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Liu T, Wang L, Zhu Z, Wang B, Lu Z, Pan Y, Sun L. Association of both depressive symptoms scores and specific depressive symptoms with all-cause and cardiovascular disease mortality. Ann Gen Psychiatry 2024; 23:25. [PMID: 39010080 PMCID: PMC11250981 DOI: 10.1186/s12991-024-00509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The presence of depression related to an increased risk of all-cause and cardiovascular disease (CVD) mortality has been reported. However, studies conducted on certain specific depressive symptoms are scarce. Our purpose was to assess the effect of both depressive symptoms scores and certain specific depressive symptoms on all-cause and CVD mortality. METHODS In the present cohort study, all participants, aged 18 years or older, were enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. Depressive symptoms score was assessed using the validated 9-item Patient Health Questionnaire Depression Scale (PHQ-9), which ranges from 0 to 27, with a PHQ-9 score ≥ 10 diagnosed as depression. The outcome events were all-cause and CVD mortality, which were followed up from 2005 to 2014. The associations of both depressive symptoms score and certain specific depressive symptoms with all-cause and CVD mortality were examined by weighted multivariable proportional hazards models. RESULTS A total of 26,028 participants aged ≥ 18 years were included in the statistical analysis, including 12,813 (49.2%) males and 13,215 (50.8%) females, with a mean (SD) age of 47.34 (18.86) years. During the 9.32 (3.20) years of mean (SD) follow-up, 3261 deaths were recorded, of which 826 were cardiovascular deaths. All-cause mortality was 16.87/1000 person-years in subjects with depression. In terms of CVD mortality, these figures were 4.53/1000 person-years. In the full model (model 3), elevated depressive symptoms scores were independently associated with an increased risk of all-cause mortality (Highest depression symptom score group: adjusted hazard ratio, 1.63; 95% CI 1.44-1.85) and CVD mortality (Highest depression symptom score group: adjusted hazard ratio, 1.73; 95% CI 1.34-2.24). All 9 specific depressive symptoms that make up the PHQ-9 were related to an increased risk of all-cause mortality. However, only 3 symptoms, including trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation, were no significantly associated with an increased risk of CVD mortality. CONCLUSIONS The elevated depressive symptoms scores were strongly associated with an increased risk of all-cause and CVD mortality in US adults. Furthermore, all 9 specific depressive symptoms were associated with high all-cause mortality. However, trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation might not increase the risk of CVD mortality.
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Affiliation(s)
- Tao Liu
- Department of Cardiology, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Lili Wang
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhijian Zhu
- Department of Cardiology, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Bing Wang
- Department of Cardiology, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yesheng Pan
- Department of Cardiology, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China.
| | - Lifang Sun
- Department of Cardiology, Jinshan District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
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Csukly G, Tombor L, Hidasi Z, Csibri E, Fullajtár M, Huszár Z, Koszovácz V, Lányi O, Vass E, Koleszár B, Kóbor I, Farkas K, Rosenfeld V, Berente DB, Bolla G, Kiss M, Kamondi A, Horvath AA. Low Functional network integrity in cognitively unimpaired and MCI subjects with depressive symptoms: results from a multi-center fMRI study. Transl Psychiatry 2024; 14:179. [PMID: 38580625 PMCID: PMC10997664 DOI: 10.1038/s41398-024-02891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024] Open
Abstract
Evidence suggests that depressive symptomatology is a consequence of network dysfunction rather than lesion pathology. We studied whole-brain functional connectivity using a Minimum Spanning Tree as a graph-theoretical approach. Furthermore, we examined functional connectivity in the Default Mode Network, the Frontolimbic Network (FLN), the Salience Network, and the Cognitive Control Network. All 183 elderly subjects underwent a comprehensive neuropsychological evaluation and a 3 Tesla brain MRI scan. To assess the potential presence of depressive symptoms, the 13-item version of the Beck Depression Inventory (BDI) or the Geriatric Depression Scale (GDS) was utilized. Participants were assigned into three groups based on their cognitive status: amnestic mild cognitive impairment (MCI), non-amnestic MCI, and healthy controls. Regarding affective symptoms, subjects were categorized into depressed and non-depressed groups. An increased mean eccentricity and network diameter were found in patients with depressive symptoms relative to non-depressed ones, and both measures showed correlations with depressive symptom severity. In patients with depressive symptoms, a functional hypoconnectivity was detected between the Anterior Cingulate Cortex (ACC) and the right amygdala in the FLN, which impairment correlated with depressive symptom severity. While no structural difference was found in subjects with depressive symptoms, the volume of the hippocampus and the thickness of the precuneus and the entorhinal cortex were decreased in subjects with MCI, especially in amnestic MCI. The increase in eccentricity and diameter indicates a more path-like functional network configuration that may lead to an impaired functional integration in depression, a possible cause of depressive symptomatology in the elderly.
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Affiliation(s)
- Gabor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
- Neurocognitive Research Center, Budapest, National Institute of Mental Health, Neurology, and Neurosurgery, Budapest, Hungary.
| | - László Tombor
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zoltan Hidasi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Eva Csibri
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Máté Fullajtár
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zsolt Huszár
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Vanda Koszovácz
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Orsolya Lányi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Edit Vass
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Boróka Koleszár
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - István Kóbor
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Katalin Farkas
- Neurocognitive Research Center, Budapest, National Institute of Mental Health, Neurology, and Neurosurgery, Budapest, Hungary
| | - Viktoria Rosenfeld
- Neurocognitive Research Center, Budapest, National Institute of Mental Health, Neurology, and Neurosurgery, Budapest, Hungary
| | - Dalida Borbála Berente
- Neurocognitive Research Center, Budapest, National Institute of Mental Health, Neurology, and Neurosurgery, Budapest, Hungary
| | - Gergo Bolla
- Neurocognitive Research Center, Budapest, National Institute of Mental Health, Neurology, and Neurosurgery, Budapest, Hungary
- Department of Measurement and Information Systems, University of Technology and Economics, Budapest, Hungary
| | - Mate Kiss
- Siemens Healthcare, Budapest, Hungary
| | - Anita Kamondi
- Neurocognitive Research Center, Budapest, National Institute of Mental Health, Neurology, and Neurosurgery, Budapest, Hungary
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Andras Attila Horvath
- Neurocognitive Research Center, Budapest, National Institute of Mental Health, Neurology, and Neurosurgery, Budapest, Hungary
- Department of Anatomy Histology and Embryology, Semmelweis University, Budapest, Hungary
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Hannon K, Bijsterbosch J. Challenges in Identifying Individualized Brain Biomarkers of Late Life Depression. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 5:e230010. [PMID: 38348374 PMCID: PMC10861244 DOI: 10.20900/agmr20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Research into neuroimaging biomarkers for Late Life Depression (LLD) has identified neural correlates of LLD including increased white matter hyperintensities and reduced hippocampal volume. However, studies into neuroimaging biomarkers for LLD largely fail to converge. This lack of replicability is potentially due to challenges linked to construct variability, etiological heterogeneity, and experimental rigor. We discuss suggestions to help address these challenges, including improved construct standardization, increased sample sizes, multimodal approaches to parse heterogeneity, and the use of individualized analytical models.
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Affiliation(s)
- Kayla Hannon
- Department of Radiology, Washington University in St Louis, St Louis MO, 63110, USA
| | - Janine Bijsterbosch
- Department of Radiology, Washington University in St Louis, St Louis MO, 63110, USA
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Borim FSA, Assumpção DD, Yassuda MS, Costa HTDM, Batistoni SST, Neri AL, Voshaar RCO, Aprahamian I. Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty. EINSTEIN-SAO PAULO 2023; 21:eAO0284. [PMID: 38126546 DOI: 10.31744/einstein_journal/2023ao0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly. OBJECTIVE To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. METHODS Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. RESULTS Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. CONCLUSION The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.
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Affiliation(s)
- Flávia Silva Arbex Borim
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Daniela de Assumpção
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Mônica Sanches Yassuda
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Henrique Trajano de Moraes Costa
- Group of Investigation on Multimorbidity and Mental Health in Aging, Department of Internal Medicine, Faculdade de Medicina de Jundiaí, São Paulo, SP, Brazil
| | - Samila Sathler Tavares Batistoni
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anita Liberalesso Neri
- Programa de pós-graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, Groningen, The Netherlands
| | - Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging, Department of Internal Medicine, Faculdade de Medicina de Jundiaí, São Paulo, SP, Brazil
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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Oude Voshaar RC. The 'discontinuity hypothesis' of depression in later life-clinical and research implications. Age Ageing 2023; 52:afad239. [PMID: 38156879 PMCID: PMC10756079 DOI: 10.1093/ageing/afad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/08/2023] [Indexed: 01/03/2024] Open
Abstract
The term depression is overused as an umbrella term for a variety of conditions, including depressed mood and various psychiatric disorders. According to psychiatric diagnostic criteria, depressive disorders impact nearly all aspects of human life and are a leading cause of disability worldwide. The widespread assumption that different types of depression lie on a continuum of severity has stimulated important research on subthreshold depression in later life. This view assumes that depressed mood is a precursor of a depressive disorder. The present narrative review argues why in later life depressed mood might either (i) lie on a continuum with depressive disorders among people vulnerable for a depressive disorder or (ii) be an ageing-related epiphenomenon of underlying physical illnesses in people who are resilient to depressive disorders ('discontinuity hypothesis'). Three arguments are discussed. First, the course of depressed mood and depressive disorders differs across the life span. Second, screening instruments for depression have low predictive value for depressive disorders in later life. Third, a dose-response relationship has not been consistently found across different types of depression and detrimental health outcomes. Using the umbrella term depression may partly explain why pharmacological treatment is less effective with increasing age, and negative health-related outcomes might be overestimated. The discontinuity hypothesis may prevent pharmacological overtreatment of milder subtypes of depression and may stimulate comprehensive multidisciplinary assessment as well as the development of separate treatment algorithms for depressed mood and depressive disorders.
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Affiliation(s)
- Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherland
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6
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Zhang P, Liu X, Zhang R, Xia N. Depression mediates the relationship between social capital and health-related quality of life among Chinese older adults in the context of the COVID-19 pandemic: A cross-sectional study. Nurs Open 2023; 10:6517-6526. [PMID: 37400957 PMCID: PMC10416043 DOI: 10.1002/nop2.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/08/2023] [Accepted: 06/05/2023] [Indexed: 07/05/2023] Open
Abstract
AIM To explore the association between social capital and health-related quality of life (HRQoL) and to determine whether depression mediates the association among Chinese older adults in the context of the COVID-19 pandemic. DESIGN A descriptive cross-sectional research design. METHODS The Geriatric Depression Scale-15, Social Capital Questionnaire and 12-item Short-Form Health Survey were used to investigate 1201 older adults selected from Jinan, Shandong Province, China, using a multistage stratified cluster random sampling method. RESULTS Pearson's correlation analysis revealed a significant positive correlation between social capital and HRQoL (r = 0.269, p < 0.01). Multivariate linear regression analyses demonstrated that social capital was significantly negatively associated with depression (β = -0.072, p < 0.001) and that depression was associated with HRQoL (β = -1.031, p < 0.001). The mediation analyses showed that depression mediated the association between social capital and HRQoL, and the indirect effect size was 0.073 (95% confidence interval: 0.050, 0.100).
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Affiliation(s)
- Ping Zhang
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xiao‐Li Liu
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Rong‐Mei Zhang
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Ning Xia
- Department of Transplantation, Second Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
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7
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Janssen NP, Oude Voshaar RC, Wassink-Vossen S, Hendriks GJ. Functional improvement by behavioural activation for depressed older adults. Eur Psychiatry 2023; 66:e62. [PMID: 37496446 PMCID: PMC10594265 DOI: 10.1192/j.eurpsy.2023.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Recovery in mental health care comprises more than symptomatic improvement, but preliminary evidence suggests that only collaborative care may improve functioning of depressed older adults. This study therefore evaluates the effectiveness of behavioural activation (BA) on functional limitations in depressed older adults in primary care. METHODS This study uses data from a multicentre cluster randomised controlled trial in which 59 primary care centres (PCCs) were randomised to BA and treatment as usual (TAU), and 161 consenting older (≥65 years) adults with clinically relevant symptoms of depression participated. Interventions were an eight-week individual BA programme by a mental health nurse (MHN) and unrestricted TAU. The outcome was self-reported functional limitations (WHODAS 2.0) at post-treatment (9 weeks) and at 12-month follow-up. RESULTS At the end of treatment, the BA participants reported significantly fewer functional limitations than TAU participants (WHODAS 2.0 difference -3.62, p = 0.01, between-group effect size = 0.39; 95% CI = 0.09-0.69). This medium effect size decreases during follow-up resulting in a small and non-significant effect at the 12-month follow-up (WHODAS 2.0 difference = -2.22, p = 0.14, between-group effect size = 0.24; 95% CI = -0.08-0.56). MoCA score moderated these results, indicating that the between-group differences were merely driven by those with no cognitive impairment. CONCLUSIONS Compared to TAU, BA leads to a faster improvement of functional limitations in depressed older adults with no signs of cognitive decline. Replication of these findings in confirmatory research is needed.
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Affiliation(s)
- Noortje P. Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Richard C. Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sanne Wassink-Vossen
- Department of Old Age Psychiatry, GGNet Mental Health, Warnsveld, The Netherlands
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
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Janssen NP, Lucassen P, Huibers MJH, Ekers D, Broekman T, Bosmans JE, Van Marwijk H, Spijker J, Oude Voshaar R, Hendriks GJ. Behavioural Activation versus Treatment as Usual for Depressed Older Adults in Primary Care: A Pragmatic Cluster-Randomised Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:255-266. [PMID: 37385226 DOI: 10.1159/000531201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Effective non-pharmacological treatment options for depression in older adults are lacking. OBJECTIVE The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated. METHODS In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up. RESULTS Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p < 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24). CONCLUSIONS BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.
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Affiliation(s)
- Noortje P Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Marcus J H Huibers
- NPI Centre for Personality Disorders/Arkin Amsterdam, Amsterdam, The Netherlands
| | - David Ekers
- Mental Health and Addictions Research Group, Tees Esk and Wear Valleys NHS FT/University of York, York, UK
| | | | - Judith E Bosmans
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Richard Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
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Ho HE, Yeh CJ, Cheng-Chung Wei J, Chu WM, Lee MC. Association between multimorbidity patterns and incident depression among older adults in Taiwan: the role of social participation. BMC Geriatr 2023; 23:177. [PMID: 36973699 PMCID: PMC10045862 DOI: 10.1186/s12877-023-03868-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Previous research has found different multimorbidity patterns that negatively affects health outcomes of older adults. However, there is scarce evidence, especially on the role of social participation in the association between multimorbidity patterns and depression. Our study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan, including the social participation effect on the different multimorbidity patterns.
Methods
Data were retracted from the Taiwan longitudinal study on ageing (TLSA) for this population-based cohort study. 1,975 older adults (age > 50) were included and were followed up from 1996 to 2011. We used latent class analysis to determine participants’ multimorbidity patterns in 1996, whereas their incident depression was determined in 2011 by CES-D. Multivariable logistic regression was used to analyse the relationship between multimorbidity patterns and depression.
Results
The participants’ average age was 62.1 years in 1996. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis-cataract group (n = 105), (3) Multimorbidity group (n = 128) and (4) Relatively healthy group (n = 1649). Greater risk of incident depression was found among participants in the Multimorbidity group (OR: 1.62; 95% CI: 1.02–2.58) than the Relatively healthy group after the multivariable analysis. Compare to participants in the relatively healthy group with social participation, participants in the arthritis-cataract group without social participation (OR: 2.22, 95% CI: 1.03–4.78) and the multimorbidity group without social participation (OR: 2.21, 95% CI: 1.14–4.30) had significantly increased risk of having depression.
Conclusion
Distinct multimorbidity patterns among older adults in Taiwan are linked with the incident depression during later life, and social participation functioned as a protective factor.
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Merritt SH, Krouse M, Alogaily RS, Zak PJ. Continuous Neurophysiologic Data Accurately Predict Mood and Energy in the Elderly. Brain Sci 2022; 12:brainsci12091240. [PMID: 36138976 PMCID: PMC9497070 DOI: 10.3390/brainsci12091240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
The elderly have an elevated risk of clinical depression because of isolation from family and friends and a reticence to report their emotional states. The present study explored whether data from a commercial neuroscience platform could predict low mood and low energy in members of a retirement community. Neurophysiologic data were collected continuously for three weeks at 1Hz and averaged into hourly and daily measures, while mood and energy were captured with self-reports. Two neurophysiologic measures averaged over a day predicted low mood and low energy with 68% and 75% accuracy. Principal components analysis showed that neurologic variables were statistically associated with mood and energy two days in advance. Applying machine learning to hourly data classified low mood and low energy with 99% and 98% accuracy. Two-day lagged hourly neurophysiologic data predicted low mood and low energy with 98% and 96% accuracy. This study demonstrates that continuous measurement of neurophysiologic variables may be an effective way to reduce the incidence of mood disorders in vulnerable people by identifying when interventions are needed.
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11
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Cross-sectional associations of personal efforts and beliefs and depressive symptoms among older adults in India. Sci Rep 2022; 12:13194. [PMID: 35915137 PMCID: PMC9343383 DOI: 10.1038/s41598-022-17578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Whilst there is growing evidence on the increased vulnerability of older adults to depression, there is limited research on potentially mitigative factors against symptoms of depression at a population level. This research examined associations of possible protective factors (personal efforts and beliefs) and depressive symptoms among older adults in India. This cross-sectional study used data from the Longitudinal Aging Study in India with 31,464 respondents aged 60 years and above. Depressive symptoms were assessed using the 10-item Centre for Epidemiologic Studies Depression Scale. Multivariable linear regression was used while exploring the associated factors of depressive symptoms. The mean score of depressive symptoms was 2.94 (CI 2.92, 2.96). Older adults who engaged in moderate [aCoef: −0.11, CI −0.18, −0.05], vigorous [aCoef: −0.09, CI −0.16, −0.03], or both types of physical activity [aCoef: −0.10, CI −0.19, −0.02] had lower likelihood of depressive symptoms in comparison to those who were physically inactive. Older adults who participated in social activities were less likely to have depressive symptoms [aCoef: −0.44, CI −0.50, −0.39] compared to their socially inactive counterparts. Further, older adults who perceived religion as very important [aCoef: −0.29, CI −0.41, −0.17], who had high life satisfaction [aCoef: −0.78, CI −0.82, −0.73], who had good self-perceived health [aCoef: −0.29, CI −0.33, −0.25] and those who had high self-perceived social standing [aCoef: −0.39, CI −0.47, −0.31] had lower likelihood of depressive symptoms in comparison to their respective counterparts. Physical activity, social participation, voluntary work and financial contribution to family, religiosity, life satisfaction, self-perceived health and self-perceived social standing are associated with lower likelihood of depressive symptoms among community-dwelling older adults in this study. Future longitudinal studies should explore these factors that can guide interventions against depression in old age.
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Tsai SJ, Hsiao YH, Liao MY, Lee MC. The Influence of Depressive Mood on Mortality in Elderly with Different Health Status: Evidence from the Taiwan Longitudinal Study on Aging (TLSA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116922. [PMID: 35682505 PMCID: PMC9180873 DOI: 10.3390/ijerph19116922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
Depression and related syndromes are well identified in older adults. Depression has been reported to increase the incidence of a multitude of somatic disorders. In older adults, the severity of depression is associated with higher mortality rates. The aim of the study is to examine whether the effect of depression screening on mortality is different between individuals with different physical health status. In order to meet this aim, we will first reprove the relationship between depression and mortality rate, and then we will set a subgroup analysis by using self-reported health (SRH) status. Our data source, Taiwan Longitudinal Study on Aging (TLSA), is a population-based prospective cohort study that was initiated by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. The depression risk was evaluated by 10-items Center for Epidemiologic Studies Depression (CES-D-10), we set 3 CES-D-10 cutting points (5, 10, and 12) and cut our subjects into four groups. Taking mortality as an end point, we use the Taiwan National Death Registry (TNDR) record from 1999 to 2012. Self-rated health (SRH) was taken as an effect modifier between depression and mortality in the elderly group, and stratification took place into three groups (good, fair, poor). The case numbers of 4 CES-D-10 groups were 2253, 939, 285 and 522, respectively. After dividing into 4 CES-D-10 groups, the mortality prevalence rose as the CES-D-10 level grew (40.7%, 47.82%, 54.39% and 67.62%, respectively). In the subgroup analysis, although the p-value of log-rank test showed <0.05 in three groups, as the SRH got worse the Hazard Ratio became more significant (p = 0.122, 0.033, <0.001, respectively). Kaplan−Meier (K-M) survival estimates for different CES-D groups in SRH were poor, and we can see the curves representing second and third CES-D group going almost together, which may suggest the cutting point of CES-D-10 in predicting depression risk should be adjusted in the relatively unhealthy elderly. The importance of the relationship between depression and mortality is re-emphasized in our study. Moreover, through joining SRH in our analysis, we can conclude that in self-rated poor health any sign of depression may lead to a rise in mortality. Therefore, we should pay attention to the old age group’s psychological status, and remember that depressive mood should be scrutinized more carefully in the elderly who feel themselves to be unhealthy.
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Affiliation(s)
- Shen-Ju Tsai
- Department of Family Medicine, Everan Hospital, Taichung 411001, Taiwan;
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yu-Han Hsiao
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 403301, Taiwan; (Y.-H.H.); (M.-Y.L.)
- College of Management, Chaoyang University of Technology, Taichung 413310, Taiwan
- Department of Public Health, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Miao-Yu Liao
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 403301, Taiwan; (Y.-H.H.); (M.-Y.L.)
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 403301, Taiwan; (Y.-H.H.); (M.-Y.L.)
- College of Management, Chaoyang University of Technology, Taichung 413310, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 350401, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
- Correspondence:
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Fernandez-Rodrigues V, Sanchez-Carro Y, Lagunas LN, Rico-Uribe LA, Pemau A, Diaz-Carracedo P, Diaz-Marsa M, Hervas G, de la Torre-Luque A. Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry 2022; 12:187-203. [PMID: 35111588 PMCID: PMC8783161 DOI: 10.5498/wjp.v12.i1.187] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). RESULTS Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.
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Affiliation(s)
| | - Yolanda Sanchez-Carro
- Department of Psychiatry, Universidad Autonoma de Madrid, Madrid 28046, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
| | - Luisa Natalia Lagunas
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
| | - Laura Alejandra Rico-Uribe
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Psychology, La Rioja International University, Logrono 26006, Spain
| | - Andres Pemau
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | | | - Marina Diaz-Marsa
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
- Institute of Psychiatry and Mental Health, San Carlos Clinical Hospital, Madrid 28040, Spain
| | - Gonzalo Hervas
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
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Demirer I, Kühhirt M, Karbach U, Pfaff H. Does positive affect mediate the association of multimorbidity on depressive symptoms? Aging Ment Health 2022; 26:65-76. [PMID: 33543998 DOI: 10.1080/13607863.2020.1870209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives Multimorbidity poses various challenges, and previous research has indicated a causal relation with depression. As multimorbidity is not curable, the underlying mechanisms are of great interest. Positive affect is a major resource for coping with chronic conditions and for the prevention of depression. Long-term multimorbidity, however, may deplete positive affect. The purpose of this paper is to investigate the role of positive affect in the association between multimorbidity and depressive symptoms.Method We used four consecutive waves (2008, 2011, 2014, 2017) of the nationally representative German Ageing Survey (DEAS) with a total of 1,558 older adults aged 40 and over. To account for time-varying confounding, exposure-induced mediator-outcome confounding, and reciprocities, we applied the mediational g-formula with inverse-probability weighting techniques. We also tested for exposure-mediator interaction to adjust for differences in mediation across the duration of multimorbidity.Results We confirmed a positive longitudinal relation between multimorbidity and depressive symptoms, both of which were negatively associated with while positive affect. The model without interaction indicated a share mediated of ca. 18.3% on the total effect of multimorbidity on depressive symptoms. Addition of interaction led to substantial differences for multimorbidity duration and levels of positive affect. Associations for long-term multimorbidity (at least two survey waves) were more substantial, and the share mediated doubled (>40%). Additionally, the direct effect of multimorbidity on depressive symptoms diminished for short-term multimorbidity.Conclusion Strengthening positive affect could reduce depressive symptoms in those facing multimorbidity. This study also discusses methodological challenges in performing longitudinal mediation analysis. We advise researchers to consider the mediational g-formula and exposure-mediator interaction.
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Affiliation(s)
- Ibrahim Demirer
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Michael Kühhirt
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Institute of Rehabilitation Science, Technical University Dortmund, Dortmund, Germany
| | - Holger Pfaff
- Institute of Medical Sociology Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Vasquez-Goñi GA, Papuico-Romero BM, Urrunaga-Pastor D, Runzer-Colmenares FM, Parodi JF. The depressed frail phenotype as a risk factor for mortality in older adults: A prospective cohort in Peru. Heliyon 2022; 8:e08640. [PMID: 35028442 PMCID: PMC8741456 DOI: 10.1016/j.heliyon.2021.e08640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/23/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Frailty and depression can coexist as depressed frail phenotype, useful for the comprehensive evaluation of older adults and prevention of adverse outcomes. The objective of this study was to evaluate the role of the depressed frail phenotype and its components as risk factors for mortality in older adults of the Centro Médico Naval (CEMENA) of Peru during 2010-2015. MATERIAL AND METHODS We carried out a secondary data analysis of a prospective cohort that included older adults (60 years and older) treated in the Geriatrics service of CEMENA between the years 2010-2015. Frailty was defined as the presence of three or more Fried phenotype criteria and depression was determined using a Yesavage ultrashort scale score of three or more. The presence of both conditions was defined as depressed frail phenotype. In addition, sociodemographic characteristics, medical and personal history, and performance-based measures were included. We employed crude and adjusted Cox regression models to evaluate the association of interest and estimate Hazard Ratios (HR) with their respective 95% confidence intervals (95% CI). RESULTS 946 older adults were included in the analysis, with a mean age of 78.0 ± 8.5 years. 559 (59.1%) were male, 148 (15.6%) were found to be frail, 231 (24.4%) had depressive symptoms, 105 (11.1%) had depressed frail phenotype, and 79 (8.3%) participants died during follow-up. The adjusted Cox regression analysis revealed that depressed frail phenotype (HR = 3.53; 95%CI: 2.07-6.00; p < 0.001) was a risk factor for mortality in older adults. CONCLUSIONS The depressed frail phenotype was associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies that allow estimating this phenotype's impact on mortality and evaluate interventions to improve quality of life and reduce the risk of adverse outcomes.
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Affiliation(s)
- Gabriel A.J. Vasquez-Goñi
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Lima, Perú
| | - Basilio M. Papuico-Romero
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Lima, Perú
| | - Diego Urrunaga-Pastor
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Lima, Perú
| | - Fernando M. Runzer-Colmenares
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Lima, Perú
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Perú
| | - José F. Parodi
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Perú
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Jellinger KA. Pathomechanisms of Vascular Depression in Older Adults. Int J Mol Sci 2021; 23:ijms23010308. [PMID: 35008732 PMCID: PMC8745290 DOI: 10.3390/ijms23010308] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Depression in older individuals is a common complex mood disorder with high comorbidity of both psychiatric and physical diseases, associated with high disability, cognitive decline, and increased mortality The factors predicting the risk of late-life depression (LLD) are incompletely understood. The reciprocal relationship of depressive disorder and age- and disease-related processes has generated pathogenic hypotheses and provided various treatment options. The heterogeneity of depression complicates research into the underlying pathogenic cascade, and factors involved in LLD considerably differ from those involved in early life depression. Evidence suggests that a variety of vascular mechanisms, in particular cerebral small vessel disease, generalized microvascular, and endothelial dysfunction, as well as metabolic risk factors, including diabetes, and inflammation that may induce subcortical white and gray matter lesions by compromising fronto-limbic and other important neuronal networks, may contribute to the development of LLD. The "vascular depression" hypothesis postulates that cerebrovascular disease or vascular risk factors can predispose, precipitate, and perpetuate geriatric depression syndromes, based on their comorbidity with cerebrovascular lesions and the frequent development of depression after stroke. Vascular burden is associated with cognitive deficits and a specific form of LLD, vascular depression, which is marked by decreased white matter integrity, executive dysfunction, functional disability, and poorer response to antidepressive therapy than major depressive disorder without vascular risk factors. Other pathogenic factors of LLD, such as neurodegeneration or neuroimmune regulatory dysmechanisms, are briefly discussed. Treatment planning should consider a modest response of LLD to antidepressants, while vascular and metabolic factors may provide promising targets for its successful prevention and treatment. However, their effectiveness needs further investigation, and intervention studies are needed to assess which interventions are appropriate and effective in clinical practice.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150 Vienna, Austria
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Borges MK, Aprahamian I, Romanini CV, Oliveira FM, Mingardi SVB, Lima NA, Cecato JF, Petrella M, Oude Voshaar RC. Depression as a determinant of frailty in late life. Aging Ment Health 2021; 25:2279-2285. [PMID: 33307781 DOI: 10.1080/13607863.2020.1857689] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. METHOD Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. RESULTS Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. CONCLUSION Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status.
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Affiliation(s)
- Marcus K Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carla V Romanini
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Fabiana M Oliveira
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Silvana V B Mingardi
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Natália A Lima
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Juliana F Cecato
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Marina Petrella
- Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Oude Voshaar RC, Aprahamian I, Borges MK, van den Brink RHS, Marijnissen RM, Hoogendijk EO, van Munster B, Jeuring HW. Excess mortality in depressive and anxiety disorders: The Lifelines Cohort Study. Eur Psychiatry 2021; 64:e54. [PMID: 34462033 PMCID: PMC8446070 DOI: 10.1192/j.eurpsy.2021.2229] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background To examine the mortality risk of current and life-time depressive as well as anxiety disorders, whether this risk is moderated by sex or age, and whether this risk can be explained by lifestyle and/or somatic health status. Methods A cohort study (Lifelines) including 141,377 participants (18–93 years) which were followed-up regarding mortality for 8.6 years (range 3.0–13.7). Baseline depressive and anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria were assessed with the Mini International Neuropsychiatric Interview and lifetime diagnoses by self-report. All-cause mortality was retrieved from Statistics Netherlands. Cox-regression was applied to calculate proportional hazard ratios, adjusted for lifestyle (physical activity, alcohol use, smoking, and body mass index) and somatic health status (multimorbidity and frailty) in different models. Results The mortality rate of depressive and anxiety disorders was conditional upon age but not on sex. Only in people below 60 years, current depressive and anxiety disorders were associated with mortality. Only depressive disorder and panic disorder independently predicted mortality when all mental disorders were included simultaneously in one overall model (hazard ratio [HR] = 2.18 [95% confidence intervals (CI): 1.56–3.05], p < 0.001 and HR = 2.39 [95% CI: 1.15–4.98], p = 0.020). Life-time depressive and anxiety disorders, however, were independent of each other associated with mortality. Associations hardly changed when adjusted for lifestyle characteristics but decreased substantially when adjusted for somatic health status (in particular physical frailty). Conclusions In particular, depressive disorder is associated with excess mortality in people below 60 years, independent of their lifestyle. This effect seems partly explained by multimorbidity and frailty, which suggest that chronic disease management of depression-associated somatic morbidity needs to be (further) improved.
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Affiliation(s)
- R C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - I Aprahamian
- Faculty of Medicine of Jundiaí, Internal Medicine Department, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - M K Borges
- Department of Psychiatry, Universidade Federal do Paraná, Curitiba, Brazil
| | - R H S van den Brink
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R M Marijnissen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, The Netherlands
| | - B van Munster
- Department of Internal Medicine and Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H W Jeuring
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Dang JZ, Zhu GY, Yang YJ, Zheng F. Clinical characteristics of coronavirus disease 2019 in patients aged 80 years and older. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:395-400. [PMID: 32690444 PMCID: PMC7347492 DOI: 10.1016/j.joim.2020.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
Objective Coronavirus disease 2019 (COVID-19) has raised concern around the world as an epidemic or pandemic. As data on COVID-19 has grown, it has become clear that older adults have a disproportionately high rate of death from COVID-19. This study describes the early clinical characteristics of COVID-19 in patients with more than 80 years of age. Methods Epidemiological, clinical, laboratory, radiological, and treatment data from 17 patients diagnosed with COVID-19 between January 20 and February 20, 2020 were collected and analyzed retrospectively. Treatment outcomes among subgroups of patients with non-severe and severe symptoms of COVID-19 were compared. Results Of the 17 hospitalized patients with COVID-19, the median age was 88.0 years (interquartile range, 86.6–90.0 years; range, 80.0–100.0 years) and 12 (70.6%) were men. The age distribution of patients was not significantly different between non-severe group and severe group. All patients had chronic pre-existing conditions. Hypertension and cardiovascular diseases were the most common chronic conditions in both subgroups. The most common symptoms at the onset of COVID-19 were fever (n = 13; 76.5%), fatigue (n = 11; 64.7%), and cough (n = 5; 29.4%). Lymphopenia was observed in all patients, and lymphopenia was significantly more severe in the severe group than that in non-severe group (0.4 × 109/L vs 1.2 × 109/L, P = 0.014). The level of serum creatinine was higher in the severe group than in the non-severe group (99.0 μmol/L vs 62.5 μmol/L, P = 0.038). The most common features of chest computed tomography images were nodular foci in 10 (58.8%) patients and pleural thickening in 7 (41.2%) patients. All patients received antiviral therapy, while some patients also received intravenous antibiotics therapy (76.5%), Chinese medicinal preparation therapy (Lianhuaqingwen capsule, 64.7%), corticosteroids (35.3%) or immunoglobin (29.4%). Eight patients (47.1%) were transferred to the intensive care unit because of complications. Ten patients (58.8%) received intranasal oxygen, while 3 (17.6%) received non-invasive mechanical ventilation, and 4 (23.5%) received high-flow oxygen. As of June 20, 7 (41.2%) patients had been discharged and 10 (58.8% of this cohort, 77.8% of severe patients) had died. Conclusion The mortality of patients aged 80 years and older with severe COVID-19 symptoms was high. Lymphopenia was a characteristic laboratory result in these patients, and the severity of lymphopenia was indicative of the severity of COVID-19. However, the majority of patients with COVID-19 in this age cohort had atypical symptoms, and early diagnosis depends on prompt use of a viral nucleic acid test.
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Affiliation(s)
- Jian-Zhong Dang
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China.
| | - Gang-Yan Zhu
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Ying-Jie Yang
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Fang Zheng
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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