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Wrzeciono A, Cieślik B, Kiper P, Szczepańska-Gieracha J, Gajda R. Exploratory analysis of the effectiveness of virtual reality in cardiovascular rehabilitation. Sci Rep 2024; 14:281. [PMID: 38168468 PMCID: PMC10762219 DOI: 10.1038/s41598-023-50788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
Virtual reality therapy has been shown to be effective in coping with psychological disorders accompanied by cardiovascular disease. Age appears to be a factor that can affect the effectiveness of psychological therapy in a virtual environment. Therefore, the aim of the study was to explore whether there are age-related differences in the effectiveness of reducing levels of depression and anxiety during a virtual reality psychological intervention implemented for rehabilitation. The study included 25 younger (< 65 years) and 25 older (65 +) patients with cardiovascular disease who participated in virtual reality therapy to cope with anxiety and depression. The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive disorders before and after intervention. Significant reductions in anxiety and depression scores after intervention were observed in both age-matched groups, and no significant differences were found between the younger and older participants. Further evaluation of patient age as a predictor of the effectiveness of psychological intervention in virtual reality did not show a significant effect of age on effectiveness in reducing anxiety and depressive disorders. The results obtained suggest that older patients benefit similarly to younger patients from psychological intervention in a virtual environment. Furthermore, age does not appear to be considered a predictor of effectiveness in reducing the level of anxiety and depression in patients with cardiovascular disease using virtual reality therapy.
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Affiliation(s)
- Adam Wrzeciono
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612, Wroclaw, Poland
| | - Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126, Venezia, Italy.
| | - Paweł Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126, Venezia, Italy
| | | | - Robert Gajda
- Gajda-Med District Hospital, 06-100, Pultusk, Poland
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200, Czestochowa, Poland
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Kiper P, Przysiężna E, Cieślik B, Broniec-Siekaniec K, Kucińska A, Szczygieł J, Turek K, Gajda R, Szczepańska-Gieracha J. Effects of Immersive Virtual Therapy as a Method Supporting Recovery of Depressive Symptoms in Post-Stroke Rehabilitation: Randomized Controlled Trial. Clin Interv Aging 2022; 17:1673-1685. [PMID: 36447623 PMCID: PMC9701456 DOI: 10.2147/cia.s375754] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/25/2022] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Depressive symptoms constitute an important group of mental problems that alter the course of post-stroke rehabilitation by reducing quality of life, physical activity, social functioning, and interpersonal relationships. Although several studies have shown the efficacy of virtual reality (VR) in the motor treatment of poststroke patients, there is a lack of studies that would also evaluate the impact of VR on psychological aspects. Thus, we investigated the effectiveness of immersive VR therapy on both functional activity and depressive symptoms in stroke survivors. PATIENTS AND METHODS We conducted a single blind, randomized controlled trial comparing VR therapy with Schultz's Autogenic Training (SAT). Patients randomized to the VR group received treatment in an immersive VR therapeutic garden with elements of psychotherapy and physical activity of the upper extremities, whereas patients in the control group received SAT. Additionally, patients in both groups received standard neurological rehabilitation. The full research cycle lasted six weeks. We used Geriatric Depression Scale, Generalized Self-Efficacy Scale, Acceptance of Illness Scale, Visual Analogue Scale of pain, Hospital Anxiety and Depression Scale, Barthel Index, Lawton Instrumental Activities of Daily Living Scale and Rivermead Motor Assessment for outcome assessment. This trial was registered with ClinicalTrials.gov (NCT03830372). RESULTS We assessed 60 patients and randomly assigned to the VR or control group. The VR group showed a significant reduction in depressive symptoms (ηp2 = 0.13, p < 0.01) compared to SAT. The applied VR therapy significantly increased the sense of self-efficacy and the level of acceptance of the illness; however, this effect was similar to that obtained with the standard intervention. We did not observe statistically significant changes in the functional parameters of post-stroke patients. CONCLUSION The use of VR therapy combined with neurological rehabilitation had a positive effect on improving mood and reducing depressive symptoms in post-stroke patients.
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Affiliation(s)
- Pawel Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venezia, Italy
| | - Ewa Przysiężna
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venezia, Italy
| | | | | | - Jarosław Szczygieł
- Humanitas University in Sosnowiec, Sosnowiec, Poland
- Neurorehabilitation Department, District Hospital, Zawiercie, Poland
| | - Katarzyna Turek
- The Karol Lipiński Academy of Music in Wroclaw, Wrocław, Poland
| | - Robert Gajda
- Gajda-Med District Hospital in Pultusk, Pułtusk, Poland
- Department of Kinesiology and Health Prevention, Jan Dlugosz University in Częstochowa, Częstochowa, Poland
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Sun Q, Xu H, Zhang W, Zhou Y, Lv Y. Behavioral Activation Therapy for Subthreshold Depression in Stroke Patients: An Exploratory Randomized Controlled Trial. Neuropsychiatr Dis Treat 2022; 18:2795-2805. [PMID: 36471746 PMCID: PMC9719268 DOI: 10.2147/ndt.s392403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Subthreshold depression (SD) is known to be a major risk factor for the development of post-stroke depression (PSD). Appropriate intervention to prevent the transition from SD to PSD is thus imperative. As a form of short-term psychotherapy adapted for individuals with cognitive and communication impairments, behavioral activation therapy (BAT) may be a suitable choice. However, the effects of BAT on psychological outcomes in stroke patients with SD has not been established. This study investigated the feasibility and effectiveness of BAT in reducing the development of depressive symptoms in this patient population. METHODS A double-blind, randomized controlled trial was performed. Seventy participants were randomized to either a BAT group (n=35) or a control group (n=35). Participants in the BAT group received a six-week BAT intervention. The feasibility of BAT was assessed by the number of sessions attended by participants, and the acceptability of BAT to participants and the incidence of adverse events were recorded. The primary clinical outcome measure was the Center for Epidemiological Studies Depression Scale (CES-D) and the 17-item Hamilton Depression Scale (HAMD-17) at baseline, six weeks, and three months after the group allocation. Secondary outcomes included behavioral activation and the incidence of depression. RESULTS The intervention was feasible and acceptable, with 94.3% of participants in the BAT group (33 of 35) attending at least five sessions. No adverse events were reported in either group. Compared with the control group, the BAT group showed significant improvements in the CES-D (F=67.689, P<0.05), HAMD-17 (F=4.170, P<0.05), and behavioral activation (F=25.355, P<0.05) scores after intervention, and these differences were maintained at the three-month assessment. CONCLUSION BAT appears to be feasible and efficacious for reducing depressive symptoms and increasing behavioral activation among stroke patients with SD. The findings of this study may contribute to the primary prevention of PSD.
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Affiliation(s)
- Qiuxue Sun
- School of Nursing, Harbin Medical University (Daqing), Daqing, People's Republic of China
| | - Hailian Xu
- School of Medical, Quzhou College of Technology, Quzhou, People's Republic of China
| | - Wenyue Zhang
- Department of Rehabilitation, People's Hospital of Daqing, Daqing, People's Republic of China
| | - Yuqiu Zhou
- School of Nursing, Harbin Medical University (Daqing), Daqing, People's Republic of China
| | - Yumei Lv
- School of Nursing, Harbin Medical University (Daqing), Daqing, People's Republic of China
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Moon HI, Jeong YJ, Suh JH. Voxel-based lesion symptom mapping analysis for dysphagia in stroke patients with isolated cerebellar lesions. J Neural Transm (Vienna) 2021; 129:65-74. [PMID: 34773172 DOI: 10.1007/s00702-021-02438-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 12/01/2022]
Abstract
Because the cerebellum plays a role in motor coordination, timing, sequencing, and feedback, it is hypothesized to be involved in swallowing-related functions. The role of the cerebellum in deglutition has become increasing evident, but the exact nature of this role remains inconclusive because of limited data from pure cerebellar lesions. Therefore, we conducted location analysis in isolated cerebellar lesions to complement previous findings and provide additional information. We reviewed 40 stroke patients with isolated cerebellar lesion. Lesion location and volume were measured on brain magnetic resonance images. We generated statistical maps of lesions related to VDS using voxel-based lesion symptom mapping (VLSM). We also created an overlay map of subgroups according to VDS score, those who have low risk and those who have high risk. Patients with cerebellar lesion had difficulty swallowing, both in the oral and pharyngeal phases. Multivariate analysis of cognitive function was selected as an independent predictor. In the group of high-risk patients, the overlay map showed some bilateral asymmetry, with a wider distribution in the left hemisphere and involvement of deep cerebellar nuclei. Using VLSM, we found that lesion location was associated with dysphagia. Although these results were not statistically significant, they showed a lesion pattern with predominant distribution in the left posterior lobe. Our results suggest that damage to the posterior lobe of the left cerebellum tends be related to severity of dysphagia in patients with isolated cerebellar lesion.
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Affiliation(s)
- Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam, Gyeonggi, 13590, Republic of Korea.
| | - Yoon Jeong Jeong
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam, Gyeonggi, 13590, Republic of Korea
| | - Ji Hyun Suh
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam, Gyeonggi, 13590, Republic of Korea
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Ashaie SA, Hung J, Funkhouser CJ, Shankman SA, Cherney LR. Depression over Time in Persons with Stroke: A Network Analysis Approach. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:10.1016/j.jadr.2021.100131. [PMID: 34528021 PMCID: PMC8438599 DOI: 10.1016/j.jadr.2021.100131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Network analysis has been used to elucidate the relationships among depressive symptoms, but this approach has not been typically used in persons with stroke. METHOD Using a sample of 835 persons with stroke from Stroke Recovery in Underserved Populations 2005-2006 dataset, this study used network analysis to (1) examine changes in relationships between depressive symptoms over time, and (2) test whether baseline network characteristics were prognostic for depression persistence. Network analysis was performed on depressive symptoms collected at discharge from inpatient rehabilitation and at 3-months and 12-months post-discharge. RESULTS The depressive symptom network at discharge was less connected than at both post-discharge follow-ups. Trouble focusing and feeling good as others were the most predictable symptoms at post-discharge, even though they were less connected to other depressive symptoms. Among participants with elevated baseline depression severity, those whose depression persisted 12 months later had more strongly connected networks at discharge than those who recovered 12 months later. LIMITATIONS This study was unable to determine the directionality of edges. The depression scale was administered differently across time points. CONCLUSION These results suggest that baseline network connectivity can predict the course of post-stroke depression, similar to non-stroke populations. More broadly, the study highlights the importance of examining relationships between individual depressive symptoms rather than only sum-scores.
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Affiliation(s)
- Sameer A Ashaie
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Jinyi Hung
- Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
| | - Carter J. Funkhouser
- Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
- Department of Psychology, University of Illinois at Chicago
| | - Stewart A. Shankman
- Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
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A Review of Risk Factors for Cognitive Impairment in Stroke Survivors. ScientificWorldJournal 2016; 2016:3456943. [PMID: 27340686 PMCID: PMC4906214 DOI: 10.1155/2016/3456943] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/04/2016] [Indexed: 02/02/2023] Open
Abstract
In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.
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Mohd Zulkifly MF, Ghazali SE, Che Din N, Subramaniam P. The Influence of Demographic, Clinical, Psychological and Functional Determinants on Post-stroke Cognitive Impairment at Day Care Stroke Center, Malaysia. Malays J Med Sci 2016; 23:53-64. [PMID: 27547115 PMCID: PMC4976714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/30/2016] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND This study aims to estimate the prevalence and explore the predictors for post-stroke cognitive impairment at the community level in Malaysia. METHODS A total of 50 stroke patients aged 29 to 81-year-old were included in this study. A face to face interview was conducted to gather the demographic and clinical data. Subsequently, assessments including Barthel ADL Index (BI), Addenbrooke's Cognitive Examination-Revised (ACE-R) and Hospital Anxiety and Depression Scale (HADS) were administered to the subjects. RESULTS The results showed that the prevalence of cognitive impairment was 76% among the studied populations. The subjects' race (Fisher's value= 9.56, P < 0.05) and education level (Fisher's value = 7.29, P < 0.05) were significantly associated with the cognitive status. The depression score was significantly higher in cognitively impaired group [t (48) = -4.42, P < 0.001] while the Barthel Index score was significantly lower in cognitively impaired group (median = 18.00, P < 0.05). The univariate logistic analysis demonstrated that Chinese (OR 7.33, 95% CI = 1.61-33.51), lower education level (OR 9.33, 95% CI = 0.89-97.62), right sided lesion (OR 0.29, 95% CI = 0.06-1.54), left face weaknesses (OR 0.40, 95% CI 0.09-1.83), high cholesterol (OR 0.45, 95% CI = 0.12-1.75), depression (OR 2.16, 95% CI = 0.85-1.35), and Barthel Index (OR 0.79, 95% CI = 0.57-1.10) were significant predictors. Finally, multivariate logistic regression verified that depression was the only significant predictor of post-stroke cognitive impairment (OR 2.03, 95% CI = 1.20-3.45). CONCLUSION In conclusion, the prevalence of cognitive impairment in this study was higher than other community based studies and depression was a risk factor for cognitive impairment.
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Affiliation(s)
- Mohd Faizal Mohd Zulkifly
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
- Center for Neuroscience Services and Research (P3Neuro), Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Shazli Ezzat Ghazali
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Normah Che Din
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Moran GM, Fletcher B, Calvert M, Feltham MG, Sackley C, Marshall T. A systematic review investigating fatigue, psychological and cognitive impairment following TIA and minor stroke: protocol paper. Syst Rev 2013; 2:72. [PMID: 24011357 PMCID: PMC3846122 DOI: 10.1186/2046-4053-2-72] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/30/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approximately 20,000 people have a transient ischemic attack (TIA) and 23,375 have a minor stroke in England each year. Fatigue, psychological and cognitive impairments are well documented post-stroke. Evidence suggests that TIA and minor stroke patients also experience these impairments; however, they are not routinely offered relevant treatment. This systematic review aims to: (1) establish the prevalence of fatigue, anxiety, depression, post-traumatic stress disorder (PTSD) and cognitive impairment following TIA and minor stroke and to investigate the temporal course of these impairments; (2) explore impact on quality of life (QoL), change in emotions and return to work; (3) identify where further research is required and to potentially inform an intervention study. METHODS/DESIGN A systematic review of MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane libraries and grey literature between January 1993 and April 2013 will be undertaken. Two reviewers will conduct screening search results, study selection, data extraction and quality assessment. Studies of adult TIA and minor stroke participants containing any of the outcomes of interest; fatigue, anxiety, depression, PTSD or cognitive impairment will be included. Studies at any time period after TIA/minor stroke, including those with any length of follow-up, will be included to investigate the temporal course of impairments. QoL, change in emotions and return to work will also be documented. The proportion of TIA or minor stroke participants experiencing each outcome will be reported.If appropriate, a meta-analysis will pool results of individual outcomes. Studies will be grouped and analyzed according to their follow-up timeframe into short-term (< 3 months after TIA/minor stroke), medium-term (3 to 12 months) and long term (> 12 months). Sub-analysis of studies with a suitable control group will be conducted. Exploratory sub-analysis of memory and attention domains of cognitive impairment will be conducted. DISCUSSION The current treatment goal for TIA and minor stroke patients is secondary stroke prevention. If these patients do experience fatigue, psychological or cognitive impairments then this treatment alone is unlikely to be sufficient. The results of this comprehensive review will increase understanding of treatment needs for this patient group, identify where further research is required and potentially inform an intervention trial.
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Affiliation(s)
- Grace M Moran
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, England.
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Klinedinst NJ, Clark PC, Dunbar SB. Older adult stroke survivors discussing poststroke depressive symptoms with a healthcare provider: a preliminary analysis. Rehabil Psychol 2013; 58:263-71. [PMID: 23855380 DOI: 10.1037/a0033005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The purposes of this study were to examine the relationship between the poststroke depressive symptoms, older adult stroke survivors' perceptions of the depressive symptoms, and the congruence with an informal caregiver about the presence of depressive symptoms, and comfort talking to the health care provider with whether or not older stroke survivors discussed their depressive symptoms with a health care provider. METHOD A cross-sectional study where 44 caregiver/older adult stroke survivor dyads completed questionnaires including the Center for Epidemiologic Studies Depression Scale, Symptom Perception Questionnaire, and reporting of depressive symptoms to the health care provider via one time interview. RESULTS Thirty-seven percent (n = 16) of all older stroke survivors reported depressive symptoms to their health care provider. Of the stroke survivors who had high levels of depressive symptoms (CESD ≥ 16; n = 11), seven reported the depressive symptoms to their health care provider. Identifying the symptoms as possible depression and attributing the cause of the depressive symptoms to the stroke were related to stroke survivors reporting the depressive symptoms to a health care provider. CONCLUSIONS High functioning, older stroke survivors may benefit from strategies to help them identify when they experience depressive symptoms, in order to be able to play an active role in their recovery by appropriately discussing their symptoms with a health care provider.
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Meeks T, Vahia I, Lavretsky H, Kulkarni G, Jeste D. A tune in "a minor" can "b major": a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011; 129:126-42. [PMID: 20926139 PMCID: PMC3036776 DOI: 10.1016/j.jad.2010.09.015] [Citation(s) in RCA: 342] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/15/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. METHODS We searched PubMed (1980-Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression. RESULTS In older adults subthreshold depression was generally at least 2-3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8-10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. LIMITATIONS Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. CONCLUSIONS The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.
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Affiliation(s)
- Thomas Meeks
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Ipsit Vahia
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Helen Lavretsky
- Department of Psychiatry, University of California, Los Angeles
| | | | - Dilip Jeste
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
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