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Caillot-Ranjeva S, Bergua V, Meillon C, Amieva H. Impact of Cohabitation during Confinement on Older Adults' Negative Affect: What Specificity of Life as a Couple? J Frailty Aging 2024; 13:64-70. [PMID: 38305445 PMCID: PMC10212736 DOI: 10.14283/jfa.2023.25] [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] [Received: 12/16/2022] [Accepted: 02/14/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Social isolation is a risk factor for older adults' physical and psychological health. The beneficial effect of social connections in times of major health events is undeniable. Nevertheless, it remains unclear whether the positive effect of social support depends on the relationship type. OBJECTIVES This study aimed to investigate the influence of older adults' living conditions on the risk of experiencing negative affect during the first lockdown and post-lockdown. DESIGN An epidemiological study conducted during the COVID-19 crisis, at the time of the first lockdown, and 2 to 3 months following the lockdown. SETTING A subset sample of the PACOVID survey, a population-based survey of older adults. PARTICIPANTS Altogether, 277 participants were included into three groups depending on their living conditions: Group 1 "living alone" (n = 141); Group 2 "living with their spouse" (n = 106); Group 3 "living in cohabitation with relatives" (n = 30). MEASUREMENTS Mixed logistic regression analyses were used to study the change in the risk of experiencing negative affects over time according to the living conditions. The presence of negative affects during lockdown was assessed using three items from the 20-item Center for Epidemiologic Studies Depression Scale : «Do you feel sad?»; «Do you feel depressed?; «Do you feel lonely? RESULTS Participants living with their relatives or partner were significantly less likely to experience negative affect than those living alone during lockdown. Moreover, over time, only those living with their spouse had this lesser risk compared to those living alone. CONCLUSIONS These findings highlight the protective effect of social support over time and more specifically of that provided by the spouse. Couple functioning ought to be given consideration when studying the impact of health crisis situation on the mental health of older adults.
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Affiliation(s)
- S Caillot-Ranjeva
- Valérie Bergua, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 146 rue Léo Saignat, CS61292, F-33076 Bordeaux Cedex, France, Phone: 0033 5 57 57 56 44 / Fax: 0033 5 57 57 14 86
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Kanumuri M, Khan A, Neshat A, Alapati G, Mulaka GSR, Nisar N, Batool S, Arti F. Comparison of Risk of Stroke in Patients With and Without Depression: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53057. [PMID: 38410306 PMCID: PMC10896251 DOI: 10.7759/cureus.53057] [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] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Individuals with depression face an elevated stroke risk, marked by an unfavorable prognosis. This meta-analysis aims to determine the impact of depression on stroke risk. The current meta-analysis was conducted using the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We selected studies through a systematic review of electronic databases, including PubMed, EMBASE, and CINAHL from January 2011 to January 2023. Google Scholar was utilized to identify supplementary studies. Furthermore, we scrutinized citation lists of reported articles for additional potential studies. Only English-language articles were included in the review. A total of 15 studies were included in this meta-analysis. The pooled sample size was 744,179. Sample size of the included studies ranged from 560 to 487,377. The pooled estimate of 15 studies showed that the risk of stroke was 1.47 times higher in individuals with depression compared to the individuals without depression, and the difference is statistically significant (RR: 1.47, 95% CI: 1.30 to 1.66, p-value<0.001). Age and hypertension emerged as significant predictors of stroke risk in depressed individuals identified through meta-regression. These findings underscore the importance of targeted preventive strategies for depression-related stroke risk, especially considering age-specific considerations and associated factors.
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Affiliation(s)
- Manisha Kanumuri
- Psychiatry, MediCiti Institute of Medical Sciences, Hyderabad, IND
| | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
| | - Asfia Neshat
- Internal Medicine, Connolly Hospital, Dublin, IRL
| | - Goutham Alapati
- Oncology, St. Martinus University Faculty of Medicine, Willemstad, CUW
| | | | - Nimra Nisar
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
| | - Fnu Arti
- Medicine, Muhammad Mahar Medical College, Sukkur, PAK
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Cai W, Ma W, Mueller C, Stewart R, Ji J, Shen WD. Association between late-life depression or depressive symptoms and stroke morbidity in elders: A systematic review and meta-analysis of cohort studies. Acta Psychiatr Scand 2023; 148:405-415. [PMID: 37728003 DOI: 10.1111/acps.13613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Whether late-life depression or depressive symptoms are a risk factor of future stroke in elders is important for prevention measures. A systematic review and meta-analysis were used to investigate the association between depression or depressive symptoms and risk of stroke in elders. METHODS Embase, MEDLINE, PsychINFO, and Web of Science were searched for studies published from inception to January 6, 2023. Prospective cohort studies reporting quantitative estimates of the association between depression or depressive symptoms and stroke morbidity in participants aged over 60 years were included. Reviews, meta-analyses, case reports, retrospective, cross-sectional, and theoretical studies were excluded. Study screening and data extraction were conducted by two researchers independently. Random-effects meta-analysis was used to estimate pooled adjusted hazard ratios (HRs). Publication bias was evaluated via the symmetry of funnel plots and Egger tests. The Newcastle Ottawa Scale was used to assess the risk of bias. The quality of evidence of synthesis was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcome was any stroke, including non-fatal, fatal, ischemic and hemorrhagic sub-types. RESULTS Seventeen studies of 57,761 patients in total were included in the meta-analysis. A positive association was found between depressive disorder or symptoms and stroke risk (HR: 1.39; 95% CI: 1.22-1.58; p < 0.001). CONCLUSIONS Late-life depression or depressive symptoms are a significant risk factor for stroke in older people. Regular assessment and more effective management of associated comorbidities are recommended to reduce stroke risk.
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Affiliation(s)
- Wa Cai
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Ma
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychological Medicine and Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychological Medicine and Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jun Ji
- Department of Acupuncture Literature, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Wei-Dong Shen
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Barlet BD, Hauson AO, Pollard AA, Zhang EZ, Nemanim NM, Sarkissians S, Lackey NS, Stelmach NP, Walker AD, Carson BT, Flora-Tostado C, Reszegi K, Allen KE, Viglione DJ. Neuropsychological Performance in Alzheimer's Disease versus Late-Life Depression: A Systematic Review and Meta-Analysis. Arch Clin Neuropsychol 2023; 38:991-1016. [PMID: 37332152 DOI: 10.1093/arclin/acad036] [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: 04/14/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE Despite decades of research, neuropsychological tests (NPTs) that clearly differentiate between Alzheimer's disease (AD) and late-life depression (LLD) have yet to be agreed upon. Given this gap in knowledge and the rapid deployment of disease-modifying drugs for the two disorders, accurate clinical diagnosis using evidence-based assessment is essential. This study aims to systematically examine the literature to identify NPTs that would be able to differentiate AD and LLD. METHOD Databases and bibliographies were searched to identify articles for analysis. Two major inclusion criteria were that the studies compared neuropsychological functioning of AD versus LLD using normed NPTs and provided data for effect size calculation. Risk of bias was minimized by having independent coders for all steps in the review. RESULTS Forty-one studies met inclusion criteria (N = 2,797) and provided effect sizes for tests that were classified as belonging to 15 domains of functioning. The two groups were well differentiated by tasks of delayed contextual verbal memory as compared to immediate or non-contextual memory, recognition cueing, confrontation naming, visuospatial construction, and conceptualization. Specific NPTs that appear to be useful for differential diagnosis include the Rey Auditory Verbal Learning Test-Delayed Recognition; Boston Naming Test; the Dementia Rating Scale's memory, conceptualization, and construction subscales; and the CERAD Constructional Praxis. CONCLUSIONS The NPTs highlighted in this systematic review could be used as a relatively simple and cost-effective method to differentiate between patients with cognitive dysfunction due to AD versus LLD.
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Affiliation(s)
- Brianna D Barlet
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Alexander O Hauson
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Anna A Pollard
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Emily Z Zhang
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Natasha M Nemanim
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Sharis Sarkissians
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Nick S Lackey
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Nicholas P Stelmach
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Alyssa D Walker
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Bryce T Carson
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Christopher Flora-Tostado
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Katalin Reszegi
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Kenneth E Allen
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINs.org), San Diego, CA 92105, USA
| | - Donald J Viglione
- Clinical Psychology PhD Program, California School of Professional Psychology, San Diego, CA 92131, USA
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Saracino RM, Tobias KG, Shuk E, Avildsen I, Emanu J, Demirjian C, Rosenfeld B, Roth AJ, Alici Y, Nelson CJ. On taking up space: a qualitative inquiry of depression in older adults with cancer. Aging Ment Health 2023; 27:1744-1751. [PMID: 36907588 PMCID: PMC10495533 DOI: 10.1080/13607863.2023.2187758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To identify the phenomenology of depression in older adults with cancer (OACs) in order to improve the accuracy of depression screening for this population. METHOD Inclusion criteria were: ≥70 years old, history of cancer, no cognitive impairment or severe psychopathology. Participants completed a demographic questionnaire, a diagnostic interview, and a qualitative interview. Using a Thematic Content Analysis framework, critical themes, passages, and phrases used by patients to describe their perceptions of depression and how it is experienced were identified. Particular attention was paid to divergences between depressed and non-depressed participants. RESULTS Among 26 OACs (13 depressed, 13 non-depressed), qualitative analyses revealed four major themes indicative of depression (i.e. anhedonia, reduction in social relationships/loneliness, lack of meaning and purpose, lack of usefulness/feeling like a burden) and four minor themes (i.e. attitude towards treatment, mood, regret/guilt, physical symptoms/limitations). Themes of adaptation and acceptance of symptoms also emerged. CONCLUSIONS Of the eight themes identified, only two overlap with DSM criteria. This supports the need to develop assessment methods of depression in OACs that are less reliant on DSM criteria and distinct from existing measures. This may improve the ability to identify depression in this population.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristen G Tobias
- Department of Psychology, Fordham University, The Bronx, NY, USA
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Isabelle Avildsen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Emanu
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caraline Demirjian
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, The Bronx, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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6
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Yu S, Wang X, Lv L, Liu T, Guan Q. Borneol-modified PEGylated graphene oxide as a nanocarrier for brain-targeted delivery of ginsenoside Rg1 against depression. Int J Pharm 2023; 643:123284. [PMID: 37527732 DOI: 10.1016/j.ijpharm.2023.123284] [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] [Received: 05/05/2023] [Revised: 07/07/2023] [Accepted: 07/29/2023] [Indexed: 08/03/2023]
Abstract
Depression is a chronic mental disorder which threatens human health and lives. However, the treatment of depression remains challenging largely due to blood brain barrier (BBB), which restricts drugs from entering the brain, resulting in a poor distribution of antidepressants in the brain. In this work, a novel brain-targeted drug delivery system was developed based on borneol-modified PEGylated graphene oxide (GO-PEG-BO). GO-PEG-BO was characterized and proved to possess excellent biocompatibility. By incorporating borneol, GO-PEG-BO could penetrate BBB efficiently by opening tight junctions and inhibiting the efflux system of BBB. The targeted distribution of GO-PEG-BO in the brain was observed by an in vivo biodistribution study. Moreover, GO-PEG-BO exhibited a neuroprotective effect, which is beneficial to the treatment of depression. Ginsenoside Rg1 (GRg1), which can relieve depressive symptoms but difficult to cross BBB, was loaded to GO-PEG-BO for the therapy of depression. In depressive rats, GRg1/GO-PEG-BO improved stress-induced anhedonia, despair and anxiety, and comprehensively relieved the depressive symptoms. In conclusion, GO-PEG-BO could serve as a promising nanocarrier for brain-targeted drug delivery, and provide a new strategy for the therapy of depression.
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Affiliation(s)
- Shangmin Yu
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jilin University, 1266 Fujin Road, Changchun, Jilin 130021, China; Department of Pharmaceutics, School of Pharmacy, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui 233000, China
| | - Xinying Wang
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jilin University, 1266 Fujin Road, Changchun, Jilin 130021, China
| | - Linlin Lv
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jilin University, 1266 Fujin Road, Changchun, Jilin 130021, China
| | - Tongyan Liu
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jilin University, 1266 Fujin Road, Changchun, Jilin 130021, China
| | - Qingxiang Guan
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jilin University, 1266 Fujin Road, Changchun, Jilin 130021, China.
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Robinson RG, Jorge RE, Starkstein SE. Poststroke Depression: An Update. J Neuropsychiatry Clin Neurosci 2023; 36:22-35. [PMID: 37559511 DOI: 10.1176/appi.neuropsych.21090231] [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] [Indexed: 08/11/2023]
Abstract
The presence of neuropsychiatric disorders after stroke has been recognized for more than 100 years, but controlled systematic studies did not begin until the 1970s. The most clinically important advances, however, have been in the treatment and prevention of poststroke depression (PSD). Recent meta-analyses of randomized controlled trials (RCTs) for the treatment of PSD have demonstrated the efficacy of antidepressants. Similarly, RCTs for the prevention of PSD have shown that antidepressants significantly decrease the incidence of PSD compared with placebo. Early treatment of PSD with antidepressants also appears to enhance both physical and cognitive recovery from stroke and may increase survival up to 10 years. Genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission may be relevant etiological factors.
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Affiliation(s)
- Robert G Robinson
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
| | - Ricardo E Jorge
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
| | - Sergio E Starkstein
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
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Devita M, De Salvo R, Ravelli A, De Rui M, Coin A, Sergi G, Mapelli D. Recognizing Depression in the Elderly: Practical Guidance and Challenges for Clinical Management. Neuropsychiatr Dis Treat 2022; 18:2867-2880. [PMID: 36514493 PMCID: PMC9741828 DOI: 10.2147/ndt.s347356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Depression is one of the most common mood disorders in the late-life population and is associated with poor quality of life and increased morbidity, disability and mortality. Nevertheless, in older adults, it often remains undetected and untreated. This narrative review aims at giving an overview on the main definitions, clinical manifestations, risk and protective factors for depression in the elderly, and at discussing the main reasons for its under/misdiagnosis, such as cognitive decline and their overlapping symptomatology. A practical approach for the global and multidisciplinary care of the older adult with depression, derived from cross-checking evidence emerging from the literature with everyday clinical experience, is thus provided, as a short and flexible "pocket" guide to orient clinicians in recognizing, diagnosing and treating depression in the elderly.
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Affiliation(s)
- Maria Devita
- Department of General Psychology (DPG), University of Padua, Padua, Italy.,Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Rossella De Salvo
- Department of General Psychology (DPG), University of Padua, Padua, Italy
| | - Adele Ravelli
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Marina De Rui
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Alessandra Coin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Giuseppe Sergi
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology (DPG), University of Padua, Padua, Italy
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Tetsuka S. Depression and Dementia in Older Adults: A Neuropsychological Review. Aging Dis 2021; 12:1920-1934. [PMID: 34881077 PMCID: PMC8612610 DOI: 10.14336/ad.2021.0526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 01/23/2023] Open
Abstract
Depression and dementia are the most common neuropsychiatric disorders in the older adult population. There are a certain number of depressed patients who visit outpatient clinics because they suspect dementia due to similarities in the clinical symptoms in both disorders. Depressive symptoms associated with dementia may be diagnosed with depression, and treatment with antidepressants is continued for a long time. Depression and dementia differ in their treatment approaches and subsequent courses, and it is necessary to carefully differentiate between the two in the clinical practice of dementia treatment. In this review, I describe the similarities between depression and dementia and how to differentiate depression in dementia treatment based on the differences and emphasize that there is a significant potential to cure depression, in contrast to dementia, for which there is currently no fundamental therapy. Therefore, it is important to recognize that depression and dementia may present with common symptoms and to appropriately differentiate depressed patients who are suspected of having dementia. Dementia is a disorder in which cognitive dysfunction is caused by a variety of causative diseases and conditions, resulting in impairment of activities of daily living. However, current medical science has had difficulty finding a cure for the causative disease. Based on clinical findings, it has also been shown that the degree of symptoms for preexisting psychiatric disorders is alleviated as the brain ages. In the presence of dementia, the speed of the alleviation will increase. The importance of focusing on the positive aspects of aging is also discussed.
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Affiliation(s)
- Syuichi Tetsuka
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, 329-2763, Japan
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Bridging late-life depression and chronic somatic diseases: a network analysis. Transl Psychiatry 2021; 11:557. [PMID: 34718326 PMCID: PMC8557204 DOI: 10.1038/s41398-021-01686-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 01/07/2023] Open
Abstract
The clinical presentation of late-life depression is highly heterogeneous and likely influenced by the co-presence of somatic diseases. Using a network approach, this study aims to explore how depressive symptoms are interconnected with each other, as well as with different measures of somatic disease burden in older adults. We examined cross-sectional data on 2860 individuals aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, Stockholm. The severity of sixteen depressive symptoms was clinically assessed with the Comprehensive Psychopathological Rating Scale. We combined data from individual clinical assessment and health-registers to construct eight system-specific disease clusters (cardiovascular, neurological, gastrointestinal, metabolic, musculoskeletal, respiratory, sensory, and unclassified), along with a measure of overall somatic burden. The interconnection among depressive symptoms, and with disease clusters was explored through networks based on Spearman partial correlations. Bridge centrality index and network loadings were employed to identify depressive symptoms directly connecting disease clusters and depression. Sadness, pessimism, anxiety, and suicidal thoughts were the most interconnected symptoms of the depression network, while somatic symptoms of depression were less interconnected. In the network integrating depressive symptoms with disease clusters, suicidal thoughts, reduced appetite, and cognitive difficulties constituted the most consistent bridge connections. The same bridge symptoms emerged when considering an overall measure of somatic disease burden. Suicidal thoughts, reduced appetite, and cognitive difficulties may play a key role in the interconnection between late-life depression and somatic diseases. If confirmed in longitudinal studies, these bridging symptoms could constitute potential targets in the prevention of late-life depression.
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Lauderdale SA, Martin KJ, Oakes KR, Moore JM, Balotti RJ. Pragmatic Screening of Anxiety, Depression, Suicidal Ideation, and Substance Misuse in Older Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Gudayol-Ferré E, Duarte-Rosas P, Peró-Cebollero M, Guàrdia-Olmos J. THE EFFECT OF SECOND-GENERATION ANTIDEPRESSANT TREATMENT ON THE EXECUTIVE FUNCTIONS OF PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS STUDY WITH STRUCTURAL EQUATION MODELS. Psychiatry Res 2021; 296:113690. [PMID: 33387749 DOI: 10.1016/j.psychres.2020.113690] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
Major depressive disorder (MDD) has been linked to executive functions (EF) deficits that can be improved after pharmacological treatment, but it is unclear whether there is a class of antidepressants that is more effective than others to ameliorate these deficits in MDD. Additionally, the possible effects of clinical and demographic variables on the improvement of MDD EF deficits after pharmacological treatment are currently unknown. Our aim was to study the possible neuropsychological effects of second-generation antidepressant classes on the EF of MDD patients and the potential influence of clinical and demographic variables as moderators of these effects through a meta-analytic approach. Twenty-one papers were included in our study. A structural equation model meta-analysis was performed. The improvement of EF after pharmacological treatment is clinically relevant, but it is incomplete. This effect is influenced by age and years of education of the patients. Selective serotonin reuptake inhibitors (SSRIs) and dual inhibitors are the drugs causing the greatest improvement in EF of MDD patients. Antidepressant class is an important variable linked to EF improvement after MDD treatment, but the degree of improvement in these cognitive functions is strongly influenced by some clinical and demographic variables of patients with depression.
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Affiliation(s)
- Esteve Gudayol-Ferré
- Facultad de Psicología. Universidad Michoacana San Nicolás de Hidalgo, Morelia, México.
| | - Patricia Duarte-Rosas
- Doctorado de Psicología Clínica y de la Salud. Facultat de Psicologia. Universitat de Barcelona, Barcelona Spain
| | - Maribel Peró-Cebollero
- Facultat de Psicologia, Institut de Neurociències, UB Institute of Complex Systems, Universitat de Barcelona, Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Facultat de Psicologia, Institut de Neurociències, UB Institute of Complex Systems, Universitat de Barcelona, Barcelona, Spain
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13
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Triolo F, Harber-Aschan L, Belvederi Murri M, Calderón-Larrañaga A, Vetrano DL, Sjöberg L, Marengoni A, Dekhtyar S. The complex interplay between depression and multimorbidity in late life: risks and pathways. Mech Ageing Dev 2020; 192:111383. [DOI: 10.1016/j.mad.2020.111383] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
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14
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Saracino RM, Cham H, Rosenfeld B, Nelson CJ. Confirmatory Factor Analysis of the Center for Epidemiologic Studies Depression Scale in Oncology With Examination of Invariance Between Younger and Older Patients. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020; 36:229-236. [PMID: 32684745 DOI: 10.1027/1015-5759/a000510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Accurate measurement of depressive symptoms in the cancer setting is critical for ensuring optimal quality of life and patient outcomes. The present study compared the one-factor, correlated two-factor, correlated four-factor, and second-order factor models of the Center for Epidemiologic Studies Depression Scale (CES-D), a commonly used measure in oncology settings. Given the importance of adequate psychometric performance of the CES-D across age groups, a second aim was to examine measurement invariance between younger and older adults with cancer. Participants (N = 663) were recruited from outpatient clinics at a large cancer center. Over one-fourth of the sample endorsed clinically significant depressive symptoms (25.9%, n = 165). Confirmatory factor analysis of the CES-D supported the hypothesized correlated four-factor model as the best fit. The second-order factor also demonstrated good fit, but interpretations of the factors were more complex. Factors were highly correlated (range = .38-.91). There was also support for full scalar invariance between age groups, suggesting that regardless of age, respondents endorse the same response category for the same level of the latent trait (i.e., depression) on the CES-D. Taken together, the results suggest that the CES-D is a viable depression screening option for oncology settings and does not require scoring adjustments for respondent age.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Psychology, Fordham University, Bronx, NY, USA
| | - Heining Cham
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Barry Rosenfeld
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Psychology, Fordham University, Bronx, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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The Effect of Second-Generation Antidepressant Treatment on the Memory of Patients With Major Depressive Disorder: A Meta-analysis Study With Structural Equation Models. J Clin Psychopharmacol 2020; 40:54-62. [PMID: 31834095 DOI: 10.1097/jcp.0000000000001150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been linked to episodic memory deficits that may be improved after pharmacological treatment, but it is unclear whether there is a class of antidepressants that is more effective than others to ameliorate these deficits in MDD. In addition, the possible effects of clinical and sociodemographic variables on the improvement of MDD memory deficits after pharmacological treatment are currently unknown. Our aims are to study the possible neuropsychological effects of second-generation antidepressant classes on the episodic memory of MDD patients and to study the potential effects of clinical and demographic variables as moderators of the effects of antidepressants on the memory of depressed patients through a meta-analysis approach. PROCEDURES Nine articles were included in our study. A structural equation model meta-analysis was performed. RESULTS Our results suggest that selective serotonin reuptake inhibitors and serotonine-noradrenaline reuptake inhibitors would bring about a substantial improvement in the memory of depressed patients, whereas other antidepressant classes would cause rather modest effects. Our results also suggest that clinical and demographic variables play a very important role as mediators of memory improvement after MDD treatment. Thus, a relatively low level of symptom severity, a high degree of clinical improvement, a younger age, and more years of education were positively related to memory improvement after MDD treatment. CONCLUSIONS Although antidepressant class is an important variable linked to memory improvement in MDD, overall, the degree of memory amelioration in depression is very closely related to clinical and demographic variables of patients with depression.
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16
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Williamson V, Harwood H, Greenberg K, Stevelink SAM, Greenberg N. The impact of military service on the mental health of older UK veterans: A qualitative study. Int J Geriatr Psychiatry 2019; 34:1412-1420. [PMID: 31034673 DOI: 10.1002/gps.5131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/20/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND There may be ongoing psychological problems associated with military service later in life; yet as the elderly in the general population also suffer from mental health problems, whether such issues can be attributed to military service or are a feature of ageing remains unclear. This study aimed to explore veteran and nonveteran perceptions of the impact of their occupation on their psychological well-being later in life. METHODS Twenty-five veterans (≥65 y); 25 nonveterans (≥65 y); 10 veterans with diagnoses of mental health issues (≥65 y); and a close companion of all participants (≥18 y, spouse, child, and close friend) were recruited. Using a qualitative approach, participants completed semistructured qualitative interviews with measures of psychological adjustment used to describe the sample. RESULTS Veterans were found to experience higher levels of workplace stress and trauma exposure compared with nonveterans. When such challenges were positively appraised, veterans described increased confidence and resilience. Social support in response to occupational stress was central to veteran and nonveteran well-being, especially for those with mental health problems. Nonetheless, providing support was challenging for close companions, with many feeling overwhelmed and requiring additional guidance from the veteran's clinical care team. CONCLUSIONS The findings delineate the impact of occupation on the well-being of older veterans and nonveterans. The results illustrated the psychological support needs and formal guidance desired by veterans, nonveterans, and their families, which could ultimately improve coping of both the individual and family.
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Affiliation(s)
- Victoria Williamson
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - Hannah Harwood
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - Karla Greenberg
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
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17
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Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S, Härkönen P, Jurvelin H, Suija K. Validation of the Zung self-rating depression scale (SDS) in older adults. Scand J Prim Health Care 2019; 37:353-357. [PMID: 31286810 PMCID: PMC6713148 DOI: 10.1080/02813432.2019.1639923] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: The main objective of this study was to investigate the psychometric properties of the Zung Self-Rating Depression Scale (SDS) and evaluate screening parameters capability of the SDS with the Beck Depression Inventory (BDI-21) among the elderly population. Design: A population-based study Setting: Community Subjects: 520 adults, aged 72-73 years, living in the city of Oulu, Finland. Main outcome measures: The screening parameters of the SDS questions and BDI-21 for detecting severity of depression. The Mini Neuropsychiatric Interview for diagnosing major depression. Results: The optimal cut-off point for the SDS was 39. The sensitivity and specificity parameters for this cut-off point were 79.2% (95% CI 57.8-92.9) and 72.2% (95% CI 67.9-76.1), respectively. Positive and negative predictive values were 12.5% (95% CI 7.7-18.8) and 98.6% (95% CI 96.7-99.5), respectively. Moreover, there was no statistically significant difference in diagnostic accuracy indices of the cut-off points 39 and 40. In a receiver operating characteristic analysis, the area under the curve was 0.85 (95%CI 0.77-0.92) for the SDS total score and 0.89 (95% CI 0.83-0.96) for the BDI-21 (p = 0.137). Conclusion: Using the traditional cut-off point, the SDS was convenient for identifying clinically meaningful depressive symptoms in an elderly Finnish population when compared with the BDI-21 which is one of the most commonly used depression screening scales. The sensitivity and specificity of these two screening tools are comparable. Based on our study, the SDS is convenient for identifying clinically meaningful depressive symptoms among older adults at the community level. Key points The widely used Zung Self-Rating Depression Scale (SDS) has not previously been validated among elderly people at the community level. The sensitivity and specificity of SDS (cut-off point 39) were 79.2% and 72.2%. The positive and negative predictive values for SDS were 12.5% and 98.6%. SDS is convenient for identifying major depression in an elderly population and regarding sensitivity and specificity comparable to BDI-21.
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Affiliation(s)
- Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland;
- CONTACT Jari Jokelainen Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Unit of General Practice, Oulu University Hospital, P.O. Box 10, FI-90029 Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland;
- Health Center of Oulu, Oulu, Finland;
| | - Pirjo Härkönen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
| | - Heidi Jurvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
| | - Kadri Suija
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
- Department of Family Medicine, University of Tartu, Tartu, Estonia
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18
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Saracino RM, Nelson CJ. Identification and treatment of depressive disorders in older adults with cancer. J Geriatr Oncol 2019; 10:680-684. [PMID: 30797709 DOI: 10.1016/j.jgo.2019.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 01/07/2023]
Abstract
The increasing number of older adults living with cancer will inevitably include vulnerable subgroups who experience a range of depressive symptoms throughout the care continuum. It is well established that depression can lead to decreased quality of life, poor treatment adherence, increased length of hospital stay and health service utilization, and in severe cases, suicide. Thus, clinicians working in oncology must be able to identify, conceptualize, and treat (or connect to services) the mental health concerns of their older patients. This brief review describes the unique etiologies, features, and treatments for depressive syndromes among older adults in the oncology setting, drawing on the literature and prevailing depression management guidelines from both psycho-oncology and geriatric depression research.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
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19
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Saracino RM, Cham H, Rosenfeld B, J Nelson C. Latent Profile Analyses of Depressive Symptoms in Younger and Older Oncology Patients. Assessment 2018; 27:1383-1398. [PMID: 29947548 DOI: 10.1177/1073191118784653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aging of America will include a significant increase in the number of older patients with cancer, many of whom will experience significant depressive symptoms. Although geriatric depression is a well-studied construct, its symptom presentation in the context of cancer is less clear. Latent profile analysis was conducted on depressive symptoms in younger (40-64 years) and older (≥65 years) patients with cancer (N = 636). The sample was clinically heterogeneous (i.e., included all stages, dominated by advanced stage disease). Participants completed questionnaires including the Center for Epidemiological Studies Depression Scale, which was used for the latent profile analysis. A four-class pattern was supported for each age group. However, the four-class pattern was significantly different between the younger and older groups in terms of the item means within each corresponding latent class; differences were primarily driven by severity such that across classes, older adults endorsed milder symptoms. An unexpected measurement issue was uncovered regarding reverse-coded items, suggesting that they may generate unreliable scores on the Center for Epidemiological Studies Depression Scale for a significant subset of patients. The results indicate that cancer clinicians can expect to see depressive symptoms along a continuum of severity for patients of any age, with less severe symptoms among older patients.
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Affiliation(s)
- Rebecca M Saracino
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Fordham University, Bronx, NY, USA
| | | | - Barry Rosenfeld
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Fordham University, Bronx, NY, USA
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20
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Williamson V, Stevelink SAM, Greenberg K, Greenberg N. Prevalence of Mental Health Disorders in Elderly U.S. Military Veterans: A Meta-Analysis and Systematic Review. Am J Geriatr Psychiatry 2018; 26:534-545. [PMID: 29221697 DOI: 10.1016/j.jagp.2017.11.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/09/2017] [Accepted: 11/01/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Older veterans may be vulnerable to mental health problems. Meta-analytic and systematic review methods sought to determine the prevalence rate of mental health disorders in older military veterans (≥65 years). METHODS Eleven studies were eligible, and meta-analyses of veteran depression, substance abuse, post-traumatic stress disorder (PTSD), anxiety, dementia, bipolar disorder, and schizophrenia were conducted. RESULTS Although conducted exclusively with U.S. veterans, high prevalence rates of substance (5.7%) and alcohol use disorders (5.4%) in older veterans were found. However, the prevalence of other mental health disorders, including PTSD and depression, in older veterans was not markedly high. CONCLUSION The rates of disorder prevalence observed indicates a need for continued awareness of mental health difficulties, particularly substance and alcohol use disorders, in older veterans. In the future studies with non-U.S. military samples using a longitudinal design are required to further understand the prevalence of mental health disorders in geriatric veterans.
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Affiliation(s)
- Victoria Williamson
- King's Centre for Military Health Research, King's College London, London, United Kingdom.
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Karla Greenberg
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, United Kingdom
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21
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Lee H, Seol KH, Kim JW. Age and sex-related differences in risk factors for elderly suicide: Differentiating between suicide ideation and attempts. Int J Geriatr Psychiatry 2018; 33:e300-e306. [PMID: 28967671 DOI: 10.1002/gps.4794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/10/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the age and sex-related differences in socio-demographic factors that influence suicide ideation and attempts in the elderly. METHODS The total number of subjects was 93 151, of whom 8441 belonged to the high suicide-risk group (2064 male; 6377 female). Following this identification, we investigated their socio-demographic information, health status, and depressive symptoms, which might have influenced their suicide ideation and attempts. RESULTS Residence in an urban area was identified as a risk factor for both male and female elderly in their 60s and 70s and female elderly in their 80s. Marital status showed a different influence on suicide ideation depending on age and sex. A negative perception of one's own health status was a significant risk factor that increased the likelihood of suicide ideation in all ages, except the female elderly in their 60s. No factor was identified that significantly influenced suicide attempts in the male elderly. However, in the female elderly, residence in an urban area and a negative perception of one's own health status were identified as significant risk factors. CONCLUSIONS This study revealed that factors known to influence suicide ideation in the elderly from previous studies, such as residence area, separation from a spouse, education level, religion, and drinking, show changed influence as the elderly reach their 70s and 80s. However, a negative perception of one's own health status was a risk factor that encompassed most ages and sexes.
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Affiliation(s)
- Hyuk Lee
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea.,Medical Unit of the 7th Division, Korea Army, Hwacheon, Republic of Korea
| | - Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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22
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Charlton RA, Lamar M, Zhang A, Ren X, Ajilore O, Pandey GN, Kumar A. Associations between pro-inflammatory cytokines, learning, and memory in late-life depression and healthy aging. Int J Geriatr Psychiatry 2018; 33:104-112. [PMID: 28271543 PMCID: PMC7297321 DOI: 10.1002/gps.4686] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/24/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Pro-inflammatory cytokines may play a role in learning and memory difficulties and may be exacerbated in late-life depression (LLD), where pro-inflammatory markers are already elevated because of aging and age-related vascular risk. METHODS Learning and memory, and pro-inflammatory cytokines-Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and Interleukin-6 (IL-6) were measured in 24 individuals with LLD and 34 healthy older adults (HOA). Hippocampal volumes were segmented using Freesurfer software. RESULTS Pro-inflammatory cytokines were higher in LLD compared with HOA. Regression analyses demonstrated that educational level and right hippocampal volume significantly contributed to explaining the variance in learning. For memory performance, educational level, right hippocampal volume and a group-by-IL-6 interaction significantly contributed to the model. CONCLUSIONS High levels of IL-6 impact cognition in LLD but not HOA. Results suggest that high levels of inflammation alone are not sufficient to account for cognitive difficulties, but may interact with other factors in at-risk populations like LLD, to contribute to memory difficulties. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rebecca A. Charlton
- Department of Psychology, Goldsmiths University of London, London, UK,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Melissa Lamar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Xinguo Ren
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Ghanshyam N. Pandey
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL,Department of Pharmacology, University of Illinois at Chicago, Chicago, IL
| | - Anand Kumar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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23
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Scholz B, Crabb S, Wittert GA. "Males Don't Wanna Bring Anything Up To Their Doctor": Men's Discourses of Depression. QUALITATIVE HEALTH RESEARCH 2017; 27:727-737. [PMID: 27055495 DOI: 10.1177/1049732316640294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Men experiencing depression may present with externalizing behaviors including avoidance, getting angry, or finding distractions rather than seeking help. General practitioners report that depression is harder to diagnose in men than in women. Research has not typically focused on men's accounts of depression; thus, the current study uses an exploratory design to better understand men's subjectivities of depression. A thematic framework informed the analysis of interviews with 10 men who had experienced high levels of depressive symptoms at least once within the prior 5 years, with two overarching discourses of depression discussed. The first relates to links between depression and health, including comorbid illnesses. The second relates to social contexts in which depression is experienced. These findings extend upon previous research suggesting medical practitioners have difficulty with competing biomedical and social discourses of depression, highlighting the importance of continuing to improve understandings of men's depression discourses.
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Affiliation(s)
- Brett Scholz
- 1 University of Canberra, Bruce, Australia
- 2 The University of Adelaide, Adelaide, Australia
- 3 Spur Projects, Brisbane, Queensland, Australia
| | - Shona Crabb
- 2 The University of Adelaide, Adelaide, Australia
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24
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Diniz BS, Reynolds CF, Sibille E, Lin CW, Tseng G, Lotrich F, Aizenstein HJ, Butters MA. Enhanced Molecular Aging in Late-Life Depression: the Senescent-Associated Secretory Phenotype. Am J Geriatr Psychiatry 2017; 25:64-72. [PMID: 27856124 PMCID: PMC5164865 DOI: 10.1016/j.jagp.2016.08.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aims to investigate whether a systemic molecular pattern associated with aging (senescent-associated secretory phenotype [SASP]) is elevated in adults with late-life depression (LLD), compared with never-depressed elderly comparison participants. DESIGN Cross-sectional study. PARTICIPANTS We included 111 older adults (80 with LLD and 31 comparison participants) in this study. MEASUREMENT A panel of 22 SASP-related proteins was extracted from a previous multiplex protein panel performed in these participants. We conducted a principal component analysis to create the SASP index based on individual weights of each of protein. RESULTS Participants with LLD showed a significantly increased SASP index compared with comparison participants, after controlling for age, depressive symptoms, medical comorbidity (CIRS-G) scores, sex, and cognitive performance (F(1,98) = 7.3, p = 0.008). Correlation analyses revealed that the SASP index was positively correlated with age (r = 0.2, p = 0.03) and CIRS score (r = 0.27, p = 0.005), and negatively correlated with information processing speed (r = -0.34, p = 0.001), executive function (r = -0.27, p = 0.004) and global cognitive performance (r = -0.28, p = 0.007). CONCLUSIONS To the best of our knowledge, this is the first study to show that a set of proteins (i.e., SASP index) primarily associated with cellular aging is abnormally regulated and elevated in LLD. These results suggest that individuals with LLD display enhanced aging-related molecular patterns that are associated with higher medical comorbidity and worse cognitive function. Finally, we provide a set of proteins that can serve as potential therapeutic targets and biomarkers to monitor the effects of therapeutic or preventative interventions in LLD.
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Affiliation(s)
- Breno Satler Diniz
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX.
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Etienne Sibille
- Departments of Psychiatry and of Pharmacology and Toxicology, Campbell Family Mental Health Research Institute of CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Chien-Wei Lin
- Department of Statistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - George Tseng
- Department of Statistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Francis Lotrich
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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25
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Saracino RM, Rosenfeld B, Nelson CJ. Towards a new conceptualization of depression in older adult cancer patients: a review of the literature. Aging Ment Health 2016; 20:1230-1242. [PMID: 26312455 PMCID: PMC4925309 DOI: 10.1080/13607863.2015.1078278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer. METHOD PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer. RESULTS The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms. CONCLUSIONS Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.
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Affiliation(s)
- Rebecca M. Saracino
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA,Corresponding author.
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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26
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Jonsson U, Bertilsson G, Allard P, Gyllensvärd H, Söderlund A, Tham A, Andersson G. Psychological Treatment of Depression in People Aged 65 Years and Over: A Systematic Review of Efficacy, Safety, and Cost-Effectiveness. PLoS One 2016; 11:e0160859. [PMID: 27537217 PMCID: PMC4990289 DOI: 10.1371/journal.pone.0160859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/26/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives Depression in elderly people is a major public health concern. As response to antidepressants is often unsatisfactory in this age group, there is a need for evidence-based non-pharmacological treatment options. Our objectives were twofold: firstly, to synthesize published trials evaluating efficacy, safety and cost-effectiveness of psychological treatment of depression in the elderly and secondly, to assess the quality of evidence. Method The electronic databases PubMed, EMBASE, Cochrane Library, CINAL, Scopus, and PsycINFO were searched up to 23 May 2016 for randomized controlled trials (RCTs) of psychological treatment for depressive disorders or depressive symptoms in people aged 65 years and over. Two reviewers independently assessed relevant studies for risk of bias. Where appropriate, the results were synthesized in meta-analyses. The quality of the evidence was graded according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results Twenty-two relevant RCTs were identified, eight of which were excluded from the synthesis due to a high risk of bias. Of the remaining trials, six evaluated problem-solving therapy (PST), five evaluated other forms of cognitive behavioural therapy (CBT), and three evaluated life review/reminiscence therapy. In frail elderly with depressive symptoms, the evidence supported the efficacy of PST, with large but heterogeneous effect sizes compared with treatment as usual. The results for life-review/reminiscence therapy and CBT were also promising, but because of the limited number of trials the quality of evidence was rated as very low. Safety data were not reported in any included trial. The only identified cost-effectiveness study estimated an incremental cost per additional point reduction in Beck Depression Inventory II score for CBT compared with talking control and treatment as usual. Conclusion Psychological treatment is a feasible option for frail elderly with depressive symptoms. However, important questions about efficacy, generalizability, safety and cost-effectiveness remain.
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Affiliation(s)
- Ulf Jonsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroscience, Child and adolescent psychiatry, Uppsala University, Uppsala, Sweden
- National Board of Health and Welfare, Stockholm, Sweden
- * E-mail:
| | - Göran Bertilsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Per Allard
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Harald Gyllensvärd
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, Mälardalen, Våsterås, Sweden
| | - Anne Tham
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Abstract
Depression is among the most frequent psychiatric comorbid conditions in dementia. There is no strong consensus as to what criteria should be used to diagnose depression in AD. This is at least partially explained by the overlap between symptoms of depression and symptoms of AD. Recent studies using latent class analysis provided clarification to this diagnostic dilemma. All nine DSM-IV symptoms of major depression were found to characterize a class with a high chance (96% ) of having a clinical diagnosis of major depression, and symptoms of anxiety were also frequent. Other psychiatric symptoms may also be included under the construct of depression in AD, since both apathy and anxiety are among the most frequent comorbid conditions for major depression in AD. Subtypes of depression should also be validated in this condition. For instance, increased awareness of cognitive and functional deficits is significantly associated with dysthymia but not with major depression, suggesting that different depressive syndromes in AD may have different etiology.
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Affiliation(s)
- Filipa Novais
- Serviço de Psiquiatria e Saúde Mental, Departamento de Neurociências, Hospital de Santa Maria, Lisboa, Portugal
| | - Sergio Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia, and Fremantle Hospital, Fremantle, Western Australia
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DiNapoli EA, Cully JA, Wayde E, Sansgiry S, Yu HJ, Kunik ME. Age as a predictive factor of mental health service use among adults with depression and/or anxiety disorder receiving care through the Veterans Health Administration. Int J Geriatr Psychiatry 2016; 31:575-82. [PMID: 26388526 DOI: 10.1002/gps.4362] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/26/2015] [Accepted: 08/28/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study compared mental health service utilization by treatment modality and determined predictive factors of use among younger-adult (18-35 years), middle-aged adult (36-64 years), and older-adult veterans (65+ years) with a newly recognized diagnosis of depression and/or anxiety disorder. METHODS This retrospective study used data from the Veterans Health Administration National Patient Care Database outpatient and inpatient treatment files during the 2010 fiscal year (N = 583,692). RESULTS Younger adults were the most likely to use mental health services, followed by middle-aged adults and then older adults. Age was found to be one of the greatest predictors of utilization of mental health services, with odds of use being threefold among younger adults compared with older adults. CONCLUSIONS Continued efforts are needed to improve the awareness of, access to, and receipt of mental health services in veterans, particularly older adults, with depression and anxiety disorders. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Elizabeth A DiNapoli
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Jeffery A Cully
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Ernest Wayde
- Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Shubhada Sansgiry
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hong Jen Yu
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Mark E Kunik
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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Rao JA, Kassel MT, Weldon AL, Avery ET, Briceno EM, Mann M, Cornett B, Kales HC, Zubieta JK, Welsh RC, Langenecker SA, Weisenbach SL. The double burden of age and major depressive disorder on the cognitive control network. Psychol Aging 2016; 30:475-85. [PMID: 26030776 DOI: 10.1037/pag0000027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Poor cognitive control (CC) is common among older individuals with major depressive disorder (OMDD). At the same time, studies of CC in OMDD with fMRI are relatively limited and often have small samples. The present study was conducted to further examine poor CC in OMDD with early onset depression, as well as to investigate the interactive effects of MDD and aging on cognitive control. Twenty OMDD, 17 older never-depressed comparisons (ONDC), 16 younger adults with MDD (YMDD), and 18 younger never-depressed comparisons (YNDC) participated. All participants completed the Go level of the Parametric Go/No-Go Test, which requires sustained attention and inhibitory control while undergoing functional MRI (fMRI). YNDC were faster in reaction times (RTs) to go targets relative to the other 3 groups, and the YMDD group was faster than the OMDD group. fMRI effects of both age and diagnosis were present, with greater activation in MDD, and in aging. Additionally, the interaction of age and MDD was also significant, such that OMDD exhibited greater recruitment of fronto-subcortical regions relative to older comparisons. These results are consistent with prior research reporting that OMDD recruit more fronto-striatal regions in order to perform at the same level as their never-depressed peers, here on a task of sustained attention and inhibitory control. There may be an interaction of cognitive aging and depression to create a double burden on the CC network in OMDD, including possible fronto-striatal compensation during CC that is unique to OMDD, as younger MDD individuals do not show this pattern.
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Affiliation(s)
- Julia A Rao
- Department of Psychiatry, University of Illinois at Chicago
| | | | - Anne L Weldon
- Department of Psychiatry, University of Illinois at Chicago
| | - Erich T Avery
- Department of Psychiatry, University of Michigan Medical Center
| | - Emily M Briceno
- Department of Psychiatry, University of Michigan Medical Center
| | - Megan Mann
- Department of Psychiatry, University of Michigan Medical Center
| | - Bridget Cornett
- Department of Psychiatry, University of Michigan Medical Center
| | - Helen C Kales
- Department of Psychiatry, University of Michigan Medical Center
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Michigan Medical Center
| | - Robert C Welsh
- Department of Psychiatry, University of Michigan Medical Center
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Beheydt LL, Schrijvers D, Docx L, Bouckaert F, Hulstijn W, Sabbe B. Cognitive and psychomotor effects of three months of escitalopram treatment in elderly patients with major depressive disorder. J Affect Disord 2015; 188:47-52. [PMID: 26342888 DOI: 10.1016/j.jad.2015.08.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although psychomotor retardation (PR) and cognitive disfunctioning are essential symptoms of elderly depressed patients, the differential effect of treatment with an SSRI in the elderly on these symptoms has hardly got any attention in studies with objective experimental measures. Since effects appear relatively slower in elderly, this study evaluates the effect on cognitive and psychomotor functioning as compared to mood, on four points during a twelve week follow up of monotreatment with escitalopram. METHOD 28 non-demented elderly unipolar depressive patients on 5-20mg escitalopram were compared to 20 matched healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests at the start and after 2, 6 and 12 weeks. Statistical analysis consisted of a General Linear Model (GLM) repeated measures multivariate analysis of variance of completers to compare the psychomotor and cognitive outcomes of the two groups. RESULTS Although, apart from the significant mood effect, no interaction effects were found for the psychomotor and cognitive tasks, the means in general show a trend of differential effects in cognitive and psychomotor functions, with smaller effects and delayed timeframes and with presence of subgroups compared to mood effects. LIMITATION Longer follow up studies are necessary to evaluate differential long term effects. CONCLUSION In elderly, moderate effects of SSRI treatment on mood precede slow or limited effects on cognition and psychomotor retardation.
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Affiliation(s)
- Lieve Lia Beheydt
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp, Belgium; University Psychiatry Center, Psychiatric Hospital, Duffel, Belgium.
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp, Belgium; University Psychiatry Center, Psychiatric Hospital, Duffel, Belgium
| | - Lise Docx
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp, Belgium; Psychiatric Hospital, Broeders Alexianen, Boechout, Belgium
| | - Filip Bouckaert
- University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Wouter Hulstijn
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp, Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp, Belgium; University Psychiatry Center, Psychiatric Hospital, Duffel, Belgium
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Brown EL, Raue PJ, Halpert K. Evidence-Based Practice Guideline: Depression Detection in Older Adults With Dementia. J Gerontol Nurs 2015; 41:15-21. [DOI: 10.3928/00989134-20151015-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sanglier T, Saragoussi D, Milea D, Tournier M. Depressed older adults may be less cared for than depressed younger ones. Psychiatry Res 2015; 229:905-12. [PMID: 26233825 DOI: 10.1016/j.psychres.2015.07.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/16/2015] [Accepted: 07/12/2015] [Indexed: 12/31/2022]
Abstract
The aim of the study was to investigate depression treatment use, either psychotherapy (PT) or antidepressant drugs (ADT) in the older and younger depressed population. Cohorts of 6316 elderly (≥65 year-old) and 25,264 matched non-elderly (25-64 year-old) depressed patients were created from a large national claims database of managed care plans from 2003 to 2006. Factors associated with ADT or PT were assessed using multivariate logistic models. During the 120 days following the depression diagnosis, the elderly persons were less often treated than the younger adults either by ADT (25.6% vs. 33.8%) or by PT (13.0% vs. 34.4%). ADT dispensing occurred later in the elderly group (51 vs. 14 days). ADT was associated with comorbid chronic conditions or polypharmacy in the elderly and younger adults. The selection of treatment (ADT or PT) was associated with the history of treated depression using the same type of treatment, in both groups. Thus, depression goes commonly untreated. Comorbidity was associated with higher ADT dispensing rates. However, although depressed elderly commonly presented with comorbidity, this age group was at higher risk of untreated illness or later treatment.
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Affiliation(s)
- Thibaut Sanglier
- Université Claude Bernard Lyon I, Villeurbanne, France; Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Delphine Saragoussi
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Dominique Milea
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Marie Tournier
- Université de Bordeaux, U657, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France; Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France.
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Psychotherapy for depression in older veterans via telemedicine: a randomised, open-label, non-inferiority trial. Lancet Psychiatry 2015; 2:693-701. [PMID: 26249300 DOI: 10.1016/s2215-0366(15)00122-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/17/2015] [Accepted: 03/16/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many older adults with major depression, particularly veterans, do not have access to evidence-based psychotherapy. Telemedicine could increase access to best-practice care for older adults facing barriers of mobility, stigma, and geographical isolation. We aimed to establish non-inferiority of behavioural activation therapy for major depression delivered via telemedicine to same-room care in largely male, older adult veterans. METHODS In this randomised, controlled, open-label, non-inferiority trial, we recruited veterans (aged ≥58 years) meeting DSM-IV criteria for major depressive disorder from the Ralph H Johnson Veterans Affairs Medical Center and four associated community outpatient-based clinics in the USA. We excluded actively psychotic or demented people, those with both suicidal ideation and clear intent, and those with substance dependence. The study coordinator randomly assigned participants (1:1; block size 2-6; stratified by race; computer-generated randomisation sequence by RGK) to eight sessions of behavioural activation for depression either via telemedicine or in the same room. The primary outcome was treatment response according to the Geriatric Depression Scale (GDS) and Beck Depression Inventory (BDI; defined as a 50% reduction in symptoms from baseline at 12 months), and Structured Clinical Interview for DSM-IV, clinician version (defined as no longer being diagnosed with major depressive disorder at 12 months follow-up), in the per-protocol population (those who completed at least four treatment sessions and for whom all outcome measurements were done). Those assessing outcomes were masked. The non-inferiority margin was 15%. This trial is registered with ClinicalTrials.gov, number NCT00324701. FINDINGS Between April 1, 2007, and July 31, 2011, we screened 780 patients, and the study coordinator randomly assigned participants to either telemedicine (120 [50%]) or same-room treatment (121 [50%]). We included 100 (83%) patients in the per-protocol analysis in the telemedicine group and 104 (86%) in the same-room group. Treatment response according to GDS did not differ significantly between the telemedicine (22 [22·45%, 90% CI 15·52-29·38] patients) and same-room (21 [20·39%, 90% CI 13·86-26·92]) groups, with an absolute difference of 2·06% (90% CI -7·46 to 11·58). Response according to BDI also did not differ significantly (telemedicine 19 [24·05%, 90% CI 16·14-31·96] patients; same room 19 [23·17%, 90% CI 15·51-30·83]), with an absolute difference of 0·88% (90% CI -10·13 to 11·89). Response on the Structured Clinical Interview for DSM-IV, clinician version, also did not differ significantly (39 [43·33%, 90% CI 34·74-51·93] patients in the telemedicine group and 46 [48·42%, 90% CI 39·99-56·85] in the same-room group), with a difference of -5·09% (-17·13 to 6·95; p=0·487). Results from the intention-to-treat population were similar. MEM analyses showed that no significant differences existed between treatment trajectories over time for BDI and GDS. The criteria for non-inferiority were met. We did not note any adverse events. INTERPRETATION Telemedicine-delivered psychotherapy for older adults with major depression is not inferior to same-room treatment. This finding shows that evidence-based psychotherapy can be delivered, without modification, via home-based telemedicine, and that this method can be used to overcome barriers to care associated with distance from and difficulty with attendance at in-person sessions in older adults. FUNDING US Department of Veterans Affairs.
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Gothwal VK, Bagga DK, Sumalini R. Rasch validation of the PHQ-9 in people with visual impairment in South India. J Affect Disord 2015; 167:171-7. [PMID: 24973769 DOI: 10.1016/j.jad.2014.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Patient-Health Questionnaire (PHQ-9) is a widely used screening instrument for depression. Recently, its properties as a measure were investigated using Rasch analysis in an Australian population with visual impairment (VI) and it was demonstrated to possess excellent measurement properties, but the response scale required shortening (modified PHQ-9). However, further validation was recommended to substantiate its use with the growing population of VI. Therefore, we aimed to use Rasch analysis to evaluate the measurement properties of the modified PHQ-9 in an Indian population with VI. METHODS 303 patients with VI (mean age 40.2 years; 71% male) referred to Vision Rehabilitation Centres were administered the PHQ-9 by trained interviewer. Rasch analysis was used to investigate the psychometric properties of the modified PHQ-9. RESULTS Rasch analysis showed good fit to the model, no misfitting items and an acceptable person separation reliability (0.82). Dimensionality testing supported combining 9 items to create a total score. Targeting was sub-optimal (-1.30 logits); more difficult items are needed. One item ('trouble falling asleep') showed notable differential item functioning, DIF (1.18 logits) by duration of VI. LIMITATIONS The generalisability of these results might be restricted to patients with VI presenting to a tertiary eye care centre. CONCLUSIONS Except for DIF, the performance of the modified PHQ-9 is consistent with that of the original, albeit in a different cultural context (Indian population with VI). Clinicians/researchers can readily use the modified PHQ-9 without formal training in Rasch procedures given the provision of ready-to-use spreadsheets that convert raw to Rasch-scaled scores. However the conversions will apply only if the sample being tested is similar to that of the present study.
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Affiliation(s)
- Vijaya K Gothwal
- Meera and L.B. Deshpande Centre for Sight Enhancement, Vision Rehabilitation Centres, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad 500034, Andhra Pradesh, India.
| | - Deepak K Bagga
- Meera and L.B. Deshpande Centre for Sight Enhancement, Vision Rehabilitation Centres, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad 500034, Andhra Pradesh, India
| | - Rebecca Sumalini
- Meera and L.B. Deshpande Centre for Sight Enhancement, Vision Rehabilitation Centres, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad 500034, Andhra Pradesh, India
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Diniz BS, Reynolds CF. Major depressive disorder in older adults: benefits and hazards of prolonged treatment. Drugs Aging 2015; 31:661-9. [PMID: 24989627 DOI: 10.1007/s40266-014-0196-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Antidepressants have been shown to reduce the risk of depression recurrence in adults, justifying prolonged antidepressant maintenance therapy for most if not all patients. However, older depressed adults may be at increased risk for antidepressant adverse effects. This article discusses the benefits and hazards of continued treatment in elderly depressed patients, and indicates which patients should and should not receive maintenance phase antidepressants. Most clinical trials conducted so far suggest that prolonged antidepressant use in older adults is efficacious to reduce recurrence rates. The benefits of prolonged antidepressant use may not be restricted to preventing recurrence but also include preservation of overall well-being, social functioning, reduced mortality risk from medical disorders, and reduced risk of dementia. Although generally safe, the prolonged use of antidepressants has been associated with higher risk of osteopenia/osteoporosis (in particular the selective serotonin reuptake inhibitors) and cardiovascular toxicity (tricyclic antidepressants). Fewer data are available for special populations, like those with multiple medical comorbidities or those with dementia; thus, the benefits of prolonged antidepressant use are not clear in these individuals.
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Affiliation(s)
- Breno S Diniz
- Department of Mental Health and National Institute of Science and Technology, Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Tapia-Muñoz T, Mascayano F, Toso-Salman J. Collaborative care models to address late-life depression: lessons for low-and-middle-income countries. Front Psychiatry 2015; 6:64. [PMID: 25999866 PMCID: PMC4419549 DOI: 10.3389/fpsyt.2015.00064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/12/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Thamara Tapia-Muñoz
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Franco Mascayano
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Sulmont-Rosse C, Maitre I, Amand M, Symoneaux R, Van Wymelbeke V, Caumon E, Tavares J, Issanchou S. Evidence for Different Patterns of Chemosensory Alterations in the Elderly Population: Impact of Age Versus Dependency. Chem Senses 2015; 40:153-64. [DOI: 10.1093/chemse/bju112] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lopez-Anton R, Santabárbara J, De-la-Cámara C, Gracia-García P, Lobo E, Marcos G, Pirez G, Saz P, Haro JM, Rodríguez-Mañas L, Modrego PJ, Dewey ME, Lobo A. Mild cognitive impairment diagnosed with the new DSM-5 criteria: prevalence and associations with non-cognitive psychopathology. Acta Psychiatr Scand 2015; 131:29-39. [PMID: 24893954 DOI: 10.1111/acps.12297] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To contrast the prevalence of mild cognitive impairment (MCI) as diagnosed using DSM-5 criteria (DSM5-MCI) with MCI as diagnosed using Petersen's criteria (P-MCI) and to explore the association of both with non-cognitive psychopathological symptoms (NCPS). METHOD A two-phase epidemiological screening was implemented in a population-based sample of individuals aged 55+ (n = 4803). The Geriatric Mental State (GMS) was the main psychopathological instrument used, and AGECAT was used to make psychiatric diagnoses. Research psychiatrists diagnosed DSM5-MCI and P-MCI using operational criteria. Logistic regression models were then used to investigate the association of MCI with anxiety and depression and with NCPS. RESULTS Weighted prevalence of DSM5-MCI and P-MCI was, respectively, 3.72% and 7.93% for the aged 65+. NCPS were common in both MCI categories, but negative-type symptoms such as 'anergia' and 'observed slowness' were considerably more frequent among persons with DSM5-MCI. Anxiety and depression diagnostic categories were associated with both P-MCI and DSM5-MCI, but affective-type symptoms were mainly associated with P-MCI. Some negative-type symptoms were inversely associated with P-MCI, and no association was observed with DSM5-MCI. CONCLUSION The prevalence of DSM5-MCI was half that of P-MCI. Negative-type NCPS were more frequently and typically associated with DSM5-MCI.
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Affiliation(s)
- R Lopez-Anton
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
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Palliative care as a primary therapeutic approach in advanced dementia: a narrative review. Clin Ther 2014; 36:1512-7. [PMID: 25457122 DOI: 10.1016/j.clinthera.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE The goal of this narrative review was to identify and summarize the ways in which palliative care could benefit patients who have advanced dementia. METHODS This case-based discussion article examines current literature on palliative care for dementia. FINDINGS Dementia is an incurable, progressive disease that affects millions of subjects. The prevalence has grown in the last decade and is projected to continue on this trajectory. In the later stages of dementia, subjects require increasing levels of care due to severe cognitive and functional impairment. Although the field of palliative medicine focuses on improving the quality of life of patients with life-limiting illnesses, many patients with advanced dementia do not receive palliative care services. IMPLICATIONS Palliative care has been shown to improve patient and caregiver satisfaction, quality of life, and symptom burden at the end of life. Patients with advanced dementia would benefit from increased access to palliative care.
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Abstract
This paper illustrates a sequential item development process to create a new self-report instrument of depression refined with Rasch analysis from a larger pool of potential diagnostic items elicited through a consensus approach by clinical experts according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders criteria for major depression. A 51-item pool was administered to a sample of 529 subjects (300 healthy community-dwelling adults and 229 psychiatric outpatients). Item selection resulted in a 21-item set, named the Teate Depression Inventory, with an excellent Person Separation Index and no evidence of bias due to an item-trait interaction (χ (2)=147.71; df =168; P=0.48). Additional support for the unidimensionality, local independence, appropriateness of the response format, and discrimination ability between clinical and nonclinical subjects was provided. No substantial differential item functioning by sex was observed. The Teate Depression Inventory shows considerable promise as a unidimensional tool for the screening of depression. Finally, advantages and disadvantages of this methodology will be discussed in terms of subsequent possible mathematical analyses, statistical tests, and implications for clinical investigations.
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Affiliation(s)
- Michela Balsamo
- DiSPUTer, Department of Psychological Sciences, Humanities and Territory, “G d’Annunzio” University, Chieti-Pescara, Italy
| | - Giuseppe Giampaglia
- Department of Economics and Statistics, “Federico-II” University, Naples, Italy
| | - Aristide Saggino
- DiSPUTer, Department of Psychological Sciences, Humanities and Territory, “G d’Annunzio” University, Chieti-Pescara, Italy
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Oliffe JL, Rasmussen B, Bottorff JL, Kelly MT, Galdas PM, Phinney A, Ogrodniczuk JS. Masculinities, work, and retirement among older men who experience depression. QUALITATIVE HEALTH RESEARCH 2013; 23:1626-37. [PMID: 24177678 DOI: 10.1177/1049732313509408] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The high incidence of depression among older men has been linked to numerous factors. In this qualitative descriptive study of 30 older, Canadian-based men who experienced depression, we explored the connections between participants' depression, masculinities, work, and retirement. Our analyses revealed three thematic findings. The recursive relationship between depression and work was reflected in depression impeding and emerging from paid work, whereby men's careers and work achievements were negatively impacted by depression amid assertions that unfulfilling work could also invoke depression. Lost or unrealized empires highlighted the centrality of wealth accumulation and negative impact of many participants' unfulfilled paid work aspirations. Retirement as loss and the therapeutic value of work reflected how masculine ideals influenced men to continue working to avoid the losses they associated with retirement. The findings confirm the need to support men's work-related transitions by affirming a diversity of masculine identities beyond traditional workman/breadwinner roles.
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Affiliation(s)
- John L Oliffe
- 1University of British Columbia, Vancouver, British Columbia, Canada
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Zivin K, Pirraglia PA, McCammon RJ, Langa KM, Vijan S. Trends in depressive symptom burden among older adults in the United States from 1998 to 2008. J Gen Intern Med 2013; 28:1611-9. [PMID: 23835787 PMCID: PMC3832736 DOI: 10.1007/s11606-013-2533-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 05/01/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown. OBJECTIVE To examine trends in depressive symptoms among older adults in the US between 1998 and 2008. DESIGN Serial cross-sectional analysis of six biennial assessments. SETTING Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N = 16,184 in 1998). MAIN OUTCOME MEASURE The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics. RESULTS Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13-1.19), with significant increases in those aged ≥ 60 relative to those aged 55-59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60. CONCLUSIONS Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.
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Affiliation(s)
- Kara Zivin
- Department of Veterans Affairs, National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA,
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43
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Pišljar M, Repovš G, Pirtošek Z. Cognition in late onset depression. Psychiatry Res 2013; 210:89-94. [PMID: 23477900 DOI: 10.1016/j.psychres.2013.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 11/19/2022]
Abstract
The aim of study was to assess cognition in patients with late onset depression in a symptom-free remission period measuring event-related potentials and reaction times (RT) in a modified computer version of the Stroop test. Thirty four patients with late-onset depression were included after they had reached remission. They were compared to age-, gender- and education-matched healthy controls. Each participant completed a single item computer version of the Stroop Color-word task using verbal response mode. EEG and RT were simultaneously recorded. RTs were significantly prolonged in patients in all conditions of the Stroop paradigm, and the interference effect was significantly greater in patients compared to controls. Results also revealed abnormal late positive Stroop related potentials in the period of about 500-600 ms period corresponding to the so-called P300b wave. Our study supports the view that patients with late onset depression are also cognitively impaired and that this impairment persists in the period of early remission. Using more sensitive ERP measurement of the Stroop task we demonstrated impaired information processing at an earlier, pre-response related stage.
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Affiliation(s)
- Marko Pišljar
- Psychiatric Hospital Idrija, Pot sv. Antona 49, 5280 Idrija, Slovenia.
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Forkmann T, Kroehne U, Wirtz M, Norra C, Baumeister H, Gauggel S, Elhan AH, Tennant A, Boecker M. Adaptive screening for depression--recalibration of an item bank for the assessment of depression in persons with mental and somatic diseases and evaluation in a simulated computer-adaptive test environment. J Psychosom Res 2013; 75:437-43. [PMID: 24182632 DOI: 10.1016/j.jpsychores.2013.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study conducted a simulation study for computer-adaptive testing based on the Aachen Depression Item Bank (ADIB), which was developed for the assessment of depression in persons with somatic diseases. Prior to computer-adaptive test simulation, the ADIB was newly calibrated. METHODS Recalibration was performed in a sample of 161 patients treated for a depressive syndrome, 103 patients from cardiology, and 103 patients from otorhinolaryngology (mean age 44.1, SD=14.0; 44.7% female) and was cross-validated in a sample of 117 patients undergoing rehabilitation for cardiac diseases (mean age 58.4, SD=10.5; 24.8% women). Unidimensionality of the itembank was checked and a Rasch analysis was performed that evaluated local dependency (LD), differential item functioning (DIF), item fit and reliability. CAT-simulation was conducted with the total sample and additional simulated data. RESULTS Recalibration resulted in a strictly unidimensional item bank with 36 items, showing good Rasch model fit (item fit residuals<|2.5|) and no DIF or LD. CAT simulation revealed that 13 items on average were necessary to estimate depression in the range of -2 and +2 logits when terminating at SE≤0.32 and 4 items if using SE≤0.50. Receiver Operating Characteristics analysis showed that θ estimates based on the CAT algorithm have good criterion validity with regard to depression diagnoses (Area Under the Curve≥.78 for all cut-off criteria). CONCLUSION The recalibration of the ADIB succeeded and the simulation studies conducted suggest that it has good screening performance in the samples investigated and that it may reasonably add to the improvement of depression assessment.
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Affiliation(s)
- Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Germany.
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Vehren T, Boecker M, Norra C, Wirtz M, Gauggel S, Forkmann T. Cross-sectional validation of the Rasch-based Depression Screening (DESC) in a mixed sample of patients with mental and somatic diseases. Compr Psychiatry 2013; 54:1082-9. [PMID: 23751247 DOI: 10.1016/j.comppsych.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 04/18/2013] [Accepted: 05/02/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The study aimed to cross-validate the psychometric properties of the two parallel versions of the "Rasch-based Depression Screening (DESC)" in a mixed clinical sample of patients with mental disorders and somatic diseases. Additionally, it was intended to confirm the initially proposed cut-off scores. METHODS One hundred eleven inpatients from the Departments of Psychiatry (n=50), Cardiology (n=39) and Otorhinolaryngology (n=22) were examined. Accordance to Rasch model assumptions was determined by analyzing item infit and outfit as well as unidimensionality and local independence via residual principal components factor analysis (PCFA). Furthermore, separation, reliability and the targeting were considered. Differential item functioning (DIF) was investigated with regard to gender, age and clinical group. Finally, receiver operating characteristics (ROC) curves analyses were conducted and parallel test reliability was calculated. RESULTS Item and person separation and reliability were good with separation values being above 2.90 and reliability exceeding being .90. Rasch model fit was good for all items except for the two items "sad" and "hopeless" displaying slight misfit. Targeting was appropriate with a person mean of -1.6 (DESC-I) and -1.5 (DESC-II) reflecting as expected that the two DESC versions were in average to easy for a mixed sample of patients with mental disorders and somatic. PCFA showed unidimensionality and local independence: The Rasch dimension "depression" explained 84.8% (DESC-I) and 82.2% (DESC-II) of the observed variance. No DIF was found. ROC curves confirmed the proposed cut-off score of 12 points. The area under the curve amounted to .91 for both DESC forms. The Youden index was 75.5 for DESC-I and 75.7 for DESC-II. A high parallel test reliability of .94 showed virtual equivalence of both DESC forms. CONCLUSIONS Results of the present study support the good psychometric properties of both DESC forms in patients with mental disorders and somatic diseases. This study confirmed the cut-off scores that had already been determined in former patient samples. Thus, both DESC forms can be used validly as screening instruments for depression in clinical practice.
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Affiliation(s)
- Thomas Vehren
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstr. 19, 52074 Aachen, Germany.
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46
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Siqueira-Neto JI, Pontes-Neto OM, do Vale FDAC, dos Santos JV, Sales PMG, dos Santos JV, Santos AC. Neuropsychiatric Symptoms (NPS) in patients with pure Vascular Dementia (VaD) and Mixed Dementia (MD) from a memory outpatient clinic in southeast Brazil. Dement Neuropsychol 2013; 7:263-268. [PMID: 29213849 PMCID: PMC5619197 DOI: 10.1590/s1980-57642013dn70300006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/04/2013] [Indexed: 11/22/2022] Open
Abstract
Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries. OBJECTIVE We aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic. METHODS We reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation. RESULTS Two hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors. CONCLUSION We found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.
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Affiliation(s)
- José Ibiapina Siqueira-Neto
- MD, PhD. Associate Professor of Neurology, Clinical
Medicine Department, Faculty of Medicine, Federal University of Ceará,
Brazil
| | - Octávio Marques Pontes-Neto
- MD, PhD. Associate Professor of Neurology, Department of
Neuroscience and Behavior Sciences, University of São Paulo, University
Hospital of Ribeirao Preto, Brazil
| | | | | | | | | | - Antônio Carlos Santos
- MD, PhD. Associate Professor of Neuroradiology in Center
of Sciences of Imaging and Medical Physics of São Paulo
University-Ribeirão Preto, Ribeirão Preto University Central Hospital,
Brazil
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47
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Forkmann T, Gauggel S, Spangenberg L, Brähler E, Glaesmer H. Dimensional assessment of depressive severity in the elderly general population: psychometric evaluation of the PHQ-9 using Rasch Analysis. J Affect Disord 2013; 148:323-30. [PMID: 23411025 DOI: 10.1016/j.jad.2012.12.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The depression module of the Patient Health questionnaire (PHQ-9) is a wide-spread self-report instrument for the assessment of depression with compelling psychometric characteristics when relying on classical test theory assumptions. This study aimed at evaluating whether the PHQ-9 may be interpreted as a dimensional scale measuring depression severity in the elderly general population using Rasch analysis with special emphasis on its unidimensional structure and differential item functioning (DIF) due to gender, age, and the presence of somatic multimorbidity. METHODS A representative sample of the elderly German general population (N=1631; age 60-85 years, 53.5% female) filled in the PHQ-9, a questionnaire about chronic medical conditions and a demographic data sheet. Unidimensionality and psychometric properties of the PHQ-9 were ascertained applying confirmatory factor analysis (CFA) and Rasch analysis. RESULTS Results revealed substantial violations of the unidimensionality of the scale: item 8 (retardation or agitation) had to be eliminated and multiple residual correlations were added. Gender-related DIF emerged for two items, and three items showed insufficient Rasch model fit. LIMITATIONS The large sample leads to high statistical power that might technically increase the probability of detecting model misfit or DIF. The sampling procedure leads to a possible underestimation of morbidity due to the exclusion of those elderly patients living in nursing homes. CONCLUSIONS Results suggest that - when applied in the elderly general population - the PHQ-9 should be interpreted in terms of a diagnostic algorithm for classificatory decisions about a DSM-IV based probable diagnosis of depression rather than as a dimensional scale.
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Affiliation(s)
- Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstraße 19, 52074, Aachen, Germany
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48
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Wan Mohd Azam WMY, Din NC, Ahmad M, Ghazali SE, Ibrahim N, Said Z, Ghazali AR, Shahar S, Razali R, Maniam T. Loneliness and depression among the elderly in an agricultural settlement: mediating effects of social support. Asia Pac Psychiatry 2013; 5 Suppl 1:134-9. [PMID: 23857850 DOI: 10.1111/appy.12061] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Loneliness has long been known to have strong association with depression. The relationship between loneliness and depression, however, has been associated with other risk factors including social support. The aim of this paper is to describe the role of social support in the association between loneliness and depression. METHODS This cross-sectional study examined the mediating effects of social support among 161 community-based elderly in agricultural settlement of a rural area in Sungai Tengi, Malaysia. Subjects were investigated with De Jong Gierveld Loneliness Scale, Geriatric Depression Scale and Medical Outcome Survey Social Support Survey. Data were analyzed using Pearson correlation, linear and hierarchical regression. RESULTS Results indicated that social support partially mediated the relationship between loneliness and depression. DISCUSSION This suggests that social support affects the linear association between loneliness and depression in the elderly.
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Somme D, Rousseau C. [Standardized geriatric assessment or comprehensive gerontological assessment: where do we stand?]. Rev Med Interne 2012; 34:114-22. [PMID: 23154109 DOI: 10.1016/j.revmed.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/07/2012] [Indexed: 11/17/2022]
Abstract
The concept of comprehensive gerontological assessment is a foundation of modern geriatrics. Our focus was to try to clarify the underlying concepts, assess the level of evidence and clarify the issues still under debate. The concept implies the definition of an interdisciplinary process for a multidimensional assessment in order to produce a coordinated plan. The central notion is that the systematization of this multidimensionality and interdisciplinarity needs the establishment of dedicated process (meeting tools, clinical information system, etc.). Following dimensions should be covered: health, social, economic, environmental and psychological. Any assessment process that could lead to forgetting one of its dimensions cannot be viewed as a comprehensive gerontological assessment. The level of evidence is higher in hospital acute inpatient unit but it is still low in all other areas of health care but the scattered data in the literature argues for qualitative benefits (improved quality of care or quality of life). The questions that remain are numerous including the choice of strategy for initial evaluation (maximum versus minimum; from the outset by many professionals versus graduated based on the minimum initial evaluation), the choice of tool, the optimal location, the required intensity of monitoring and the ideal target population.
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Affiliation(s)
- D Somme
- Service de gériatrie, centre hospitalier universitaire de Rennes, France.
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50
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Cherubini A, Nisticò G, Rozzini R, Liperoti R, Di Bari M, Zampi E, Ferrannini L, Aguglia E, Pani L, Bernabei R, Marchionni N, Trabucchi M. Subthreshold depression in older subjects: an unmet therapeutic need. J Nutr Health Aging 2012; 16:909-13. [PMID: 23208031 DOI: 10.1007/s12603-012-0373-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Major depression, defined according to DSM IV TR criteria, is less common in older subjects, while other types of depression are two to three times more prevalent. This heterogeneous group of disturbances has received different names: depression not otherwise specified, minor depression, subthreshold or subsyndromal depression. Moreover, each condition has been defined using heterogeneous criteria by different authors. The term of subthreshold depression will be adopted in this position statement. Subthreshold depression has been associated with the same negative consequences of major depression, including reduced well being and quality of life, worsening health status, greater disability, increased morbidity and mortality. Nevertheless, there is a dearth of clinical trials in this area, and therefore older patients with subthreshold depression are either not treated or they are treated with the same non pharmacological and pharmacological therapies used for major depression, despite the lack of supporting scientific evidence. There is an urgent need to reach a consensus concerning the diagnostic criteria for subthreshold depression as well as to perform clinical trials to identify effective and safe therapies in this too long neglected patient group.
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Affiliation(s)
- A Cherubini
- Department of Geriatrics, Research Hospital of Ancona, Italian National Research Center on Aging (INRCA), Ancona, Italy.
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