The importance of social activity to risk of major depression in older adults

Community-based going-out program and dementia onset in Japanese older adults: A longitudinal observational study

OBJECTIVES

With dementia prevalence rising globally among older adults, effective and scalable community-based interventions are urgently needed to reduce dementia onset. This study aimed to estimate the association of the going-out program with dementia onset in older adults.

METHODS

A 5-year longitudinal observational study was employed. Following a baseline assessment in 2015 and 2017, we observed 2,977 individuals engaging in a community-based going-out program for 12 months in Japan. Participants with continuous data over 12 months were defined as the engaged group, while those without such data were classified as the non-engaged group. After propensity score matching, 1,690 participants were selected. Dementia onset was obtained from the Japanese National Health Insurance and Later-Stage Medical Care System for 48-month follow-up. Incidence of dementia, absolute risk reduction (ARR), and number needed to treat (NNT) were calculated. The Cox proportional hazards model was used to estimate the effect of engagement in the program on dementia onset and to calculate a hazard ratio and 95 % confidential interval (CI).

RESULTS

The incidence of dementia onset was 59 out of 845 (7.0 %) in the non-engagement group and 34 out of 845 (4.0 %) in the engagement group. The ARR rate was 3.0 % (95 % CI 0.8, 5.2), and the NNT was 33 (95 % CI 19, 125). The hazard ratio was 0.57 (95 % CI 0.37, 0.86).

DISCUSSION

Engagement in the going-out program resulted in a 3.0 % reduction in the risk of dementia onset. The going-out program, which can be implemented in communities, holds potential efficacy in preventing dementia onset.

Bidirectional changes in depressive symptoms and social functioning in older adults attending psychological therapy services

BACKGROUND

Impairments in the ability to carry out social activities commonly co-occur alongside depression. Improving social functioning is often overlooked in treatment. This is despite the high value placed by patients on social functioning and the potential for interventions focused on social functioning to have additional benefits in reducing depressive symptoms. In older adults the relationship between depressive symptoms and social functioning during treatment is poorly understood.

METHODS

We analysed data across the first four treatment sessions of 3260 older adults receiving psychological therapy for depression at eight NHS Talking Therapies for anxiety and depression services in England. Random-intercept cross-lagged panel models were estimated, modelling bi-directional change between depressive symptoms, and impairments in (a) social leisure activities, and (b) close relationships, controlling for gender and diagnosis.

RESULTS

Over treatment sessions, depressive symptoms and impairments in social functioning decreased. A bi-directional relationship was observed whereby depressive symptoms were associated with future impairments in social functioning and vice versa. Changes in depressive symptoms appeared to have a greater association with future social functioning, compared to the reverse.

LIMITATIONS

Patients lived in Greater London and findings may not translate to other settings. We included older adults that attended at least four treatment sessions, and had no missing data at the first assessment, potentially biasing the sample and results.

CONCLUSIONS

Older adults receiving psychological therapy experience reductions in depressive symptoms and impairment in social functioning early in treatment. Treating core depressive symptoms and impairments in social functioning may benefit one another, and improve outcomes.

Impact of air pollution on depressive symptoms and the modifying role of physical activity: Evidence from the CHARLS study

The association between air pollution and depressive symptoms has not been thoroughly investigated, and the role of physical activity (PA) is particularly unclear. Although PA has been shown to alleviate depression, it may also increase exposure to air pollution, potentially exacerbating its adverse effects. A total of 17,332 participants aged 45 years and older from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS) were included in this study to assess the causal effect of air pollution on depressive symptoms in China and to clarify the role of PA in this relationship. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Data on particulate matter (PM1, PM2.5, and PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) were obtained from the ChinaHighAirPollutants (CHAP) dataset. PA levels were measured using a standardized questionnaire and categorized as low or high. An instrumental variable (IV) approach was used to estimate the causal effect of air pollution on depressive symptoms. Potential effect modification by PA was assessed. The IV estimates showed that all air pollutants were significantly and adversely associated with depressive symptoms, with a per interquartile range (IQR) increase in PM1, PM2.5, PM10, NO2, SO2, O3, and CO associated with 1.57 (95% confidence interval (CI): 1.15, 1.99), 1.49 (95% CI: 1.10, 1.89), 1.71 (95% CI: 1.26, 2.17), 2.22 (95% CI: 1.62, 2.81), 1.30 (95% CI: 0.96, 1.65), 4.67 (95% CI: 3.37, 5.98), and 0.97 (95% CI: 0.71, 1.22) units increase in CES-D scores, respectively. PA significantly modified this association, with higher PA levels mitigating the adverse effects of air pollution on depressive symptoms.

The impact of urban agglomeration planning on depression in older adults

Introduction

The residential environment significantly impacts the mental health of older adults. Urban agglomeration planning, while fostering regional economic development, also influences the psychological well-being of this demographic.

Methods

This study investigates the effects of urban agglomeration planning on depression levels in older adults, utilizing cohort data from the China Health and Retirement Longitudinal Study (CHARLS) and the multi-temporal double-difference-in-differences (DID) model.

Results

Our findings reveal that urban agglomeration planning alleviates depression by enhancing green spaces, improving air quality, and advancing digital infrastructure development. Moreover, these benefits are particularly pronounced among older females, residents of Central and Western regions, and those with lower educational attainment.

Conclusion

Based on our research findings, we recommend expediting the dissemination of urban agglomeration construction experiences to alleviate depression among older adults. In the implementation of policies, it is essential to consider objective conditions such as geographical location and educational level. The formulation of differentiated urban agglomeration planning to promote mental health among older adults.

Sleep duration and pain during the COVID-19 pandemic with depression and chronic diseases as mediators

The bidirectional relationship between sleep duration and pain during the COVID-19 pandemic remains poorly understood. This study explores these interactions and the mediating roles of depression and chronic diseases using data from the China Health and Retirement Longitudinal Study (CHARLS) cohort. A cross-sectional analysis was conducted on 15,979 participants aged 45 and older. Sleep duration was self-reported, and pain was assessed using validated anatomical charts. Depression symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), and chronic diseases were self-reported. Personal activity during the pandemic was measured using the Personal Activity Score during COVID-19 (PAS-COVID-19). The results showed a significant association between deviations from optimal sleep duration and increased pain frequency. Participants with both shorter and longer sleep durations reported higher pain levels, with depression and chronic diseases acting as significant mediators. However, personal activity did not significantly mediate the association between sleep duration and pain. These findings underscore the complex interplay among sleep duration, pain, depression, and chronic diseases during the COVID-19 pandemic, emphasizing the importance of integrated interventions to manage these interconnected health issues.

Effects of activity participation and cognitive levels on depression in middle-aged and older adults with chronic illness: a national cross-sectional study

Introduction

The world population is rapidly aging, and depression mainly affects middle-aged and older adults with chronic diseases and cognitive impairments. The sample for this study was obtained from the China Health and Retirement Longitudinal Study (CHARLS) public database. The sample size for inclusion was 12,767. There were 6,773 females and 5,994 males, with an overall low level of education. This study aims to provide a theoretical and practical reference basis for the clinical non-pharmacological treatment of depression in middle-aged and older adults (age ≥ 50 years) with chronic diseases. Additionally, the study seeks to promote the development of mental health interventions for middle-aged and older adults (age ≥ 50 years) with chronic diseases, ultimately enhancing the sense of well-being and quality of life for this demographic.

Methods

Cognitive functioning and depressive symptoms of the study participants were assessed using the Mini-Mental State Examination Scale (MMSE) and the short version of the Center for Epidemiological Studies Depression Scale (CESD-10).

Results and discussion

Binary logistic regression results showed that among middle-aged and older adults (age ≥ 50 years) with chronic diseases, participation in physical activity [OR = 1.397; 95% CI (1.181-1.651); p < 0.05] was more effective than participation in social activities [OR = 0.997; 95% CI (0.924-1.076); p < 0.05] for preventing depression. Those with cognitive impairment [OR = 1.206; 95% CI (1.089-1.335); p < 0.05] were more likely to experience depression than those without cognitive impairment. Activity participation (physical activity and social activity) had a more significant effect on mild and moderate depression compared to no depression, and cognitive level had a more pronounced effect on moderate depression [OR = 1.491; 95% CI (1.278-1.740); p < 0.05] and major depression [OR = 2.231; 95% CI (1.282-3.884); p < 0.05]. Within the specific cohort of middle-aged and older adults (age ≥ 50 years) with chronic diseases, both activity participation and cognitive level exert a significant influence on the prevention and intervention of depression. Engagement in physical activity, participation in social activities, and enhanced cognitive functioning emerged as protective factors against depression. Therefore, the policy-maker should strengthen the prevention and treatment of depression in a comprehensive manner through the promotion of physical and social activities and the enhancement of cognitive level, so as to safeguard the mental health of middle-aged and older adults with chronic diseases.

Effects of Activities on the Psychological Well-Being of Caregivers of Older Adults: A Systematic Review

Given that approximately 41.8 million Americans provide unpaid care to older adults and caregiving roles are often associated with decreased well-being, it is critical to identify strategies to maximize their well-being. The purpose of this review was to explore which activities significantly improve well-being among caregivers of older adults. A systematic literature review was conducted using PsycINFO and 24 research articles met inclusion criteria and were included in the final analysis. Eight cohesive activity categories were identified: Social (n = 5), Psychoeducation (n = 3), Arts/entertainment in the home (n = 2), Psychotherapy (n = 5), Religious/Spiritual (n = 4), Multimodal (n = 4), Physical (n = 5), and Arts/entertainment outside the home (n = 2). Findings suggest that caregivers of older adults should seek opportunities for engagement in meaningful activities, particularly social, psychoeducational activities, arts/entertainment activities in the home, which showed positive impacts, as well as psychotherapy, religious/spiritual, multimodal, and physical activities, which showed mixed impacts on caregivers' psychological well-being.

Exploring social activity patterns among community-dwelling older adults in South Korea: a latent class analysis

BACKGROUND

With the trend of digitalization, social activities among the older population are becoming more diverse as they increasingly adopt technology-based alternatives. To gain a comprehensive understanding of social activities, this study aimed to identify the patterns of digital and in-person social activities among community-dwelling older adults in South Korea, examine the associated factors, and explore the difference in depressive symptoms by the identified latent social activity patterns.

METHODS

Data were extracted from a nationwide survey conducted with 1,016 community-dwelling older adults (mean age 68.0 ± 6.5 years, 47.8% male). The main variables assessed were digital social activities (eight items), in-person social activities (six items), and depressive symptoms (20 items). Data were analyzed using latent class analysis, multinomial logistic regression, and multiple linear regression.

RESULTS

We identified four distinct social activity patterns: "minimal in both digital and in-person" (22.0%), "moderate in both digital and in-person" (46.7%), "moderate in digital & very high in in-person" (14.5%), and "high in both digital and in-person" (16.8%). Younger age, living in multi-generational households, and higher digital literacy were associated with a higher likelihood of being in the "moderate in both digital and in-person" than the "minimal in both digital and in-person" group. Younger age, male, living in multi-generational households, residing in metropolitan areas, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "moderate in digital & very high in in-person" than the "minimal in both digital and in-person" group. Younger age, living in multi-generational households, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "high in both digital and in-person" than the "minimal in both digital and in-person" group. Depressive symptoms were significantly higher in the group with minimal engagement in both digital and in-person activities, compared to other three groups.

CONCLUSIONS

This study highlights distinct patterns of social activities among Korean community-dwelling older adults. Since older adults with minimal social activity engagement can be more vulnerable to depressive symptoms, interventions that address modifiable attributes, such as supporting digital literacy and facilitating physical activity of older adults, could serve as potential strategies to enhance their social activity engagement and, consequently, their mental well-being.

Mediation of the association between depression and coronary heart disease by metabolic syndrome components

BACKGROUND

Depression is associated with incident coronary heart disease (CHD) via a pathway that may be causal, but the mechanisms underlying this association are unclear. We assessed the extent to which metabolic syndrome (MetS) and its components (i.e., elevated waist circumference, low high-density lipoprotein [HDL] cholesterol, elevated triglycerides, elevated blood pressure, and elevated fasting plasma glucose) may mediate this association.

METHODS

Data were Framingham Heart Study Research Materials obtained from the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHR) representing the total effect (aHRTE) of probable depression, measured via the Centers for Epidemiological Studies - Depression scale, on incident CHD over approximately 18 years. Using inverse odds ratio weighting, we decomposed this estimate into natural direct effects (aHRNDE) and natural indirect effects (aHRNIE) through potential mediators (measured approximately three years after depression).

RESULTS

Probable depression was associated with incident CHD (aHRTE=1.45, 95% confidence interval [CI]: 0.93, 2.25), and elevated waist circumference partially mediated this association (aHRNDE=1.34, 95% CI: 0.76-2.32; aHRNIE=1.08, 95% CI: 0.63-1.91). We did not find evidence of additional mediation by additional MetS components.

CONCLUSIONS

Elevated waist circumference appears to play a role in the association between depression and CHD.

Psychometric properties of a Turkish version of the social activities scale for community-dwelling older people requiring support

BACKGROUND

Social activities decelerate the deterioration of mental capacity in older people and improve their physical and psychosocial health. Valid and reliable measurement tools are needed to determine the social activity status of older people and plan health services to protect their mental health.

OBJECTIVE

This study aimed to adapt the Social Activities Scale for Community-Dwelling Older People Requiring Support (SASOS) into Turkish.

METHODS

This methodological study was conducted in Northern Cyprus between January and June 2022. Convenience sampling was used to recruit 155 community-dwelling older people who needed support. Expert opinion, item-content validity index, and scale-content validity index were used to evaluate content validity. Internal consistency and test-retest reliability tests were used to evaluate reliability. Exploratory factor analysis was used to evaluate construct validity. The Loneliness Scale for Elderly was used to evaluate concurrent validity.

RESULTS

The Cronbach's alpha of SASOS was 0.90. Additionally, correlation coefficients of all items ranged between 0.61 and 0.79. Exploratory factor analysis revealed a three-factor structure. 'Interactions with friends and neighbors' was the factor that explained the highest variance (46%). There was a negative, weak, and statistically significant relationship between the scores obtained from the social loneliness subscale of LSE and all three subscales of SASOS.

CONCLUSIONS

The Turkish version of SASOS is a valid, reliable instrument to evaluate social activities in community-dwelling older people who needed support.

IMPLICATIONS FOR PRACTICE

The SASOS has been identified as a valuable measure for assessing the social support needs of older individuals. It serves as a guide for both planning and evaluating interventions to enhance their health.

Social anxiety, behavioural activation and depression risk in older men: protection through Men's Shed membership

Reducing rates of depressive symptoms in older adults is a public health priority. Men's Sheds are a community organisation that may protect against depressive symptoms in older men. It is currently unclear how social anxiety and behavioural activation may relate to depressive symptoms for Men's Shed members. We employed a cross-sectional design to explore whether the relationships between social anxiety, behavioural activation and depressive symptoms were contingent upon Shed social network quality in a sample of 164 Men's Shed members. Conditional effects analysis found social anxiety (B = -0.08, p < 0.01) and behavioural activation's (B = 0.02, p < 0.001) relationships with depression to be contingent on Shed social network quality. Additionally, we found evidence for a conditional effect of social anxiety on the relationship between behavioural activation and depression (B = -0.03, p < 0.01) such that this relationship was stronger for those with higher levels of social anxiety. Our findings suggest that a strong social network within a Men's Shed weakens the association between social anxiety and depression, that the relationship between behavioural activation and depression is stronger in those with poorer Shed social networks, and that the relationship between behavioural activation and depression may be stronger for those with higher levels of social anxiety. We suggest that our findings contribute to increasing quantitative support for the mental health benefits of Men's Shed membership, highlight the potential importance of Shed social network quality and explore how social anxiety may affect the mental health outcomes for members.

Association of hearing impairment with social participation restriction and depression: comparison between midlife and older adults

OBJECTIVES

This study examined the association between hearing impairment and depression, focusing on the role of restricted social engagement as a mediator and whether the mediating relationship differed between midlife individuals (45-64) and older adults (65+).

METHODS

Individuals aged 45 and older from the cross-sectional National Health and Nutrition Examination Survey 2017-2018 were analyzed (N = 3,020). A multiple-group path analysis was conducted to compare midlife individuals (n = 1,774) and older adults (n = 1,246).

RESULTS

The results indicated that among U.S. adults aged 45 or older, 12.3% reported having serious difficulty hearing (21.2% among older adults vs. 7.4% among midlife adults). In both age groups, significant direct relationship between hearing impairment and depression, as well as indirect relationship via social participation restriction, were found. However, a significant difference was found in the relationship between restricted social participation and depression by age group (i.e. moderated mediation): The coefficient was greater among midlife adults than among older adults (Δbmidlife-older=1.109-0.383 = 0.726, p<.001).

CONCLUSION

These findings highlight that adverse psychosocial effects of hearing impairment are also an important concern for midlife adults. As the importance of social engagement was greater among midlife adults with hearing impairment, age-specific interventions should be adopted to reduce depression associated with hearing impairment.

Social relationship satisfaction and accumulation of chronic conditions and multimorbidity: a national cohort of Australian women

Background

Social relationships are associated with mortality and chronic conditions. However, little is known about the effects of social relationship satisfaction on multiple chronic conditions (multimorbidity).

Aims

To examine whether social relationship satisfaction is associated with the accumulation of multimorbidity.

Methods

Data from 7 694 Australian women who were free from 11 chronic conditions at 45-50 years of age in 1996 were analysed. Five types of social relationship satisfaction (partner, family members, friends, work and social activities) were measured approximately every 3 years and scored from 0 (very dissatisfied) to 3 (very satisfied). Scores from each relationship type were summed to provide an overall satisfaction score (range: ≤5-15). The outcome of interest was the accumulation of multimorbidity in 11 chronic conditions.

Results

Over a 20-year period, 4 484 (58.3%) women reported multimorbidities. Overall, the level of social relationship satisfaction had a dose-response relationship with the accumulation of multimorbidities. Compared with women reporting the highest satisfaction (score 15), women with the lowest satisfaction (score ≤5) had the highest odds of accumulating multimorbidity (odds ratio (OR)= 2.35, 95% confidence interval (CI): 1.94 to 2.83) in the adjusted model. Similar results were observed for each social relationship type. Other risk factors, such as socioeconomic, behavioural and menopausal status, together explained 22.72% of the association.

Conclusions

Social relationship satisfaction is associated with the accumulation of multimorbidity, and the relationship is only partly explained by socioeconomic, behavioural and reproductive factors. Social connections (eg, satisfaction with social relationships) should be considered a public health priority in chronic disease prevention and intervention.

Changes in social activities and the occurrence and persistence of depressive symptoms: Do type and combination of social activities make a difference?

OBJECTIVE

We aimed to explore the association between changes in social activities and the occurrence/persistence of depressive symptoms and investigate the difference in effect sizes among the types and combinations of social activities.

METHODS

The study adopted a valid 15-item Geriatric Depression Scale to assess depressive symptoms in 2480 community-dwelling adults aged 64/65 years. Changes in social-related, learning, and personal activities were classified into four categories: continued low frequency (CLF), increased frequency (IF), decreased frequency (DF), and continued regular frequency (CRF)¹. Relative ratios (RRs) and 95% confidence intervals (95% CI) were calculated using a modified Poisson regression model.

RESULTS

Those without depressive symptoms at baseline and who engaged in social-related (RR_IF = 0.56 (0.39, 0.81), RRC_RF= 0.55 (0.41, 0.74)), learning (RR_IF = 0.63 (0.44, 0.89), RR_CRF = 0.62 (0.46, 0.85)), and personal activities (RRIF = 0.37 (0.24, 0.57), RR_CRF = 0.41 (0.30, 0.56)) at IF or CRF were less likely to develop depressive symptoms. Those with depressive symptoms at baseline, engaging in personal activities at IF (RR=0.67 (0.51, 0.87)) and CRF (RR= 0.80 (0.65-1.00)) were less likely to have persistent depressive symptoms. Participation in all three activities consistently at a regular frequency was inversely associated with the occurrence/persistence of depressive symptoms.

CONCLUSIONS

The effect of personal activities was more manifest in preventing depressive symptoms than the other two kinds, regardless of depressive symptoms at baseline. Regularly engaging in a combination of all three activities at baseline and follow-up was associated with the occurrence and persistence of depressive symptoms.