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

Psychosocial Clusters and Their Associations with Depression, Anxiety and Stress Among Older Adults in Shanghai Communities: Results from a Longitudinal Study

Purpose

Psychosocial factors have been found to profoundly impact mental health of older adults, but the main focus in the current literature has been on one particular aspect of these factors. This study aimed to identify latent classes of older adults based on four psychosocial factors (loneliness, social isolation, perceived social support, and social capital) and the transition of classes over 6 months. We also sought to assess the predictive role of changes in these classes in relation to depression, anxiety, and stress at 18-month follow-up.

Methods

We analyzed longitudinal data from 581 community-dwelling older adults in Shanghai, China. The data were collected at baseline (T0), 6-month follow-up (T1) and 18-month follow-up (T2) between March 2021 and April 2023. Using latent class analysis, we identified three underlying classes (Social Connectors, Subjective Social Isolates, and Social Isolates) of the sample. We also established five transition categories from T0 to T1 (Social Connectors T0-T1, Subjective Social Isolates T0-T1, Social Isolates T0-T1, Good Transition, and Bad Transition) using latent transition analysis. Logistic regression was employed to examine the temporal relationships between these transition categories and subsequent symptoms of depression, anxiety and stress, adjusting for age, sex, education, marital status, family income level, sleep quality, health status and outcome variables at T0.

Results

Multivariable associations revealed that compared to older adults with persistent good social environment (Social Connectors T0-T1), those with persistent high levels of loneliness and social isolation and low levels of perceived social support and social capital (Social Isolates T0-T1), and those who shifted towards a poorer social environment (Bad Transition) were more likely to experience depression, anxiety and stress at T2. Sustained subjective social isolation (Subjective Social Isolates T0-T1) was associated with more severe depressive symptoms at T2.

Conclusion

Our study indicated that adverse psychosocial environment worsened mental health in older adults. These findings highlight the importance of early identification of older individuals at long-term psychosocial risk and development of tailored interventions to improve their social environment and mental health.

Cognitive and Emotional Factors Influencing the Incorporation of Advice Into Decision Making Across the Adult Lifespan

OBJECTIVES

The present study sought to investigate the influence of advice on decision making in older age, as well as the potential influence of depressive symptoms and age-related differences in the cognitively demanding emotion regulation on advice-taking.

METHOD

A nonclinical sample (N = 156; 50% female; 47 young: M age = 29.87, standard deviation [SD] = 5.58; 54 middle-aged: M age = 50.91, SD = 7.13; 55 older: M age = 72.51, SD = 5.33) completed a judge-advisor task to measure degree of advice-taking, as well as measures of fluid intelligence, depressive symptoms, confidence, perceived advice accuracy, and emotion regulation.

RESULTS

Age did not influence degree of advice-taking. Greater depressive symptoms were associated with more reliance on advice, but only among individuals who identified as emotion regulators. Interestingly, older age was associated with perceiving advice to be less accurate.

DISCUSSION

The study contributes to the sparse literature on advice-taking in older age. Cognitive and emotional factors influence the degree to which advice is incorporated into decision making in consistent ways across the adult lifespan. A key difference is that older adults take as much advice as younger adults despite perceiving the advice to be less accurate.

Depression among inmates of Gandaki Province, Nepal: a cross-sectional study

INTRODUCTION

Depression is a pervasive mental health condition that affects individuals across various demographic categories, including imprisoned adults. The prevalence of mental health problems among inmates worldwide is considerably higher than in the general population, and it is estimated that 11% of inmates have significant mental disorders, such as anxiety and depression. This study aimed to find out the prevalence of depression and factors associated with it among the prisoners of Gandaki Province, Nepal.

METHODS

A descriptive cross-sectional study was conducted among the inmates in Gandaki Province, Nepal. Data were collected from 223 inmates, who were recruited through systematic random sampling from eight district-level prisons. The Beck Depression Inventory-II was used to measure depression, with the cumulated score dichotomized into depressed and not-depressed categories. Additionally, a structured questionnaire was employed to capture socio-demographic and imprisonment-related variables. Bivariate and multivariable logistic regressions were performed to examine the factors associated with depression.

RESULTS

Findings revealed that 18.8% of the inmates exhibited symptoms of depression. Inmates with health problems [(adjusted odds ratio (aOR) = 2.39], suicide ideation during imprisonment (aOR = 4.37), and attempted suicide before imprisonment (aOR = 7.97) had a statistically significant relationship with depression. This study revealed a notable prevalence of depression among incarcerated individuals in the Gandaki Province of Nepal.

CONCLUSION

The findings imply a crucial need for psychosocial and rehabilitative interventions to enhance inmates' mental health and overall well-being.

Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains

This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.

Elder abuse, depression, anxiety, and stress in community-dwelling older adults

BACKGROUND

Elder abuse as an important public health issue is associated in the literature with various physical and psychological symptoms. The aim of the study is to determine the relationship between elder abuse and depression, anxiety, and stress in the elderly living in the community.

METHOD

The cross-sectional study was completed with 729 older people. Data were collected through a face-to-face interview and a survey form. The Geriatric Mistreatment Scale (GMS) was used to evaluate elder abuse and the Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress. Multivariate regression analysis was performed to determine the relationship between elder abuse and depression, anxiety, and stress.

RESULTS

Of the participants, 20.9% were exposed to at least one type of abuse, 9.2% experienced physical abuse, 18.2% experienced psychological abuse, 4.4% experienced neglect, and 7.0% had financial abuse. The general prevalence of moderate to very severe depression, anxiety, and stress among the elderly was respectively 17.1%, 16%, and 10%. As a result of multivariate analysis it was determined that neglect (t = 6245; ß = 4952) and economic abuse (t = 3865; ß = 3350) had statistically significant effects on depression; psychological abuse (t = 2924; ß = 0,992), economic abuse (t = 3127; ß = 3517) and neglect (t = 5913; ß = 4810) had statistically significant effects on anxiety, while psychological (t = 5023; ß = 1756) and economic abuse (t = 5719; ß = 5238) had statistically significant effects on stress (P < 0.05).

CONCLUSION

As a result of the study, it was seen that the prevalence of abuse and depression, anxiety, and stress was high in the elderly. There was also a strong relationship between types of elder abuse and depression, anxiety, and stress. It is recommended that health professionals working with older people to screen them for types of abuse and mental symptoms with the help of appropriate screening tools.

Does internet use benefit the mental health of older adults? Empirical evidence from the China health and retirement longitudinal study

The mental health (MH) of older adults is a prominent public health concern. However, research regarding the impact of emerging Internet use on MH among older adults remains limited, particularly in transitional economies experiencing a rapidly aging population such as China. Thus, to address this research gap, this study uses data from the 2013-2018 waves of the China Health and Retirement Longitudinal Study. To investigate the causal relationship between Internet use and MH among older adults and explore the underlying channels through which this relationship operates. The results reveal a notable positive association between Internet use and MH among older adults. Furthermore, the study highlights social interaction, social trust, traveling expenses, and healthy habits as crucial channels through which Internet use can impact MH among older adults. The analysis also reveals how Internet use demonstrates a stronger positive effect on older individuals who have fewer chronic diseases and live with their offspring compared with their counterparts. These findings have significant policy implications, which thus emphasizes the need to enhance Internet use among older adults as a means of improving their MH.

Interplay of G-proteins and Serotonin in the Neuroimmunoinflammatory Model of Chronic Stress and Depression: A Narrative Review

INTRODUCTION

This narrative review addresses the clinical challenges in stress-related disorders such as depression, focusing on the interplay between neuron-specific and pro-inflammatory mechanisms at the cellular, cerebral, and systemic levels.

OBJECTIVE

We aim to elucidate the molecular mechanisms linking chronic psychological stress with low-grade neuroinflammation in key brain regions, particularly focusing on the roles of G proteins and serotonin (5-HT) receptors.

METHODS

This comprehensive review of the literature employs systematic, narrative, and scoping review methodologies, combined with systemic approaches to general pathology. It synthesizes current research on shared signaling pathways involved in stress responses and neuroinflammation, including calcium-dependent mechanisms, mitogen-activated protein kinases, and key transcription factors like NF-κB and p53. The review also focuses on the role of G protein-coupled neurotransmitter receptors (GPCRs) in immune and pro-inflammatory responses, with a detailed analysis of how 13 of 14 types of human 5-HT receptors contribute to depression and neuroinflammation.

RESULTS

The review reveals a complex interaction between neurotransmitter signals and immunoinflammatory responses in stress-related pathologies. It highlights the role of GPCRs and canonical inflammatory mediators in influencing both pathological and physiological processes in nervous tissue.

CONCLUSION

The proposed Neuroimmunoinflammatory Stress Model (NIIS Model) suggests that proinflammatory signaling pathways, mediated by metabotropic and ionotropic neurotransmitter receptors, are crucial for maintaining neuronal homeostasis. Chronic mental stress can disrupt this balance, leading to increased pro-inflammatory states in the brain and contributing to neuropsychiatric and psychosomatic disorders, including depression. This model integrates traditional theories on depression pathogenesis, offering a comprehensive understanding of the multifaceted nature of the condition.

Do living arrangements and health behaviors associate with anxiety symptoms among Chinese older people? Differences between urban and rural areas

Living arrangements and health behaviors are considered to be associated with mental health, but their relationship has been less investigated by national survey data in China. The purpose of this study is to explore the relationship of living arrangements and health behaviors with anxiety among Chinese older people and to compare the results between urban and rural areas. The study was based on the Chinese Longitudinal Healthy Longevity Survey conducted in 2018, and a total of 12 726 old-aged respondents were included. Ordinal logistic regression was used to analyze the associations between living arrangements, health behaviors and anxiety. This study found that people living in nursing institutions are likely to be more anxious than their dwelling counterparts. Although we found no significant relationships of health behaviors such as smoking, drinking alcohol and exercise with anxiety, older adults with greater dietary diversity were less likely to experience anxiety. Furthermore, different trends between living arrangements and anxiety, smoking and anxiety were also found among urban versus rural respondents. The findings of this study help to better understand anxiety among Chinese older people and shed light on health policy on older people protection and services.

Chronic stressors, coping strategies, and depressive symptoms: A comparison across older age groups

Late-life depression is a prevalent mental health problem among older adults. Variations may exist in the intensity of chronic stressors experienced by people in different older age groups and their effects on depressive symptoms. To examine differences among older adults by age group in the experienced intensity of chronic stressors in relation to coping strategies and depressive symptoms. Participants were 114 older adults. The sample was divided into three age groups: 65-72, 73-81, and 82-91. The participants completed questionnaires on coping strategies, depressive symptoms, and chronic stressors. Moderation analyses were conducted. The lowest levels of depressive symptoms were in the young-old age group and the highest levels were in the oldest-old age group. The young-old age group used more engaged and less disengaged coping strategies than the two other groups. The association between intensity of chronic stressors and depressive symptoms was stronger in the two older age groups compared to the youngest (moderating effect of age groups). Differences exist in the relationships among chronic stressors, coping strategies, and depressive symptoms by age groups in the older adult population. Professionals should be aware of the possible differences between age groups in depressive symptoms and the impact of stressors on depressive symptoms in different older adult age groups.

Effectiveness of mental health interventions for older adults in South Asia: A scoping review

OBJECTIVE

Mental health problems among older adults are becoming a growing public health concern in South Asia due to continued changes in population dynamics caused by declining fertility rates and increasing life expectancy. This scoping review aimed to explore and summarize evidence about mental health interventions and their impacts on geriatric mental health and highlight gaps and areas for future research.

METHODS

We searched six electronic databases and additional sources for experimental/non-experimental studies evaluating the effectiveness of geriatric mental health interventions in eight countries in the South Asia region from the date of inception of each database up to August 5, 2022. Following the preliminary screening, we extracted data from the eligible articles using a Microsoft Excel data extraction worksheet. We followed Joanna Briggs Institute (JBI) guidelines for this scoping review and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

RESULTS

From a total of 3432 potential articles retrieved, 19 were included in this review following pre-determined eligibility criteria. Across studies, mental health interventions can be broadly categorized into the following types- 1) traditional Yoga, Tai chi, or other meditative movements; 2) behavioral, occupational, or learning-based interventions; 3) tech-based interventions; 4) music therapy; and 5) new healthcare model. The evidence was predominantly based on India (n = 16), whereas three articles were identified from Pakistan. No article was found from six other South Asian countries. Depression and anxiety were the most frequent mental health outcomes, followed by quality of life, cognitive function, self-esteem, physical performance, and many more.

CONCLUSION

Although limited, this review found various interventions that have varying effects on different geriatric mental health outcomes. A handful of evidence on mental health intervention in South Asia indicates a lack of acknowledgment that may develop a serious paucity of geriatric mental health practice. Therefore, future researchers are encouraged to conduct empirical studies to understand disease burden, including associated factors of geriatric mental health, which may help to construct contextually appropriate mental health interventions in this region.

Prevalence and the affecting factors on depression, anxiety and stress (DASS) among elders in Qazvin City, in the Northwest of Iran

BACKGROUND

Depression, anxiety, and stress are among the most common mental health disorders of the elderly that affect the health of individuals and society. Considering the growing trend of the elderly population in Iran, this study aimed to determine the prevalence of these disorders and to identify the factors affecting them in the elderly.

METHODS

We conducted this cross-sectional study using cluster random sampling on 301 elderly people referred to Qazvin health centers. Data was collected using the Depression, Anxiety, Stress Scale 21 (DASS-21) questionnaire and analyzed through univariate and multivariate linear regression tests with the interaction between variables in STATA Version 14 software. A P-value of less than 0.05 was significant.

RESULTS

The prevalence of depression was 45.5%, anxiety 35.5%, and stress 40.2%. Our findings showed that 22.9%, 7.9%, and 14.3% of people had severe and very severe levels of depression, anxiety, and stress. The variables of age, comorbidity, living status and job status had a significant relationship with the DASS score (p < 0.05). There was an interaction between the variables of comorbidity and income status influencing the DASS score (β = 0.68, 95% CI 0.15, 1.22).

CONCLUSION

The prevalence of depression, anxiety and stress in the elderly was high, indicating the inappropriate status of their mental health. Therefore, it is necessary to take operational steps to reduce some problems in the elderly, prioritize the elderly suffering from concurrent diseases, the unemployed elderly, those who do not have a certain income, and the elderly who live alone.

Internal and International Migration and the Mental Health of “Left-Behind” Older Parents

Despite evidence of the impact of adult children's migration on left-behind older parents, the comparison of left-behind older parents’ mental health and psychological well-being between internal and international migration is limited. This article examines how the relationship between adult children's migration and parent's mental health differs according to the migrant's destination — only internal migration, only international migration, or hybrid migration (at least one child who migrated internally and at least one child who migrated internationally). Drawing on a 2019 cross-sectional population-based survey of 697 left-behind older adults (≥ 60 years) in Nepal, we assessed the mental health of older parents, using the 21-item Depression Anxiety Stress Scales and a range of socio-demographic, health, lifestyle, and child-related characteristics. Multilevel mixed-method linear regression was performed to examine the effect of adult children's migration on left-behind older parents’ depression, anxiety, and stress symptoms. Results showed that parents whose children had all migrated internationally were at higher risk of mental health problems, particularly anxiety and stress, compared to parents whose children had all migrated internally. Older parents from the hybrid group (having both internal and international migrant adult children) had higher levels of anxiety, compared to parents whose children had all migrated internally, with no significant difference in depression and stress symptoms. Further, mothers of internationally migrated children were at higher risk of mental health symptoms than fathers. Interventions aiming to improve left-behind older parents’ mental health and psychological well-being should specifically target parents whose children have migrated internationally.

Understanding changes in mental health symptoms from young-old to old-old adults by sex using multiple-group latent transition analysis

Older adults are classified into three homogeneous groups: young-old (age 65-74), old-old (age 75-84), and oldest-old (age 85 and over). Mental health symptoms are likely to change over time, especially when older adults transition from one age group to another. Yet, little is known on changes in mental health symptoms as they transition to another age group, and if these changes differ by sex. This is a secondary data analysis using the longitudinal data from the National Social Life, Health, and Aging Project. A total of 1183 young-old adults at wave 1 was included. Mental health symptoms were depression, anxiety, loneliness, perceived stress, and happiness. Multiple-group latent transition analysis was conducted to model the transition probabilities of latent classes and to compare these differences between sex. Descriptive and inferential statistics were conducted to obtain demographic characteristics and to test for differences. Three latent classes were identified based on severity: class 1-mild, class 2-moderate, and class 3-severe. Regardless of sex, young-old adults remained in the same class from waves 1 to 2. However, they moved to a less severe group when transitioning into the old-old from waves 2 to 3. Statistically significant differences were found in their demographic characteristics among the latent classes. Older adults, when transitioning from young-old to old-old, are likely to transition to latent classes with less severe mental health symptoms in both sex. Clinicians need to provide a comprehensive assessment to all older adults, regardless of the severity of their mental health symptoms, to promote well-being.

The Relationship between Social Support and Anxiety among Rural Older People in Elderly Caring Social Organizations: A Cross-Sectional Study

BACKGROUND

Social support and anxiety have a major impact on later life quality in rural, older people in elderly caring social organizations (SOs). This study aimed to explore the relationship between social support and anxiety and their relevant influential factors among rural older people in elderly caring SOs in Anhui Province, China.

METHODS

This cross-sectional study was conducted through a multi-stage stratified cluster random sampling method. Independent t-tests, one-way ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, and a generalized linear model were employed.

RESULTS

A significantly negative association between friends' support and anxiety were found among rural older people in elderly caring SOs. Statistically significant relationships were found between social support and gender, marital status, education level, whether visited by relatives, and institutional satisfaction. Similarly, anxiety was associated with gender, institutional satisfaction, comorbid chronic diseases, and friends' support.

CONCLUSIONS

Social support from friends plays an important role in preventing and regulating anxiety among rural older people, especially those from elderly caring SOs. To reduce the occurrence and level of anxiety among rural elderly in elderly caring SOs, an effort should be given to strengthening social support, improving institutional satisfaction, and emphasizing comorbid chronic diseases.

The positive association between internal migration and hospitalization among the older adults in China: Regional heterogeneity and chronic disease management

Background

Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association.

Methods

14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions.

Results

Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89).

Conclusions

Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.

Prevalence and correlates of depression among South Korean older adults living in relative poverty

This secondary analysis of the Tailored Health Visiting Service Program examined depression prevalence and associated factors among 1181 community-dwelling, South Korean older adults (range: 65 to 99 years) who live in relative poverty. Depression was assessed using the Geriatric Depression Scale short form. Generalized linear models with Poisson family and log link functions were employed to identify factors associated with depression. The overall depression prevalence was 46.3%, with most subjects mildly depressed. Better self-rated health and healthy activities were associated with lower depression prevalence, while having a disability was associated with higher prevalence. The factors identified in this study should be considered in community mental health interventions for older adults, especially those who experience economic disadvantage.

The association between falls and anxiety among elderly Chinese individuals: The mediating roles of functional ability and social participation

BACKGROUND

Elderly individuals who experience falls suffer from higher levels of anxiety because of physical or mental injury. This study examined the association between falls and anxiety among elderly Chinese individuals. It also explored the mediating roles of functional ability and social participation in the link between falls and anxiety.

METHODS

The analytical sample included 8233 elderly people aged 60 and above, and prospective data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Anxiety was evaluated by a 7-item Generalized Anxiety Disorder (GAD-7) scale, and falls were determined by self-report. The association between falls and anxiety was assessed by linear regression. Mediation analysis was used to explore the potential mediating roles of functional ability and social participation on the association between falls and anxiety.

RESULTS

Suffering falls predicted higher anxiety levels among elderly individuals (B = 0.608, 95% CI: 0.471, 0.746). Functional ability and social participation play partial mediating roles in the association between falls and anxiety, and the mediating effects were 0.036 (95% CI: 0.020, 0.058) and 0.005 (95% CI: 0.003, 0.014), respectively. The serial mediating effect of functional ability and social participation on the association between falls and anxiety was 0.003 (95% CI: 0.002, 0.005).

LIMITATIONS

This study is based upon cross-sectional data, which limit inferring causality.

CONCLUSIONS

This study suggests that policy-makers should explore how to encourage elderly individuals who experience falls to restore functional ability and participate in appropriate social activities to alleviate anxiety.

Efficacy of internet-based interventions for common mental disorder symptoms and psychosocial problems in older adults: A systematic review and meta-analysis

BACKGROUND

Although a high proportion of older adults suffer from common mental disorder symptoms and psychosocial problems, only a small number of older individuals seek psychological treatment. Internet-based interventions have the potential to bridge this treatment gap. However, while there is extensive literature on internet-based treatments in younger to middle-aged adults, research on older individuals is lacking.

OBJECTIVE

We aimed to summarize narratively and empirically the existing literature on the efficacy of internet-based interventions for the treatment of common mental disorder symptoms and psychosocial problems (loneliness, stress) in older individuals.

METHODS

This systematic review and meta-analysis was registered in PROSPERO (registration number: CRD42021235129). Systematic literature searches were conducted in PsycInfo, Ageline, Medline, CINHAL, and Psyndex. Studies were eligible for inclusion if they a) focused on older adults, b) assessed the efficacy of an internet-delivered psychological intervention, c) included a control condition and d) assessed common mental disorder symptoms or psychosocial problems as outcomes. Meta-analyses were conducted based on studies that included a passive, minimally active or placebo control condition to estimate pooled effects on overall symptom severity as well as on specific psychological outcomes.

RESULTS

11 Studies met inclusion criteria, with the majority of interventions focusing on depression or anxiety symptoms and being based on CBT principles. Significant large effect of internet-based interventions for older adults were found for overall symptom severity (depression, anxiety, PTSD, stress) as well as for depression symptom severity. No significant effects were found for anxiety symptom severity.

DISCUSSION

Our findings provide preliminary support that internet-based interventions might be a feasible and effective intervention method for the treatment of common mental disorder symptoms and stress in older adults. However, research in this area is still at an early stage. More studies are needed to shed light on the role of various treatment and patient characteristics in the efficacy of internet-delivered treatments.

Impact of Multimorbidity on Symptoms of Depression, Anxiety, and Stress in Older Adults: Is There a Sex Difference?

Introduction: Multimorbidity has become a key issue in the health care sector globally, and it can also lead to psychological distress in older adults. This study aimed to assess the impact of multimorbidity on depression, anxiety, and stress symptoms and identify whether there is a sex difference in these associations.

Methods: A cross-sectional study using a multistage random sampling method was conducted among 3,266 older adults in China. Multiple linear regression models were used to estimate the independent associations between multimorbidity and depression, anxiety, and stress symptoms. Furthermore, interaction analysis was employed to investigate the interaction effect of multimorbidity and sex on depression, anxiety, and stress symptoms.

Results: A total of 3,250 participants aged 60 years and older were included in this study. Our findings suggest that multimorbidity is strongly positively associated with depression, anxiety, and stress symptoms. In addition, the positive relations between multimorbidity and depression, anxiety, and stress symptoms are stronger for older female than male adults.

Conclusion: Old adults with multimorbidity are more likely have depression, anxiety, and stress symptoms. This study offers new insight for the mental health from the perspective of multimorbidity among older people, implies that encouraging the accessibility of treatment for multimorbidity in older people with different sex may be effective in promoting mental health in China.

Elderly care in Nepal: Are existing health and community support systems enough

In Nepal, a few governmental and community-based programmes for elderly care are in place; however, information about successful implementation and overall effectiveness of these programmes is not well understood. In this article, we introduced these programmes and discussed existing programmes’ gaps and implementation problems in light of existing grey and peer-reviewed evidence. A few notable governmental programmes, such as providing monthly allowances, pensions and free health care, have targeted specifically the elderly individuals. Yet, most health care institutions and providers are privately owned and profit-oriented, and there is a general lack of proper governmental health as well as social security systems for the elderly in the country. Generally, Nepalese communities consist of neighbourhood-based and religious-based groups that provide emotional and spiritual support to elderly individuals as well as provide support for health care access when needed. However, the influence that these groups can have on health and social well-being of elderly remains not well understood. Traditional family-based support systems may be feasible only for some families, while for others it could impose financial and psychological burdens. The role of the state is important in the effective implementation of existing programmes as well as in the development and implementation of additional programmes to ensure health and social well-being of elderly individuals. Furthermore, there is a need to establish partnerships with existing community structures and to mobilize them in the implementation of community-based programmes.

A classification algorithm to predict chronic pain using both regression and machine learning - A stepwise approach

This secondary data analysis study aimed to (1) investigate the use of two sense-based parameters (movement and sleep hours) as predictors of chronic pain when controlling for patient demographics and depression, and (2) identify a classification model with accuracy in predicting chronic pain. Data collected by Oregon Health & Science University between March 2018 and December 2019 under the Collaborative Aging Research Using Technology Initiative were analyzed in two stages. Data were collected by sensor technologies and questionnaires from older adults living independently or with a partner in the community. In Stage 1, regression models were employed to determine unique sensor-based behavioral predictors of pain. These sensor-based parameters were used to create a classification model to predict the weekly recalled pain intensity and interference level using a deep neural network model, a machine learning approach, in Stage 2. Daily step count was a unique predictor for both pain intensity (75% Accuracy, F1 = 0.58) and pain interference (82% Accuracy, F1 = 0.59). The developed classification model performed well in this dataset with acceptable accuracy scores. This study demonstrated that machine learning technique can be used to identify the relationship between patients' pain and the risk factors.

Perceived fear of COVID-19 and its associated factors among Nepalese older adults in eastern Nepal: A cross-sectional study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has affected all age groups worldwide, but older adults have been affected greatly with an increased risk of severe illness and mortality. Nepal is struggling with the COVID-19 pandemic. The normal life of older adults, one of the vulnerable populations to COVID-19 infection, has been primarily impacted. The current evidence shows that the COVID-19 virus strains are deadly, and non-compliance to standard protocols can have serious consequences, increasing fear among older adults. This study assessed the perceived fear of COVID-19 and associated factors among older adults in eastern Nepal.

METHODS

A cross-sectional study was conducted between July and September 2020 among 847 older adults (≥60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). Multivariate logistic regression identified the factors associated with COVID-19 fear.

RESULTS

The mean score of the FCV-19S was 18.1 (SD = 5.2), and a sizeable proportion of older adults, ranging between 12%-34%, agreed with the seven items of the fear scale. Increasing age, Dalit ethnicity, remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. In contrast, preexisting health conditions were inversely associated with fear.

CONCLUSION

Greater fear of the COVID-19 among the older adults in eastern Nepal suggests that during unprecedented times such as the current pandemic, the psychological needs of older adults should be prioritized. Establishing and integrating community-level mental health support as a part of the COVID-19 preparedness and response plan might help to combat COVID-19 fear among them.

Depressive Symptoms and Associated Health-Related Variables in Older Adult Breast Cancer Survivors and Non-Cancer Controls

OBJECTIVES

To examine the prevalence of depressive symptoms and associated risk factors in older adult breast cancer survivors (BCS) and age-matched non-cancer controls.

SAMPLE & SETTING

Using the Surveillance, Epidemiology, and End Results-Medicare Health Outcome Survey linked dataset from 1998 to 2012, BCS and non-cancer controls aged 65 years or older were identified.

METHODS & VARIABLES

Depressive symptoms, comorbidities, functional limitations, socio-demographics, and health-related information were examined. Univariate and multivariable logistic regression and marginal models were performed.

RESULTS

5,421 BCS and 21,684 controls were identified. BCS and non-cancer controls had similar prevalence of depressive symptoms. Having two or more comorbidities and functional limitations were strongly associated with elevated risk of depressive symptoms in BCS and non-cancer controls.

IMPLICATIONS FOR NURSING

Having multiple comorbidities and multiple functional status are key factors associated with depressive symptoms in older adult BCS and non-cancer controls. Nurses are in an ideal position to screen older adult BCS and non-cancer controls at risk for depressive symptoms.

Psychometric properties of the Nepali language version of the Depression Anxiety Stress Scales (DASS-21)

Aim

To assess the psychometric properties of the Nepali language version of the Depression Anxiety Stress Scales (DASS‐21).

Design

Descriptive, cross‐sectional survey.

Methods

The DASS‐21 was administered (May–July 2019) among 794 randomly selected older adults aged ≥60 years. Factor structure was evaluated using exploratory and confirmatory factor analyses. Cronbach's alpha was calculated, and correlation analyses with quality of life evaluated convergent validity.

Results

Exploratory factor analysis indicated that the 21 items loaded on three factors, with factor loadings ranging from 0.50–0.88. Confirmatory factor analysis suggested a four‐factor model including the three subscales and an additional common 'general distress’ factor, which demonstrated a better overall fit. Good reliability was found for each subscale, with Cronbach's alphas 0.79 for Anxiety, 0.91 for Stress, and 0.93 for Depression. The Nepali language version of the DASS‐21 satisfied convergent validity with all subscales depicting significant negative correlations with quality of life demonstrating adequate psychometric properties.

Effects of social support on mental health outcomes in disasters: A cross-sectional study

This study examined the mediating effects of social support on the association between disaster distress and mental health outcomes. We analyzed the data of 1006 participants with either direct or indirect exposure to one or more disasters. Disaster distress, social support, depression, and anxiety were significantly correlated. Multiple regression and mediation analyses with bootstrapping showed that social support was a partial mediator between disaster distress and depression, and between disaster distress and trait anxiety. It was a complete mediator between disaster distress and state anxiety. The results suggest that enhancing social support may reduce the negative effects of disaster distress on depression and anxiety. Therefore, comprehensive interventions incorporating disaster distress management and enhanced social support are essential in national disaster management policies and psychiatric and mental health nursing services for individuals who have experienced disasters.

Effect of Tai Chi on depression symptoms and sleep quality among older adult women after exercise cessation

This study investigated the effects of Tai Chi exercise on the psychological health and sleep quality of older adult women after exercise cessation. Nineteen Tai Chi practitioners and 20 controls completed the final tests. All participants completed the Profile of Mood States (POMS) and the Pittsburgh Sleep Quality Index (PSQI) at 0, 24 and 28 weeks (4 weeks after Tai Chi cessation). Compared with baseline, the fatigue, depression, total mood disturbance and PSQI scores in the Tai Chi group decreased at week 24 by 18.8%, 24.7%, 5.7% and 24.6%, and the vigour score increased by 18.3%. At week 28, depression and PSQI scores in the Tai Chi group decreased by 24.0% and 20.4%, respectively. Practicing Tai Chi for 24 weeks positively affected fatigue, depression, vigour and sleep quality among older adult women. The effect on reducing depression and improving sleep quality was sustained 4 weeks after Tai Chi was stopped.