Social correlates of the dimensions of depression in the elderly

Functional disability and suicidal ideation in Korean older adults: the moderating role of socioeconomic status

OBJECTIVES

Although the relationship between functional disability and suicidal ideation among older adults has been well documented, limited research exists regarding how socioeconomic status might moderate the relationship between functional disability and suicidal ideation. The objective of this study is to identify the relationship between functional disability and suicidal ideation and assess how SES moderates this relationship among Korean older adults.

METHODS

Using data from wave 3 of the Korean Retirement and Income Study, this study has conducted a linear regression analysis with interaction terms.

RESULTS

There are three main findings. First, the main effects of Activities of Daily Living, Instrumental Activities of Daily Living, and economic status on suicidal ideation were identified. Second, functional disability is identified as a serious risk factor for suicidal ideation among Korean older individuals who express dissatisfaction with their economic circumstances. Last, the moderating effect of economic condition and education on the relationship between functional disability and suicidal ideation exhibited some differences.

CONCLUSION

This study suggests that the interactions of functional disability and economic status yield a significant predictive effect on suicidal ideation in South Korea.

Men who have sex with men were more depressed than their counterparts because of lower social support and higher loneliness: A comparative survey among Chinese university students

BACKGROUND

Poor mental health is prevalent among men who have sex with men (MSM), including MSM university students (MSMUS), causing a significant burden on their health and society. The study aimed to compare the difference in levels of depressive symptoms between Chinese MSMUS and non-MSMUS and test the mediating roles of social support and loneliness in the relationship between MSM status and depressive symptoms among male university students.

METHODS

From June to October 2018, a total of 305 MSMUS and 2447 non-MSMUS from two cities in Sichuan province (China) were investigated using questionnaires.

RESULTS

The proportion of depression in the MSMUS and non-MSMUS groups was 54.1 % and 36.4 %, respectively. MSM status, social support, and loneliness were all significantly associated with depressive symptoms among Chinese university students. Structural equation modelling showed that the association between MSM status and depressive symptoms was partially mediated by three indirect paths, including 1) via social support (mediated proportion = 19.4 %), 2) via loneliness (mediated proportion = 19.3 %), and 3) via social support and then loneliness (mediated proportion = 16.1 %).

CONCLUSIONS

Depression was prevalent among university students in China, especially MSMUS. The findings increased our understanding of the mediating roles of social support and loneliness in the link between MSM status and depressive symptoms among Chinese male university students, which have great implications for designing interventions to improve their mental health.

LIMITATION

The cross-sectional study design limited causal inferences.

Psychometric Validation and Setting Cutoff Point for the Persian Version of Mindful Self-Care Scale (MSCS) Among Older Adults

Mindful self-care is a valuable activity that contributes to old people's independence and self-control and its development is in line with the duties of social workers. This study aimed to validate the mindful self-care scale (MSCS) for Iranian old people and was performed on old people living in the community of Shiraz, Iran. This cross-sectional study was conducted on old people living in the community who met the inclusion criteria in Shiraz, Iran. After linguistic validation of the Persian version of MSCS with 36 items, face, and content validity were determined. Then the first part of construct validity was conducted using a kurtosis test, and exploratory factor analysis with the first sample (n = 250). After selecting the appropriate items, confirmatory factor analysis was assessed with the second sample (n = 250). Scale reliability was also evaluated. The optimal cut-off points were obtained by calculating the area under the curve (AUC). SPSS version 23 was used for further data analysis, while confirmatory factor analysis was conducted using AMOS version 24. Exploratory factor analysis loaded only 24 items with four factors. The modified second-order confirmatory factor analysis model displayed a good fit (RMSEA = 0.04; CFI = 0.90; GFI = 0.90). Cronbach's alpha coefficient of MSCS with 24 items was .94. The cut-off points were 38, 11, 23, and 17 for factors of resilience, goal achievement, supportive relationship, and self-care respectively, and 90 for the whole instrument. The study found that the MSCS short form with 24 items is valid and reliable in the Iranian elderly population, making it an effective tool for mental self-care screening and a practical tool for social workers. However, the study recommends repeating the study in other cities of Iran to generalize the findings.

Empathic Accuracy and Shared Depressive Symptoms in Close Relationships

Empathic accuracy, the ability to accurately understand others' emotions, is typically viewed as beneficial for mental health. However, empathic accuracy may be problematic when a close relational partner is depressed because it promotes shared depression. Across two studies, we measured empathic accuracy using laboratory tasks that capture the ability to rate others' emotional valence accurately over time: first, in a sample of 156 neurotypical married couples (Study 1; Total N=312), and then in a sample of 102 informal caregivers of individuals with dementia (Study 2). Across both studies, the association between empathic accuracy and depressive symptoms varied as a function of a partner's level of depressive symptoms. Greater empathic accuracy was associated with (a) fewer depressive symptoms when a partner lacked depressive symptoms, but (b) more depressive symptoms when a partner had high levels of depressive symptoms. Accurately detecting changes in others' emotional valence may underpin shared depressive symptoms.

Ambient air pollution exposure and depressive symptoms: Findings from the French CONSTANCES cohort

BACKGROUND AND AIM

Few studies have reported the association between air pollution exposure with different dimensions of depression. We aimed to explore this association across different dimensions of depressive symptoms in a large population.

METHODS

Data from the enrollment phase of the French CONSTANCES cohort (2012-2020) were analyzed cross-sectionally. Annual concentrations of particulate matter with a diameter < 2.5 µm (PM_2.5), black carbon (BC), and nitrogen dioxide (NO₂) from the land-use regression models were assigned to the residential addresses of participants. Total depressive symptoms and its four dimensions (depressed affect, disturbed interpersonal relations, low positive affect, somatic complaints) were measured using Centre of Epidemiologic Studies Depression questionnaire (CES-D). We reported results of negative binomial regression models (reported as Incidence Rate Ratio (IRR) and 95 % confidence interval (CI) for an interquartile range (IQR) increase in exposure), for each pollutant separately. Stratified analyses were performed by sex, income, family status, education, and neighborhood deprivation.

RESULTS

The study included 123,754 participants (mean age, 46.50 ± 13.61 years; 52.4 % women). The mean concentration of PM_2.5, BC and NO₂ were 17.14 µg/m³ (IQR = 4.89), 1.82 10^-5/m (IQR = 0.88) and 26.58 µg/m³ (IQR = 17.41) respectively. Exposures to PM_2.5, BC and NO₂ were significantly associated with a higher CES-D total (IRR = 1.022; 95 % CI = 1.002: 1.042, IRR = 1.027; 95 % CI = 1.013: 1.040, and IRR = 1.029; 95 % CI = 1.015: 1.042 respectively), and with depressed affect, and somatic complaints. For all pollutants, a higher estimate was observed for depressed affect. We found stronger adverse associations for men, lower-income participants, low and middle education groups, those living in highly deprived areas, and single participants.

CONCLUSION

Our finding could assist the exploration of the etiological pathway of air pollution on depression and also considering primary prevention strategies in the areas with air pollution.

Age-period-cohort analysis of depression trends: are depressive symptoms increasing across generations in Germany?

Several studies have examined trends in depression, but only few have explicitly considered possible generational differences. I examined changes in the burden of depressive symptoms between 2002 and 2017 according to age, time period and birth cohort in Germany. I used population-based data drawn from the German Aging Survey (N = 33,723, 54% female, ages 40 +) from 2002, 2008, 2011, 2014, and 2017. Depressive symptoms were measured via the CES-D 15. Hierarchical age-period-cohort models were used to examine trends in depression. I found that depressive symptoms changed across age, time period and birth cohorts. While there was a general decrease across time periods, strong evidence for a U-shaped cohort effect was also found: Younger generations, beginning with cohorts born after the World War II, increasingly report more depressive symptoms than older generations. This U-shaped cohort trend appeared most pronounced for the somatic symptoms subscale. Contrarily, only minimal cohort differences were found regarding the positive affect subscale. Therefore, depressive symptoms, and especially somatic symptoms, seem to increase in more recent birth cohorts in Germany, who might thus be at risk to experience more mental health problems in the future. Potential reasons for these trends and the generalizability of the results to other countries should be investigated by future studies.

Dyadic Links Between Health Changes and Well-Being: The Role of Non-Spousal Confidants

Although the marital relationship is often the primary source of emotional support in adulthood, sole reliance on the spouse to discuss health-related issues may be harmful to the well-being of both partners. The first aim of this study was to examine whether declines in health during later life would be associated with poorer psychological well-being in self and partner. We further investigated whether declining health would have a stronger impact on own and partner psychological well-being in the absence of non-spousal health confidants. Longitudinal actor-partner interdependence models (APIMs) were used to test both hypotheses with dyadic data from Wave 2 (2010-2011) and Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Contrary to prediction, increased anxiety following spousal declines in gait speed and cognitive function occurred for those whose spouse did (rather than did not) have additional health confidants. A much fuller understanding is needed in regard to whether close relationships provide resources or present unwanted complications to dyadic coping, and the processes by which effects occur.

The Mediation Effect of Health Literacy on Social Support with Exchange and Depression in Community-Dwelling Middle-Aged and Older People in Taiwan

The proportion of the world’s population that are over 60 years old is increasing rapidly. The physical and mental health of older people is affected by depression. Health literacy is a major determinant of health and healthcare for the aging; middle-aged and older people with high health literacy are more likely to maintain a healthy lifestyle, and control or manage their chronic diseases. Therefore, this study explored the relationship between health literacy, social support with exchange, and depression, in middle-aged and older adults in the community, using data from the 2015 Taiwan Longitudinal Study on Aging (TLSA) database. Of the 7636 participants, 1481 (19.4%) were middle-aged or older persons with depression symptoms. We found age, gender, and education level to be significantly related to health literacy status, social support with exchange, and depression. Health literacy was positively correlated with depression and social exchange in social support with exchange, whereas the emotional support component of social support with exchange was negatively correlated with depression. Regression-based process analysis was used to verify the mediation effect of health literacy. Our results indicated that when health literacy was entered into the regression model (a × b path), the effect of social exchange on depression was insignificant (c′ = −0.01, p = 0.84), indicating a complete mediation effect. These findings suggest that improving health literacy may offset the impact of social support with exchange on depression, and lead to the mitigation of depression in middle-aged and older people in Taiwanese communities.

Predicting depression among the elderly by stressful life events and coping strategies

Background and Aim:

Aging is a stage during which stressful events occur frequently. The method of coping with this stress can play an important role in an elderly's mental health. The present study aimed at investigating the role of coping strategies in stressful life events associated with depression.

Method:

The present study was a correlational one conducted by structural equation analysis. As many as 841 elderly people were selected from the general population by adopting a cluster sampling method. Beck's Depression Inventory as well as strategies of coping with stress and stressful events were applied.

Results:

The model test, analyzed by AMOS by using path analysis, indicated that age is positively associated with stressful life events and depression. The “stressful life events” variable is directly and indirectly associated with depression. The emotion-focused coping strategies were positively associated with depression, and problem-focused coping strategies were negatively associated with depression.

Conclusion:

As an individual grows older and experiences stressful life events, his/her depression increases. Elderly people with problem-focused coping strategies are likely to experience less depression.

Exploring Language Learning as a Potential Tool against Cognitive Impairment in Late-Life Depression: Two Meta-Analyses and Suggestions for Future Research

Late-life depression (LLD) affects about an eighth of community-dwelling seniors. LLD impacts well-being, with loneliness and small social networks being typical. It has also been linked to cognitive dysfunction and an increased risk of developing dementia. Safety and efficacy of pharmacological treatments for LLD have been debated, and cognitive dysfunction often persists even after remission. Various cognitive interventions have been proposed for LLD. Among these, one has received special attention: foreign language learning could serve as a social intervention that simultaneously targets brain structures affected in LLD. Lifelong bilingualism may significantly delay the onset of cognitive impairment symptoms by boosting cognitive reserve. Even late-life foreign language learning without lifelong bilingualism can train cognitive flexibility. It is then counterintuitive that the effects of language learning on LLD have never been examined. In order to create a theoretical basis for further interdisciplinary research, this paper presents a status quo of current work through two meta-analyses investigating cognitive functioning in LLD on the one hand and in senior bilinguals or seniors following a language course on the other hand. While LLD was consistently associated with cognitive dysfunction, inconsistent results were found for bilingualism and language learners. Possible reasons for this and suggestions for future research are subsequently discussed.

Structural Social Support and Changes in Depression During the Retirement Transition: “I Get by With a Little Help from My Friends”

Objectives

This study evaluated whether (a) retirement was associated with increased depressive symptoms, (b) four sources social support were associated with decreased depressive symptoms, and (c) whether the relationship between retirement and depressive symptoms varied across four sources social support.

Method

Health and Retirement Study data were used to assess whether four measures of structural support moderated the association between transitioning to full retirement (relative to remaining in full-time work) and symptoms of depression.

Results

Results from two-stage mixed-effects multilevel models indicated (a) on average retirement was associated with a small but significant increase in depressive symptoms after adjusting for preretirement social support, (b) on average, social support not associated with changes in symptoms of depression, but (c) social support from friends moderates the association between retirement and symptoms of depression such that at low levels of social support, retirement was associated with a sizeable increase in depressive symptoms, but this association decreased as level of social support from friends increased.

Discussion

Results suggest people with low levels of social support may benefit from actively cultivating friendships in retirement to help mitigate some of deleterious effects of retirement.

Depression Symptom Patterns and Social Correlates among Chinese Americans

The aim of this study is to examine and compare the depression symptoms pattern and social correlates in three groups: foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. This study used data from the Collaborative Psychiatric Epidemiology Surveys (CPES). The study sample consists of 599 Chinese Americans (468 for the foreign-born and 121 for the US-born) and 4032 non-Hispanic whites. Factor analysis was used to examine the depression symptom patterns by each subgroup. Four depression symptoms dimensions were examined: negative affect, somatic symptoms, cognitive symptoms, and suicidality. Logistic regression was used to investigate the effects of sociodemographic (age, gender, marital status, and education), physical health condition, and social relational factors (supports from and conflict with family and friends) on specific types of depression symptoms separately for the three subgroups. The findings showed little differences in depression symptom patterns but clear variation in the social correlates to the four depression dimensions across the three ethnocultural groups, foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. Clinicians should take into account the sociocultural factors of patients when making diagnosis and suggesting treatments. In addition, psychiatrists, psychologists, or other mental health service providers should offer treatment and coping suggestions based on the specific symptom dimensions of patients, and patients’ ethnocultural backgrounds.

Impact of family characteristics by marital status of cohabitating adult children on depression among Korean older adults

AIM

To identify the association between different living arrangements of intergenerational household composition and depression in older adults.

METHODS

Data from the Korea Longitudinal Study of Aging, the first to fourth waves, were used. Using the first wave as baseline, our analysis included 5046 participants aged ≥60 years with at least one living child. Depression was measured using the 10-item Center for Epidemiological Studies Depression scale. Factors investigated included living arrangements according to household composition and the marital status of a cohabiting adult child. A generalized estimating equation with the logit link for binary outcomes was used to examine the association between living arrangements and depression.

RESULTS

Compared with the older adults living with a married child and grandchildren, those living alone, those living with an unmarried child, and those living with an unmarried child and grandchildren were more likely to have depression (OR 1.41, 95% CI 1.13-1.75; OR 1.40, 95% CI 1.18-1.66; OR 1.60, 95% CI 1.27-2.01). In particular, women were more likely to have depression than men in the association between living arrangements and depression.

CONCLUSIONS

Efforts should be made to provide social services for older adults living alone and those living with an unmarried child in a two-/three-generation family, in particular, for those who are female. Geriatr Gerontol Int 2017; 17: 2527-2536.

More than eight in every nineteen inmates were living with depression at prisons of Northwest Amhara Regional State, Ethiopia, a cross sectional study design

BACKGROUND

Mental health is the greatest challenges for the current and future generations. Worldwide, out of the 66 million people suffering from depression; majority (85%) were from low and middle income countries. The prevalence was more common among the prisons population than the community. However, a worldwide consideration given to the problems is very low, particularly for prisoners.

METHODS

To assess level of depression and associated factors among prisoners in prisons of Northwest Amhara Regional State, Ethiopia, Institutional based cross sectional study was employed on 727 prisoners selected by multistage random sampling from three prisons of northwest Amhara. Patient Health Questionnaire (PHQ-9) was used to assess an individuals' depression level. The reliability of the tool was checked by Cronbach's Alpha (yielding value of 0.841). Multivariable logistic regression was done to identify factors associated with depression after Hosmer and lemeshow goodness of fit test was used for model fitness.

RESULTS

Of the total prisoners participated (649), 284 (43.8%; 95% CI: 39.90, 47.67%) had symptoms of depression. Detainees' satisfaction level about life before imprisonment, belief about their life after imprisonment, plan to commit suicide, social support and types of prisons were significantly associated with depression.

CONCLUSIONS

Depression level among detainees was found to be high. Thus, providing training to scale up satisfaction of prisoners, on how to cope up with environment just before imprisonment and release, and treating prisoners will improve the problem.

Effects of social integration on depressive symptoms in Korea: analysis from the Korean Longitudinal Study of Aging (2006–12)

Objectives The effects of a range of types of social integration and patterns of change in social integration over time were examined directly in relation to depressive symptoms in a large sample of the Korean population aged ≥45 years. Methods Data from the Korean Longitudinal Study of Aging (KLoSA) between 2006 and 2012 were assessed using longitudinal data analysis. We included 10 242 research subjects at baseline (2006) and based the primary analysis on generalised linear mixed models to examine association between social integration and depressive symptom. Results The odds ratio (OR) for depressive symptoms in individuals at the lowest level of social integration was 1.539-fold higher (95% confidence interval (CI) 1.360–1.742) that that for those at highest level of social integration. Results of subgroup analysis according to gender revealed a similar trend. A five-class linear solution fit the data best; Class 1 (lowest constant social integration level, 10.5% of the sample) was significantly associated with the highest risk of depressive symptoms (OR 1.933, 95% CI 1.706–2.190). Conclusions The results of the present study provide a scientific basis for the specific association between the level of social integration and changes in social integration pattern with the risk of depressive symptoms in current practice. Therefore, interventions to provide emotional support for older adults via social integration may be important to protect against depressive symptoms. What is known about the topic? Although there has been considerable discussion about social integration among old adults, few studies related to effect of social integration on depression have been conducted. What does this paper add? The findings of the present study indicate that a high level of social integration is inversely related to depressive symptoms and is also associated with a substantial positive effect on depressive symptoms among individuals aged ≥45 years. What are the implications for practitioners? This paper provides evidence showing that it is useful to assess indicators of both social and emotional loneliness, which have been theorised to correspond to low social integration.

The impact of living arrangements on quality of life among Korean elderly: findings from the Korean Longitudinal Study of Aging (2006-2012)

PURPOSE

To investigate the impact of different living arrangements on quality of life (QoL) and health-related quality of life (HRQoL) in the elderly.

METHODS

We used data from the first to fourth wave of the Korean Longitudinal Study of Aging. Using the first wave as a baseline, the data included 5050 individuals aged 60 years and older with at least one living child. QoL and HRQoL were measured using a visual analogue scale developed by the Korean Labor Institute that bears similarity to the EQ-VAS. Living arrangements were categorized based on household composition (single household, one-generation household, two-generation household, and three-generation household) and the marital status of a cohabiting adult child. A generalized estimating equation was used to examine the association between living arrangements and QoL/HRQoL.

RESULTS

Compared to elderly individuals living in three-generation families with a married child, those in a single household (QoL: β = -2.67 [P = 0.001]; HRQoL: β = -2.24 [P = 0.007]), those living in a three-generation family with an unmarried adult child (QoL: β = -5.19 [P < 0.0001]; HRQoL: β = -3.41 [P < 0.0001]), and those living in a two-generation family with an unmarried adult child (QoL: β = -2.88 [P < 0.0001]; HRQoL: β = -2.80 [P < 0.0001]) were more likely to have lower QoL and HRQoL. These associations were particularly strong for women and individuals in the lowest equivalent household income group.

CONCLUSION

It is necessary to devise government programs not only for elderly individuals living alone, but also for those living with an unmarried adult child; elderly persons who are female and part of the lowest equivalent household income group must receive particular attention.

Depression in Older Ethnic Groups

The generality of George's model of the social precursors of depression was tested in a sample of older persons ( N = 803) from three ethnic groups: U.S.-born African Americans, African Caribbeans, and U.S.-born European Americans. The social precursors model includes demographic variables, early events and achievements, later events and achievements, social integration, vulnerability and protective factors, and provoking agents and coping efforts. Zero-order correlations indicated that nearly all the predictor variables were significantly associated with depression. A test of the overall model with all six stages was followed by separate regressions for each ethnic group. Four of the six stages of the model contributed unique variance to the prediction of depressed affect in European Americans but only two in the case of African Americans and African Caribbeans. The most robust and consistent predictor of depression was the sixth-stage variables of stress and emotion regulation.

Implications of Non-Response of Older Women to a Short form of the Center for Epidemiologic Studies Depression Scale

The Center for Epidemiologic Studies Depression Scale (CES-D) is frequently used in epidemiological surveys to screen for depression, especially among older adults. This article addresses the problem of non-completion of a short form of the CES-D (CESD-10) in a mailed survey of 73- to 78-year-old women enrolled in the Australian Longitudinal Study on Women's Health. Completers of the CESD-10 had more education, found it easier to manage on available income and reported better physical and mental health. The Medical Outcomes Study Short Form Health Survey (SF-36) scores for non-completers were intermediate between those for women classified as depressed and not depressed using the CESD-10. Indicators of depression had an inverted U-shaped relationship with the number of missing CESD-10 items and were most frequent for women with two to seven items missing. Future research should pay particular attention to the level of missing data in depression scales and report its potential impact on estimates of depression.

Social, Health, and Age Differences Associated with Depressive Disorders in Women with Rheumatoid Arthritis

Depression in women with rheumatoid arthritis (RA) may be related to social role experiences, physical health, and age. The purpose of this study was to examine the social and health factors contributing to depression in two age groups of women with RA. One-hundred and thirty-eight midlife and late-life women with a diagnosis of RA participated in this cross sectional survey study. Multiple regression analysis indicated that social role balance, functional status, number of co-existing health problems, and age were significant predictors of depression in midlife and late-life women with RA. Role balance was the strongest factor contributing to a woman's depression score. Compared to midlife women, late-life women reported significantly higher role balance and lower depression scores, despite poorer functional status and more concomitant health problems.

Is the APOE ∊4 Allele a Risk to Person-Environment Fit?

This study uses Lawton’s model of “the good life” to examine whether the Apolipoprote in E-∊4 genotype functions as a risk factor not only for specific diseases but also for a misfit between elders’ personal needs and their physical and social environments. A biracial cohort of communitydwelling elders from five North Carolina Piedmont counties was assessed annually for 10 years. Six-year survivors (N = 2,076) were genotyped for this retrospective-prospective cohort study. Compared to those in whom this allele was absent, participants with the 4 allele were not different in social or residential resources, social behavioral competence, or perceived quality of resources. Exposed elders had an excess 10-year adjusted risk of institutionalization of 1.72 (95% CI = 1.29, 2.29), totally mediated by cognitive problems. The threat of the APOE 4 genotype to person-environment fit is mediated by cognitive problems, a finding that has focused but important implications for residential decision making in late life.

Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults

OBJECTIVES

To examine the association between life-space mobility and different dimensions of depressive symptoms among older community-dwelling people.

METHODS

Cross-sectional analyses of baseline data of the 'Life-Space Mobility in Old Age' cohort study were carried out. The participants were community-dwelling women and men aged 75-90 years (N = 848). Data were gathered via structured interviews in participants' home. Life-space mobility (the University of Alabama at Birmingham (UAB) Life-Space Assessment - questionnaire) and depressive symptoms (Centre for Epidemiological Studies Depression Scale, CES-D) were assessed. Other factors examined included sociodemographic factors, difficulties walking 500 m, number of chronic diseases and the sense of autonomy in participation outdoors (subscale of Impact on Participation and Autonomy questionnaire).

RESULTS

Poorer life-space mobility was associated with higher prevalence of different dimensions of depressive symptoms. The associations were partially mediated through walking difficulties, health and the sense of autonomy in participation outdoor activities.

CONCLUSION

Poorer life-space mobility interrelates with higher probability for depressive symptoms, thus compromising older adults' mental wellbeing. A focus on older adults' life-space mobility may assist early identification of persons, who have elevated risk for depressive symptoms. The association between life-space mobility and depressive symptoms should be studied further utilizing longitudinal study designs to examine temporality and potential causality.

Association Between Depressive Symptoms, Multiple Dimensions of Depression, and Elder Abuse: A Cross-Sectional, Population-Based Analysis of Older Adults in Urban Chicago

OBJECTIVE

Depression is conceptualized as both a risk factor for and a consequence of elder abuse; however, current research is equivocal. This study examined associations between elder abuse and dimensions of depressive symptoms in older adults.

METHOD

Participants were 10,419 older adults enrolled in theChicago Health and Aging Project (CHAP), a population-based study of older adults. Regression was used to determine the relationships between depressive symptoms, depression dimensions, and abuse variables.

RESULTS

Depressive symptoms were consistently associated with elder abuse. Participants in the highest tertile of depressive symptoms were twice as likely to have confirmed abuse with a perpetrator (odds ratio = 2.07, 95% confidence interval = [1.21, 3.52], p = .008). Elder abuse subtypes and depression dimensions were differentially associated.

DISCUSSION

These findings highlight the importance of routine depression screening in older adults as a component of abuse prevention and intervention. They also provide profiles of depressive symptoms that may more accurately characterize risk for specific types of abuse.

The Impact of Sleep Disturbance on the Association Between Stressful Life Events and Depressive Symptoms

OBJECTIVES

Sleep problems are common across the adult life span and may exacerbate depressive symptoms and the effect of common risk factors for depressive symptoms such as life stress. We examine sleep disturbance as a moderator of the association between stressful life events and depressive symptoms across five waves (25 years) of the nationally representative, longitudinal American Changing Lives Study.

METHOD

The sample includes 3,597 adults aged 25 years or older who were surveyed up to five times over 25 years. Multilevel models were run to examine between- and within-person variability in sleep disturbance and life event stress as predictors of depressive symptoms, and an interaction to test sleep disturbance as a moderator is included in a second step.

RESULTS

Life events and sleep disturbance were associated with elevated depressive symptoms at the between- and within-person levels. A significant sleep disturbance by interaction of life events was found, indicating that when individuals experienced an above average number of life events and slept more restlessly than usual, they had a higher risk for depressive symptoms than individuals who experienced above average stress but slept well.

DISCUSSION

Sleeping restfully may allow individuals the rejuvenation needed to manage stress adaptively and reduce depressive symptom burden.

NEW AND EMERGING PROFESSIONALS: Does Race Moderate Social Support and Psychological Distress Among Rural Older Adults?

Greater social support is associated with decreased psychological distress among older adults. Researchers have found racial differences in psychological distress. Might race moderate social support and psychological distress? The authors hypothesized African American collectivistic values could increase the importance of social support. Participants were rural adults aged 60 and older (N = 100). Multiple regression analyses controlled for health, income, education, and sex. Race moderated satisfaction with social support and psychological distress. However, greater satisfaction predicted less psychological distress among Caucasians while it was not associated with African Americans' distress in this sample. Achieving satisfaction with social support may be particularly important for Caucasians receiving therapy. Interventions may also address strategies to improve physical health, emotional support, and quality of social support, which significantly predicted psychological distress for both groups.

Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study

BACKGROUND

The quality and quantity of social relationships are associated with depression but there is less evidence regarding which aspects of social relationships are most predictive. We evaluated the relative magnitude and independence of the association of four social relationship domains with major depressive disorder and depressive symptoms.

METHODS

We analyzed a cross-sectional telephone interview and postal survey of a probability sample of adults living in Switzerland (N=12,286). Twelve-month major depressive disorder was assessed via structured interview over the telephone using the Composite International Diagnostic Interview (CIDI). The postal survey assessed depressive symptoms as well as variables representing emotional support, tangible support, social integration, and loneliness.

RESULTS

Each individual social relationship domain was associated with both outcome measures, but in multivariate models being lonely and perceiving unmet emotional support had the largest and most consistent associations across depression outcomes (incidence rate ratios ranging from 1.55-9.97 for loneliness and from 1.23-1.40 for unmet support, p's<0.05). All social relationship domains except marital status were independently associated with depressive symptoms whereas only loneliness and unmet support were associated with depressive disorder.

CONCLUSIONS

Perceived quality and frequency of social relationships are associated with clinical depression and depressive symptoms across a wide adult age spectrum. This study extends prior work linking loneliness to depression by showing that a broad range of social relationship domains are associated with psychological well-being.

Social integration, social support and mortality in the US National Health Interview Survey

BACKGROUND

Social relationship quantity and quality are associated with mortality, but it is unclear whether each relationship dimension is equally important for longevity and whether these associations are sensitive to baseline health status.

METHODS

This study examined the individual and joint associations of relationship quantity (measured using a social integration score) and quality (measured by perceived social support) with mortality in a representative US sample (n = 30,574). The study also evaluated whether these associations were consistent across individuals with and without diagnosed chronic illness and whether they were independent of socioeconomic status (SES; education, income, employment, and wealth). Baseline data were collected in 2001 and were linked to vital status records 5 years later (1836 deaths).

RESULTS

Both social integration and social support were individually related to mortality (hazard ratios [HRs] = 0.83 [95% confidence interval {CI} = 0.80-0.85] and HR = 0.94 [95% CI = 0.89-0.98], respectively). However, in multivariate models including demographic and SES variables, social integration (HR = 0.86, 95% CI = 0.83-0.89) but not social support (HR = 1.03, 95% CI = 0.98-1.08) was associated with mortality. The social integration association was linear and consistent across baseline health status and men and women.

CONCLUSIONS

Social integration but not social support was independently associated with mortality in the US sample. This association was consistent across baseline health status and not accounted for by SES.

Dealing with missing data in the Center for Epidemiologic Studies Depression self-report scale: a study based on the French E3N cohort

BACKGROUND

The Center for Epidemiologic Studies - Depression scale (CES-D) is a validated tool commonly used to screen depressive symptoms. As with any self-administered questionnaire, missing data are frequently observed and can strongly bias any inference. The objective of this study was to investigate the best approach for handling missing data in the CES-D scale.

METHODS

Among the 71,412 women from the French E3N prospective cohort (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale) who returned the questionnaire comprising the CES-D scale in 2005, 45% had missing values in the scale. The reasons for failure to complete certain items were investigated by semi-directive interviews on a random sample of 204 participants. The prevalence of high depressive symptoms (score ≥ 16, hDS) was estimated after applying various methods for ignorable missing data including multiple imputation using imputation models with CES-D items with or without covariates. The accuracy of imputation models was investigated. Various scenarios of nonignorable missing data mechanisms were investigated by a sensitivity analysis based on the mixture modelling approach.

RESULTS

The interviews showed that participants were not reluctant to answer the CES-D scale. Possible reasons for nonresponse were identified. The prevalence of hDS among complete responders was 26.1%. After multiple imputation, the prevalence was 28.6%, 29.8% and 31.7% for women presenting up to 4, 10 and 20 missing values, respectively. The estimates were robust to the various imputation models investigated and to the scenarios of nonignorable missing data.

CONCLUSIONS

The CES-D scale can easily be used in large cohorts even in the presence of missing data. Based on the results from both a qualitative study and a sensitivity analysis under various scenarios of missing data mechanism in a population of women, missing data mechanism does not appear to be nonignorable and estimates are robust to departures from ignorability. Multiple imputation is recommended to reliably handle missing data in the CES-D scale.

Social capital and psychological distress of elderly in Japanese rural communities

The growing recognition of the social determinants of health has stimulated research on social capital and mental health. We explored new empirical evidence regarding whether social capital was a determinant of psychological distress. Baseline surveys examining psychological distress were conducted in two towns in 2006–2007 (participation rates for those aged 20 or over were 27.6 per cent, 6.1 per cent). We also conducted follow-up surveys in 2008 to capture the social capital measured by trust. By linking these data and excluding the missing data, 141 males and 234 females remained as the subjects of our study. Results showed that the odds ratios of psychological distress was higher in groups with low social capital measured by trust (odds ratio 2.17; 95 per cent CI, 1.40-3.36), than those in groups with high social capital. Further, we examined the interaction effect of social capital and social support. The odds ratios of psychological distress was higher in groups with some social support/lower trust (odds ratio 2.21; 95 per cent CI, 1.36-3.58) or no social support/lower trust (odds ratio 2.07; 95 per cent CI, 1.06–4.05), than those in groups with some social support/higher trust. These findings reinforce the hypothesized discussion regarding pathways from social capital to psychological distress via supportive relationships.

The role of resources and appraisals in predicting burden among Latina and non-Hispanic white female caregivers: a test of an expanded socio-cultural model of stress and coping

OBJECTIVES

The goal of this study is to propose and evaluate an expanded socio-cultural model of stress and coping that examines the role of culturally situated factors, such as coping abilities and the caregiver's self-efficacy beliefs, as mediators of outcomes among Latina and non-Hispanic white female caregivers.

METHODS

Using baseline data from 89 Latina and 96 non-Hispanic white female caregivers enrolled in an intervention study in the San Francisco area, exogenous and mediating factors were regressed on levels of burden among self-identified caregivers of older adults with Alzheimer's disease or another form of dementia.

RESULTS

Results from structural equation modeling provided empirical evidence for a model in which the effects of ethnicity and other background variables are mediated through coping resources and appraisals of self-efficacy for managing care.

CONCLUSION

This study adds to the existing literature that underscores the importance of evaluating the role of culturally mediated values for their impact on mental health outcomes. This influence is not only due to structural factors that reflect the disadvantaged minority status of ethnically diverse caregivers (e.g. socioeconomic status), but also to their coping resources and their appraisal of being able to meet caregiving demands, as shaped by their perceptions about caregiving. Future research is encouraged to explore the role of other culturally mediated factors that may affect mental health outcomes among caregivers of relatives with dementia.

What's Wrong with Research Literatures? And how to Make Them Right

Meta-analysis is now the accepted procedure for summarizing research literatures in areas of applied psychology. Because of the bias for publishing statistically significant findings, while usually rejecting nonsignificant results, our research literatures yield misleading answers to important quantitative questions (e.g., How much better is the average psychotherapy patient relative to a comparable group of untreated controls? How much more aggressive are children who watch a great deal of violent TV than children who watch little or no violence on TV?). While all such research literatures provide overly optimistic meta-analytic estimates, exactly how practically important are these overestimates? Three studies testing the literature on implementation intentions finds only slightly elevated effectiveness estimates. Conversely, in three studies another growing research literature (the efficacy of remote intercessory prayer) is found to be misleading and is in all likelihood not a real effect (i.e., our three studies suggest the literature likely consists of Type I errors). Rules of thumb to predict which research literatures are likely invalid are offered. Finally, revised publication and data analysis procedures to generate unbiased research literatures in the future are examined.

A comparison of rural and urban older adults in Iowa on specific markers of successful aging

This study examines the differences between rural and urban older adults on level of life satisfaction and depressive symptoms, focusing on the effect of social support. Data were collected through structured interviews at senior centers and senior meal sites in eastern and southeastern Iowa. The Duke Social Support Index (DSSI), the Life Satisfaction Index-Z (LSI-Z), and the Geriatric Depression Scale 15 (GDS15) were used. Correlations (Pearson's r), independent sample t-tests, and multiple regression were computed. Findings indicated that urban residents reported more depressive symptoms, as compared to rural residents. Subjective level of social support was a stronger predictor of life satisfaction and was more negatively related to depressive symptoms among rural than among urban older adults. Results suggest that social workers who work with aging people need to be aware of rural-urban differences in mental health. Furthermore, social workers need to have knowledge of older adults' social networks and work to ensure greater opportunity for social interaction.

The influence of depression on sexual risk reduction and STD infection in a controlled, randomized intervention trial

BACKGROUND

A randomized controlled trial of SAFE, a cognitive/behavioral intervention, revealed that it significantly reduces reinfection and behavioral risks among participants compared with controls. However, studies suggest that depression may moderate intervention efficacy among affected persons because of impaired information processing, failure to recognize risk, or inability to change behavior.

GOAL

We evaluated SAFE efficacy among depressed and nondepressed Mexican- and African American women after comparing initial risk factors by depression status. We further explored intervention effects in moderately and severely depressed women.

STUDY DESIGN

We stratified 477 participants (249 intervention, 228 controls) according to their depression status at baseline determined by CES-D scores. Using chi and multivariate logistic regression, we evaluated differences in reinfection and behavioral risk at 6-month, 12-month, and 1-year cumulative follow-ups between groups within baseline depression strata.

RESULTS

: At baseline, 74.4% of women were depressed and had significantly greater levels of behavioral risks than nondepressed women. At follow-up intervals, behavioral risks and reinfection rates were lower among intervention women compared with controls regardless of depression status. For example, at 1-year follow-up reinfection rates were 15.2% in nondepressed intervention women versus 21.4% in nondepressed controls (AOR = 0.6), and 18.6% in depressed intervention women versus 27.3% in depressed controls (AOR = 0.6). Moreover, reinfection was consistently lower among moderately and severely depressed intervention women than controls (moderately depressed: 19.3% vs. 27.2%, AOR = 0.6; severely depressed: 17.9% vs. 27.5%, AOR = 0.6).

CONCLUSIONS

Despite significantly greater behavioral risk among depressed women at baseline, SAFE was equally successful in reducing reinfection and high-risk behavior among depressed and nondepressed participants.

The Impact of Social Embarrassment on Caregiving Distress in a Multicultural Sample of Caregivers

The purpose of this study was to gauge the impact of social embarrassment on caregivers of Alzheimer's patients. Two hypotheses were tested: First, social embarrassment adds a unique component of distress to caregivers of Alzheimer's patients, controlling for other factors known to cause depression; second, the negativity of the embarrassment varies according to the caregiver's race/ethnicity. Using data from the Alzheimer's Disease Demonstration Grants to States program ( N = 1,183), the caregiver's perceived depression was regressed on culturally situated variables and a set of covariates that included characteristics of both caregiver and care receiver. Results indicate that social embarrassment exerts a substantial effect on caregiver depression, but the effect does not vary meaningfully across cultural groups. In addition to social embarrassment, the health of the caregiver, the certainty of the Alzheimer's diagnosis, and the caregiver's perceived duty to care all uniquely contribute to the caregiver's level of depression.

Social support and family functioning on psychological symptoms in elderly Chinese

The purpose of this study was to extend our knowledge about how social support and family functioning affect mental health, and to examine the buffering effects of support in the presence of health stressors. A random cluster sample of 507 elderly community people were surveyed with a structured questionnaire, which included the depression and anxiety subscale of the Chinese version of Symptom Checklist 90-R (SCL-90-R), Social Support Rating Scale (SSRS), Family Emotional Involvement and Criticism Scale (FEICS), Short Portable Mental Status Questionnaire (SPMSQ), and the Katz Activities of Daily Living Scale (KADL). Results revealed that women had more anxiety symptoms than men (mean=3.49; 95% CI: 3.02-3.95 versus mean=2.56; 95% CI: 2.27-2.85). Emotional support was more important than instrumental support for psychological symptoms. Family emotional involvement was inversely correlated to depression (r=-0.19) and anxiety (r=-0.22), while criticism was positively correlated to depression (r=0.29) and anxiety (r=0.31). Multivariate analysis revealed that women, impaired cognitive function, urban residents with chronic diseases, less emotional support, and more criticism from the family were associated with more depressive and anxiety symptoms. Family involvement had buffering effects on psychological symptoms for people with cognitive impairment and medical diseases. Our results imply that elderly people with mental symptoms and chronic medical diseases benefit more from family involvement.

Underlying factors in the association between depressed mood and mobility limitation in older people

BACKGROUND

Depressed mood may either precede mobility limitation or follow from mobility limitation.

OBJECTIVE

To compare mood status among people with manifest mobility limitation, those with preclinical mobility limitation and those without mobility limitation and investigate factors explaining the association between depressed mood and mobility limitation.

DESIGN

Cross-sectional.

SUBJECTS

645 community-living 75- to 81-year-old people.

METHODS

Depressed mood was assessed using the Centre for Epidemiologic Studies Depression Scale (CES-D, cut-off score 16); difficulty walking 500 m was assessed by self-report. Those reporting difficulty were categorised as having manifest mobility limitation. Those with no difficulty but reporting task modifications, such as reduced frequency of walking, were categorised as having preclinical mobility limitation. The association between depressed mood and mobility limitation was analysed using logistic regression analysis with gender, age, economic situation, the availability of a confidant, chronic conditions, and widespread pain as covariates.

RESULTS

Depressed mood was found in 34% of subjects with manifest mobility limitation, in 26% of those with preclinical mobility limitation, and in 13% of those without mobility limitation. The unadjusted odds ratio for depressed mood was 3.43 (95% CI 2.04-5.76) among subjects with manifest mobility limitation and 2.38 (95% CI 1.52-3.73) among those with preclinical mobility limitation, compared to those without mobility limitation. Adjustment for covariates reduced the risks to 2.10 (95% CI 1.15-3.82) and 1.99 (95% CI 1.24-3.20), respectively. Widespread pain explained 28% of the increased risk of depressed mood among those with manifest mobility limitation.

CONCLUSION

The dose-response relationship between depressed mood and mobility limitation suggests that both conditions may progress simultaneously and may share aetiology, at least in part. Pain may be an underlying factor in both depressed mood and mobility limitation.

How does functional disability affect depressive symptoms in late life? The role of perceived social support and psychological resources

This study examines the process whereby functional disability amplifies depressive symptoms through decreasing perceived social support and psychological resources. The study analyzed two waves of panel data (1986 to 1992) of a large sample of older adults from the National Institutes of Aging Established Populations for Epidemiologic Studies of the Elderly. The results of longitudinal change models and path analyses show that the perceived availability of a confidant, satisfaction with support, sense of control, and self-esteem mediate the effects of disability on increments in depressive symptoms in late life. Psychological resources play a dominant role in mediating the effects of functional impairment. Scales of sense of control and self-esteem account for 53 percent of the total effect of baseline disability and 43 percent of the total effect of changes in disability on changes in the CES-D depression scale. Self-esteem appears to be the strongest mediator.

Living alone and depression in Chinese older adults

Western literature has repeatedly indicated a strong relationship between living alone and depression among the aged population, however, studies among the Chinese population are scarce. In this paper, we examine whether the association between living alone and depression is independent of health status, social support and financial strain among Chinese older adults, and subsequently assess whether such association persists after adjusting these variables. Cross-sectional data drawn from the Hong Kong Population Census consisting of 2,003 Chinese elderly people aged 60 or over were analyzed. Chi-square tests and logistic regression analyses revealed that living alone results in higher levels of depressive symptoms for older women but not for older men. This relationship remained significant even when socio-demographic variables, health indicators, social support, and financial strains were adjusted; yet, the impact of living alone with depression disappeared when all variables were controlled. In summary, this paper is the first to report that living alone is an independent risk factor contributing to depression among Chinese older women, as well as identifying certain significant factors including social support and health indicators that can affect and explain the link between living alone and depression. Preventive measures and related issues were discussed.

Functional disability, disability transitions, and depressive symptoms in late life

OBJECTIVE

This article addresses how stable functional disability statuses and disability transitions are related to change in depressive symptoms in the elderly.

METHOD

The authors estimate longitudinal residual change models using two waves of data, 1986 and 1992, from the National Institute of Aging Established Populations for Epidemiologic Studies of the Elderly, Duke University.

RESULTS

Both stable disability statuses and transitions in disability statuses are significantly related to change in depressive symptoms (Center for Epidemiologic Studies depression scale [CES D]). Stable disability statuses in strength and mobility, instrumental activities of daily living (IADL) items and activities of daily living (ADL) items have increasing effects on increment in CES-D scores by the follow-up. The onset of disability has stronger effects on change in CES-D scores than recovery. These effects also differ by types of transitions in disability statuses.

DISCUSSION

The authors discuss alternative interpretations of the findings and methodological concerns and also suggest avenues for future research.

Linking race and well-being within a biopsychosocial framework: variation in subjective sleep quality in two racially diverse older adult samples

Differential life experiences associated with race may critically affect the balance between physical and psychological well-being. This study investigated an age-related and disease-related symptom, restless sleep, among older African American and white members of two sociodemographically matched cohorts, community-dwelling older adults and older adults with chronic renal failure undergoing maintenance dialysis therapy. Sleep behaviors reflect age-dependent and disease-dependent homeostatic and circadian state regulation but are also socioculturally patterned. As hypothesized, restless sleep was significantly more characteristic of the older adults in the chronic disease cohort. With non-renal health conditions, depressed mood, perceived health, medication use, and sociodemographic variables controlled, however, African Americans were significantly less likely than whites in the chronic disease cohort to report restless sleep. African American and white patients differed in their expression of public and private religiousness, which in turn were associated, respectively, with depressed mood and restless sleep complaint. In addition, we suggest that differences for African American and white patients in the environmental exposure of chronic dialysis therapy, including African Americans' greater social integration within the dialysis treatment setting, contributed to their being less at risk than their white peers for subjective perception of sleep decay, a marker of overall well-being.

Religious practice and depression among geriatric home care patients

OBJECTIVE

To examine the relationship between religious practice and depression in a sample of geriatric patients receiving homecare nursing services.

METHODS

Patients were sampled weekly for six months from all those aged 65 to 102, and newly enrolled in a visiting nurse agency (N = 130). Depression was assessed by home interviews using the SCID and HRSD. Patients reported their religious service participation prior to receiving homecare and currently. Health status, disability, pain, social support and history of depression were also assessed.

RESULTS

The current prevalence of DSM-IV Major Depressive Disorder (MDD) was significantly greater (p < .05), and depressive symptoms were more severe (p < .02), among those persons who had not attended religious services prior to receiving homecare. Logistic regression demonstrated that the effect of religious attendance remained significant when controlling for health status, disability, pain, social support and history of depression. A subsequent analysis compared three groups of patients. They were those who had: 1) Not attended religious services; 2) Stopped attending since homecare; 3) Continued attending. Data demonstrated significantly decreasing prevalence of MDD (p < .03) across the groups.

CONCLUSIONS

Prevalence of DSM-IV Major Depressive Disorder and the severity of depressive symptoms were significantly lower among homecare patients who attend religious services. Because a large proportion of persons stop attending religious services after initiating homecare, it is suggested that visitation by clergy may improve depressive symptoms for these patients.

Loneliness and depression in spousal caregivers of those with Alzheimer's disease versus non-caregiving spouses

Loneliness as a factor in the development of depression in Alzheimer's disease (AD) spousal caregivers has been given little attention. In this sample, 49 AD caregiving spouses reported significantly higher levels of loneliness and depression than did 52 non-caregiving spouses. AD caregiving wives reported greater loss of self and significantly higher levels of loneliness and depression than did AD caregiving husbands. Loneliness was the only predictive variable for AD caregiver depression, explaining 49% of the total variance. To meet the mental health needs of AD caregiving spouses, loneliness must be addressed along with the development of nursing interventions.

Competing risk of household expansion or institutionalization in late life

OBJECTIVES

The purpose of this study was to evaluate predictors of change in household size and institutionalization in late life.

METHODS

The Duke Established Populations for Epidemiologic Studies of the Elderly cohort (n = 3730) was assessed annually (1986-1996). Independent variables included home ownership, income, cognitive and functional ability, chronic illness, mood, household size, social support, and stressful life events. Competing risk of household expansion or institutionalization was modeled using (a) hazard of either event and (b) odds of household expansion or institutionalization among elders who experienced an event.

RESULTS

Hazard of either event was associated with younger age, Black race, lower income, cognitive problems and stability, functional abilities and deterioration, low chronic illness burden, being unmarried, having more living children, and recent life events. Among those who reported either event, odds of institutionalization (vs. household expansion) were associated with older age, White race, cognitive and functional problems, high chronic illness burden, being married, having fewer living children, smaller household size, social isolation, and exits of nonspouse coresidents.

DISCUSSION

Modeling separate effects of whether there was a household expansion or institutionalization, and if so, which type of event occurred, and taking into account acute and evolving states, enabled more precise understanding of the complex mechanisms involved in determining continued community residence or institutionalization.

The importance of psychosocial factors, gender, and severity of depression in distinguishing between adjustment and depressive disorders

BACKGROUND

This study evaluated the severity of depressive symptomatology as it relates to: (a) sociodemographic factors and (b) the occurrence and type of acute and chronic psychosocial triggers or life events before admission.

METHODS

In total, 718 psychiatric inpatients were assessed with the AMDP-system by the treating psychiatrist within the first 2 days after admission.

RESULTS

In the females, sociodemographic factors (being married, children in the household, higher education and the quality of interactions) but not psychosocial stressors or life events were found to be related to severity of depression on admission. Females showed more severe depressive syndromes than males, however, depression severity in males was independent of sociodemographic factors, life events or psychosocial triggers.

LIMITATIONS

Clinical assessment was based on retrospective history taking. The sample consisted of inpatients only, the results require replication using larger and more diverse samples.

CONCLUSION

Gender differences and life conditions such as familial distress are related to severity of depression. The present criteria for the differentiation between depressive disorders and adjustment disorders are not independent and should be substituted by a multiaxial assessment.

Cognitive style predictors of affect change in older adults

Cognitive styles are the lenses through which individuals habitually process information from their environment. In this study, we evaluated whether different cognitive style individual difference variables, such as explanatory style and dispositional optimism, could predict changes in affective state over time in community-dwelling older adults. Based on previous research, we hypothesized that an optimistic explanatory style would be adaptive except when combined with life stressors, but that dispositional optimism would predict positive affective states regardless of life events. We found that older adults with a more optimistic explanatory style for health/cognitive events actually appeared to develop more depressive symptoms over six months of follow-up. However, dispositional optimism and orientation toward the future predicted a better affective profile over time.

Comorbidity of late life depression: an opportunity for research on mechanisms and treatment

Late life depression principally affects individuals with other medical and psychosocial problems, including cognitive dysfunction, disability, medical illnesses, and social isolation. The clinical associations of late life depression have guided the development of hypotheses on mechanisms predisposing, initiating, and perpetuating specific mood syndromes. Comorbidity studies have demonstrated a relationship between frontostriatal impairment and late life depression. Further research has the potential to identify dysfunctions of specific frontostriatal systems critical for antidepressant response and to lead to novel pharmacological treatments and targeted psychosocial interventions. The reciprocal interactions of depression with disability, medical illnesses, treatment adherence, and other psychosocial factors complicate the care of depressed older adults. Growing knowledge of the clinical complexity introduced by the comorbidity of late life depression can guide the development of comprehensive treatment models. Targeting the interacting clinical characteristics associated with poor outcomes has the potential to interrupt the spiral of deterioration of depressed elderly patients. Treatment models can be most effective if they focus on amelioration of depressive symptoms, but also on treatment adherence, prevention of relapse and recurrence, reduction of medical burden and disability, and improvement of the quality of life of patients and their families.

The cumulative effects of life event, personal and social resources on subjective well-being of elderly widowers

A multidimensional Life Stress Model was used to test the independent contributions of background characteristics, personal resources, life event, and environmental influences on 200 widowers' levels of well-being, measured by the Affect Balance Scale. Stepwise regression analyses revealed that environmental resources were unrelated to negative affect which is influenced more by the life event and personal resource variables. The environmental resource variables, particularly interactions with friends and neighbors, mostly influenced positive affect. The explanatory model for well-being included multiple variables and explained 33 percent of the variance. Although background characteristics had the greatest impact, absence of hospitalization, higher mastery, higher self-esteem, contacts with friends, and interaction with neighbors enhanced well-being. The results support previous speculations on the importance of positive exchanges for positive affect. African-American widowers showed higher levels of well-being than Caucasian widowers did. The results advance knowledge about differences among elderly men.