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Qie R, Huang H, Sun P, Bi X, Chen Y, Liu Z, Chen Q, Zhang S, Liu Y, Wei J, Chen M, Zhong J, Qi Z, Yao F, Gao L, Yu H, Liu F, Zhao Y, Chen B, Wei X, Qin S, Du Y, Zhou G, Yu F, Ba Y, Shang T, Zhang Y, Zheng S, Xie D, Chen X, Liu X, Zhu C, Wu W, Feng Y, Wang Y, Xie Y, Hu Z, Wu M, Yan Q, Zou K, Zhang Y. Combined healthy lifestyles and risk of depressive symptoms: A baseline survey in China. J Affect Disord 2024; 363:152-160. [PMID: 39038619 DOI: 10.1016/j.jad.2024.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Little evidence exists about whether a combination of healthy lifestyle factors is associated with a lower risk of depressive symptoms among Chinese population. We aimed to investigate the association between combined healthy lifestyle factors and risk of depressive symptoms. METHODS We conducted a baseline survey from July 2021 to December 2023, including 53,642 Chinese adults from general population. A healthy lifestyle score was constructed based on six lifestyle factors (physical activity, smoking status, alcohol consumption, diet, sleep duration, and body mass index). Logistic regression models were used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) adjusted for confounding variables. RESULTS Each additional healthy lifestyle score was associated with a 20 % lower risk of having depressive symptoms (OR (95 % CI): 0.80 (0.78-0.81)). Compared with individuals with ≤2 healthy lifestyle factors, individuals with all the six healthy lifestyle factors had a 58 % reduced risk of having depressive symptoms (0.42 (0.37-0.47)). After stratification by gender, education and urbanization, the significant inverse association with healthy lifestyle score was stronger in women, individuals with high education, and urban residents. Besides, the significant negative association between healthy lifestyle score and depressive symptoms remained for different severity of depressive symptoms. LIMITATIONS Given the cross-sectional nature of data, we cannot make causal inferences. CONCLUSIONS Our study indicated that adherence to healthy lifestyle factors was associated with a reduced risk of having depressive symptoms among Chinese adults. The observed associations were modified by gender, education and urbanization. These findings warrant further verification in interventional studies.
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Affiliation(s)
- Ranran Qie
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, Henan, China
| | - Huang Huang
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peiyuan Sun
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Bi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingtai Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiong Chen
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, Henan, China
| | - Shaokai Zhang
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, Henan, China
| | - Yin Liu
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, Henan, China
| | - Jiankun Wei
- Dongguan Center for Disease Control and Prevention, Dongguan, Guangdong, China
| | - Miaochang Chen
- Dongguan Center for Disease Control and Prevention, Dongguan, Guangdong, China
| | - Jieying Zhong
- Dongguan Center for Disease Control and Prevention, Dongguan, Guangdong, China
| | - Zhi Qi
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Fan Yao
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Lijuan Gao
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Huanling Yu
- Department of Nutrition and Food Hygiene, School of Public Health, Capital Medical University, Beijing, China
| | - Fen Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yao Zhao
- Beijing Fangshan District Center for Disease Control and Prevention, Beijing, China
| | - Baozhong Chen
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Xiaoli Wei
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Shasha Qin
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yuhui Du
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Guoyu Zhou
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Fangfang Yu
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yue Ba
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Tingting Shang
- Department of Ecology and Environment of Gansu Province, Lanzhou, Gansu, China
| | - Yaqun Zhang
- Department of Ecology and Environment of Gansu Province, Lanzhou, Gansu, China
| | - Shan Zheng
- Lanzhou University, Lanzhou, Gansu, China
| | - Dongmei Xie
- Genertec Medical Cheng Fei Hospital, Chengdu, Sichuan, China
| | - Xiaolan Chen
- Genertec Medical Cheng Fei Hospital, Chengdu, Sichuan, China
| | - Xiaoling Liu
- Genertec Medical Cheng Fei Hospital, Chengdu, Sichuan, China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiwei Wu
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yongliang Feng
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ying Wang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuting Xie
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuolun Hu
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyao Wu
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Yan
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaiyong Zou
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yawei Zhang
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Ahmed W, Muhammad T, Irshad CV. Interaction between depressive symptoms and obesity-related anthropometric measures on multimorbidity among community-dwelling older adults: evidence from India. BMC Public Health 2024; 24:402. [PMID: 38326765 PMCID: PMC10851490 DOI: 10.1186/s12889-024-17894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND This study aimed to examine the associations between depressive symptoms, body mass index (BMI), waist circumference, waist-hip ratio and multimorbidity among community-dwelling older adults. We also examine the interaction effects between depressive symptoms, BMI, waist circumference and waist-hip ratio on multimorbidity among older adults in India. METHODS A cross-sectional study was conducted, and the data were obtained from the Longitudinal Ageing Study in India (LASI) wave-1, with a sample of 31,464 older adults aged 60 years and above (men-15,098 and women-16,366). We used multinomial logistic regression to explore the independent associations between depressive symptoms, obesity-measures, and single and multimorbidity. We also estimated the interaction effects of depressive symptoms and obesity-measures on multimorbidity. RESULTS The prevalence of multimorbidity was higher among individuals with depressive symptoms (39.22%) than individuals with no depressive symptoms (29.94%). Adjusted models indicated that older adults with depressive symptoms had higher odds of single and multimorbidity [(AOR = 1.40, 95% CI: 1.17-1.68) and (AOR = 1.85, 95% CI: 1.58-2.16), respectively]. Similarly, in comparison to the normal BMI category, overweight and obese older adults were more likely to report single morbidity [(AOR = 1.62, 95% CI: 1.37-1.92 and (AOR = 2.14, 95% CI: 1.67-2.75), respectively] and multimorbidity [(AOR = 2.00, 95% CI: 1.72-2.33) and (AOR = 3.77, 95% CI: 2.94-4.82), respectively]. CONCLUSION The findings revealed that the presence of depressive symptoms, overweight or obesity, and high-risk anthropometric measures such as high-risk waist circumference and high-risk waist to hip ratio significantly increased the risk of morbidity among older adults in India. Thus, it is suggested to adopt an integrated public health policy approach to control depressive symptoms and high-risk body composition to strategically prepare against the elevated risk of multimorbidity among ageing populations.
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Affiliation(s)
- Waquar Ahmed
- Department of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - T Muhammad
- Pennsylvania State University, University Park, USA.
| | - C V Irshad
- School of Social Sciences and Languages, Vellore Institute of Technology, Vellore, India
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Navarra-Ventura G, Coronado-Simsic V, Riera-Serra P, Castro A, García-Toro M, Roca M, Gili M. Associations between unhealthy lifestyle and depression: Cross-sectional results from the Spanish National Health Survey. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00035-2. [PMID: 38591831 DOI: 10.1016/j.sjpmh.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/02/2023] [Accepted: 08/25/2023] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Depression usually worsens lifestyle habits, but previous evidence also suggests that an unhealthy lifestyle (UL) increases the risk of depression. Many studies have analyzed the association between lifestyle and depression in several nationally representative samples, but none have done so in the Spanish adult population. Our aim was to examine the associations between UL habits and depression in Spain. MATERIALS AND METHODS Analysis of cross-sectional data from the latest National Health Survey published in 2018 (N=23,089). Data on depression and 4 lifestyle factors (diet, physical exercise, smoking, and alcohol consumption) were used. These factors were combined into an UL index ranging from 0 (healthiest lifestyle) to 4 (unhealthiest lifestyle). The prevalence of depression at different levels of the UL index, and the association between depression and both the cumulative UL index and the 4 UL factors was analyzed using parametric and non-parametric tests. RESULTS Sedentarism was the most prevalent UL factor, followed by unhealthy diet, smoking and high-risk alcohol consumption. Having ≥1 UL factors was associated with a higher prevalence of depression compared to having 0 UL factors (2.5% vs. ≥5.2%), regardless of the cumulative number UL factors (1, 2, 3 or 4). Being physically inactive (OR=1.6) and a smoker (OR=1.3) increased the likelihood of depression. Being a high-risk wine drinker (OR=0.26) decreased the likelihood of depression. Dietary intake was not significant. CONCLUSIONS The prevalence of depression changes depending on several modifiable lifestyle factors. Policy makers should therefore spare no resources in promoting strategies to encourage healthy lifestyles and prevent the acquisition of UL habits.
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Affiliation(s)
- Guillem Navarra-Ventura
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain
| | - Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain.
| | - Adoración Castro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
| | - Mauro García-Toro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain; Department of Medicine, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain; Department of Medicine, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
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Yayan J, Rasche K. Risk Factors for Depression in Patients with Chronic Obstructive Pulmonary Disease. Respir Physiol Neurobiol 2023:104110. [PMID: 37393968 DOI: 10.1016/j.resp.2023.104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023]
Abstract
Depression, anxiety, and panic disorders are common in chronic obstructive pulmonary disease (COPD) and important for the further course of the disease, as they are associated with increased hospital admissions, longer hospital stays, more frequent doctor visits, and a worsened quality of life. There are also indications of premature death in affected patients. Therefore, knowledge of the risk factors for depression in COPD patients is all the more important for early detection and treatment. Hence, Embase, the Cochrane Library, and the MEDLINE/PubMed databases were analyzed for studies on these risk factors. The main factors are as follows: female gender; older/younger age; living alone; higher education; unemployment; retirement; a low quality of life; social isolation; high/low income; high cigarette and alcohol consumption; poor physical fitness; severe respiratory symptoms; high/low body mass index, airway obstruction, dyspnea, exercise capacity index scores; and comorbidities (mainly heart disease, cancer, diabetes, and stroke). This article presents the analyzed medical literature.
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Affiliation(s)
- Josef Yayan
- Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Witten/Herdecke University, Witten, Germany.
| | - Kurt Rasche
- Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
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MacNeil A, Birk S, Villeneuve PJ, Jiang Y, de Groh M, Fuller-Thomson E. Incident and Recurrent Depression among Adults Aged 50 Years and Older during the COVID-19 Pandemic: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15032. [PMID: 36429749 PMCID: PMC9690838 DOI: 10.3390/ijerph192215032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic and accompanying public health measures have exacerbated many risk factors for depression in older adulthood. The objectives of the current study are: (1) to determine the risk of incident and recurrent depression during the COVID-19 pandemic among those with, or without, a history of depression; and (2) to identify factors that were predictive of depression in these two groups. The study population included 22,622 participants of the Canadian Longitudinal Study on Aging who provided data at baseline (2011-2015), follow-up (2015-2018), and twice during the pandemic (April-May 2020, September-December 2020). The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to classify individuals with depression. Logistic regression was used to estimate the odds of depression during COVID across a series of risk factors. Individuals with a history of depression had four times the risk of depression during the pandemic when compared to those without a history of depression, even after controlling for relevant covariates. Other factors associated with depression during the pandemic include being female, having fewer savings, and experiencing COVID-19 related stressors, such as health stressors, difficulties accessing resources, and family conflict. Clinicians working with older adults should consider interventions to support high-risk groups, such as those with recurrent depression.
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Affiliation(s)
- Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Sapriya Birk
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Paul J. Villeneuve
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- CHAIM Research Centre, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Ying Jiang
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
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Hou F, Han X, Wang Q, Zhou S, Zhang J, Shen G, Zhang Y. Cross-Sectional Associations between Living and Built Environments and Depression Symptoms among Chinese Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105819. [PMID: 35627355 PMCID: PMC9140945 DOI: 10.3390/ijerph19105819] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023]
Abstract
In this study, we explored the cross-sectional associations between living and built environments and depression among older Chinese adults. Data from 5822 participants were obtained. Depression symptoms were evaluated through the use of the Patient Health Questionnaire (PHQ-9), with a score higher than 4 categorized as having depression symptoms. The living environment was assessed by asking about dust in the environment and barrier-free facilities. We considered the presence of amenities within a 10 min walking distance and the proportion of green space within an 800 m distance from participants’ dwellings to reflect the built environment. Data were analyzed by multilevel logistic regression. Participants living in a non-dusty environment with proximity to green space had a lower risk of depression (non-dusty environment: OR = 0.784, 95% CI = 0.642, 0.956; green space: OR = 0.834, 95% CI = 0.697, 0.998). However, having no access to barrier-free facilities and hospital proximity increased the depression risk (barrier-free facilities: OR = 1.253, 95% CI = 1.078, 1.457; hospital: OR = 1.318, 95% CI = 1.104, 1.574). Dusty environments, access to barrier-free facilities and proximity to hospitals and green spaces were associated with depression symptoms among older Chinese adults.
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Affiliation(s)
- Fangfang Hou
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Xiao Han
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Qiong Wang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Shuai Zhou
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Jingya Zhang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Guodong Shen
- Department of Geriatrics, The First Affiliated Hospital of University of Science and Technology of China, Gerontology Institute of Anhui Province, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei 230001, China
- Correspondence: (G.S.); (Y.Z.); Tel.: +86-551-62282371 (G.S.); +86-551-65161220 (Y.Z.)
| | - Yan Zhang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
- Correspondence: (G.S.); (Y.Z.); Tel.: +86-551-62282371 (G.S.); +86-551-65161220 (Y.Z.)
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Wang X, Arafa A, Liu K, Eshak ES, Hu Y, Dong JY. Combined healthy lifestyle and depressive symptoms: a meta-analysis of observational studies. J Affect Disord 2021; 289:144-150. [PMID: 33979724 DOI: 10.1016/j.jad.2021.04.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND To systematically summarize the association between combined lifestyle (at least three factors, including but not limited to smoking, drinking, physical activity, body mass index, diet) and depressive symptoms by a meta-analysis in general populations. METHODS Multiple electronic databases were searched for observational studies investigating combined lifestyle factors and depressive symptoms published before September 2020. Pooled risk estimates were calculated using random-effects models. Publication bias was conducted using the Egger's and Begg's tests. RESULTS A total of 12 studies with 185,899 participants were included. The pooled OR of depressive symptoms in meta-analysis of 7 cross-sectional studies was 0.53 (0.39, 0.72), I2 = 83.6%, P for heterogeneity <0.001 and the pooled RR was 0.33 (0.12, 0.89), I2 = 95.3%, P for heterogeneity <0.001 in meta-analysis of 5 cohort studies for people with the highest versus lowest score of heathy lifestyles. In sensitivity analyses, the heterogeneity was significantly reduced in cross-sectional studies (pooled OR = 0.74 [0.65, 0.85], I2 = 21.7%, P for heterogeneity = 0.27) and cohort studies (pooled RR = 0.53 [0.38, 0.74], I2 = 15.2%, P for heterogeneity = 0.32). The publication bias corrected by "trim-and-fill" analysis yielded unchanged results. LIMITATIONS Limitations included residual confounding in original studies, heterogeneity between studies, and potential publication bias in the analysis of cross-sectional studies. CONCLUSION The healthy lifestyle was associated with a reduced risk of depressive symptoms. Adherence to overall healthy lifestyles is essential for the primary prevention of depression in general populations.
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Affiliation(s)
- Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Ahmed Arafa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan; Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Ehab S Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan; Department of Public Health, Faculty of Medicine, Minia University, El-Minya, Egypt
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Medical Informatics Center, Peking University Health Science Center, Beijing, China
| | - Jia-Yi Dong
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan.
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Causey ST, Towe SL, Hartsock J, Xu Y, Meade CS. Perceived Healthcare Access among Persons with and without HIV Who Use Illicit Stimulants: The Role of Cumulative Risk. Subst Use Misuse 2021; 56:1387-1396. [PMID: 34034631 PMCID: PMC8370044 DOI: 10.1080/10826084.2021.1928211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Persons who use stimulant drugs have greater morbidity and mortality relative to non-users. HIV infection has the potential to contribute to even great disparity in health outcomes among persons who use stimulants. These health disparities likely result in part due to poorer access to healthcare. Our study used a cumulative risk model to examine the impact of multiple risk factors on healthcare access in a sample of persons with and without HIV who use stimulants. Method: Our sample included 453 persons who reported recent use of illicit stimulants (102 HIV+, 351 HIV-). Participants completed clinical interviews, questionnaires, and a rapid oral HIV test. We constructed an 8-item cumulative risk index that included factors related to socioeconomic status, homelessness, legal history, and substance use. Results: Participants with HIV (PHW) were older than participants without HIV and more likely to have health insurance. Participants with and without HIV reported similar prior treatment utilization, but PWH reported better healthcare access and lower cumulative risk scores. Regression analyses showed cumulative risk was a significant predictor of healthcare access (β = -0.20, p < 0.001) even after controlling for age, HIV status, and health insurance status. We did not observe an interaction of HIV status by cumulative risk. Conclusions: Access to care among persons who use stimulants, both with and without HIV, is negatively impacted by the accumulation of risk factors from a number of different domains. Understanding the cumulative effects of these factors is critical for developing interventions to facilitate access to care, thus reducing health disparities and improving health outcomes.
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Affiliation(s)
- Shakiera T Causey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeremiah Hartsock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yunan Xu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Chau R, Kissane DW, Davison TE. Risk Factors for Depression in Long-term Care: A Prospective Observational Cohort Study. Clin Gerontol 2021; 44:112-125. [PMID: 31264523 DOI: 10.1080/07317115.2019.1635548] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Depression among older adults in long-term care remains a problem, despite the uptake of antidepressants and the development of intervention programs. A better understanding of the risk factors for depression is much needed. Guided by a systematic assessment of the evidence, this prospective observational cohort study sought to clarify existing evidence, identify modifiable risk factors and explore novel variables. Methods: Adults aged ≥65 (T1 n=147, T2 n= 81) were recruited from 15 long-term-care facilities in Melbourne, Australia. Cognitive impairment, functional impairment, pain, sleep disturbance, social support, and person-environment fit were investigated as risk factors. Outcomes were depressive symptoms and indicated Major Depressive Episode. Results: Generalized Estimating Equations (GEE) identified that changes in pain (b= 0.06, p<.05), sleep disturbance (b= 0.02, p< .001), social support (b= -0.02, p< .001) and person-environment fit (b= -0.02, p= <.01) were significantly associated with changes in depression score. Conclusions: Pain, sleep disturbance, social support, and person-environment fit are modifiable risk factors, making them strongly positioned to strategically inform prevention and intervention strategies. Clinical Implications: Individuals with clinically significant symptoms on these risk factors for depression should be selected for interventions that target these risk factors. For depressed individuals, psychotherapy should prioritize the potential role of these risk factors. Finally, these risk factors should be used as screening and monitoring variables: clinically significant changes in symptoms warrant investigation.
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Affiliation(s)
- Rebecca Chau
- School of Psychological Sciences, Monash University , Melbourne, Victoria, Australia
| | - David W Kissane
- Palliative Medicine Research, University of Notre Dame Australia , Sydney, Australia
| | - Tanya E Davison
- School of Health Sciences, Swinburne University of Technology , Melbourne, Victoria, Australia
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10
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Almeida OP. Risk factors and consequences of depression in later life: Findings from the health in men study (HIMS). AGING BRAIN 2021; 1:100014. [PMID: 36911509 PMCID: PMC9997175 DOI: 10.1016/j.nbas.2021.100014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022] Open
Abstract
Background The Health In Men Study (HIMS) has been collecting data on risk factors and health events for the past 25 years in a large community-representative sample of older men. This paper summarises key-findings of the study about depression in later life. Methods Narrative review of selected HIMS studies published over the past 15 years describing risk factors associated with prevalent and incident depression in older men, as well as clinical outcomes associated with depression. Results Data from HIMS showed that cardiovascular diseases and risk factors are associated with increased risk of depression, but this association is neither specific nor causative. Findings from HIMS are not supportive of the vascular hypothesis of depression in later life. Studies investigating lifestyle have generated risk tables capable of guiding risk reduction strategies. Other potentially modifiable risk factors associated with depression in the HIMS cohort included abnormal allostatic inflammatory response, high plasma homocysteine and low testosterone. The results from HIMS also showed that depression is most likely a prodromal manifestation of dementia rather that a true risk factor, but it increases frailty and mortality. The association between depression and suicide in older men is largely mediated by deteriorating health and increasing frailty. Conclusion HIMS has contributed to advance knowledge about risk factors associated with depression, as well as the health consequences of depression in older men. The study is ongoing and the investigators welcome the opportunity to share data with colleagues who are interested in the health of older people.
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Affiliation(s)
- Osvaldo P Almeida
- WA Centre for Health & Ageing, Medical School, University of Western Australia, Australia
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11
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Almeida OP, Hankey GJ, Golledge J, Yeap BB, Flicker L. Depression and the Risk of Fractures in Later Life: the Health In Men Cohort Study. Maturitas 2020; 145:6-11. [PMID: 33541564 DOI: 10.1016/j.maturitas.2020.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/16/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Fractures are common and disabling health events, particularly later in life. The presence of clinically significant depressive symptoms has been associated with increased risk of fractures, and we designed the present study to clarify if this association is likely to be causal or due to the confounding effect of measures associated with both fractures and depression. METHOD Cohort study of a community-derived sample of 4224 men aged 70 to 88 years at the start of the follow-up period of up to 17 years. Clinically significant symptoms of depression were defined as a recorded diagnosis of depressive episode in the Western Australian Data Linkage System (WADLS) or by a total score of 7 or greater on the 15-item Geriatric Depression Scale. Health contacts associated with fractures were retrieved from WADLS. Other measures included age, past history of fractures, education, smoking, frailty, poor vision, falls, medications, and the concentration of vitamin D, homocysteine, hsCRP and testosterone. Death was considered a competing risk for fractures. RESULTS 911 (21.6%) participants had a bone fracture during follow-up. After adjustment for multiple potential confounders, past and current depression were associated with an increase in the risk of novel fractures; respective odds ratios were 1.41 (95%CI = 1.03, 1.93) and 1.64 (95%CI = 1.20, 2.25). Parsimonious competing risk regression showed that both past and current depression were associated with an increase in the risk of novel fractures: sub-hazard ratio = 1.29 (95%CI = 1.03, 1.63) and 1.27 (95%CI = 1.05, 1.55) respectively. Estimation of confounding due to unmeasured factors showed that a small additional effect could potentially dilute the association between depression and fractures. DISCUSSION History of clinically significant symptoms of depression is associated with an increased risk of future fractures. This association may be due to multiple other associated risk factors, both measured and unmeasured, but nevertheless the presence of depression should alert clinicians to the need to develop a management plan that includes the management not only of depression but also of fracture risk.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia; WA Centre for Health and Ageing of the University of Western Australia, Perth, Australia.
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia; WA Centre for Health and Ageing of the University of Western Australia, Perth, Australia
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12
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Agustini B, Lotfaliany M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Ernst ME, Reid CM, Tonkin A, Lockery JE, Williams LJ, Berk M, Mohebbi M. Patterns of Association between Depressive Symptoms and Chronic Medical Morbidities in Older Adults. J Am Geriatr Soc 2020; 68:1834-1841. [PMID: 32402115 DOI: 10.1111/jgs.16468] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the association between depressive symptoms and several medical morbidities, and their combination, in a large older population. DESIGN Cross-sectional study of baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. SETTING Multicentric study conducted in Australia and the United States. PARTICIPANTS A total of 19,110 older adults (mean age = 75 years [standard deviation = ±4.5]). MEASUREMENTS Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 10) scale. Medical morbidities were defined according to condition-specific methods. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to test associations before and after accounting for possible confounders. RESULTS Depressive symptoms were significantly associated with obesity (OR = 1.19; 95% CI = 1.07-1.32), diabetes (OR = 1.22; 95% CI = 1.05-1.42), gastroesophageal reflux disease (GERD) (OR = 1.41; 95% CI = 1.28-1.57), metabolic syndrome (OR = 1.16; 95% CI = 1.03-1.29), osteoarthritis (OR = 1.41; 95% CI = 1.27-1.57), respiratory conditions (OR = 1.25; 95% CI = 1.10-1.42), history of cancer (OR = 1.19; 95% CI = 1.05-1.34), Parkinson's disease (OR = 2.56; 95% CI = 1.83-3.56), polypharmacy (OR = 1.60; 95% CI = 1.44-1.79), and multimorbidity (OR = 1.29; 95% CI = 1.12-1.49). No significant association was observed between depressive symptoms and hypertension, chronic kidney disease, dyslipidemia, and gout (P > .05). A significant dose-response relationship was evident between the number of medical comorbidities and the prevalence of depression (OR = 1.18; 95% CI = 1.13-1.22). CONCLUSION Late-life depressive symptoms are significantly associated with several medical morbidities, and there appears to be a cumulative effect of the number of somatic diseases on the prevalence of depression. These findings augment the evidence for a complex relationship between mental and physical health in an otherwise healthy older population and might guide clinicians toward early recognition of high-risk individuals. J Am Geriatr Soc 68:1834-1841, 2020.
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Affiliation(s)
- Bruno Agustini
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, Iowa, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lana J Williams
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammadreza Mohebbi
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
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13
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Gómez-Gómez I, Bellón JÁ, Resurrección DM, Cuijpers P, Moreno-Peral P, Rigabert A, Maderuelo-Fernández JÁ, Motrico E. Effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms: Systematic review and meta-analysis. Prev Med 2020; 134:106067. [PMID: 32194097 DOI: 10.1016/j.ypmed.2020.106067] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/06/2020] [Accepted: 03/14/2020] [Indexed: 01/12/2023]
Abstract
Though many studies have explored the association between single-risk lifestyle interventions and depression, unhealthy lifestyle factors often co-occur, with adults engaging in two or more risk behaviours. To date, little is known about the effectiveness of universal multiple-risk lifestyle interventions to reduce depressive symptoms. We conducted a SR/MA to assess the effectiveness of universal multiple-risk lifestyle interventions (by promoting a healthy diet, physical activity and/or smoking cessation) to reduce depressive symptoms in adults. We searched MEDLINE, Scopus, CENTRAL, PsycINFO, WOS, OpenGrey, the ICTRP and other sources from inception to 16 September 2019. We selected only randomized controlled trials, with no restrictions on language or setting. Our outcome was the reduction of depressive symptoms. We calculated the standardized mean difference using random-effect models. Sensitivity, sub-group and meta-regression analyses were performed. Of the 9386 abstracts reviewed, 311 were selected for full-text review. Of these, 23 RCTs met the inclusion criteria, including 7558 patients from four continents. Twenty RCTs provided valid data for inclusion in the meta-analysis. The pooled SMD was -0.184 (95% CI, -0.311 to -0.057; p = 0.005). We found no publication bias, but heterogeneity was substantial (I2 = 72%; 95% CI: 56% to 82%). The effectiveness disappeared when only studies with a low risk of bias were included. The quality of evidence according GRADE was low. Although a small preventive effect was found, the substantial heterogeneity and RCTs with lower risk of bias suggested no effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms in a varied adult population. Further evidence is required.
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Affiliation(s)
| | - Juan Á Bellón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga, Spain; El Palo Health Centre, Andalusian Health Service (SAS), Málaga, Spain; Department of Public Health and Psychiatry, University of Málaga (UMA), Spain.
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Development Psychology, Section of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga, Spain.
| | - Alina Rigabert
- Department of Psychology, Universidad Loyola Andalucía, Spain.
| | - José Ángel Maderuelo-Fernández
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain; Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Spain.
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain.
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Terassi M, Rossetti ES, Luchesi BM, Gramani-Say K, Hortense P, Pavarini SCI. Factors associated with depressive symptoms in elderly caregivers with chronic pain. Rev Bras Enferm 2020; 73:e20170782. [PMID: 31994674 DOI: 10.1590/0034-7167-2017-0782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/08/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify factors associated with depressive symptoms in elderly caregivers with chronic pain. METHOD the study included people 60 years of age or older who reported chronic pain and cared for another elderly person living in the same household (n=186). Statistical analyzes were performed using the Mann-Whitney test, univariate and multiple logistic regression. RESULTS most participants had no depressive symptoms (70.4%), 24.2% had mild depressive symptoms and 5.4% had severe symptoms. Univariate analysis showed that the variables family income, number of diseases, number of medications in use, pain intensity, overload and perceived stress were associated with depressive symptoms. Multivariate analysis found an association with perceived stress (95% CI 1.101-1207) and number of medications (95% CI 1.139-1.540) in use. CONCLUSION factors associated with depressive symptoms in elderly caregivers with chronic pain were stress and the number of medications in use.
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Affiliation(s)
- Marielli Terassi
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
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15
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Andreas S, Dehoust M, Volkert J, Schulz H, Sehner S, Suling A, Wegscheider K, Ausín B, Canuto A, Crawford MJ, Da Ronch C, Grassi L, Hershkovitz Y, Muñoz M, Quirk A, Rotenstein O, Belén Santos-Olmo A, Shalev AY, Weber K, Wittchen HU, Härter M. Affective disorders in the elderly in different European countries: Results from the MentDis_ICF65+ study. PLoS One 2019; 14:e0224871. [PMID: 31710630 PMCID: PMC6844556 DOI: 10.1371/journal.pone.0224871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/23/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Affective disorders are among the most prevalent disorders in the elderly. The present study aims to examine the sociodemographic and clinical correlates of major depressive disorder (MDD) and dysthymia in different European and Associated countries using standardized interview techniques. Furthermore, service utilization for the elderly with depression is assessed. METHODS The MentDis_ICF65+ study is a cross-sectional survey (N = 3,142) that was conducted in six different European and Associated countries (Germany, Italy, Spain, Switzerland, England and Israel) with a subsample of n = 463 elderly with any depressive disorder. RESULTS Sociodemographic and clinical correlates, such as gender, age and symptom severity, were significantly associated with MDD and dysthymia in the elderly. Only 50% of elderly with any depressive disorder were treated with psycho- or pharmacotherapy. CONCLUSION Our findings identified sociodemographic and clinical characteristics for depression risk in the elderly and highlight the need to improve service delivery to older adults who suffer from depression.
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Affiliation(s)
- Sylke Andreas
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Psychology, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
- Department of Psychology, University Witten, Herdecke, Germany
| | - Maria Dehoust
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Volkert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg- Eppendorf, Hamburg, Germany
| | - Anna Suling
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg- Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg- Eppendorf, Hamburg, Germany
| | - Berta Ausín
- School of Psychology, Complutense University of Madrid, Campus de Somosaguas s/n, Madrid, Spain
| | - Alessandra Canuto
- Nant Foundation, East Vaud Psychiatric Institute, Route de Nant, Corsier-sur-Vevey, Switzerland
| | - Mike J. Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, United Kingdom
| | - Chiara Da Ronch
- Institute of Psychiatry, Dpt. Biomedical and Specialty Surgical Sciences, Corso, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Dpt. Biomedical and Specialty Surgical Sciences, Corso, Italy
| | - Yael Hershkovitz
- Department of Psychiatry, Hadassah University Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - Manuel Muñoz
- School of Psychology, Complutense University of Madrid, Campus de Somosaguas s/n, Madrid, Spain
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, United Kingdom
| | - Ora Rotenstein
- Department of Psychiatry, Hadassah University Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - Ana Belén Santos-Olmo
- School of Psychology, Complutense University of Madrid, Campus de Somosaguas s/n, Madrid, Spain
| | - Arieh Y. Shalev
- Department of Psychiatry, Hadassah University Medical Center, Kiryat Hadassah, Jerusalem, Israel
- Department of Psychiatry, NY Langone Medical Center, New York, NY, United States of America
| | - Kerstin Weber
- Curabilis, Medical Direction, University Hospitals of Geneva, Chemin de Champ-Dollon, Puplinge, Switzerland
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universtiät Dresden, Chemnitzer Straße, Dresden, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Velasquez Reyes D, Patel H, Lautenschlager N, Ford AH, Curran E, Kelly R, Lai R, Chong T, Flicker L, Ekers D, Gilbody S, Etherton-Beer C, Lo Giudice D, Ellis KA, Martini A, Almeida OP. Behavioural activation in nursing homes to treat depression (BAN-Dep): study protocol for a pragmatic randomised controlled trial. BMJ Open 2019; 9:e032421. [PMID: 31676658 PMCID: PMC6830697 DOI: 10.1136/bmjopen-2019-032421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/06/2019] [Accepted: 10/11/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Depression is a common disorder among older people living in residential aged care facilities. Several trials have demonstrated the effectiveness of behavioural therapies in treating depressive symptoms in older adults living in the community and in residential aged care. Behavioural Activation is demonstrably effective even when delivered by non-specialists (staff without formal psychological training), although strategies for adapting its use in residential aged care facilities are yet to be explored. This study will determine whether training residential care staff in the use of a structured Behavioural Activation programme is more effective at decreasing depressive symptoms among older residents than internet-based training about depression recognition and management alone. METHOD AND ANALYSIS The behavioural activation in nursing homes to treat depression (BAN-Dep) trial is a pragmatic two-arm parallel clustered randomised controlled trial. It will recruit 666 residents aged 60 or older from 100 residential aged care facilities, which will be randomly assigned to the Behavioural Activation or control intervention. Staff in both treatment groups will be encouraged to complete the Beyondblue Professional Education to Aged Care e-learning programme to improve their recognition of and ability to respond to depression in older adults. Selected staff from intervention facilities will undergo additional training to deliver an 8-module Behavioural Activation programme to residents with subthreshold symptoms of depression-they will receive ongoing Mental support from trained Behavioural Activation therapists. Outcome measures will be collected by blind research officer at baseline and after 3, 6 and 12 months. The Patient Health Questionnaire-9 is the primary outcome measure of the study. ETHICS AND DISSEMINATION The trial will comply with the principles of the Declaration of Helsinki for Human Rights and is overseen by the University of Western Australia (reference RA/4/20/4234) and Melbourne Health (reference number HREC/18/MH/47) Ethics Committees. The results of this research project will be disseminated through publications and/or presentations in a variety of media to health professionals, academics, clinicians and the public. Only de-identified group data will be presented. TRIAL REGISTRATION ACTRN12618000634279.
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Affiliation(s)
| | - Hema Patel
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | - Andrew H Ford
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Eleanor Curran
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachael Kelly
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Rhoda Lai
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Terence Chong
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leon Flicker
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | | | - Christopher Etherton-Beer
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | - Kathryn A Ellis
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angelita Martini
- Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Osvaldo P Almeida
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
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17
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Mohebbi M, Agustini B, Woods RL, McNeil JJ, Nelson MR, Shah RC, Nguyen V, Storey E, Murray AM, Reid CM, Kirpach B, Wolfe R, Lockery JE, Berk M. Prevalence of depressive symptoms and its associated factors among healthy community-dwelling older adults living in Australia and the United States. Int J Geriatr Psychiatry 2019; 34:1208-1216. [PMID: 30989707 PMCID: PMC6924573 DOI: 10.1002/gps.5119] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/08/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was conducted to estimate prevalence rates and factors associated with depressive symptoms indexed by the Centre for Epidemiological Studies-Depression (CES-D-10) score in a large sample of community-dwelling healthy older adults from Australia and the United States. Convergent and divergent validity of the CES-D-10 were also examined. METHODS A total of 19 114 individuals aged greater than or equal to 65 years old were enrolled from a primary prevention clinical trial. Depressive symptoms were classified using the CES-D-10 score greater than or equal to 8 and greater than or equal to 10. Gender-specific prevalence for subgroups according to sociodemographic characteristics were reported, and factors associated with depressive symptoms were estimated. RESULTS The overall prevalence rates of depressive symptoms were 9.8%, 95% CI, 8.5-11.2 and 5.0%, 95% CI, 4.0-6.0, according to the CES-D-10 score greater than or equal to 8 and greater than or equal to 10, respectively. Depressive symptoms were more common in women, individuals with less than 12 years of education, those living alone or in a residential care, ethnic minorities, current smokers, and former alcohol users. Convergent and divergent validities of the CES-D-10 were confirmed by observing strong negative association with the SF-12 mental health component and a modest negative association with SF-12 physical component, respectively. CONCLUSIONS This study reports the prevalence of depressive symptoms in Australian and US community-dwelling healthy older populations. These findings emphasize the high burden of the condition and factors associated with depressive symptoms, to better inform clinicians and help with early detection and treatment of depression in this age group.
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Affiliation(s)
- Mohammadreza Mohebbi
- Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
| | - Bruno Agustini
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Van Nguyen
- Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin County Medical Center, Minneapolis, MN, USA
- Division of Geriatrics, Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Brenda Kirpach
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Berk
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Orygen, the National Centre of Excellence in Youth Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Lycke KD, Christiansen CF, Lund JL, Iversen LH, Nørgaard M. Preadmission use of antidepressants and risk of complications and death after colorectal cancer surgery: a nationwide population-based cohort study. Colorectal Dis 2019; 21:651-662. [PMID: 30740875 DOI: 10.1111/codi.14579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 02/02/2019] [Indexed: 01/15/2023]
Abstract
AIM Few studies have evaluated how preadmission use of antidepressants affects outcomes in colorectal cancer (CRC) patients after they have undergone surgery. Therefore, our aim is to examine whether preadmission use of antidepressants increased the risk of complications and death in patients who underwent CRC surgery. METHOD Using the Danish Colorectal Cancer Group Database we identified patients who underwent CRC surgery in Denmark from 2005 to 2012. We identified prescriptions for antidepressants redeemed within 1 year prior to surgery and categorized patients as current users (≤ 90 days), former users (91-365 days) and nonusers. All patients were followed from surgery to 30 days thereafter or to death. We calculated 30-day rates of complications, intensive care unit (ICU) admission and mortality and compared these between users and nonusers using logistic and Cox regression adjusting for potential confounders. RESULTS Of 27 374 patients, 8.9% were current users and 3.0% were former users. Antidepressant users were older and had more comorbidity but a similar cancer stage. Compared with nonusers, current users had a higher risk of postoperative reoperation [adjusted odds ratio (aORs) = 1.15 (95% CI 1.02-1.30)], medical complications [aORs = 1.41 (95% CI 1.25-1.60)] and increased ICU admission rate [adjusted hazard ratio (aHR) = 1.32 (95% CI 1.21-1.45)]. The 30-day mortality was 11.4% for current users, 9.1% for former users and 6.2% for nonusers [aHR = 1.34 (95% CI 1.17-1.53) for current vs nonusers]. CONCLUSION Patients with preadmission use of antidepressants had a higher risk of complications and ICU admission, and higher 30-day mortality following CRC surgery than nonusers.
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Affiliation(s)
- K D Lycke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J L Lund
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - L H Iversen
- Danish Colorectal Cancer Group, Copenhagen, Denmark.,Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Gómez-Gómez I, Motrico E, Moreno-Peral P, Rigabert A, Conejo-Cerón S, Ortega-Calvo M, Recio JI, Bellón JA. Effectiveness of complex multiple-risk lifestyle interventions in reducing symptoms of depression: a study protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2019; 9:e026842. [PMID: 30878992 PMCID: PMC6429884 DOI: 10.1136/bmjopen-2018-026842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/11/2019] [Accepted: 01/25/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Many studies have explored the impact of lifestyle interventions on depression. However, little is known about the effectiveness of complex multiple-risk lifestyle interventions in reducing symptoms of depression. Our objective is to assess the effectiveness of complex multiple-risk lifestyle interventions in reducing depressive symptoms in the adult population by the acquisition of at least two healthy habits-healthy diet, physical activity and/or smoking cessation. For such purpose, a systematic review and meta-analysis of randomised controlled trials will be conducted. METHOD AND ANALYSIS MEDLINE (through Ovid and PubMed), Scopus, Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, OpenGrey Register (System for Information on Grey Literature in Europe) and the International Clinical Trials Registry Platform will be searched for relevant articles. Additionally, a supplementary manual search will be performed using lists of references, references to expert authors and other systematic reviews and/or meta-analyses. Study selection, data extraction (target habits, country, target populations, conditions and statistical data to name a few) and assessment of the risk of bias will be performed separately by two independent researchers. The primary outcome measure will be the reduction of depression symptoms, as measured by validated instruments. We will calculate pooled standardised mean differences and 95% CIs using random-effect models. Heterogeneity, sensitivity and publication bias will be assessed, and sub-group analysis will be performed. Heterogeneity will be explored by random-effects meta-regression analysis. ETHICS AND DISSEMINATION Ethical approval is not required for this study. The results of this systematic review and meta-analysis will be presented in relevant conferences and published in a peer-review journal. The findings of this study could have important clinical and scientific implications for the improvement of symptoms of depression. PROSPERO REGISTRATION NUMBER CRD42018100253; Pre-results.
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Affiliation(s)
- Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
- Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain
| | - Alina Rigabert
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
| | - Sonia Conejo-Cerón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
- Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain
| | - Manuel Ortega-Calvo
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Family Medicine, Primary Care Division of Seville, Seville, Spain
| | - José-Ignacio Recio
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Salamanca, Spain
| | - Juan A Bellón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
- Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
- El Palo Health Centre, Andalusian Health Service (SAS), Málaga, Spain
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20
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Almeida OP, Ford AH, Hankey GJ, Yeap BB, Golledge J, Flicker L. Hearing loss and incident psychosis in later life: The Health in Men Study (HIMS). Int J Geriatr Psychiatry 2019; 34:408-414. [PMID: 30430657 DOI: 10.1002/gps.5028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/03/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if hearing loss is associated with increased risk of incident psychosis in later life. METHODS Longitudinal cohort study of a community-representative sample of 38 173 men aged 65 to 85 years at the start of the follow-up period of 18 years. We used the Western Australian Data Linkage System to ascertain the presence of hearing loss and of psychotic disorders according to the International Classification of Diseases (ICD) (versions 8, 9, and 10). We also collected information on concurrent morbidities: cancer and diseases of the cardiovascular, respiratory, digestive, and renal systems. RESULTS One thousand four hundred forty-two (3.8%) and 464 (1.2%) men had a recorded diagnosis of hearing loss and psychosis at the start of follow-up. After excluding the 464 participants with prevalent psychosis, 37 709 men were available for the longitudinal study, and of these, 252 (0.7%) developed a psychotic disorder. Competing risk regression showed that hearing loss was associated incident psychosis (subhazard ratio = 2.03, 95% CI, 1.24-3.32; after statistical adjustment for age and concurrent morbidities). CONCLUSIONS Hearing loss is associated with double the risk of incident psychosis in older men. Available evidence suggests that this link could be causal, although conclusive evidence is still missing from randomized controlled trials designed to test the effect of correction of hearing loss on the prevalence and incidence of psychosis.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health & Ageing, Faculty of Health and Medical Sciences, University of Western Australia.,Department of Psychiatry, Royal Perth Hospital and Bentley Hospital, Perth, Australia
| | - Andrew H Ford
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health & Ageing, Faculty of Health and Medical Sciences, University of Western Australia.,Department of Psychiatry, Royal Perth Hospital and Bentley Hospital, Perth, Australia
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health & Ageing, Faculty of Health and Medical Sciences, University of Western Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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21
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Depression as a modifiable factor to decrease the risk of dementia. Transl Psychiatry 2017; 7:e1117. [PMID: 28463236 PMCID: PMC5534958 DOI: 10.1038/tp.2017.90] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/13/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023] Open
Abstract
Depression is an accepted risk factor for dementia, but it is unclear if this relationship is causal. This study investigated whether dementia associated with depression decreases with antidepressant use and is independent of the time between exposure to depression and the onset of dementia. We completed a 14-year longitudinal study of 4922 cognitively healthy men aged 71-89 years, and collected information about history of past depression, current depression and severity of depressive symptoms. Other measures included use of antidepressants, age, education, smoking and history of diabetes, hypertension, coronary heart disease, and stroke. The onset of dementia and death during follow-up was ascertained via the Western Australian Data Linkage System. A total of 682 men had past (n=388) or current (n=294) depression. During 8.9 years follow-up, 903 (18.3%) developed dementia and 1884 (38.3%) died free of dementia. The sub-hazard ratios (SHRs) of dementia for men with past and current depression were 1.3 (95% confidence interval (CI)=1.0, 1.6) and 1.5 (95% CI=1.2, 2.0). The use of antidepressants did not decrease this risk. Compared to men with no symptoms, the SHRs of dementia associated with questionable, mild-to-moderate and severe depressive symptoms were 1.2 (95% CI=1.0, 1.4), 1.7 (95% CI=1.4, 2.2) and 2.1 (95% CI=1.4, 3.2), respectively. The association between depression and dementia was only apparent during the initial 5 years of follow-up. Older men with history of depression are at increased risk of developing dementia, but depression is more likely to be a marker of incipient dementia than a truly modifiable risk factor.
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Abstract
Depression is common in geriatric patients, especially in those with multiple comorbidities and polypharmacy. Depression in older adults is often underdiagnosed and undertreated. Initial screening for depression can easily be accomplished in the waiting room. Yet the clinical interview still remains the gold standard for diagnosing geriatric depression. Key components of the clinical interview are observant watching of the patient for the subtle signs of depression. Clinical interview should be done with sensitivity to the importance of privacy. Illicit substances and medical conditions may significantly contribute. Suicide assessment should be done in a step wise manner.
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Affiliation(s)
- George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA; Department of Anatomy and Neurobiology, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA; Division of Geriatric Medicine, Department of Internal Medicine, Dementia, Health Aging, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
| | - David Beck
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA
| | - Syed Noman Y Zaidi
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, USA.
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Almeida OP, Hankey GJ, Yeap BB, Golledge J, Hill KD, Flicker L. Depression Among Nonfrail Old Men Is Associated With Reduced Physical Function and Functional Capacity After 9 Years Follow-up: The Health in Men Cohort Study. J Am Med Dir Assoc 2017; 18:65-69. [PMID: 27776985 DOI: 10.1016/j.jamda.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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24
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Reducing depression during the menopausal transition with health coaching: Results from the healthy menopausal transition randomised controlled trial. Maturitas 2016; 92:41-48. [DOI: 10.1016/j.maturitas.2016.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/21/2022]
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Abstract
El objetivo del presente estudio fue evaluar la prevalencia de depresión, detectar el riesgo suicida e identificar los factores sociodemográficos y personales asociados a este trastorno. La muestra no aleatorizada estuvo conformada por 1525 hombres colombianos con edades entre 18 y 83 años procedentes de 22 departamentos y de distintos niveles educativos. Para evaluar la depresión se usó el Cuestionario de Depresión para Hombres (Álvarez y Londoño, 2012); para evaluar la comorbilidad con ansiedad se usó la Escala de Ansiedad HADS (Zigmond y Snaith, 1983) y el IMAFE (Lara, 1991); y para recolectar información acerca de los factores personales y sociodemográficos se usó una ficha de registro. Se analizaron los datos para calcular la prevalencia de corte, el riesgo suicida, la comorbilidad a través del uso del paquete estadístico SPSS. Se concluye que la prevalencia real reportada y el riesgo suicida en la población estudiada son más altos que los detectados usando un instrumento no sensible al género.
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Almeida OP, McCaul K, Hankey GJ, Yeap BB, Golledge J, Norman PE, Flicker L. Duration of diabetes and its association with depression in later life: The Health In Men Study (HIMS). Maturitas 2016; 86:3-9. [PMID: 26921921 DOI: 10.1016/j.maturitas.2016.01.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine if diabetes and duration of diabetes are direct or indirect causes of depression in later life. RESEARCH DESIGN AND METHODS Cross-sectional study of a community-derived sample of 5462 men aged 70-89 years. Men with 'current depression' scored 7 or more on the abbreviated Geriatric Depression Scale (GDS-15), whereas men with 'ever depression' were either currently depressed or reported history or treatment for past depression. The presence of diabetes was established by self-reported history, fasting glucose ≥7 mmol/L (126 mg/dL), or use of insulin or hypoglycemic drugs. Duration of diabetes relied on self-report. Other measured factors included age, place of birth, education, smoking history, and the FRAIL scale. RESULTS Diabetes was associated with increased odds ratio (OR) of ever (OR=1.49, 95%CI=1.25, 1.76) and current depression (OR=1.94, 95%CI=1.15, 2.48). The association between duration of diabetes and risk of current depression was 'J-shaped' with odds ratios of 1.92 (95%CI=1.44, 2.54), 1.56 (95%CI=0.89, 2.75), 2.49 (95%CI=1.16, 5.32) and 3.13 (95%CI=1.28, 7.63) for <10, 10-19.9, 20-29.9 and ≥30 years of diabetes history compared with older men without diabetes. The strength of these associations was attenuated after the analyses were adjusted for other measured factors, but the shape of the curve did not change. Structural equation modeling showed that frailty mediated some of the association between diabetes duration and depression (about 15%) and was a strong predictor of depression in the sample. CONCLUSIONS In older men, the association between time lived with the diagnosis of diabetes and the risk of depression is 'J-shaped'. Frailty mediates some of the association between diabetes and depression, although other unmeasured factors are also likely to play a role. The introduction of strategies that are effective at decreasing diabetes-related complications may also contribute to decrease the risk of depression among older men.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia; WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
| | - Kieran McCaul
- WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Endocrinology, Fiona Stanley Hospital, Perth, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Paul E Norman
- School of Surgery, University of Western Australia & Department of Surgery, Fiona Stanley Hospital, Australia
| | - Leon Flicker
- WA Centre for Health & Ageing of Centre for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Tully PJ, Winefield HR, Baker RA, Denollet J, Pedersen SS, Wittert GA, Turnbull DA. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: a five year longitudinal cohort study. Biopsychosoc Med 2015; 9:14. [PMID: 26019721 PMCID: PMC4445298 DOI: 10.1186/s13030-015-0041-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/21/2015] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level. METHODS Before coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease. RESULTS In the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE. CONCLUSIONS Generalized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.
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Affiliation(s)
- Phillip J. Tully
- />Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergstr. 41, D-79085 Freiburg, Germany
- />Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
- />Department of Medicine, Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Adelaide, Australia
| | | | - Robert A. Baker
- />Department of Medicine, Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Adelaide, Australia
| | - Johan Denollet
- />CoRPS, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Susanne S. Pedersen
- />Department of Psychology, University of Southern Denmark, Odense, Denmark
- />Department of Cardiology, Odense University Hospital, Odense, Denmark
- />Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gary A. Wittert
- />Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Deborah A. Turnbull
- />Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
- />School of Psychology, The University of Adelaide, Adelaide, Australia
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Depression, Frailty, and All-Cause Mortality: A Cohort Study of Men Older than 75 Years. J Am Med Dir Assoc 2015; 16:296-300. [DOI: 10.1016/j.jamda.2014.10.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 11/19/2022]
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30
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Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study. Aust Crit Care 2015; 28:24-30. [DOI: 10.1016/j.aucc.2014.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/08/2014] [Accepted: 04/22/2014] [Indexed: 12/18/2022] Open
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31
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Smith M, Haedtke C, Shibley D. Evidence-Based Practice Guideline: Late-Life Depression Detection. J Gerontol Nurs 2015; 41:18-25. [DOI: 10.3928/00989134-20150115-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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van der Waerden JEB, Hoefnagels C, Hosman CMH, Jansen MWJ. Defining subgroups of low socioeconomic status women at risk for depressive symptoms: the importance of perceived stress and cumulative risks. Int J Soc Psychiatry 2014; 60:772-82. [PMID: 24599903 DOI: 10.1177/0020764014522751] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most disadvantaged women are exposed to risk factors for depression, but not all necessarily have an identical risk for this mental health problem. A better prediction of which low socioeconomic status (SES) women are most at risk for depressive symptoms can help target preventive interventions at high-risk subgroups most in need of support. AIMS Exploring which demographic, socioeconomic and psychological risk factors are associated with self-reported depressive symptoms in a sample of low-SES women and whether the number of risk factors might expose them to an accumulated risk. METHODS Between April 2005 and November 2007, 519 disadvantaged women from urban neighbourhoods in Maastricht, a southern Dutch city, participated in a cross-sectional survey on stress and depressive symptoms. RESULTS Lower education levels, no current employment and lower net monthly family incomes were socioeconomic risk factors associated with higher scores for depressive symptoms. The psychological risk factor 'perceived stress' had the highest explained variance and was most strongly associated with depressive symptoms. Women exposed to multiple risk factors across domains had a cumulated risk for depressive symptomatology. CONCLUSION Low-SES women who seem most eligible for targeted preventive action are those with cumulative risks. Depression prevention strategies for this population may benefit from focusing on perceived stress since this is an important modifiable risk factor.
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Affiliation(s)
- Judith E B van der Waerden
- INSERM, UMR_S 1136, Department of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Paris, France Department of Health Promotion, Maastricht University, Maastricht, The Netherlands CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Cees Hoefnagels
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands
| | - Clemens M H Hosman
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Maria W J Jansen
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Public Health Services South Limburg, Geleen, The Netherlands
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Almeida OP, Hankey GJ, Yeap BB, Golledge J, Norman PE, Flicker L. Mortality among people with severe mental disorders who reach old age: a longitudinal study of a community-representative sample of 37,892 men. PLoS One 2014; 9:e111882. [PMID: 25360781 PMCID: PMC4216120 DOI: 10.1371/journal.pone.0111882] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/02/2014] [Indexed: 12/26/2022] Open
Abstract
Background Severe mental illnesses are leading causes of disability worldwide. Their prevalence declines with age, possibly due to premature death. It is unclear, however, if people with severe mental disorders who reach older age still have lower life expectancy compared with their peers and if their causes of death differ. Methods and Findings Cohort study of a community-representative sample of 37892 Australian men aged 65–85 years in 1996–1998. Follow up was censored on the 31st December 2010. Lifetime prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorder was established through record linkage. A subsample of 12136 consented to a face-to-face assessment of sociodemographic, lifestyle and clinical variables. Information about causes of death was retrieved from the Australian Death Registry. The prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorders was 1.2%, 0.3%, 2.5% and 1.8%. The mortality hazard for men with a severe mental disorder was 2.3 and their life expectancy was reduced by 3 years. Mortality rates increased with age, but the gap between men with and without severe mental disorders was not attenuated by age. Cardiovascular diseases and cancer were the most frequent causes of death. The excess mortality associated with severe mental disorders could not be explained by measured sociodemographic, lifestyle or clinical variables. Conclusions The excess mortality associated with severe mental disorders persists in later life, and the causes of death of younger and older people with severe mental disorders are similar. Hazardous lifestyle choices, suboptimal access to health care, poor compliance with treatments, and greater severity of medical comorbidities may all contribute to this increased mortality. Unlike young adults, most older people will visit their primary care physician at least once a year, offering health professionals an opportunity to intervene in order to minimise the harms associated with severe mental disorders.
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Affiliation(s)
- Osvaldo P. Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
- WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia
- Department of Psychiatry, Royal Perth Hospital, Perth, Australia
- * E-mail:
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Bu B. Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Endocrinology, Fremantle Hospital, Fremantle, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Paul E. Norman
- School of Surgery, University of Western Australia, Perth, Australia
| | - Leon Flicker
- WA Centre for Health & Ageing, Centre for Medical Research, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Almeida OP, Ford AH, Flicker L, Hankey GJ, Yeap BB, Clancy P, Golledge J. Angiogenesis inhibition and depression in older men. J Psychiatry Neurosci 2014; 39:200-5. [PMID: 24331740 PMCID: PMC3997605 DOI: 10.1503/jpn.130158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiovascular diseases have been associated with depression in later life, and a potential mechanism is inhibition of angiogenesis. We designed this study to determine if depression is associated with higher serum concentration of endostatin, an endogenous angiogenesis inhibitor. METHODS We performed a cross-sectional examination of a random sample of men aged 69-86 years. Those who scored 7 or higher on the 15-item Geriatric Depression Scale were deemed depressed. We determined the concentration of serum endostatin using a reproducible assay. Other measures included age, education, body mass index, smoking, history of depression, use of antidepressants, hypertension, diabetes, coronary heart disease and stroke, high sensitivity C-reactive protein, plasma homocysteine, triglycerides and cholesterol. We used logistic regression to investigate the association between endostatin and depression, and adjusted the analyses for confounding factors. RESULTS Our sample included 1109 men. Sixty-three (5.7%) men were depressed. Their serum endostatin was higher than that of nondepressed participants (p = 0.021). Men in the highest decile of endostatin had greater adjusted odds of depression (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.03-3.06). A doubling of endostatin doubled the odds of depression (OR 1.93, 95% CI 1.31-2.84). The probability of depression increased with the concentration of endostatin in a log-linear fashion up to a maximum of about 20%-25%. LIMITATIONS The cross-sectional design limits the study's ability to ascribe causality to the association between high endostatin and depression. CONCLUSION Serum endostatin is associated with depression in older men. It remains to be established whether correction of this imbalance is feasible and could decrease the prevalence of depression in later life.
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Affiliation(s)
- Osvaldo P. Almeida
- Correspondence to: O.P. Almeida, School of Psychiatry & Clinical Neurosciences (M573), University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia;
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Prevention of depression in older age. Maturitas 2014; 79:136-41. [PMID: 24713453 DOI: 10.1016/j.maturitas.2014.03.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 01/17/2023]
Abstract
Depression is a common disorder in later life that is associated with increased disability and costs, and negative health outcomes over time. Antidepressant treatments in the form of medications or psychotherapy are available, but a large proportion of those treated fail to respond fully, and relapse or recurrence of symptoms is frequent among those who recover. Hence, successful prevention would avoid these negative outcomes. This paper selectively reviews currently available observational and trial data on the prevention of depression. It initially reviews risk factors associated with depression, and then discusses strategies for primary (including universal, selective and indicated), secondary and tertiary prevention. Currently available evidence suggests that selective and indicated preventive interventions are feasible and initial results look promising. Existing trial data indicate that ongoing antidepressant treatments reduce the risk of relapse and recurrence of symptoms, but benefits may not extend beyond two or three years. At this point in time, no interventions have been shown to reduce the long term complications associated with depression. Mental health professionals will need to work collaboratively to develop primary, secondary and tertiary preventive interventions that are effective at targeting relevant risk factors systematically and that can be easily adopted into clinical practice.
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A risk table to assist health practitioners assess and prevent the onset of depression in later life. Prev Med 2013; 57:878-82. [PMID: 24103566 DOI: 10.1016/j.ypmed.2013.09.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/21/2013] [Accepted: 09/28/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aimed to develop a simple risk table of modifiable factors prospectively associated with depression in later life that could be used to guide the assessment, management and introduction of preventive strategies in clinical practice. METHODS This retrospective cohort study included 4636 men aged 65 to 83 years living in the community who denied history of past diagnosis or treatment for depression. They self-reported information about their physical activity, weight and height, smoking history, alcohol consumption and dietary habits, as well as history of hypertension, diabetes, coronary heart disease and stroke. We calculated the body mass index (BMI) in kg/m(2). Three to 8 years later they were assessed with the Geriatric Depression Scale 15 (GDS-15) and those with a total score of 7 or greater were considered to display clinically significant symptoms of depression. We used binomial exponentiated log-linked general linear models to estimate the risk ratio (RR) and 95% confidence interval (95% CI) of incident depression after adjusting for age, education, marital status and prevalent medical illnesses. We calculated the probability of depression for each individual combination of risk factors and displayed the results in a risk table. RESULTS Two hundred and twenty-nine men (4.5%) showed evidence of incident depression 5.7±0.9 (mean±standard deviation) years later. Measured dietary factors showed no association with incident depression. The probability of depression was the highest for older men who were underweight, overweight or obese, physically inactive, risk drinkers and smokers (12.0%, 95% CI=7.0%, 17.1%), and the lowest for those who had all 4 healthy lifestyle markers: physically active, normal body mass, non-risk drinking and non-smoking (1.6%, 95% CI=0.6%, 2.5%). The probability of incident depression fell between these two extremes for different combinations of lifestyle practices. CONCLUSION Four modifiable lifestyle factors can be used in combination to produce a risk table that predicts the probability of incident depression over a period of 3 to 8 years. The risk table is simple, informative and can be easily incorporated into clinical practice to guide assessment and risk reduction interventions.
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Kelley KW, O'Connor JC, Lawson MA, Dantzer R, Rodriguez-Zas SL, McCusker RH. Aging leads to prolonged duration of inflammation-induced depression-like behavior caused by Bacillus Calmette-Guérin. Brain Behav Immun 2013; 32:63-9. [PMID: 23454036 PMCID: PMC3686980 DOI: 10.1016/j.bbi.2013.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 02/02/2013] [Accepted: 02/13/2013] [Indexed: 01/10/2023] Open
Abstract
Geriatric depression is a costly health issue, but little is known about its physiological underpinnings. Systemic inflammation sensitizes the innate immune system of aged animals and humans, but it is unknown if chronic, low-grade infections affect the duration of depressive-like behaviors. In this report, we infected adult (4-6 months) and aged (20-24 months) Balb/c mice with an attenuated strain of Mycobacterium bovis, Bacillus Calmette-Guérin (BCG), to induce a chronic infection. We then measured depression-like behaviors that have construct, face and predictive validity for human inflammation-associated clinical depression. Exposure to BCG caused acute sickness responses in both adult and aged mice. However, sickness behavior was prolonged in aged mice, as assessed by both locomotor and rearing activity. Two measures of depression-like behavior, which were tests involving sucrose preference and tail suspension, both showed that adult mice displayed depression-like behaviors at one day and seven days after exposure to BCG. However, aged mice continued to express both of these depression-like behaviors at three weeks following infection. Infection with BCG caused an increase in tryptophan catabolism, as evidenced by a significant rise in the plasma kynurenine/tryptophan ratio that peaked at 7 days post-infection. In aged mice, greater tryptophan catabolism persisted longer and remained elevated at 21 days post-infection. This finding is consistent with the prolonged duration of depression-like behaviors in aged mice. These are the first data using a chronic infection model to establish that recovery from inflammation-induced depression-like behavior and tryptophan catabolism are prolonged in aged animals.
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Affiliation(s)
- Keith W Kelley
- Integrative Immunology and Behavior Program, Department of Animal Sciences, College of ACES, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Almeida OP, Alfonso H, Yeap BB, Hankey GJ, Flicker L. Cardiovascular diseases do not influence the mental health outcome of older men with depression over 6 years. J Affect Disord 2013; 144:248-52. [PMID: 22858261 DOI: 10.1016/j.jad.2012.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/29/2012] [Accepted: 06/30/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The concept of 'vascular depression' implies that cardiovascular disease facilitates the onset or persistence of depression in later life, and that the natural course of depression should differ according to whether or not vascular pathology is present. METHODS Population-based cohort of 431 older men were diagnosed with depression (prevalent cases) and followed for up to 6 years. We used the Western Australian Data Linkage System to establish the presence of cardiovascular disease (CVD, documented history of coronary heart disease or stroke) and subsequent persistence or recurrence of depression during follow up (ICD-10 codes). Other measures recorded: age, place of birth, education, social support and disadvantage, smoking history, sensory impairment, medical morbidity burden and use of antidepressants. RESULTS The age of participants ranged from 69 to 86 years and CVD was present in 212 (49.2%) of them. Depressed men with and without CVD had a similar distribution of demographic, lifestyle, social and clinical factors as men without CVD, but higher medical morbidity. One hundred and twenty six (29.2%) men died and another 43 had a recorded diagnosis of depressive disorder between the baseline assessment and the 31st December 2007. Compared with participants without CVD, the adjusted hazard ratio of recurrent or persistent depression during follow up for participants with CVD was 0.78 (95% confidence interval, 95% CI=0.43-1.42). An additional 30 men were identified with depression during a new clinical assessment in 2008-09. Logistic regression showed that the adjusted odds of depression for men with compared to those without CVD was 0.98 (95% CI=0.61-1.59). CONCLUSION Persistence or recurrence of symptoms over 6 years in older men with depression is not influenced by the presence of CVD, which raises doubts about the usefulness and validity of the concept of vascular depression.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Australia.
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Krauskopf KA, Sofianou A, Goel MS, Wolf MS, Wilson EAH, Martynenko ME, Halm EA, Leventhal H, Feldman JM, Federman AD, Wisnivesky JP. Depressive symptoms, low adherence, and poor asthma outcomes in the elderly. J Asthma 2013; 50:260-6. [PMID: 23294120 DOI: 10.3109/02770903.2012.757779] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the impact of depressive symptoms on asthma outcomes and medication adherence in inner-city elderly patients with asthma. METHODS Cohort study of elderly asthmatics receiving primary care at three clinics in New York City and Chicago from 1 January 2010 to 1 January 2012. Depressive symptoms were ascertained with the Patient Health Questionnaire (PHQ-9). Outcomes included asthma control (Asthma Control Questionnaire, ACQ), asthma-related quality of life (Asthma Quality of Life Questionnaire, AQLQ), and acute resource utilization (inpatient and outpatient visits). Asthma medication adherence was evaluated using the Medication Adherence Reporting Scale (MARS). RESULTS Three hundred and seventeen participants ≥60 years were included in the study (83% women, 30% Hispanic, and 31% Black). In unadjusted analyses, participants with depressive symptoms were more likely to report poor asthma control (p < .001), worse AQLQ scores (p < .001), and higher rates of inpatient asthma-related visits (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.04-3.99). Those with depressive symptoms also reported lower medication adherence (OR: 0.23, 95%CI: 0.10-0.54). Similar results were obtained in analyses adjusting for age, sex, race/ethnicity, income, asthma medication prescription, years with asthma, intubation history, comorbidities, and health literacy. CONCLUSION In this cohort of elderly inner-city participants, depressive symptoms were associated with poorer asthma control and quality of life, as well as with lower rates of adherence to controller medications. Future work exploring possible mediators, including adherence, might elucidate the relationship between depression and poorer asthma outcomes in this population.
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Affiliation(s)
- Katherine A Krauskopf
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Byers AL, Vittinghoff E, Lui LY, Hoang T, Blazer DG, Covinsky KE, Ensrud KE, Cauley JA, Hillier TA, Fredman L, Yaffe K. Twenty-year depressive trajectories among older women. ACTA ACUST UNITED AC 2012; 69:1073-9. [PMID: 23026957 DOI: 10.1001/archgenpsychiatry.2012.43] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Despite the frequent occurrence of depressive symptoms among older adults, especially women, little is known about the long-term course of late-life depressive symptoms. OBJECTIVE To characterize the natural course of depressive symptoms among older women (from the young old to the oldest old) followed up for almost 20 years. DESIGN Using latent-class growth-curve analysis, we analyzed women enrolled in an ongoing prospective cohort study (1988 through 2009). SETTING Clinic sites in Baltimore, Maryland; Minneapolis, Minnesota; the Monongahela Valley near Pittsburgh, Pennsylvania; and Portland, Oregon. PARTICIPANTS We studied 7240 community-dwelling women 65 years or older. MAIN OUTCOME MEASURE The Geriatric Depression Scale short form (score range, 0-15) was used to routinely assess depressive symptoms during the follow-up period. RESULTS Among older women, we identified 4 latent classes during 20 years, with the predicted probabilities of group membership totaling 27.8% with minimal depressive symptoms, 54.0% with persistently low depressive symptoms, 14.8% with increasing depressive symptoms, and 3.4% with persistently high depressive symptoms. In an adjusted model for latent class membership, odds ratios (ORs) for belonging in the increasing depressive symptoms and persistently high depressive symptoms classes, respectively, compared with a group having minimal depressive symptoms were substantially and significantly (P < .05) elevated for the following variables: baseline smoking (ORs, 4.69 and 7.97), physical inactivity (ORs, 2.11 and 2.78), small social network (ORs, 3.24 and 6.75), physical impairment (ORs, 8.11 and 16.43), myocardial infarction (ORs, 2.09 and 2.41), diabetes mellitus (ORs, 2.98 and 3.03), and obesity (ORs, 1.86 and 2.90). CONCLUSIONS During 20 years, almost 20% of older women experienced persistently high depressive symptoms or increasing depressive symptoms. In addition, these women had more comorbidities, physical impairment, and negative lifestyle factors at baseline. These associations support the need for intervention and prevention strategies to reduce depressive symptoms into the oldest-old years.
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Affiliation(s)
- Amy L Byers
- Department of Psychiatry, University of California, San Francisco, CA 94121, USA.
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Almeida OP, Draper B, Snowdon J, Lautenschlager NT, Pirkis J, Byrne G, Sim M, Stocks N, Flicker L, Pfaff JJ. Factors associated with suicidal thoughts in a large community study of older adults. Br J Psychiatry 2012. [PMID: 23209090 DOI: 10.1192/bjp.bp.112.110130] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thoughts about death and self-harm in old age have been commonly associated with the presence of depression, but other risk factors may also be important. AIMS To determine the independent association between suicidal ideation in later life and demographic, lifestyle, socioeconomic, psychiatric and medical factors. METHOD A cross-sectional study was conducted of a community-derived sample of 21 290 adults aged 60-101 years enrolled from Australian primary care practices. We considered that participants endorsing any of the four items of the Depressive Symptom Inventory -Suicidality Subscale were experiencing suicidal thoughts. We used standard procedures to collect demographic, lifestyle, psychosocial and clinical data. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale. RESULTS The 2-week prevalence of suicidal ideation was 4.8%. Male gender, higher education, current smoking, living alone, poor social support, no religious practice, financial strain, childhood physical abuse, history of suicide in the family, past depression, current anxiety, depression or comorbid anxiety and depression, past suicide attempt, pain, poor self-perceived health and current use of antidepressants were independently associated with suicidal ideation. Poor social support was associated with a population attributable fraction of 38.0%, followed by history of depression (23.6%), concurrent anxiety and depression (19.7%), prevalent anxiety (15.1%), pain (13.7%) and no religious practice (11.4%). CONCLUSIONS Prevalent and past mood disorders seem to be valid targets for indicated interventions designed to reduce suicidal thoughts and behaviour. However, our data indicate that social disconnectedness and stress account for a larger proportion of cases than mood disorders. Should these associations prove to be causal, then interventions that succeeded in addressing these issues would contribute the most to reducing suicidal ideation and, possibly, suicidal behaviour in later life.
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Affiliation(s)
- Osvaldo P Almeida
- Western Australia Centre for Health and Ageing (M573), University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia.
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Abstract
PURPOSE OF REVIEW Depression is a common and disabling disorder that affects people of all ages and 10% of those older than 65 years. Current strategies to decrease the personal and societal burden of depression in older age rely on the management of people with depression or of those at risk, but benefits have been limited and data remain scant. RECENT FINDINGS Existing data suggest that decreasing the onset of a depressive disorder in people at risk is a reasonable way of reducing its prevalence in the community. Older adults with subthreshold symptoms of depression and those who have suffered a stroke have been successfully targeted with various interventions. In addition, the use of collaborative care has improved the immediate and long-term outcome of patients with depression. Finally, the findings of epidemiological studies indicate that a more systematic approach to the management of risk factors might improve the outcome of patients and those at risk, but trial data are still lacking. SUMMARY Current evidence suggests that it is possible to decrease the prevalence of depression in later life, but a more systematic approach to the assessment and management of older adults is necessary.
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Anxiety, depression, and comorbid anxiety and depression: risk factors and outcome over two years. Int Psychogeriatr 2012; 24:1622-32. [PMID: 22687290 DOI: 10.1017/s104161021200107x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA); (2) the risk factor profile of depression, anxiety, and DA; (3) the course of depression, anxiety, and DA over 24 months. METHODS Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data. RESULTS The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depression, and DA showed persistence of symptoms after two years. Repeated anxiety was more common in women and repeated depression in men. Socioeconomic stressors were common in repeated DA. CONCLUSIONS Clinically significant anxiety and depression are distinct conditions that frequently coexist in later life; when they appear together, older adults endure a more chronic course of illness.
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Relationship of age and gender to the prevalence and correlates of psychological distress in later life. Int Psychogeriatr 2012; 24:1009-18. [PMID: 22244348 DOI: 10.1017/s1041610211002602] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND As populations age, psychological distress in late life will become of increasing public health and social importance. This study seeks to bridge the gap in information that exists about psychological distress in late life, by exploring the prevalence of psychological distress among a very large sample of older adults to determine the impact of age and gender, and the modifying effect of these factors on the associations between measures of psychological distress and sociodemographic and comorbid conditions. METHODS We analyzed self-reported data from 236,508 men and women in the New South Wales 45 and Up Study, to determine the impact of age and gender, and the modifying effects of these factors on associations between psychological distress and sociodemographic and comorbid conditions. RESULTS Higher education, married status, and higher income were associated with lower risk of psychological distress. Although overall prevalence of psychological distress is lower at older ages, this increases after age 80, and is particularly associated with physical disabilities. Some older people (such as those requiring help because of disability and those with multiple comorbid health conditions) are at increased risk of psychological distress. CONCLUSION These findings have implications for both healthcare providers and policy-makers in identifying and responding to the needs of older people in our aging society.
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Almeida OP, Pirkis J, Kerse N, Sim M, Flicker L, Snowdon J, Draper B, Byrne G, Lautenschlager NT, Stocks N, Alfonso H, Pfaff JJ. Socioeconomic disadvantage increases risk of prevalent and persistent depression in later life. J Affect Disord 2012; 138:322-31. [PMID: 22331024 DOI: 10.1016/j.jad.2012.01.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/17/2011] [Accepted: 01/16/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression is more frequent in socioeconomically disadvantaged than affluent neighbourhoods, but this association may be due to confounding. This study aimed to determine the independent association between socioeconomic disadvantage and depression. METHODS We recruited 21,417 older adults via their general practitioners (GPs) and used the Patient Health Questionnaire (PHQ-9) to assess clinically significant depression (PHQ-9≥10) and major depressive symptoms. We divided the Index of Relative Socioeconomic Disadvantage into quintiles. Other measures included age, gender, place of birth, marital status, physical activity, smoking, alcohol use, height and weight, living arrangements, early life adversity, financial strain, number of medical conditions, and education of treating GPs about depression and self-harm behaviour. After 2 years participants completed the PHQ-9 and reported their use of antidepressants and health services. RESULTS Depression affected 6% and 10% of participants in the least and the most disadvantaged quintiles. The proportion of participants with major depressive symptoms was 2% and 4%. The adjusted odds of depression and major depression were 1.4 (95% confidence interval, 95%CI=1.1-1.6) and 1.8 (95%CI=1.3-2.5) for the most disadvantaged. The adjusted odds of persistent major depression were 2.4 (95%CI=1.3-4.5) for the most disadvantaged group. There was no association between disadvantage and service use. Antidepressant use was greatest in the most disadvantaged groups. CONCLUSIONS The higher prevalence and persistence of depression amongst disadvantaged older adults cannot be easily explained by confounding. Management of depression in disadvantaged areas may need to extend beyond traditional medical and psychological approaches.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, WA, Australia.
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Abstract
Depression is a common and disabling mental disorder that affects people of all ages, cultures and ethnic backgrounds (Hendersonet al., 2000; Matherset al., 2001; Kessleret al., 2005; Princeet al., 2007). Its presence has been recorded throughout history (Berrios, 1985), which suggests that the signs and symptoms of depression are not simply a product of our time. However, given the overwhelmingly negative consequences of depression (Broadheadet al., 1990; Ellis and Gordon, 2004), it may seem surprising that depression is so ubiquitous and that evolution by means of natural selection has not eliminated it from our midst.
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