Depression in the elderly

Bidirectional relationship between afternoon naps and depressive symptoms in Chinese middle-aged and older adults: Evidence from a nationally representative cohort study

BACKGROUND

Limited studies have investigated the association between depressive symptoms and napping habits. In this study, nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) were employed to conduct cross-sectional and longitudinal analyses to investigate their associations among Chinese middle-aged and older adults.

METHODS

The study included 12,208 participants from the 2015 CHARLS. Depressive symptoms were measured using the Depression Scale. Napping duration was categorized into four groups: no napping (0 min), short (<30 min), moderate (30-89 min), and prolonged (≥90 min). Logistic regression analysis was used to assess bidirectional relationships, and dose-response patterns were analyzed via restricted cubic splines (RCS).

RESULTS

A total of 2487 participants (32.0 %) developed new-onset depressive symptoms, and moderate napping group exhibited the lowest incidence rate. Statistical analysis revealed that moderate napping was a protective factor for the depressive symptoms (OR, 95 % CI, 0.689, 0.567-0.843). A total of 1742 participants (42.3 %) newly experienced poor napping, and the incidence of poor napping gradually rose by the increase of the CES-D-10 score quartiles. Moreover, depressive symptoms were also found to be a risk factor for poor napping (OR, 95 % CI, 1.149, 1.004-1.314). The RCS model revealed that there was an approximately U-shaped association between nap duration and depressive symptoms, and there was a negative linear association between CES-D-10 scores and nap duration.

LIMITATION

The observational design limits ruling out unobserved confounding factors.

CONCLUSION

There was a significant bidirectional relationship and a dose-response association between napping and depressive symptoms in middle-aged and older adults.

The global, regional, and national late-life depression burden and trends from 1990 to 2021: A systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Late-life depression (LLD) represents a growing global public health concern. This study aimed to assess the worldwide burden of LLD using comprehensive data.

METHODS

Leveraging the latest evidence from the Global Burden of Disease Study, we analyzed trends in LLD burden from 1990 to 2021, encompassing incidence, prevalence, and disability-adjusted life years (DALYs). We quantified disparities in LLD burden across socioeconomic, gender, regional, and national dimensions. Decomposition analysis was employed to identify key drivers of LLD burden variation. Frontier analysis illustrated the potential for burden reduction in various countries.

RESULTS

Globally, there were 49,137,544 new cases, 46,672,175 prevalent cases, and 7,351,377 DALYs attributed to LLD in 2021. Between 1990 and 2021, the agestandardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), and age-standardised DALYs rate (ASDR) of LLD all rose. In 2021, low SDI regions exhibited the highest all ASRs, while middle SDI regions had the fastest growth rates in these indicators. Regionally, Central and Eastern Sub-Saharan Africa had the highest ASIR, ASPR, and ASDR, respectively. Nationally, Uganda ranked highest in all ASRs in 2021. Women had higher burdens than men. Population growth was a primary driver of DALYs increase in middle SDI regions that had the greatest potential for improvement.

CONCLUSIONS

The global burden of LLD has risen, with marked inequities across SDI, gender, region, and country. The burden is most pronounced in low and middle SDI regions. These findings offer guidance for developing LLD screening guidelines and enhancing prevention and intervention strategies in relevant countries, particularly Uganda.

Prevalence of depressive symptoms in people aged 50 years and older: A retrospective cross-sectional study

BACKGROUND

Depression is a serious health problem worldwide and is often associated with disability and reduced quality of life. In aging societies, early recognition of depression in older adults is highly relevant. Therefore, this study investigated the prevalence of depressive symptoms in individuals aged 50 and older with the aim to identify those at risk for major depression.

METHODS

We performed a retrospective cross-sectional study with data from 1000BRAINS to assess depressive symptoms in a sample of 1017 healthy adults aged 50 and older. The prevalence and dimension of depressive symptoms were measured by the Beck Depression Inventory II, and differences between demographic, clinical, and lifestyle-associated variables and the prevalence of depressive symptoms were analyzed.

RESULTS

Depressive symptoms were present in 21.3 % of the participants and were minimal in 14.2 %, mild in 4.5 %, moderate in 1.8 %, and severe in 0.8 %. The prevalence of depressive symptoms was highest in the age group 50 to 59 years, and the prevalence of severe depressive symptoms decreased with increasing age. A positive family history of depression, cognitive impairment, medication intake, and polyneuropathy were associated with significantly higher levels of depressive symptoms.

LIMITATIONS

The retrospective cross-sectional design and evaluation of depressive symptoms by a self-rating instrument may limit the generalizability of the results.

CONCLUSION

This study supports earlier findings of a higher prevalence of depressive symptoms among older adults. The group aged 50 to 59 appears to be particularly affected. Additionally, poor physical health, greater cognitive impairment, and sex-specific factors appear to contribute to depressive symptomatology.

The prevalence and correlates of depression and anxiety symptoms in older adults receiving in-home aged care: A cross-sectional survey

OBJECTIVES

To estimate the prevalence of depression and anxiety symptoms in older Australians accessing in-home aged care, and to identify characteristics associated with symptoms.

METHODS

A cross-sectional telephone survey with a random sample of in-home aged care clients from a national provider (Silverchain) was conducted between November 2022 and July 2023. The percentage of clients experiencing depression and anxiety symptoms was estimated, weighted to the age and gender of the Silverchain population. Multivariable linear regression was utilised to identify characteristics associated with higher depression and anxiety symptoms.

RESULTS

A total of 237 participants completed the survey. Over half (52%) of participants experienced symptoms of depression (≥5 on the PHQ-9), while 16% experienced clinically meaningful symptoms indicative of probable major depressive disorder (≥10 on the PHQ-9). Over one-third (37%) of participants experienced symptoms of anxiety (≥5 on the GAD-7), while 12% experienced clinically meaningful symptoms indicative of probable generalised anxiety disorder (≥10 on the GAD-7). Most clients (61%) experienced symptoms of depression and/or anxiety, with 29% experiencing co-morbid symptoms. Younger age, lower quality of life, higher loneliness, living in a major city (compared with rural/remote areas) and living with family (compared to living alone) were associated with higher levels of depression or anxiety symptoms in this cohort.

CONCLUSIONS

Symptoms of depression and anxiety are common in older Australians accessing in-home aged care, with many experiencing co-morbid symptoms. In-home aged care providers are ideally situated to identify and facilitate treatment and monitoring for these individuals.

Effectiveness of information technology-based cognitive behavioral therapy on depression and anxiety symptoms among older adults: Systematic review and meta-analysis

BACKGROUND

Depression and anxiety are prevalent among older adults. However, most older adults have poor access to age-specific mental health services. While Information technology-based Cognitive Behavioral Therapy (ICBT) has shown promise as an accessible alternative to face-to-face interventions, its effectiveness specifically within the older adults warrants further investigation.

OBJECTIVE

To evaluate the effectiveness of ICBT on depression and anxiety symptoms among older adults.

METHODS

Research articles retrieved from PubMed, EMBASE, the Cochrane Library, Web of Science, PsycINFO, and MEDLINE from inception to April 10, 2024, were reviewed. The search was designed to identify Randomized Controlled Trials (RCTs) that examined the efficacy of ICBT in reducing self-reported depression or anxiety symptoms in older adults. The quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2.0. Posttreatment means and standard deviations (SDs) were compared between intervention and control groups, and pooled effect sizes (Hedges' g) were calculated.

RESULTS

A total of 11 RCTs were eligible for inclusion in this review. Compared to control groups, ICBT yielded small to medium post-treatment pooled effect sizes regarding depressive symptoms (Hedges' g = -0.65, 95 % CI -0.95 to -0.35; P < 0.001) and anxiety symptoms (Hedges' g = -0.47, 95 % CI -0.74 to -0.19; P < 0.001). Subgroup analyses showed that: (1) interventions lasting ≥8 weeks (Hedges' g = -0.88, 95 % CI -1.37 to -0.39; P < 0.001) were more effective than <8 weeks for depressive symptoms; however, <8 weeks (Hedges' g = -0.52, 95 % CI -0.93 to -0.10; P = 0.014) was more effective for anxiety symptoms; (2) ICBT delivered through slideshows was more effective than through other digital platforms for both depressive (Hedges' g = -1.36, 95 % CI -2.40 to -0.31; P = 0.011) and anxiety symptoms (Hedges' g = -1.00, 95 % CI -1.30 to -0.70; P < 0.001); and (3) non-tailored ICBT was more effective than tailored versions for both depressive (Hedges' g = -1.06, 95 % CI -2.03 to -0.09; P = 0.032) and anxiety symptoms (Hedges' g = -0.70, 95 % CI -1.14 to -0.27; P = 0.001).

CONCLUSIONS

This meta-analysis reinforces the effectiveness of ICBT in relieving depression and anxiety symptoms among older adults. Future research should identify the most effective components of ICBT to optimize their development.

Evaluating the role of simple assistive devices in promoting motivation and self-care in chronic disease management

OBJECTIVE

This study evaluates the development and distribution of simple assistive devices designed to support individuals in managing their health conditions at home. The focus is on older adults from lower socio-economic groups in Stoke-on-Trent and Newcastle-under-Lyme, UK.

METHODS

Assistive kits were distributed to participants between December 2021 and April 2022, addressing weight management, diabetic foot care, mental wellbeing, and daily living independence. Each kit contained affordable and accessible assistive devices, including portion plates, exercise bands, and remote-operated plugs, alongside educational materials to promote self-care. Feedback was collected between March and June 2022 to assess user satisfaction and engagement. A qualitative analysis, informed by self-determination theory, explored how these kits supported autonomy, competence, and relatedness in self-management.

RESULTS

Over 90 % of recipients reported using the kits more than once weekly and an increased confidence in managing their health conditions independently. Qualitative analysis indicated that the kits facilitated motivation towards self-management by enhancing users' autonomy, competence, and social connectedness. However, barriers such as cost, availability, and lack of support were identified as limiting factors for broader adoption.

CONCLUSIONS

This study highlights the potential of affordable, simple assistive devices to empower individuals in managing their health and wellbeing. The initiative demonstrates a promising approach to addressing health management challenges in lower socio-economic groups. Further research is needed to expand access and refine interventions to maximise impact and improve quality of life.

Association of mental health with walking capacity in patients with claudication: a cross-sectional study

OBJECTIVES

The purpose of this investigation was to verify the association between mental health (MH) indicators with walking capacity in patients with PAD.

METHODS

Two hundred and forty-six patients with PAD and claudication symptoms participated in this study. Physical function was assessed objectively with the 6-min walk test (6MWT) and subjectively using the Walking Impairment Questionnaire (WIQ). MH was assessed by the World Health Organization Quality of Life-Bref (WHOQOL-Bref) (six questions were selected - 1, 2, 10, 16, 19, and 26). Patients were divided into tertile groups according to their composite z-score for mental health (Low MH, Middle MH, and High MH).

RESULTS

The High MH group presented higher scores (p < 0.05) for the WIQ (distance = 26.8 ± 25.6, speed = 25.4 ± 17.3, and stairs = 33.6 ± 27.5), claudication onset distance (161.6 ± 83.6 m), and total walking distance (352.9 ± 79.6 m) compared to Low MH (WIQ distance = 14.8 ± 16.2, 17.7 ± 13.0, and stairs = 22.7 ± 20.7). Additionally, the High MH group presented a longer claudication onset distance (115.5 ± 70.5 m), and total walking distance in 6MWT (306.6 ± 83.2 m), and higher scores in the total walking distance compared to Middle MH (309.5 ± 93.6 m) (p < 0.05).

CONCLUSION

In patients with PAD, MH was positively associated with walking capacity. Based on these results, treatments that can improve mental health, through different mechanisms, can also positively influence the ability of these patients to walk.

Unveiling the brain mechanism underlying depression: 12 Years of insights from bibliometric and visualization analysis

Depression is a common but serious mental health illness affected human's physiology and psychology. In contemporary times, neurophysiological research on depression has emerged as a prominent area of investigation, yet there remains a paucity of review elucidating the central mechanisms of depression in the brain. Consequently, we undertook a bibliometric analysis and visualization assessment to underscore recent advancements in research pertaining to the neural underpinnings of depression. By employing these methods, we have collected articles spanning the period from 2013 to 2024, shedding light on the latest insights into the brain mechanisms associated with depression. Bibliometric analysis found 16327 research papers in the field of brain mechanism underlying depression, overall showing a sustained growth trend. Through meticulous analysis of collected data on institutions and countries, authors, co-cited literature, keywords, etc., this paper humbly aims to tentatively identify future research hotspots and frontiers, hoping to modestly contribute to and stimulate further scholarly progress in the field.

Exploring disparities in depressive symptoms between rural and urban middle-aged and elderly adults in China: evidence from CHARLS

The study was to investigate the relevant factors that were associated with differences in depressive symptoms between urban and rural middle-aged and elderly population in China, measuring the contribution of related influencing factors. We constructed binary logistic regression models to investigate the primary factors influencing depressive symptoms and employed Fairlie models to examine these factors contributing to the differences in depressive symptoms between urban and rural middle-aged and elderly individuals. The proportion of depressive symptoms among middle-aged and older individuals in China was 38.16%, with findings indicating that rural areas exhibited higher rates (44.47%) of depressive symptoms compared to urban areas (31.85%). The Fairlie decomposition analysis demonstrated 53.51% of the disparities in depressive symptoms could be accounted for, which was mainly linked to differences in self-reported health status (19.16%), education level (14.45%), insurance (8.28%), instrumental activities of daily living dysfunction (6.16%), gender (-3.72%), sleep time (2.35%), falling history (2.31%), age (-2.17%), physical examination (2.03%), and chronic disease condition (-0.50%). The prevalence of depressive symptoms in rural middle-aged and elderly was greater than urban, linked to demographics, lifestyle, health status and social status. This study aided policymakers in reducing health disparities and designing targeted mental health interventions for vulnerable populations.

Effects of Client-Centered Occupational Therapy Intervention in Older Adults With Depression: A Randomized Controlled Trial

Objective: The purpose of this study was to determine the impact of client-centered occupational therapy intervention on the mental health, activities of daily living (ADL), and community participation of older adults with depression. Methods: This study was a single-blind, randomized controlled study conducted on older adults with depression, and those who met the selection and exclusion criteria were randomly divided into an experimental group of 15 people and a control group of 15 people. The experimental group performed client-centered occupational therapy intervention using the Canadian Occupational Performance Measure (COPM) and Barth Time Construction (BTC), and the control group performed case management and a strength-brain exercise program. Both groups underwent intervention twice a week for 60 min, for a total of 16 sessions. Before and after the intervention, depression, anxiety, stress, ADL, and community partitioning were measured using assessment tools with proven reliability and validity in both the experimental group and the control group. Results: The experimental group exhibited significant changes after the intervention in depression, anxiety, stress, social integration, and community integration scores (p < 0.05 and p < 0.01), while the control group showed significant changes only in depression scores (p < 0.05). As a result of comparing the amount of change between the experimental and control groups, significant differences were found in social integration among the areas of depression, stress, and community integration (p < 0.05 and p < 0.01). Conclusion: These results suggest that client-centered occupational therapy intervention could serve as an effective intervention for improving mental health, ADL, and community participation in older adults with depression. Trial Registration: Korea Clinical Research Information Service (CRIS): KCT0009358.

Association between cognitive decline and depression in middle-aged and older adults: Findings from six large cohorts in different countries

BACKGROUND

The relationship between depression and cognition in middle-aged adults is a topic of interest. Whether poor cognitive function exacerbates depression remains controversial. We clarified the association between cognitive decline and depression based on six nationwide cohorts.

METHODS

89,056 participants were retrieved from six cohorts in Europe, North America, Asia and Africa. Each two consecutive interviews were collected as a sample set with a total of twenty-eight sample sets to assess changes in depression and cognitive function. Multiple linear regression was conducted within each sample set to evaluate the association between cognitive decline and depression. A two-stage meta-analysis was performed to obtain the average effect within each cohort and the overall effect excluding population and regional heterogeneity. Meta-regression and subgroup analysis were used to explore heterogeneity and potential effect modifiers.

RESULTS

Almost all sample sets indicated negative association between changes in cognitive function and depression scores. The average effects varied across regions: Korea (-0.150 [-0.175, -0.126]), Europe (-0.130 [-0.149, -0.112]), South Africa (-0.090 [-0.129, -0.060]), China (-0.083 [-0.137, -0.030]), Mexico (-0.063 [-0.084, -0.042]), and North America (-0.048 [-0.056, -0.040]). The overall effect excluding population and regional heterogeneity was -0.094 [-0.129, -0.060], and was robust across populations of different age, sex, alcohol consumption, daily living activities and marital status.

LIMITATIONS

The cross-sectional design limited our ability to determine causal relationships.

CONCLUSION

Cognitive decline was associated with the exacerbation of depression status in middle-aged and older adults worldwide. Country-level factors, rather than individual-level factors, are more likely to modify this effect.

Association between depressive status and mild cognitive impairment in middle-aged and elderly Chinese adults from CHARLS study

Background

The potential association between depressive status and the risk of mild cognitive impairment (MCI) remains unclear, especially in the absence of prospective evidence. This study aims to elucidate the impact of either depression score or depression on the risk of MCI using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods

This prospective study included 5,766 participants from CHARLS followed from 2011 to 2015. We calculated the baseline depression score using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the cognitive status score after 3 years of follow-up through four dimensions: orientation, memory, calculation, and draw. We collected baseline sociological characteristics and health-related factors as covariates, using multivariate-adjusted logistics regression models (odds ratios (OR) and 95% confidence intervals (CI)) and restricted cubic splines (RCS) to estimate the effect of depressive status on MCI risk.

Results

We observed 724 new cases of MCI at follow-up. Logistics regression analysis showed that participants with depression had a 58% higher risk of developing MCI than those without depression (OR = 1.58, 95%CI: 1.35-1.85), and the positive association persisted after adjusting for covariates such as sociological characteristics of the population and health-related factors (OR = 1.24, 95%CI: 1.04-1.48). We also observed a dose-response relationship between depression score and MCI risk, with participants with 11~20 and 21~30 scores having a progressively higher risk of MCI compared to participants with depression score of 0~10 (p for trend < 0.05), and a 3% increase in MCI risk for each 1-point increase in depression scores (OR = 1.03, 95%CI: 1.01-1.04). RCS analysis also showed a nonlinear association between depression score and MCI risk (p for non-linearity = 0.001), with MCI risk increasing with increasing depression score. In addition, stratified analyses based on sex, age, marital status, residence, BMI, nighttime sleep, smoking status, alcohol drinking status, baseline serological indicators, and comorbidities showed no interaction (p for interaction > 0.05) other than serum total cholesterol levels (p for interaction = 0.008).

Conclusions

Among middle-aged and elderly adults from CHARLS, depression is an independent risk factor for MCI, indicating that individuals with more severe depression symptoms are more likely to suffer from MCI. Early depression screening based on CESD-10 may help identify individuals at high risk of MCI, and early intervention may reduce the incidence of MCI and Alzheimer's disease, thereby reducing the social care burden of an ageing population.

Evaluating the effectiveness of integrated traditional Chinese and Western treatment based on symptom grading: a study protocol for a multi-center, randomized controlled trial of patients with depressive disorder

Background

Approximately one-third of depressed individuals receive treatment globally. The application rate of traditional Chinese medicine (TCM) for treating depression globally remains relatively low. The proposed study presents a pilot trial to evaluate the effectiveness of interventions at different levels in improving depression status in community populations.

Methods

A randomized controlled trial will be conducted in two communities in Guangdong, China, with a follow-up period of 12 weeks. Participants will be randomly allocated to control or intervention groups. Participants in the control group will be assigned to routine care, while participants in the intervention group will receive TCM intervention measures. The participants in the intervention group will receive integrated traditional Chinese and Western treatment according to the symptom grading of depression severity. Primary outcome measurements include the Patient Health Questionnaire (PHQ-9), the Hamilton Depression Rating Scale (HAMD-17), and the Self-Rating Depression Scale (SDS). Secondary outcome measurements include the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), the Multiple Mental Health Literacy Scale (MMHL), the Short-Form 12 (SF-12), and the Treatment Emergent Symptom Scale (TESS). The data will be collected at baseline (T1), 2 weeks after intervention (T2), 4 weeks after intervention (T3), 8 weeks after intervention (T4), and 12 weeks after intervention (T5).

Discussion

This study will provide an experimental basis for the effectiveness of hierarchical integrated traditional Chinese and Western medicine (ITCWM) in improving the condition of patients with different degrees of depression. At the end of the study, it is expected for the experimental group to have an improvement in depressive symptoms and sleep quality and an enhancement in mental health awareness.

Clinical trial registration

http://www.chictr.org.cn, identifier ChiCTR2300075169.

Association of depression and loneliness with risk of disability among community-dwelling older adults

This study aimed to examine whether the risk of disabilities was reduced among community-dwelling older adults who experienced either depression or loneliness compared with those who experienced both. This sample included 5,005 older adults. Participants were followed for two years from baseline for incidence of disability. They were classified into four groups based on the presence of loneliness and depressive symptoms. The Cox proportional-hazards model, adjusted for confounders, was used to examine their associations with the incidence of disability. The incidence of disability in the comorbid, depression-only, loneliness-only, and robust groups was 11.6 %, 6.9 %, 5.3 %, and 4.2 %, respectively. The depression-only (HR 0.59, 95 % CI 0.36‒0.96), loneliness-only (HR 0.44, 95 % CI 0.31‒0.62), and robust groups (HR 0.34, 95 % CI 0.25‒0.46) had a significantly lower risk of disability compared with the comorbid group. It was concluded that alleviating depression or loneliness may reduce the risk of future disability.

Association Between Biomass Fuel Use and Depression Symptoms in the Adult Population of Oaxaca, Mexico

BACKGROUND

The impact of biomass fuel exposure on mental health, along with the associated gender disparities, remains largely unexplored. This study aimed to examine the association between biomass fuel use and depressive symptoms in the population of Oaxaca, Mexico, while also identifying gender differences in this relationship.

METHODS

This study used data from the 2022 National Health and Nutrition Survey (ENSANUT). Depressive symptoms, the outcome variable, were assessed using the Center for Epidemiologic Studies Depression Scale (CESD). The primary predictor variable was biomass fuel use, with gender, age, and residency stratum included as covariates. First, a binary logistic regression model was developed to estimate the dichotomous variable "depression symptoms". Subsequently, a second binary logistic regression model was constructed to evaluate potential interactions between the covariates and the predictor variable.

FINDINGS

The sample included 1.4 million adults from Oaxaca, with a prevalence of depressive symptoms of 15%. Biomass fuel was used by 15.4% of the population. The first logistic regression model showed that women (Odds Ratio (OR): 1.249; 95% CI: 1.235-1.263; p < 0.001), individuals aged 60 years and older compared to the younger population group (OR: 12.192; 95% CI: 12.064-12.321; p < 0.001), those residing in rural areas (OR: 1.245; 95% CI: 1.232-1.259; p < 0.001), and individuals using firewood or charcoal for cooking (OR: 1.674; 95% CI: 1.651-1.697; p < 0.001) had higher odds of depressive symptoms. In the second binary logistic regression model, all associations and OR coefficients retained their direction, although the coefficients underwent a slight adjustment following the introduction of the interaction term, indicating the presence of an interaction.

CONCLUSIONS

The study findings suggest a gendered association between biomass fuel exposure and depressive symptoms in the adult population of Oaxaca, with older women and women dwelling in rural areas being the most vulnerable. Interventions aimed at reducing biomass air pollution exposure and strengthening mental health support for women are strongly recommended.

Association of serum total folate and serum vitamin D concentrations with W-shape in depressed older adults with cognitive dysfunction: A cross-sectional observational study

BACKGROUND

Depression and cognitive dysfunction are prevalent in the elderly population and have a serious impact on patients' quality of life and social functioning. Nutritional factors play a key role in the prevention and management of these disorders, particularly folate and vitamin D. The aim of this study was to elucidate the association between serum total folate and serum vitamin D concentrations and depressive symptoms and cognitive dysfunction in older adults.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, 2042 participants aged 60 years and older were analyzed. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and cognitive function was assessed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Animal Fluency test and the Digit Symbol Substitution Test (DSST). Associations between serum total folate and vitamin D concentrations and depression with cognitive dysfunction were analyzed using multivariate logistic regression models, incorporating stratification and sensitivity analyses.

RESULTS

For every 1 nmol/L increase in serum vitamin D concentration, there was a 1 % reduction in the risk of depression in older adults (OR = 0.99 95 % CI 0.98-0.99). Serum total folate showed a significant W-shaped association with depression with cognitive dysfunction: when serum total folate concentration was below 33.00 nmol/L, the risk of depression was reduced by 7.6 % for every 1 nmol/L increase in its concentration (OR = 0.924 95 % CI 0.89-0.959); this association was not significant when the concentration was above 33.00 nmol/L (OR = 1.006 95 % CI 0.998-1.013).

CONCLUSIONS

Adequate levels of vitamin D and folate may help prevent and manage depression and cognitive dysfunction in older adults. The W-shaped association between serum total folate and these conditions suggests that folic acid supplementation could be effective within a specific range, warranting further exploration and validation through clinical studies.

Rural-urban differences in the association between afternoon napping and depressive symptoms among middle-aged and older adults in China

OBJECTIVE

This study aimed to examine the association between afternoon napping and depressive symptoms among Chinese middle-aged and older adults and to evaluate the rural-urban differences.

METHODS

A total of 11,056 participants, aged≥45, 5646 rural and 5410 urban, were included using data from CFPS. Each participant provided data on afternoon napping through field interviews. CESD8 was used to measure depressive symptoms. Multivariable logistic regressions were used to investigate the association.

RESULTS

2654 (24.01 %) participants had depressive symptoms and 7239 (65.48 %) napped. Nappers were likely to have a lower risk of depressive symptoms (OR = 0.899; 95%CI =0.816-0.991). A significantly lower risk of depressive symptoms was found in the moderate-duration afternoon napping groups (31-60 min/day) compared with non-nappers (OR = 0.816; 95%CI =0.727-0.917). In terms of rural-urban differences, rural participants had a lower risk of depressive symptoms compared with non-nappers (OR = 0.813; 95%CI =0.716-0.926). A significant association was also found between age groups. Participants aged 65-74 years old had a lower risk of depressive symptoms compared with non-nappers (OR = 0.776; 95%CI = 0.627-0.959).

LIMITATIONS

First, the cross-sectional study may limit the ability to infer causality. Second, only those who responded to the questionnaire were included; selection bias was unavoidable. Finally, answers were retrospective self-reported, which may cause recall bias and social desirability bias.

CONCLUSIONS

Afternoon napping was associated with a lower risk of depressive symptoms among Chinese middle-aged and older adults. The associations varied between rural-urban and age groups. We recommend taking a moderate-duration afternoon napping every day to prevent the risk of potential depression.

Comparative efficacy of multiple non-invasive brain stimulation to treat major depressive disorder in older patients: A systematic review and network meta-analysis study based on randomized controlled trials

BACKGROUND

Major depressive disorder (MDD) is prevalent among older patients and is frequently associated with cognitive decline and a reduced quality of life. Non-invasive brain stimulation (NIBS) techniques show promise for treating MDD, but their comparative efficacy and safety older populations remain unclear. This study aimed to compare the efficacy and cognitive effects of various NIBS techniques in treating MDD in older patients.

METHODS

We searched the PubMed, EMBASE, Cochrane Library, and Web of Science core databases from inception to March 2024. Seventeen randomized controlled trials (RCTs) were included.

RESULTS

Surfaces under the cumulative ranking curve (SUCRA) values were used to rank the interventions. The SUCRA rankings for the Hamilton Depression Rating Scale (HDRS) outcomes indicated that repetitive transcranial magnetic stimulation (rTMS) (89.0 %) had the highest efficacy, followed by transcranial direct current stimulation (tDCS) (68.7 %). rTMS demonstrated significantly superior efficacy compared with bilateral electroconvulsive therapy (BL ECT) and right unilateral electroconvulsive therapy (RUL ECT). Theta burst stimulation (TBS) had the highest response rate (69.6 %), followed by rTMS (61.8 %). Based on the Mini-Mental State Examination, rTMS (86.4 %) ranked the highest, with RUL ECT showing significantly better outcomes than BL ECT.

CONCLUSION

NIBS, particularly rTMS and TBS, may offer effective treatment options for older patients with MDD. Further research with larger sample sizes and longer follow-up periods is required to validate these findings and inform clinical practice.

The prevalence and risk factors for post-traumatic stress disorder, depression and anxiety among older survivors post-earthquake: A systematic review and meta-analysis

BACKGROUND

The occurrence of PTSD, depression, and anxiety is notably high among older adults following an earthquake. This research aimed to assess the prevalence and determinants of mental health conditions among older survivors after an earthquake.

METHODS

The review was conducted in accordance with the PRISMA process. A comprehensive search was conducted across various databases including PubMed, EMBASE, Web of Science, Scopus, CINAHL, Cochrane Library, SinoMed, China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals, and the Wan Fang Database for Chinese Periodicals for studies reporting on the prevalence of PTSD, depression, and anxiety among older survivors post-earthquake. Each database was searched from inception to August 1, 2023 each database, and updated the search on October 1, 2024. The random effects model was employed to conduct meta-analysis, and the I2 index was taken into account to evaluate heterogeneity among studies. A narrative synthesis was performed to identify the risk factors associated with these mental health conditions.

RESULTS

A total of 33 studies were analyzed in this meta-analysis, mainly from China, Japan, Nepal, and Mexico. The prevalence rates of PTSD, depression, and anxiety among older earthquake survivors were found to be 19.3 % (95 % CI [16.0-22.6 %]; I2 = 99.486 %, P = 0.000), 23.5 % (95 % CI [13.9-33.1 %]; I2 = 99.901 %, P = 0.000) and 10.9 % (95 % CI [6.7-15.1 %]; I2 = 99.287 %, P = 0.000), respectively. The identified major risk factors were categorized into four dimensions, including demographic variables (e.g., older age, chronic illness), pre-disaster mitigation variables (e.g., lack of insurance), responding in disaster variables (e.g., being injured, property damage) and post-disaster relief variables (e.g., inadequate psychological care, low levels of social/family support).

LIMITATIONS

The optimal cut-off for different screening tools may be sensitive to changes in the prevalence of older survivors post-earthquake. Furthermore, due to the heterogeneity of the studies, a narrative synthesis of risk factors was conducted.

CONCLUSIONS

The findings of this review may increase the awareness of the burden and risk factors associated with PTSD, depression, and anxiety in older survivors post-earthquake. It serves as a reference for the government in formulating recovery policies focusing on interventions, such as financial allocation, psychological treatment, and insurance claims. These policies aim to mitigate the long-term psychological effects on older survivors and ultimately lower the prevalence of mental health conditions.

The Role of Cortisol and Dehydroepiandrosterone in Obesity, Pain, and Aging

Obesity, chronic pain, and aging are prevalent global challenges with profound implications for health and well-being. Central to these processes are adrenal hormones, particularly cortisol and dehydroepiandrosterone (DHEA), along with its sulfated form (DHEAS). Cortisol, essential for stress adaptation, can have adverse effects on pain perception and aging when dysregulated, while DHEA/S possess properties that may mitigate these effects. This review explores the roles of cortisol and DHEA/S in the contexts of obesity, acute and chronic pain, aging, and age-related diseases. We examine the hormonal balance, specifically the cortisol-to-DHEA ratio (CDR), as a key marker of stress system functionality and its impact on pain sensitivity, neurodegeneration, and physical decline. Elevated CDR and decreased DHEA/S levels are associated with worsened outcomes, including increased frailty, immune dysfunction, and the progression of age-related conditions such as osteoporosis and Alzheimer's disease. This review synthesizes the current literature to highlight the complex interplay between these hormones and their broader implications for health. It aims to provide insights into potential future therapies to improve pain management and promote healthy weight and aging. By investigating these mechanisms, this work contributes to a deeper understanding of the physiological intersections between pain, aging, and the endocrine system.

Sex influences whether hippocampal volumes mediate the relationship between depression and cognition in older adults without dementia: A UK Biobank study

Depression is a modifiable risk factor for dementia; however, it remains unclear whether there are sex differences in how depression affects dementia risk. To better understand sex-specific differences in how depression confers risk of dementia, the link between depression, hippocampal volumes, and cognition was evaluated in a sample of older adults without dementia from the UK Biobank cohort. A total of 18,220 participants (women n = 9,474; men n = 8,746) were selected based on completion of the Patient Health Questionnaire (PHQ-9), structural MRI, and cognitive assessments. Causal mediation analyses were used to evaluate if the relationship between depression and cognition is mediated by the hippocampus differently by sex. Women reported greater depression severity than men. Hippocampal volumes were found to mediate the relationship between depression severity and fluid intelligence only in women. Upon categorization of the depression symptoms as either cognitive/affective or somatic, the mediation effect of the hippocampus was seen for both cognitive/affective and somatic symptom severity in women for fluid intelligence. These results offer insight into the sex-specific pathways underlying the relationship between depression, hippocampal volumes, and cognition in older adults without dementia with a focus on the type of depression symptoms. This knowledge could aid in the development of sex-focused dementia prevention strategies and treatments.

The association between the ten-year trajectory of multimorbidity and depressive symptoms among the middle-aged and older adults: Results from the China Health and Retirement Longitudinal Study

BACKGROUND

Despite the established link between chronic conditions and depressive symptoms in recent decades, research into the temporal dynamics between multimorbidity and the occurrence of depressive symptoms remains scarce.

METHODS

A total of 15,882 Chinese middle-aged and older adults with 63,246 observations from the China Health and Retirement Longitudinal Study were included in the present study. Depressive symptoms were evaluated using a 10-item CESD scale, with a threshold set at 12 points. Group-based trajectory modeling was used to examine the multimorbidity developmental trajectories. The risk of depressive symptoms was analyzed using mixed effect logistic regression models.

RESULTS

Among the final included 15,896 participants, 37.6 % reported states of multimorbidity, and 25.7 % were detected as depressive symptoms. In the fully adjusted model, those with multimorbidity were 2.36 (2.24 to 2.49) times more likely to present depressive symptoms, and the likelihood increased 1.38 (1.36 to 1.40) times with each additional chronic condition. Four distinct multimorbidity trajectory groups were identified: no-new-condition group (32.6 %), slow growth group (42.9 %), steady growth group (19.7 %), and rapid growth group (4.9 %). Compared to the no-new-condition group, the likelihood of developing depressive symptoms was greater in the subsequent three groups, with ORs of 1.53 (1.39 to1.71), 2.54 (2.24 to 2.89), and 4.40 (3.62 to 5.34), respectively.

CONCLUSION

Our results highlight the substantial health effects of accumulating multimorbidity on depressive symptoms, showing a direct link between risk and accumulation rate. We urge focusing on depressive symptoms in those with multimorbidity to tackle the significant healthcare challenges arising from concurrent physical and mental health issues.

Bidirectional relationship between epigenetic age and stroke, dementia, and late-life depression

Chronological age is an imperfect estimate of molecular aging. Epigenetic age, derived from DNA methylation data, provides a more nuanced representation of aging-related biological processes. We examine the bidirectional relationship between epigenetic age and brain health events (stroke, dementia, late-life depression) using data from 4,018 participants. Participants with a prior brain health event are 4% epigenetically older (β = 0.04, SE = 0.01), indicating these conditions are associated with accelerated aging beyond that captured by chronological age. Additionally, a one standard deviation increase in epigenetic age is associated with 70% higher odds of experiencing a brain health event in the next four years (OR = 1.70, 95% CI = 1.16-2.50), suggesting epigenetic age acceleration is not just a consequence but also a predictor of poor brain health. Mendelian Randomization analyses replicate these findings, supporting their causal nature. Our results support using epigenetic age as a biomarker to evaluate interventions aimed at preventing and promoting recovery after brain health events.

Anxiety and depression prevalence and associated factors in patients with knee osteoarthritis

Objective

With the evolving spectrum of diseases, psychological conditions such as anxiety and depression have emerged as significant global public health concerns. Notably, these psychological disorders are prevalent among patients suffering from knee osteoarthritis (KOA). Consequently, this study included 360 hospitalized patients diagnosed with KOA to examine their levels of anxiety and depression and to analyze the factors influencing these psychological states.

Methods

A cohort of KOA patients from the Second Hospital of Shanxi Medical University was assessed using a general condition questionnaire, European five-dimensional health status scale (EQ5D), Western Ontario and McMaster University Osteoarthritis (WOMAC), Social Support Rating Scale (SSRS), and Hospital Anxiety and Depression Scale (HADS). Logistic regression analysis was employed to identify the factors affecting anxiety and depression.

Results

Among 360 patients with KOA, 28.06% experienced anxiety, and 30.27% experienced depression. Multivariate logistic regression analysis showed that lower BMI, QOL, and utilization of social support scores are risk factors for anxiety and depression in KOA patients (P<0.05). Additionally, in patients with KOA, younger age, lower subjective support, and higher scores in function and daily activities emerged as significant risk factors for depression (P<0.05).

Conclusion

Anxiety and depression in patients with KOA warrant significant attention due to their impact on overall well-being. The factors influencing these mental health conditions are multidimensional. In clinical practice, it is essential to integrate these various influencing factors to develop targeted mental health care services. By doing so, healthcare providers can enhance the overall mental health and QOL for individuals suffering from KOA.

Bibliometric and visual analysis of suicide in aged people over the past 20 years

Background

The rapid aging of the global population presents pressing public health challenges, notably an increase in suicide rates among older adults. Despite this critical issue, there is a scarcity of comprehensive assessments regarding the existing literature on suicide within this demographic. This study seeks to employ bibliometric analysis and knowledge mapping to elucidate prevailing research trends and the overall status of this field.

Methods

We performed a comprehensive computer-based search of the Web of Science Core Collection to identify relevant articles and reviews concerning suicide in the elderly. A bibliometric analysis was conducted, examining various aspects including countries or regions, institutions, authors, journals, keywords, and references. This analysis utilized tools such as CiteSpace, VOSViewer, Pajek, and Excel 365 to facilitate a thorough assessment.

Results

The analysis covered 1,116 publications from 2005 to 2024. The annual number of publications showed a fluctuating upward trend, with notable decreases in 2007, 2012, 2015, 2017, and 2022, and increases in 2009, 2013, 2016, and 2019, peaking at 121 in 2021, with citations reaching 4,741 in 2022, but declining since then. The United States stands out as the most productive and influential country in the field, boasting the highest number of publications and citations. The country is home to institutions leading in both publication and citation metrics. Prominent authors contributing significantly to this domain include Conwell Yeates, Van Orden Kimberly A., and Waern Margda. Key journals disseminating crucial research are the Journal of Affective Disorders, American Journal of Geriatric Psychiatry, and Lancet. Frequent keywords in this field encompass depression, suicidal ideation, suicide, older-adults, risk, risk factors, prevalence, older adults, ideation, behavior, health, mental health, life, age, people, prevention, symptoms, scale, population, and elderly. The contemporary research emphasis is primarily on identifying, treating, and preventing the suicide risk associated with depression in older adults.

Conclusions

This study highlights the growing research focus on suicide in older adults, particularly related to depression and the identification, treatment, and prevention of suicide risk. The findings underscore the need for targeted prevention strategies and further investigation in this critical public health area.

Association between internet use and depression among the middle-aged and elderly adults with multimorbidity in China: do gender differences exist?

Objectives

Internet use and the results of mental health are related. Numbers of studies presented the association between Internet use and depression, and the middle-aged and elderly adults with multimorbidity are of concern. The study aimed to explore the relationship between Internet use and depression in middle-aged and elderly adults with multimorbidity.

Methods

We selected 2550 respondents aged 45 years and above with multimorbidity from the China Health and Retirement Longitudinal Study (CHARLS) 2018 database. Logistic regression models were constructed to examine the effects of Internet use on depression, as well as comparing gender differences. Meanwhile, propensity score matching (PSM) was used to test the robustness of the results.

Results

Overall, 49.8% of respondents had a risk of developing depression, and 14.9% of the participants used the Internet. Internet use (OR = 0.66, P = 0.002), type of devices (one type: OR = 0.69, P = .011;≥2 types: OR = 0.53, P = 0.03), frequency of Internet use (regularly: OR = 0.67, P = 0.005) were all inversely associated with depression. Significant differences between genders were observed, Internet use was associated with a lower prevalence of depression among men, while the association was not statistically significant among women.

Conclusions

There is a significantly negative association between Internet use and depression in the middle-aged and elderly adults with multimorbidity in China, and this relationship varies across different genders. This suggests that Internet use may be a protective factor for depressive symptoms in the older population, offering a guideline for policymakers to develop specific strategies for different genders.

Depressive symptoms are linked to age-specific neuroanatomical and cognitive variations

Depression is a heterogeneous disorder, both in terms of patient symptomatology and in patient sociodemographic factors. Here, we examine the contribution of age to this heterogeneity, by characterizing the associations of depressive symptoms with cognitive performance and brain structure across the lifespan. We analyzed data from the Cambridge Centre for Aging Neuroscience (Cam-CAN) cohort (N = 2591, age 18-99). A subset of this cohort (N = 647) underwent structural MRI. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Cognitive assessments were performed using The Addenbrooke's Cognitive Examination Revised. Generalized linear models were employed to examine the relationship between depressive symptoms and cognitive performance. Statistical parametric mapping explored age-dependent associations between depressive symptoms and grey matter volume. Cognitive performance was associated with a significant age by depression by cognitive domain interaction, indicating that older individuals with more depressive symptoms had a lower cognitive performance, particularly in the fluency domain. Structural MRI revealed preferential depression-related reduction in grey matter volume in the left and right hippocampi in older adults. By contrast, in younger adults, depressive symptoms were more strongly associated with grey matter volume reduction in the left superior frontal gyrus and left middle frontal gyrus. Collectively, these findings indicate that the associations of depression with cognitive performance and brain structure are age-dependent, suggesting that the pathophysiological mechanisms underlying depression may differ between young and older adults. Recognizing these differences will support the development of better diagnostic tools and therapeutic interventions for depression across the lifespan.

Functional Connectivity Alterations Associated with COVID-19-Related Sleep Problems: A Longitudinal Resting-State fMRI Study

Background

COVID-19 has led to reports of fatigue and sleep problems. Brain function changes underlying sleep problems (SP) post-COVID-19 are unclear.

Purpose

This study investigated SP-related brain functional connectivity (FC) alterations.

Patients and methods

Fifty-five COVID-19 survivors with SP (COVID_SP) and 33 without SP (COVID_NSP), matched for demographics, completed PSQI and underwent rs-fMRI at baseline and 2-month follow-up. Correlations between FC and clinical data were analyzed by Pearson correlation analysis with Gaussian random field (GRF) correction. The repeated-measures analysis of variance (R-M ANOVA) was completed to explore the interaction with time.

Results

At baseline, COVID_SP exhibited elevated FC: right precentral gyrus (PrG) with left lateral occipital cortex (LOcC)/right PrG, left inferior parietal lobule (IPL) with right superior frontal gyrus (SFG), left hippocampus with right inferior frontal gyrus (IFG). Higher FC between left hippocampus and right SFG correlated with PSQI scores. At 2-month follow-up, decreased FC implicated in emotion regulation, executive function, and memory; increased FC in semantics, attention, and auditory-visual processing. The changes in these regions are correlated with the scores of PSQI, GAD, and PHQ. The Repeated-Measures Analysis of Variance (R-M ANOVA) revealed a significant time interaction effect between sleep and various emotion scales. Moreover, the analysis of the functional connectivity between the right PrG and the right PrG as well as that between the left IPL and the right SFG also discovered a significant time interaction effect.

Conclusion

This study provides insight into the changes in brain function associated with SP after COVID-19. These changes may partially explain the development of SP, and they also changed over time.

Sex in aging matters: exercise and chronic stress differentially impact females and males across the lifespan

Assessing sex as a biological variable is critical to determining the influence of environmental and lifestyle risks and protective factors mediating behavior and neuroplasticity across the lifespan. We investigated sex differences in affective behavior, memory, and hippocampal neurogenesis following short- or long-term exposure to exercise or chronic mild stress in young and aged mice. Male and female mice were assigned control, running, or chronic stress rearing conditions for 1 month (young) or for 15 months (aged), then underwent a behavioral test battery to assess activity, affective behavior, and memory. Stress exposure into late-adulthood increased hyperactivity in both sexes, and enhanced anxiety-like and depressive-like behavior in aged female, but not male, mice. One month of stress or running had no differential effects on behavior in young males and females. Running increased survival of BrdU-labelled hippocampal cells in both young and aged mice, and enhanced spatial memory in aged mice. These findings highlight the importance of considering sex when determining how aging is differently impacted by modifiable lifestyle factors across the lifespan.

The associations of cardiovascular health and all-cause mortality among individuals with depression

The association between the recently updated cardiovascular health (CVH) assessment algorithm, the Life's Essential 8 (LE8), and all-cause mortality among adults with depression remains unknown. From the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018, a cohort of 2,935 individuals diagnosed with depression was identified. Their CVH was evaluated through the LE8 score system. The investigation of mortality status utilized connections with the National Death Index up to December 31, 2019. To assess the impact of CVH on mortality risk, Kaplan-Meier survival analysis and Cox proportional hazards models, adjusting for variables related to demographics and socioeconomic status, were applied. Among 2,935 participants, those with higher CVH levels had significantly lower all-cause mortality compared to those with lower CVH levels. Cox regression analyses demonstrated that each 1-point increase in CVH score was associated with a lower risk of all-cause mortality [HR = 0.97, 95%CI:0.96-0.98]. The inverse association between CVH and mortality persisted across different demographic and socioeconomic subgroups. Higher CVH levels were associated with a significantly lower risk of all-cause mortality in individuals with depression. These findings underscore the importance of comprehensive CVH management as part of healthcare strategies for people with depression, suggesting that improving CVH may contribute to longer life expectancy in this vulnerable population.

Machine learning algorithms to predict depression in older adults in China: a cross-sectional study

Objective

The 2-fold objective of this research is to investigate machine learning's (ML) predictive value for the incidence of depression among China's older adult population and to determine the noteworthy aspects resulting in depression.

Methods

This research selected 7,880 older adult people by utilizing data from the 2020 China Health and Retirement Longitudinal Study. Thereafter, the dataset was classified into training and testing sets at a 6:4 ratio. Six ML algorithms, namely, logistic regression, k-nearest neighbors, support vector machine, decision tree, LightGBM, and random forest, were used in constructing a predictive model for depression among the older adult. To compare the differences in the ROC curves of the different models, the Delong test was conducted. Meanwhile, to evaluate the models' performance, this research performed decision curve analysis (DCA). Thereafter, the Shapely Additive exPlanations values were utilized for model interpretation on the bases of the prediction results' substantial contributions.

Results

The range of the area under the curve (AUC) of each model's ROC curves was 0.648-0.738, with significant differences (P < 0.01). The DCA results indicate that within various probability thresholds, LightGBM's net benefit was the highest. Self-rated health, nighttime sleep, gender, age, and cognitive function are the five most important characteristics of all models in terms of predicting the occurrence of depression.

Conclusion

The occurrence of depression among China's older adult population and the critical factors leading to depression can be predicted and identified, respectively, by ML algorithms.

Association between age-related hearing loss and depression: A systematic review and meta-analysis

INTRODUCTION

This meta-analysis examined the relationship between age-related hearing loss (ARHL) and depression in older adults, and further explored whether this relationship is moderated by age and gender.

METHODS

We searched in 4 English databases: PubMed, Embase, Web of Science, and Cochrane Library. Ultimately, we identified 9 studies, involving 3 cohort studies and 6 cross-sectional studies. We used Hedges' g as the effect size, and all pooled analyses were performed using random-effects models.

RESULTS

ARHL patients had higher depressive symptom scores than non-ARHL older adults (g = 0.52). When divided into subgroups based on study type, a large effect size was demonstrated in the cross-sectional study group (g = 0.68) and was not statistically different in the cohort study group (g = 0.06). Meta-regression results showed that the effect size of depression in older adults with ARHL was significantly associated with the percentage of females (t = 5.97, p = 0.000) and not significantly associated with age (t = 0.94, p = 0.364).

CONCLUSIONS

Patients with ARHL are more likely to be depressed than older adults with normal hearing, and this relationship is influenced by the gender of the patients.

Association Between Kyphosis and Sleep Disturbance in Community-Dwelling Older Adults: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study

PURPOSE

Worsening sagittal alignment of the spine, particularly kyphosis, may cause difficulty in assuming a supine position, restricting sleeping posture and movement and potentially leading to sleep disturbances. However, no studies have explored the relationship between sagittal spinal alignment and sleep disturbance. This study aimed to clarify the relationship between sagittal spinal alignment and sleep disturbance.

METHODS

Data were drawn from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) in 2010. Sleep disturbance was assessed using a self-administered questionnaire on average sleep duration over the past month, with patients classified as having sleep disturbance if they slept for fewer than six hours per day. The sagittal vertical axis (SVA) was measured on standing whole-spine radiographs and classified into three groups based on the Scoliosis Research Society Schwab classification: non-kyphosis: <40 mm; moderate kyphosis: 40-95 mm; and severe kyphosis: >95 mm. Age, sex, drinking habits, depressive symptoms, overactive bladder symptoms, and napping habits were assessed as confounding factors. The association between SVA and sleep disturbance was evaluated using adjusted odds ratios and 95% confidence intervals (CIs).

RESULTS

The percentage of sleep disturbance among the 772 subjects in the analysis was 8.9% for non-kyphosis, 9.1% for moderate kyphosis, and 20.0% for severe kyphosis. Using non-kyphosis as the reference, adjusted odds ratios (ORs; 95% confidence intervals (95% CIs)) were 1.16 (0.65-2.05) for moderate kyphosis and 2.86 (1.13-7.26) for severe kyphosis.

CONCLUSION

Kyphosis in community-dwelling adults was found to be associated with sleep disturbance. Therefore, it is necessary to focus on the parasomnias of sleep disturbance in patients presenting with spinal kyphosis.

Coexistence of somatic and psychological symptoms of depression among community-dwelling older adults is associated with the incidence of dementia

BACKGROUND

Depression in old age is associated with the incidence of dementia. However, whether a combination of somatic and psychological symptoms influences the risk of dementia has not been fully investigated.

OBJECTIVE

We aimed to determine the association between the combination of psychological and somatic symptoms of depression and the incidence of dementia.

METHODS

This prospective cohort study included 2111 community-dwelling older adults (median age = 73 years, interquartile range = 68-78 years, 39.5% male). Participants were evaluated for 5 years from baseline to assess the incidence of dementia. Somatic symptoms were defined as the presence of one or more symptoms of fatigue, weight loss, sleep disturbances, and abnormal appetite. Psychological symptoms were assessed using the 15-item Geriatric Depression Scale. Participants were stratified into four groups based on the presence or absence of somatic and psychological symptoms. A Cox proportional hazards model was used to examine the associations with the incidence of dementia, adjusted for potential confounders.

RESULTS

The hazard ratios for the incidence of dementia in the somatic (HR 1.42, 95% CI: 0.96-2.09) and psychological symptoms-only groups (HR 1.47, 95% CI: 0.83-2.59) were not significantly different; however, they were significantly higher in the coexistent group than in the normal group (HR 1.91, 95% CI: 1.24-2.94).

CONCLUSIONS

The coexistence of somatic and psychological symptoms of depression increases the risk of dementia. Therefore, interventions should consider both somatic and psychological symptoms to prevent or delay dementia.

MALDI-TOF MS-based SNP assay used to determine the appropriate antidepression for Chinese patients

Medicine remains the preferred primary treatment for depression, although some patients show remarkable individual variations in achieving satisfactory clinical outcomes during medication. Genetic polymorphisms cause approximately 40 % of individual differences in treatment response. Therefore, this study aimed to develop a technique to identify single nucleotide polymorphisms (SNPs) associated with the metabolism, effectiveness, and side effects of antidepressant medications in Chinese patients. Bibliometrics was used to search literature related to "depression" and "SNP" in Web of Science. The obtained SNP information was screened using the PharmGKB database. By designing and optimizing primers and conducting a compound amplification system, a method was established based on MALDI-TOF MS to detect polymorphisms associated with the antidepressant drugs, including sertraline, fluoxetine, citalopram, escitalopram, venlafaxine, fluvoxamine, paroxetine, and mirtazapine. The accuracy and sensitivity of the established method were verified by Sanger sequencing. A total of 10,043 articles were screened from the database, and 46 SNPs with a mutation frequency of >1 % in Asian populations and annotated with relevant clinical drugs were extracted from the PharmGKB database. This method was compared with the results of Sanger sequencing, and the accuracy of the detection results was 100 %. The MALDI-TOF MS-based SNP assay developed in this study can be a fast, convenient and effective way for patients to find the right medication for themselves. Moreover, we found that this SNP assay holds the promise of being a potential reference tool for assessing individualised differences in drug efficacy, not only for screening the causes of poor antidepressant efficacy in patients after taking medication, but also for advising physicians to understand individualised differences in drug efficacy.

Association between major depressive disorder or depressive symptoms and the risk of vascular complications among patients with type 2 diabetes, and the mediating role of metabolic biomarkers: an analysis of the UK Biobank cohort

Background

Depression is a severe mental disorder commonly co-morbid with diabetes, but it remains to elucidate whether depression is associated with the risks of a wide range of vascular complications in people with type 2 diabetes mellitus (T2DM) and whether metabolic biomarkers may mediate this pathway.

Methods

We conducted this prospective analysis among the participants of the UK Biobank who were diagnosed with T2DM and free of vascular complications at baseline between March 13, 2006 and September 30, 2010. Major depressive disorder (MDD) was ascertained according to the hospital admission records and self-report of doctor-diagnosed conditions, while the presence of depressive symptoms was assessed using the Patient Health Questionnaire-2. Cox proportional hazards models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MDD and depressive symptoms with the risks of incident heart failure (HF); total and individual atherosclerotic cardiovascular disease (ASCVD) including coronary artery disease (CAD), ischemic stroke (IS), and peripheral artery disease (PAD); total and individual microvascular complications of diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic neuropathy (DN). Mediation analyses were conducted to quantify the potential mediation effects of circulating metabolites (involved in insulin-resistance, lipid profile, liver function, renal function, and inflammation) in the association of MDD with the outcomes.

Findings

Of the total 23,856 patients with T2DM in the UK Biobank, 13,706 participants (61% males) were eligible and included in this study. During an average of 13 years of follow-up, 2927 (21.36%) ASCVD, 1070 (7.81%) HF, and 2579 (18.82%) microvascular complications occurred. The adjusted HR (95% CI) for MDD was 1.32 (1.09-1.61) with HF, 1.17 (1.03-1.32) with ASCVD, and 1.29 (1.14-1.46) with microvascular complications, while those for depressive symptoms were 1.47 (1.20-1.79), 1.25 (1.10-1.42) and 1.20 (1.05-1.37), respectively. The HRs ranged from 1.26 (1.09-1.44) to 1.96 (1.57-2.45) for MDD with individual complications and mortality, and from 1.26 (1.08-1.47) to 1.49 (1.16-1.93) for depressive symptoms. Up to 7.8% of adverse complications were attributable to MDD and 3.8% to depressive symptoms. A series of circulating metabolites involving lipid profile, renal function, and inflammation were observed to mediate the associations of MDD with vascular complications. The identified mediators jointly accounted for 7.29%-26.87% of the disparities in incident vascular complications between patients with and without MDD.

Interpretation

Our findings highlight the role of MDD and depressive symptoms in the development of vascular complications among people with T2DM, and suggest that the effect of improving mental health on vascular outcomes in patients with T2DM should be investigated in future work.

Funding

Three-Year Public Health Action Plan of Shanghai.

Depressive symptoms among the oldest-old in China: a study on rural-urban differences

BACKGROUND

In China, In China, depression among the oldest-old (aged 80 + years) is a major public health issue. As the gap in development between urban and rural China widens, the aim of this study was to demonstrated whether there are disparities in the incidence of depressive symptoms between the urban and rural oldest-old (aged 80+) in China and to quantify the contribution of relevant influencing factors.

METHODS

The study evaluated data on 5,116 oldest adults (female, 55.88%; male, 44.12%) from the 2018 Chinese Longitudinal Healthy Longevity Survey. A chi-square test analyzed the distribution characteristics of related indicators among the oldest-old adults in the two areas. Multiple linear regression was applied to exploring the influencing factors of depressive symptoms in the oldest-old (aged 80+) adults in different regions. The Blinder-Oaxaca decomposition method quantified the four categories of influencing factors (demographic characteristics, sociological characteristics, personal lifestyle, personal lifestyle) of the differences in depressive symptoms and estimated their contributions among urban and rural oldest-old (aged 80+) adults.

RESULTS

14.60% of oldest-old (aged 80+) adults reported having depressed symptoms, with rural oldest-old (aged 80+) adults reporting more of these symptoms (15.70%) than urban oldest-old (aged 80+) adults (12.25%). In urban areas, age (90-99: β = -0.583, 95%CI = -1.008 to -0.158), annual income (rich: β = -0.699, 95%CI = -1.368 to -0.029), smoking (yes: β = -0.752, 95%CI = -1.376 to -0.127), exercise (yes: β = -1.447, 95%CI = -1.828 to -1.065), self-rated health status (good: β = -2.994, 95% CI = -3.362 to -2.625) were protective factors against depressive symptoms, and married status (other: β = 1.222, 95%CI = 0.564 to 1.880) were risk factors. In rural areas, education level (1-6: β = -0.374, 95%CI =  -0.686 to -0.062), annual income (poor: β = -0.374, 95%CI = -0.721 to -0.026; rich: β = -0.781, 95%CI = -1.115 to -0.447), exercise (yes: β = -0.844, 95%CI = -1.143 to -0.545) and SRH status (good: β = -3.023, 95%CI = -3.274 to -2.772) were protective factors, whereas body mass index (BMI) (< 18.5: β = 0.532, 95%CI = 0.221 to 0.842) and married status (widowed: β = 0.630, 95%CI = 0.283 to 0.978) were risk factors. The Blinder-Oaxaca decomposition showed that 90.47% of the factors, such as age (90-99, 1.90%), living status (living in an institution, -12.35%), annual income (rich, 42.69%), smoking (yes, -5.56%), exercise (yes, 37.45%), and SRH (good, 19.09%) could significantly explain the depressive symptoms differences between the two populations (p < 0.05).

CONCLUSIONS

The oldest-old (aged 80+) adults in rural areas had a higher prevalence of depressive symptoms than that in urban areas, mostly attributed to variations in income, marital status, physical activity, and health status. These findings can help government agencies design targeted and precise intervention strategies (e.g., health education, improving medical security, and providing sports venues and equipment) to improve mental health and lower the risk of depression among the oldest population.

Depression, Anxiety, and Stress Symptoms (DASS-21) in Elderly Women in Association with Health Status (SHSQ-25): A Cross-Sectional Study

Background/Objectives: International studies state that older adults are at an increased risk of mental health symptoms and disorders (depression, anxiety, and stress), especially elderly women aged >65 years. The literature on this topic is scarce, and there is a need for studies that investigate the associations between mental health issues and overall health in elderly women. This study aimed to investigate depression, anxiety, and stress symptoms in elderly women in association with health status. Methods: A community-based cross-sectional study was conducted in Klaipeda, Lithuania, in 2020. The survey included elderly women (n = 306) aged 65 to 80 years studying at the Third Age University in Klaipeda city. The DASS-21 and SHSQ-25 scales were used for the survey. Associations and correlations between both scale indicators were calculated. Results: Sociodemographic factors such as age, marital status, and place of residence were not statistically significant in terms of mental health, except for women living alone, who had slightly lower levels of depressive symptoms (p = 0.015). Mental health issues were quite common; almost half of the participants had higher than normal levels of anxiety (49.0%) and depression (48.4%), and one-third (29.8%) experienced stress. A strong positive correlation was observed between mental health symptoms and physical health, with anxiety having the greatest effect size on fatigue (Cohen's d = 0.950, p < 0.001), cardiovascular symptoms (Cohen's d = 0.757, p < 0.001), and mental status (Cohen's d = 1.036, p < 0.001). Depressive symptoms had a large effect size on fatigue (Cohen's d = 0.764, p < 0.001) and mental status (Cohen's d = 0.816, p < 0.001), while stress had a moderate effect size on all health domains. Conclusions: The findings highlight that anxiety symptoms are a major contributor to mental health conditions and overall health in elderly women. This study's results emphasise the need for targeted interventions to address mental health challenges in elderly women.

Associations Between Brominated Flame Retardant Exposure and Depression in Adults: A Cross-Sectional Study

BACKGROUND

Brominated flame retardants (BFRs) are a type of widespread pollutant that can be transmitted through particulate matter, such as dust in the air, and have been associated with various adverse health effects, such as diabetes, metabolic syndrome, and cardiovascular disease. However, there is limited research on the link between exposure to mixtures of BFRs and depression in the general population.

METHODS

To analyze the association between exposure to BFRs and depression in the population, nationally representative data from the National Health and Nutrition Examination Survey (NHANES; 2005-2016) were used. In the final analysis, a total of 8138 adults aged 20 years and older were included. To investigate the potential relationship between BFRs and outcomes, we used binary logistic regression, restricted cubic spline (RCS), quantile-based g computation (QGC), and weighted quantile sum (WQS) regression.

RESULTS

The findings showed that serum BFR concentrations were associated with depressive symptoms over a broad spectrum. Binary logistic regression and RCS analysis showed that certain BFRs, particularly PBB153, were significantly and positively associated with the incidence of depression, even after adjustment for various confounders (p < 0.05). Mixed exposure to BFRs was also found to be associated with depression in the population, with a stronger association in men. The two most influential BFRs, PBB153 and PBDE85, were identified in both mixed exposure models and are potential risk factors of concern.

CONCLUSION

Our study identified new insights into the relationship between BFRs and depression, but sizable population-based cohort studies and toxicology mechanism studies will be needed to establish causality.

Prevalence and influencing factors of medication-related burden among patients with late-life depression in typical city of eastern China: a cross-sectional study

AIM

To evaluate the medication-related burden (MRB) of patients with late-life depression (LLD) and its influencing factors in China using the Living with Medicines Questionnaire-3 (LMQ-3), providing reference for reducing the MRB of those patients.

METHOD

A cross-sectional study was conducted between September 2023 and January 2024 on 588 patients with LLD. LMQ-3 and MRB factors questionnaire were used for data collection. The distribution of variables was assessed using descriptive analysis, while analyses of Mann-Whitney and Kruskal-Wallis were performed to evaluate inter-group differences. To explore the MRB among patients with LLD and influencing factors, multiple linear regression analysis was performed.

RESULTS

The median (IQR) LMQ-3 score of 588 participants was 102 (18), indicating a moderate MRB level. Regression analysis revealed a significant trend toward higher perceived burden among patients aged 70-79 years old, living in rural areas, receiving more medical insurance settlements, using all cash, taking more than 5 drugs each time, and taking medicine more than 3 times a day (p < 0.05), which were risk factors for higher MRB. Conversely, patients who lived with their children, had an annual household income (including adult children) more than 50,000 Chinese Yuan, and no adverse drug reactions had lower LMQ-3 scores (p < 0.05), which were protective factors. Patients' concerns about medicine, their lack of autonomy in medicine regimens, and the lack of communication between patients and doctors on treatment regimens were the main causes of the burden.

CONCLUSIONS

Results of this study provided preliminary evidence of the MRB among patients with LLD. Age, residence, living status, annual household income, type of drug payment, quantity and frequency of medication, and adverse reactions significantly affected the perceived medication burden. It is advisable for health policy makers and health care providers to implement appropriate intervention strategies and burden reduction programs for this vulnerable group.

Depression and emotion regulation strategy use moderate age-related attentional positivity bias

Effective emotion regulation is critical for maintaining emotional health in the face of adverse events that accumulate over the lifespan. These abilities are thought to be generally maintained in older adults, accompanied by the emergence of attentional biases to positive information. Such age-related positivity biases, however, are not always reported and may be moderated by individual differences in affective vulnerabilities and competencies, such as those related to dispositional negative affect and emotion regulation styles. To examine these relationships, we analyzed eye-tracking data from 72 participants (35-74 years; 50 female), 44 without and 28 with a diagnosis of Major Depressive Disorder during a free-viewing task comprising neutral-neutral, negative-neutral, and positive-neutral image pairs. Emotional bias scores were calculated based on the ratio of time spent dwelling on the emotional image vs. the neutral image in each emotional-neutral pair. Results indicate that healthy participants exhibited a stronger positivity bias than a negativity bias, whereas individuals with higher depressive symptom scores showed no difference. Next, we examined how age and emotion regulation strategy use (reappraisal vs. suppression, measured with the Emotion Regulation Questionnaire) impacted these effects. Individuals with Major Depressive Disorder did not exhibit a significant relationship between age and positivity bias. However, for healthy participants who self-reported a preference for using reappraisal in daily life, increased age was associated with an increased positivity bias. These findings indicate that the emergence of the positivity effect in older adults is related to reappraisal regulatory preferences in the absence of depressive symptoms.

LUTS/BPH increases the risk of depressive symptoms among elderly adults: A 5-year longitudinal evidence from CHARLS

OBJECTIVE

The prevalence of Lower Urinary Tract Symptoms suggestive of Benign Prostatic Hyperplasia (LUTS/BPH) is notably high and potentially elevates the likelihood of depressive symptoms. This study was designed to employ both cross-sectional and longitudinal methodologies to explore the correlation between LUTS/BPH and depressive symptoms among middle-aged and elderly men in China.

METHODS

This investigation utilized data from the China Health and Retirement Longitudinal Study (CHARLS), with the initial dataset from 2015 serving as the baseline and subsequent data from 2018 and 2020 facilitating longitudinal analysis. The study encompassed a baseline cohort of 5156 men aged 45 years and above, and an expansive longitudinal analytical sample of 23,530 participants spanning from 2015 to 2020. The assessment of depressive symptoms was conducted using the 10-item Center for Epidemiological Studies Depressive Symptoms Scale (CESD-10). To investigate the factors associated with LUTS/BPH, the relationship between LUTS/BPH and depressive symptoms, and to evaluate the incidence rate of depressive symptoms onset based on LUTS/BPH status, multivariate logistic analyses and logistic regression models were employed.

RESULTS

Our results reveal a markedly higher incidence of depressive symptoms among individuals with LUTS/BPH, at 30.16 %, compared to 22.94 % in those without LUTS/BPH. This pattern was consistent in both mild and moderate depressive symptoms categories. However, the prevalence of severe depressive symptoms did not exhibit a significant disparity between the two groups. Longitudinal analysis spanning from 2015 through 2018 and 2020 further corroborated these observations. Individuals with LUTS/BPH showed a substantially higher incidence of depressive symptoms across all severity levels compared to those without LUTS/BPH. Specifically, the presence of LUTS/BPH was linked to a 53 % heightened risk of mild depressive symptoms, a 45 % increase in moderate depressive symptoms, and an alarming 229 % surge in severe depressive symptoms risk between 2015 and 2018. Additionally, from 2015 to 2020, there was a 30 % increased risk for mild depressive symptoms, a 41 % rise for moderate depressive symptoms, and a 106 % escalation in the risk of severe depressive symptoms among those with LUTS/BPH.

CONCLUSION

In middle-aged and older Chinese adults, LUTS/BPH were correlated with an elevated risk of depressive symptoms.

Development and validation of a nomogram to predict depression in older adults with heart disease: a national survey in China

Background

Comorbid depression, frequently observed in heart disease patients, has detrimental effects on mental health and may exacerbate cardiac conditions. The objective of this study was to create and validate a risk prediction nomogram specifically for comorbid depression in older adult patients suffering from heart disease.

Methods

The 2018 data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) was analyzed and 2,110 older adult patients with heart disease aged 60 and above were included in the study. They were randomly divided in a 7:3 ratio into a training set (n = 1,477) and a validation set (n = 633). Depression symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the participants were categorized into depressed (n = 687) and non-depressed (n = 1,423) groups. We collected information regarding general demographics, lifestyle habits, and medical history of the included patients. LASSO regression and binary logistic regression analyses were performed to identify independent risk factors and construct the depression prediction nomogram. Receiver operating characteristic curve analysis and the Hosmer-Lemeshow test were used to assess the model's discrimination and calibration. Decision curve analysis helped evaluate the clinical utility of the predictive nomogram.

Results

Based on the LASSO and multivariable regression analyses, education level, quality of life, sleep quality, frequency of watching TV, and history of arthritis were identified as independent risk factors for comorbid depression in the older adult heart disease patients. A nomogram model was constructed with these five independent risk factors. The nomogram showed good clinical performance with an area under the curve (AUC) value of 0.816 (95% CI: 0.793 to 0.839). The calibration curves and Hosmer-Lemeshow goodness-of-fit test (training setχ t 2 = 4.796, p = 0.760; validation setχ v 2 = 7.236, p = 0.511) showed its satisfactory. Clinical usefulness of the nomogram was confirmed by decision curve analysis.

Conclusions

A five-parameter nomogram for predicting depression in older adult heart disease patients was developed and validated. The nomogram demonstrated high accuracy, discrimination ability, and clinical utility in assessing the risk of depression in the older adult patients with heart disease.

Using machine learning to predict the probability of incident 2-year depression in older adults with chronic diseases: a retrospective cohort study

BACKGROUND

Older adults with chronic diseases are at higher risk of depressive symptoms than those without. For the onset of depressive symptoms, the prediction ability of changes in common risk factors over a 2-year follow-up period is unclear in the Chinese older population. This study aimed to build risk prediction models (RPMs) to estimate the probability of incident 2-year depression using data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

Four ML algorithms (logistic regression [LR], AdaBoost, random forest [RF] and k-nearest neighbor [kNN]) were applied to develop RPMs using the 2011-2015 cohort data. These developed models were then validated with 2018-2020 survey data. We evaluated the model performance using discrimination and calibration metrics, including an area under the receiver operating characteristic curve (AUROC) and the precision-recall curve (AUPRC), accuracy, sensitivity and calibrations plot. Finally, we explored the key factors of depressive symptoms by the selected best predictive models.

RESULTS

This study finally included 7,121 participants to build models to predict depressive symptoms, finding a 21.5% prevalence of depression. Combining the Synthetic Minority Oversampling Technique (SMOTE) with the logistic regression model (LR-SM) exhibited superior precision to predict depression than other models, with an AUROC and AUPRC of 0.612 and 0.468, respectively, an accuracy of 0.619 and a sensitivity of 0.546. In additiona, external validation of the LR-SM model using data from the 2018-2020 data also demonstrated good predictive ability with an AUROC of 0.623 (95% CI: 0.555- 0.673). Sex, self-rated health status, occupation, eyesight, memory and life satisfaction were identified as impactful predictors of depression.

CONCLUSIONS

Our developed models exhibited high accuracy, good discrimination and calibration profiles in predicting two-year risk of depression among older adults with chronic diseases. This model can be used to identify Chinese older population at high risk of depression and intervene in a timely manner.

Post-ICU Syndrome and the "3 Ds" in Geriatric Psychiatry: A Complicated Case Report of Major Depression With Psychosis in a 96-Year-Old Woman

In the growing field of geriatric psychiatry, the "3 Ds"-depression, dementia, and delirium-are a complex clinical challenge, especially in patients with medical comorbidities. This is a case report of a 96-year-old Saudi woman with chronic kidney disease, heart failure, and recurrent hyponatremia presented with worsening sleep, depression, persecutory delusions, and hallucinations following an intensive care unit (ICU) stay for urinary tract infection. Examination revealed cognitive decline and depressive symptoms, with sodium at 123 mmol/L. After a psychiatric evaluation, she was diagnosed with major depressive disorder with psychosis, likely exacerbated by hyponatremia and ICU-related stress. She was treated with sertraline, olanzapine, and sodium correction. One-month follow-up showed significant improvement in mood, sleep, and resolution of psychotic symptoms, restoring her quality of life. In conclusion, this case highlights the challenges between these conditions and the importance of comprehensive assessment in geriatric care.

Bereavement due to child loss, divorce, and depressive mood in older age across European welfare regimes

While bereavement, particularly the loss of a child, is a well-known risk factor for mental health in the short term, its long-term consequences on depressive mood in old age and across different welfare regimes have been investigated less. This study focused on the combined role of child loss and divorce on depressive symptoms, measured using the EURO-D scale in Central, Nordic, Southern, and Eastern European countries. We used data from the European SHARE project, covering 22,959 participants aged 50+ over a 16-year period. Using OLS regressions, we found that, compared to no child loss and no divorce, the association between depressive symptoms and child loss was significant ( β  = 0.22, 95% C.I. = [0.13, 0.30]), among both women and men. The absolute increase was even stronger when the mutual effect of child loss and divorce was considered ( β  = 0.34, 95% C.I. = [0.18, 0.48]). Employing Generalized Estimating Equations, we found that depressive symptoms related to divorce did not increase over time, regardless of past bereavement. Compared with people in the Nordic countries, those living in Southern Europe experienced more depressive symptoms related to child loss and no divorce, but fewer depressive symptoms related to the combined effect of child loss and divorce. In sum, our findings indicate that bereavement due to child loss may lead to more depressive symptoms among both women and men in old age, especially in combination with divorce. In the latter case, we posit that participants living in Southern European countries may be protected by higher levels of social support through family ties or informal social networks.

Associations between sleep duration, depression status, and cognitive function among Chinese elderly: A community-based study

BACKGROUND

The associations of sleep duration and depressive status on cognitive function among the elderly remain controversial. This study aimed to investigate the associative effects and mediating mechanisms between sleep duration and depressive status on cognitive function in elderly adults.

METHODS

Participants were recruited from cross-sectional and cohort surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We identified thresholds for sleep duration and depression and used logistic regression to explore their independent and joint effects on cognitive impairment. Further, we analyze the mediating effects of depressive status on the association between sleep duration and cognitive function.

RESULTS

Of 13840 elderly (median age: 84 years, female: 54.6 %), 2835 (20.5 %) had cognitive impairment. Compared with those who slept 6-8 h, the ORs (95%CIs) for those who slept < 6 h and > 8 h were 0.98 (0.85, 1.12) and 1.48 (1.32, 1.66). Compared with non-depressed, the OR (95%CI) for the depressed participants was 1.74 (1.53, 1.98). Compared with those with sleep 6-8 h and none-depression, those with sleep > 8 h and depression had the highest odds of cognitive impairment (OR = 2.40, 95%CI: 1.88-3.07). Additionally, Compared with those who slept 6-8 h, the associations between depression-mediated short and long sleep and cognitive impairment were 51.1 % and 6.5 %, respectively.

LIMITATIONS

Cross-sectional studies require caution in the interpretation of causal associations.

CONCLUSIONS

Long sleep and depression were independently and jointly associated with higher odds of cognitive impairment among the Chinese elderly, and short sleep increased the risk of cognitive impairment by promoting the prevalence of depression.

Sensory impairments and depressive symptoms in Europe: a cross-national cohort study

OBJECTIVES

To investigate the associations between sensory impairments and the development of depressive symptoms across sex, age, and European regions, and to examine the mediating role of cognitive function, activities of daily living (ADL), and physical activity.

METHOD

A cohort study including 56,847 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Associations were analyzed using mixed effects logistic regression models considering several confounders.

RESULTS

Overall, 17.8% developed depressive symptoms. Compared to participants with good vision and hearing, those with vision impairment (VI) (odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.27-1.44), hearing impairment (HI) OR = 1.32, 95% CI 1.21-1.43, and dual sensory impairment (DSI, i.e. VI and HI) (OR = 1.93, 95% CI 1.75-2.13) had increased odds of depressive symptoms. The associations were consistent across sex and European regions but became stronger with advancing age among men. Dose-response relationships were found for all associations. Mediation analyses revealed that preventing cognitive decline, ADL limitations, and physical inactivity would eliminate 15.0%, 11.5%, and 21.4% of the total effect for VI, HI, and DSI, respectively.

CONCLUSION

Our findings emphasize the importance of preventing sensory impairments to avoid depressive symptoms.

Prevalence and risk factors of depression among elderly people in nursing homes from 2012 to 2022: a systematic review and meta-analysis

OBJECTIVES

To determine a pooled prevalence of depression and its influencing factors among nursing home residents.

METHOD

PsycINFO, PubMed, Embase, and Web of Science were searched for studies investigating the prevalence and risk factors of late-life depression among nursing home residents between January 2012 and November 2022. Two reviewers independently completed the literature screening, data extraction and quality assessment. A random-effects model was utilized to pool the prevalence of depression and summarize the influencing factors.

RESULTS

This meta-analysis included 48 studies involving 28,501 participants. The pooled prevalence of depressive mood and major depressive disorder was 53% and 27%, respectively. The rate of depressive mood is higher in lower-middle-income countries (60.0%), compared with high- (53.0%) and upper-middle-income countries (44.0%). The rate of depressive mood (35.0%) is higher among females than male (19.0%). Depression was influenced by factors, including male (OR = 0.28), insufficient income (OR = 3.53), comorbidities (OR = 2.66), pain (OR = 2.67; r = 0.31), functional disability (r = 0.33), loneliness (r = 0.43), number of chronic health problems (r = 0.18), social support (r = -0.28), activities of daily living (r = -0.43), subjective health (r = -0.28), autonomy (r = -0.41), environment (r = -0.50) and physical (r = -0.57) and psychological health (r = -0.65).

CONCLUSION

The prevalence of depressive mood is high among nursing home residents, especially in lower-middle-income countries. It is influenced by factors including gender, income, social support, daily activities, environment, physical and psychological health and autonomy. Understanding those factors can provide evidence-based recommendations for improved awareness, prevention and better management of late-life depression.

The association of major dietary patterns with odds and severity of anxiety disorders: a case-control study

BACKGROUND

In the present study, we explored the association between major dietary patterns, odds, and severity of anxiety disorders, which has not been clarified to date.

METHODS

This case-control study was conducted on 85 patients who were group-matched by gender with 170 healthy subjects. Dietary intakes were evaluated applying a 147-item validated food frequency questionnaire (FFQ). Anthropometric data collection was accomplished based on precise clinical assessments. Major dietary patterns were identified using principal component analysis (PCA). Multivariate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association of the identified dietary patterns with anxiety disorders. Multiple linear regression analysis was used to evaluate the association between the GAD-7 score and major dietary pattern scores.

RESULTS

Three major dietary patterns were derived through PCA labeled as 'healthy', 'Western', and 'Mixed'. Those in the top tertile of the healthy dietary pattern were less likely to have anxiety disorders (OR =   0.26; 95%CI: 0.10, 0.66), while no significant relationship was found between Western and mixed dietary patterns and the odds of anxiety disorders. The severity of anxiety disorders, assessed by the GAD-7 score, was reduced by higher adherence to healthy dietary pattern (P = 0.003), and increased by greater adherence to mixed (P = 0.002) and Western (P = 0.001) dietary patterns.

CONCLUSION

We provided evidence demonstrating an inverse association of healthy dietary pattern with odds, and severity of anxiety disorders. Also, higher adherence to Western and mixed dietary patterns resulted in greater GAD-7 scores.