Onset of anxiety and depression in the aging population: comparison of risk factors in a 9-year prospective study

Cactus flour (Opuntia ficus-indica) reduces brain lipid peroxidation and anxious-like behavior in old Wistar rats

The aim of this research was to evaluate the effect of cactus flour on the anxious-like behavior and cerebral lipid peroxidation in elderly rats (18 months of life). The rats were divided into four groups (n=10). control (CG) - received the AIN-93M ration. P5%. P10% and P15%. treated with the AIN-93M ration with the addition of 5, 10 and 15% of cactus flour respectively. In the elevated plus maze (EPM) groups P5%, P10% and P15% remained longer in the open arms. P15% remained longer in this region and less time in the closed arms. No significant differences were observed between the groups regarding the time the rats remained in the center of the apparatus. P5%. P10% and P15% performed a greater number of head dips. Regarding the open field animals P5%. P10% and P15% performed a greater number of rearing and stayed for a longer time in the center of the apparatus with P15% being the group that remained for the longest time when compared to the other groups. There was no difference in locomotion and grooming. As for the light-dark box. P15% spent more time in the light part. less time in the dark part and performed a smaller number of transitions. P5%. P10% and P15% had the lowest concentrations of brain lipid peroxidation. Our data demonstrated that consumption of cactus flour by rats promoted anxiolytic effects and minimized brain lipid peroxidation in aging. Given the above, it can be deduced that cactus pear can contribute to the prevention and/or treatment of anxiety in the aging phase.Due to its concentrations of mono and polyunsaturated fatty acids, soluble fibers and antioxidant contents such as vitamin E and selenium.

PROTOCOL: Non-pharmacological interventions for older people with a diagnosis of depression: An evidence and gap map

This is the protocol for an evidence and gap map. The objectives are as follows: To map available randomized control trials, economic evaluations, and systematic reviews that assess the effectiveness and cost-effectiveness of non-pharmacological interventions for older people with a diagnosis of depression and identify any existing gaps in the evidence that can inform future research.

Rumination moderates the longitudinal associations of awareness of age-related change with depressive and anxiety symptoms

OBJECTIVE

Lower awareness of age-related gains (AARC-gains) and higher awareness of age-related losses (AARC-losses) may be risk factors for depressive and anxiety symptoms. We explored whether: (1) Baseline AARC-gains and AARC-losses predict depressive and anxiety symptoms at one-year follow-up; (2) age and rumination moderate these associations; (3) levels of AARC-gains and AARC-losses differ among individuals with different combinations of current and past depression and/or with different combinations of current and past anxiety.

METHODS

In this one-year longitudinal cohort study participants (N = 3386; mean age = 66.0; SD = 6.93) completed measures of AARC-gains, AARC-losses, rumination, depression, anxiety, and lifetime diagnosis of depression and anxiety in 2019 and 2020. Regression models with tests of interaction were used.

RESULTS

Higher AARC-losses, but not lower AARC-gains, predicted more depressive and anxiety symptoms. Age did not moderate these associations. Associations of lower AARC-gains and higher AARC-losses with more depressive symptoms and of higher AARC-losses with more anxiety symptoms were stronger in those with higher rumination. Individuals with both current and past depression reported highest AARC-losses and lowest AARC-gains. Those with current, but not past anxiety, reported highest AARC-losses.

CONCLUSION

Perceiving many age-related losses may place individuals at risk of depressive and anxiety symptoms, especially those who frequently ruminate.

Predictors of resilience in older adults with lower limb osteoarthritis and persistent severe pain

BACKGROUND

Resilience refers to the process in which people function well despite adversity. Persistent severe pain may be considered an adversity in people with lower limb osteoarthritis (LLOA). The objectives of this study are: (1) to identify what proportion of older adults with LLOA and persistent severe pain show good functioning; and (2) to explore predictors of resilience.

METHODS

Data from the European Project on OSteoArthritis (EPOSA) were used involving standardized data from six European population-based cohort studies. LLOA is defined as clinical knee and/or hip osteoarthritis. Persistent severe pain is defined as the highest tertile of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index both at baseline and follow-up. Resilience is defined as good physical, mental or social functioning at follow-up despite having LLOA with persistent severe pain.

RESULTS

In total, 95 (14.9%) out of 638 individuals with LLOA had persistent severe pain. Among these, 10 (11.0%), 54 (57.4%) and 49 (53.8%) had good physical, mental and social functioning, respectively. Only 4 individuals (4.5%) were resilient in all three domains of functioning. Younger age, male sex, higher education, higher mastery, smoking and alcohol use, higher physical activity levels, absence of chronic diseases, and more contacts with friends predicted resilience in one or more domains of functioning.

CONCLUSIONS

Few people with LLOA and persistent severe pain showed good physical functioning and about half showed good mental or social functioning. Predictors of resilience differed between domains, and might provide new insights for treatment.

Sex differences in mental health among older adults: investigating time trends and possible risk groups with regard to age, educational level and ethnicity

OBJECTIVES

Older women report lower mental health compared to men, yet little is known about the nature of this sex difference. Therefore, this study investigates time trends and possible risk groups.

METHOD

Data from the Doetinchem Cohort Study (DCS) and the Longitudinal Aging Study Amsterdam (LASA) were used. General mental health was assessed every 5 years, from 1995 to 1998 onwards (DCS, n = 1412, 20-year follow-up, baseline age 55-64 years). Depressive and anxiety symptoms were assessed for two birth cohorts, from 1992/1993 onwards (LASA cohort 1, n = 967, 24-year follow-up, age 55-65 years,) and 2002/2003 onwards (LASA cohort 2, n = 1002, 12-year follow-up, age 55-65 years) with follow-up measurements every 3-4 years.

RESULTS

Mixed model analyses showed that older women had a worse general mental health (-6.95; -8.36 to 5.53; range 0-100, ∼10% lower), more depressive symptoms (2.09; 1.53-2.63; range 0-60, ∼30% more) and more anxiety symptoms (0.86; 0.54-1.18; range 0-11, ∼30% more) compared to men. These sex differences remained stable until the age of 75 years, where after they decreased due to an accelerated decline in mental health for men compared to women. Sex differences and their course by age were consistent over successive birth cohorts, educational levels and ethnic groups (Caucasian vs. Turkish/Moroccan).

CONCLUSION

There is a consistent female disadvantage in mental health across different sociodemographic groups and over decennia (1992 vs. 2002) with no specific risk groups.

Geriatric Depression and Inappropriate Medication: Benefits of Interprofessional Team Cooperation in Nursing Homes

An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.

The Moderating Role of Views of Aging in the Longitudinal Relationship Between Physical Health and Mental Distress

OBJECTIVES

Some degree of mental distress is commonly present in old age, and it is often exacerbated in later life following changes in physical health. This work presents in 2 studies among samples that have been exposed to stressful experiences in the past, a prospective examination of how the association between physical health and mental distress is attenuated by 2 forms of views on aging, evaluations of age, and evaluations of one's future.

METHOD

Study 1 (N = 226) was conducted in 2008 (Time 1) and 2014 (Time 2), among Israeli war veterans (mean age 64.90, SD = 5.04); Study 2 (N = 132) was conducted in 2014 (Time 1) and 2015 (Time 2) among older adults who were exposed to ongoing rocket fire in the south of Israel (mean age 66.44, SD = 9.77). Participants reported on their subjective age, subjective life expectancy (SLE [in Study 1]/distance to death [DtD; in Study 2]), health, and mental distress.

RESULTS

Both studies showed that after controlling for exposure to trauma and for Time 1 mental distress, Time 1 subjective age, but not SLE/DtD, moderated the association between Time 1 physical health and Time 2 mental distress.

DISCUSSION

Subjective age and SLE represent distinct features of views of aging. Subjective age may reflect perceptions of one's aging process, associated more directly with health-related outcomes over time. SLE reflects future, death-related perceptions, therefore perhaps less directly associated with such outcomes.

Progression of Nonmotor Symptoms in Parkinson's Disease by Sex and Motor Laterality

Nonmotor symptoms (NMS) in Parkinson's disease (PD) can start up to a decade before motor manifestations and strongly correlate with the quality of life. Understanding patterns of NMS can provide clues to the incipient site of PD pathology. Our goal was to systematically characterize the progression of NMS in PD (n = 489), compared to healthy controls, HC (n = 241), based on the sex of the subjects and laterality of motor symptom onset. Additionally, NMS experienced at the onset of PD were also compared to subjects with scans without dopaminergic deficit, SWEDD (n = 81). The Parkinson's Progression Markers Initiative (PPMI) database was utilized to analyze several NMS scales. NMS experienced by PD and SWEDD cohorts were significantly higher than HC and both sex and laterality influenced several NMS scales at the onset of motor symptoms. Sex Differences. PD males experienced significant worsening of sexual, urinary, sleep, and cognitive functions compared to PD females. PD females reported significantly increased thermoregulatory dysfunction and anxious mood over 7 years and significantly more constipation during the first 4 years after PD onset. Laterality Differences. At onset, PD subjects with right-sided motor predominance reported significantly higher autonomic dysfunction. Subjects with left-sided motor predominance experienced significantly more anxious mood at onset which continued as Parkinson's progressed. In conclusion, males experienced increased NMS burden in Parkinson's disease. Laterality of motor symptoms did not significantly influence NMS progression, except anxious mood. We analyzed NMS in a large cohort of PD patients, and these data are valuable to improve PD patients' quality of life by therapeutically alleviating nonmotor symptoms.

Is well-being prior to receiving rehabilitation services associated with postrehabilitation mental health and functioning?

OBJECTIVES

Millions of older adults receive rehabilitation services every year, which aim to restore, maintain, or limit decline in functioning. We examine whether lower reported well-being prior to receiving rehabilitation services is associated with increased odds of worsening anxiety symptoms, depressive symptoms, and impairment in self-care and household activities following rehabilitation.

METHODS

Data come from the National Health and Aging Trends Study (NHATS), an annual survey of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Our sample consists of 811 NHATS participants who, in the 2015 interview, had information on well-being and, in the 2016 interview, reported receiving rehabilitation services in the prior year.

RESULTS

In multivariable logistic regression analyses, compared to the highest quartile, those in the lowest quartile of well-being at baseline have increased odds of having worsening depressive symptoms (OR = 9.25, 95% CI: 3.78-22.63) and worsening impairments in self-care activities (OR = 2.39, 95% CI: 1.12-5.11).

CONCLUSION

Our findings suggest that older adults with the lowest levels of baseline well-being may be susceptible to having worsening depressive symptoms and impairment in self-care activities following rehabilitation services. Examination on whether consideration of well-being during the rehabilitation process could lead to better mental health and functional outcomes following rehabilitation is needed.

Prevalence and factors associated with depression, anxiety, and stress symptoms among older adults: A cross-sectional population-based study

Despite population aging and the increase in mental health problems, studies on the mental health of older people in developing countries are lacking. This population-based cross-sectional study estimated the prevalence and associated factors for depression, anxiety and stress symptoms among older adults in Nepal. Community-dwelling older adults (N = 794) were interviewed using a questionnaire which consisted of the 21-item Depression Anxiety Stress Scales; and a wide range of sociodemographic, health-related, and lifestyle characteristics; functional ability, social support, participation in social activities, and adverse life events. The prevalence of symptoms was 15.4% for depression, 18.1% for anxiety, and 12.1% for stress. Risk factors for symptoms included female gender, working in agriculture, lower household wealth, perceived poor health, smoking, chronic conditions, migration of adult children, and exposure to adverse life events. Receiving an allowance, physical exercise, functional ability, social support, and participation in social activities were found to have protective effects. The findings indicate the need for community-based interventions, including appropriate diagnosis and treatment of mental health conditions, and mental health promotion programs targeting the risk and protective factors.

Association of Late Life Depression, (Non-) Modifiable Risk and Protective Factors with Dementia and Alzheimer's Disease: Literature Review on Current Evidences, Preventive Interventions and Possible Future Trends in Prevention and Treatment of Dementia

The number of people living with dementia and Alzheimer’s disease is growing rapidly, making dementia one of the biggest challenges for this century. Many studies have indicated that depression plays an important role in development of dementia, including Alzheimer’s disease; depression, especially, during the late life may either increase the risk of dementia or even being its prodromal stage. Despite a notably large number of carried observational studies and/or clinical trials, the association between the late life depression and dementia remains, due to the complexity of their relationship, still unclear. Moreover, during past two decades multiple other (non-)modifiable risk and possibly protective factors such as the hypertension, social engagement, obesity, level of education or physical (in)activity have been identified and their relationship with the risk for development of dementia and Alzheimer’s disease has been extensively studied. It has been proposed that to understand mechanisms of dementia and Alzheimer’s disease pathogeneses require their multifactorial nature represented by these multiple factors to be considered. In this review, we first summarize the recent literature findings on roles of the late life depression and the other known (non-)modifiable risk and possibly protective factors in development of dementia and Alzheimer’s disease. Then, we provide evidences supporting hypotheses that (i) depressive syndromes in late life may indicate the prodromal stage of dementia (Alzheimer’s disease) and, (ii) the interplay among the multiple (non-)modifiable risk and protective factors should be considered to gain a better understanding of dementia and Alzheimer’s disease pathogeneses. We also discuss the evidences of recently established interventions considered to prevent or delay the prodromes of dementia and provide the prospective future directions in prevention and treatment of dementia and Alzheimer’s disease using both the single-domain and multidomain interventions.

Examination of associations between personality traits, and polymorphisms of MAO-A and 5-HTT with the severity of menopausal symptoms and depression levels

The aim of the present study was to investigate the association between different personality traits with monoamine oxidase A (MAO-A) and serotonin transporter (5-HTT), and to examine their effects on the severity of menopause symptoms as well as the levels of depression in menopausal women. The study was designed as an analytical cross-sectional study, performed on 132 healthy post-menopausal women in Iran. Personality was assessed using the Revised Edition of the NEO Personality Index (Neuroticism-Extroversion-Openness-Five Factor Inventory). The symptoms score sheet, used for measuring menopausal symptoms, was used to classify the participants according to their menopausal symptoms. Furthermore, Beck Depression Inventory short version was also used to assess depressive symptoms. Examination of blood samples taken from all participants was to identify DNA polymorphisms of 5-HTT using PCR. The results of the present study showed that a high level of neuroticism (P<0.0001), low levels of extroversion (P<0.002), an openness to experience (P=0.039) and conscientiousness (P=0.001) were all positively associated with the severity of menopausal symptoms. In addition, a high level of neuroticism (P<0.0001), low levels of extroversion (P<0.0001), and a low level of agreeableness (P<0.024) and conscientiousness (P<0.0001) were all positively associated with depressive symptoms. There was no statistically significant association between MAO-A and 5-HTT polymorphisms with menopause and depression scores. Based on these results, there appears to be a significant association between personality traits with both depression and menopausal symptoms. Identification of homogeneous groups of women who are predisposed to depression and severe menopausal symptoms may allow for the implementation of early prevention programs.

Anxiety, depressive symptoms, and cardiac autonomic function in perimenopausal and postmenopausal women with hot flashes: a brief report

OBJECTIVE

The aim of the study was to examine whether anxiety and depressive symptoms are associated with an adverse cardiac autonomic profile among midlife women with hot flashes.

METHODS

Anxiety and depressive symptoms were evaluated by validated self-administered questionnaires among peri- and postmenopausal women in a randomized trial of slow-paced respiration for hot flashes. Pre-ejection period (PEP), a marker of sympathetic activation, and respiratory sinus arrhythmia (RSA), a marker of parasympathetic activation, were measured at baseline and 12 weeks using impedance cardiography and electocardiography. Multivariable repeated measures linear regression models examined associations between anxiety and depression symptoms and autonomic markers, corrected for multiple comparisons with Benjamini-Hochberg procedure, and adjusted for age and body mass index.

RESULTS

Among the 121 participants, greater state anxiety was associated with shorter PEP, reflecting higher sympathetic activity (β = -0.24, P = 0.02). Greater trait anxiety and cognitive anxiety were associated with lower RSA, reflecting decreased parasympathetic activity (β = -0.03, P < 0.01 for Spielberger Trait Anxiety; β = -0.06, P = 0.02 for Hospital Anxiety and Depression Scale [HADS] Anxiety Subscale). Greater depressive symptoms were associated with lower RSA (β = -0.06, P = 0.03 for HADS Depression Subscale; β = -0.03, P = 0.04 for Beck Depression Inventory).

CONCLUSIONS

Among peri- and postmenopausal women with hot flashes, greater self-reported anxiety and depressive symptoms were associated with lower levels of resting cardiac parasympathetic activity, and greater state anxiety was associated with higher levels of cardiac sympathetic activity. Findings suggest that midlife women with increased anxiety and depressive symptoms may have an unfavorable cardiac autonomic profile with potential implications for their overall cardiovascular risk.

Prognostic Value of Anxiety Between Heart Failure With Reduced Ejection Fraction and Heart Failure With Preserved Ejection Fraction

Background

Evidence suggests differences in clinical characteristics, causes, and prognoses between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Most studies have failed to support the prognostic relevance of anxiety in HFrEF or unclassified HF with mean left ventricular ejection fraction <40%. Meanwhile, the association between anxiety and prognoses in HFpEF remains unexamined. This study compared the prognostic value of anxiety between HFrEF and HFpEF.

Methods and Results

A total of 158 patients with HFrEF (left ventricular ejection fraction=28.51±7.53%) and 108 patients with HFpEF (left ventricular ejection fraction=64.53±9.67%) were recruited between May 2012 and December 2014. Demographic and clinical characteristics, Spielberger State‐Trait Anxiety Inventory, Beck Depression Inventory‐II scale, and 18‐month follow‐up outcomes were recorded during the hospital stay. There were significant differences in age, sex, comorbidities, laboratory biomarkers, discharge medications, and unhealthy behaviors, which supported the contention that HFrEF and HFpEF represent 2 distinct phenotypes, although there were no significant differences in anxiety and 18‐month outcomes. Multiple logistic regression yielded no significant associations between anxiety and 18‐month outcomes in HFrEF. By contrast, trait anxiety could predict 18‐month all‐cause mortality (odds ratio, 1.429; 95% CI, 1.020–2.000; P=0.038), all‐cause readmission or death (odds ratio, 1.147; 95% CI, 1.036–1.271; P=0.008), and cardiac readmission or death (odds ratio, 1.133; 95% CI, 1.031–1.245; P=0.010) in HFpEF after adjusting for possible confounders.

Conclusions

Trait anxiety was independently associated with 18‐month all‐cause mortality, all‐cause readmission or death, and cardiac readmission or death in HFpEF, but not in HFrEF.

Late-Life Depressive and Anxiety Symptoms Following Rehabilitation Services in Medicare Beneficiaries

OBJECTIVE

The aim of this study was to determine whether patients who received rehabilitation services had an increased risk of having late-life depressive or anxiety symptoms within the year following termination of services.

METHODS

The National Health and Aging Trends Study (NHATS) is a population-based, longitudinal cohort survey of a nationally representative sample of Medicare beneficiaries aged 65years and older. This study involved 5,979 participants from the 2016 NHATS survey. The Patient Health Questionnaire-2 and Generalized Anxiety Disorder 2-item assessed for clinically significant depressive and anxiety symptoms.

RESULTS

The prevalence of depressive and anxiety symptoms was higher in older adults who had received rehabilitation services in the year prior and varied by site: no rehabilitation (depressive and anxiety symptoms): 10.4% and 8.8%; nursing home or inpatient rehabilitation: 38.8% and 23.8%; outpatient rehabilitation: 8.6% and 5.5%; in-home rehabilitation: 35.3% and 20.5%; multiple rehabilitation sites: 20.3% and 14.4%; and any rehabilitation site: 18.4% and 11.8%. In multiple logistic regression analyses, nursing home and inpatient and in-home rehabilitation services, respectively, were associated with an increased risk of having subsequent depressive symptoms (odds ratio: 3.51; 95% confidence interval [CI]: 1.85-6.63; OR: 2.15; 95% CI: 1.08-4.30) but not anxiety symptoms.

CONCLUSION

Older adults who receive rehabilitation services are at risk of having depressive and anxiety symptoms after these services have terminated. As mental illness is associated with considerable morbidity and may affect rehabilitation outcomes, additional efforts to identify and treat depression and anxiety in these older adults may be warranted.

Patient phenotypes associated with outcome following surgery for mild degenerative cervical myelopathy: a principal component regression analysis

BACKGROUND CONTEXT

Predictors of outcome after surgery for degenerative cervical myelopathy (DCM) have been determined previously through hypothesis-driven multivariate statistical models that rely on a priori knowledge of potential confounders, exclude potentially important variables because of restrictions in model building, cannot include highly collinear variables in the same model, and ignore intrinsic correlations among variables.

PURPOSE

The present study aimed to apply a data-driven approach to identify patient phenotypes that may predict outcomes after surgery for mild DCM.

STUDY DESIGN

This is a principal component analysis of data from two related prospective, multicenter cohort studies.

PATIENT SAMPLE

The study included patients with mild DCM, defined by a modified Japanese Orthopaedic Association score of 15-17, undergoing surgical decompression as part of the AOSpine CSM-NA or CSM-I trials.

OUTCOME MEASURES

Patient outcomes were evaluated preoperatively at baseline and at 6 months, 1 year, and 2 years after surgery. Quality of life (QOL) was evaluated by the Neck Disability Index (NDI) and Short Form-36 version 2 (SF-36v2). These are both patient self-reported measures that evaluate health-related QOL, with NDI being specific to neck conditions and SF-36v2 being a generic instrument.

MATERIALS AND METHODS

The analysis included 154 patients. A heterogeneous correlation matrix was created using a combination of Pearson, polyserial, and polychoric regressions among 67 variables, which then underwent eigen decomposition. Scores of significant principal components (PCs) (with eigenvalues>1) were included in multivariate logistic regression analyses for three dichotomous outcomes of interest: achievement of the minimum clinically important difference [MCID] in (1) NDI (≤-7.5), (2) SF-36v2 Physical Component Summary (PCS) score (≥5), and (3) SF-36v2 Mental Component Summary (MCS) score (≥5).

RESULTS

Twenty-four significant PCs accounting for 75% of the variance in the data were identified. Two PCs were associated with achievement of the MCID in NDI. The first (PC 1) was dominated by variables related to surgical approach and number of operated levels; the second (PC 21) consisted of variables related to patient demographics, severity and etiology of DCM, comorbid status, and surgical approach. Both PC 1 and PC 21 also correlated with SF-36v2 PCS score, in addition to PC 4, which described patients' physical profile, including gender, height, and weight, as well as comorbid renal disease; PC 6, which received large loadings from variables related to cardiac disease, impaired mobility, and length of surgery and recovery; and PC 9, which harbored large contributions from features of upper limb dysfunction, cardiorespiratory disease, surgical approach, and region. In addition to PC 21, a component profiling patients' socioeconomic status and support systems and degree of physical disability (PC 24) was associated with achievement of the MCID in SF-36 MCS score.

CONCLUSIONS

Through a data-driven approach, we identified several phenotypes associated with disability and physical and mental health-related QOL. Such data reduction methods may separate patient-, disease-, and treatment-related variables more accurately into clinically meaningful phenotypes that may inform patient care and recruitment into clinical trials.

[Prevalence of anxiety disorders in people over 65 years-old: A systematic review]

Anxiety is an emotional problem that causes discomfort and suffering to those that suffer from it. Anxiety disorders can affect the functioning in different facets of a person's life. Studies on the prevalence of anxiety disorders in people over 65 years show variable results, ranging between 0.1% and 17.2%. Most of these studies include samples of the general population, in which the population of people over 65 years is under-represented. These studies evaluate older people with the same diagnostic tools used to assess anxiety disorders in people under 65 years, and collect data from people between 65 and 75 years old, leaving out people aged 75 and over. A systematic review of the prevalence studies of anxiety disorders in elderly people is presented. It is concluded that when representative samples of people over 65 years are used and evaluated with suitable tools, the prevalence rate of these disorders in the elderly is much higher than previously thought, reaching an annual prevalence rate of 20.8%.

Decreased anxiety after Dawood fasting in the pre-elderly and elderly

Background A high prevalence of anxiety in the elderly often leads to decreased quality of life (QOL). A restrictive diet can increase the production of ketone bodies that encourage mood enhancement, neural protection and pain reduction. This study aimed to identify whether Dawood fasting could increase the QOL of the elderly by reducing anxiety. Methods This research was a quasi-experimental study involving a pretest-post-test control group design. The subjects were pre-elderly and elderly or healthy people aged more than 50, and a consecutive sampling method was employed. The fasting group observed the fast of Dawood, in which they abstained from eating, drinking, or having sexual intercourse from the break of dawn to dusk with the expressed intent to fast every other day. The fast was observed for 22 days (11 fasting days). Anxiety was examined using the Hamilton Rating Scale for Anxiety (HRS-A), while QOL was identified using the Indonesian version of the World Health Organisation Quality of Life (WHOQOL). Results A total of 48 respondents participated in this study with 24 respondents observing the fast of Dawood and 24 others not fasting. Results showed that the 22 days of Dawood fast reduced respondents' complaints about anxiety by 4.37% and was significantly different from the non-fasting group (p=0.001). There was an increase in the QOL of the fasting group (p=0.019), although no significant difference was found when compared to the non-fasting group. Conclusions The fast of Dawood reduced anxiety in the pre-elderly and elderly.

The importance of personality and life-events in anxious depression: from trait to state anxiety

OBJECTIVES

Anxious depression is associated with severe impairment and bad prognoses. We hypothesize that recent life-events are associated with more anxiety in late-life depression and that this is conditional upon the level of certain personality traits.

METHOD

Baseline data of the Netherlands Study of Depression in Older Persons (NESDO) were used. In 333 patients (≥60 years) suffering from a major depressive disorder, anxiety was assessed with the BAI, personality traits with the NEO-FFI and the Mastery Scale, and life-events with the Brugha questionnaire. Multiple linear regression analyses were applied with anxiety severity as dependent and life-events and personality traits as independent variables.

RESULTS

147 patients (44.1%) had recently experienced one or more life-events. The presence of a life-event is not associated with anxiety (p = .161) or depression severity (p = .440). However, certain personality traits interacted with life-events in explaining anxiety severity. Stratified analyses showed that life-events were associated with higher anxiety levels in case of high levels of neuroticism and openness and low levels of conscientiousness or mastery.

CONCLUSIONS

In the face of a life-event, personality traits may play a central role in increased anxiety levels in late-life depression.

The relationship between serum 25(OH)D levels and anxiety symptoms in older persons: Results from the Longitudinal Aging Study Amsterdam

OBJECTIVE

Low serum 25-hydroxyvitamin D levels (25(OH)D<50nmol/L) are common in older persons and associated with depressive symptoms. Depression and anxiety are highly interrelated, but only very few studies examined the association between 25(OH)D and anxiety. This study investigated whether 25(OH)D levels are related to anxiety symptoms in older persons, both cross-sectionally and over time.

METHODS

Data from two samples of a large population-based cohort study were used (sample 1: N=1259, 64-88years; sample 2: N=892, 60-98years). Anxiety symptoms were measured with the Hospital Anxiety and Depression Scale - Anxiety subscale at baseline and after three years; serum 25(OH)D was measured at baseline. Cross-sectional and longitudinal relationships between 25(OH)D and anxiety were examined using logistic regression analysis, taking into account relevant confounding variables.

RESULTS

Of the participants, 48.0% (sample 1) and 26.4% (sample 2) had 25(OH)D levels <50nmol/L, whereas 8.1% (sample 1) and 6.5% (sample 2) had clinically relevant anxiety symptoms. Cross-sectionally, persons with 25(OH)D<50nmol/L experienced more anxiety symptoms than persons with 25(OH)D≥50nmol/L (sample 1: OR=1.55; 95% CI: 1.03-2.32, p=0.035; sample 2: OR=1.74; 95% CI: 1.03-2.96, p=0.040). However, after adjustment for demographic and lifestyle variables and depressive symptoms, significant associations were no longer observed (p=0.25-0.72). Similarly, 25(OH)D levels were not significantly related to anxiety symptoms after three years in both samples.

CONCLUSIONS

After adjustment for confounding, there was no cross-sectional or longitudinal association between 25(OH)D levels and anxiety symptoms, independently from depression, in two large samples of older persons.

Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of a Combined Prospective Dataset

STUDY DESIGN

Analysis of a combined prospective dataset.

OBJECTIVE

To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM).

SUMMARY OF BACKGROUND DATA

Psychiatric comorbidities, including depression, have been associated with worse clinical outcomes after lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM.

METHODS

Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6, 12, and 24 months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36v2) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months among patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors.

RESULTS

Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (P < 0.0001). Patients with psychiatric comorbidities were more likely to have cardiovascular (P = 0.0177), respiratory (P < 0.0001), gastrointestinal (P < 0.0001), rheumatologic (P = 0.0109), and neurologic (P = 0.0309) disorders. At 24 months after surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI, and SF-36v2 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36v2 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24 months among patients in each group. Improvement in NDI, SF-36v2 PCS, and MCS, however, were smaller in patients with depression or bipolar disorder than those without.

CONCLUSION

Patients with depression or bipolar disorder have smaller functional and quality of life improvements after surgery compared to patients without psychiatric comorbidities.

LEVEL OF EVIDENCE

2.

The correlates of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review

OBJECTIVE

To synthesize and summarize the studies examining the correlates and predictors of anxiety in older adults living in residential aged care.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to peer-reviewed literature published in English. Eligible studies examined the association between at least one correlate/factor and anxiety disorders or symptoms in aged care residents aged 50+ years.

RESULTS

A total of 3741 articles were identified, of which 34 studies (with a total of 1 543 554 participants) were included in this review. Correlates associated with anxiety included pain, use of anti-depressants/lithium, depression, and lower perceived quality of life. Less consistent and/or less studied variables included younger age, female gender, higher educational level, functional dependence, subjective health status, more prescribed medications, impaired vision, insomnia, external locus of control, fear of falling, attachment, hope, meaning in life, and the influence of social, environmental, and staff/policy correlates.

CONCLUSIONS

While several variables were found to have strong associations with anxiety in aged care residents, a number of factors have been examined by only one or two studies. Further research (preferably prospective studies) is therefore needed to reliably confirm findings and to help plan and develop preventative and intervention strategies. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of life review interventions on psychosocial outcomes among older adults: A systematic review and meta-analysis

AIM

The present study aimed to evaluate the effects of life review interventions on psychosocial outcomes among older adults.

METHODS

We searched PubMed, Ovid, CINHAL, Cochrane library, PsycINFO, Springer Link, Oxford Journals Collection, FRMS, CBM, VIP, CNKI, and Wanfang to identify randomized controlled trials and controlled clinical trials that evaluate the effects of life review among older adults. The quality of studies included was evaluated and the relevant information was extracted. Then, a meta-analysis was carried out with RevMan software.

RESULTS

We identified 15 studies that met the inclusion criteria, and 11 studies were allowed for meta-analysis. The combined results of the meta-analysis showed that life review significantly reduced depression (standardized mean difference 0.57, 95% CI 0.73 to -0.42) and hopelessness (mean difference [MD] 4.01, 95% CI 6.13 to -1.89). There was a significant improvement in well-being (standardized mean difference 0.54, 95% CI 0.01-1.06) and specific memory (MD 1.05, 95% CI 0.07-2.03). However, other study findings did not support its effect in life satisfaction (MD 2.15, 95% CI 0.69- 5.00), self-esteem (MD 0.21, 95% CI 2.09-2.50), the quality of life (standardized mean difference 0.15, 95% CI 0.96-0.66), extended memory (MD 0.03, 95% CI 0.61-0.55), categorical memory (MD 0.48, 95% CI 1.08- 0.12) and no recall (MD 0.30, 95% CI 1.12- 0.52).

CONCLUSIONS

Life review is a worthwhile intervention for reducing depression and hopelessness, and improving quality of life, well-being and specific memory in older adults. More well-designed trials with a large sample and long-term follow up are necessary to confirm the effects of life review on other psychosocial outcomes. Geriatr Gerontol Int 2017; 17: 1344-1357.

Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants

BACKGROUND

This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory.

METHOD

This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants.

RESULTS

The results showed large unadjusted prospective associations between neuroticism and symptoms/diagnosis of anxiety, depression, and non-specific mental distress (d = 0.50-0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10-0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03-0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short (<4 year) than long (⩾4 years) follow-up intervals, suggesting a substantial decay of the association with increasing time intervals. Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect.

CONCLUSION

High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.

Comorbid Anxiety and Depressive Symptoms in Children and Adolescents: A Systematic Review and Analysis

BACKGROUND

A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited.

OBJECTIVE

The goal of this systematic review was to examine the current literature focused on comorbid anxiety and depression in children and adolescents. The review included theoretical conceptualizations as well as diagnostic, neurobiological, prevention, and treatment considerations. In addition, a proposed algorithm for the treatment of comorbid anxiety and depression in children/adolescents is provided.

METHODS

This systematic literature review included 3 discrete searches in Ovid SP Medline, PsycInfo, and PubMed.

RESULTS

The review included and synthesized 115 articles published between 1987 and 2015. The available evidence suggests that anxiety and depression are common in clinical populations of children and adolescents, and that comorbidity is likely underestimated in children and adolescents. Children and adolescents with comorbid anxiety and depression have unique presentations, greater symptom severity, and treatment resistance compared with those who have either disease in isolation. A dimensional approach may be necessary for the future development of diagnostic strategies and treatments for this population. Nascent neuroimaging work suggests that anxiety and depression each represents a distinct neurobiological phenotype.

CONCLUSIONS

The literature that is currently available suggests that comorbid anxiety and depression is a common presentation in children and adolescents. This diagnostic picture underscores the importance of comprehensive dimensional assessments and multimodal evidence-based approaches given the high disease severity. Future research on the neurobiology and the treatment of these common clinical conditions is warranted.

Mapping abnormal subcortical brain morphometry in an elderly HIV+ cohort

Over 50% of HIV + individuals exhibit neurocognitive impairment and subcortical atrophy, but the profile of brain abnormalities associated with HIV is still poorly understood. Using surface-based shape analyses, we mapped the 3D profile of subcortical morphometry in 63 elderly HIV + participants and 31 uninfected controls. The thalamus, caudate, putamen, pallidum, hippocampus, amygdala, brainstem, accumbens, callosum and ventricles were segmented from high-resolution MRIs. To investigate shape-based morphometry, we analyzed the Jacobian determinant (JD) and radial distances (RD) defined on each region's surfaces. We also investigated effects of nadir CD4 + T-cell counts, viral load, time since diagnosis (TSD) and cognition on subcortical morphology. Lastly, we explored whether HIV + participants were distinguishable from unaffected controls in a machine learning context. All shape and volume features were included in a random forest (RF) model. The model was validated with 2-fold cross-validation. Volumes of HIV + participants' bilateral thalamus, left pallidum, left putamen and callosum were significantly reduced while ventricular spaces were enlarged. Significant shape variation was associated with HIV status, TSD and the Wechsler adult intelligence scale. HIV + people had diffuse atrophy, particularly in the caudate, putamen, hippocampus and thalamus. Unexpectedly, extended TSD was associated with increased thickness of the anterior right pallidum. In the classification of HIV + participants vs. controls, our RF model attained an area under the curve of 72%.

•

We model subcortical morphometry of elderly HIV + participants.

•

We explore classifying HIV status based on shape and volume of brain regions.

•

Morphometry of brain regions was associated with infection status and duration.

•

HIV status was classifiable with 72% accuracy in morphometry-based classifiers.

Comorbid anxiety disorders in late-life depression: results of a cohort study

BACKGROUND

Comorbid anxiety disorders are common in late-life depression and negatively impact treatment outcome. This study aimed to examine personality characteristics as well as early and recent life-events as possible determinants of comorbid anxiety disorders in late-life depression, taking previously examined determinants into account.

METHODS

Using the Composite International Diagnostic Interview (CIDI 2.0), we established comorbid anxiety disorders (social phobia (SP), panic disorder (PD), generalized anxiety disorder (GAD), and agoraphobia (AGO)) in 350 patients (aged ≥60 years) suffering from a major depressive disorder according to DSM-IV-TR criteria within the past six months. Adjusted for age, sex, and level of education, we first examined previously identified determinants of anxious depression: depression severity, suicidality, partner status, loneliness, chronic diseases, and gait speed in multiple logistic regression models. Subsequently, associations were explored with the big five personality characteristics as well as early and recent life-events. First, multiple logistic regression analyses were conducted with the presence of any anxiety disorder (yes/no) as dependent variable, where after analyses were repeated for each anxiety disorder, separately.

RESULTS

In our sample, the prevalence rate of comorbid anxiety disorders in late-life depression was 38.6%. Determinants of comorbid anxiety disorders were a lower age, female sex, less education, higher depression severity, early traumatization, neuroticism, extraversion, and conscientiousness. Nonetheless, determinants differed across the specific anxiety disorders and lumping all anxiety disorder together masked some determinants (education, personality).

CONCLUSIONS

Our findings stress the need to examine determinants of comorbid anxiety disorder for specific anxiety disorders separately, enabling the development of targeted interventions within subgroups of depressed patients.

Behavioral correlates of anxiety in well-functioning older adults

BACKGROUND

Research on the behavioral correlates of anxiety in older adults is sparse. The aim of this study was to explore the association of anxiety with behavioral patterns defined by health, activity, emotional and social variables.

METHODS

A convenience sample of 395 older adults completed measures of health, activity, emotions, social variables and experiential avoidance. Cross-sectional data were analysed using cluster analysis.

RESULTS

Five clusters were identified: active healthy, healthy, active vulnerable, lonely inactive and frail lonely. Participants in the active healthy and healthy clusters showed the highest scores on health variables (vitality and physical function), and adaptive scores on the rest of variables. They also reported the lowest scores on anxiety and included the lowest number of cases with clinically significant anxiety levels. Active vulnerable showed high scores on social support, leisure activities and capitalization on them but low scores in vitality and physical functioning. Participants in the lonely inactive cluster reported the highest mean score in experiential avoidance and high scores on boredom and loneliness, and low scores on social support, leisure activities capitalizing on pleasant activities and health variables. Frail lonely represent a particularly vulnerable profile of participants, similar to that of lonely inactive, but with significantly lower scores on health variables and higher scores on boredom and hours watching TV.

CONCLUSIONS

Anxiety in older adults is not only linked to poor health, but also to dysfunctional social behavior, loneliness, boredom and experiential avoidance. Maladaptive profiles of older adults with regard to these variables have been identified.

Risk factors for late-onset generalized anxiety disorder: results from a 12-year prospective cohort (the ESPRIT study)

Generalized anxiety disorder (GAD) is a chronic and highly prevalent disorder associated with increased disability and mortality in the elderly. Treatment is difficult with low rate of full remission, thus highlighting the need to identify early predictors for prevention in elderly people. The aim of this study is to identify and characterize incident GAD predictors in elderly people. A total of 1711 individuals aged 65 years and above and free of GAD at baseline were randomly recruited from electoral rolls between 1999 and 2001 (the prospective ESPRIT study). The participants were examined at baseline and five times over 12 years. GAD and psychiatric comorbidity were diagnosed with a standardized psychiatric examination, the Mini-International Neuropsychiatry Interview on the basis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria and validated by a clinical panel. During the follow-up, 8.4% (95% confidence interval=7.1-9.7%) of the participants experienced incident GAD, 80% being first episodes; the incident rate being 10 per 1000 person-years. The principal predictors of late-onset incident GAD over 12 years derived from a multivariate Cox model were being female, recent adverse life events, having chronic physical (respiratory disorders, arrhythmia and heart failure, dyslipidemia, cognitive impairment) and mental (depression, phobia and past GAD) health disorders. Poverty, parental loss or separation and low affective support during childhood, as well as history of mental problems in parents were also significantly and independently associated with incident GAD. GAD appears as a multifactorial stress-related affective disorder resulting from both proximal and distal risk factors, some of them being potentially modifiable by health care intervention.

Comparison of anxiety as reported by older people with intellectual disabilities and by older people with normal intelligence

OBJECTIVES

Older people with intellectual disabilities (ID) may experience more and different symptoms of anxiety than older people with normal intelligence.

STUDY QUESTIONS

(1) Is the reported severity of anxiety in this group similar to that in the general older population; (2) Are specific anxiety symptoms reported as frequently by both groups?

DESIGN

Cross-sectional.

SETTING

Formal Dutch intellectual disability services and Dutch population-based study.

PARTICIPANTS

One hundred fifty-four participants of the Healthy Ageing and Intellectual Disability study with mild or moderate ID (IQ <70), aged 55-85 years, and 2,917 participants of the Longitudinal Aging Study Amsterdam with normal intelligence, aged 55-85 years.

MEASUREMENTS

The general anxiety subscale of the Hospital Anxiety and Depression Scale.

RESULTS

Mean (standard deviation) Hospital Anxiety and Depression Scale total score of subjects with ID was significantly higher than that of subjects with normal intelligence (3.53 [3.03]) versus 2.53 [3.30]; p <0.01), whereas the percentage of scores above cutoff in both groups was similar. Four of 7 items were more often reported as present by subjects with ID: "tense or wound up feelings," "frightened feelings," "worrying thoughts," and "sudden feelings of panic."

CONCLUSIONS

Older people with ID report more symptoms of anxiety than older people with normal intelligence. Tense feelings and worrying especially need more attention, because more than one-half of all older people with ID reported such symptoms.

A controlled study of suicide in middle-aged and older people: personality traits, age, and psychiatric disorders

Personality traits were examined using the NEO Five-Factor Inventory-Revised in an Australian psychological autopsy study involving 259 suicide deaths and 181 sudden death controls aged 35 years and over. Interviews included the Structured Clinical Interview for DSM-IV to determine the presence of psychiatric disorder. Personality traits of suicide deaths differed significantly from those of controls, scoring higher in the Neuroticism and Openness to Experience domains and lower on the Agreeableness and Extraversion domains. These findings varied with the presence of psychiatric disorder and by age. High Neuroticism scores were the most consistent finding in people who died by suicide, although these scores decreased in older suicides.

Ageing and the prevalence and treatment of mental health problems

BACKGROUND

Ageing is an important factor in the development of mental health problems and their treatment. We assessed age trajectories of common mental disorders (CMDs) and psychotherapy utilization from adolescence to old age, and examined whether these trajectories were modified by time period or birth cohort effects.

METHOD

British Household Panel Survey (BHPS) with an 18-year follow-up between 1991 and 2009 (n=30 224 participants, aged 15–100 years, with an average 7.3 person-observations per person). CMDs were assessed with the 12-item version of the General Health Questionnaire (GHQ). Psychotherapy treatment utilization during the past year was self-reported by the participants. The modifying influences of time period and cohort effects were assessed in a cohort-sequential longitudinal setting.

RESULTS

Following a moderate decrease after age 50, the prevalence of GHQ caseness increased steeply from age 75. This increase was more marked in the 2000s (GHQ prevalence increasing from 24% to 43%) than in the 1990s (from 22% to 34%). Psychotherapy utilization decreased after age 55, with no time period or cohort effects modifying the age trajectory. These ageing patterns were replicated in within-individual longitudinal analysis.

CONCLUSIONS

Old age is associated with higher risk of CMDs, and this association has become more marked during the past two decades. Ageing is also associated with an increasing discrepancy between prevalence of mental disorders and provision of treatment, as indicated by lower use of psychotherapy in older individuals.

Do negative affect characteristics and subjective memory concerns increase risk for late life anxiety?

To better understand the development and exacerbation of late-life anxiety, we tested a risk model positing that trait negative affect (NA) characteristics would interact with cognitive functioning, thereby increasing some older adults' risk for increased anxiety symptoms. The moderator-mediator model consisted of measures of NA, cognitive functioning, and their interaction, as predictors of later Hamilton Anxiety Rating Scale scores (HARS) via a mediational process, subjective memory concerns (SMCs). Older adults (aged 65-years and over; M(age)=76.7 years, SD=6.90 years) completed evaluations four times over approximately 18 months. A latent growth curve model including Anxiety Sensitivity Index total score (ASI), Mattis Dementia Rating Scale-2 (DRS) total raw score, the ASI×DRS interaction, a SMC measure as mediator, HARS intercept (scores at times 3 and 4), and HARS slope provided good fit. The ASI×DRS-2 interaction at Time 1 predicted HARS slope score (β=-.34, p<.05). When ASI score was high, stronger cognitive functioning was associated with fewer anxiety symptoms. The indirect effect of ASI score predicting HARS score 18-months later through the SMC mediator was statistically significant (β=.08, p<.05). Results suggest that the cognitive functioning changes associated with aging might contribute to the development of anxiety symptoms in older adults with specific NA traits. Implications for predicting and preventing late life anxiety disorders are discussed.

Anxiety and 10-year risk of incident and recurrent depressive symptomatology in older adults

BACKGROUND

Anxiety has been shown to often precede depression in children and young adults. Only a small number of investigations have examined this form of comorbidity in older adults and the temporal relationship of these syndromes remains unclear. The objective was to verify whether trait anxiety predicts incident/recurrent depressive symptomatology in older adults independently of variables susceptible to explain this relationship in this population, such as cognitive complaints, subjective health, and baseline depressive symptoms.

METHODS

A random sample of 4,649 individuals aged 65 years or older from the Three-City Study, a prospective longitudinal study with a 10-year follow-up, was used. Incident and recurrent depressive symptomatology were determined by Center for Epidemiological Studies Depression Scale cutoff scores. Anxiety was measured using the trait scale of the State-Trait Anxiety Inventory. Cox proportional hazards models were used to determine the independent risk of depressive symptomatology for baseline anxiety, cognitive complaints, subjective health, and depressive symptoms, adjusting for sociodemographic, mental health, and physical health covariates.

RESULTS

Incident depressive symptomatology was independently predicted by baseline anxiety, depressive symptoms, cognitive complaints, and subjective health. Recurrent depressive symptomatology was independently predicted by baseline anxiety and depressive symptoms, but not by cognitive complaints and subjective health. Anxiety was associated with a higher risk of incident depressive symptomatology only in participants without a history of a major depressive episode, and with a higher risk of recurrent depressive symptomatology in men than in women.

CONCLUSIONS

Trait anxiety constitutes an important independent risk factor for subsequent depressive symptomatology in older adults.

Neuroticism and common mental disorders: meaning and utility of a complex relationship

Neuroticism's prospective association with common mental disorders (CMDs) has fueled the assumption that neuroticism is an independent etiologically informative risk factor. This vulnerability model postulates that neuroticism sets in motion processes that lead to CMDs. However, four other models seek to explain the association, including the spectrum model (manifestations of the same process), common cause model (shared determinants), state and scar models (CMD episode adds temporary/permanent neuroticism). To examine their validity we reviewed literature on confounding, operational overlap, stability and change, determinants, and treatment effects. None of the models is able to account for (virtually) all findings. The state and scar model cannot explain the prospective association. The spectrum model has some relevance, especially for internalizing disorders. Common causes are most important but the vulnerability model cannot be excluded although confounding of the prospective association by baseline symptoms and psychiatric history is substantial. In fact, some of the findings, such as interactions with stress and the small decay of neuroticism's effect over time, are consistent with the vulnerability model. We describe research designs that discriminate the remaining models and plea for deconstruction of neuroticism. Neuroticism is etiologically not informative yet but useful as an efficient marker of non-specified general risk.

Gender differences in the relation between depression and social support in later life

BACKGROUND

Prevalence of depression is twice as high in women as in men, also in older adults. Lack of social support is a risk factor for late-life depression. The relation between depression and social support may be different for men and women.

METHODS

Data from the Longitudinal Aging Study Amsterdam were used to investigate gender differences in the relation between social support and depression in a population-based sample aged 55-85 years, with n = 2,823 at baseline and using the 13-year follow-up data on onset of depression.

RESULTS

Respondents without a partner in the household, with a small network, and with low emotional support were more often depressed, with men showing higher rates of depression than women. A high need for affiliation was associated with depression in women but not in men. Lack of a partner in the household and having a small network predicted onset of depression in men but not in women. In respondents with high affiliation need and low social support, depression rates were higher, with men being more often depressed than women.

CONCLUSIONS

Low social support and a high need for affiliation were related to depression in later life, with men being more vulnerable for depression than women. Considering the serious consequences of depression, especially in older people, it is important to identify the persons with low social support and a high need for affiliation, and to help them to increase their social support or to adjust their needs.

Determinants of receiving mental health care for depression in older adults

BACKGROUND

Major Depressive Disorder (MDD) is common among elderly people. However, it appears that only a minority receives treatment. This study aims to identify and analyse the factors that determine whether elderly people with depressive disorders have contact with health care professionals for mental problems.

METHOD

Cross-sectional analysis of cohort data collected in the Netherlands Study of Depression in Older persons (NESDO) and the Netherlands Study of Depression and Anxiety (NESDA) among 167 respondents aged ≥55 with a depressive disorder as indicated by the CIDI. Contacts for mental health problems during the past six months (TiC-P), and indicators of predisposing, enabling, and objective need factors were assessed by interview.

RESULTS

Of the total sample, 70% had contact for mental health problems, almost entirely within primary care (62%). The odds of having contact increased with advancing age; for respondents born in the Netherlands; for those who felt less lonely; and for those with a higher household income.

LIMITATIONS

Our study is based on base-line interviews and thus has a cross-sectional character. Therefore, causal conclusions cannot be drawn. Furthermore, we studied the respondents' perception whether mental health care was received.

CONCLUSIONS

The contact rate for mental health problems is high. Health care professionals should be aware that having contact is not associated with a higher objective need, but rather with increasing age, being Dutch-born, being less lonely and having a higher household income.

Natural course of depressive symptoms in late life. An 8-year population-based prospective study

AIMS

The aim of the study was to follow the natural course of late-life depressive symptoms within a German population-based study.

METHODS

Within the Leipzig Longitudinal Study of the Aged (LEILA 75+), a representative sample of 1265 individuals aged 75 years and older were interviewed every 1.5 years over 8 years. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D, German-specific cut-off score ≥23).

RESULTS

The incidence of depressive symptoms was 34 per 1000 person-years (95% confidence interval 31-37). In a multivariate regression model, female gender, poor self-rated health status, stroke, risky alcohol consumption, a poor social network, higher number of specialist visits, functional impairment, and CES-D score at baseline were significant risk factors of future depressive symptoms. We observed remission in 60%, an intermittent course in 17% and a chronic course in 23% of the participants. No baseline characteristic distinguished the remission group from the persistently depressed.

CONCLUSION

Depressive symptoms in late life are common and highly persistent. In the present study encountered risk factors entailed potentialities for secondary prevention.

[Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part I: Risk Factors, Screening, Suicide Risk Diagnosis and Assessment in Patients with a Depression Diagnosis]

INTRODUCTION

Depression is an important cause of morbidity and disability in the world; however, it is under-diagnosed at all care levels.

OBJECTIVE

The purpose here is to present recommendations based on the evidence gathered to answer a series of clinical questions concerning risk factors, screening, suicide risk diagnosis and evaluation in patients undergoing a depressive episode and recurrent depressive disorder. Emphasis has been made upon the approach used at the primary care level so as to grant adult diagnosed patients the health care guidelines based on the best and more updated evidence available thus achieving minimum quality standards.

METHODOLOGY

A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from guides NICE90 and CANMAT were adopted and updated so as to answer the questions posed while de novo questions were developed.

RESULTS

Recommendations 1-22 corresponding to screening, suicide risk and depression diagnosis were presented. The corresponding degree of recommendation is included.

The incidence of depression and its risk factors in Dutch nursing homes and residential care homes

OBJECTIVE

Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for depression in Dutch nursing homes and residential care homes.

DESIGN

Data on depression were extracted from the Vrije Universiteit naturalistic cohort on routine care monitoring with the Minimum Data Set of the Resident Assessment Instrument.

PARTICIPANTS

A total of 1,324 residents in six nursing homes and 1,723 residents in 23 residential care homes with an average follow-up of 1.2 years.

MEASUREMENTS

Depression was defined as a clinical diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and the use of antidepressants. Residents with prevalent depression at baseline were excluded.

RESULTS

The incidence rate was 13.6 per 100 person years in the nursing homes and 10.2 per 100 person years in the residential care homes. The independent risk factors for in-home depression for residents in nursing homes included dementia (OR: 1.7; 95% CI: 1.02-2.95) and a score of 3 or more on the Depression Rating Scale (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.23-3.70). A protective effect was seen on the use of a hearing aid (OR: 0.3; 95% CI: 0.12-0.80). In the residential care homes, being male (OR: 2.1; 95% CI: 1.27-3.30), having cancer (OR: 2.9; 95% CI: 1.64-4.95), and a score of 2 or higher on the Cognitive Performance Scale (OR: 1.5; 95% CI: 1.05-2.22) increased the risk to develop depression. Age greater than 85 years (OR: 0.5; 95% CI: 0.31-0.67) and hearing impairment (OR: 0.8; 95% CI: 0.60-1.00) appeared to be protective.

CONCLUSIONS

The incidence rate for depression in residents of Dutch nursing homes and residential care homes was high and the associated risk factors found may have important implications for staff.

Structural and cognitive social capital and depression among older adults in two Nordic regions

OBJECTIVE

To study the association between structural and cognitive aspects of social capital and depression among older adults in two Nordic regions.

METHOD

Data were retrieved from a postal survey targeting older adults aged 65, 70, 75 and 80 years (N=6 838, response rate=64%) residing in the Västerbotten region (Sweden), and the Österbotten region (Finland) in 2010. The associations between structural (measured by frequency of social contact with friends and neighbours) and cognitive (measured by experienced trust in friends and neighbours) aspects of social capital and depression (measured by Geriatric Depression Scale, GDS-4) were tested by logistic regression analyses.

RESULTS

Both low structural and cognitive social capital as defined in the study showed statistically significant associations with depression in older adults. Only experienced trust in neighbours failed to show significant association with depression. In addition, being single and being 80 years of age indicated a higher risk of depression as defined by GDS-4.

CONCLUSION

The findings underline the connection between adequate levels of both structural and cognitive individual social capital and mental health in later life. They also suggest that the connection differs depending on various network types; the cognitive aspect of relationships between friends was connected to depression, while the connection was not found for neighbours. Further, the oldest age group in the sample (80 years of age) is pointed out as a population especially vulnerable for depression that should not be overlooked in mental health promotion and depression prevention.

Anxiety, depression, and comorbid anxiety and depression: risk factors and outcome over two years

BACKGROUND

This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA); (2) the risk factor profile of depression, anxiety, and DA; (3) the course of depression, anxiety, and DA over 24 months.

METHODS

Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data.

RESULTS

The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depression, and DA showed persistence of symptoms after two years. Repeated anxiety was more common in women and repeated depression in men. Socioeconomic stressors were common in repeated DA.

CONCLUSIONS

Clinically significant anxiety and depression are distinct conditions that frequently coexist in later life; when they appear together, older adults endure a more chronic course of illness.

Neighborhood characteristics and depressive mood among older adults: an integrative review

BACKGROUND

There is growing evidence that neighborhood environments are related to depressive mood in the general population. Older adults may be even more vulnerable to neighborhood factors than other adults. The aim of this paper is to review empirical findings on the relationships between neighborhood characteristics and depressive mood among older adults.

METHODS

A search of the literature was undertaken in PsycINFO and MEDLINE.

RESULTS

Nineteen studies were identified. Study designs were most often cross-sectional, included large sample sizes, and controlled for major individual characteristics. Mediational effects were not investigated. Statistical analysis strategies often included multilevel models. Spatial delimitations of neighborhood of residence were usually based on administrative and statistical spatial boundaries. Six neighborhood characteristics were assessed most often: neighborhood socioeconomic disadvantage, neighborhood poverty, affluence, racial/ethnic composition, residential stability, and elderly concentration. Selected neighborhood characteristics were associated with depressive mood after adjusting for individual variables. These associations were generally theoretically meaningful.

CONCLUSIONS

Neighborhood variables seem to make a unique and significant contribution to the understanding of depressive mood among older adults. However, few studies investigated these associations and replication of results is needed. Several substantive neighborhood variables have been ignored or neglected in the literature. The implications of neighborhood effects for knowledge advancement and public health interventions remain unclear. Recommendations for future research are discussed.

Relationship of age and gender to the prevalence and correlates of psychological distress in later life

BACKGROUND

As populations age, psychological distress in late life will become of increasing public health and social importance. This study seeks to bridge the gap in information that exists about psychological distress in late life, by exploring the prevalence of psychological distress among a very large sample of older adults to determine the impact of age and gender, and the modifying effect of these factors on the associations between measures of psychological distress and sociodemographic and comorbid conditions.

METHODS

We analyzed self-reported data from 236,508 men and women in the New South Wales 45 and Up Study, to determine the impact of age and gender, and the modifying effects of these factors on associations between psychological distress and sociodemographic and comorbid conditions.

RESULTS

Higher education, married status, and higher income were associated with lower risk of psychological distress. Although overall prevalence of psychological distress is lower at older ages, this increases after age 80, and is particularly associated with physical disabilities. Some older people (such as those requiring help because of disability and those with multiple comorbid health conditions) are at increased risk of psychological distress.

CONCLUSION

These findings have implications for both healthcare providers and policy-makers in identifying and responding to the needs of older people in our aging society.