Mental health trajectories among women in Australia as they age

Bidirectional, longitudinal associations between depressive symptoms and IADL/ADL disability in older adults in China: a national cohort study

INTRODUCTION

Based on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability.

METHODS

Data were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves.

RESULTS

Data on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08-0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09-0.10).

DISCUSSION

Study findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression.

Social Mobility and Health-Related Quality of Life Trajectory Classes Among Older Women and Men

OBJECTIVES

Changes in socioeconomic status (SES) during life may impact health in old age. We investigated whether social mobility and childhood and adulthood SES are associated with trajectories of health-related quality of life (HrQoL) over a 17-year period.

METHODS

We used data from the Helsinki Birth Cohort Study (n = 2003, 46% men, mean age 61.5 years). Social mobility was derived from childhood SES, obtained from healthcare records, and register-based adulthood SES.

RESULTS

Logistic regression models showed that lower adulthood SES was associated with lower physical HrQoL trajectories. Among men low (OR 3.95, p < .001), middle (OR 2.20, p = .006), and declining lifetime SES (OR 2.41, p = .001) were associated with lower physical HrQoL trajectories compared to men with high SES. Socioeconomic status was not associated with mental HrQoL trajectories.

DISCUSSION

Declining SES during life course may have negative health consequences, while improving SES is potentially as beneficial as high SES to later-life health among men.

Pre-pandemic trajectories of depressive symptomatology and their relation to depression during the COVID-19 pandemic: longitudinal study of English older people

BACKGROUND

Although the COVID-19 pandemic has affected depression, evidence of the role of pre-pandemic history of depression remains limited.

AIMS

We investigated how long-term trajectories of depressive symptomatology before the COVID-19 pandemic were related to depression during the pandemic, over and above the latest pre-pandemic depression status. Furthermore, we examined whether those experiencing depression closer to the pandemic were at higher risk during the pandemic.

METHOD

Employing data from waves 4-9 of the English Longitudinal Study of Ageing (2008-2009 to 2018-2019), we used group-based trajectory modelling on 3925 English older adults aged 50+ years to identify distinctive trajectories of elevated depressive symptoms (EDS). Fully adjusted logistic models were then used to examine the associations between trajectories and depression during the COVID-19 pandemic (June-July and November-December 2020).

RESULTS

We identified four classes of pre-pandemic trajectories of EDS. About 5% were classed as 'enduring EDS', 8% as 'increasing EDS', 10% as 'decreasing EDS' and 77% as 'absence of EDS'. Compared with respondents with absence of EDS, those with EDS history were more likely to have depression during the COVID-19 pandemic, particularly those with enduring or increasing EDS in the previous 10 years. Moreover, the frequency of EDS was more crucial in predicting the risks of depression during the pandemic than the timing of the latest episode.

CONCLUSIONS

Trajectories of depressive symptomatology are an important risk factor for older adults' mental health, particularly in the context of crisis. Older people with enduring or increasing EDS should receive particular attention from policy makers when provisioning post-pandemic well-being support.

Does psychological distress directly increase risk of incident cardiovascular disease? Evidence from a prospective cohort study using a longer-term measure of distress

OBJECTIVE

Cardiovascular disease (CVD) incidence is elevated among people with psychological distress. However, whether the relationship is causal is unclear, partly due to methodological limitations, including limited evidence relating to longer-term rather than single time-point measures of distress. We compared CVD relative risks for psychological distress using single time-point and multi-time-point assessments using data from a large-scale cohort study.

DESIGN

We used questionnaire data, with data collection at two time-points (time 1: between 2006 and 2009; time 2: between 2010 and 2015), from CVD-free and cancer-free 45 and Up Study participants, linked to hospitalisation and death records. The follow-up period began at time 2 and ended on 30 November 2017. Psychological distress was measured at both time-points using Kessler 10 (K10), allowing assessment of single time-point (at time 2: high (K10 score: 22-50) vs low (K10 score: <12)) and multi-time-point (high distress (K10 score: 22-50) at both time-points vs low distress (K10 score: <12) at both time-points) measures of distress. Cox regression quantified the association between distress and major CVD, with and without adjustment for sociodemographic and health-related characteristics, including functional limitations.

RESULTS

Among 83 906 respondents, 7350 CVD events occurred over 410 719 follow-up person-years (rate: 17.9 per 1000 person-years). Age-adjusted and sex-adjusted rates of major CVD were elevated by 50%-60% among those with high versus low distress for both the multi-time-point (HR=1.63, 95% CI 1.40 to 1.90) and single time-point (HR=1.53, 95% CI 1.39 to 1.69) assessments. HRs for both measures of distress attenuated with adjustment for sociodemographic and health-related characteristics, and there was little evidence of an association when functional limitations were taken into account (multi-time-point HR=1.09, 95% CI 0.93 to 1.27; single time-point HR=1.14, 95% CI 1.02 to 1.26).

CONCLUSION

Irrespective of whether a single time-point or multi-time-point measure is used, the distress-CVD relationship is substantively explained by sociodemographic characteristics and pre-existing physical health-related factors.

Promoting older women's mental health: Insights from Baby Boomers

Optimal mental health underpins full social participation. As people age, they confront personal and cultural challenges, the effects of which on mental health are not fully understood. The aim of this research was to learn from women of the Baby Boomer generation (born 1946–1964) what contributes to and hinders their mental health and wellbeing. Eighteen women participated in qualitative interviews (in English); data were analysed thematically. Participants were located across Australia in rural and urban areas; not all were born in Australia. They were diverse in education, employment status, and experiences of life and ageing. The women nominated as the main contributors to poor mental health in older women Illness and disability, Financial insecurity, Maltreatment, and Loss and grief. Contributors to good mental health were identified as Social interdependence, Feeling valued, Physical activity, Good nutrition, and Having faith or belief. Women’s accounts supplied other influences on mental health, both associated with the person (Personality and Intimate relationships and sex) and with society (Constructs of ageing, Gender, and Culture). Women also specified what they needed from others in order to improve their mental health as they aged: Public education about ageing, Purposeful roles for older women in society, Adequate services and resources, and Sensitive health care. In sum, older women wanted to be treated with respect and for their lives to have meaning. It is evident from these results that circumstances throughout life can have profound influences on women’s mental health in older age. Anti-discriminatory policies, informed and inclusive health care, and social structures that support and enhance the lives of girls and women at all ages will therefore benefit older women and increase the potential for their continuing contribution to society. These conclusions have implications for policy and practice in well-resourced countries.