The interplay between life stressors and depressive symptoms among older adults

Factors associated with poor mental health during mandatory home work: a cross-sectional study in university staff

BACKGROUND

During the first wave of the Covid-19 pandemic in 2020, a total lockdown of universities was implemented by the government in Belgium. University staff was required to work at home. The purpose of the study was to identify factors associated with poor mental health in university staff during mandatory home work.

METHODS

Mental well-being of 702 university employees was assessed by need for recovery after work and presence of burnout symptoms. Following factors were considered: personal factors (gender, age), professional status, specific home work environment factors (quiet place to work, taking care of ill or old people, number of children < 12yrs. at home, family member at risk for Covid-19), work-private life balance and worries about long- and short-term work situation. Multivariable logistic regression analyses were used to calculate the odds ratios for the presence a high need for recovery and burnout symptoms.

RESULTS

The presence of a high need for recovery and the presence of burnout symptoms were significantly associated with poor work-private life balance (OR 5.14 and 2.80, respectively), no quiet place to work (OR 3.23 and 2.00, respectively) and being worried about long-term work situation (OR's increasing with increasing degree of worries). Being able to discuss the worries with the supervisor was only significant with a decreased risk of burnout symptoms for the lowest level of discussability with the supervisor. Following factors were not associated with both mental health outcomes: professional status, being worried about short-term work situation, taking care of ill or old people, number of children < 12yrs. at home and having a family member at risk for Covid-19.

CONCLUSIONS

When working at home special attention should be paid to work-private life balance and the presence of a quiet place to work. Additionally, in the case of mandatory home work in university personnel, specific worries about long-term work situation should be tackled. Universities and/or governments should provide measures to ensure an extension of research deadlines and, if applicable, job security.

Youth stress generation: an examination of the role of anxiety, anxiety symptoms and cognitive distortions

INTRODUCTION

Stress generation suggests a reciprocal relationship between depression and prospective stressful life events. However, the applicability of stress generation to anxiety disorders has been understudied, particularly among youth. We address this gap by examining stress generation in youth at high-risk of developing anxiety disorders.

METHODS

Participants were one-hundred thirty-six at-risk youth (M age = 8.69, 84.6% Caucasian; 55.9% female), each of whom had a parent with an anxiety disorder. We examined the role of an anxiety disorder diagnosis, anxiety symptoms, and cognitive distortions in youth's prospective one and six-year stressful life events (i.e., stress generation).

RESULTS

Anxiety symptoms and cognitive distortions were significant predictors of one-year total dependent stress. Anxiety diagnosis and anxiety symptoms were significant predictors of one-year dependent interpersonal stress. Anxiety diagnosis and anxiety symptoms were significant predictors of six-year independent stress.

CONCLUSION

Support for the stress generation model was found in high-risk youth, but only over a one-year period. This suggests important effects of anxiety and cognitive distortions on stress generation, though their implications might be time-capped.

COVID-19: Factors Predicting Depressive Symptoms in People Aging With Long-Term Physical Disabilities

The mental health impact of the COVID-19 pandemic may be greater than that of the viral infection. This impact is likely greater for disadvantaged groups such as people with long-term physical disabilities (PwLTPD). This cross-sectional study used a multiple linear regression model to examine factors associated with depressive symptoms and to understand their relative importance during the onset of the COVID-19 pandemic. The model explained 58% of the variance in depressive symptoms. Anxiety was the most important predictor, accounting for 8% of variance. Higher levels of anxiety, loneliness, and financial stress; prior diagnosis of depression; and non-Black race predicted a higher level of depressive symptoms in PwLTPD during the onset of the COVID-19 pandemic. Occupational therapy practitioners should strategically acknowledge predictors of depression that cannot be modified and actively address those that can be modified through evidence-based interventions to improve depressive symptoms in PwLTPD.

Transcranial magnetic stimulation (TMS) for geriatric depression

BACKGROUND

The prevalence of treatment-resistant geriatric depression (GD) highlights the need for treatments that preserve cognitive functions and recognize polypharmacy in elderly, yet effectively reduce symptom burden. Transcranial magnetic stimulation (TMS) is a proven intervention for treatment-resistant depression in younger adults but the efficacy of TMS to treat depressed older adults is still unclear. This review provides an updated view on the efficacy of TMS treatment for GD, discusses methodological differences between trials in TMS application, and explores avenues for optimization of TMS treatment in the context of the ageing brain.

METHODS

A systematic review was conducted to identify published literature on the antidepressant efficacy of TMS for GD. Databases PubMed, Embase, and PsycINFO were searched for English language articles in peer-reviewed journals in March 2021.

RESULTS

Seven randomized controlled trials (RCTs) (total n = 260, active n = 148, control n = 112) and seven uncontrolled trials (total n = 160) were included. Overall, we found substantial variability in the clinical response, ranging from 6.7% to 54.3%.

CONCLUSIONS

The reviewed literature highlights large heterogeneity among studies both in terms of the employed TMS dosage and the observed clinical efficacy. This highlights the need for optimizing TMS dosage by recognizing the unique clinical features of GD. We showcase a set of novel approaches for the optimization of the TMS protocol for depression and discuss the possibility for a standardized TMS protocol tailored for the treatment of GD.

A Systematic Review and Comparison of Neurocognitive Features of Late-Life Attention-Deficit/Hyperactivity Disorder and Dementia With Lewy Bodies

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) in adulthood and dementia with Lewy bodies (DLB) share many cognitive and noncognitive similarities. The overlapping features between both disorders complicate differential diagnosis. The aim of the current systematic review was to compare patterns of neuropsychological profiles in older adults with ADHD and DLB.

METHOD

Of the 1989 ADHD-related articles and 1332 DLB-related articles screened, 3 ADHD and 25 DLB articles were retained for qualitative synthesis and review.

RESULTS

A synthesis of individual study findings revealed isolated working memory deficits for late-life ADHD, and performance deficits in areas of attention, memory, language, and visuoperceptual abilities for DLB. Results were limited by small samples and absence of data in some cognitive domains.

CONCLUSION

These initial findings support potentially unique neurocognitive profiles for ADHD in later life and DLB that would enable practitioners to differentially diagnose and appropriately treat older adults presenting with these phenotypically similar disorders.

Association between sources of stress and depressive mood in Korean adults

OBJECTIVE

The present study investigated the association between different sources of stress and depressive mood in Korean adults.

METHODS

A total of 4464 adults who completed the 2018 Korean National Health and Nutrition Examination Survey were included in the analysis. Data included sources of stress, depressive mood assessed by the nine-item Patient Health Questionnaire, sociodemographic characteristics, and health-related habits. Multiple logistic regression models were applied to calculate the odds ratio for depressive mood according to each source of stress and stratified by sex and age.

RESULTS

Fully adjusted models revealed that individuals who reported a financial problem or health concern as their main source of stress were more likely to experience depressive mood; when data were stratified by sex, these associations remained significant among females only. An age-stratified analysis indicated that financial problems were associated with depressive mood in middle-aged individuals and health concerns were associated with depressive mood in elderly.

CONCLUSION

Korean adults with specific sources of stress should be monitored for the development of emotional distress.

Adverse Life Events: Do Home Care Clients Have Resources for Mastering Them?

Objectives: Research on life stressors and adverse life events has a long tradition. Few studies have addressed this topic in connection to very old people. Life stressors, especially major life stressors (MLSs) experienced by clients of home care services in the community have rarely been the subject of studies. Considering this gap, we investigated the prevalence of MLSs in home care clients. We examined the effects that MLSs have on their mood and health status as well as the impact of clients' social resources on MLSs and their outcomes.

Method: We used assessment data from 2,884 home care clients in six European countries. The methodological basis was the comprehensive and standardized interRAI Home Care Assessment (interRAI HC).

Results: Fifteen point four percent of the sample—that consisted of women and men with an average age of 82.89 years–experienced an MLS in the last 6 months before the assessment. They were more depressed than persons without these experiences, and their health status indicated a higher level of instability and deterioration. At reassessment after 6 months, the situation changed. Despite the fact that both outcomes of the MLSs, depression and health status became worse in the reassessment-sample, home care clients without MLS were more affected by the worsening, especially that of depression. The expected buffering impact of social resources was low.

Discussion: Although this study worked with limited information on MLSs, it could contribute to closing various knowledge gaps. The study shows that the MLSs represent a prevalent problem in a population of home care clients and that this problem has negative consequences for their mood and the stability of their health status. Furthermore, this research took up the situation of very old and vulnerable adults, who have previously rarely been considered in studies on major critical life events and stressors.

Conclusion and Research Perspective: Future research on MLSs has to take up the issue of the time passage between the MLS and the impact on health and well-being of individuals dependent on care. It has to determine immediate as well as later consequences and identify those factors that are appropriate to reduce the MLS-effects on very old people dependent on care.

Midlife Children's and Older Mothers' Depressive Symptoms: Empathic Mother-Child Relationships as a Key Moderator

OBJECTIVE

This study aimed to evaluate the link between midlife children's and older mothers' depressive symptoms, whether this link is exacerbated in highly empathic mother-child relationships (i.e., shared strong feelings of being loved, cared for, and understood in the mother-child tie), and whether these associations vary by children's gender.

BACKGROUND

Empathic mother-child relationships in later life may intensify the link between midlife children's and older mothers' depressive symptoms. Yet little is known about the emotional implications of the mother-child tie for midlife daughters and sons.

METHOD

The sample included 234 midlife children (M = 49.75 years) and their mothers (M = 75.27 years) from Wave 1 of the Family Exchanges Study. Linear regressions were estimated to determine the link between midlife children's and older mothers' depressive symptoms and the potential moderating role of highly empathic mother-child relationships.

RESULTS

Midlife children had greater depressive symptoms when their mothers had greater depressive symptoms in the context of highly empathic mother-child relationships. This association was not moderated by children's gender.

CONCLUSION

These findings underscore the enduring emotional salience of the mother-child tie and emphasize the importance of relationship characteristics that may heighten the link between midlife children's and their mothers' depressive symptoms.

IMPLICATIONS

Interventions to prevent or treat depressive symptoms among midlife adults may benefit from accounting for the role that their mothers' depressive symptoms might play in maintaining these symptoms, particularly when mother-child ties are highly empathic.

Depression and family arguments: disentangling reciprocal effects for women and men

BACKGROUND

Depression is a debilitating condition that affects the individual and the family.

OBJECTIVE

This study sought to identify potential reciprocal influences between family arguments and depressive symptoms among clinically depressed patients over a 23-year span.

METHODS

The present study employed a longitudinal, observational design with 424 depressed patients. Separate cross-lagged path models examined longitudinal associations for women and men over 23 years while adjusting for age, income, and marital and parental status.

RESULTS

Among depressed men, more severe baseline depressive symptoms predicted more family arguments 10 years later. Among depressed women, more severe baseline depressive symptoms predicted fewer family arguments 1 year later, while more severe depressive symptoms at 10-year follow-up predicted more family arguments at 23-year follow-up. More family arguments predicted more severe depressive symptoms among women and men, with some variation in the time intervals of these associations.

CONCLUSION

These findings suggest that while depressive symptoms may temporarily diminish family arguments among women, such symptoms were associated with more family arguments over longer time intervals. Moreover, family arguments put depressed men and women at risk for more severe depressive symptoms. These results support the use of screening for family arguments and interventions to help depressed individuals develop skills to manage interpersonal conflict.

Early Detection of the Risk of Developing Psychiatric Disorders: A Study of 461 Chinese University Students under Chronic Stress

Chronic stress, a characteristic of modern time, has a significant impact on general health. In the context of psychiatric disorders, insufficient coping behavior under chronic stress has been linked to higher rates of (1) depressive symptoms among subjects of the general population, (2) relapse among patients under treatment for clinical depression, and (3) negative symptoms among subjects with an elevated vulnerability to psychosis. In this normative study we assessed basic coping behavior among 461 Chinese freshman university students along with their consumption behavior and general health in terms of regular exercises, physical health, psychosomatic disturbances, and mental health. The assessments relied on two instruments that have already demonstrated their capability of (1) reliably detecting insufficient coping behavior under chronic stress and (2) reliably quantifying the interrelation between coping behavior and mental health in the Western world. Thus, we aimed to complement existing data and to develop a generally available, socioculturally independent tool that can be used for the early detection of subjects with an elevated risk of mental health problems. Structural analyses yielded essentially the same scales "activity" and "defeatism" as previous studies on 2,500 students from Switzerland, Italy, Spain, the USA, and Argentina. These scales explained 74.3% of the observed variance in coping behavior among the 461 Chinese students. We found highly significant correlations (p < 0.0001) between the "defeatism" scale on the one hand, and the scales "regular use of medicine," "psychosomatic disturbances," and "impaired mental health" on the other. Particularly intriguing was the finding that a neural net classifier could be constructed to identify students with the highest contributions to the interrelation between "coping behavior" and "mental health," yielding a correlation coefficient as high as r = 0.597 for the respective subgroup. Based on the normative data, an online tool for risk assessments was developed with immediate feedback to users. This study provided another piece of evidence regarding the close link between basic coping behavior and mental health, across cultures and ethnicities. In consequence, our approach to quantifying basic coping behavior, along with other risk factors, can be expected to clear the way for an "early" detection of students with an elevated risk of stress-related mental health problems, nota bene prior to the development of clinically relevant symptoms. The socioeconomic impact of the potential prevention of depressive -disorders, and psychiatric disorders in general, may be enormous.

Autism and depression are connected: A report of two complimentary network studies

Autism and depression often co-occur. Through network analysis, we seek to gain a better understanding of this co-occurrence by investigating whether (1) autism and depression share overlapping groups of symptoms and/or (2) are connected through a bridge of mastery or worry symptoms. This is addressed in two complimentary studies: (1) Study 1 focusing on depressed (N = 258) and non-depressed adults (N = 117), aged 60-90 years; (2) Study 2 focusing on autistic (N = 173) and non-autistic adults (N = 70), aged 31-89 years. Self-report questionnaire data were collected on autistic traits (AQ-28), depression symptoms (Study 1: Inventory of Depressive Symptomatology Self Report; Study 2: Symptom Checklist 90-Revised depression subscale), worry (Worry Scale-R) and mastery (the Pearlin Mastery Scale). For both studies, data were analysed by creating glasso networks and subsequent centrality analyses to identify the most influential variables in the respective networks. Both depressed and autistic adults are highly similar in the perceived amount of worries and lack of control. While caution is needed when interpreting the pattern of findings given the bootstrapping results, findings from both studies indicate that overlapping symptoms do not fully explain the co-occurrence of autism and depression and the perception of having control over your life, that is, mastery seems a relevant factor in connecting autism and depression.

Predicting the Effect of a Predictor When Controlling for Baseline

The present simulation study indicates that a method where the regression effect of a predictor (X) on an outcome at follow-up (Y1) is calculated while adjusting for the outcome at baseline (Y0) can give spurious findings, especially when there is a strong correlation between X and Y0 and when the test-retest correlation between Y0 and Y1 is relatively weak. Researchers wishing to avoid spurious findings and Type 1 errors should be aware of this phenomenon and are recommended to verify found effects by an unadjusted effect of X on the Y1-Y0 difference.

Resource or Hindrance? The benefits and costs of social support for functional difficulties and its implications for depressive symptoms

OBJECTIVES

The impact of social support on the relationship between stress and well-being remains somewhat inconclusive, with work suggesting either null, buffering, or amplification effects. The current study investigated the conditions in which perceived social support is likely to act as a buffer or amplifier by considering individual differences in self-perceptions of aging.

METHODS

Using data from two subsamples of the Wisconsin Longitudinal Study (graduates: 70-74 years, siblings: 40-92 years), we examined how perceived social support (emotional versus instrumental) and self-perceptions of aging (SPA) moderated the effect of functional limitations on depressive symptoms (DS).

RESULTS

Although emotional support positively predicted DS, its effects did not depend on SPA. Instrumental support was associated with both increases and decreases in well-being that were dependent upon SPA. Functional limitations predicted more DS at both low and high levels of instrumental support when SPA were negative. However, when SPA were positive, low levels of social support were found to decrease depressive symptoms, and high levels were found to increase depressive symptoms.

CONCLUSIONS

The impact of social social may enhance or deteriorate well-being, depending on how it interacts with self-evaluative beliefs. Findings offer insights as to the boundary conditions associated with the (positive) effects of social support and SPA, and highlight the need for continued research on the mechanisms associated these effects.

Modeling life course pathways from adverse childhood experiences to adult mental health

Although the association between adverse childhood experiences (ACEs) and adult mental health is becoming well established, less is known about the complex and multiple pathways through which ACEs exert their influence. Growing evidence suggests that adversity early in life conveys not only early impacts, but also augments risk of stress-related life course cascades that continue to undermine health. The present study aims to test pathways of stress proliferation and stress embodiment processes linking ACEs to mental health impairment in adulthood. Data are from the 2011 Behavioral Risk Factor Surveillance Survey, a representative sample of Washington State adults ages 18 and over (N = 14,001). Structural equation modeling allowed for testing of direct and indirect effects from ACEs though low income status, experiences of adversity in adulthood, and social support. The model demonstrated that adult low income, social support and adult adversity are in fact conduits through which ACEs exert their influence on mental health impairment in adulthood. Significant indirect pathways through these variables supported hypotheses that the effect of ACEs is carried through these variables. This is among the first models that demonstrates multiple stress-related life course pathways through which early life adversity compromises adult mental health. Discussion elaborates multiple service system opportunities for intervention in early and later life to interrupt direct and indirect pathways of ACE effects.

Risk factors for late-life depression and correlates of antidepressant use in Costa Rica: Results from a nationally-representative longitudinal survey of older adults

BACKGROUND

Risk factors for late-life depression have been studied in high-income countries, but there have been no longitudinal studies from middle-income countries. This study reports risk factors for late-life depression and correlates of antidepressant using the Costa Rican Longevity and Healthy Aging Study (CRELES), a nationally representative cohort of adults age 60 and over.

METHODS

CRELES contains baseline interviews in 2005 (n=2827) with follow-up interviews in 2007 and 2009. CRELES used the Geriatric Depression Scale Short Form to identify depression using cut-offs for mild and severe depression and contained a 14-question assessment to determine physical disability. Participants self-reported antidepressant use and chronic health conditions. We examined correlates of newly screened depression and new antidepressant use among participants not depressed or not using antidepressants in the previous study wave. We used generalized estimating equations to estimate the association among variables.

RESULTS

Increases in disability were associated with newly screening for mild and severe depression. New medical conditions and recent widowhood were associated with newly screening for severe depression. Recent widowhood was also associated with new use of antidepressant medication.

LIMITATIONS

Limitations of this study include absence of persons living in institutions, inconsistency of screening tools with clinical diagnoses, and possible effects of stigma and recall bias on screening.

CONCLUSIONS

Risk factors for late-life depression in Costa Rica are similar to risk factors in high-income countries. Patterns of antidepressant use suggest providers may recognize the role of bereavement as a risk factor for late-life depression but not of disability or chronic conditions.

Depressive Symptom Trajectories, Aging-Related Stress, and Sexual Minority Stress Among Midlife and Older Gay Men: Linking Past and Present

We concatenate 28 years of historical depressive symptoms data from a longitudinal cohort study of U.S. gay men who are now midlife and older (n = 312), with newly collected survey data to analyze trajectories of depressive symptomatology over time and their impact on associations between current stress and depressive symptoms. Symptoms are high over time, on average, and follow multiple trajectories. Aging-related stress, persistent life-course sexual minority stress, and increasing sexual minority stress are positively associated with depressive symptoms, net of symptom trajectories. Men who had experienced elevated and increasing trajectories of depressive symptoms are less susceptible to the damaging effects of aging-related stress than those who experienced a decrease in symptoms over time. Intervention efforts aimed at assisting gay men as they age should take into account life-course depressive symptom histories to appropriately contextualize the health effects of current social stressors.

The role of adverse life events on depression in older adults with ADHD

BACKGROUND

Comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression is high, also in older adults. Thus far it is not well understood why ADHD and depression are so strongly interrelated. One factor that may play a role in older adults with ADHD is an increased risk of experiencing adverse life events.

METHODS

Six year follow-up data were used from the Longitudinal Aging Study Amsterdam (LASA). To diagnose ADHD, the DIVA 2.0, a diagnostic interview was administered among a subsample (N=230, age 60-94). In addition to the ADHD diagnosis, the associations between the number of ADHD symptoms, depressive symptoms and adverse life events were examined. Data were analyzed by means of logistic and linear regression analyses.

RESULTS

Compared to older adults without ADHD, those with ADHD reported more serious conflicts. The risk of depression in older adults with ADHD was partly explained by serious conflicts. Furthermore, the association between ADHD severity and depression was stronger in those who experienced serious conflicts and those who experienced more adverse life events.

LIMITATIONS

The ADHD diagnosis was based on the DSM-IV criteria, which were developed for children, and have not yet been validated in (older) adults.

CONCLUSIONS

Having conflicts with others and accumulation of adverse life events over time partly explained the association between ADHD and depression. Better and earlier treatment of ADHD may prevent the development of depression in the presence of life events associated with ADHD.

The relations among relatedness needs, subjective well-being, and depression of Korean elderly

The first part of the study examined what the relatedness needs Korean elderly have in close relationships (spouse, children, friends) are. The most salient needs were "love and care" for spouse and "contact and often meeting" for children and friends. The second part of the study assessed the relations among the difference between expectation and satisfaction of relatedness needs, subjective well-being, and depression of Korean elderly. Regression analyses showed that the difference between expectation and satisfaction of relatedness needs for spouse and children significantly predicted subjective well-being and depression. Finally, gender differences are discussed in terms of the patriarchal culture of Korean society.

Development of a new multidimensional individual and interpersonal resilience measure for older adults

OBJECTIVES

Develop an empirically grounded measure that can be used to assess family and individual resilience in a population of older adults (aged 50-99).

METHODS

Cross-sectional, self-report data from 1006 older adults were analyzed in two steps. The total sample was split into two subsamples and the first step identified the underlying latent structure through principal component exploratory factor analysis (EFA). The second step utilized the second half of the sample to validate the derived latent structure through confirmatory factor analysis (CFA).

RESULTS

EFA produced an eight-factor structure that appeared clinically relevant for measuring the multidimensional nature of resilience. Factors included self-efficacy, access to social support network, optimism, perceived economic and social resources, spirituality and religiosity, relational accord, emotional expression and communication, and emotional regulation. CFA confirmed the eight-factor structure previously achieved with covariance between each of the factors. Based on these analyses we developed the multidimensional individual and interpersonal resilience measure, a broad assessment of resilience for older adults.

CONCLUSION

This study highlights the multidimensional nature of resilience and introduces an individual and interpersonal resilience measure developed for older adults which is grounded in the individual and family resilience literature.

The effect of lifetime cumulative adversity and depressive symptoms on functional status

OBJECTIVES

The study aimed to examine whether lifetime cumulative adversity (LCA) and depressive symptoms moderate time-related trajectories of functional status.

METHOD

A total of 15,073 older adults (mean age = 63.91 at Wave 1) who participated in the first four waves of the Survey of Health, Ageing and Retirement in Europe reported on exposure to negative life events, depressive symptoms and three measures of functional status-difficulty in performing daily and instrumental activities, and functional limitation.

RESULTS

Growth-curve models showed that time-related increase in disability and functional limitation was steeper among those exposed to higher levels of lifetime adversity. Moreover, a three-way interaction between time, lifetime adversity, and depressive symptoms emerged across measures of functional status, so that when exposure to lifetime adversity was accompanied by high level of depressive symptoms, the time-related increase in disability and functional limitation was the steepest.

DISCUSSION

LCA is associated with a hastening of the disablement process, especially under conditions of high distress. Although the overall modest effects imply that resilience to lifetime adversity is widespread among older adults, prevention and intervention programs should consider that distressed older adults previously exposed to high levels of lifetime adversity are at risk for more rapid impairment in functional status.

Perceived control as a longitudinal moderator of late-life stressors on depressive symptoms

OBJECTIVES

This study examined perceived control as a moderator of the relationship between late-life stressors and depressive symptoms among a sample of older New Zealanders.

METHOD

Data were drawn from a longitudinal study with two data collection periods, one year apart. The Time 1 sample consisted of 1489 participants ranging in age from 65 to 94 years and 72% percent participated at Time 2. Correlational and multiple regression procedures were used to examine study hypotheses.

RESULTS

Results showed that Time 1 perceived control beliefs were a unique predictor of depressive symptoms at Time 2 after controlling for Time 1 depressives symptoms and other relevant variables. Further, perceived control beliefs at Time 1 moderated the relationship between late-life stressors and depressive symptoms at Time 2. Those with low perceived control demonstrated a stronger relationship between late-life stressors and depressive symptoms than those with high perceived control.

CONCLUSION

This study provides evidence that perceived control influences levels of depressive symptoms over time among older adults. Results also support the hypothesis that control beliefs moderate the relationship between late-life stressors and depressive symptoms among older adults. Implications include attributional retraining to promote perceived control and subsequent well-being in older adults.

Social support and physical activity as moderators of life stress in predicting baseline depression and change in depression over time in the Women's Health Initiative

PURPOSE

To determine whether social support and/or physical activity buffer the association between stressors and increasing risk of depression symptoms at baseline and at 3-year follow-up.

METHODS

This is a secondary analysis of data from the Women's Health Initiative Observational Study. 91,912 community-dwelling post-menopausal women participated in this prospective cohort study. Depression symptoms were measured at baseline and 3 years later; social support, physical activity, and stressors were measured at baseline.

RESULTS

Stressors at baseline, including verbal abuse, physical abuse, caregiving, social strain, negative life events, financial stress, low income, acute pain, and a greater number of chronic medical conditions, were all associated with higher levels of depression symptoms at baseline and new onset elevated symptoms at 3-year follow-up. Social support and physical activity were associated with lower levels of depressive symptoms. Contrary to expectation, more social support at baseline strengthened the association between concurrent depression and physical abuse, social strain, caregiving, and low income. Similarly, more social support at baseline increased the association between financial stress, income, and pain on new onset depression 3 years later. Physical activity similarly moderated the effect of caregiving, income, and pain on depression symptoms at baseline.

CONCLUSION

Stressors, social support, and physical activity showed predicted main effect associations with depression. Multiplicative interactions were small in magnitude and in the opposite direction of what was expected.

Stressful life events and neuroticism as predictors of late-life versus early-life depression

BACKGROUND

The occurrence of depression in younger adults is related to the combination of long-standing factors such as personality traits (neuroticism) and more acute factors such as the subjective impact of stressful life events. Whether an increase in physical illnesses changes these associations in old age depression remains a matter of debate.

METHODS

We compared 79 outpatients with major depression and 102 never-depressed controls; subjects included both young (mean age: 35 years) and older (mean age: 70 years) adults. Assessments included the Social Readjustment Rating Scale, NEO Personality Inventory and Cumulative Illness Rating Scale. Logistic regression models analyzed the association between depression and subjective impact of stressful life events while controlling for neuroticism and physical illness.

RESULTS

Patients and controls experienced the same number of stressful life events in the past 12 months. However, in contrast to the controls, patients associated the events with a subjective negative emotional impact. Negative stress impact and levels of neuroticism, but not physical illness, significantly predicted depression in young age. In old age, negative stress impact was weakly associated with depression. In this age group, depressive illness was also determined by physical illness burden and neuroticism.

CONCLUSIONS

Our data suggest that the subjective impact of life stressors, although rated as of the same magnitude, plays a less important role in accounting for depression in older age compared to young age. They also indicate an increasing weight of physical illness burden in the prediction of depression occurrence in old age.

The effect of lifetime cumulative adversity on change and chronicity in depressive symptoms and quality of life in older adults

BACKGROUND

Lifetime cumulative adversity (LCA) has a detrimental effect on mental health. However, it is less clear whether it also increases the risk for mental health deterioration across time, and whether it is related to a continuous impairment in mental health among older adults. The current study aimed to examine whether LCA is related to deterioration and to continuous vulnerability in depressive symptoms and quality of life.

METHOD

Nine thousand one hundred fifty four older adults (mean age = 63 at Wave 1) who participated in the first three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) reported exposure to negative life events, depressive symptoms, and quality of life.

RESULTS

Respondents with more LCA were at greater risk of high level of depressive symptoms and low level of quality of life. Those with more adversity were at greater risk of reporting an increase in depressive symptoms and a decrease in quality of life between waves. LCA was also related to continuous high level of depressive symptoms and low level of quality of life. The effect of LCA was stronger for depressive symptoms than for quality of life.

CONCLUSIONS

LCA is associated with decline, as well as with continuous impairment, in major markers of mental health at the second half of life. The overall modest effects imply that resilience to LCA is widespread among older adults. Still, prevention and intervention programs should target old people with cumulative adversity, as they are in risk for deterioration and chronic vulnerability in important components of mental health.

Comparison between the first and second versions of the Copenhagen Psychosocial Questionnaire: psychosocial risk factors for a high need for recovery after work

PURPOSE: The Copenhagen Psychosocial Questionnaire (COPSOQ I) was developed as a tool to assess a broad range of psychosocial work environment factors and was recently revised (COPSOQ II). The research question in this study was: Do COPSOQ II-scales predict a high need for recovery (NFR) after work better than COPSOQ I-scales? METHODS: A cross-sectional questionnaire study was conducted in 990 subjects (84.5% response), employed in the public sector. Psychosocial factors were assessed by COPSOQ I and COPSOQ II. Multivariate logistic regression analysis was used to calculate the odds ratios for the presence of a high NFR, controlled for gender, age, physical workload and other relevant occupational and non-occupational factors. Analyses were performed for COPSOQ I and COPSOQ II separately. RESULTS: In both COPSOQ versions, 'quantitative demands' (p < 0.001) and 'job insecurity' (p < 0.005) were significantly associated with a high NFR. Additionally, in the COPSOQ I model, 'demands for hiding emotions' (p < 0.05) and 'degrees of freedom' (p < 0.05), and in the COPSOQ II model 'emotional demands' (p < 0.05) and 'commitment to the workplace' (p < 0.005) were significant as well. 'Degrees of freedom' was omitted by the developers in the revised COPSOQ II. Reintroducing it into the COPSOQ II model did not alter the existing associations, but pointed out 'degrees of freedom' to be an additional important dimension (p < 0.05). The COPSOQ II model with 'degrees of freedom' included also had the best data fit. CONCLUSIONS: The results suggested the COPSOQ II to be better predictive than COPSOQ I for a high NFR, but also indicated that 'degrees of freedom' should be included into the COPSOQ II when studying the NFR as outcome parameter.

Comorbidity of substance use disorders among community-based and high-risk adolescents

The aim of this article was to examine the frequency and comorbidity of substance use disorders (SUD) among community-based adolescents and high-risk adolescents, using the same methodology. Adolescents from the community (N=1035) were recruited from 36 schools. High-risk adolescents (N=374) comprised those whose parent(s) have the diagnosis of SUD and who were undergoing a treatment for their SUD. Adolescents were interviewed using the computerized Munich version of the Composite International Diagnostic Interview to access the presence of SUD and other major DSM-IV psychiatric disorders. The lifetime rate of SUD was significantly lower in the community-based (12.3%) than the high-risk (38.3%) groups of adolescents. In both settings, SUD co-occurred highly with other psychiatric disorders. About 52.7% and 62.2% of the community-based and high-risk adolescents with SUD, respectively, had at least one additional disorder. Adolescents with SUD and comorbid disorders were significantly more psychologically distressed, compared to adolescents with SUD only. Adolescents with SUD had significantly lower perceived attachment to parents, but significantly higher attachment to peers compared to adolescents without any psychiatric disorders. The implications of the present findings were discussed in terms of the need to design prevention program especially for high-risk children, and also stressed the importance of conducting comprehensive assessment among adolescents referred for the treatment of SUD.

The Unique Role of Sleep Quality in Older Adults’ Psychological Well-Being

Previous research has established a link between sleep quality and psychological well-being in older adults. However, no research to date has investigated this relationship in the context of other factors known to influence both sleep and psychological well-being. Among a sample of 489 independently living older adults (ages 60 to 98), the current study examined the association between sleep quality and psychological well-being (positive emotions, negative emotions, depression) while controlling for individual differences in factors known to affect sleep: physical health, stress, physical activity, functional ability, and demographics. Multiple linear regression models showed that both better current sleep quality and better comparative sleep quality (from middle to older adulthood) predicted better psychological well-being. Implications include interventions to improve sleep quality in older adults.

US Latina age of sexual debut: long-term associations and implications for HIV and drug abuse prevention

This cross-sectional study explored associations among (a) age of sexual debut; (b) drug abuse; and (c) sexual risk behaviors among an urban community-based sample of 158 predominantly immigrant, Latina adults. Time in the USA and having a mother who used drugs during the participants' childhood or adolescence were significantly related to age of sexual debut. In turn, younger ages of sexual debut were associated with drug abuse and more sexual risk behaviors (greater number of sexual partners, more frequent alcohol and drug use before or during sex, greater levels of intoxication from alcohol or drugs during sex). Implications for HIV/AIDS and drug abuse clinical services and future research with US Latina populations are discussed.

Stress generation in depression: A systematic review of the empirical literature and recommendations for future study

Within the past 20 years, depression research has given increasing consideration to the possibility of complex and reciprocal relations between stress and depression. Not only does stress increase risk for depression (i.e., a stress exposure model of depression), but depression, or depressogenic vulnerabilities, in turn, also increases susceptibility to stressful events that are at least in part influenced by the individual (i.e., stress generation; Hammen, 1991). The present review provides a systematic examination of the stress generation literature to date, with specific focus given to depression and depressogenic risk factors (i.e., past stress, negative cognitive styles, and personality and interpersonal vulnerabilities) as predictors of the stress generation effect, as well as gender differences in stress generation, the sequelae of generated stress, and the relative specificity of this phenomenon to depression. The research thus far appears most consistent in supporting the role of depression in predicting generated stress, although more research is still required. In addition to highlighting these findings, methodological limitations and conceptual gaps in the literature are discussed with the view of informing future research in this area.

Stress Generation Research in Depression: A Commentary

The concept of stress generation is a powerful tool that is consistent with existing cognitive-behavioral theories of depression. In this brief commentary on the literature on stress generation in depression, we highlight several issues that we believe will help to advance the stress generation field. Specifically, we discuss important methodological considerations, issues related to generality and specificity, and theoretical and clinical implications of stress generation. We then address common misperceptions of the stress generation hypothesis. Finally, we end by posing several questions about the mechanisms driving stress generation that should be addressed in future research. Advancing the field's knowledge about stress generation will yield a tangible direction for theory-driven, targeted intervention. Our hope is that this commentary will help to stimulate and frame future research in this exciting area.

Adverse life events among community-dwelling persons aged 65-70 years: gender differences in occurrence and perceived psychological consequences

OBJECTIVES

To describe the occurrence of selected adverse life events in young-old men and women, as well as their perceived psychological consequences.

METHODS

In 2005, 1,422 participants in the Lausanne Cohort 65+ study, born in 1934-1938, self-reported whether they experienced any of 26 life events during the preceding year. Most participants (N = 1,309, 92%) completed the geriatric adverse life events scale during a face-to-face interview, by rating the level of stress associated with each event, as well as its impact on their psychological well-being.

RESULTS

Overall, 72% of the participants experienced at least one of the 26 events in the preceding year (range 1-9). Disease affecting the respondent (N = 525) or a close relative (N = 276) was most frequent, as well as the death of a friend or non-close relative (N = 274). Women indicated a higher frequency of events (mean 2.1 vs. 1.7 events, P < 0.001), as well as a higher level of stress and a stronger negative impact on well-being than men. In multivariate analyses adjusting for self-rated health, depressive symptoms and comorbidity, female gender remained significantly associated with the level of stress and negative impact on psychological well-being.

CONCLUSION

This exploratory study shows that several types of adverse life events frequently occur at age 65-70, with gender differences both in the frequency of reporting and consequences of these events. However, information on this topic is limited and studies based on different populations and designs are needed to better understand the impact of such events.

Family members of people with alcohol or drug dependence: health problems and medical cost compared to family members of people with diabetes and asthma

AIMS

To compare the medical costs and prevalence of health conditions of family members of people with an alcohol or drug dependence (AODD) diagnosis to family members of people with diabetes and asthma.

SETTING

Kaiser Permanente of Northern California (KPNC).

PARTICIPANTS

Family members of people diagnosed with AODD between 2002 and 2005, and matched samples of family members of people diagnosed with diabetes and asthma.

MEASUREMENTS

Logistic regression was used to determine whether the family members of people with AODD were more likely to be diagnosed with medical conditions than family members of people with diabetes or asthma. Multivariate models were used to compare health services cost and utilization of AODD family members and diabetes and asthma family members. Analyses were for the year before, and 2 years following, initial diagnosis of the index person.

FINDINGS

In the year before initial diagnosis of the index person, AODD family members were more likely to be diagnosed with substance use disorders, depression and trauma than diabetes or asthma family members. AODD family members had higher total health-care costs than diabetes family members in the year following, and the second year following, the index date ($217 and $293, respectively). AODD family members had higher total health-care costs than asthma family members in the year before, and second year following, the index date ($104 and $269, respectively).

CONCLUSIONS

AODD family members have unique patterns of health conditions compared to the diabetes and asthma family members and have similar, or higher, health-care cost and utilization.

Psychosocial stress and anxiety in musculoskeletal pain patients with and without depression

OBJECTIVE

The objective of this study was to determine if psychosocial stress and anxiety were associated with depression severity in primary care patients with chronic musculoskeletal pain.

METHODS

A cross-sectional sample of 500 primary care patients with musculoskeletal pain (250 with depression and 250 without depression) was assessed for anxiety, psychosocial stress, depression severity and demographics. The depressed and nondepressed participants were compared using t test and chi(2) analyses. Multiple linear regression analyses were used to evaluate the respective associations of psychosocial stressors and anxiety with depression severity based on the 20-item Symptoms Check List across all 500 participants.

RESULTS

Compared with nondepressed patients, the depressed patients reported significantly more psychosocial stressors and more severe anxiety. Depressed patients reported a higher frequency of difficulties with every psychosocial stressor assessed. After controlling for covariates, both anxiety and psychosocial stressors were found to be associated with depression severity.

CONCLUSIONS

Both anxiety and psychosocial stress should be considered in the assessment and treatment of patients with musculoskeletal pain and depression. Psychosocial stressors among patients with pain may have an impact on depression beyond that of anxiety. Tailored, integrated treatments that target the psychosocial needs of patients with pain and depression are needed. In addition to pharmacotherapy, psychotherapy and other behavioral treatments may be especially important for depression complicated by anxiety or psychosocial stress.

Stress and depression among older residents in religious monasteries: do friends and God matter?

The purpose of this investigation was to explore how friendship and attach-0 ment to God provide protective benefits against stress and depression. Participants included 235 men and women, age 64 and older, residing in religious monasteries affiliated with the Order of St. Benedict. Hierarchical multiple regression analyses were completed to assess main and moderating effects of friendship and attachment to God relative to the influence of stress on depressive symptomology. Lower degree of friendship closeness (beta = -.12, p < .10) and greater insecurity with God (beta = -.15, p < .01) were directly associated with greater depressive symptoms. A significant three-way interaction (Stress x Friendship x Attachment to God) also existed relative to depressive symptoms (beta = .14, p < .05). Three "stress-buffering" mechanisms emerged relative to the influence of stress on depressive symptomology. First, a greater degree of friendship closeness in combination with less secure attachment to God represented a greater risk for depressive symptoms. Second, greater friendship closeness in combination with greater secure attachment to God reduced the risk for depressive symptoms. Third, lower degree of friendship closeness combined with less secure attachment to God diminished the noxious effects of stress on depressive symptoms. This has implications relative to how social and spiritual resources can be used to reduce stress and improve quality of life for older adults residing in religious communities.

Needs in screening cardiovascular parameters during dental care in the elderly

AIMS

The aim of this study was to compare physiological reactivity during oral care between elderly and young subjects.

MATERIALS AND METHODS

Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) and blood oxygen saturation (SPO2) were recorded seven times during two consecutive dental impression sessions in 31 complete denture wearers (aged 60.7+/-11.44 yrs) and 31 young subjects (aged 21.8+/-1.5 yrs). Subjects also reported pain and anxiety on a visual analogue scale.

RESULTS

In the group of young subjects, SBP and DBP increased after the first impression and remained unchanged after the second. In the group of elderly persons, SBP and DBP increased significantly during both first and second dental impressions. Intergroup comparisons showed a longer-term relative increase in SBP and DBP in the group of elderly subjects.

CONCLUSIONS

These results emphasize the need to screen cardiovascular parameters during dental care in elderly subjects.

Depression in older adults with schizophrenia spectrum disorders: prevalence and associated factors

RATIONALE

Although depression is common in older adults with schizophrenia, it has not been well studied. The authors examine those factors that are related to depression in a multiracial urban sample of older persons with schizophrenia.

METHODS

The schizophrenia group consisted of 198 persons aged 55 or older who lived in the community and developed schizophrenia before age 45. Persons with substantial cognitive impairment were excluded from the study. A community comparison group (N = 113) was recruited using randomly selected census tract data. The authors adapted George's Social Antecedent Model of Depression, which consists of six categories comprising 16 independent variables, and used a dichotomous dependent variable based on a Center for Epidemiologic Studies Depression Scale cutoff score of > or = 16.

RESULTS

The schizophrenia group had significantly more persons with clinical depression than the community comparison group (32% versus 11%, respectively; chi(2) = 28.23, df = 1, p = 0.001). Bivariate analysis revealed that eight of the 16 variables were significantly related to clinical depression in the schizophrenia group. In logistic regression, six variables retained significance: physical illness (odds ratio [OR] = 1.60, 95% confidence interval [CI], 1.17-2.18), quality of life (OR = 0.84, 95% CI, 0.76-0.93), presence of positive symptoms (OR = 1.12, 95% CI, 1.02-1.21), proportion of confidants (OR = 0.03, 95% CI, 0.01-0.39), copes by using medications (OR = 2.12, 95% CI, 1.08-4.13), and copes with conflicts by keeping calm (OR = 1.34, 95% CI, 1.03-1.74).

CONCLUSION

Consistent with earlier studies of schizophrenia in older persons, the authors found physical health, positive symptoms, and several nonclinical variables to be associated with depression. Potential points for intervention include strengthening social supports, improving physical well-being, more aggressive treatment of positive symptoms, and increasing the recognition and treatment of depression.

Childhood adversity, recent life events and depression in late life

BACKGROUND

The study investigates whether persons who have experienced childhood adversity are more likely to develop depressive symptoms when faced with recent events.

METHOD

Data were used from a population-based sample, aged 55 to 85 years (n=1887), which were not depressed at baseline. Childhood adversities and recent stressful life events were retrospectively assessed. Depressive symptoms were measured with the CES-D.

RESULTS

14.4% of our sample experienced adverse events during childhood (<18 yrs) and 35.4% experienced recent events. Associations of depressive symptoms were found with both, childhood adversity (OR 1.80, 95% CI 1.21-2.69) and recent life events (OR 1.42, 95% CI 1.01-2.00). The effect of recent events on depressive symptoms was not modified by childhood adversity.

LIMITATIONS

Underreporting may be present due to unwillingness to report embarrassing events or to disclose painful memories.

CONCLUSIONS

No evidence was found for the assumption that older persons were more vulnerable for depression in reaction to recent life events when they were exposed to childhood adversity.

Differences between younger and older workers in the need for recovery after work

OBJECTIVE

The aim of this study was to test the hypothesis whether ageing workers have a higher need for recovery than younger workers.

METHODS

1100 subjects (84.3% participation rate) employed in the public sector participated in a cross-sectional questionnaire study. The subjects were divided into two age groups: older workers (> or =45 years) and younger workers (<45 years). The dependent outcome variable was assessed by "The Need for Recovery Scale" questionnaire. A need for recovery score higher than 45 was defined as a high need for recovery. A standardized questionnaire was used to assess psychosocial and physical work strain. Other occupational factors were included: part-time or full-time work, shift work and more than one employment. The following personal and social life and family related factors were also considered: gender, presence of chronic disease, degree of ability to cope with stress, number of children at home, taking care of disabled or elderly people, degree of satisfaction on family and social relationships. Stepwise multiple logistic regression analysis was used to examine the presence of a high need for recovery in older workers.

RESULTS

The mean recovery score was significantly higher in the group of the older workers (40.9) as compared to the younger workers (33.6) (P < 0.005). In the final multivariate logistic regression model the older age group had a significantly higher risk for the presence of a high need for recovery versus the younger group (OR 1.56, 95%CI 1.15-2.11). Gender, presence of musculoskeletal disorder, work pressure, monotonous work, social support from superiors, full time work and unsatisfactory social contacts were also significantly associated with the need for recovery.

CONCLUSION

The hypothesis that ageing workers have a higher need for recovery than younger workers was confirmed.