Age- and gender-specific prevalence and risk factors for depressive symptoms in the elderly: a population-based study

Associations and attributable burdens in late-life exposure to PM2.5 and its major components and depressive symptoms in middle-aged and older adults: A nationwide cohort study

BACKGROUND

Depression in late life has been associated with reduced quality of life and increased mortality. Whether the chronic fine particular matter (PM2.5) and its components exposure are contributed to the older depression symptoms remains unclear.

METHOD

Middle-aged and older adults (>45 years) were selected from the China Health and Retirement Longitudinal Study during the four waves of interviews. The concentrations of PM2.5 and its major constituents were calculated using near real-time data at a spatial resolution of 10 km during the study period. The depressive symptom was evaluated by the Depression Center for Epidemiologic Studies Depression (CES-D)-10 score. The fix-effect model was applied to evaluate the association between PM2.5 and its major constituents with depressive symptoms. Three three-step methods were used to explore the modification role of sleep duration against the depressive symptoms caused by PM2.5 exposure.

RESULTS

In our study, a total of 52,683 observations of 16,681 middle-aged and older adults were assessed. Each interquartile range (IQR) level of PM2.5 concentration exposure was longitudinally associated with a 2.6 % (95 % confidence interval [CI]: 1.3 %, 4.0 %) increase in the depression CES-D-10 score. Regarding the major components of PM2.5, OM, NO3-, and NH4+ showed the leading toxicity effects, which could increase the depression CES-D-10 score by 2.2 % (95 %CI: 1.0 %, 3.4 %), 2.2 % (0.6 %, 3.9 %), and 2.0 % (95 %CI: 0.6 %, 3.4 %) correspondingly. Besides, males were more susceptible to the worse depressive symptoms caused by PM2.5 and its major components exposure than female subpopulations. Shortened sleep duration might be the mediator of PM2.5-associated depressive symptoms.

CONCLUSION

Our results suggest that long-term exposure to PM2.5 and its major components were associated with an increased risk for depressive symptoms in middle-aged and older adults. Reducing the leading components of PM2.5 may cost-effectively alleviate the disease burden of depression and promote healthy longevity in heavy pollutant countries.

[Positive aging-How does it work? : Contribution of resilience to the prevention of depressive disorders in old age]

BACKGROUND

Although the prevalence of depressive disorders in old age is high, many older people succeed in staying healthy despite age-related stressors. The individual resilience or mental power of resistance can explain these differences.

OBJECTIVE

It is shown how resilience factors or strategies of healthy aging can be used for the primary prevention of depressive disorders in old age.

MATERIAL AND METHODS

The article summarizes the practically relevant age-specific aspects of resilience obtained through a narrative literature search and evaluates the relevant state of knowledge, also with respect to the consecutive development of primary preventive measures to avoid depressive disorders.

RESULTS

Individual psychological strategies for promoting resilience include "stay active", and "mindfulness towards positive things", social strategies "remain socially connected" and "acceptance of support options". In addition to this individual level, which aims at every single person, the social dimension of resilience also includes strategies that start at the social level. Above all, this includes the esteem of older people in society as well as improved opportunities for participation.

CONCLUSION

Age-specific aspects of resilience can be specifically used for the prevention of depressive disorders in old age. They enable a framework to establish resource-promoting and activating interventions, to counteract the deficit perspective on ageing. At the same time, there are clear limits to individual prevention and resilience. The responsibility cannot be seen solely for each individual but above all social structures and framework conditions must enable successful implementation in old age.

A machine learning model to predict the risk of depression in US adults with obstructive sleep apnea hypopnea syndrome: a cross-sectional study

Objective

Depression is very common and harmful in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). It is necessary to screen OSAHS patients for depression early. However, there are no validated tools to assess the likelihood of depression in patients with OSAHS. This study used data from the National Health and Nutrition Examination Survey (NHANES) database and machine learning (ML) methods to construct a risk prediction model for depression, aiming to predict the probability of depression in the OSAHS population. Relevant features were analyzed and a nomogram was drawn to visually predict and easily estimate the risk of depression according to the best performing model.

Study design

This is a cross-sectional study.

Methods

Data from three cycles (2005-2006, 2007-2008, and 2015-2016) were selected from the NHANES database, and 16 influencing factors were screened and included. Three prediction models were established by the logistic regression algorithm, least absolute shrinkage and selection operator (LASSO) algorithm, and random forest algorithm, respectively. The receiver operating characteristic (ROC) area under the curve (AUC), specificity, sensitivity, and decision curve analysis (DCA) were used to assess evaluate and compare the different ML models.

Results

The logistic regression model had lower sensitivity than the lasso model, while the specificity and AUC area were higher than the random forest and lasso models. Moreover, when the threshold probability range was 0.19-0.25 and 0.45-0.82, the net benefit of the logistic regression model was the largest. The logistic regression model clarified the factors contributing to depression, including gender, general health condition, body mass index (BMI), smoking, OSAHS severity, age, education level, ratio of family income to poverty (PIR), and asthma.

Conclusion

This study developed three machine learning (ML) models (logistic regression model, lasso model, and random forest model) using the NHANES database to predict depression and identify influencing factors among OSAHS patients. Among them, the logistic regression model was superior to the lasso and random forest models in overall prediction performance. By drawing the nomogram and applying it to the sleep testing center or sleep clinic, sleep technicians and medical staff can quickly and easily identify whether OSAHS patients have depression to carry out the necessary referral and psychological treatment.

Associations of Migration, Socioeconomic Position and Social Relations With Depressive Symptoms - Analyses of the German National Cohort Baseline Data

Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.

Sleep profile and the risk of cardiovascular events in patients undergoing percutaneous coronary intervention

A significant proportion of patients with coronary artery disease (CAD) who undergo percutaneous coronary intervention (PCI) suffer from physical and mental disorders which lead to the decline of sleep profile. Sleep disorders are highly prevalent in these patients. But the effect of sleep on the outcomes of post-PCI patients remains unclear. We aim to examine the individual and joint effects of sleep quality and sleep duration on the risk of adverse cardiovascular events in post-PCI patients. We included 314 participants who were diagnosed with a first CAD and underwent PCI with drug-eluting stents and followed up for a mean duration of 341 days to assess major adverse cardiovascular events (MACEs). Sleep quality, based on the Pittsburgh Sleep Quality Index, was categorized as good (a score of ≤7) or poor (>7). Sleep duration was categorized into three classes: ≤ 5, 6-8 (reference group) and ≥ 9 hours per day. The log-rank test and the Cox regression model were used for data analysis. MACEs occurred in 26 (8.3%) patients. Subjects whose sleep duration was ≤ 5 hours per day had a shorter time to MACEs than those whose sleep duration was 6-8 hours (p = 0.036). A significantly increased risk for MACEs was observed for participants with a ≤ 5 hours sleep duration (HR = 2.18, 95% CI = 1.02-4.64) after adjustment for demographic and clinical confounders. Associations between long sleep duration (≥ 9 hours), sleep quality, or their joint effect and MACEs were not found. This suggests the importance of considering sleep loss when developing strategies to improve health outcomes of PCI patients. And further researches are needed to examine the effects of different aspects of sleep quality on the prognosis of PCI patients and explore the reasons that lead to the decline of sleep profile.

The critical role of physical frailty and function on depressive symptoms among community-dwelling older adults in China: A cross-sectional study

INTRODUCTION

With rapid population aging in China, geriatric depression has imposed a heavy burden on public health and society. This study aimed to investigate the prevalence and influencing factors of depressive symptoms among community-dwelling older adults in China. The findings of this study will contribute to the early detection and effective interventions for older adults with depressive symptoms.

METHODS

A cross-sectional study was conducted among people aged ≥65 years old in urban communities in Shenzhen, China, in 2021. This study assessed depressive symptoms (Geriatric Depression Scale-5, GDS-5), physical frailty (FRAIL Scale, FS), and physical function (Katz index of independence in the Activities of Daily Living, ADL). Multiple linear regression was used to examine potential predictors of depressive symptoms.

RESULTS

A total of 576 participants aged 71.73 ± 6.41 years were included in the analysis. More than half of them were females (53.0%). The average score of GDS-5 was 0.57 ± 1.11, with 78 (13.61%) participants with depressive symptoms (≥2). The mean scores of FS and ADL were 0.80 ± 1.08 and 9.49 ± 1.67, respectively. The final regression model indicated that those who were living alone, less satisfied with their personal life, frailer, and with worse abilities in ADL had a higher level of depression symptoms (R² = 0.406, p < 0.001).

CONCLUSION

The prevalence of depressive symptoms is high in this urban community-dwelling older adults in China. Given the critical role of frailty and ADL on depressive symptoms, specific attention to psychological support should be paid to older adults who are living alone and with poor physical conditions.

Age-related changes in mice behavior and the contribution of lipocalin-2

Aging causes considerable changes in the nervous system, inducing progressive and long-lasting loss of physiological integrity and synaptic plasticity, leading to impaired brain functioning. These age-related changes quite often culminate in behavioral dysfunctions, such as impaired cognition, which can ultimately result in various forms of neurodegenerative disorders. Still, little is known regarding the effects of aging on behavior. Moreover, the identification of factors involved in regenerative plasticity, in both the young and aged brain, is scarce but crucial from a regenerative point of view and for our understanding on the mechanisms that control the process of normal aging. Recently, we have identified the iron-trafficking protein lipocalin-2 (LCN2) as novel regulator of animal behavior and neuronal plasticity in the young adult brain. On the other hand, others have proposed LCN2 as a biological marker for disease progression in neurodegenerative disorders such as Alzheimer's disease and multiple sclerosis. Still, and even though LCN2 is well accepted as a regulator of neural processes in the healthy and diseased brain, its contribution in the process of normal aging is not known. Here, we performed a broad analysis on the effects of aging in mice behavior, from young adulthood to middle and late ages (2-, 12-, and 18-months of age), and in the absence of LCN2. Significant behavioral differences between aging groups were observed in all the dimensions analyzed and, in mice deficient in LCN2, aging mainly reduced anxiety, while sustained depressive-like behavior observed at younger ages. These behavioral changes imposed by age were further accompanied by a significant decrease in cell survival and neuronal differentiation at the hippocampus. Our results provide insights into the role of LCN2 in the neurobiological processes underlying brain function and behavior attributed to age-related changes.

[The development of mental health in oldest-old individuals during the COVID-19 pandemic and the role of social support]

BACKGROUND

The elderly population is one of the high-risk groups with regard to a severe course of disease and increased mortality when infected with the coronavirus SARS-CoV‑2 (Severe Acute Raspiratory Syndrom Coronavirus 2). This group may be at higher risk for psychological strains from the COVID-19 pandemic itself but also from the health protection measures. The aim is to examine how symptoms of depressiveness, anxiety, and somatization change over the course of the pandemic and which role social support plays in that.

METHODS

Using two written surveys of n = 156 elderly participants in the periods May to June 2020 and March to May 2021, sociodemographic data, factors of psychological strain (depressiveness, anxiety, and somatization), as well as the perceived social support were recorded. The mean age of the respondents was 87.20 years (SD = 4.65; age range = 77.68-96.75 years) and 88.03 years (SD = 4.63; age range = 78.52-97.62 years) for 2020 and 2021, respectively. Data were analyzed using Wilcoxon t‑tests and generalized linear regression models.

RESULTS

A significant increase in the expression of psychological strain with regards to depressiveness, anxiety, and somatization can be identified. Higher scores of psychological strains in 2020 are associated with a higher psychological strain in 2021. Higher perceived social support in 2020 is associated with lower depressiveness one year later.

CONCLUSION

An increase in psychological strain has been observed in the elderly population over the course of the COVID-19 pandemic until May 2021. This population should be supported by preventive programs to avert a further increase in symptoms. The expansion of social support could be useful, especially in the prevention of depressive symptoms.

Association between air quality satisfaction, family relationships, and depression symptoms among middle-aged and elderly chinese people: the mediation role of perceived health status

BACKGROUND

Population aging has led to depression becoming a serious public health problem both in China and worldwide. Marital relationships, relationships with their children, and air pollution might play an important role in the process of depressive disorders. In this study, we aimed to reveal the mechanism of the effects of these factors on depression.

METHODS

Participants were recruited from The China Health and Retirement Longitudinal Study (CHARLS) (wave 4) from July 2018 to March 2019. Depression symptoms were evaluated using the 10-item Center for Epidemiologic Studies depression scale (CESD-10). Marital relationships, relationships with their children, air quality satisfaction, and perceived health status were analyzed using Likert 5-point evaluation methods. Structural equation modeling-path (SEM) models were used to explore these variables' mediation effects on depression symptoms.

RESULTS

Marital relationships, relationships with their children, air quality satisfaction, perceived health status, and depression symptoms were significantly associated with each other (P < 0.001). Mediation analysis showed that family relationships (standardized beta = -0.28 [-0.31, -0.26]) and quality satisfaction (standardized beta = -0.03 [-0.05, -0.01]) had negative effects on depression symptoms. The total indirect effects of family relationships and air quality satisfaction on depression symptoms were -0.06 (95% confidence interval (CI) = [-0.07, -0.05]) and -0.016 (95% CI = [-0.02, -0.01]), respectively.

CONCLUSION

Family relationships, air quality satisfaction, and perceived health status influenced depression symptoms. The effects of family relationships and air quality satisfaction on depression symptoms were significantly mediated by perceived health status. Therefore, perceived health status aspects should be considered when conducting targeted intervention toward depression symptoms among middle-aged and elderly adults.

Disruption to well-being activities and depressive symptoms during the COVID-19 pandemic: The mediational role of social connectedness and rumination

BACKGROUND

Disruption to everyday routine during the COVID-19 pandemic has resulted in considerable implications for global mental health. The inter- and intra-personal mechanisms by which disrupted routine can contribute to elevated depressive symptoms has not been well-explored. The present study aimed to examine how feelings of social (dis)connectedness and rumination, as a maladaptive coping strategy, could explain the association between disrupted well-being activities and depressive symptoms.

METHODS

Participants (N = 496) ranging in age from 18 to 73 years (M = 28.73, SD = 10.93) completed an online survey within the first 3 months of the COVID-19 pandemic, which included measures of disruption to usual psychological and physical well-being activities, social connectedness, rumination, and depressive symptoms. Social connectedness and rumination were investigated as serial mediators of the association between disrupted well-being activities and depression using Hayes' PROCESS macro.

RESULTS

39.5% of the sample reported clinically significant levels of depression. Disruption to well-being activities predicted higher depressive symptoms, and this was partially explained by feelings of social disconnectedness and subsequent rumination. Rumination, alone, was not a significant mediator between disrupted routine and depressive symptoms.

LIMITATIONS

The cross-sectional survey design does not preclude the possibility of bidirectional effects.

CONCLUSION

The social distancing public health measures to combat COVID-19 have contributed to widespread disrupted routine, and in turn, elevated symptoms of depression. Social disconnectedness plays a particularly important role in this association. Intervention strategies should consider social factors as a 'social cure' for mass, positive mental health promotion during COVID-19.

Scoping review: Influence of cisgender male and female genders on health literacy of the elderly people

This scoping review mapped out the relevant literature, identified gaps and made suggestions on the influence of cisgender on the health literacy (HL) of the elderly people. This scoping review was guided by the PRISMA-ScR checklist. The databases Wiley Online Library™ and Elsevier™ were searched for academic articles published in the English language between February 2011 and February 2021 that met a pre-set criteria of content. The process of selection of sources of evidence based on screening and eligibility of evidence reduced the initially identified 153 sources of evidence in the searched databases to 14 sources of evidence. The content of these 14 sources of evidence was mapped out on a charting table where data was summarised and synthesised individually and collectively by the authors. Repetitive and irrelevant data were deleted. Identified gaps include the lack of extensive exploration of male and female genders alone as a determinant of HL, how gender may be utilised to encourage elderly men and women to apply HL, how different sociocultural and sociodemographic backgrounds of elderly men and women would require separate academic research, the scarcity of social sciences based research and qualitative research methodologies on the subject as well as the use of mixed-methodologies and longitudinal studies. Future research directions were suggested and limitations of this scoping review are addressed in the discussion.

Predictors of Psychological Distress and Confidence Negotiating Physical and Social Environments Among Mobility Device Users

OBJECTIVE

We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments.

DESIGN

Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale, and self-reported functional independence scale.

PARTICIPANTS

The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 yrs, 53% were female, and 52% lived alone and were functionally independent with the use of assistive technology.

RESULTS

We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments.

CONCLUSIONS

Age is associated with psychosocial outcomes for assistive device users, and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.

Religious Coping Styles and Depressive Symptoms in Geriatric Patients: Understanding the Relationship through Experiences of Integrity and Despair

Older persons are often confronted with challenging events in their lives. Religion can offer them a way to deal with these challenges. The study of religious coping styles helps us to understand how people find support in their religion or wrestle with aspects of their religion when they are confronted with difficulties. Especially when older adults face illness and hospitalization, religious coping styles might be triggered. Despite the fact that the public role of religion, especially Christianity, is diminishing in West European societies, a large group of Belgian geriatric patients call themselves religious. Previous studies have shown that there is a link between positive/negative religious coping styles and the depressive symptoms that often occur in older adults. More recently, some scholars have emphasized that this relationship is more complex. Therefore, this paper investigates the role of one possible underlying mechanism between positive/negative religious coping styles and depressive symptoms in geriatric patients, namely the developmental process of integrity and despair as two factors within this mechanism. One hundred thirty-nine geriatric inpatients from three hospitals in Belgium who reported to feel religiously affiliated were involved in this study. Our results indicate that experiences of integrity and despair function as an explanatory pathway in the relationship between negative religious coping styles and depressive symptoms. Further, a direct link was found between both when accounting for experiences of integrity and despair. For positive religious coping styles, no direct or indirect relationship with depressive symptoms was found. In healthcare, geriatric caregivers need to be aware of the interaction between positive and negative religious coping styles, the developmental process of integrity and despair, and depressive symptoms.

Needs and Needs Communication of Nursing Home Residents with Depressive Symptoms: A Qualitative Study

Nursing home residents are affected by depressive symptoms more often than elders living at home. There is a correlation between unmet needs and depression in nursing home residents, while met needs positively correlate with greater satisfaction and well-being. The study aims to examine the needs of nursing home residents with depressive symptoms and the communication of those needs, as no previous study has explicitly addressed the needs of this group of people and the way they are communicated. We conducted semi-structured interviews with 11 residents of three nursing homes and analyzed them using content-structuring content analysis. The residents reported diverse needs, assigned to 12 categories. In addition, barriers such as health impairments prevented the fulfillment of needs. As to the communication of needs, various interlocutors, facilitators, and barriers were identified. The findings reveal that residents can express their needs and are more likely to do so if the interlocutors are patient and take them seriously. However, lack of confidants, missing or non-functioning communication tools, impatience and perceived lack of understanding on the part of caregivers, and residents’ insecurities limit communication of needs.

Psychological Effects of Social Isolation During the COVID-19 Pandemic 2020

Abstract. The SARS-CoV2 pandemic meant considerable restrictions in the social life of many people. Older people belong to the high-risk group for a severe to fatal course of the SARS-CoV2 disease, which is why these groups received special protection. This protection included drastic restrictions on their personal and social contacts, including the suspension of psychosocial therapies. This study examines the cognitive and emotional effects of social isolation on older people. A group of 49 participants who lived in nursing homes was tested before and after social isolation in 2020. The results of the present study provide empirical evidence for the negative effects of social isolation of older people in nursing homes regarding cognitive performance, anxiety, depressive symptoms, and quality of life.

Factors associated with depression across age groups of older adults: The Singapore Chinese health study

OBJECTIVES

We studied sociodemographic and health factors associated with depression across three age groups of community-dwelling older adults.

METHODS/DESIGN

We used data from 16,785 participants from the third follow-up of the Singapore Chinese Health Study (mean age: 73, range: 61-96 years). We defined depression as having a score of ≥5 using the 15-item Geriatric Depression Scale. We used regression splines to examine the pattern of depression risk with age and applied multivariable logistic regression to study factors associated with depression.

RESULTS

Increasing age was associated with depression in an inverted J-shape relationship with the highest odds ratio (OR) at age 75. Compared to the youngest-old (<70 years), the middle-old (70-80 years) had higher odds of depression [OR = 1.20, 95% confidence interval (CI) = 1.09-1.31], while the oldest-old (>80 years) had no increased risk (OR = 1.01, 95% CI = 0.89-1.15). We also found demographic (men, lower education, unemployment), social (living alone, poor social support, no social activity) and health factors (instrumental limitations, poor physical function, function-limiting pain, chronic diseases, cognitive impairment, poor sleep quality, poor self-rated health) associated with depression. In stratified analysis by age groups, the OR estimates for lower education level, instrumental limitations and cognitive impairment decreased with age, whereas the risk of depression for men increased with age (all p-values for interaction<0.03).

CONCLUSIONS

Compared to the youngest-old, the likelihood of depression was highest among middle-old adults and decreased to null in the oldest-old. The associations between some factors and depression were attenuated with age, suggesting a coping mechanism among oldest-old survivors.

Association of Depression With Atrial Fibrillation in South Korean Adults

IMPORTANCE

The risk of atrial fibrillation (AF) in people with depression is not fully known. Depression is associated with sympathetic activation and emotional stress, which might increase the risk of new-onset AF.

OBJECTIVE

To assess the incidence of new-onset AF in those with and without depression using data from a nationwide health care database.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study obtained data from the Korean National Health Insurance Service database and enrolled people who underwent a nationwide health checkup in 2009. People younger than 20 years and those with a history of heart valve surgery, previous diagnosis of mitral stenosis, or who were diagnosed with AF between January 1, 2002 and December 31, 2008 were excluded. The risk of new-onset AF (occurring between 2009 and 2018) was compared in people who were and were not diagnosed with depression within a year before the 2009 nationwide health checkup. Data were analyzed between August 1, 2020 and October 31, 2020.

EXPOSURE

Previous diagnosis of depression.

MAIN OUTCOMES AND MEASURES

Cumulative incidence and risk of new-onset AF between 2009 and 2018 in participants with and without depression. Kaplan-Meier analysis was conducted to assess incidence of AF, and Cox proportional hazards regression was used to calculate adjusted and unadjusted hazard ratios (HRs) and 95% CIs.

RESULTS

A total of 5 031 222 individuals with a mean (SD) age of 46.99 (14.06) years (2 771 785 men [55.1%]) were included in the analysis; of these individuals, 148 882 (3.0%) had a diagnosis of depression in the year before the 2009 health checkup and 4 882 340 (97%) did not. People with depression vs those without depression were older (aged 56.7 vs 46.7 years) and more likely to be women (96 472 [64.8%] vs 2 162 965 [44.3%]). Prevalence of hypertension, diabetes, dyslipidemia, and heart failure was higher in the depression group. The cumulative incidence of new-onset AF was significantly higher in people with depression vs without depression in the Kaplan-Meier analysis and showed steady divergence throughout 10 years of follow-up (cumulative incidence, 4.44% vs 1.92%; log-rank P < .001). After adjusting for covariates, depression was associated with a 25.1% increased risk of new-onset AF (HR, 1.25; 95% CI, 1.22-1.29; P < .001). People with recurrent episodes of depression showed even higher risk of new-onset AF (HR, 1.32; 95% CI, 1.27-1.37; P < .001). Young age and female sex had significant interactions with depression, which suggests that young people and women with depression may have an increased risk of new-onset AF.

CONCLUSIONS AND RELEVANCE

This study found that depression was associated with a significantly increased cumulative incidence and risk of new-onset AF. Recurrent episodes of depression were associated with even higher risk. These findings suggest the need for adequate screening for AF in people with depression, particularly in younger people and women.

Association of Dietary Inflammatory Index With Depression and Suicidal Ideation in Older Adult: Results From the National Health and Nutrition Examination Surveys 2005-2018

BACKGROUND

The relationship between diet and psychological disorders in older adults has attracted considerable attention as the global trend of aging. This study examines the relationship between Dietary inflammatory index (DII) and the risk of depression and suicide in older adults using the National Health and Nutrition Examination Survey (NHANES) as a large cross-sectional study.

METHODS

The data were extracted from NHANES from 2005 to 2018, and cross-sectional studies were conducted on older adults (age ≥ 60 years). According to their median DII, participants were classified into High-DII (DII ≥ 1.23) and Low-DII (DII < 1.23) groups. Depression was the primary outcome, and suicidal ideation was a secondary outcome. Utilizing multi-factor logistic regression to correlate DII with outcomes.

RESULTS

There were 10,956 elderly participants included in the analysis. In comparison to Low-DII group, High-DII group exhibited a higher rate of depression (8.9% vs. 6.7%; P < 0.001) and higher ideation to commit suicide (3.7% vs. 3.0%; P = 0.039). Moreover, in terms of gender ratio, men accounted for 44% of the High-DII group, which was significantly lower than 56.2% of the Low-DII group (P < 0.001). Furthermore, logistic regression revealed that High-DII group had a higher risk of depression in the previous 2 weeks (OR = 1.358, 95% CI: 1.180-1.564; P < 0.001) and a higher risk of suicidal ideation (OR = 1.244, 95% CI: 1.010-1.532; P = 0.040). Additionally, after adjusting for demographic covariates such as age, gender and race, High-DII group still had a higher risk of depression (OR = 1.293, 95% CI: 1.121-1.493; P < 0.001) and suicidal ideation (OR = 1.261, 95% CI: 1.021-1.55; P = 0.031). Furthermore, after adjusting for various covariates like demographic, social factors, and comorbidities, the High-DII group remained at higher risk for depression (OR = 1.178, 95% CI: 1.019-1.363; P = 0.027), and the risk of comorbid suicidal ideation remained high (OR = 1.136, 95% CI: 0.917-1.408), but the difference was not significant (P = 0.243).

CONCLUSION

In older adults, high levels of DII are associated with depression and suicidal ideation. Multiple factors affect the mental health of older adults, and it is unknown to what extent a pro-inflammatory diet contributes to depression and suicidal thoughts in older adults. Nonetheless, daily dietary management in older adults should be emphasized.

Meaning Reflectivity in Later Life: The Relationship Between Reflecting on Meaning in Life, Presence and Search for Meaning, and Depressive Symptoms in Older Adults Over the Age of 75

Background: Over the last decades, there is growing attention for the importance of meaning in life for older adults. However, there is virtually no insight into the mental processes that contribute to this experience. Some scholars recently called for an investigation of meaning reflectivity, or the process of reflecting on issues specifically related to meaning in life. In this study, we explored to what extent older adults talk and think about issues of meaning in life, and how this meaning reflectivity is related to the search for and presence of meaning in life, and to depressive symptoms.

Method: In this cross-sectional observational study, 282 community-residing older adults (75 or older) in Belgium filled in paper questionnaires on meaning in life (presence and search), depressive symptoms, and meaning reflectivity (categorical item). ANOVA analyses were used to explore differences in meaning in life and depressive symptoms across the meaning reflectivity categories. Regression and negative binomial models investigated the association between meaning reflectivity and presence, search and depressive symptoms. Finally, an exploratory structural equation model examined whether presence of meaning statistically mediated the relationship between meaning reflectivity and depressive symptoms.

Results: The majority of participants (42.4%) indicated that they had thought about meaning in life before, 23.2% indicated that they had talked about it before, 18% indicated that they hadn’t thought about it before but found it interesting, and 16.4% indicated that they were indifferent/unconcerned about meaning in life. The latter group reported lower levels of presence of meaning and search for meaning and higher levels of depressive symptoms. Belonging to this category was also associated with lower presence and search in regression analyses, but not with depressive symptoms above the effect of presence of meaning. Exploratory mediation analyses suggested that presence of meaning may be a mediator between meaning reflectivity and depressive symptoms.

Conclusion: Meaning reflectivity is an important process to consider in the context of the experience of meaning in life for older adults. Those older adults who are indifferent about issues of meaning in life might be more vulnerable to experience a lack of meaning and depressive symptoms.

Analysis of Factors Associated With Depression in Community-Dwelling Older Adults in Wuhan, China

Objectives: This study aimed to identify the independent factors associated with depression in community-dwelling older adults in Wuhan, China. Methods: Four hundred and seventy older adults (aged ≥65 years) from four communities dwelling on Junshan Street in Wuhan, China were included in this study. Participants completed a questionnaire that asked questions pertaining to age, gender, educational level, income, living situation, care situation, social support, and social engagement. The 30-item Geriatric Depression Scale (GDS-30), the Fried frailty phenotype scale, the activities of daily living (ADL) scale, the mini nutritional assessment scale-short form (MNA-SF), and the Mini-cog scale were used to assess depression, frailty, self-care ability, malnutritional risk, and cognitive dysfunction, respectively. Differences in age, gender, educational level, income, living situation, care situation, social support, social engagement, ADL score, risk of malnutrition, frailty, and cognitive dysfunction between the non-depression (GDS-30 score <10 points) and depression groups (GDS-30 score ≥10 points) were compared using a chi-square test. Moreover, correlations between factors and depression were analyzed using Pearson's correlation. Then, significant variables (p < 0.05) from the chi-square test were included in a multivariable logistic regression model to identify the independent factors associated with depression. Results: The incidence of depression among the participants was 14.04%. Age (p < 0.001), educational level (p < 0.001), living situation (p < 0.001), social support (p = 0.001), ADL score (p = 0.023), frailty (p < 0.001), and cognitive dysfunction (p < 0.001) were all significantly associated with depression, in which age, poor social support, frailty, and cognitive dysfunction were identified as independent factors. Conclusion: Improving social support and effective interventions for frailty and cognitive dysfunction may help relieve depression in community-dwelling older adults.

Gender-specific factors associated with risk of depression among Lebanese older adults

BACKGROUND

Depression among older adults is a frequent and underdiagnosed condition. However, there is a paucity of research on mental health problems among elderly people in Arab countries. The purpose of this study was to describe the risk of depression among a representative sample of older Lebanese adults living in rural areas and to identify gender-specific factors associated with depression risk.

METHODS

This study included a randomly selected sample of 823 rural elderly people aged ≥65 years without cognitive decline. Data, including sociodemographic characteristics, living condition, health and functional status, were collected during face-to-face interviews. Depression was assessed by the five-item Geriatric Depression Scale.

RESULTS

Risk for depression was significantly higher in women than in men (39.5% vs 26.2%, P < 0.001). Among men, reporting a higher versus a lower income (adjusted odds ratio (AOR) = 0.299) and being physically active significantly decreased the odds of depressive symptoms. In addition, physical disability (AOR = 3.03) and a high level of loneliness (AOR = 41.76) were significantly related to an increased risk of depression. Among women, daily or occasional physical activity was related to a reduced risk of depression compared to sedentary lifestyles (AOR = 0.35; AOR = 0.50). Furthermore digestive symptoms (AOR = 1.98), poor nutritional status (AOR = 1.99), and strong feelings of loneliness (AOR = 10.86) were significantly related to an increased odds of depression.

CONCLUSION

Elderly Lebanese people, especially women, were at high risk for depression. Among other gender-specific factors, loneliness was strongly associated with depressive disorders in both genders, with a four times greater odds ratio in men than in women.

Factors associated with depressive symptoms among the elderly in China: structural equation model

OBJECTIVES

To establish a structural equation model for exploring the direct and indirect relationships of depressive symptoms and their associated factors among the Chinese elderly population.

DESIGN

A cross-sectional research. The 2015 data from the China Health and Retirement Longitudinal Study (CHARLS) were adopted.

SETTING

CHARLS is an ongoing longitudinal study assessing the social, economic, and health status of nationally representative samples of middle-aged and elderly Chinese residents.

PARTICIPANTS

A total of 5791 participants aged 60 years and above were included.

MEASUREMENTS

Depressive symptoms were used as the study outcome. Sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration were used as predictors. Confirmatory factor analysis was first conducted to test the latent variables. Structural equation model was then utilized to examine the associations among latent variables and depressive symptoms.

RESULTS

The mean age of the participants was 68.82 ± 6.86 years, with 55.53% being males. The total prevalence of depressive symptoms was 37.52%. The model paths indicated that sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration were directly associated with depressive symptoms, and the effects were 0.281, 0.509, -0.067, and -0.162, respectively. Sociodemographic characteristics, unhealthy habits, and sleep duration were indirectly associated with depressive symptoms, mediating by poor health status. Their effects on poor health status were -0.093, 0.180, and -0.279, respectively. All paths of the model were significant (P < 0.001). The model could explain 40.9% of the variance in the depressive symptoms of the Chinese elderly population.

CONCLUSIONS

Depressive symptoms were significantly associated with sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration among Chinese elderly population. The dominant predictor of depressive symptoms was poor health status. Targeting these results might be helpful in rationally allocating health resources during screening or other mental health promotion activities for the elderly.

Influence of Health-Related Status and Social Activities on Depressive Symptoms in Korean Older Adults Who Live Alone

The current study aimed to explore predictors of depressive symptoms in Korean older adults who live alone using data from the 2017 National Survey of Older Koreans. Participants were 2,258 adults (females, n = 1,838 [81.4%]; males, n = 420 [18.6%]) aged ≥65 years (mean = 75.9, SD = 6.8 years). Multiple hierarchical regression analysis indicated that perceived health status, instrumental activities of daily living (IADL), social gatherings, interaction frequency with children living separately, income quintile, religion, and education were significant predictors of depressive symptoms. In particular, perceived health status, IADL, and interaction frequency with children living separately were the most powerful predictors of depressive symptoms in older adults living alone. The result of the current study was to verify the relationship between social activity and depression of older adults who live alone. This study suggests that contact with children and social gatherings may help prevent depression in older adults who live alone. [Journal of Psychosocial Nursing and Mental Health Services, 59(2), 25-30.].

Influence of Health Status, Cognitive Function, and Social Capital on Depressive Symptoms in Korean Older Adults

The current study explored the influence of health status, cognitive function, and social capital on depressive symptoms in Korean older adults. Data from the National Survey of Older Koreans, conducted by the Korean Institute for Health and Social Affairs in 2017, were used. Social capital was measured by dividing it into structural and cognitive social capital. Final analysis included 6,100 individuals aged ≥65 years (mean age = 72.6, SD = 5.8 years; 3,466 males [56.8%], 2,634 females [43.2%]). Multiple hierarchical regression analysis indicated that age, income, economic activity status, religion, household type, self-rated health, apoplexy (e.g., stroke, cerebral infarction), cognitive function, structural social capital, and cognitive social capital were significant predictors of depressive symptoms in older adults. This study suggests that researchers and clinicians should consider the factors associated with self-rated health, cognitive social capital, and economic status (income and economic activity) to prevent or alleviate depressive symptoms in older adults. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 24-31.].

Dose-response relationship between intergenerational contact frequency and depressive symptoms amongst elderly Chinese parents: a cross-sectional study

Background

Given the high prevalence of depressive symptoms amongst the elderly Chinese population and the significance of intergenerational contact in this demographic group, the purpose of this study was to examine the association and dose–response relationship between the frequency of intergenerational contact and depressive symptoms.

Methods

Data were obtained from the third wave of the China Health and Retirement Longitudinal Study. A total of 5791 participants at age 60 or older were included in this study. Depressive symptoms were defined by the 10-item version of the Centre for Epidemiologic Studies Depression Scale. Intergenerational contact included in-person meeting and remote connecting, and they were analysed separately. Intergenerational contact frequency was classified into ten categories and then treated as a continuous variable for analysis. We performed univariate and multivariate logistic regressions to identify risk covariables. Restrictive cubic spline analysis was used to examine the dose–response relationship between intergenerational contact frequency and the outcome of depressive symptoms.

Results

Both the frequency of meeting and the frequency of connecting with children were independently associated with depressive symptoms in the elderly, and the odds ratios for depressive symptoms increased with decreasing frequencies (P < 0.01). There was a negative dose–response relationship between intergenerational contact frequency and depressive symptoms. The odds of depressive symptoms steadily decreased with increasing frequency of meeting with their children. Following an initial increase, the odds rapidly decreased as the frequency of connecting with children increased with an inflection point at once a monthly. Both associations were nonlinear (P < 0.001).

Conclusions

Our findings revealed a negative dose–response relationship between intergenerational contact frequency and depressive symptoms in the elderly Chinese population. Thus, future health interventions should consider cultural norms in shaping the mental well-being of Chinese elderly persons.

EZH2 is involved in vulnerability to neuroinflammation and depression-like behaviors induced by chronic stress in different aged mice

BACKGROUND

Microglial activation and pro-inflammatory cytokines expression is closely related to pathogenesis of depression. Aging is a known risk factor for neuroinflammation in the central nervous system and subsequent behavioral impairment. Enhancer of zeste homolog 2 (EZH2), a methyltransferase of histone H3 lysine 27 which regulates microglial activation, plays a crucial role in proinflammatory cytokines expression. However, whether the EZH2 is involved in susceptibility to depression in different ages remains elusive.

METHODS

Young and aged C57BL/6 mice were exposed to chronic unpredictable mild stress for three weeks. Depression- and anxiety-like behaviors, spatial memory impairment, and the expression of pro-inflammatory cytokines, P-p65, EZH2, H3K27me3 and SOCS3 in the prefrontal cortex and hippocampus were measured using an established behavioral battery, ELISA, immunohistochemistry and western blotting techniques. Moreover, EPZ-6438, an inhibitor of EZH2, was utilized to detect the role of EZH2 in neuroinflammation and behavioral abnormalities.

RESULTS

CUMS induced depression-like behaviors and spatial memory impairment, elevated levels of proinflammatory cytokines and P-p65, enhanced M1 microglia activation, and increased levels of EZH2, H3K27me3 and SOCS3 in the prefrontal cortex and hippocampus in young and aged mice. Both unstressed and stressed aged mice displayed attention-deficit behavioral outcomes, alteration of protein levels compared with young mice. However, inhibition of EZH2 could relieve most of behavioral and molecular alterations.

LIMITATIONS

A relative small sample size is a limitation.

CONCLUSIONS

EZH2 might be involved in susceptibility to neuroinflammation and depression-like behaviors in different aged mice.

A prospective investigation of factors associated with depressive symptoms in older adults' post-hospitalisation

OBJECTIVE

The transition from hospital to home is a period where older adults are at risk of experiencing depressive symptoms. The present study applied the Social Antecedent Model of Psychopathology (SAMP) to identify factors present at hospital discharge associated with depressive symptoms at discharge and future symptoms at 3- and 6-month post-discharge home.

METHOD

286 older adults aged over 65 (M = 78.38, SD = 7.68, 57% female) reported on a range of variables that were mapped to the SAMP at hospital discharge, 3- and 6-month post-discharge.

RESULTS

At baseline assessment, male gender, increased anxiety symptoms, low social support and low perceived coping ability were associated with concurrent baseline depressive symptoms. Depressive symptoms at baseline were strongly associated with future depressive symptoms at 3- and 6-month post-discharge. Low household physical activity was also associated with depressive symptoms at 3 months and elevated baseline anxiety symptoms and low social support were associated with depressive symptoms at 6-month post-discharge.

CONCLUSION

Pre-discharge screening of depressive and anxiety symptoms, social support, household physical activity and coping ability may assist in identifying elderly patients at risk of developing depressive symptoms during the hospital-to-home transition. These factors may also serve as potential targets for preventative interventions post-discharge for older adults.

Health Risk Assessment Indicators for the Left-Behind Elderly in Rural China: A Delphi Study

In China, many young and middle-aged rural residents move to urban areas each year. The rural elderly are left behind. The number of the rural left-behind elderly is increasing with urbanization, but it is unclear which indicators can be used to assess their health condition. The health risk assessment index system was developed to improve the health level of the rural left-behind elderly. A two-round web-based Delphi process was used to organize the recommendations from fifteen Chinese experts in geriatrics, health management, social psychology who participated in this study. Meaningfulness, importance, modifiability, and comprehensive value of the health risk assessment indicators in the index system were evaluated. The effective recovery rates of the two-round Delphi were 86.67% and 92.31%, respectively. The judgement coefficient and the authority coefficient were 0.87 and 0.82, respectively. The expert familiarity was 0.76. Ultimately, the health risk assessment index system for the rural left-behind elderly consisted of five first-level indicators, thirteen second-level indicators, and sixty-six third-level indicators. The final indicators can be used to evaluate the health of the rural left-behind elderly and provide the basis for additional health risk interventions.

Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging

BACKGROUND

Little is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults.

METHODS

Using weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (n = 27,162) of adults aged 45-85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake.

RESULTS

The sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56-65 years (58.9%), earning between C$50,000-99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15-1.66, p's < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67-83, p's < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71-0.743, p's < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36-3.65, p's < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14-1.72, p's < 0.05) predicted a higher likelihood of depression.

CONCLUSIONS

The odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45-85.

Association between tea consumption and depressive symptom among Chinese older adults

Background

Despite accumulating evidence on the protective effect of tea consumption against depression, studies specifically focusing on the elderly population are yet limited. This paper examined the association between the frequency and duration of tea drinking and depressive symptoms of older adults by gender and age groups, based on a nationally representative sample in China.

Method

The study employed the panel data from 2005, 2008/2009, 2011/2012 and 2014 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the frequency and consistency of tea drinking behaviors to identify four types of tea consumption amongst Chinese seniors. Depressive symptoms were assessed by a five-item scale. Linear mixed effects models were applied.

Results

We found that consistent and frequent tea-drinking was associated with significantly less depressive symptoms, and such impact was partially mediated by socioeconomic status, health behavior, physical health, cognitive function, and social engagement. However, the association was only significant for males and the oldest-old, rather than females and younger elders.

Conclusions

Consistent and frequent tea-drinking may effectively reduce the risk of depressive symptoms for the Chinese elderly. The promotion of the traditional lifestyle of tea drinking could be a cost-effective way towards healthy aging for China.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1259-z) contains supplementary material, which is available to authorized users.

Depression in migrant workers and nationals of Qatar: An exploratory cross-cultural study

BACKGROUND

The aim of this study was to compare the prevalence of depressive symptoms among migrants and non-migrants living in Qatar and identify variables associated with depressive symptomology in these groups, including culture of origin, time living in country and perceived quality of life. In addition, we tested if the latter two variables moderated the effect of culture of origin on depressive symptomology in the migrant groups.

SUBJECT AND METHODS

A telephone survey of a probability-based sample of 2,520 participants was conducted in February 2016. The sample was divided into three groups based on nationality and income: labour migrants (LMs), white-collar migrants (WCMs) and non-migrants or Qatari nationals (QNs). Participants completed the Whooley two-question test for depression.

RESULTS

The odds of depression were significantly increased in LMs (OR = 3.31, 95% CI = 2.36-4.65) and WCMs (OR = 1.40, 95% CI = 1.04-1.90) compared with non-migrants. Among LMs, having a problem with current employer in the last 3 months was also associated with depressive symptoms (OR = 2.10, 95% CI = 1.14-3.84). Culture of origin was significantly associated with depressive symptoms including South Asians (OR = 3.12, p < .001), East Asians (OR = 0.52, p = .013) and Westerners (OR = 0.45, p = .044) relative to Arabs. LM status remained strongly associated with depressive symptoms independent of culture of origin (OR = 2.02, p < .001).

CONCLUSION

Perceived quality of life, but not length of stay, appears to be an important variable in explaining differences in symptoms between some cultural groups. Findings from this study highlight the importance of the context of migration and culture of origin as potential determinants of depressive symptomology in the host country.

Improved mood despite worsening physical health in older adults: Findings from the International Mobility in Aging Study (IMIAS)

Objectives

Older adults experience increasing physical illness with age, but paradoxically, they frequently describe improvements in mood and self-rated health. The role of declining physical health as a risk for depression in elderly men and women remains unclear. We assessed whether declining physical health predicted changes in depression over time among seniors using data from the International Mobility in Aging Study (IMIAS).

Methods

IMIAS is a longitudinal population-based study of older adults in Canada, Colombia, and Brazil. We assessed change in depression by comparing Center for Epidemiology–Depression (CES-D) scores for 1161 men and women between 2012 and 2016, and used multiple regression to identify whether changes in chronic health conditions, grip strength and self-rated health predicted change in depression over time.

Results

Despite worsening physical health measured as chronic health conditions and grip strength, mean CES-D scores decreased from 8.15 (95% CI 7.70–8.60) in 2012 to 7.15 (95% CI 6.75 to 7.56) in 2016. Counterintuitively, women reported increased self-rated health despite having declining physical health, p = 0.004. Decreases in depressive symptoms were aligned with higher CES-D in 2012 and with increases in self-rated health among women and overall, and with high CES-D 2012 and increases in chronic health conditions in men, ps < 0.05.

Conclusions

Mental health appears to be a fundamentally different construct than physical health in older adults, allowing seniors to experience improved mood despite declining physical health. Clinicians should not consider depression in elderly populations as an inevitability of aging.

Religiosity and Meditation Practice: Exploring Their Explanatory Power on Psychological Adjustment

There has been increased interest in the relationships between religiosity, meditation practice and well-being, but there is lack of understanding as to how specific religious components and distinct meditation practices could influence different positive and negative psychological adjustment outcomes. The aim of this study was to assess the explanatory power of religious beliefs and the practice of prayer, focused attention (FA), open monitoring (OM), and compassion meditation (CM) on psychological adjustment, taking into consideration a number of practice-related variables such as session length, frequency of practice and lifetime practice. Psychological adjustment was assessed by means of happiness, positive affect, depression, negative affect, and emotional overproduction. A cross-sectional design was used, with a final sample comprising 210 Spanish participants who completed an online assessment protocol. Hierarchical regressions were performed, including age, sex and psychotropic medication use in the first step as possible confounders, with the addition of religious beliefs and the practice of prayer, FA, OM, and CM in the second step. FA session length was related to all psychological adjustment outcomes: happiness (ΔR 2 = 0.09, p = 0.002; β = 0.25, p = 0.001), positive affect (ΔR 2 = 0.09, p = 0.002; β = 0.18, p = 0.014), depression (ΔR2 = 0.07, p = 0.004; β = -0.27, p < 0.001), negative affect (ΔR 2 = 0.08, p = 0.007; β = -0.27, p < 0.001) and emotional overproduction (ΔR 2 = 0.07, p = 0.013; β = -0.23, p = 0.001). CM session length was related to positive affect (β = 0.18, p = 0.011). CM practice frequency was associated with happiness (ΔR 2 = 0.06, p = 0.038; β = 0.16, p = 0.041). Lifetime practice of FA was related to happiness (ΔR 2 = 0.08, p = 0.007; β = 0.21, p = 0.030) and OM to emotional overproduction (ΔR 2 = 0.08, p = 0.037; β = -0.19, p = 0.047). Religious beliefs and prayer seemed to be less relevant than meditation practices such as FA, OM, and CM in explaining psychological adjustment. The distinct meditation practices might be differentially related to distinct psychological adjustment outcomes through different practice-related variables. However, research into other forms of institutional religiosity integrating social aspects of religion is required.

Can Gender and Age Impact on Response Pattern of Depressive Symptoms Among College Students? A Differential Item Functioning Analysis

Background: Self-reported depressive complaints among college students might indicate different degrees of severity of depressive states. Through the framework of item response theory, we aim to describe the pattern of responses to items of the Beck Depression Inventory-II (BDI-II), in terms of endorsement probability and discrimination along the continuum of depression. Potential differential item functioning of the scale items of the BDI-II is investigated, by gender and age, to compare across sub-groups of students. Methods: The 21-item BDI-II was cross-sectionally administered to a representative sample of 12,677 Brazilian college students. Reliability was evaluated based on Cronbach's alpha coefficient. Severity (b _i ) and discrimination (a) parameters of each BDI-II items were calculated through the graded response model. The influence of gender and age were tested for differential item functioning (DIF) within the item response theory-based approach. Results: The BDI-II presented good reliability (α = 0.91). Women and younger students significantly presented a higher likelihood of depression (cut-off > 13) than men and older counterparts. In general, participants endorsed more easily cognitive-somatic items than affective items of the scale. "Guilty feelings," "suicidal thoughts," and "loss of interest in sex" were the items that most likely indicated depression severity (b ≥ 3.60). However, all BDI-II items showed moderate-to-high discrimination (a ≥ 1.32) for depressive state. While two items were flagged for DIF, "crying" and "loss of interest in sex," respectively for gender and age, the global weight of these items on the total score was negligible. Conclusions: Although respondents' gender and age might present influence on response pattern of depressive symptoms, the measures of self-reported symptoms have not inflated severity scores. These findings provide further support to the validity of using BDI-II for assessing depression in academic contexts and highlight the value of considering gender- and age-related common symptoms of depression.

The Predictive Value of Personality Traits for Psychological Problems (Stress, Anxiety and Depression): Results from a Large Population Based Study

The current study aimed to determine the prognostic values of personality traits for common psychological problems in a large sample of Iranian adult. In a large sample of healthy people (n = 4763) who lived in Isfahan province; the NEO-FFI was used to assess the personality traits; depression and anxiety were assessed using the "Hospital Anxiety and Depression Scale (HADS)" also stress was measured through Persian validated version of General Health Questionnaire (GHQ-12). Receiver Operating Characteristics Curve (ROC) analysis was used as main statistical method for data analysis. ROC analysis showed neuroticism was the best predictor for all psychological problems with highest area under the curve (AUC) (95% confidence interval) for stress, 0.837 (0.837-0.851), anxiety 0.861 (0.847-0.876) and depression 0.833 (0.820-0.846) (p < .001) and the corresponding cut-off points (sensitivity, specificity), were 21.5 (77%, 66%), 22.5 (81%, 77%) and 20.5 (77%, 74%), respectively. Other personality traits were significant protective factors for being affected with psychological problems (p < .001). Similar findings were observed separately in women and men. The present study showed that the neuroticism is significant risk factor for being affected with three psychological problems while other traits are significant protective factors. Personality traits are useful indices for screening psychological problems and an effective pathway toward prevention in general population.

Childhood maltreatment and perceived stress in young adults: The role of emotion regulation strategies, self-efficacy, and resilience

Childhood maltreatment has many deleterious outcomes; however, trait resilience as well as emotion regulation strategies, including suppression and reappraisal, may mediate between childhood maltreatment and later perceived stress. For this study, 267 college students (183 females and 84 males; M age = 19.77, SD = 2.29) completed self-report measures of parental psychological and physical maltreatment, parental emotion neglect, habitual use of suppression and reappraisal strategies, emotion regulation self-efficacy, trait resilience, and recent perceived stress. Analyses were conducted to investigate gender-specific associations. In females, both suppression and reappraisal mediated the relationship between maternal/paternal emotional neglect and perceived stress, and suppression also mediated the relationship between maternal psychological maltreatment and perceived stress. Trait resilience mediated the relationships of all three types of maternal maltreatment, paternal psychological maltreatment, and paternal emotional neglect with perceived stress in females. There were no significant mediation effects in males. Thus, interventions aiming at reducing perceived stress associated with maternal or paternal emotional neglect or maternal psychological maltreatment in women may benefit from targeting both suppression and reappraisal. Such interventions may also be enhanced by efforts to strengthen trait resilience.

Psychosocial determinants of depression in the community of the elderly with cardiovascular disease

The co-morbidity of cardiovascular disease (CVD) and depression is quite frequent in old people, and some potential biological and behavioural mechanisms linking them have been reported. Yet the impact of psychosocial factors on depression in the elderly with CVD remains unclear. This study aimed to analyze the psychosocial determinants of depression in the elderly with CVD. Using the Geriatric Mental Status-Automated Geriatric Examination for Computer Assisted Taxonomy, a community-based household survey was performed in 2,199 elderly people from the Anhui cohort third-wave survey from 2007 to 2009 and an extended study in Hubei from 2010 to 2011. Multiple logistic regression analyses were employed to assess the influence of psychosocial factors on depression. Among them, the prevalence of depression was 4.77%. Three factors were associated with depression in elderly in the community: self-assessed physical health status, anything else severely upsetting and unpleasantness with relatives, friends, or neighbors. In particular, associations of psychosocial factors with depression were more evident in individuals with CVD. This study confirms several psychosocial determinants of depression and the impact of CVD on the associations among the elderly, which provides some clues for interventional strategies of late-life depression.

Unmet needs in the depressed primary care elderly and their relation to severity of depression: results from the AgeMooDe study

OBJECTIVES

This study aims at examining the distribution of unmet environmental, physical, social and psychological care needs in a sample of the oldest old primary care patients with different levels of depression severity. Furthermore, the objective of this study was to analyze the association between specific unmet care needs and severity of depression.

METHOD

The sample of patients aged 75 years (n = 202) and more was derived from the multicenter prospective cohort study AgeMooDe ('Late-life depression in primary care: Needs, health care utilization and costs'). Patients were assessed via structured clinical interviews containing the German version of the Camberwell Assessment of Need for the Elderly (CANE) and the German Hospital Anxiety and Depression Scale (HADS-D). Descriptive statistics, Spearman correlation coefficients and binary logistic regression analyses were computed.

RESULTS

Unmet needs appeared to be substantially higher in the patient group with higher levels of depression severity according to the HADS-D score. Overall, there was weak positive linear correlation between depression and CANE total unmet needs. Except of the physical unmet needs category, all other CANE care categories showed little to moderate positive linear correlations with depression according to the HADS-D score. Depression and psychological unmet needs showed the strongest of all correlations, followed by social unmet needs. The binary logistic regression analysis revealed that patients having psychological unmet needs were 4.8 times more likely diagnosed with a probable depression.

CONCLUSION

Systematic needs assessment, especially psychological needs, may play a crucial role in the course of prevention and effective treatment of late-life depression in the primary care context.

Social support in the general population: standardization of the Oslo social support scale (OSSS-3)

BACKGROUND

The objectives of the study were to generate normative data for the Oslo Social Support Scale (OSSS-3) for different age groups for men and women and to further investigate the factor structure in the general population.

METHODS

Nationally representative face-to face household surveys were conducted in Germany in 2008 (n = 2524).

RESULTS

Normative data for the Oslo Social Support Scale were generated for men and women (52.3% female) and different age levels (mean age (SD) of 48.9 (18.3) years). Men had mean scores comparable to women (10.1 [SD = 2.3] vs. 10.2 [SD = 2.2]). The EFA resulted in a clear one-factor solution for the OSSS-3.

CONCLUSIONS

The normative data provide a framework for the interpretation and comparisons of social support with other populations.

Exploration of 27 plasma immune markers: a cross-sectional comparison of 64 old psychiatric inpatients having unipolar major depression and 18 non-depressed old persons

BACKGROUND

The prevalence of major depression (MD) according to population studies is the same for old (65 years and older) and younger adults. In contrast, an elevated proportion of old MD patients are hospitalized compared to younger adults with MD, indicating a need to expand the characteristics of old inpatients with MD. To illustrate this point, the association between inflammation and MD in old psychiatric inpatients is sparsely investigated even though an association between inflammation and treatment resistance among younger adults with MD has been reported. In this study, we aimed to explore the plasma concentrations of 27 immune markers in old inpatients with MD, and our purpose was to expand the understanding of inflammatory mechanisms in these patients.

METHODS

Prior to electroconvulsive treatment of MD, we compared 64 inpatients with unipolar MD (mean age 75.2 years) and 18 non-depressed controls (mean age 78.0 years). Symptoms characterizing MD were assessed by the Hamilton Rating Scale of Depression (HRSD)-17, and the immune markers from peripheral blood plasma were analysed using multiplex assay technology. For statistical analysis of data, we used the independent samples median test, independent samples t-test, χ²-test, receiver operating characteristic curve analyses, stepwise discriminant analysis, and multivariate linear regression.

RESULTS

Twenty-two immune markers representing pro- and anti-inflammatory, adaptive and trophic signalling had higher concentrations in the inpatients compared to the controls. Only the four immune markers IL-1β, IL-5, IL-10 and IL-15 had concentrations below the lower detection limit in a considerable portion (above 20%) of the patient cases. A combination of the concentration in plasma of TNF, vascular endothelial growth factor (VEGF), IL-1β, IL-7 and monocyte chemotactic protein (MCP)-1, correctly classified 98.4% of the depressed patients and 83.3% of the non-depressed controls. Plasma concentration of TNF and VEGF were associated with the HRSD-17 scores (p = 0.017 and 0.005, respectively).

CONCLUSIONS

Our results indicate that several inflammatory mechanisms may be highly activated in old psychiatric inpatients with MD, and indicate that immune markers may contribute to a more comprehensive understanding of MD in old persons.

TRIAL REGISTRATION

NCT01559324 ClinicalTrials.gov.

Association Between Depression and Elder Abuse and the Mediation of Social Support: A Cross-Sectional Study of Elder Females in Mexico City

OBJECTIVE

We assessed the association between depression and elder abuse, and the mediation effect of social support among elder women in Mexico City.

METHOD

A total of 526 noninstitutionalized elder women, residing in Mexico City and attending public community centers were selected. Logistic regressions and structural equation models (SEM) were estimated.

RESULTS

One fifth of the elderly women were at risk of depression, one third suffered some type of abuse in the past 12 months, and 82% reported low social support. Logistic models confirmed that depression was statistically associated with elder abuse and vice versa (odds ratio [OR] = 1.97 and 1.96, respectively). In both models, social support significantly reduced the association between these variables leading to study these associations through SEM. This approach highlighted that social support buffers the association between depression and elder abuse.

DISCUSSION

Findings underline the relevance of programs and strategies targeted at increasing social support among urban older adults.

The bidirectional relationship between sleep duration and depression in community-dwelling middle-aged and elderly individuals: evidence from a longitudinal study

BACKGROUND

There are several studies that have focused on the relationship between sleep duration and depression, however, only a few prospective studies have centered on the bidirectional relationship between them. This four-year longitudinal study aimed to identify the association between sleep duration and depression in community-dwelling mid-age and elderly individuals.

METHODS

10,704 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included for baseline and four-year follow up. Of these individuals, 7866 and 2956 were used to identify the effects of sleep duration on onset and recurrent depression respectively. 4504 individuals with normal sleep duration at baseline were included to examine the effects of depression on changes of sleep time. The 10-item version of the Centre for Epidemiological Studies Depression scale (CESD-10) was used to access depressive symptoms, as well sleep duration was self-reported.

RESULTS

Participants with short sleep duration (<5 and 5-6 h) had a higher risk of depression onset (OR 1.69 [1.36-2.11], 1.48 [1.19-1.84]) and recurrent depression (OR 1.44 [1.12-1.86], 1.32 [1.00-1.74]) compared to participants with normal sleep durations (7-8 h). Long sleep durations (>9 h) had no significant risks for depression. Males and the elderly (over 60 years-old) were more sensitive to short sleep durations and experienced a higher incidence of depression. Individuals with depression were more likely to have short sleep durations instead of long ones (RRR 1.20 [1.02-1.43]).

CONCLUSIONS

The present study identified the bidirectional relationship between sleep duration and depression. Short sleep durations were a risk factor for the onset and recurrent depression. Conversely, depression induced short sleep durations rather than excessive sleep durations. Future studies need to focus on identifying the mechanism between sleep duration and depression, and develop additional evidence-based cost-effective interventions to prevent depression and sleep problems.

Social capital, socioeconomic status, and depression in community-living elderly

A growing body of evidence has suggested that social capital is an upstream social determinant of mental health. We investigated the association of cognitive social capital, including interpersonal trust and reciprocity, with depressive symptoms in the elderly. We also explored the mediating role of cognitive social capital in the association between socioeconomic status (SES) and depressive symptoms and the moderating effect of SES on the relationship between social capital and depressive symptoms. Data from the 2012 Korea Welfare Panel Study (KOWEPS) was analyzed for 5969 participants aged 60 years or older. Cognitive components of social capital, including interpersonal trust and reciprocity, were evaluated using single-item questionnaires. Socioeconomic and health-related characteristics were investigated and depressive symptoms were evaluated by an 11-item version of the Center for Epidemiologic Studies Depression Scale. Low interpersonal trust and reciprocity levels were significantly associated with depressive symptoms in the elderly. Reciprocity level mediated the association between household income level and depressive symptoms. We did not observe any significant moderating effect of SES on the association between cognitive social capital and depressive symptoms. A significant association between cognitive social capital and depressive symptoms in Korean elderly was found. We elucidated how SES interacted with depressive symptoms through the mediation pathway of cognitive social capital using a representative sample of the Korean elderly population.

Quality of life and psychological symptoms in patients with pulmonary hypertension

BACKGROUND

Pulmonary arterial hypertension (PAH) has a delay in diagnosis that makes time since diagnosis of interest in this population.

OBJECTIVES

To assess psychological conditions, perceived stress, QOL, and interpersonal support and to explore whether these factors may correlate with time since diagnosis in patients with PAH.

METHODS

Participants at an academic medical center (n = 108) completed psychological questionnaires (Cambridge Pulmonary Hypertension Outcome Review, Patient Health Questionnaire-9, Perceived Stress Scale-10, and Interpersonal Support Evaluation List-Short Form).

RESULTS

Prevalence of psychiatric disorder, major depression, and "other depressive disorder" were 29.6%, 15.7%, and 9.3%, respectively. Participants reported adequate social support, high perceived stress, and average quality of life. Time since diagnosis was positively associated with greater perceived social support (ρ = 0.174, p = .075) and greater perceived stress (ρ = 0.191, p = .048), but no other psychological factor.

CONCLUSIONS

Routine psychological assessment and timely referral for mental health services are suggested. Social support may buffer patients from stress.

Prevalence and predictors of depression, pain, and fatigue in older- versus younger-adult cancer survivors

BACKGROUND

As the number of older adults in the United States continues to grow, there will be increasing demands on health care providers to address the needs of this population. Cancer is of particular importance, with over half of all cancer survivors older than 65 years. In addition, depression, pain, and fatigue are concerns for older adults with cancer and have been linked to poorer physical outcomes.

METHODS

For this retrospective chart review, 1012 eligible participants were identified via a query of the Electronic Medical Record for all patients referred to 1 of 4 Survivorship Clinics at Memorial Sloan Kettering Cancer Center. All patients were between the ages of 30 to 55 (younger adults) and >65 (older adults). Depression was measured using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

The overall rate of depression in this sample of adult cancer survivors was 9.3%. There were no differences in the rates of clinically significant depression (defined as PHQ-9 score ≥10) between younger and older adult cohorts. However, there was a small trend toward higher mean PHQ-9 scores in the younger adult cohort (3.42 vs 2.95; t = 1.763, P = .10). Women reported greater rates of depression and higher pain and fatigue scores. Hispanic/Latino patients also reported significantly greater rates of depression.

CONCLUSION

There were no observed differences in depression between older and younger adult cancer survivors. Gender and ethnic discrepancies in depression were observed. Future research should focus on understanding the nature of these differences and targeting interventions for the groups most vulnerable to depression after cancer treatment.

Increased estrogen level can be associated with depression in males

BACKGROUND

Several studies have shown a positive association between depression and obesity; however the underlying mechanisms are not fully understood. It is not known if this association is driven by altered sex hormone levels in men due to increased BMI.

PATIENTS AND METHODS

Data were obtained from the LIFE-Adult-Study, a population-based cohort study. A total of 3925 men (2244<60years and 1681>60years) were included into analyses. Associations between BMI, sex hormones and depressive symptomatology according to CES-D score were evaluated.

RESULTS

Obese men had compared to normal weight controls lower total testosterone (12.6±4.7 vs 19.4±5.5 nmol/L, p<0.001 in <60years, and 13.8±6.9 vs 18.3±5.9 nmol/L, p<0.001 in >60years group) and free testosterone (249.0±73.9 vs 337.2±82.0pmol/L, p<0.001, and 217.8±71.2 vs 263.4±72.2pmol/L, p<0.001), and increased estradiol in older group only (97.3±43.0 vs 82.3±34.2pmol/L, p<0.001 in obese). Men <60years old with depressive symptomatology had higher estradiol levels compared to those without depressive symptomatology (96.3±40.7 vs 84.4±36.6pmol/L, p<0.001), however no association with BMI was observed.

CONCLUSIONS

Selected sex hormone parameters were significantly different in overweight and obese compared to normal weight males and certain differences could be seen between younger and older males. Depressive symptomatology was associated with increased estradiol levels in younger men, regardless of BMI.

Syndemics of Severity and Frequency of Elder Abuse: A Cross-Sectional Study in Mexican Older Females

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency. Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships. Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had happened few or many times) correlate among them. For each of these measures we estimated a multinomial model to examine associations with social support, functional impairments, socioeconomic status, food insecurity, depression, and comorbidities, while controlling for key socio-demographic variables. Results: 30.5% of the older women reported psychological abuse, 8.2% financial exploitation, 5.1% caregiver neglect, 3.5% physical abuse, and 1.2% sexual abuse. In terms of frequency, 77.8% of the women self-reported having never been abused or only once in the last 12 months, whereas 13.1% reported abusive experiences repeating few times, and 9.9% repeating many times. In terms of severity, 66.7% of the older women had not been abused, 22.3% had suffered one type of abuse, and 11.1% two or more. Similarly, 15.0% reported one abusive experience, 8.1% two, and 10.3% three or more abusive events during the last 12 months. Severity measures showed similar associations: social support and high socioeconomic level as protective factors among those with less severe abuse, whereas increased depression, food insecurity and functional impairments were associated with more severe experiences of elder abuse. Frequency followed a different pattern, depressive symptoms were significantly associated with those with few experiences (compared to those with none or once), while functional impairments were associated with many experiences of elder abuse. Conclusions: It is relevant to assess elder abuse through its severity and frequency as inter-individual variability and the complexity of the experience shows different determinants suggesting a syndemic approach. This has important clinical and policy implications.

The Gender Difference in Depression: Are Elderly Women at Greater Risk for Depression Than Elderly Men?

Numerous epidemiological reports have found that adolescent, young adult, and middle-aged adult girls and women are more likely to be diagnosed with unipolar depression and report greater symptoms of depression when compared to boys and men of similar ages. What is less well-known is whether this gender difference persists into late life. This literature review examines whether the well-known gender difference in unipolar depression continues into old age, and, if it does, whether the variables that are known to contribute to the gender difference in unipolar depression from adolescence through adulthood continue to contribute to the gender difference in the elderly, and/or whether there are new variables that arise in old age and contribute to the gender difference in the elderly. In this review of 85 empirical studies from every continent except for Antarctica, we find substantial support for the gender difference in depression in individuals who are 60 and older. More research is necessary to determine which factors are the strongest predictors of the gender difference in depression in late life, and particularly whether the factors that seem to be responsible for the gender difference in depression in earlier life stages continue to predict the gender difference in the elderly, and/or whether new factors come into play in late life. Longitudinal research, meta-analyses, and model-based investigations of predictors of the gender difference in depression are needed to provide insights into how and why the gender difference in depression persists in older age.