indian population. Bioinformation 2023; 19:266-271. [PMID: 37808370 PMCID: PMC10557448 DOI: 10.6026/97320630019266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 10/10/2023] Open
Abstract
Depression is a pervasive mental health disorder characterized by persistent sadness and an inability to enjoy activities that were once enjoyable. This study compares the dermatoglyphic patterns of depressed patients with those of healthy, normal individuals in order to determine if dermatoglyphic patterns can be used as biomarkers for early diagnosis and prompt intervention of depression. A total of 100 depressive disorder patients of both sexes between the ages of 18 and 60 were selected for the study. Dermatoglyphic patterns of individual digits were analyzed using the "Ink and Paper" technique. The Whorl, Loop, and Arch patterns, as well as the AFRC, TFRC, and a-b ridge count, were examined using One-Way ANOVA significance and a Chi-Square test using SPSS 20.0. The results showed that the right hand in the depressive diseased group had decreased numbers of Whorls in the 2nd and 5th digits, and decreased numbers of Loops in all five digits. Similarly, decreased numbers of Whorls were found in the 1st, 2nd, 4th, and 5th digits of the left hand, as well as decreased Loops in the 4th digit. However, there were no changes in the Arches of either hand when compared to the control group. The AFRC and TFRC were significantly decreased (p<0.0001), but there was no significant decrease in the a-b ridge count in the depressive diseased group when compared to the control group. Dermatoglyphics, a noninvasive method, can serve as a screening indicator for depressive individuals, the appearance of the decreased count of whorls and loops parameters might be used as an exploratory sign.
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Affiliation(s)
- Hemasankar C
- Department of Physiology, Saveetha Medical College, Saveetha institute of medical and technical sciences, Thandalam, Chennai- 602 105, India
| | - Suresh R Rao
- Department of Anatomy, Faculty of Medicine, University of West Indies, Trinidad- 685509, Jamaica
| | - Balaji K
- Department of Anatomy, Saveetha Medical College, Saveetha institute of medical and technical sciences, Thandalam, Chennai- 602 105, India
| | - Sai Sushma Yeturu
- Department of Ophthalmology, Subbaiah Institute of Medical Sciences, Purle, Shivamogga, 577202, Karnataka, India
| | - Ragavendra MP
- Department of Pharmacology, Saveetha Medical College, Saveetha institute of medical and technical sciences, Thandalam, Chennai- 602 105, India
| | - Madhan Krishnan
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam- 603103, Tamilnadu, India
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Kim S, Cho S, Morgan MR. Neighborhood and Depressive Symptoms in Older Adults Living in Rural and Urban Regions in South Korea. Healthcare (Basel) 2023; 11:healthcare11040476. [PMID: 36833010 PMCID: PMC9957275 DOI: 10.3390/healthcare11040476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023] Open
Abstract
Neighborhoods have a significant impact on depressive symptoms in older adults. In response to the increasing depression of older adults in Korea, this study aims to identify the relationship between perceived and objective neighborhood characteristics in depressive symptoms and find differences between rural and urban areas. We used a National survey collected in 2020 of 10,097 Korean older adults aged 65 and older. We also utilized Korean administration data for identifying the objective neighborhood characteristics. Multilevel modeling results indicated that depressive symptoms decreased when older adults perceived their housing condition (b = -0.04, p < 0.001), their interaction with neighbors (b = -0.02, p < 0.001), and overall neighborhood environment (b = -0.02, p < 0.001) positively. Among the objective neighborhood characteristics, only nursing homes (b = 0.09, p < 0.05) were related to depressive symptoms of older adults living in urban areas. For older adults living in rural areas, the number of social workers (b = -0.03, p < 0.001), the number of senior centers (b = -0.45, p < 0.001), and nursing home (b = -3.30, p < 0.001) in the neighborhood were negatively associated with depressive symptoms. This study found that rural and urban areas have different neighborhood characteristics related to older adults' depressive symptoms in South Korea. This study encourages policymakers to consider neighborhood characteristics to improve the mental health of older adults.
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Steinman LE, Gasca A, Hoeft TJ, Raue PJ, Henderson S, Perez R, Huerta A, Fajardo A, Vredevoogd MA, James K, Hinton L, Rath L, Unutzer J. "We are the sun for our community:" Partnering with community health workers/promotores to adapt, deliver and evaluate a home-based collaborative care model to improve equity in access to quality depression care for older U.S. Latino adults who are underserved. Front Public Health 2023; 11:1079319. [PMID: 36817932 PMCID: PMC9932325 DOI: 10.3389/fpubh.2023.1079319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Background While depression is a leading cause of poor health, less than half of older adults receive adequate care. Inequities in both access and outcomes are even more pronounced for socially disadvantaged older adults. The collaborative care model (CCM) has potential to reduce this burden through community-based organizations (CBOs) who serve these populations. However, CCM has been understudied in diverse cultural and resource-constrained contexts. We evaluated the implementation and effectiveness of PEARLS, a home-based CCM adapted with and for community health workers/promotores (CHWs/Ps). Methods We used an instrumental case study design. Our case definition is a community-academic partnership to build CHW/P capacity for evidence-based depression care for older U.S. Latino adults in the Inland Empire region of California (2017-2020). We aimed to understand adaptations to fit local context; acceptability, feasibility, and fidelity; clinical effectiveness; and contextual determinants of implementation success or failure. Data sources included quantitative and qualitative administrative and evaluation data from participants and providers. We used descriptive statistics and paired t-tests to characterize care delivery and evaluate effectiveness post-intervention, and deductive thematic analysis to answer other aims. Findings This case study included 152 PEARLS participants and nine data sources (N = 67 documents). The CBO including their CHWs/Ps partnered with the external implementation team made adaptations to PEARLS content, context, and implementation strategies to support CHWs/Ps and older adults. PEARLS was acceptable, feasible and delivered with fidelity. Participants showed significant reductions in depression severity at 5 months (98% clinical response rate [mean (SD), 13.7 (3.9) drop in pre/post PHQ-9; p < 0.001] and received support for 2.6 social needs on average. PEARLS delivery was facilitated by its relative advantage, adaptability, and trialability; the team's collective efficacy, buy-in, alignment with organization mission, and ongoing reflection and evaluation during implementation. Delivery was challenged by weak partnerships with clinics for participant referral, engagement, reimbursement, and sustainability post-grant funding. Discussion This case study used existing data to learn how home-based CCM was adapted by and for CHWs/Ps to reduce health inequities in late-life depression and depression care among older Latino immigrants. The CBOs and CHWs/Ps strong trust and rapport, addressing social and health needs alongside depression care, and regular internal and external coaching and consultation, appeared to drive successful implementation and effectiveness.
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Affiliation(s)
- Lesley E. Steinman
- Department of Health Systems and Population Health, Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, United States
| | - Amelia Gasca
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Theresa J. Hoeft
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Patrick J. Raue
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Stuart Henderson
- School of Medicine Office of Research, University of California Davis, Sacramento, Sacramento, CA, United States
| | - Rosa Perez
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Alfredo Huerta
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Alex Fajardo
- El Sol Neighborhood Educational Center, San Bernardino, CA, United States
| | - Melinda A. Vredevoogd
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Katherine James
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, Sacramento, CA, United States
| | - Laura Rath
- Archstone Foundation, Long Beach, CA, United States
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
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12
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Huntsman JL, Bulaj G. Health education via "empowerment" digital marketing of consumer products and services: Promoting therapeutic benefits of self-care for depression and chronic pain. Front Public Health 2023; 10:949518. [PMID: 36703812 PMCID: PMC9871258 DOI: 10.3389/fpubh.2022.949518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
Increasing health care costs and high economic burden exemplify the impact of chronic diseases on public health. Multifaceted approaches to treating chronic diseases include pharmaceutical drugs, digital therapeutics, and lifestyle medicine. Chronic diseases are largely preventable, and health promotion yields positive outcomes. However, despite positive return on investment (ROI) and cost-to-benefit ratio (CBR) for health promotion (median ROI 2.2, median CBR 14.4), commercial marketing of healthy lifestyles and self-care is limited. The objective of this perspective article is to discuss how digital marketing of consumer goods and services that support therapeutic self-care can also bridge public health and for-profit interests. We describe how "empowerment" marketing campaigns can provide evidence-based associations between products/services and self-care benefits for people living with chronic pain and depression. Such a "health education as marketing" strategy is illustrated by educational ads describing how contact with nature, music, and yoga can improve chronic pain and reduce depressive symptoms. Creating associations between health-related benefits of these activities with products (outdoor and yoga apparel, audio equipment) and services (music streaming services, music mobile apps, eco-tourism, yoga studios) that support them expand their value proposition, thus incentivizing profit-driven companies to engage in public health campaigns. Long-term success of companies that incorporate evidence-based health education as marketing and branding strategies will depend on following ethical considerations and advertising guidelines defined by consumer protection regulatory agencies, such as the Federal Trade Commission (FTC). In conclusion, integration of health education about self-care and commercial marketing can support health care outcomes and disease prevention.
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Affiliation(s)
| | - Grzegorz Bulaj
- OMNI Self-care, LLC, Salt Lake City, UT, United States,L. S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT, United States,*Correspondence: Grzegorz Bulaj ✉
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13
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Jung S. Gender-based depression factors of older adults living alone during the COVID-19 pandemic: A cross-sectional and secondary data approach. Heliyon 2022; 8:e12148. [PMID: 36510561 PMCID: PMC9726648 DOI: 10.1016/j.heliyon.2022.e12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic negatively affected the mental health of older adults living alone. This study aimed to examine the differences in factors that influence depression among older adults based on gender. This study was a cross-sectional study employing the secondary data of 3581 older adults living alone at the early stage of COVID-19, collected from the 2020 Korea Community Health Survey, and used multiple linear regression analyses to identify factors associated with depression. We found that women had a higher level of depressive status than men. Low subjective health status was most significantly related to depression in both older men and older women. For women, body mass index and more changes in daily life due to COVID-19 were predictors of depression. Conversely, for men, a lower level of monthly income and smoking were significant predictors of depression. Depressive status caused by COVID-19 was likely to be frailer for older women who were living alone. There were differences in the factors related to depression due to COVID-19 by gender.
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14
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Bullock-Palmer RP, Bravo-Jaimes K, Mamas MA, Grines CL. Socioeconomic Factors and their Impact on Access and Use of Coronary and Structural Interventions. Eur Cardiol 2022; 17:e19. [PMID: 36643068 PMCID: PMC9820075 DOI: 10.15420/ecr.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 01/18/2023] Open
Abstract
In the past few decades, the accelerated improvement in technology has allowed the development of new and effective coronary and structural heart disease interventions. There has been inequitable patient access to these advanced therapies and significant disparities have affected patients from low socioeconomic positions. In the US, these disparities mostly affect women, black and hispanic communities who are overrepresented in low socioeconomic. Other adverse social determinants of health influenced by structural racism have also contributed to these disparities. In this article, we review the literature on disparities in access and use of coronary and structural interventions; delineate the possible reasons underlying these disparities; and highlight potential solutions at the government, healthcare system, community and individual levels.
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Affiliation(s)
| | - Katia Bravo-Jaimes
- Division of Cardiology, Department of Internal Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of CaliforniaLos Angeles, CA, US
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityKeele, UK
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Northside Cardiovascular Institute, Northside HospitalAtlanta, GA, US
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15
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Sekhon H, Lavin P, Vacaflor B, Rigas C, Cinalioglu K, Su CL, Bodenstein K, Dikaios E, Goodman A, Raymond FC, Ibrahim M, Bein M, Gruber J, Se J, Sasi N, Walsh C, Nazar R, Hanganu C, Berkani S, Royal I, Schiavetto A, Looper K, Launay C, McDonald EG, Seitz D, Kumar S, Beauchet O, Khoury B, Bouchard S, Battistini B, Fallavollita P, Miresco M, Bruneau MA, Vahia I, Bukhari S, Rej S. Isolating together during COVID-19: Results from the Telehealth Intervention Program for older adults. Front Med (Lausanne) 2022; 9:948506. [PMID: 36304184 PMCID: PMC9592737 DOI: 10.3389/fmed.2022.948506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022] Open
Abstract
Background A pressing challenge during the COVID-19 pandemic and beyond is to provide accessible and scalable mental health support to isolated older adults in the community. The Telehealth Intervention Program for Older Adults (TIP-OA) is a large-scale, volunteer-based, friendly telephone support program designed to address this unmet need. Methods A prospective cohort study of 112 TIP-OA participants aged ≥60 years old was conducted in Quebec, Canada (October 2020–June 2021). The intervention consisted of weekly friendly phone calls from trained volunteers. The primary outcome measures included changes in scores of stress, depression, anxiety, and fear surrounding COVID-19, assessed at baseline, 4 and 8-weeks. Additional subgroup analyses were performed with participants with higher baseline scores. Results The subgroup of participants with higher baseline depression scores (PHQ9 ≥10) had significant improvements in depression scores over the 8-week period measured [mean change score = −2.27 (±4.76), 95%CI (−3.719, −0.827), p = 0.003]. Similarly, participants with higher baseline anxiety scores (GAD7 ≥10) had an improvement over the same period, which, approached significance (p = 0.06). Moreover, despite peaks in the pandemic and related stressors, our study found no significant (p ≥ 0.09) increase in stress, depression, anxiety or fear of COVID-19 scores. Discussion This scalable, volunteer-based, friendly telephone intervention program was associated with decreased scores of depression and anxiety in older adults who reported higher scores at baseline (PHQ 9 ≥10 and GAD7 ≥10).
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Affiliation(s)
- Harmehr Sekhon
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada,McLean Hospital, Harvard Medical School, Boston, MA, United States,*Correspondence: Harmehr Sekhon
| | - Paola Lavin
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Blanca Vacaflor
- GeriPARTy Research Lab, Montreal, QC, Canada,Pierre-Boucher Hospital, Longueuil, QC, Canada
| | - Christina Rigas
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Karin Cinalioglu
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | | | - Katie Bodenstein
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | | | - Allana Goodman
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | | | | | - Magnus Bein
- GeriPARTy Research Lab, Montreal, QC, Canada
| | | | - Jade Se
- GeriPARTy Research Lab, Montreal, QC, Canada
| | - Neeti Sasi
- GeriPARTy Research Lab, Montreal, QC, Canada
| | - Chesley Walsh
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Rim Nazar
- GeriPARTy Research Lab, Montreal, QC, Canada
| | - Cezara Hanganu
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Sonia Berkani
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Isabelle Royal
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | | | - Karl Looper
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Cyrille Launay
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | | | - Dallas Seitz
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Sanjeev Kumar
- Geriatric Clinical Research, The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Olivier Beauchet
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Bassam Khoury
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Stephane Bouchard
- Department of Psychoeducation and Psychology, Université du Quebec en Outaouais, Gatineau, QC, Canada
| | - Bruno Battistini
- Quebec Heart and Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada
| | - Pascal Fallavollita
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Marc Miresco
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Ipsit Vahia
- McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Syeda Bukhari
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
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16
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Petkus AJ, Resnick SM, Wang X, Beavers DP, Espeland MA, Gatz M, Gruenewald T, Millstein J, Chui HC, Kaufman JD, Manson JE, Wellenius GA, Whitsel EA, Widaman K, Younan D, Chen JC. Ambient air pollution exposure and increasing depressive symptoms in older women: The mediating role of the prefrontal cortex and insula. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 823:153642. [PMID: 35122843 PMCID: PMC8983488 DOI: 10.1016/j.scitotenv.2022.153642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 04/13/2023]
Abstract
Exposures to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) have been associated with the emergence of depressive symptoms in older adulthood, although most studies used cross-sectional outcome measures. Elucidating the brain structures mediating the adverse effects can strengthen the causal role between air pollution and increasing depressive symptoms. We evaluated whether smaller volumes of brain structures implicated in late-life depression mediate associations between ambient air pollution exposure and changes in depressive symptoms. This prospective study included 764 community-dwelling older women (aged 81.6 ± 3.6 in 2008-2010) from the Women's Health Initiative Memory Study (WHIMS) Magnetic Resonance Imaging study (WHIMS-MRI; 2005-06) and WHIMS-Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO; 2008-16). Three-year average annual mean concentrations (scaled by interquartile range [IQR]) of ambient PM2.5 (in μg/m3; IQR = 3.14 μg/m3) and NO2 (in ppb; IQR = 7.80 ppb) before WHIMS-MRI were estimated at participants' addresses via spatiotemporal models. Mediators included structural brain MRI-derived grey matter volumes of the prefrontal cortex and structures of the limbic-cortical-striatal-pallidal-thalamic circuit. Depressive symptoms were assessed annually by the 15-item Geriatric Depression Scale. Structural equation models were constructed to estimate associations between exposure, structural brain volumes, and depressive symptoms. Increased exposures (by each IQR) were associated with greater annual increases in depressive symptoms (βPM2.5 = 0.022; 95% Confidence Interval (CI) = 0.003, 0.042; βNO2 = 0.019; 95% CI = 0.001, 0.037). The smaller volume of prefrontal cortex associated with exposures partially mediated the associations of increased depressive symptoms with NO2 (8%) and PM2.5 (13%), and smaller insula volume associated with NO2 contributed modestly (13%) to the subsequent increase in depressive symptoms. We demonstrate the first evidence that the smaller volumes of the prefrontal cortex and insula may mediate the subsequent increases in depressive symptoms associated with late-life exposures to NO2 and PM2.5.
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Affiliation(s)
- Andrew J Petkus
- University of Southern California, Department of Neurology, 1520 San Pablo St. Suite 3000, Los Angeles, CA 90033, United States
| | - Susan M Resnick
- National Institute on Aging, Laboratory of Behavioral Neuroscience, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224, United States
| | - Xinhui Wang
- University of Southern California, Department of Neurology, 1520 San Pablo St. Suite 3000, Los Angeles, CA 90033, United States
| | - Daniel P Beavers
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157, United States of American
| | - Mark A Espeland
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157, United States of American
| | - Margaret Gatz
- University of Southern California, Center for Economic and Social Research, 635 Downey Way, Los Angeles, CA 90089-3332, United States of America
| | - Tara Gruenewald
- Chapman University, Department of Psychology, 1 University Dr., Orange, CA 92866, United States of America
| | - Joshua Millstein
- University of Southern California, Department of Population and Public Health Sciences, 2001 North Soto Street, Los Angeles, CA 90033, United States of America
| | - Helena C Chui
- University of Southern California, Department of Neurology, 1520 San Pablo St. Suite 3000, Los Angeles, CA 90033, United States
| | - Joel D Kaufman
- University of Washington, Department of Environmental and Occupational Health Sciences, 1959 NE Pacific St., Box 257230, Seattle, WA 98105, United States of America
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, United States of America
| | - Gregory A Wellenius
- Boston University, Boston, School of Public Health, Department of Environmental Health, 715 Albany St., Boston, MA 02118, United States of America
| | - Eric A Whitsel
- University of North Carolina, Gillings School of Public Health, Department of Epidemiology, 123 W. Franklin St., Suite 410, Chapel Hill, NC 27516-8050, United States of America
| | - Keith Widaman
- University of California, Riverside, Graduate School of Education, 900 University Ave, Riverside, CA 9251, United States of America
| | - Diana Younan
- University of Southern California, Department of Population and Public Health Sciences, 2001 North Soto Street, Los Angeles, CA 90033, United States of America
| | - Jiu-Chiuan Chen
- University of Southern California, Department of Neurology, 1520 San Pablo St. Suite 3000, Los Angeles, CA 90033, United States; University of Southern California, Department of Population and Public Health Sciences, 2001 North Soto Street, Los Angeles, CA 90033, United States of America.
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17
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Short Daily-Life Walking Bouts and Poor Self-Reported Health Predict the Onset of Depression in Community-Dwelling Older People: A 2-Year Longitudinal Cohort Study. J Am Med Dir Assoc 2022; 23:1242-1247.e3. [DOI: 10.1016/j.jamda.2021.12.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/07/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022]
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18
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Ha SC, Nam E. Community welfare resources and late-life depression among older adults in Seoul: A multi-level analysis. Int J Geriatr Psychiatry 2022; 37. [PMID: 35137450 DOI: 10.1002/gps.5690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to examine whether community welfare resources in neighborhoods (recreational facilities, healthcare access, and public welfare expenditure) are associated with late-life depression among older adults in Seoul, South Korea. METHODS Data for this study were obtained by merging two different data sources: the 2018 Seoul Elderly Survey for individual-level variables and publicly available administrative data for neighborhood-level variables. The sample included 3036 older adults (unweighted n = 3034) living in 25 neighborhoods (Gu) in Seoul. Multilevel regression models examined the effects of neighborhood-level variables on late-life depression while controlling for individual-level variables. We also explored the extent to which individual characteristics moderate the main effects of neighborhood characteristics on late-life depression. RESULTS The results indicated that recreational facilities, health care centers, and public welfare expenditure in the neighborhoods were associated with late-life depression among older adults beyond individuals' predisposing conditions. Also, the effects of recreational facilities and public welfare expenditure on depressive symptoms were larger for those with higher education level. CONCLUSIONS Older adults living in neighborhoods with more recreational facilities, more health care centers, and high public welfare expenditure were less likely to experience late-life depression. Of note is that the effects of neighborhoods' recreational facilities and public welfare expenditure varied by certain individual characteristics. Hence, local governments should introduce neighborhood-based health promotion policies to prevent depression among older adults. In doing so, local governments should also consider ways to improve access to community welfare resources for underprivileged older adults.
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Affiliation(s)
- Seok Cheol Ha
- Incheon Public Agency for Social Service, Incheon Center for Aging Society, Incheon, South Korea
| | - Eunji Nam
- Department of Social Welfare, Incheon National University, Incheon, South Korea
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19
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Mwangala PN, Ssewanyana D, Mwangi P, Chongwo E, Nasambu C, Kagonya VA, Scerif G, Newton CR, Abubakar A. Correlates of health-related quality of life in primary caregivers of perinatally HIV infected and HIV exposed uninfected adolescents at the Kenyan Coast. Health Qual Life Outcomes 2022; 20:11. [PMID: 35062964 PMCID: PMC8780308 DOI: 10.1186/s12955-022-01915-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mothers and other primary caregivers play a crucial role in looking after perinatally HIV infected, and HIV exposed uninfected adolescents in sub-Saharan Africa. Day- to-day caregiving in the context of limited instrumental support and added biomedical risk (HIV seropositivity) may expose these caregivers to adverse states of health. Unfortunately, very few studies have examined their health-related quality of life (HRQoL). Our study documents the HRQoL profile, and associated factors in primary caregivers of perinatally HIV infected, perinatally HIV exposed but uninfected and HIV unexposed/uninfected adolescents aged 12-17 years at the Kenyan Coast. METHODS This was a cross-sectional analysis of 485 primary caregivers: 195 of perinatally HIV infected adolescents, 128 of perinatally HIV exposed but uninfected adolescents and 162 of HIV unexposed/uninfected adolescents. All caregivers completed a self-report measure of HRQoL (having 8 subscales), depressive symptoms, and parenting stress. They also provided their sociodemographic information and that of the care recipients. We used one-way analysis of variance to assess statistical differences among the groups. Linear regression analyses were used to identify correlates of HRQoL. RESULTS Overall, caregivers of HIV unexposed/uninfected adolescents reported significantly higher mean HRQoL scores than the other caregivers in the overall HRQoL domain and majority of the subscales. There were no statistical differences in the overall HRQoL scores and most subscales between caregivers of HIV exposed adolescents. Linear regression analyses across the sample indicated that depressive symptoms, increasing age of caregiver, and caring for an adolescent perinatally exposed to HIV were significantly associated with reduced HRQoL at both the overall and sub-scale level. Having a professional job relative to subsistence farming was the only factor associated with improved overall HRQoL. At subscale level, higher socioeconomic status correlated positively with HRQoL while being a grandparent, level of education, parenting stress were negatively associated with HRQoL. CONCLUSIONS Caregivers in this sample, especially those who are ageing, at risk of mental ill-health, and taking care of adolescents perinatally exposed to HIV, appear to be vulnerable to poor quality of life. Inclusive and multi-component interventions tailored to the caregivers' psychosocial and mental needs will potentially enhance their quality of life.
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Affiliation(s)
- Patrick N. Mwangala
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya ,grid.11951.3d0000 0004 1937 1135School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193 South Africa
| | - Derrick Ssewanyana
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya ,grid.470490.eInstitute for Human Development, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
| | - Paul Mwangi
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya
| | - Esther Chongwo
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya
| | - Carophine Nasambu
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya
| | - Vincent A. Kagonya
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya
| | - Gaia Scerif
- grid.4991.50000 0004 1936 8948Department of Experimental Psychology, University of Oxford, Anna Watts Building, Oxford, OC2 6GG UK
| | - Charles R. Newton
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Ln, Oxford, OX3 7JX UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Ln, Oxford, OX3 7JX UK ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, P.O. Box 195-80108, Kilifi, Kenya ,grid.470490.eInstitute for Human Development, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
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Estrada-Fernández ME, Gil-Lacruz M, Gil-Lacruz AI, Viñas-López A. The impact of community care: Burden and quality of life of the informal caregivers of patients with severe mental disorder. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:487-501. [PMID: 33999449 DOI: 10.1002/jcop.22594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
This study analyzes the dimensions and consequences of the burden of caregivers of patients with SMD (Severe Mental Disorder) and the repercussions that this role has on their quality of life and health in the physical, psychic and social spheres. This is a descriptive cross-sectional study and inferential observational study which explores caregivers of patients with SMD admitted to Psychiatry Day Hospital (Huesca, Spain). The technique of consecutive cases was used as a technique for sampling and sample selection. An individualized interview was arranged, where sociodemographic data were collected and scales and instruments were administered. 52 caregivers met the inclusion criteria. The female sex predominates (67%), being the patient's mother (48%). The average age of caregivers is 60 years old. Almost 60% of the sample presents intense burden and alterations of general mental health, 77% reveal anxiety and depression, and 46% little social support. Burden is associated with hospitalization within the last year, anxiety, or total social support received. It is appreciated how the diagnosis of a chronic disease constitutes an important challenge for the patient and their family, due to the burden of the disease and the impact of the new routines imposed by the continuous treatment.
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Affiliation(s)
| | - Marta Gil-Lacruz
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Ana I Gil-Lacruz
- Department of Management and Organisation, University of Zaragoza, Zaragoza, Spain
| | - Antonio Viñas-López
- Department of Traumatology and Orthopaedics Surgery Unit, San Jorge Hospital, Huesca, Spain
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21
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Vieta E, Alonso J, Pérez-Sola V, Roca M, Hernando T, Sicras-Mainar A, Sicras-Navarro A, Herrera B, Gabilondo A. Epidemiology and costs of depressive disorder in Spain: the EPICO study. Eur Neuropsychopharmacol 2021; 50:93-103. [PMID: 34058711 DOI: 10.1016/j.euroneuro.2021.04.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
Depressive Disorders are the most common psychiatric diagnoses in the general population. To estimate the frequency, costs associated with Depressive Disorders in usual clinical practice, and in the whole Spanish population, a longitudinal, retrospective, observational study was carried out using data from the BIG-PAC database®. Study population: all patients aged ≥ 18 years with a diagnosis of a Depressive Disorder in 2015-2017. Prevalence was computed as the proportion of Depressive Disorder cases in the adult general population, and the incidence rate, as the number of new Depressive Disorder cases diagnosed per 1,000 person-years in the population using health services, during 2015-2017. We collected demographic variables, comorbidity, direct health costs, and indirect costs (temporary and permanent disability). Health costs related to Depressive Disorders were estimated according to the annual resource use rate (resource/patient/year). Indirect costs were calculated according to the human capital method. Using the study data and information from the Spanish National Institute of Statistics, we estimated the cost of Depressive Disorders corresponding to the Spanish adult population, including premature mortality. 69,217 Depressive Disorder patients aged ≥ 18 years who met the inclusion/exclusion criteria were studied (mean age: 56.8 years; female: 71.4%). Prevalence of Depressive Disorders in the general population was 4.73% (95% CI: 4.70-4.76%). Annual incidence rates (2015-2017) were 7.12, 7.35 and 8.02 per 1,000 person-years, respectively. Total costs observed in our Depressive Disorder patients were € 223.9 million (corresponding to a mean of € 3,235.3; mean/patient/year), of which, 18.4% were direct health care costs and 81.6%, non-health indirect costs (18% temporary occupational disability, 63.6% permanent disability). Considering also the cost of premature death, the mean cost per patient/year was € 3,402 and the estimated societal costs of Depressive Disorders in Spain were € 6,145 million. The prevalence and incidence of Depressive Disorders are consistent with other series reviewed. Resource use and total costs (especially non-health costs) were high.
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Affiliation(s)
- Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Jordi Alonso
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), CIBERESP, Pompeu Fabra University, Barcelona, Spain
| | - Víctor Pérez-Sola
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona IMIM (Hospital del Mar Medical Research Institute), Barcelona, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Roca
- Institut Universitari d' Investigació en Ciències de la Salut, Idisba, Rediapp, University of Balearic Islands, Palma, Spain
| | | | | | | | | | - Andrea Gabilondo
- Mental Health and Psychiatric Care Research Group, Biodonostia Health Research Institute Osakidetza, San Sebastian, Spain
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22
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Saberi A, Mohammadi E, Zarei M, Eickhoff SB, Tahmasian M. Structural and functional neuroimaging of late-life depression: a coordinate-based meta-analysis. Brain Imaging Behav 2021; 16:518-531. [PMID: 34331655 DOI: 10.1007/s11682-021-00494-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Several neuroimaging studies have investigated localized aberrations in brain structure, function or connectivity in late-life depression, but the ensuing results are equivocal and often conflicting. Here, we provide a quantitative consolidation of neuroimaging in late-life depression using coordinate-based meta-analysis by searching multiple databases up to March 2020. Our search revealed 3252 unique records, among which we identified 32 eligible whole-brain neuroimaging publications comparing 674 patients with 568 controls. The peak coordinates of group comparisons between the patients and the controls were extracted and then analyzed using activation likelihood estimation method. Our sufficiently powered analysis on all the experiments, and more homogenous subsections of the data (patients > controls, controls > patients, and functional imaging experiments) revealed no significant convergent regional abnormality in late-life depression. This inconsistency might be due to clinical and biological heterogeneity of LLD, as well as experimental (e.g., choice of tasks, image modalities) and analytic flexibility (e.g., preprocessing and analytic parameters), and distributed patterns of neural abnormalities. Our findings highlight the importance of clinical/biological heterogeneity of late-life depression, in addition to the need for more reproducible research by using pre-registered and standardized protocols on more homogenous populations to identify potential consistent brain abnormalities in late-life depression.
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Affiliation(s)
- Amin Saberi
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Esmaeil Mohammadi
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany.,Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.
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Sfetcu R, Toma D, Tudose C, Vladescu C. Romanian GPs Involvement in Caring for the Mental Health Problems of the Elderly Population: A Cross-Sectional Study. Front Neurol 2021; 12:641217. [PMID: 34248814 PMCID: PMC8263930 DOI: 10.3389/fneur.2021.641217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/31/2021] [Indexed: 11/02/2022] Open
Abstract
The mental health of the elderly is a matter of increased concern in the context of an aging population since currently only a small fraction of this population is receiving adequate care. The provision of treatment in primary care by the General Practitioners (GPs) has been proposed for over a decade as a potential solution, as services offered by GPs are more accessible, less susceptible to stigma, and have a more comprehensive view of the other health care problems that the elderly might suffer from. In this study, we explored the perception of Romanian GPs regarding their practice and roles in caring for the mental health of the elderly as well as the willingness to increase their future involvement in the management of dementia and other mental health problems. Data was collected via an online questionnaire structured on four dimensions: (1) GPs' sociodemographic profile and practice characteristics, (2) GPs assessment of the services available for elderly with mental health problems, (3) GPs current involvement in mental health care for different categories of problems, and (4) factors that might influence the future involvement of GPs in providing care for elderly with mental health problems. The survey was sent via the member mailing lists of the National Society for Family Medicine. Results show that GPs are currently limited by prescribing possibilities, available resources and knowledge in the area, but they are willing to expand their role in the areas of early recognition and prevention of mental health problems as well as providing disease management and collaborative care. An improved communication with mental health care professionals, a better access to resources and having more financial incentives are the three most important categories for GPs to increase their involvement. In conclusion, increasing the access to personal and professional resources and setting up functional communication channels with specialized mental health care could motivate GPs to provide timely mental health support to elderly patients.
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Affiliation(s)
- Raluca Sfetcu
- Psychology Department, “Spiru Haret” University, Bucharest, Romania
- The Center for Health Services Assessment and Research, National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Daciana Toma
- National Society for Family Medicine, Bucharest, Romania
| | - Catalina Tudose
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Cristian Vladescu
- The Center for Health Services Assessment and Research, National School of Public Health, Management and Professional Development, Bucharest, Romania
- Public Health Department, Faculty of Medicine, “Titu Maiorescu” University, Bucharest, Romania
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Abstract
After participating in this activity, learners should be better able to:• Identify risk factors for late-life depression• Evaluate strategies to prevent late-life depression ABSTRACT: Late-life depression (LLD) is one of the major sources of morbidity and mortality in the world. Because LLD is related to increased public health burden, excess health care costs and utilization, reduced quality of life, and increased mortality, prevention is a priority. Older adults differ from younger adults with respect to key features, such as their chronicity and lifetime burden of depression and their constellation of comorbidities and risk factors. LLD likely arises from a complex interplay of risk factors, including medical, physiologic, psychosocial, behavioral, and environmental factors. Thus, a comprehensive understanding of LLD risk factors is necessary to inform prevention strategies. In this narrative literature review, we address both the risk architecture of LLD and several potential strategies for prevention. Our description of LLD risk factors and prevention approaches is informed by the framework developed by the National Academy of Medicine (formerly, Institute of Medicine), which includes indicated, selective, and universal approaches to prevention.
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25
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Xiang X, Yang Y, Cheng J, An R. The Impact of Late-Life Disability Spectrum on Depressive Symptoms: A Fixed-Effects Analysis of Panel Data. J Gerontol B Psychol Sci Soc Sci 2021; 76:810-819. [PMID: 32357224 DOI: 10.1093/geronb/gbaa060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study examines the impact of a previously validated disability spectrum that accounts for compensatory strategies on depressive symptoms in older adults. METHODS This study was a secondary data analysis of 2011 through 2018 surveys from the National Health and Aging Trends Study (N = 7,609). The disability spectrum was categorized using a 5-level hierarchical scheme: fully able, successful accommodation, reduced activity, difficulty, and assistance for 12 mobility, self-care, and household activities. The individual fixed-effects panel model was used to examine the impact of this disability spectrum on depressive symptoms. RESULTS Depressive symptoms rose progressively with each successive category on the disability spectrum in descriptive analyses. In fixed-effects models, moving from "fully able" to "successful accommodation" was not associated with significant changes in depressive symptoms; this result held for all self-care and mobility activities. Moving from "fully able" to "reduced activity" was associated with a significant increase in depressive symptoms for 3 household activities (doing laundry, making hot meals, and shopping for groceries) but not for paying bills/banking or keeping track of medications. Going up 2 or more stages above "fully able" on the disability spectrum was associated with a significant increase in depressive symptoms across all 12 activities. DISCUSSION While limitations in a range of daily activities have harmful effects on mental health, using compensatory strategies that do not erode one's perception of autonomy can help older adults cope with the psychological detriments of late-life disability.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor
| | - Yong Yang
- Social and Behavioral Science, School of Public Health, University of Memphis, Tennessee
| | - Jianjia Cheng
- School of Social Work, University of Michigan, Ann Arbor
| | - Ruopeng An
- Brown School, Washington University in St. Louis
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26
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Kumar RG, Jayasinghe N, Walker RL, Gibbons LE, Power MC, Larson EB, Crane PK, Dams-O’Connor K. Association of remote traumatic brain injury and military employment with late-life trajectories of depressive symptom severity. J Affect Disord 2021; 281:376-383. [PMID: 33348181 PMCID: PMC8887889 DOI: 10.1016/j.jad.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) and military service are common lifetime exposures among current older adults that may affect late-life mental health. The objective of the present study was to evaluate the association between TBI with loss of consciousness (LOC) and military employment and late-life depressive symptom severity trajectory. METHODS 1445 males and 2096 females adults at least 65 years old without dementia or recent TBI were enrolled and followed biennially for up to 10 years in the Adult Changes in Thought study from Kaiser Permanente Washington in Seattle, Washington. RESULTS Using group-based trajectory modeling, we documented four distinct depressive symptom severity trajectories that followed a similar course in males and females (Minimal, Decreasing, Increasing, and Persistent). In multinomial regression analyses, TBI with LOC in males was associated with greater likelihood of Persistent versus Minimal depressive symptom severity compared to individuals without TBI (OR = 1.51, 95% CI: 1.01, 2.27; p=0.046). Males reporting past military employment had greater likelihood of Decreasing versus Minimal depressive symptom severity compared to individuals without past military employment (OR = 1.54, 95% CI: 1.03, 2.31; p=0.035). There was no association between TBI or military employment and depression trajectories in females, and no evidence of effect modification by age or between exposures. LIMITATIONS Lifetime history of TBI was ascertained retrospectively and may be subject to recall bias. Also, past military employment does not presuppose combat exposure. CONCLUSIONS Remote TBI and past military employment are relevant to late-life trajectories of depressive symptom severity in dementia-free older males.
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Affiliation(s)
- Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai
| | - Nimali Jayasinghe
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai,Department of Psychiatry, Weill Cornell Medicine
| | - Rod L. Walker
- Kaiser Permanente Washington Health Research Institute
| | | | - Melinda C. Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
| | - Eric B. Larson
- Department of Medicine, University of Washington,Kaiser Permanente Washington Health Research Institute
| | | | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai,Department of Neurology, Icahn School of Medicine at Mount Sinai,Corresponding author: Kristen Dams-O’Connor, PhD, One Gustave L. Levy Place, Box 1163, New York, NY 10029, (212) 241-0137, kristen.dams-o’
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27
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González-Suñer L, Carbonell-Duacastella C, Aznar-Lou I, Rubio-Valera M, Iglesias-González M, Peñarrubia-María MT, Gil-Girbau M, Serrano-Blanco A. Use of Mental Health Services for Patients Diagnosed with Major Depressive Disorders in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:885. [PMID: 33498567 PMCID: PMC7908155 DOI: 10.3390/ijerph18030885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 11/16/2022]
Abstract
Major depressive disorder (MDD) is one of the most disabling diseases worldwide, generating high use of health services. Previous studies have shown that Mental Health Services (MHS) use is associated with patient and Family Physician (FP) factors. The aim of this study was to investigate MHS use in a naturalistic sample of MDD outpatients and the factors influencing use of services in specialized psychiatric care, to know the natural mental healthcare pathway. Non-randomized clinical trial including newly depressed Primary Care (PC) patients (n = 263) with a 12-month follow-up (from 2013 to 2015). Patient sociodemographic variables were assessed along with clinical variables (mental disorder diagnosis, severity of depression or anxiety, quality of life, disability, beliefs about illness and medication). FP (n = 53) variables were also evaluated. A multilevel logistic regression analysis was performed to assess factors associated with public or private MHS use. Subjects were clustered by FP. Having previously used MHS was associated with the use of MHS. The use of public MHS was associated with worse perception of quality of life. No other sociodemographic, clinical, nor FP variables were associated with the use of MHS. Patient self-perception is a factor that influences the use of services, in addition to having used them before. This is in line with Value-Based Healthcare, which propose to put the focus on the patient, who is the one who must define which health outcomes are relevant to him.
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Affiliation(s)
- Laura González-Suñer
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (L.G.-S.); (A.S.-B.)
| | - Cristina Carbonell-Duacastella
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | | | - Maria Teresa Peñarrubia-María
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Institut Català de la Salut i Institut d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08006 Barcelona, Spain
| | - Montserrat Gil-Girbau
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (L.G.-S.); (A.S.-B.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
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28
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Park SY. Intergenerational Differences in Age-friendly Environments and Health Outcomes: Social Support as a Mediator. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2021. [DOI: 10.1080/15350770.2021.1868240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Li N, Shou J. The prevalence and correlates of depression in elderly outpatients in community health centers. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tegeler C, Beyer AK, Hoppmann F, Ludwig V, Kessler EM. Current state of research on psychotherapy for home-living vulnerable older adults with depression. Z Gerontol Geriatr 2020; 53:721-727. [PMID: 33185718 PMCID: PMC7661801 DOI: 10.1007/s00391-020-01805-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/10/2020] [Indexed: 01/24/2023]
Abstract
Older home-living vulnerable adults often suffer from chronic conditions accompanied by restrictions in mobility, social participation and reduced independence. Among this rapidly growing population depression is a common and serious health problem; however, there are shortcomings in the diagnosis of depression and provision of psychotherapy. Despite growing evidence in treating depression among the group of nursing home residents or the "young-old", there is a research gap regarding needs-oriented healthcare strategies for very old, frail or care-dependent older adults living at home. The present article provides an overview of different outpatient psychotherapeutic treatment approaches for vulnerable older adults with depression, in particular adaptations tailored to those who are homebound or in need of care. Based on the current state of research, this article derives recommendations for psychotherapy in this special setting to consider the physical and psychosocial resources of this patient group. Furthermore, healthcare strategies for embedding psychotherapy in collaborative, telehealth or home-delivered healthcare services are described and their applicability as psychosocial support for older adults during the coronavirus disease 2019 (COVID-19) pandemic is discussed. Psychotherapy is an efficacious treatment for depression in home-living vulnerable older adults. Further implementing telehealth or home delivered settings, individually tailored psychotherapeutic approaches as well as collaborative and stepped care approaches can increase utilization and medical supply of this patient group. More research and innovative programs are needed to improve access to and provision of psychotherapeutic care as well as their social inclusion.
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Affiliation(s)
- Christina Tegeler
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany.
| | - Ann-Kristin Beyer
- Institute for Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Fee Hoppmann
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany
| | - Valentina Ludwig
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany
| | - Eva-Marie Kessler
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany.
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Pabón-Carrasco M, Ramirez-Baena L, López Sánchez R, Rodríguez-Gallego I, Suleiman-Martos N, Gómez-Urquiza JL. Prevalence of Depression in Retirees: A Meta-Analysis. Healthcare (Basel) 2020; 8:healthcare8030321. [PMID: 32899813 PMCID: PMC7551681 DOI: 10.3390/healthcare8030321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Retirement is a final life stage characterized by the ceasing of work and the loss of a routine, social relations, role, status, accomplishments, and aspirations, etc. Many times it is accompanied by negative feelings and can provoke different psychoemotional reactions such as depression, among others. The aim of this study is to analyze the prevalence of depression, as well as its psychoeducational approach in retirees. Methods: A paired systematic review with meta-analysis was conducted in different databases—Medline, Scopus, CUIDEN, CINAHL, LILACS and PsycINFO. Original studies were included in English, Spanish and French that were published in the last 10 years, and which approached depression in retirees. Results: A total of 11 articles were selected after applying inclusion and exclusion criteria. The mean value of the prevalence levels of depression in retirees obtained in the meta-analysis was 28%. Depression is more frequent in retirees, with mandatory retirement, retirement due to illness, and anticipated retirement presenting higher levels of this disease. The health role in the psychoeducational approach is highlighted in 41.6% (n = 5). Conclusions: With almost one-third of retirees suffering from depression, it is necessary to implement prevention and early detection measures to approach a public health problem.
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Affiliation(s)
- Manuel Pabón-Carrasco
- Spanish Red Cross Nursing School, Sevilla University, 41009 Sevilla, Spain; (M.P.-C.); (I.R.-G.)
| | - Lucia Ramirez-Baena
- Spanish Red Cross Nursing School, Sevilla University, 41009 Sevilla, Spain; (M.P.-C.); (I.R.-G.)
- Correspondence:
| | - Raúl López Sánchez
- Internal Medicine, Hospital Quirónsalud Barcelona, 08023 Barcelona, Spain;
| | - Isabel Rodríguez-Gallego
- Spanish Red Cross Nursing School, Sevilla University, 41009 Sevilla, Spain; (M.P.-C.); (I.R.-G.)
| | - Nora Suleiman-Martos
- Nursing Department, Faculty of Health Sciences, University of Granada, Campus University of Ceuta, 51001 Ceuta, Spain;
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Wang J, Xue J, Jiang Y, Zhu T, Chen S. Mediating effects of depressive symptoms on social support and quality of life among rural older Chinese. Health Qual Life Outcomes 2020; 18:242. [PMID: 32690060 PMCID: PMC7372751 DOI: 10.1186/s12955-020-01490-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is not well clear how psychosocial factors like depressive symptoms, social support affect quality of life in rural elderly in China. This study aimed to investigate the mediating role of depressive symptoms in the association between social support and quality of life. METHODS Cross-sectional data of 420 rural elderly were taken from four villages in Hangzhou City. They were interviewed with a demographic questionnaire, the Patient Health Questionnaire (PHQ-9) for depression, the Medical Outcomes Study Social Support Survey (MOS-SSS) for social support, and the short version of World Health Organization Quality of Life Assessment (WHOQOL-BREF) for quality of life. Mediation was examined by a nonparametric Bootstrapping method, controlling for socioeconomic variables. RESULTS Poor quality of life was associated with low social support and increased depressive symptoms. A significant indirect effect of social support existed through depression in relation to quality of life (ab = 0.0213, 95% CI [0.0071, 0.0421]), accounting for 9.5% of the effect of social support on quality of life. Approximately 4.8% of the variance in QOL was attributable to the indirect effect of social support through depressive symptoms. CONCLUSIONS Depressive symptoms mediated the impact of social support on quality of life among rural older adults.
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Affiliation(s)
- Jiayu Wang
- Department of psychology and behavioral sciences, Zhejiang University, 148 Tianmushan Road, Hangzhou, 310028, China
| | - Jiang Xue
- Department of psychology and behavioral sciences, Zhejiang University, 148 Tianmushan Road, Hangzhou, 310028, China
| | - Yuxing Jiang
- Department of psychology and behavioral sciences, Zhejiang University, 148 Tianmushan Road, Hangzhou, 310028, China
| | - Tingfei Zhu
- Department of psychology and behavioral sciences, Zhejiang University, 148 Tianmushan Road, Hangzhou, 310028, China
| | - Shulin Chen
- Department of psychology and behavioral sciences, Zhejiang University, 148 Tianmushan Road, Hangzhou, 310028, China.
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Chen R. Social support as a protective factor against the effect of grief reactions on depression for bereaved single older adults. DEATH STUDIES 2020; 46:756-763. [PMID: 32496893 DOI: 10.1080/07481187.2020.1774943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study tested the main effect model and the stress-buffering model of the mechanisms by which social support affects bereaved single older adults' depression. Data from the National Social Life, Health, and Aging Project (Wave 2; N = 621) were used to test a latent moderated structural equation model that explores the interaction between grief reactions and social support on bereaved single older adults' depression in the US. The findings provide evidence for the stress-buffering model (i.e., the relationship between grief reactions and depression, which was strongly positive when social support was low, turned negative when social support was high).
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Affiliation(s)
- Ruoxi Chen
- College of Health Sciences, University of Louisiana at Monroe, Monroe, Louisiana, USA
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34
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Cosker E, Schwan R, Angioi-Duprez K, Laprévote V, Schwitzer T. New insights on the role of the retina in diagnostic and therapeutic strategies in major depressive disorder. Neurosci Biobehav Rev 2020; 113:262-272. [PMID: 32147530 DOI: 10.1016/j.neubiorev.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 12/11/2022]
Abstract
Major depressive disorder (MDD) affects people worldwide. MDD treatments include antidepressants, which involve a delayed onset of action, long-term treatment, side effects and, frequently, only partial efficacy. The lack of access to the living brain, and the complex and still poorly elucidated pathophysiology of MDD, hinders treatment development. There is not only a need for new treatment strategies, but also for new approaches to investigating the pathophysiology of MDD. Light therapy is a well-established treatment acting through the retina. Since the retina is part of the central nervous system, it has been suggested as a useful area for investigating mental illness. In this article, we will first set out the evidence that MDD affects the retina's structure and function. We will then review studies evaluating the efficacy of light therapy in unipolar non-seasonal MDD. Finally, we discuss the disruption of melatoninergic pathways in MDD, its assessment through the retina and the treatment of this disruption with light therapy.
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Affiliation(s)
- Eve Cosker
- Pôle Hospitalo-Universitaire De Psychiatrie d'Adultes et d'Addictologie Du Grand Nancy, Centre Psychothérapique De Nancy, Laxou, France; INSERM U1114, Fédération De Médecine Translationnelle De Strasbourg, Pôle De Psychiatrie, Centre Hospitalier Régional Universitaire De Strasbourg, Strasbourg, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire De Psychiatrie d'Adultes et d'Addictologie Du Grand Nancy, Centre Psychothérapique De Nancy, Laxou, France; INSERM U1114, Fédération De Médecine Translationnelle De Strasbourg, Pôle De Psychiatrie, Centre Hospitalier Régional Universitaire De Strasbourg, Strasbourg, France; Faculté de Médecine, Université de Lorraine, Nancy, France
| | | | - Vincent Laprévote
- Pôle Hospitalo-Universitaire De Psychiatrie d'Adultes et d'Addictologie Du Grand Nancy, Centre Psychothérapique De Nancy, Laxou, France; INSERM U1114, Fédération De Médecine Translationnelle De Strasbourg, Pôle De Psychiatrie, Centre Hospitalier Régional Universitaire De Strasbourg, Strasbourg, France; Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Thomas Schwitzer
- Pôle Hospitalo-Universitaire De Psychiatrie d'Adultes et d'Addictologie Du Grand Nancy, Centre Psychothérapique De Nancy, Laxou, France; INSERM U1114, Fédération De Médecine Translationnelle De Strasbourg, Pôle De Psychiatrie, Centre Hospitalier Régional Universitaire De Strasbourg, Strasbourg, France; Faculté de Médecine, Université de Lorraine, Nancy, France.
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35
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Khoury R, Chakkamparambil B, Chibnall J, Rajamanickam J, Kumar A, Grossberg GT. Diagnostic Accuracy of the SLU AMSAD Scale for Depression in Older Adults Without Dementia. J Am Med Dir Assoc 2020; 21:665-668. [PMID: 31704225 DOI: 10.1016/j.jamda.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of a short depression screening tool, the Saint Louis University (SLU) AMSAD depression scale, relative to the Geriatric Depression Scale-15 (GDS-15) and Montgomery-Asberg Depression Rating Scale (MADRS), and in relation to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for major depressive disorder, in cognitively intact older adults. DESIGN Cross-sectional. SETTING Outpatient geriatric psychiatry clinic. PARTICIPANTS Fifty older adults (aged ≥65 years) without dementia. MEASUREMENTS GDS-15, MADRS, SLU AMSAD, and DSM-5 criteria for major depressive disorder were administered. RESULTS Total scores (continuous variables) for the GDS-15, MADRS, and SLU AMSAD correlated significantly with the DMS-5 criteria for major depressive disorder (MDD) [area under the curve (AUC) ≥ 0.93, sensitivity = 0.93, and specificity ≥ 0.80]. Optimal cutoffs were 9+ for GDS-15, 18+ for MADRS, and 7+ for SLU AMSAD. When score results were categorized according to their known cutoffs for mild, moderate, and severe depression, AUC values were again high (range = 0.82-0.89), with adequate levels of sensitivity (0.87-0.93) and specificity (0.71-0.86), distinguishing no or mild depression from moderate or severe depression in relation to the DSM-5 diagnostic criteria for MDD. CONCLUSIONS AND IMPLICATIONS Strong diagnostic accuracy was shown for the 3 scales. The SLU AMSAD performed as well as the GDS-15 and slightly better than the MADRS. The superiority of the SLU AMSAD is supported by the fact that it encompasses only 5 simply worded, simply scaled items to be used in busy clinical settings.
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Affiliation(s)
- Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | - Binu Chakkamparambil
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - John Chibnall
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Jayashree Rajamanickam
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Aneel Kumar
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
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36
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Rashidi-Ranjbar N, Miranda D, Butters MA, Mulsant BH, Voineskos AN. Evidence for Structural and Functional Alterations of Frontal-Executive and Corticolimbic Circuits in Late-Life Depression and Relationship to Mild Cognitive Impairment and Dementia: A Systematic Review. Front Neurosci 2020; 14:253. [PMID: 32362808 PMCID: PMC7182055 DOI: 10.3389/fnins.2020.00253] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/06/2020] [Indexed: 01/12/2023] Open
Abstract
Depression is a risk factor for developing Alzheimer's disease and Related Dementia (ADRD). We conducted a systematic review between 2008 and October 2018, to evaluate the evidence for a conceptual mechanistic model linking depression and ADRD, focusing on frontal-executive and corticolimbic circuits. We focused on two neuroimaging modalities: diffusion-weighted imaging measuring white matter tract disruptions and resting-state functional MRI measuring alterations in network dynamics in late-life depression (LLD), mild cognitive impairment (MCI), and LLD+MCI vs. healthy control (HC) individuals. Our data synthesis revealed that in some but not all studies, impairment of both frontal-executive and corticolimbic circuits, as well as impairment of global brain topology was present in LLD, MCI, and LLD+MCI vs. HC groups. Further, posterior midline regions (posterior cingulate cortex and precuneus) appeared to have the most structural and functional alterations in all patient groups. Future cohort and longitudinal studies are required to address the heterogeneity of findings, and to clarify which subgroups of people with LLD are at highest risk for developing MCI and ADRD.
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Affiliation(s)
- Neda Rashidi-Ranjbar
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Dayton Miranda
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Benoit H Mulsant
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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37
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Gracia-García P, López-Antón R, Santabárbara J, Quintanilla MÁ, De la Cámara C, Marcos G, Lobo E, Lobo A. Cognition and daily activities in a general population sample aged +55. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:270-283. [PMID: 32249666 DOI: 10.1080/13825585.2020.1745140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: We tested the association of individual cognitive domains measured with the Mini-Mental State Examination (MMSE) and disability. Method: Cross-sectional study in a population-based cohort aged ≥55 years (n = 4,803). Sample was divided into two groups: individuals with cognition within the normal range (CNR) (n = 4,057) and those with cognitive impairment (CI) (n = 746). Main outcome measures: The MMSE, the Katz Index (Basic Activities of Daily Living, bADL), the Lawton and Brody Scale (Instrumental Activities of Daily Living, iADL), and the Geriatric Mental State (GMS-AGECAT). Results: MMSE-orientation was associated with disability in bADL, iADL and a decrease in social participation, regardless of cognitive status. MMSE-attention was associated with disability in iADL, but only in CNR. MMSE-language was associated with disability in bADL, iADL and with reduced social participation, but only in CI. Conclusions: The associations observed between disability and orientation may have clinical and public health implications.
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Affiliation(s)
- Patricia Gracia-García
- Psychiatry Service, Hospital Universitario Miguel Servet , Zaragoza, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza , Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation , Madrid, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain
| | - Raúl López-Antón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation , Madrid, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza , Zaragoza, Spain
| | - Javier Santabárbara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation , Madrid, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain.,Department of Preventive Medicine and Public Health, Universidad de Zaragoza , Zaragoza, Spain
| | - Miguel Ángel Quintanilla
- Department of Medicine and Psychiatry, Universidad de Zaragoza , Zaragoza, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain.,Psychiatry Service, Hospital Clínico Universitario , Zaragoza, Spain
| | - Concepción De la Cámara
- Department of Medicine and Psychiatry, Universidad de Zaragoza , Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation , Madrid, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain.,Psychiatry Service, Hospital Clínico Universitario , Zaragoza, Spain
| | - Guillermo Marcos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation , Madrid, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain.,Department of Preventive Medicine and Public Health, Universidad de Zaragoza , Zaragoza, Spain
| | - Elena Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation , Madrid, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain.,Department of Preventive Medicine and Public Health, Universidad de Zaragoza , Zaragoza, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza , Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation , Madrid, Spain.,Instituto Aragonés de Ciencias de la Salud (I+CS) , Zaragoza, Spain
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38
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Rivan NFM, Shahar S, Rajab NF, Singh DKA, Che Din N, Mahadzir H, Mohamed Sakian NI, Ishak WS, Abd. Rahman MH, Mohammed Z, You YX. Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1547. [PMID: 32121194 PMCID: PMC7084438 DOI: 10.3390/ijerph17051547] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/01/2023]
Abstract
(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.
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Affiliation(s)
- Nurul Fatin Malek Rivan
- Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Suzana Shahar
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Nor Fadilah Rajab
- Biomedical Science Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme & Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Normah Che Din
- Health Psychology Programme and Centre of Rehabilitation Science, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Hazlina Mahadzir
- Internal Medicine & Geriatric Department, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Batu 9 Cheras, Kuala Lumpur 50300, Malaysia;
| | - Noor Ibrahim Mohamed Sakian
- Occupational Therapy Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Wan Syafira Ishak
- Audiology Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Mohd Harimi Abd. Rahman
- Optometry and Vision Sciences Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (M.H.A.R.); (Z.M.)
| | - Zainora Mohammed
- Optometry and Vision Sciences Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (M.H.A.R.); (Z.M.)
| | - Yee Xing You
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
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39
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Leong OS, Ghazali S, Hussin EOD, Lam SK, Japar S, Geok SK, Azmi ISM. Depression among older adults in Malaysian daycare centres. Br J Community Nurs 2020; 25:84-90. [PMID: 32040358 DOI: 10.12968/bjcn.2020.25.2.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
With the older population increasing worldwide, depressive disorder in this cohort is a serious public health problem that contributes to increased healthcare costs and mortality. This study aimed to determine the prevalence of depression among older adults in Malaysia who attended a daycare centre and to identify the relationship between depression and demographic factors. A cross-sectional study was conducted with 159 older adults recruited following screening for mental capacity. The Malay Geriatric Depression Scale questionnaire was distributed among the participants to obtain descriptive data on the symptoms of depression. Some 59.1% of the participants experienced depression. The most common factors associated with depression were being divorced, low education levels and low income. The findings indicate the need to revise and re-evaluate the activities and programmes in daycare centres for older adults in order to objectively cater to their physical and emotional needs.
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Affiliation(s)
- Ong Swee Leong
- School of Nursing, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Suriawati Ghazali
- School of Nursing, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Emni Omar Daw Hussin
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soh Kim Lam
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Salimah Japar
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Soh Kim Geok
- Department of Sports Studies, Faculty of Education, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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40
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Zhong BL, Xu YM, Xie WX, Liu XJ, Huang ZW. Depressive Symptoms in Elderly Chinese Primary Care Patients: Prevalence and Sociodemographic and Clinical Correlates. J Geriatr Psychiatry Neurol 2019; 32:312-318. [PMID: 31480989 DOI: 10.1177/0891988719862620] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China. BACKGROUND Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients. METHODS In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15). RESULTS Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001). CONCLUSIONS Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.
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Affiliation(s)
- Bao-Liang Zhong
- 1 Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China.,2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Yan-Min Xu
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Wu-Xiang Xie
- 3 Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Xiu-Jun Liu
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Zhuo-Wei Huang
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
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41
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Merino RB, Matthews JM, Sawyer S, Kosko DA, Roberson DW. Screenings, Savings, and Service: Nurses Meeting Rural Older Adults in Their Communities. J Gerontol Nurs 2019; 45:24-28. [PMID: 31560073 DOI: 10.3928/02793695-20190825-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
Abstract
Falls, depression, and dementia are major health concerns for older adults and communities across the country, which also result in increased health care expenditures. The improvement of early intervention is a tremendous need, especially for older adults who are isolated in rural areas. Nurses were deployed across 41 counties in eastern North Carolina to increase access to screening and improve the possibility of early intervention for rural community-dwelling older adults. The screenings identified at-risk older adults, who nurses then educated and referred for early intervention of falls risk, depression, and cognitive impairment. Through this grassroots intervention, nurses provided community-dwelling older adults with resources for early detection, early intervention, and cost savings. [Journal of Gerontological Nursing, 45(10), 24-28.].
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42
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Drudi LM, Ades M, Turkdogan S, Huynh C, Lauck S, Webb JG, Piazza N, Martucci G, Langlois Y, Perrault LP, Asgar AW, Labinaz M, Lamy A, Noiseux N, Peterson MD, Arora RC, Lindman BR, Bendayan M, Mancini R, Trnkus A, Kim DH, Popma JJ, Afilalo J. Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement. JAMA Cardiol 2019; 3:191-197. [PMID: 29344620 DOI: 10.1001/jamacardio.2017.5064] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. Objective To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR. Design, Setting, and Participants This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up. Main Outcomes and Measures All-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment. Results Among 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% CI, 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20). Conclusions and Relevance One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.
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Affiliation(s)
- Laura M Drudi
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Matthew Ades
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sena Turkdogan
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Huynh
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolo Piazza
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yves Langlois
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Louis P Perrault
- Division of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Anita W Asgar
- Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andre Lamy
- Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rakesh C Arora
- Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian R Lindman
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
| | - Melissa Bendayan
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Mancini
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Amanda Trnkus
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Dae H Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Obbels J, Vansteelandt K, Verwijk E, Dols A, Bouckaert F, Oudega ML, Vandenbulcke M, Stek M, Sienaert P. MMSE Changes During and After ECT in Late-Life Depression: A Prospective Study. Am J Geriatr Psychiatry 2019; 27:934-944. [PMID: 31104967 DOI: 10.1016/j.jagp.2019.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE There is ongoing concern about the impact of electroconvulsive therapy (ECT) on cognition in patients with late-life depression (LLD), especially in patients for whom pretreatment Mini-Mental State Exam (MMSE) scores are low. Our aim was to examine the evolution of cognitive effects of ECT, using the MMSE in a large group of patients with LLD. METHODS One hundred nine patients aged 55 years and older with unipolar depression, referred for ECT, were included in our study. The MMSE was assessed before, during, immediately after, and 6 months after ECT. RESULTS MMSE scores improved significantly during the course of ECT and remained stable during the 6-month period after ending ECT for the total group. In the group of patients with a low MMSE score (<24) at baseline, the MMSE score improved significantly during ECT, whereas in the group of patients with a normal MMSE score (≥24) at baseline, the score did not change significantly during ECT. In both groups, MMSE scores still increased slightly after ECT was discontinued. CONCLUSION ECT does not cause deleterious cognitive effects, as measured with the MMSE, during and for 6 months after the ECT course in patients with LLD. In the event of a baseline cognitive impairment, MMSE scores tend to improve significantly during and for 6 months after the ECT course. The presence of pretreatment cognitive impairment should not lead clinicians to withhold ECT in older patients with severe depression.
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Affiliation(s)
- Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium.
| | - Kristof Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Esmée Verwijk
- Department of Medical Psychology (EV), Neuropsychology Department, Amsterdam UMC Academic Medical Center, The Netherlands; Department of Psychology (EV), Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands; ECT Department (EV), Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Annemieke Dols
- Department of Old Age Psychiatry (AD, MLO, MS), GGZ inGeest/Amsterdam University/VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Filip Bouckaert
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium; Old-Age Psychiatry (FB, MV), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Mardien L Oudega
- Department of Old Age Psychiatry (AD, MLO, MS), GGZ inGeest/Amsterdam University/VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mathieu Vandenbulcke
- Old-Age Psychiatry (FB, MV), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Max Stek
- Department of Old Age Psychiatry (AD, MLO, MS), GGZ inGeest/Amsterdam University/VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT) (JO, KV, FB, PS), University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
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Razzak HA, Harbi A, Ahli S. Depression: Prevalence and Associated Risk Factors in the United Arab Emirates. Oman Med J 2019; 34:274-282. [PMID: 31360314 PMCID: PMC6642715 DOI: 10.5001/omj.2019.56] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A Depression is a prevalent mental healthcare problem and a common cause of disability worldwide. The purpose of this study was to determine the prevalence and risk factors of depression in individuals living in the UAE. We used a systematic review approach, searching PubMed and Scopus electronic databases to collect studies conducted between 2007 and 2017 on the UAE population (both citizens and expatriates) relating to depression. After evaluating and screening relevant articles, a review of 14 articles was conducted. The prevalence of depression and study populations varied widely across studies with some including students and workers and others limited to those with diabetes. The most common contributing factors were female sex, financial difficulties/low socioeconomic status, stressful life events, lack of social support, serious or chronic illness (e.g., diabetes, obesity, epilepsy, multiple sclerosis), and a history of eating disorders. Vitamin D deficiency was also highlighted as a risk factor for seasonal depression. Even though previous evidence has promulgated the role of numerous causative factors, the epidemiological studies including risk factors such as personal or family history of depression, low academic performance, and the use of alcohol remain lacking. Further research is needed to identify effective strategies for treating and preventing depression in the future.
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Affiliation(s)
- Hira Abdul Razzak
- Statistics and Research Center, Ministry of Health and Prevention, Dubai, UAE
| | - Alya Harbi
- Statistics and Research Center, Ministry of Health and Prevention, Dubai, UAE
| | - Shaima Ahli
- Statistics and Research Center, Ministry of Health and Prevention, Dubai, UAE
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Oude Voshaar RC, Dhondt TDF, Fluiter M, Naarding P, Wassink S, Smeets MMJ, Pelzers LPRM, Lugtenburg A, Veenstra M, Marijnissen RM, Hendriks GJ, Verlinde LA, Schoevers RA, van den Brink RHS. Study design of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) project; a cohort study of older patients with affective disorders referred for specialised geriatric mental health care. BMC Psychiatry 2019; 19:182. [PMID: 31208389 PMCID: PMC6580500 DOI: 10.1186/s12888-019-2176-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Affective disorders, encompassing depressive-, anxiety-, and somatic symptom disorders, are the most prevalent mental disorders in later life. Treatment protocols and guidelines largely rely on evidence from RCTs conducted in younger age samples and ignore comorbidity between these disorders. Moreover, studies in geriatric psychiatry are often limited to the "younger old" and rarely include the most frail. Therefore, the effectiveness of treatment in routine clinical care for older patients and impact of ageing characteristics is largely unknown. OBJECTIVE The primary aim of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) - project is to examine the impact of ageing characteristics on the effectiveness of treatment for affective disorders in specialised geriatric mental health care. METHODS ROM-GPS is a two-stage, multicentre project. In stage one, all patients aged ≥60 years referred to participating outpatient clinics for specialised geriatric mental health care will be routinely screened with a semi-structured psychiatric interview, the Mini International Neuropsychiatric Interview and self-report symptom severity scales assessing depression, generalized anxiety, hypochondria, and alcohol use. Patients with a unipolar depressive, anxiety or somatic symptom disorder will be asked informed consent to participate in a second (research) stage to be extensively phenotyped at baseline and closely monitored during their first year of treatment with remission at one-year follow-up as the primary outcome parameter. In addition to a large test battery of potential confounders, specific attention is paid to cognitive functioning (including computerized tests with the Cogstate test battery as well as paper and pencil tests) and physical functioning (including multimorbidity, polypharmacy, and different frailty indicators). The study is designed as an ongoing project, enabling minor adaptations once a year (change of instruments). DISCUSSION Although effectiveness studies using observational data can easily be biased, potential selection bias can be quantified and potentially corrected (e.g. by propensity scoring). Knowledge of age-related determinants of treatment effectiveness, may stimulate the development of new interventions. Moreover, studying late-life depressive, anxiety and somatic symptom disorders jointly enables data-driven studies for more optimal classification of these disorders in later life. TRIAL REGISTRATION Dutch Trial Register: NL6704 ( www.trialregister.nl ). Retrospectively registered on 2017-12-05.
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Affiliation(s)
- Richard C. Oude Voshaar
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ton D. F. Dhondt
- Mental Health Center GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Mario Fluiter
- Mental Health Center GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Paul Naarding
- GGNet Mental Health, Division of Old Age Psychiatry, Warnsveld & Apeldoorn, The Netherlands
| | - Sanne Wassink
- GGNet Mental Health, Division of Old Age Psychiatry, Warnsveld & Apeldoorn, The Netherlands
| | - Maureen M. J. Smeets
- 0000 0004 0468 1456grid.491215.aMental Health Center GGZ Centraal, Ermelo, The Netherlands
| | - Loeki P. R. M. Pelzers
- 0000 0004 0468 1456grid.491215.aMental Health Center GGZ Centraal, Ermelo, The Netherlands
| | - Astrid Lugtenburg
- 0000 0004 0465 6592grid.468637.8Mental Health Center GGZ Drenthe, Assen, The Netherlands
| | - Martine Veenstra
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0004 0465 6592grid.468637.8Mental Health Center GGZ Drenthe, Assen, The Netherlands
| | - Radboud M. Marijnissen
- 0000 0004 0466 1666grid.491369.0Mental health Center Pro Persona, Arnhem/Nijmegen, The Netherlands
| | - Gert-Jan Hendriks
- 0000 0004 0466 1666grid.491369.0Mental health Center Pro Persona, Arnhem/Nijmegen, The Netherlands
| | | | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob H. S. van den Brink
- 0000 0000 9558 4598grid.4494.dUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Ponce J, Latín C, Leiva V, Cortés G, Rodríguez F, Jiménez CE. Non-pharmacological motor-cognitive treatment to improve the mental health of elderly adults. ACTA ACUST UNITED AC 2019; 65:394-403. [PMID: 30994839 DOI: 10.1590/1806-9282.65.3.394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 07/10/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To propose a program of physical-cognitive dual task and to measure its impact in Chilean institutionalized elderly adults. METHOD Experimental design study with pre and post-intervention evaluations, measuring the cognitive and depressive levels by means of the Pfeiffer test and the Yesavage scale, respectively. The program was applied for 12 weeks to adults between 68 and 90 years old. The statistical analysis was based on the nonparametric Wilcoxon test for paired samples and was contrasted with its parametric version. The statistical software R was used. RESULTS Statistically significant differences were obtained in the cognitive level (p-value < 0.05) and highly significant (p-value < 0.001) in the level of depression with both tests (parametric and nonparametric). CONCLUSION Due to the almost null evidence of scientific interventions of programs that integrate physical activity and cognitive tasks together in Chilean elderly adults, a program of physical-cognitive dual task was proposed as a non-pharmacological treatment, easy to apply and of low cost to benefit their integral health, which improves significantly the cognitive and depressive levels of institutionalized elderly adults.
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Affiliation(s)
- Javiera Ponce
- Department of Sports, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Claudia Latín
- Postgraduate Faculty Universidad Mayor, Santiago, Chile
| | - Víctor Leiva
- Departamento de Matemáticas, Facultad de Ciencias Básicas, Universidad de Antofagasta, Antofagasta, Chile
| | | | - Fernando Rodríguez
- IR&S group, School of Physical Education, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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Aronow H, Fila S, Martinez B, Sosna T. Depression and Coleman Care Transitions Intervention. SOCIAL WORK IN HEALTH CARE 2018; 57:750-761. [PMID: 30015601 DOI: 10.1080/00981389.2018.1496514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Coleman Care Transitions Intervention (CTI) is a "Patient Activation Model." Depression can be a barrier to activation and may challenge CTI. This study addressed whether CTI coaches modified the intervention for older adults who screened positive for depression. Over 4,500 clients in a Centers for Medicare and Medicaid Services demonstration completed screening for depression with the PHQ-9; one in five screened positive (score = 9+). Our findings suggest that coaches modified CTI and played a more directive role for clients who screened positive for depression, resulting in similar 30-day readmission rates among patients who screened positive for depression risk and those who did not. That finding stands in contrast to the widely reported higher readmission rates among people screening positive for depression.
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Affiliation(s)
- Harriet Aronow
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Susan Fila
- b Santa Monica College , Department of Health and Wellbeing Services , Los Angeles , CA , USA
| | - Bibiana Martinez
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Todd Sosna
- c Jewish Family Service of Los Angeles , Los Angeles , USA
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48
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Wongpakaran T, Wongpakaran N, Sirirak T, Arunpongpaisal S, Zimet G. Confirmatory factor analysis of the revised version of the Thai multidimensional scale of perceived social support among the elderly with depression. Aging Ment Health 2018. [PMID: 28621147 DOI: 10.1080/13607863.2017.1339778] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Difficulties in modeling the Multidimensional Scale of Perceived Social Support (MSPSS) have occurred, and these were corrected in the revised version of the Thai MSPSS. However, the revised version has not been tested in elderly populations. The present study aimed at confirming the factor structure of the revised version of the MSPSS among the elderly with depressive disorders, in populations with or without depressive disorders. METHODS Eight hundred and three elderly patients were recruited from four tertiary hospitals; 190 (23.7%) had depressive disorders. All completed the revised Thai MSPSS consisting of 12 items, using a 7-point Likert scale. Confirmatory factor analysis (CFA) of the MSPSS was conducted in both groups. RESULTS The mean age was 69.24 years (SD 6.88), and 70% of the sample was female. There were no significant difference in demographic data between two groups. The revised version of the Thai MSPSS provided excellent internal consistency. The three-factor model was clearly superior to other alternative models in both depressed and non-depressed groups. CFA for the whole group revealed an acceptable model fit: χ2 = 147.44, df = 45, p < 0.001; Tucker-Lewis Index 0.975; Comparative Fit Index 0.982; Good Fit Index 0.966; and root-mean-square error of approximation 0.056. The fit statistics in the depressed group was better than in the non-depressed group across all models. CONCLUSIONS Due to its robust factor structure, these data support the use of the revised MSPSS as a brief instrument for assessing perceived social support in the elderly with or without depressive disorders.
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Affiliation(s)
| | | | - Thanitha Sirirak
- c Faculty of Medicine, Prince of Songkla University , Hat Yai , Thailand
| | | | - Gregory Zimet
- e Department of Pediatrics , Indiana University , Indianapolis , IN , USA
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Kim H, Kwon S, Hong S, Lee S. Health behaviors influencing depressive symptoms in older Koreans living alone: secondary data analysis of the 2014 Korean longitudinal study of aging. BMC Geriatr 2018; 18:186. [PMID: 30126354 PMCID: PMC6102924 DOI: 10.1186/s12877-018-0882-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 08/15/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Geriatric depression is a societal problem, specifically in those living alone in Korea. This study aims are to investigate (1) how sociodemographic factors, health status, and health behaviors are differently associated with depressive symptoms in older Koreans living alone compared to those living with others and (2) how living arrangements attenuated or strengthened the associations between four types of health behaviors and depressive symptoms. METHODS This secondary data analysis was conducted using data from the 2014 Korean Longitudinal Study of Aging. A structured survey assessing sociodemographic factors, health status, and health behaviors was conducted with people aged 65 or older who lived alone (n = 1359) and living with others (n = 2864). A multiple linear regression with interaction terms was conducted between mean-centered health behaviors and the status of living alone. All statistical analyses were performed using SPSS Statistics 23.0, and the two-tailed level of significance was set at 0.05. RESULTS Those living alone reported higher levels of depressive symptoms than those living with others (Mdiff = 2.129, SE = 0.005, p < 0.001). The variance of depressive symptoms explained by 13 variables was 18.1% for those living alone compared to 23.7% for those living with others. Compared to health behaviors, sociodemographic factors and health status more explained depressive symptoms, specifically with psychiatric disorders, pain, and impaired functionality as risk factors. Smoking, alcohol abstinence, physical inactivity, and social inactivity were associated with more depressive symptoms. Living arrangements moderated the association between depressive symptoms and each health behavior, except for physical inactivity (all p values < 0.001). CONCLUSIONS Older Koreans living alone were exposed to different risk factors for depressive symptoms compared to those living with others. Non-modifiable sociodemographic and health status factors were highly associated with depressive symptoms relative to health behaviors; thus, it is important to conduct early assessment and classification of vulnerable subgroups regarding geriatric depression. Specific assessment instruments should be prepared in practice according to living arrangements among older Koreans. Targeted interventions are essential to addressing living arrangements and modifying health behaviors to reduce smoking, alcohol consumption, and social inactivity, specifically in those living alone.
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Affiliation(s)
- Heejung Kim
- College of Nursing, Yonsei University, Seoul, South Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Sooyoung Kwon
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Soyun Hong
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Sangeun Lee
- College of Nursing, Yonsei University, Seoul, South Korea
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50
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Wu Y, Zhong X, Mai N, Wen Y, Shang D, Hu L, Chen B, Zhang M, Ning Y. Kynurenine pathway changes in late-life depression. J Affect Disord 2018; 235:76-81. [PMID: 29655078 DOI: 10.1016/j.jad.2018.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/05/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Kynurenine pathway (KP) activation is associated with several neuropsychiatric diseases, including major depression disorder (MDD). Although several investigations have been conducted on MDD, these have seldom shed light on KP changes in late-life depression (LLD). OBJECTIVE We aimed to investigate whether tryptophan (TRP) metabolism and kynurenine (KYN) metabolism are imbalanced in LLD patients and to explore the differences in KP characteristics between early onset depression (EOD) and late onset depression (LOD) patients. METHODS We investigated 170 LLD patients (EOD 90, LOD 80) and 135 normal controls. Serum concentrations of TRP, KYN and kynurenic acid (KYNA) were detected by the liquid chromatography-tandem mass spectrometry method. Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). RESULTS LLD patients exhibited lower levels of TRP, KYN, KYNA and KYNA/KYN ratio and a higher level of KYN/TRY ratio than normal controls. The decrease in TRP and the increase in KYN/TRP ratio were found in LOD patients. A low TRP level without increased KYN/TRP ratio was found in EOD patients. The "Depression" factor, which was extracted from HAMD-17 by the principal component factor analysis, was correlated with the TRP level and KYNA/KYN ratio in the EOD group, but no such correlation was found in the LOD group. CONCLUSIONS KP changes were observed in LLD patients; LOD patients showed profound shifts in TRP metabolism, while EOD patients showed low TRP level and a shift in KYN metabolism.
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Affiliation(s)
- Yujie Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Xiaomei Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Naikeng Mai
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Yuguan Wen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Dewei Shang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Lijun Hu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Ben Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China.
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