Prevalence rate and correlates of depressive symptoms in older individuals: the Veneto Study

Socioeconomic status and incident depressive symptoms among older adults: A 3-year longitudinal study from the Japan Gerontological Evaluation Study

OBJECTIVES

The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset.

METHODS

This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated.

RESULTS

We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12 years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR = 1.42, 95% CI = 1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p = 0.002), lower income (males: 1.64, [1.34-2.01], p < 0.001/females: 1.82, [1.49-2.22], p < 0.001), and fewer assets (males: 1.40, [1.16-1.68], p < 0.001/females: 1.21, [1.02-1.42], p = 0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously.

CONCLUSIONS

All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.

Association between depressive mood and chronic periodontitis among senior residents using the National Health Insurance Service-Senior Cohort Database

BACKGROUND

Bacteria involved in chronic periodontal disease induce inflammatory cytokines. These cytokines can enter the brain through systemic circulation and cause depression. In this study, we investigated the association between depressed mood and chronic periodontitis in older adults in Korea.

METHODS

This study used data from the Life-changing Period Health Checkup (2007-2008), performed only at 66 years of age, which is available from the National Health Insurance Service-Senior Cohort Database. The depressed mood status was evaluated by three questions in the mental health examination. The definition of chronic periodontitis was determined based on the diagnosis and treatment codes for chronic periodontitis. Based on the three questions, we investigated the association between depressive mood and chronic periodontal disease by dividing the study population into 9622 depressed mood subjects (DMS) and 9091 non-depressed mood subjects (NDMS). Multivariable-adjusted logistic regression analysis was performed, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were presented.

RESULTS

Among the NDMS, 5390 patients with chronic periodontitis were identified, and among the DMS, 5964 patients with chronic periodontitis were identified. The crude OR (95% CI) for chronic periodontitis in DMS compared to NDMS was 1.12 (1.06-1.19). The adjusted OR (95% CI) for chronic periodontitis was 1.12 (1.06-1.19). As a result of confirming the effect of sex and comorbidity on the association between depressed mood and chronic periodontitis, a significant association was observed for women at 1.15 (1.07-1.25). In addition, the adjusted OR (95% CI) for depressive mood and chronic periodontitis was 1.15 (1.07-1.25) for patients with hypertension, 1.13 (1.03-1.25) for patients with diabetes, 1.12 (1.02-1.22) for patients with dyslipidemia, and 1.18 (1.04-1.34) for patients with heart disease.

CONCLUSIONS

This study confirmed the relationship between depressed mood and chronic periodontitis in older adults. Therefore, education to strengthen the emotional management of older adults, especially with respect to depression, would play an auxiliary role in preventing and treating periodontitis.

Low mental health literacy and its association with depression, anxiety and poor sleep quality in Chinese elderly

BACKGROUND

Mental health literacy (MHL) is rarely reported in the Chinese elderly. This study explored the pattern of MHL in the Chinese elderly in relation to depression, anxiety and poor sleep quality.

METHODS

A cross-sectional study was conducted among older adults in Guangzhou, south China. Participants were investigated face-to-face using the Chinese National Mental Health Literacy Scale, the Patient Health Questionnaire-9 item (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) and the Pittsburgh Sleep Quality Index (PSQI). Mental Health Literacy Scale contains three dimensions: mental health knowledge, mental health skills (such as social support, cognitive reappraisal and attentional distraction) and mental health awareness. Multivariate logistic regression was used for examining the association between MHL and mental health.

RESULTS

A total of 506 older adults were recruited. The percentage of depression, anxiety, and poor sleep quality were 16.6%, 7.9% and 40.9%, respectively. MHL dimensions independently associated with depression included cognitive reappraisal (OR = 1.95, p < .001), attentional distraction (OR = 0.61, p = 0.044) and awareness (OR = 0.56, p = 0.027). MHL dimensions independently associated with anxiety symptoms included cognitive reappraisal (OR = 1.90, p = 0.011) and attentional distraction (OR = 0.44, p = 0.016). MHL dimensions independently associated with poor sleep quality included social support (OR = 0.75, p = 0.022), cognitive reappraisal (OR = 1.55, p = 0.003) and attentional distraction (OR = 0.65, p = 0.016).

CONCLUSION

Given the low MHL and its association with poor mental health in the Chinese elderly, policymakers and health professionals should improve the older adults' MHL, which could be conducive to the prevention and control of their mental health problems.

Understanding the relationship between social support and mental health of humanitarian migrants resettled in Australia

Background

Forced migration can lead to loss of social support and increased vulnerability to psychological distress of displaced individuals. The aims were to ascertain the associations of sociodemographic characteristics and social support received by resettled adult humanitarian migrants in Australia; determine the relationship between social support and mental health at different intervals following humanitarian migration; and examine the modification effects of gender, age and migration pathway on that relationship.

Methods

A secondary analysis was conducted of data generated in Waves One (three to six months after resettlement), Three (three years after resettlement) and Five (five years after resettlement) of the Building a New Life in Australia prospective cohort study. The association between sociodemographic characteristics and mental health were examined at each timepoint using a multivariate regression model. Exploratory factor analysis was used to develop a two-factor social support scale (emotional/instrumental and informational support) from a larger set of items collected in the BNLA. Psychological distress was measured by the Kessler-6 scale. Path analysis was used to analyse the relationships between social support and psychological distress among the three time points considering socio-demographic characteristics simultaneously.

Results

A total of 2264 participants were included in the analyses. Age, gender, birth region, migration pathway, education level and English proficiency were significantly associated with both social support types. Main source of income was only significantly associated with informational support. Remoteness area was only significantly associated with emotional/instrumental support. As emotional/instrumental support increased by one standard deviation (SD) at Wave One, psychological distress at Wave Three decreased by 0.34 score [95% CI (− 0.61; − 0.08)]. As informational support at Wave Three increased by one SD, psychological distress at Wave Five decreased by 0.35 score [95% CI (− 0.69; − 0.01)]. The relationships between social support and psychological distress varied between genders, age groups and migration pathways.

Conclusion

Findings demonstrate the importance of emotional/instrumental support and informational support for the medium and long-term mental health of humanitarian migrants. This study also highlights the important of extending current social support provisions and tailoring programs to enhance support received by humanitarian migrant subgroups years after resettlement to improve mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14082-z.

Depressive Symptoms and Healthcare Utilization in Late Life. Longitudinal Evidence From the AgeMooDe Study

Objective

The aim of this study was to investigate the longitudinal impact of depressive symptoms on utilization of healthcare in terms of GP visits as well as specialist visits and hospital admission in late life among community-dwelling individuals.

Methods

Longitudinal data (baseline and follow-up) were derived from the German multicentre, prospective cohort study “Late-life depression in primary care: needs, health care utilization and costs” study (AgeMooDe). At baseline, n = 1,230 patients aged 75 years and older were recruited from primary care practices. Main outcomes of interest were use of health care services: the number of GP visits, the number of medical specialist visits, and hospital admission. We used the Geriatric Depression Scale (GDS-15) to measure depression. Outcomes were analyzed with multilevel random intercept negative binominal regression and logistic random-effects models.

Results

At baseline (n = 1,191), mean age was 80.7 (SD 4.6) years, 62.9% were female, and 196 individuals (16.5%) had depression (GDS-15 ≥6). Our longitudinal analyses indicated that older individuals with more depressive symptoms visited their GP more often (IRR=1.03; CI [1.01-1.04], p &lt; 0.001), were visiting medical specialists more frequently (IRR=1.03; CI [1.01-1.04], p &lt; 0.01), and had higher odds of being hospitalized (OR=1.08; CI [1.02-1.13], p &lt; 0.01).

Conclusions

Based on this large longitudinal study we showed that, after adjustment for important covariates, older individuals with more depressive symptoms had higher health care utilization over time. They visited their GP and specialists more frequently and they had higher odds of being hospitalized. This may suggest that higher utilization of specialist care and increased likelihood of being hospitalized may be also attributable to unspecific symptoms or symptoms that are elevated through depressive symptoms.

Combined' Neck/Back Pain and Psychological Distress/Morbidity Among the Saudi Population: A Cross-Sectional Study

Background

Psychological distress/morbidity is amongst the primary reason for the cause of pain at multiple sites, its progression, and recovery. Though still not very clear if physical pain in the neck or the back may predict psychological morbidities or not. Thus, we investigated the association between combined neck or back pain and psychological distress/morbidity.

Methods

A cross-sectional study was conducted in Al-Kharj, Saudi Arabia, including 1,003 individuals. The questionnaire comprised of General Health Questionnaire-12 (GHQ-12) and some questions about neck and back pain. Data analysis was done using statistical software SPSS version 26.0.

Results

The results of the multivariate analysis revealed a significant positive association between neck/back pain status and total GHQ score (unstandardized Beta = 2.442, P ≤ 0.0001). Having neck/back pain had almost a 2.5 times greater risk of psychological distress/morbidity. Further, females were more likely to have a higher risk of psychological distress/morbidity (unstandardized Beta = 1.334, P = 0.007) than males while adjusting for sociodemographic and clinical characteristics.

Conclusion

The combination of neck and back pain was significantly associated with the Saudi population’s psychological problems. Therefore, the Saudi government needs to devise high-risk strategies and allocate adequate resources to the cause so that at-risk people can be shielded from the adverse complications arising from this condition in the long run.

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.

Latent class growth modeling of depression and anxiety in older adults: an 8-year follow-up of a population-based study

BACKGROUND

Depression and anxiety are common mental health conditions in the older adult population. Understanding the trajectories of these will help implement treatments and interventions.

AIMS

This study aims to identify depression and anxiety trajectories in older adults, evaluate the interrelationship of these conditions, and recognize trajectory-predicting characteristics.

METHODS

Group-based dual trajectory modeling (GBDTM) was applied to the data of 3983 individuals, aged 65 years or older who participated in the Korean Health Panel Study between 2008 and 2015. Logistic regression was used to identify the association between characteristics and trajectory groups.

RESULTS

Four trajectory groups from GBDTM were identified within both depression and anxiety outcomes. Depression outcome fell into "low-flat (87.0%)", "low-to-middle (8.8%)", "low-to-high (1.3%)" and "high-stable (2.8%)" trajectory groups. Anxiety outcome fell into "low-flat (92.5%)", "low-to-middle (4.7%)", "high-to-low (2.2%)" and "high-curve (0.6%)" trajectory groups. Interrelationships between depression and anxiety were identified. Members of the high-stable depression group were more likely to have "high-to-low" or "high-curved" anxiety trajectories. Female sex, the presence of more than three chronic diseases, and being engaged in income-generating activity were significant predictors for depression and anxiety.

CONCLUSIONS

Dual trajectory analysis of depression and anxiety in older adults shows that when one condition is present, the probability of the other is increased. Sex, having more than three chronic diseases, and not being involved in income-generating activity might increase risks for both depression and anxiety. Health policy decision-makers may use our findings to develop strategies for preventing both depression and anxiety in older adults.

Different dimensions of social support differentially predict psychological well-being in late life: opposite effects of perceived emotional support and marital status on symptoms of anxiety and of depression in older outpatients in Italy

BACKGROUND

Social support is important to psychological well-being in late life. However, findings in the literature regarding its effects are mixed, less information is available for anxiety than for depressive symptoms, and few studies have been carried out in Italy. Therefore, the aim of this study was to investigate the influence of social support on symptoms of anxiety and of depression in a sample of geriatric outpatients in Italy.

METHODS

This cross-sectional study consecutively enrolled 299 outpatients without dementia (age ≥ 65, all neuropsychologically tested). Social support was assessed with the ENRICHD Social Support Instrument and by interview. Symptoms of anxiety and of depression were evaluated with short versions of the State-Trait Personality Inventory Trait Anxiety and Geriatric Depression scales. The relationship between social support and psychological well-being was examined by multiple linear regression models with socio-demographic and clinical variables, including cognitive performance, as potential confounders.

RESULTS

Perceived emotional support was a negative predictor of symptoms of anxiety (standardised beta coefficient (β) -0.288, standard error (SE) 0.074, P < 0.001) and symptoms of depression (β -0.196, SE 0.040, P < 0.001). On the contrary, marital status (i.e. being married) was a positive predictor of symptoms of anxiety (β 0.199, SE 0.728, P = 0.003) and symptoms of depression (β 0.142, SE 0.384, P = 0.035).

CONCLUSIONS

Different dimensions of social support differentially affect psychological well-being. The protective effect of perceived emotional support is consistent with social cognitive models of health. The harmful effect of being married may be capturing the distress of the pre-bereavement period. Alternatively, it may reflect oppression by gender roles within marriage in a predominantly female sample in a traditional society. Our findings provide insight into the relationship between social support and psychological well-being, and identify potential targets for psychosocial interventions promoting mental health in late life.

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.

Changes in depressive symptoms of older adults in the Czech Republic

BACKGROUND

It is unclear whether the rising burden of depression is due to its increasing prevalence or better detection. We aimed to study trends in depressive symptoms in older individuals from the Czech Republic.

METHODS

We used data from the Survey on Health, Aging and Retirement in Europe. Depressive symptoms, defined by 4 or more points on the EURO-D scale, alone or in combination with pharmacological treatment, were compared between participants in 2006/2007 (cohort 1) and in 2015 (cohort 2). Binary logistic regression assessed the association of cohort 2 with depressive symptoms, step-wise adjusting for sociodemographic and clinical covariates.

RESULTS

The prevalence of depressive symptoms (defined by EURO-D) was 28% in cohort 1 and 22% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for all covariates (OR 0.77; 95% CI 0.63-0.94). Defined by EURO-D scale or pharmacological treatment, the prevalence was 30% in cohort 1 and 26% in cohort 2 (p < 0.001). Cohort 2 was associated with lower odds of depressive symptoms, adjusting for age and sex, but not in the fully adjusted model (OR 0.88; 95% CI 0.73-1.07). The difference in depressive symptoms between cohorts was associated in particular with increased length of education and higher household net worth.

LIMITATIONS

Information about pharmacological treatment has been reported inaccurately.

CONCLUSIONS

The prevalence of depressive symptoms has decreased in older adults in the Czech Republic. Additional increase in education and socioeconomic resources of the population could further reduce the depressive symptoms in the population.

Depressive symptoms in individuals with family members requiring ADL assistance

BACKGROUND

The number of patients with depressive symptoms worldwide is increasing steadily, and the prevalence of depression among caregivers is high. Therefore, the present study aimed to identify the effects of individuals' caregiving status with respect to their family members requiring activities of daily living (ADLs) assistance on depressive symptoms among those aged 45 or over.

METHODS

Data were collected from the 2006-2016 using the Korean Longitudinal Study of Aging surveys. Participants were categorized into three groups based on their caregiving status with respect to family members requiring ADL assistance: whether they provided the assistance themselves, whether the assistance was provided by other caregivers, or whether no assistance was required. We analyzed the generalized estimating equation model and subgroups.

RESULTS

A total of 3744 men and 4386 women were included for the analysis. Men who cared for family members requiring ADL assistance had higher depressive symptoms than those with family members who did not require ADL assistance. Among women, participants who had family members requiring ADL assistance that they themselves or others were providing had higher depressive symptoms than those without family members requiring ADL assistance. Subgroup analysis was conducted based on age, job status, regular physical activities, participation status in social activities, and the number of cohabiting generations.

CONCLUSIONS

The study results indicated higher depressive symptoms among those with family members requiring ADL assistance and those who care for such family members themselves. This suggests that an alternative to family caregiving is necessary, especially for the elderly, regardless of caregiver sex.

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.

Incidence of Depression Among Community Dwelling Healthy Elderly and the Predisposing Socio-environmental Factors

Introduction

The average life expectancy is increasing with better medical facilities and evolving technology. The ratio of the geriatric population is increasing, which drives a need to invest more in the physical and psychological health of older people. The aim of this study was to assess the incidence of depression in community-dwelling healthy older adults. 

Methods

Geriatric Depression Scale-15 (GDS-15) was utilized in this study. Community-dwelling older adults (age 65+ years) were approached in parks, mosques, grocery stores, and waiting areas of banks. Demographic information including age, gender, education, marital status, employment, and financial status, and family structure was recorded. Data were entered and analyzed using SPSS v. 22.0.

Results

Out of the 367 elderly participants, there were 165 (45%) men and 202 (55%) women. Depression was reported in 37% (n = 136) individuals; 29.7% (n = 109) were suggestive of depression, while 33.2% (n = 122) were not depressed. Risk factors for the development of depression included female gender, not living with a spouse (separated/spouse died/single), being financially dependent, being employed, and living alone (not in a joint or nuclear family).

Conclusion

The incidence of depression is high among healthy community-dwelling elderly individuals in Pakistan. Geriatric health should be taken into consideration. There should be strategies and guidelines to screen the geriatric population for psycho-social symptoms and provide them with psychological counseling.

Validation of the Hamilton Depression Rating Scale (HDRS) and sociodemographic factors associated with Lebanese depressed patients

OBJECTIVES

The Hamilton Depression Rating Scale (HDRS) is the most commonly used scale for the evaluation of patients' treatments for depression. Since the HDRS has never been validated in Lebanon to our knowledge, our primary objective, therefore, is to investigate the correlation, sensitivity, specificity, as well as the reliability and the validity of the Hamilton Depression Rating Scale (HDRS) among Lebanese depressed patients. The secondary objective is to identify sociodemographic factors that would be correlated to depression among our sample.

METHODS

This case-control study, performed between January till May 2017, included 400 patients (200 patients, 200 controls).

RESULTS

The HDRS scale items converged over a solution of four factors, explaining a total of 58.88% of the variance. A high Cronbach's alpha was found for the full scale (0.862). A stepwise linear regression, using the total HDRS score as continuous variable, showed that a low socioeconomic level, divorced participants and a family history of mental disorders would significantly increase the HDRS total score (Beta=4.278; Beta=5.405; and Beta=3.922) respectively. However, having a university level of education would significantly decrease the HDRS total score (Beta=-4.248, P<0.001).

CONCLUSION

This study shows that the Arabic version of the HDRS has promising psychometric properties, making it a good tool to use for the diagnosis of patients with depression. Depression recognition and treatment in general practice with the aim of improving patient outcome and reducing health care expenditure, is definitely warranted.

Gender differences in the trajectories and the risk factors of depressive symptoms in later life

BACKGROUND

The present study investigated changes in the trajectories of depressive symptoms in the elderly and attempted to identify risk factors that influence these changes according to gender.

METHODS

All data were obtained from a subsample of subjects who participated in the Korean Longitudinal Study of Ageing between 2006 and 2012; 3,667 individuals (1,566 men and 2,101 women) aged 60 years and older were included in the present study. A group-based trajectory model was employed to determine the appropriate number of groups and to observe changes in depressive symptoms according to research year. Following the trajectory analysis, a multinomial regression analysis was performed to examine depressive symptom-related risk factors that influenced membership in the different trajectory groups.

RESULTS

Significant gender differences were found in the trajectories of depressive symptoms among four groups (normal, mild depressed, worsening, and depressed) in men and five groups (normal, mild depressed, worsening, improving, and depressed) in women. Among the trajectory groups, physical health status such as chronic diseases, self-rated health (SRH), and somatic pain showed statistically significant differences in both genders. In addition, employment in men and social participation in women were associated with the trajectories.

CONCLUSIONS

The present study suggested that maintaining one's physical health status played an important role in preventing depressive symptoms and that employment in men and social participation in women were preventative against the development of depressive symptoms.

Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: Meta-analysis and systematic review

The present study pooled the prevalence of sleep disturbances and depression in community-dwelling older adults (mean age≥60years) and quantified the strength of evidence of the relationship between these two problems. From 23 cross-sectional studies and five sets of baseline data, a high pooled prevalence of sleep disturbances (30.5%), depressive symptoms (18.1%) and coexisting disorders (10.6%) were found. In the 23 cohort studies, self-reported sleep disturbances increased the risk of the onset of depression (relative risk [RR]=1.92). Persistent sleep disturbances increased the risk of the development (RR=3.90), recurrence (RR=7.70), and worsening (RR=1.46) of depression in older adults. Little support was found for a predictive role for objective sleep characteristics in the development of depression. Older adults with depression had a higher risk of developing (RR=1.72) and worsening (RR=1.73) symptoms of sleep disturbances. This review emphasizes the importance of timely interventions in incipient sleep disturbances and depression among older adults, preventing the development of more serious comorbidities.

Social support and protection from depression: systematic review of current findings in Western countries

BACKGROUND

Numerous studies report an association between social support and protection from depression, but no systematic review or meta-analysis exists on this topic.

AIMS

To review systematically the characteristics of social support (types and source) associated with protection from depression across life periods (childhood and adolescence; adulthood; older age) and by study design (cross-sectional v cohort studies).

METHOD

A systematic literature search conducted in February 2015 yielded 100 eligible studies. Study quality was assessed using a critical appraisal checklist, followed by meta-analyses.

RESULTS

Sources of support varied across life periods, with parental support being most important among children and adolescents, whereas adults and older adults relied more on spouses, followed by family and then friends. Significant heterogeneity in social support measurement was noted. Effects were weaker in both magnitude and significance in cohort studies.

CONCLUSIONS

Knowledge gaps remain due to social support measurement heterogeneity and to evidence of reverse causality bias.

The prevalence and predictors of severe depression among the elderly in Malaysia

The population of Malaysia is relatively young, due to this there is a dearth in research conducted among the elderly especially relating to depression. The aim of this study is to determine the prevalence and the predictors of severe depression among the elderly in Malaysia. A sample of 2005 older adults randomly selected from the Penang State government's list of elderly receiving aid participated in the study. The Geriatric Depression Scale was used to screen for depression. Socio-demographic, social support, disease, functional and other factors were looked at as possible predictor variables. The prevalence of severe depression was 19.2 %. Indians (aOR = 2.0), being married (aOR = 10.5), widowed & divorced (aOR = 5.2), having poor (aOR = 2.7) or moderate social support (aOR = 2.7), having no one (aOR = 2.9), relatives (aOR = 2.3) or religious figures & others (aOR = 1.9) as compared to a spouse as a source of emotional support, feeling extremely lonely (aOR = 3.4), not socially active (aOR = 2.3), cognitively impaired (aOR 2.5), activities limited due to illness or disability (aOR = 1.6) and poor sleep quality (aOR = 3.6) were significant predictor variables. The prevalence of severe depression was high. It is pertinent that older adults, especially those with risk factors identified in this study be screened for depression at every opportunity.

Associação da depressão com as características sociodemográficas, qualidade do sono e hábitos de vida em idosos do Nordeste brasileiro: estudo seccional de base populacional

Introdução: Os transtornos depressivos podem ser definidos como episódios de humor deprimido ou perda de interesse e prazer por quase todas as atividades. A depressão é considerada o principal transtorno mental em idosos, podendo relacionar-se com a qualidade do sono e hábitos de vida, além de ser influenciada por questões sociodemográficas.Objetivo: Verificar a prevalência de depressão em idosos no interior do Nordeste brasileiro e qual a sua relação com o perfil sociodemográfico, qualidade do sono e hábitos de vida. Método:Delineou-se um estudo epidemiológico do tipo transversal, tendo como base a população idosa da zona urbana de Campina Grande-PB. Foi investigada a presença de depressão como variável dependente, assim como aspectos sociodemográfios, qualidade do sono e hábitos de vida como variáveis independentes. Foram obtidas estimativas de prevalência das variáveis e medidas de associação por meio de regressão de Poisson. Adotou-se um nível de significância de 5% para as estimativas.Resultados: Participaram do estudo 168 idosos com idade média de 72,3 (±7,8) anos, sendo em sua maioria mulheres, 122 (72,6%). O quadro depressivo foi identificado em 72 idosos (42,9%). As idosas estavam duas vezes mais associadas ao quadro depressivo (RP=2,26) que os homens. A qualidade subjetiva do sono muito bom (RP=0,34), o médio/alto risco de distúrbio do sono (RP=4,08), tomar medicações para dormir uma ou duas vezes na semana (RP=5,21) e três vezes ou mais (RP=8,69), disfunção diurna uma ou duas vezes por semana (RP=14,40) e três vezes ou mais (RP=27,00) e má qualidade do sono no índice de Pittsburgh apresentaram associação com a depressão na análise bivariada, mas sem relação após ajustamento multivariávelConclusion:A prevalência de depressão mostrou-se elevada na população estudada, sendo claramente mais frequente nas idosas. Por outro lado, não foi possível detectar associação da depressão com os hábitos de vida e a qualidade do sono.

Influence of Social Factors to the Quality of Life of the Elderly in Malaysia

Introduction and Aim:

The increase in the life expectancy does not necessarily correlate with a higher quality of life. The objective of this study was to determine the influences of social factors to the quality of life of the elderly in Malaysia.

Methodology:

This cross sectional study was conducted in Penang, Malaysia among 2005 randomly sampled elderly using the WHOQOL-BREF scale. The sample was randomly collected from a list of residents of the state who are aged 60 years and older who receive the special aid provided by the Penang state government to all elderly residing in Penang irrespective of their socio and economic status.

Results:

Regression analysis showed that after controlling for demographic factors which include age, sex, race, marital status, education and employment; living with spouse and family members and being socially active were significantly associated with increased quality of life scores and being dependent on partner and children as compared to being selfdependent on mobility and having poor and moderate support as compared to good social support were significantly associated with decreased quality of life scores.

Conclusion:

The quality of life of the elderly is very much influenced by social factors.

Prevalence and gender differences in late-life depression: a population-based study

OBJECTIVE

The worldwide phenomenon of an aging population combined with the increasing prevalence of depression in late life are issues that need to be addressed. This study aims to estimate the frequency of depression and subthreshold depression occurring in a sample of cognitively well-functioning, community-dwelling, older Italian adults and to investigate sociodemographic and clinical correlates of depression, exploring gender differences.

METHODS

We used a cross-sectional analyses of survivors in a population-based study (the Faenza Project) that included 359 subjects aged 74 years and older (49.3% women). A modified version of Cambridge Examination for Mental Disorders of Elderly Persons-Revised was administered to all participants. Prevalence rates of depression and 95% confidence intervals (CIs) were estimated according to International Classification of Diseases, Tenth Revision criteria. Statistical analyses were implemented to describe sociodemographic and clinical features associated with depression. Odds ratios were estimated by multivariate logistic regression, and the dependant variable was any type of depression.

RESULTS

Overall prevalence of depression was 25.1% (95% CI: 20.6-29.6), with no evidence of gender difference. Prevalence of mild, moderate, and severe depression was 16.4% (95% CI: 12.6-20.2), 7.5% (95% CI: 4.8-10.2), and 1.1 (95% CI: -0.4-2.6), respectively. A rate of 5.6% of the population complained of subthreshold depressive symptoms. After age 81, depression occurrence decreased as age increased. The association between depression and functional measures, such as primary activity, mobility, and disability in performing household chores, were stronger in men than in women. Similarly, severely disabling conditions like stroke were more strongly associated with depression in men than in women.

CONCLUSION

Our data suggest a disparity between men and women regarding the impact of depression on everyday life. Specific gender differences need to be taken into account for the evaluation of the depression-related burden in late life.

[Depressive symptoms in elderly women. The influence of gender]

OBJECTIVE

To examine gender differences in depressive symptoms in people over 75 years of age in the community.

METHODS

This is a descriptive cross-sectional study. The data was obtained from the study of frailty in Lleida (FRALLE survey). Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). Logistic regression were used to analyse the relationship of gender with depressive symptoms.

RESULTS

The prevalence of depressive symptoms was 33.1%; 22.8% for men and 40.3% for women. In the total population, gender was statistically significant in all three models constructed. Thus, women have nearly double the prevalence rates for depression compared to men, even after adjusting for social and demographic factors and the health status.

CONCLUSIONS

The results suggest that women have a higher risk of depressive symptoms than men, and the protective factors of depressive symptoms are higher education in women, and the presence of a partner in men.

Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

BACKGROUND

Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.

METHOD

As part of a prospective, population-based study on a random sample of 5632 subjects aged 65-84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.

RESULTS

Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15-1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32-0.95; men MHR 0.59, 95% CI 0.37-0.93). Neither sociodemographic nor medical confounders significantly modified these associations.

CONCLUSIONS

Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

Predictors of and health services utilization related to depressive symptoms among elderly Koreans

While the prevalence, comorbidity, risk profile and health care utilization for late-life depression have been described for many Western countries, much less is known about the recent epidemiology of late-life depression in East Asian countries such as Korea. We investigated predictors for depressive symptoms and the association between depressive symptoms and the utilization of both medical care and preventive services in elderly Koreans. Data were obtained from a nationally representative sample of Koreans aged 60 and above (2226 men, 2911 women) who participated in the 2008 wave of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale. Risk factors considered included sociodemographics, health behaviors, chronic diseases, and physical function. Health care utilization factors included hospitalization, outpatient clinic use and basic medical checkup. Being female, being unmarried, and having less education, lower household income, physical inactivity and lower weight were associated with depressive symptoms. Presence of chronic diseases and limited physical function also showed a significant association with depressive symptoms. Depressive symptoms were associated with increased odds of hospitalization and outpatient visits, but decreased the odds of utilization of basic medical checkup after controlling for potential confounders. Findings on most risk factors, except lower weight, were consistent with reports from Western countries. It is important to recognize the burden of depressive symptoms in the elderly. The interaction of such symptoms with chronic diseases should be acknowledged and considered in the clinical setting as well as in health care planning and policymaking.

Sex differences in depression among older adults: are older women more vulnerable than men in social risk factors? The case of open care centers for older people in Greece

This study examined depression, which, research has indicated, is the most common mental health problem affecting older people, especially women. Our objective was to estimate the prevalence of depression among older people in an urban Greek population and to investigate the covariates of depression symptoms prevalence by gender. The sample consisted of 360 individuals, 218 women and 142 men, aged 60 years or older, members of four open care centers for older people in Greece. A questionnaire for socio-demographic and medical data was used. Depression was probed by use of the geriatric depression scale short form. One-hundred and nine persons (30.3%), 32 men (22.53%) and 77 women (35.12%) were found to have depressive symptoms. The results indicated that women have more depression symptoms than men. Being currently unmarried and suffering from multimorbidity were associated with depression symptoms in both gender groups. Meetings with friends were found to be protective factors for both sexes; care of grandchildren and participating in outings and excursions seemed to be protective factors for women only. Unfavorable economic situations, and being childless, were associated with prevalence of depression symptoms among women only. This study confirmed the relationship between depression symptoms and gender and the importance of social and medical factors in the prevalence of depression symptoms, in both gender groups. It also indicated the greater vulnerability of women to some social factors.

Age- and gender-specific prevalence of depression in latest-life--systematic review and meta-analysis

OBJECTIVE

The objective of the study is to systematically analyze the prevalence of depression in latest life (75+), particularly focusing on age- and gender-specific rates across the latest-life age groups.

DESIGN

Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, Cochrane Library and Psycinfo and relevant literature from 1999 onwards was reviewed. Studies based on the community-based elderly population aged 75 years and older were included. Quality of studies was assessed. Meta-analysis was performed using random effects model.

RESULTS

24 studies reporting age- and gender-specific prevalence of depression were found. 13 studies had a high to moderate methodical quality. The prevalence of major depression ranged from 4.6% to 9.3%, and that of depressive disorders from 4.5% to 37.4%. Pooled prevalence was 7.2% (95% CI 4.4-10.6%) for major depression and 17.1% (95% CI 9.7-26.1%) for depressive disorders. Potential sources of high heterogeneity of prevalence were study design, sampling strategy, study quality and applied diagnostics of latest life depression.

CONCLUSIONS

Despite the wide variation in estimates, it is evident that latest life depression is common. To reduce variability of study results, particularly sampling strategies (inclusion of nursing home residents and severe cognitively impaired individuals) for the old age study populations should be addressed more thoroughly in future research.

Association among physical, psychiatric and socioeconomic conditions and WHOQOL-Bref scores

The aim of this study is to investigate the impact of psychiatric morbidity, depression, cognitive deficit, number of self-reported illnesses and socio-demographic variables on the WHOQOL-Bref domain scores. WHOQOL-Bref domain scores are substantially affected by psychiatric morbidity and income. Depression, the number of self-reported illnesses and the female gender also explain the variability of other domains to a lesser extent.

Prediction of symptomatic depression by discriminant analysis in Japanese community-dwelling elderly

Although a number of studies have examined depression risk factors for elderly persons, little attention has been paid to the prediction of individuals at risk. This study constructed a predictive model for discrimination between individuals at a higher risk of depression and normal subjects in Japanese community-dwelling elderly persons, using linear discriminant analysis. Data were collected from 754 non-institutionalized elderly men and women aged 65 years and older living in the community in Japan, using face-to-face interviews in 2002. Stepwise linear discrimination analysis was used to construct a predictive model to select individuals who have a higher risk of depression. The stepwise discriminant analysis selected the five predictor variables (frequent hearing problems, poor appetite, less financial leeway, low emotional support and less subjective usefulness) and yielded a statistically significant function (λ=0.816; χ2=113.0, df=5, p<0.001). This function showed that the rate of correct prediction was 78.2% for depressed. The calculated discriminate function based on the above five predictor variables (hearing problem, less appetite, less financial leeway, low emotional support and less subjective usefulness) is useful for detecting individuals at high risk of depression and preventing its development among community-dwelling elderly persons. Prospective studies are needed to confirm the validity and feasibility of the model for earlier screening for depression among such people.

Living arrangements, social networks and depressive symptoms among older men and women in Singapore

OBJECTIVES

To examine the association of living arrangements and social networks outside the household with depressive symptoms among older men and women, ascertain if these relationships differ between older men and women, and investigate whether the association of living arrangements with depressive symptoms varies by strength of social networks.

METHODS

Data for 4489 community-dwelling Singaporeans, aged 60 years and older, from a recent nationally representative survey were analyzed. Depressive symptoms were assessed using the 11-item CES-D (Center for Epidemiologic Studies) scale, social networks through Lubben's revised social network scale, and living arrangements through household composition. Analysis was stratified by gender, and descriptive and multivariate statistics were used to assess the risk of depressive symptoms by living arrangements and social networks, adjusting for age, ethnic group, education, housing type, functional status, number of chronic diseases and involvement in social activities.

RESULTS

Women had higher depressive symptom scores than men. Living alone and living with at least 1 child (no spouse) (relative to living with spouse and children), and weak social networks outside the household were associated with higher depressive symptom scores among both men and women. Men living alone with weak social networks outside the household had higher depressive symptom scores than those with strong networks.

CONCLUSION

The findings have implications regarding the importance of strengthening non-familial social networks of older adults, particularly for those living alone.

Health and well-being profiles of older European adults

The purpose of the present study was to identify health and well-being typologies among a sample of older European adults. Further, we examined various demographic, social, and health behaviour characteristics that were used to discriminate between such groups. The participants were 1,381 community-dwelling adults aged 65 years and above (M age = 73.65; SD = 7.77) from six European Union (EU) countries who completed self-reported questionnaires. Hierarchical cluster analysis was initially conducted followed by a k means analysis to confirm cluster membership. Four clusters were identified and validated: 'good health and moderate functioning' (38.40%), 'moderate health and functioning' (30.84%), 'obese and depressed' (20.24%) and 'low health and functioning' (10.51%). The groups could be discriminated based on age, gender, nationality, years of education, social isolation and health behaviours (alcohol consumption and walking behaviour). The results of the study demonstrate heterogeneity with regard to the relationships between the variables examined. The information can be used in targeting older Europeans for health promotion interventions.

Ethnic Minority Status, Depression, and Cognitive Failures in Relation to Marital Adjustment in Ethnically Diverse Older Women

The authors investigated the relationship between marital adjustment and ethnic minority status, depressive symptomatology, and cognitive failures among 78 married, community-dwelling, and predominantly non-European-American older women (ages 57-89). Respondents were screened to rule out dementia. Level of depressive symptoms, self-report of cognitive failures, and marital adjustment were obtained. As hypothesized, higher depressive symptomatology and cognitive failures were associated with worse marital adjustment (p < .05 for both). The same was true for membership in a non-dominant ethnic group, albeit only when ethnic status was considered outside the context of the other two independent variables. These results have clinical implications and fit within the theoretical framework of the socioemotional selectivity theory (Carstensen, 1992) applied to marriage in older age, a conceptualization formulated by Bookwala and Jacobs in 2004.

Depressive symptoms are associated with hospitalization, but not with mortality in the elderly: a population-based study

OBJECTIVES

Subjects with depression might request more healthcare services. The aim of this study was to evaluate the association of depressive symptoms with hospitalization and mortality rates in a general unselected older population.

METHODS

We assessed the association of the 30-items Geriatric Depression Scale (GDS) score with one-year hospitalization and mortality in all 344 subjects aged 75+ living in Tuscania (Italy). This population had been enrolled in a national study of the genetic determinants of health status. Analyses were conducted using continuous, as well as categorical GDS score levels.

RESULTS

After adjusting for potential confounders, depressive symptoms were associated in Cox regression modelling with hospitalization (relative risk, RR = 1.05; 95% confidence interval, CI = 1.01-1.09; p = 0.016), but not with mortality (RR = 1.06; 95% CI = 0.96-1.16; p = 0.246). Increasing GDS score levels were associated with increasing risk of hospitalization (p for trend = 0.033). Up to 39% of hospitalizations might be attributed to depression.

CONCLUSION

Depressive symptoms are not associated with increased mortality rates in general older populations. However, depressive symptoms represent a potentially reversible determinant of increased hospitalization rates in these subjects, independent of the presence and severity of other medical conditions.

Correlates of depressive symptoms in rural elderly Chinese

OBJECTIVE

Late life depression has been studied in many populations around the world. However, findings on risk factors for late life depression have remained inconsistent.

METHODS

A cross-sectional survey of 1737 rural Chinese age 65 and over from two provinces in China was conducted assessing cognitive functions using various cognitive instruments and collecting information on demographic characteristics and medical history. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Analysis of covariance and logistic regression models were used to identify factors associated with the continuous GDS score, mild or severe depression.

RESULTS

In this cohort, 26.5% (95% CI: 24.4-28.6%) met the criteria for mild depression and 4.3% (95% CI: 3.4-5.4%) for severely depression. Living alone, history of heart attack, head injury, and fracture were associated with higher depressive symptoms. Alcohol consumption and higher cognitive function were associated with lower depressive symptoms. Living alone, not attended school, history of head injury, fracture, and low cognitive function were associated with increased probability of mild depression. Living alone, history of stroke or heart attack, and low cognitive function were associated with severe depression.

CONCLUSIONS

Depression, particularly mild depression, is common in rural elderly Chinese. Among a number of factors identified in this cohort as being significantly associated with depressive symptoms, living alone and lower cognitive function were the most consistent factors associated with depressive symptoms, mild and severe depression. History of stroke, heart attack, and fracture were also risk factors for depressive symptoms.

Social relationships and depression among people 65 years and over living in rural and urban areas of Quebec

OBJECTIVE

To compare the prevalence of depression within the elderly Quebec population residing in rural areas, urban areas and metropolitan Montreal, and to assess differences in the associations between social relationships and depression across these urban and rural settings.

METHODS

Data originate from the first wave of the ESA (Etude de Santé des Ainés) longitudinal study on mental health of community dwelling older persons aged over 65 (n = 2670). Depression, including major and minor depression, measured using a computer questionnaire; the ESA-Q developed by the research team and based on the DSM-IV criteria. Assessments of associations between depression and geographic area, informal social networks and community participation were estimated adjusting for demographic, socioeconomic and health characteristics.

RESULTS

The prevalence of depression was higher in rural (17%) and urban areas (15.1%) than in metropolitan Montreal (10.3%). The odds ratio of rural (OR = 2.01 95% CI 1.59-2.68) and urban (OR = 1.75; 95% CI 1.25-2.45) areas compared to the metropolitan area increased slightly after adjustment by all social and health covariates. Our study indicated that social support and the lack of conflict in intimate relationships were associated with lower prevalence of depression in all areas.

CONCLUSION

Geographic differences in depression exist within the elderly population in Quebec that may generate significant impact on their health and functional abilities. Further research should be conducted to explain these differences.

Depressive symptomatology in tertiary-care glaucoma patients

OBJECTIVE

To investigate depressive symptomatology among patients with glaucoma and to relate the findings to disease stability.

DESIGN

Cross-sectional postal survey.

PARTICIPANTS

The study sample consisted of 258 patients out of a pool of 884 respondents to a survey on health and sleep sent to 1809 glaucoma patients registered in a major tertiary glaucoma centre at the Toronto Western Hospital, Toronto, Ont.

METHODS

The Center for Epidemiologic Studies Depression Scale questionnaire was mailed along with questions related to demographic information, general health, and sleep quality. Respondents were included if (i) their diagnosis was either primary open-angle glaucoma, normal tension glaucoma, or primary angle-closure glaucoma; (ii) the disease duration was 3 years or more; (iii) clinical examinations were obtained annually; and (iv) perimetric results were reliable. Each patient's condition was classified as stable or progressive on the basis of pointwise decline in visual fields (VFs).

RESULTS

The unadjusted odds ratio for depressive symptoms was found to be 0.4 times less (95% CI 0.19-0.88) in patients with progressive VFs (n = 79) than in patients with stable VFs (n = 179). Adjusting for demographic characteristics, general health, psychiatric comorbidity, and ocular factors did not weaken this association. However, it was reduced by the increased severity of VF defects (moderate and severe).

CONCLUSIONS

In this sample of tertiary-care patients, depressive symptoms were found to be less common in patients with progressive than with stable VFs when defects were classified as early, but not when they were classified as moderate or severe.

Anxiety symptoms and objectively measured sleep quality in older women

OBJECTIVES

Few studies have examined the association between anxiety symptoms and objectively measured sleep quality in older adults. The authors determined this association in a large cohort of very old community-dwelling women.

DESIGN

Cross-sectional.

SETTING

Participants' homes, sites of the Study of Osteoporotic Fractures.

PARTICIPANTS

Three thousand forty women (mean age: 83.6 years) enrolled in a prospective study of aging.

MEASUREMENTS

Participants completed the Goldberg Anxiety Scale (ANX), the 15-item Geriatric Depression Scale (GDS), and > or = 3 nights of actigraphy--a method of measuring sleep by recording wrist movement with a device called an actigraph. Elevated anxiety symptoms were defined as ANX > or = 6. Elevated depressive symptoms were defined as GDS > or = 6.

RESULTS

Participants' mean ANX score was 1.4 (standard deviation: 2.2); 9.2% (N = 280) had ANX > or = 6. Elevated anxiety symptoms were associated with greater odds of poor sleep efficiency (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.34, 2.23) and time awake after sleep onset (OR: 1.64, 95% CI: 1.27, 2.11). Associations remained after adjustment for GDS > or = 6, antianxiety medications, and other potential confounders (sleep efficiency OR: 1.50, 95% CI: 1.15, 1.97; time awake after sleep onset OR: 1.33, 95% CI: 1.01, 1.75). Anxiety symptoms were not associated with other sleep parameters.

CONCLUSION

Findings suggest that elevated anxiety symptoms are independently associated with poor objectively measured sleep efficiency and elevated sleep fragmentation in very old women, after accounting for significant depressive symptoms, medical comorbidities, and use of antianxiety medications.

Physical disability and depressive symptomatology in an elderly population: a complex relationship. The Italian Longitudinal Study on Aging (ILSA)

OBJECTIVES

Depressive symptoms (DS) are very frequent in elderly individuals and are associated with negative outcomes. This study was undertaken to evaluate whether DS predict physical disability in this population.

METHODS

A prospective,community-based cohort study, this work included 5,632 individuals aged 65-84 years, who were recruited from the demographic registries of eight Italian municipalities in 1992. The complete data of 3,256 subjects were collected and analyzed. DS were assessed using the Geriatric Depression Scale with a score > or = 10/30 indicating DS. All traditional risk factors for disability established by questionnaires and physical examinations were assessed at baseline. The outcomes were self-reported disability on the activities of daily living (ADL) test and the performance-based physical function assessment (Physical Performance Tests, PPT). The contribution of the predictive variables to the outcomes evaluated after a mean follow-up of 3.5 +/- 0.4 years was assessed using hierarchical logistic nested models.

RESULTS

Baseline DS was associated with higher rates of ADL disability (odds ratio [OR] 1.73, 95%confidence interval [CI] 1.12-2.66) and PPT disability (OR 1.83, 95% CI 1.17-2.85)in men and with ADL disability (OR 1.81, 95% CI 1.28 -2.55) in women. The independent predictors of PPT disability in women were arthritis (OR 2.13, 95% CI 1.28 -3.53) and age (OR 1.09; 95% CI 1.03-1.15).

CONCLUSIONS

This study provides evidence that older persons who report DS are at higher risk of subsequent physical decline. In women, arthritis is a more powerful predictor of preclinical disability, as measured by PPT.

Factors associated with depressive symptoms measured by the 12-item General Health Questionnaire in community-dwelling older adults (The Bambuí Health Aging Study)

OBJECTIVE

To investigate factors associated with depressive symptoms in community-dwelling older adults.

METHOD

This study evaluated 1,510 participants of the Bambuí Health Aging Study baseline. The dependent variable was the presence of depressive symptoms assessed by the 12-item General Health Questionnaire and predictive variables were sociodemographic characteristics, social support network, lifestyle and health conditions.

RESULTS

The prevalence of depressive symptoms was 38.5% (12-item General Health Questionnaire > or = 5). Depressive symptoms were positively and independently associated with female gender (PR = 1.15; 95%CI 1.01-1.33), aged 80 years or over (PR = 1.22; 95%CI: 1.02-1.54) compared with 60-69 years, single (PR = 1.25; 95%CI: 1.02-1.46) or separated (PR = 1.30; 95%CI: 1.03-1.65) marital status, less than 4 years of schooling (PR = 1.42; 95%CI: 1.04-2.00), self-reported global health (reasonable: PR = 1.84; 95%CI 1.45-2.34; bad or very bad: PR = 2.44; 95%CI 1.91-3.12), incapacity or great difficulty in performing daily activities (PR = 1.39; 95%CI: 1.22-1.57) and complaint of insomnia in the last month (PR = 1.77; 95%CI: 1.22-1.99).

CONCLUSION

The similarities between factors associated with depressive symptoms in this population and in others do not explain the high prevalence rates previously reported in Bambuí. These findings may guide efforts to investigate others factors to elucidate the etiopathogenesis of depression in this population.

Higher burden of depression among older women: the effect of onset, persistence, and mortality over time

CONTEXT

The prevalence of depression is disproportionately higher in older women than men, yet the reasons for this sex difference are not clear.

OBJECTIVE

To determine whether the higher burden of depression among older women than men might be attributable to sex differences in the onset (ie, first or recurrent episodes) or persistence of depression and/or to differential mortality among those who are depressed.

DESIGN

Prospective cohort study.

SETTING

General community in greater New Haven, Connecticut, from March 23, 1998, to August 31, 2005.

PARTICIPANTS

A total of 754 persons, 70 years or older, who were evaluated at 18-month intervals for 72 months.

MAIN OUTCOME MEASURES

The 3 outcome states were depressed, nondepressed, and death, with scores of 20 or more and less than 20 on the Center for Epidemiological Studies Depression Scale denoting depressed and nondepressed, respectively. The association between sex and the likelihood of 6 possible transitions (namely, from nondepressed or depressed to nondepressed, depressed, or death) was evaluated over time.

RESULTS

The prevalence of depression was substantially higher among women than men at each of the 5 time points (P < .001). In most cases, transitions between the nondepressed and depressed states were characterized by moderate to large absolute changes in depression scores (ie, > or = 10 points). Adjusting for other demographic characteristics, women had a higher likelihood of transitioning from nondepressed to depressed (odds ratio, 2.02; 95% confidence interval, 1.39-2.94) and a lower likelihood of transitioning from depressed to nondepressed (odds ratio, 0.27; 95% confidence interval, 0.13-0.56) or death (odds ratio, 0.24; 95% confidence interval, 0.09-0.60).

CONCLUSION

Among older persons, the higher burden of depression in women than men seems to be attributable to a greater susceptibility to depression and, once depressed, to more persistent depression and a lower probability of death.

Risk factors for anxiety and depression in the elderly: a review

BACKGROUND

Although a number of studies have examined risk factors for anxiety and depression at a later age, there have been no systematic comparisons of risk profiles across studies. Knowledge on such risk profiles may further our understanding of both the etiology and early recognition of these highly prevalent disorders. This paper gives a comprehensive overview and compares risk factors associated with anxiety and depression in the elderly.

METHODS

The databases MEDLINE, PsycINFO and Sociological Abstracts were systematically searched, and relevant English-language articles from January 1995 to December 2005 were reviewed. Cross-sectional and longitudinal studies on risk factors in elderly from a community or primary care setting were included. The associations between risk factors and pure anxiety or depressive symptoms or disorders were summarized and compared.

RESULTS

The abstracted risk factors from studies on anxiety (N=17) and depression (N=71) were clustered into the categories biological, psychological and social. Although risk factors for anxiety and depression showed many similarities, some differences were found. Biological factors may be more important in predicting depression, and a differential effect of social factors on depression and anxiety was found.

LIMITATION

Due to a high heterogeneity between studies, no meta-analysis could be conducted.

CONCLUSIONS

There is considerable overlap between the risk profiles for anxiety and depression in the elderly, which suggests a dimensional approach on the interrelationship between anxiety and depression is more appropriate. To improve the recognition and preventive mental health programs, a clearer understanding of differentiating etiological factors will be needed.

Depression in the elderly: does family system play a role? A cross-sectional study

BACKGROUND

The most common geriatric psychiatric disorder is depression. The role of family systems in depression among the elderly has not been studied extensively. It has been suggested that urbanization promotes nucleation of family systems and a decrease in care and support for the elderly. We conducted this study in Karachi, a large urban city of Pakistan, to determine the relationship between the type of family system and depression. We also determined the prevalence of depression in the elderly, as well as correlation of depression with other important socio-demographic variables.

METHODS

A cross-sectional study was carried out in the premises of a tertiary care hospital in Karachi, Pakistan. Questionnaire based interviews were conducted among the elderly people visiting the hospital. Depression was assessed using the 15-item Geriatric Depression Scale.

RESULTS

Four hundred subjects aged 65 and above were interviewed. The age of majority of the subjects ranged from 65 to 74 years. Seventy eight percent of the subjects were male. The prevalence of depression was found to be 19.8%. Multiple logistic regression analysis revealed that the following were significant (p < 0.05) independent predictors of depression: nuclear family system, female sex, being single or divorced/widowed, unemployment and having a low level of education. The elderly living in a nuclear family system were 4.3 times more likely to suffer from depression than those living in a joint family system (AOR = 4.3 [95% CI = 2.4-7.6]).

CONCLUSION

The present study found that residing in a nuclear family system is a strong independent predictor of depression in the elderly. The prevalence of depression in the elderly population in our study was moderately high and a cause of concern. The transition in family systems towards nucleation may have a major deleterious effect on the physical and mental health of the elderly.