Association between social isolation and depression onset among older adults: a cross-national longitudinal study in England and Japan

Potential role of hippocampal neurogenesis in spinal cord injury induced post-trauma depression

It has been reported both in clinic and rodent models that beyond spinal cord injury directly induced symptoms, such as paralysis, neuropathic pain, bladder/bowel dysfunction, and loss of sexual function, there are a variety of secondary complications, including memory loss, cognitive decline, depression, and Alzheimer's disease. The large-scale longitudinal population-based studies indicate that post-trauma depression is highly prevalent in spinal cord injury patients. Yet, few basic studies have been conducted to address the potential molecular mechanisms. One of possible factors underlying the depression is the reduction of adult hippocampal neurogenesis which may come from less physical activity, social isolation, chronic pain, and elevated neuroinflammation after spinal cord injury. However, there is no clear consensus yet. In this review, we will first summarize the alteration of hippocampal neurogenesis post-spinal cord injury. Then, we will discuss possible mechanisms underlie this important spinal cord injury consequence. Finally, we will outline the potential therapeutic options aimed at enhancing hippocampal neurogenesis to ameliorate depression.

Social Isolation, Loneliness, and Depressive Symptoms Among Older Adults: The Moderating Effect of Resilience

BACKGROUND AND OBJECTIVES

Social isolation has been recognized as a social problem with negative health consequences. Using data from 3 waves of the Health and Retirement Study, this study aimed to examine the long-term impact of social isolation on loneliness and depressive symptoms and to explore the moderating effect of resilience.

RESEARCH DESIGN AND METHODS

This study comprised 3,681 U.S. adults aged 60 and older at the baseline wave. Social isolation index was constructed using 5 indicators, including not married or cohabitating with a partner, no social participation, and less than monthly contacts with children, family members, or friends. Loneliness was measured by the University of California Los Angeles (UCLA) Loneliness Scale and depressive symptoms were measured by the Center for Epidemiological Studies-Depression scale. The moderator of resilience was assessed by the simplified resilience score. Latent growth curve models with robust standard errors were estimated.

RESULTS

The results of latent growth curve models showed that social isolation was significantly associated with more initial loneliness and depressive symptoms. However, social isolation was associated with a slower increasing rate of loneliness, but no significant relationship with the change rate of depressive symptoms. Furthermore, resilience significantly buffered the negative effect of social isolation on the initial level of depressive symptoms.

DISCUSSION AND IMPLICATIONS

The findings underscore the importance of enacting strategies and interventions targeting resilience to address social isolation and its negative consequences among older adults.

The Relationship Between Social Isolation and Cognitive Frailty Among Community-Dwelling Older Adults: The Mediating Role of Depressive Symptoms

Purpose

Social isolation and depression have an impact on cognitive frailty. However, the underlying mechanisms between these variables have not been well defined. This study aims to investigate the mediating role of depressive symptoms in the association between social isolation and cognitive frailty among older adults in China.

Methods

From Mar 2023 to Aug 2023, a cross-sectional study was conducted with 496 community-dwelling older adults aged ≥60 years in Nanjing, Jiangsu Province, China. Demographic information was collected using the General Information Questionnaire. The Lubben Social Network Scale-6 (LSNS-6), Geriatric Depression Scale 15-item (GDS-15), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and FRAIL scale were used for the questionnaire survey. Multiple linear regression and binary logistic regression were utilized to explore the associations among social isolation, depressive symptoms, and cognitive frailty, and Bootstrap analysis was used to explore the mediating role of depressive symptoms in social isolation and cognitive frailty.

Results

Linear regression results revealed that social isolation was positively associated with depressive symptoms (β = 0.873, p < 0.001). Logistic regression analysis showed that social isolation (OR = 1.769, 95% CI = 1.018~3.075) and depressive symptoms (OR = 1.227, 95% CI = 1.108~1.357) were significantly associated with cognitive frailty. Mediation analysis demonstrated that depressive symptoms significantly mediated the relationship between social isolation and cognitive frailty, with an indirect effect of 0.027 (95% CI = 0.003~0.051), and the mediating effect accounted for 23.6% of the total effect.

Conclusion

Social isolation is associated with cognitive frailty in community-dwelling older adults, and depressive symptoms partially mediate the effect between social isolation and cognitive frailty. Active promotion of social integration among older individuals is recommended to enhance their mental health, reduce the incidence of cognitive frailty, and foster active aging.

Polygenic risk of social isolation behavior and its influence on psychopathology and personality

Social isolation has been linked to a range of psychiatric issues, but the behavioral component that drives it is not well understood. Here, a genome-wide associations study (GWAS) was carried out to identify genetic variants that contribute specifically to social isolation behavior (SIB) in up to 449,609 participants from the UK Biobank. 17 loci were identified at genome-wide significance, contributing to a 4% SNP-based heritability estimate. Using the SIB GWAS, polygenic risk scores (PRS) were derived in ALSPAC, an independent, developmental cohort, and used to test for association with self-reported friendship scores, comprising items related to friendship quality and quantity, at age 12 and 18 to determine whether genetic predisposition manifests during childhood development. At age 18, friendship scores were associated with the SIB PRS, demonstrating that the genetic factors can predict related social traits in late adolescence. Linkage disequilibrium (LD) score correlation using the SIB GWAS demonstrated genetic correlations with autism spectrum disorder (ASD), schizophrenia, major depressive disorder (MDD), educational attainment, extraversion, and loneliness. However, no evidence of causality was found using a conservative Mendelian randomization approach between SIB and any of the traits in either direction. Genomic Structural Equation Modeling (SEM) revealed a common factor contributing to SIB, neuroticism, loneliness, MDD, and ASD, weakly correlated with a second common factor that contributes to psychiatric and psychotic traits. Our results show that SIB contributes a small heritable component, which is associated genetically with other social traits such as friendship as well as psychiatric disorders.

Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial

Aim

To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders.

Methods

An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis.

Results

Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms (B = -0.39; 95%CI: -0.65, -0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms (B = -0.63; 95%CI: -0.96, -0.30; p < 0.001) and mental quality of life (B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period.

Conclusion

The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.

Care for Social Isolation and Loneliness in a Case With Late-Onset Delusional Disorder

Late-onset psychosis refers to the development of psychotic symptoms after the age of 40 and can encompass various conditions like schizophrenia, mood disorders with psychotic features, and delusional disorder. Non-pharmacological interventions are critically important in older adults with psychosis, especially considering the lack of evidence for the efficacy of antipsychotics and the high risk of side effects. Social isolation is recognized as one of the risks of late-onset psychosis, and interventions to eliminate this risk are becoming increasingly important in Japan, where social isolation among older people is widespread as society ages. We present a case of late-onset delusional disorder in which multidimensional interventions for social isolation and loneliness, which have significant impacts on symptoms, were effective in achieving persistent remission. The case involved a woman in her mid-70s who began to complain of paranoia that taking a painkiller recommended by her husband caused persistent pain. Her husband's hospitalization and the deterioration of her relationship with her children resulted in her becoming socially isolated, which intensified her delusions and led to aggressive behavior and depression. Although antipsychotic medications had a limited effect, remission was achieved through supportive psychotherapy, cognitive therapy, family education, participation in group occupational therapy, and the introduction of daycare services, which were implemented to reduce loneliness and social isolation. Specifically, supportive psychotherapy and family education for her loneliness, awareness of another possible cause of pain that she developed through Socratic questioning, and environmental adjustments played important roles in preparing her to accept cognitive therapy, achieve delusional remission, and maintain her state of remission, respectively. The interventions implemented in this case provide insights for addressing social isolation and loneliness in late-onset psychosis.

Cultural engagement and prevalence of pain in socially isolated older people: a longitudinal modified treatment policy approach

Background

It remains uncertain whether cultural engagement positively influences the reduction of pain risk, particularly depending on the social isolation status. The aim of this study was to examine the impact of cultural engagement on the reduction of pain prevalence over a 6-year follow-up period among older people, particularly those experiencing different dimensions of social isolation.

Methods

This study was a prospective longitudinal study. We analysed the English Longitudinal Study of Ageing cohort, consisting of 6468 community-dwelling adults aged ≥50 years old who provided data in waves 6 (2012-2013), 7 (2014-2015), 8 (2016-2017), and 9 (2018-2019). Self-reported cultural engagement (going to museums, art galleries, exhibitions, the theatre, concerts, or the opera) measured in waves 6-8 was used as the exposure variable. Meanwhile self-reported moderate-to-severe pain in wave 9 was used as the outcome variable. Social isolation was considered in waves 6-8, and the possibility of effect modification was captured by assessing each component of the social isolation index: not married or cohabiting with a partner, fewer than monthly contact with children/other immediate family/friends, and not engaging in any organisations, religious groups, or committees.

Findings

The estimated pain prevalence was 29.2% (95% confidence interval, 28.1-30.3; reference) after adjusting for time-variant, time-invariant, and loss to follow-up factors. Cultural engagement led to a reduction in pain prevalence to 24.1% for all individuals, representing a decrease of 5.1% (95% confidence interval, 0.6-9.6; P-value, 0.03). In older people who were not married or cohabiting, cultural engagement resulted in a decrease in pain prevalence to 25.8%, a reduction of 3.4% (95% confidence interval, 0.4-6.4; P-value, 0.01). For those with less frequent contact with close family members, the pain prevalence decreased to 25.3%, a reduction of 3.9% (95% confidence interval, 0.2-7.6; P-value, 0.03). Meanwhile, other dimensions of social isolation did not show a significant reduction in pain prevalence.

Interpretation

Cultural engagement may help to reduce the risk of pain in socially isolated older adults. Those who were single or living alone and had less frequent contact with immediate family were particularly vulnerable. While cultural engagement might help certain socially isolated older people feel better, its effectiveness varies, highlighting the need for targeted interventions.

Funding

The Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number (22K17648, Ikeda).

Effect of intensity of persistent social isolation on mental health in the late middle-aged and older population: results of the Korea Longitudinal Study of Ageing (2006-2020)

BACKGROUND

Social isolation (SI) was recently identified as a significant public health issue in the United States. Consequently, several studies on the association between SI and mental health were conducted. However, few studies have considered the duration and intensity of SI. In the present study, a longitudinal analysis was conducted to determine the effect of the intensity of persistent SI on the mental health status of late middle-aged and older Koreans.

METHODS

After excluding missing values, data on 6200 participants were analyzed using the group-based trajectory model (GBTM) from the first to fifth Korean Longitudinal Study of Ageing (KLoSA) to categorise the SI trajectory (SIT). The Chi-square test, t-test, analysis of variance, and time-lagged generalised estimation equations were utilised from the fifth to eighth KLoSA to determine the association between SIT and the incidence of cognitive decline (the group with a Korean version Mini-Mental State Examination score of 23 or lower), cognitive function score, and depression score.

RESULTS

Four SIT groups were identified in the GBTM analysis. These were the non-SIT (21.7%), mild (46.8%), moderate (21.1%), and severe SIT (10.4%) groups. Compared to the non-SIT group, the severe SIT group experienced a greater incidence of cognitive decline (odds ratio = 1.57, P < 0.0001) as well as poorer cognitive function scores (B = -0.63, P < 0.0001) and depression scores (B = 0.90, P < 0.0001). Furthermore, stratified analysis by sex and age showed that mental health status was inversely proportionate to the intensity of SIT, particularly in males and patients, aged 65 years and above.

CONCLUSION

A close association was observed between SIT and mental health. This finding highlighted the need for policies and institutional measures to reduce the incidence of mental health deterioration among vulnerable groups due to the intensity of SI.

Causal links between sedentary behavior, physical activity, and psychiatric disorders: a Mendelian randomization study

BACKGROUND

Studies suggest a correlation between excessive sedentary behavior, insufficient physical activity, and an elevated likelihood of experiencing psychiatric disorder. Nonetheless, the precise influence of sedentary behavior and physical activity on psychiatric disorder remains uncertain. Hence, the objective of this research was to investigate the possible causal relationship between sedentary behavior, physical activity, and the susceptibility to psychiatric disorder (depression, schizophrenia and bipolar disorder), utilizing a two-sample Mendelian randomization (MR) approach.

METHODS

Potential genetic instruments related to sedentary leisure behaviors were identified from the UK Biobank database, specifically a summary-level genome-wide association study (GWAS) involving 422,218 individuals of European descent. The UK Biobank database also provided the GWAS data for physical activity. Primary analysis was performed using inverse variance weighting (IVW) to assess the causal relationship between sedentary behavior, physical activity, and the risk of psychiatric disorder (depression, schizophrenia and bipolar disorder). Sensitivity analysis was conducted using Cochran's Q test, the MR-Egger intercept test, the MR-pleiotropy RESidual sum and outlier test, leave-one-out analysis, and funnel plot analysis.

RESULTS

According to the IVW analysis, there was a significant association between genetically predicted leisure television watching and an increased risk of depression (odds ratio [OR] = 1.027, 95% confidence interval [CI]: 1.001-1.053; P = 0.04). The IVW analysis also indicated that there was a decreased risk of depression associated with fraction accelerations of > 425 milligravities, as measured by accelerometers (OR = 0.951, 95%CI: 0.914-0.989; P = 0.013). The other MR methods obtained consistent but non-significant results in the same direction. However, there was no evidence of a causal association between genetic liability for moderate-to-vigorous physical activity, accelerometer-assessed physical activity, computer use, or driving and the risk of depression. Furthermore, IVW analysis has also found that driving has a slight effect in reducing the risk of schizophrenia (OR = 0.092, 95%CI: 0.010-0.827; P = 0.033), while leisure television viewing has a significant protective effect against the onset of bipolar disorder (OR = 0.719, 95%CI: 0.567-0.912; P = 0.006).

CONCLUSION

The study provides compelling evidence of a link between depression, bipolar disorder, and excessive TV watching. Furthermore, it suggests that higher accelerometer-assessed fraction accelerations of > 425 milligravities can serve as a genetic protective factor against depression. To mitigate the risk of developing depression, it is advisable to reduce sedentary activities, particularly television watching, and prioritize engaging in vigorous physical exercise.

The role of frailty in the relationships between social relationships and health outcomes: a longitudinal study

BACKGROUND

Socially isolated older adults incur increased risks of adverse health outcomes, though the strength of this association is unclear. We examined whether changes in physical frailty moderated the associations between changes in social relationships and changes in health outcomes among older adults.

METHODS

This longitudinal study is based on three waves of the FRéLE study among 1643 Canadian community-dwelling older adults aged 65 years and older over 2 years. We performed latent growth curve modelling (LGMs) to assess changes with the assumption of missing not at random, adjusting for time-invariant covariates. We used the latent moderated structural equations (LMS) to test the interactions in LGMs. Social relationships were measured by social participation, social networks, and social support from different social ties. Frailty was assessed using the five components of the phenotype of frailty.

RESULTS

The results revealed that changes in frailty moderated changes in social participation (β = 3.229, 95% CI: 2.212, 4.245), social contact with friends (β = 4.980, 95% CI: 3.285, 6.675), and social support from friends (β = 2.406, 95% CI: 1.894, 2.917), children (β = 2.957, 95% CI: 1.932, 3.982), partner (β = 4.170, 95% CI: 3.036, 5.305) and extended family (β = 6.619, 95% CI: 2.309, 10.923) with changes in cognitive function and depressive symptoms, but not with chronic diseases. These results highlight the beneficial role of social relationships in declining depressive symptoms and improving cognitive health among older adults experiencing increases in frailty.

CONCLUSIONS

The findings suggest that changes in social support have a protective and compensatory role in decreasing depressive symptoms and enhancing cognitive health among older adults with increasing frailty. Public health policy and strategies should consider the impact of social support on multiple health outcomes among older adults with increasing frailty. Further experimental studies and interventions are warranted to extend findings on the relationships between social relationships and health outcomes, targeting frail older adults. Future studies may also consider other health-related risk factors that may impact the associations between social relationships and health outcomes among older adults.

Effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults post hip fracture: a systematic review and meta-analysis

This study determines the effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults after hip fracture. Ovid MEDLINE, Embase, Global Health, APAPsych, CENTRAL, CIHAHL, PEDro and Open Grey were searched from database inception to June 10, 2022 for definitive, pilot or feasibility randomised controlled trials of rehabilitation interventions (versus any comparator) which reported depressive symptoms among older adults post hip fracture. Nonrandomised trials and those not published in English were excluded. Selection, quality appraisal (Cochrane Risk of Bias 2) and extraction in duplicate. Results were synthesised narratively and with meta-analysis (Hedge's g for intervention effect, I2 for heterogeneity). Eight trials (1146 participants) were included. Interventions were predominantly face-to-face exercise rehabilitation (range three to 56 sessions) at home versus usual care. Three trials were assigned overall low risk of bias, three some concerns and two high risk. The pooled effect of rehabilitation on depressive symptoms at intervention end favoured the intervention group (Hedges's g -0.43; 95% CI: -0.87, 0.01; four trials). Three trials demonstrated no between group difference following adjustment for baseline depressive symptoms. One trial found lower odds of depression when the intervention additionally included falls prevention, nutrition consultation and depression management. There is a potential benefit of exercise rehabilitation interventions on depressive symptoms after hip fracture. A mechanism for benefit may relate to baseline symptom severity, exercise frequency, frequency of health professional contacts, addition of a psychological component or of the quality of the underlying trials. To appropriately inform clinical guidelines, further appropriately powered trials with follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42022342099.

Interdependent culture and older adults' well-being: Health and psychological happiness in Japanese communities

This review article examined perspectives on the well-being and health of older adults in Japan, a nation renowned for its longevity. We emphasized the impact of social capital and social relationships in local communities, considering both individual and societal factors. The prevailing values in Japanese culture tend to foster a sustained and stable form of interdependent happiness among older adults, suggesting that communal support systems play an important role. This article highlights the value of multi-level datasets, such as the Japan Gerontological Evaluation Study (JAGES) dataset, for understanding the influence of social participation on the health and well-being of older adults. A growing body of evidence underscores the central role of social relationships in the health and well-being of older adults.

Staying connected: An umbrella review of meta-analyses on the push-and-pull of social connection in depression

BACKGROUND

Depression affects approximately 4 % of the global population and has huge social and economic implications. Social factors, including support, engagement, and stigma, play a crucial role in the development and severity of depression.

METHODS

We provide a synthesis of the consistency and magnitude of the association between measures of social connection and depression. We searched PubMed, PsycINFO, Cochrane Library, and EMBASE and 47 meta-analyses were included in the umbrella review. The strength of the associations was extracted and compared among different populations. The quality/certainty of evidence was assessed using AMSTAR-2 and GRADE tool.

RESULTS

Results indicate that social support serves as a protective factor against depression, particularly in peripartum populations, while its impact is weaker in clinical populations. No association was found between social support and depression in post-disaster populations. Stigma and discrimination favour the development and maintenance of depressive symptoms in clinical populations, but have a weaker effect in ethnic minorities.

LIMITATIONS

The quality and certainty of evidence should be taken into account when interpreting our findings. Further research with more rigorous methodology and higher-quality evidence is needed to better understand the complex relationship between depression and social connection across various populations and contexts.

CONCLUSIONS

Our findings confirm the role of social determinants in the emergence and severity of depression, particularly in the case of vulnerable populations. Efforts to counteract disconnection at the societal and individual levels and to reduce stigma should be central to an effective depression prevention agenda.

Hearing Impairment and Cognitive Function: Mediating Role of Social Isolation and Depression

ObjectivesTo examine the relationship between hearing impairment and cognitive function and the mediating role of social isolation and depression. Methods: Data came from the 2018 China Health and Retirement Longitudinal Study wave. A self-reported item, a composite index, the 10-item Center for Epidemiological Studies Depression Scale, and the Mini-Mental State Exam were used to measure hearing impairment, social isolation, depression, and cognitive function, respectively. Mediation analysis was performed. Results: 6799 participants were included. For participants reporting mild hearing impairment and severe hearing impairment, there were significant direct and indirect effects on cognitive function. Social isolation mediated 2.75% and 6.33% of the relationship between mild hearing impairment, severe hearing impairment, and cognitive function, respectively. The direct effect of hearing impairment outweighed the mediation effect of social isolation on cognitive function. Conclusions: Decreased cognitive function linked to hearing impairment might benefit from addressing hearing impairment and social isolation in older adults.

Estimating the joint effect of household solid fuel use and social isolation on depression among middle-aged and older adults in China

BACKGROUND

Household solid fuel use and social isolation are reported to increase the risk of depressive symptoms, but their joint effect has not yet been examined. This study aimed to explore the separate and joint effects of household solid fuel use and social isolation on depression.

METHODS

We used data from the latest four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS). Depression was defined as a score of ≥12 using the Center for Epidemiologic Studies Depression Scale (CES-D 10). Cox proportional hazards models were applied to explore the separate and joint associations of household solid fuel use and social isolation with incident depression.

RESULTS

During the seven-year follow-up, 2793 (30.25 %) out of the 9232 participants were identified with depressive symptoms. Solid fuel use for household heating or cooking was significantly associated with more hazards of depressive symptoms after adjusting for potential confounders (cooking: HR = 1.280, 95 % CI = 1.175-1.394; heating: HR = 1.142, 95 % CI = 1.054-1.238). High social isolation at baseline was also a significant predictor of incident depressive symptoms (HR = 1.139, 95 % CI = 1.053-1.231). Participants exposed to both solid fuel use and high social isolation were found to have higher hazards of experiencing depressive symptoms than those exposed to none or only one of these two risk factors (heating: HR for 'solid fuel use + high social isolation'=1.308 versus HR for other groups = 1-1.185; cooking: HR for 'solid fuel use + high social isolation' = 1.430 versus HR for other groups = 1-1.255).

CONCLUSION

Household solid fuel use and social isolation were separately and jointly associated with higher risks of incident depression. Appropriate interventions to reduce solid fuel use and social isolation are recommended to improve the psychological health among middle-aged and older adults in China.

Disability risk prediction model based on machine learning among Chinese healthy older adults: results from the China Health and Retirement Longitudinal Study

Background

Predicting disability risk in healthy older adults in China is essential for timely preventive interventions, improving their quality of life, and providing scientific evidence for disability prevention. Therefore, developing a machine learning model capable of evaluating disability risk based on longitudinal research data is crucial.

Methods

We conducted a prospective cohort study of 2,175 older adults enrolled in the China Health and Retirement Longitudinal Study (CHARLS) between 2015 and 2018 to develop and validate this prediction model. Several machine learning algorithms (logistic regression, k-nearest neighbors, naive Bayes, multilayer perceptron, random forest, and XGBoost) were used to assess the 3-year risk of developing disability. The optimal cutoff points and adjustment parameters are explored in the training set, the prediction accuracy of the models is compared in the testing set, and the best-performing models are further interpreted.

Results

During a 3-year follow-up period, a total of 505 (23.22%) healthy older adult individuals developed disabilities. Among the 43 features examined, the LASSO regression identified 11 features as significant for model establishment. When comparing six different machine learning models on the testing set, the XGBoost model demonstrated the best performance across various evaluation metrics, including the highest area under the ROC curve (0.803), accuracy (0.757), sensitivity (0.790), and F1 score (0.789), while its specificity was 0.712. The decision curve analysis (DCA) indicated showed that XGBoost had the highest net benefit in most of the threshold ranges. Based on the importance of features determined by SHAP (model interpretation method), the top five important features were identified as right-hand grip strength, depressive symptoms, marital status, respiratory function, and age. Moreover, the SHAP summary plot was used to illustrate the positive or negative effects attributed to the features influenced by XGBoost. The SHAP dependence plot explained how individual features affected the output of the predictive model.

Conclusion

Machine learning-based prediction models can accurately evaluate the likelihood of disability in healthy older adults over a period of 3 years. A combination of XGBoost and SHAP can provide clear explanations for personalized risk prediction and offer a more intuitive understanding of the effect of key features in the model.

Understanding the mental health impact of COVID-19 in the elderly general population: A scoping review of global literature from the first year of the pandemic

Self-isolation was common in the first year of COVID-19. While necessary, it also increased vulnerability to adverse mental health among elderly (i.e. aged 60 and above). This review seeks to summarise the outcomes, measures, and protective and risk factors of elderly mental health in the first year of COVID-19. Four international databases were systematically searched from inception to August 2021. Forty-five studies examining elderly mental health outcomes specific to COVID-19 were included - one was qualitative, 29 used cross-sectional quantitative methods, and 15 were longitudinal. Anxiety and depression were examined most commonly and consistently, largely with well-validated scales. Older age, female sex, poor financial status, being unmarried, high loneliness, low social engagement, low resilience and more severe pandemic measures were associated with poor elderly mental health outcomes. Ten of 13 longitudinal studies found deteriorations in elderly mental health outcomes over time. More consistent measures are needed to understand the pandemic's impact on elderly mental health. Our findings also suggest that socialising through digital mediums may not be helpful, and might even exacerbate loneliness. While the elderly are generally considered a high-risk population, higher-risk subpopulations were identified. We conclude by suggesting a multilevel approach to safeguard elderly mental health for future crises.

Classification of social isolation and factors related to loneliness and life satisfaction among socially isolated individuals

PURPOSE

To operationally divide social isolation into four categories and examine the factors associated with social isolation and its relationship with loneliness and life satisfaction.

METHODS

The participants were community-dwelling older adults aged ≥ 60 years who underwent functional health examinations in Chita City, Aichi, Japan. Multiple regression analysis was used to examine the associations between social isolation, loneliness, and life satisfaction.

RESULTS

A total of 5,066 participants (mean age 72.0 ± ± 6.3 years, female: 55.4 %) were included in the study. Multiple regression analysis showed that the number of experiences of social isolation, classified into four categories, was positively correlated with loneliness (β = 0.188, ΔR2 = 0.244, p < 0.001) and negatively correlated with life satisfaction (β = -0.076, ΔR2 = -0.178, p < 0.001).

CONCLUSIONS

Multiple experiences of social isolation classified into four categories were found to be associated with higher loneliness and lower life satisfaction.

Later-life depressive symptoms during the Covid-19 pandemic: Investigations of individual, cumulative, and synergistic effects of social isolation

OBJECTIVES

This study examines associations between social isolation and depressive symptoms among Hong Kong Chinese adults aged 65 and older by investigating the distinct effects of individual indicators, cumulative index, and typologies of social isolation during the Covid-19 pandemic.

METHODS

We used a sample of 260 older adults from a cross-sectional, city-wide online survey targeting 1,109 aged 45+ adults through purposive sampling. Seven indicators of social isolation (not married; living alone; not engaging in social/organizational activities; no social contact with friends or families; lack of family and friends networks; loneliness) using Cornwell & Waite's framework were selected to construct three unique types of social isolation measures. We used latent class analysis (LCA) and regression models to examine the effects of varied typologies of social isolation on depressive symptoms.

RESULTS

Individual model of social isolation showed that lack of social contact and feeling lonely were significant predictors of depressive symptoms. A strong linear-trend gradient effect of cumulative social isolation on depressive symptoms was also observed. The LCA model identified four typologies of social isolation (socially isolated; living alone but socially engaged; married but lacking social ties, and not socially isolated); those in the 'socially isolated' and 'married but lacking social ties' groups had the most depressive symptoms.

CONCLUSION

Three operationalizations of social isolation demonstrated different utilities and implications in assessing the impacts of social isolation on depressive symptoms. Social contacts and loneliness, rather than living status or other characteristics of isolation, were the factors most strongly associated with depressive symptoms. Support programs should target lonely older adults who lack social engagement opportunities, as they are at increased risk of depression.

The Impact of Loneliness and Social Isolation on Cognitive Aging: A Narrative Review

Social concepts such as loneliness and social isolation are fairly new factors that have been recently gaining attention as to their involvement in changes in cognitive function and association with dementia. The primary aim of this narrative review was to describe the current understanding of how loneliness and social isolation influence cognitive aging and how they are linked to dementia. Studies have shown that there is an association between loneliness, social isolation, and reduced cognitive function, in older adults, across multiple cognitive domains, as well as a heightened risk of dementia. Numerous changes to underlying neural biomechanisms including cortisol secretion and brain volume alterations (e.g., white/grey matter, hippocampus) may contribute to these relationships. However, due to poor quality research, mixed and inconclusive findings, and issues accurately defining and measuring loneliness and social isolation, more consistent high-quality interventions are needed to determine whether studies addressing loneliness and social isolation can impact longer term risk of dementia. This is especially important given the long-term impact of the COVID-19 pandemic on social isolation in older people is yet to be fully understood.

Social isolation, loneliness, and their correlates in older Japanese adults

BACKGROUND

Loneliness and social isolation are elevated in older adults and associated with a range of detrimental outcomes. Despite this, there has been little research on these phenomena or on similarities and differences in their occurrence or combination in older Japanese adults. The current study aims to (i) determine what factors are associated with social isolation and loneliness among older adults in Japan; and (ii) describe the characteristics of individuals who are socially isolated but not lonely, as well as those who feel lonely but are not socially isolated.

METHODS

Data were analysed from 13 766 adults aged ≥65 years who participated in the 2019 wave of the Japan Gerontological Evaluation Study. Poisson regression analysis was used to examine associations.

RESULTS

Among older Japanese adults, the attributes of higher age, male gender, lower socioeconomic status, being a welfare recipient, and having depressive symptoms were associated with social isolation, while lower socioeconomic status, unemployment, welfare receipt, and poor physical and mental health were associated with loneliness. In addition, better educated, and mentally and physically healthy people were less likely to feel lonely even when socially isolated, while people who were not working and who had mental or physical health problems were more likely to feel lonely even if they were not socially isolated.

DISCUSSION

Our results indicate that in order to reduce unwanted social isolation and loneliness among older Japanese adults, in the first instance the focus should be on those individuals who are socioeconomically disadvantaged and unhealthy.

Social isolation and subsequent health and well-being in older adults: A longitudinal outcome-wide analysis

BACKGROUND

Social isolation has become a serious public health issue. However, most previous studies examine the relationship between social isolation and a single outcome. We aimed to conduct holistic assessments to understand the multidimensional impacts of social isolation on health and well-being.

METHODS

We used the three-wave data (2013, 2016, and 2019) obtained from the Japan Gerontological Evaluation Study. Our exposure, obtained from the 2016 survey, was the Social Isolation Index (SII) comprising five components: no partner, poor interaction with children, poor interaction with relatives, poor interaction with friends, and no social participation). We assessed 36 health and well-being outcomes across six dimensions obtained from the 2019 survey: physical/cognitive health, health behaviours, mental health, subjective well-being, social isolation, and cognitive social capital. Pre-exposure characteristics and prior outcome levels in 2013 were adjusted. We included 47,318 respondents for 4 outcomes (death, dementia, and functional disability) and 34,187 respondents for 32 other outcomes. The Bonferroni correction was used to correct for multiple tests.

RESULTS

The total SII scores were associated with a wide range of health and well-being outcomes across the six dimensions. Specifically, we found a robust association between an SII score of four or greater with mortality (Odds ratio: 1.89; 95% CI: 1.46-2.43). Among the five components of the SII, poor interaction with friends and no social participation showed robust associations with a wide range of health and well-being. We also found some robust evidence regarding effect modification by gender and age in the associations between the components of the SII and health and well-being.

CONCLUSIONS

Social isolation, specifically social interaction with friends and social participation, may affect a wide range of health and well-being among older adults.

Does remaining teeth and dental prosthesis associate with social isolation? A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES)

OBJECTIVES

Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined.

METHODS

Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms.

RESULTS

The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated.

CONCLUSION

Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.

Cognitive Performance Deficits Are Associated with Clinically Significant Depression Symptoms in Older US Adults

Accumulating research has described cognitive impairment in adults with depression, however, few studies have focused on this relationship during older adulthood. Our cross-sectional study investigated the association between cognitive function performance and clinically significant depression symptoms in older adults. We analysed the data from the 2011 to 2014 National Health and Nutrition Examination Survey on older (aged 60 years and above) US adults. Cognitive function was assessed as a composite score and on a test-by-test basis based on the Consortium to Establish a Registry for Alzheimer's Disease Word List Learning Test, the Word List Recall Test, and Intrusion Word Count Test, the Animal Fluency Test, and the Digit Symbol Substitution Test (DSST). Depression was defined as clinically significant depression symptoms based on the standard cut-off point of the Patient Health Questionnaire-9 (PHQ-9) score of 10 or greater. Adjusted-logistic regression analysis was employed using survey weights to examine the former relationships. Sociodemographic factors, in addition to medical history and status in terms of self-reported chronic illness and the incidence of stroke or memory-cognitive function loss, were considered as covariates. Among 1622 participants of a survey-weighted 860,400 US older adults, cognitive performance was associated with clinically significant depression symptoms (p = 0.003) after adjustment. Most prominently, older adults with significant cognitive deficits had approximately two and a half times (OR: 2.457 [1.219-4.953]) higher odds for a PHQ-9 score above threshold compared to those with the highest performance. Particularly, those with lowest DSST score had increased odds of almost four times (OR: 3.824 [1.069-13.678]). Efforts to decipher the underlying aetiology of these negative disparities may help create opportunities and interventions that could alleviate the risks from depression, cognitive impairment, and associated consequences in older adults at a population level.

The Individual and Combined Effects of Social Networks and Loneliness on Life Satisfaction among Community-Dwelling Residing Older Adults: A Longitudinal Study

Social networks and loneliness are correlates of life satisfaction in old age. However, the evidence of the combined effects of social isolation and loneliness on life satisfaction is lacking; therefore, this study also aimed to investigate the combined effects of social networks and loneliness on life satisfaction in Malaysian older adults. Data from two waves of the "Neuroprotective Model for Healthy Longevity among Malaysian Older Adults" study were extracted. The first wave of data collection was completed in February 2013, while the second wave was conducted three years after the first wave. The main statistical analysis used was multivariable logistic regression. For individual effect, social networks (B = 0.375, p = 0.007), but not loneliness (B = -0.178, p = 0.368) significantly determined life satisfaction. Increasing social network size causes increasing life satisfaction. For combined effects, those in "the lone farmers" group (B = 0.279, p = 0.044) and "the majority" group (B = -0.413, p = 0.004) were linked to life satisfaction. Social engagement in older people is important for wellbeing in later life. Therefore, community programs and investing in a quality relationship should be encouraged to obtain adequate support and ultimately promote higher life satisfaction.

The relationship between social isolation, social support, and loneliness with cardiovascular disease and shared risk factors: A narrative review

BACKGROUND

Cardiovascular disease (CVD) is the greatest contributor to global morbidity and mortality. Poor social health plays a critical role in CVD incidence. Additionally, the relationship between social health and CVD may be mediated through CVD risk factors. However, the underlying mechanisms between social health and CVD are poorly understood. Certain social health constructs (social isolation, low social support and loneliness) have complicated the characterisation of a causal relationship between social health and CVD.

AIM

To provide an overview of the relationship between social health and CVD (and its shared risk factors).

METHOD

In this narrative review, we examined published literature on the relationship between three social health constructs (social isolation, social support, and loneliness) and CVD. Evidence was synthesised in a narrative format, focusing on the potential ways in which social health affects CVD, including shared risk factors.

RESULTS

The current literature highlights an established relationship between social health and CVD with a likelihood for bi-directionality. However, there is speculation and varied evidence regarding how these relationships may be mediated through CVD risk factors.

CONCLUSIONS

Social health can be considered an established risk factor for CVD. However, the potential bi-directional pathways of social health with CVD risk factors are less established. Further research is needed to understand whether targeting certain constructs of social health may directly improve the management of CVD risk factors. Given the health and economic burdens of poor social health and CVD, improvements to addressing or preventing these interrelated health conditions would have societal benefits.

Polygenic risk of Social-isolation and its influence on social behavior, psychosis, depression and autism spectrum disorder

Social-isolation has been linked to a range of psychiatric issues, but the behavioral component that drives it is not well understood. Here, a GWAS is carried out to identify genetic variants which contribute to Social-isolation behaviors in up to 449,609 participants from the UK Biobank. 17 loci were identified at genome-wide significance, contributing to a 4% SNP heritability estimate. Using the Social-isolation GWAS, polygenic risk scores (PRS) were derived in ALSPAC, an independent, developmental cohort, and used to test for association with friendship quality. At age 18, friendship scores were associated with the Social-isolation PRS, demonstrating that the genetic factors are able to predict related social traits. LD score regression using the GWAS demonstrated genetic correlation with autism spectrum disorder, schizophrenia, and major depressive disorder. However, no evidence of causality was found using a conservative Mendelian randomization approach other than that of autism spectrum disorder on Social-isolation. Our results show that Social-isolation has a small heritable component which may drive those behaviors which is associated genetically with other social traits such as friendship satisfaction as well as psychiatric disorders.

Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis

OBJECTIVE

To identify different profiles of socially isolated older adults during the first wave of COVID-19 in Quebec, Canada.

STUDY DESIGN

Cross-sectional data were obtained through a telehealth socio-geriatric risk assessment tool, ESOGER, administered to adults aged 70 years or more between April and July 2020 in Montreal, Canada.

MEASURES

Those living alone with no social contacts in the last few days were considered socially isolated. Latent class analysis was performed to identify profiles of socially isolated older adults based on: age, sex, polypharmacy, use of home care, use of a walking aid, recall of current year/month, anxiety level (scale 0-10), and need for follow-up from a healthcare provider.

RESULTS

Three-hundred and eighty (380) older adults identified as socially isolated were analyzed, of whom 75.5 % were female and 56.6 % were over 85. Three classes were identified: Class 1 ("physically frail older females") had the highest proportion of polypharmacy, walking aid, and home care use. Class 2 ("anxious, relatively younger males") were predominantly males who used the least home care but had the highest anxiety levels. Class 3 ("seemingly well older females") had the highest proportion of females, lowest proportion of polypharmacy, lowest anxiety level, and none used a walking aid. Recall of current year/month was similar across the three classes.

CONCLUSIONS

This study found heterogeneity among socially isolated older adults during the first wave of the COVID-19 pandemic with varying levels of physical and mental health. Our findings may contribute to the development of targeted interventions to support this vulnerable population during and after the pandemic.

Evaluation of the optimal cutoff number of types of social participation activities in older people

INTRODUCTION

Social participation activities have a close association with health aging. However, the clinical significance of numbers of social participation activities and its cutoff value has not been defined.

METHODS

We recruited 516 people aged ≥55 years. Twelve social participation behaviors modified according to Taiwanese culture were investigated, and the adequacy of cutoff number was determined by the area under the receiver operating characteristic curve (AUC) according to the results of cluster analysis of individual activities and scores of the Brief Symptom Rating Scale-5 (BSRS-5) and the Chinese Happiness Inventory (CHI). Demographic, BSRS-5 and CHI data were then compared according to the candidate cutoff numbers.

RESULTS

The distribution of the numbers of social activities suggested that the highest partition of numbers of social activities was 3 in women and 4 in men. The AUC regarding the cluster of activity types was 0.917, with the highest Youden's J value located between 3 and 4. The AUC regarding the cluster of activity types and scores of the BSRS-5 and the CHI was 0.929, with similar cutoffs. If 3 and 4 were used as cutoffs, the between-group differences of both the CHI and the BSRS-5 were significant. More types of social activities had a different engaging frequency with the 3 and 4 cutoffs.

CONCLUSION

Our findings found an adequate cutoff with better differential power in the psychopathology and happiness of older people that provided a basis for application in intervention and policy formation.

Association between Social Isolation and Loneliness with Estimated Atherosclerotic Cardiovascular Disease Risk in a UK Biobank Population-Based Study

OBJECTIVE

The association of cardiovascular (CV) risk with social isolation and loneliness remains poorly studied. The purpose of this cross-sectional study was to investigate the associations between social isolation and loneliness with estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk.

METHODS

Among 302,553 volunteers of the UK Biobank population, social isolation and loneliness were assessed with a questionnaire. Associations between social isolation and loneliness with ASCVD risk were estimated using multiple gender regressions.

RESULTS

Men presented a higher estimated 10-year ASCVD risk (8.63% vs. 2.65%, p < 0.001) and higher proportions of social isolation (9.13% vs. 8.45%, p < 0.001) and loneliness (6.16% vs. 5.57%, p < 0.001) than women. In all covariate-adjusted models, social isolation was associated with an increased ASCVD risk in men (B = 0.21 (0.16; 0.26), p < 0.001) and women (B = 0.12 (0.10; 0.14), p < 0.001). Loneliness was associated with an increased ASCVD risk in men (B = 0.08 (0.03; 0.14), p = 0.001) but not in women (p = 0.217). A significant interaction was observed between social isolation and loneliness with ASCVD risk in men (p = 0.009) and women (p = 0.016). After adjustment for all covariates, both social isolation and loneliness were significantly associated with ASCVD risk in men (B = 0.44 (0.28; 0.61), p < 0.001) and women (B = 0.20 (0.12; 0.29), p < 0.001).

CONCLUSION

Social isolation was associated with a higher estimated 10-year ASCVD risk in both genders but only loneliness among men. Social isolation and loneliness can be considered potential added risk factors for CV risk. Health policies should address these notions in prevention campaigns, in addition to traditional risk factors.

The Effects of Loneliness on Depressive Symptoms Among Older Adults During COVID-19: Longitudinal Analyses of the Canadian Longitudinal Study on Aging

Objectives

This paper examines the longitudinal effects of changes in the association between loneliness and depressive symptoms during the pandemic among older adults (65+). Methods Baseline (2011–2015) and Follow-up 1 (2015–2018) from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit waves of the CLSA COVID-19 study (April–December, 2020) ( n = 12,469) were used. Loneliness was measured using the 3-item UCLA Loneliness Scale and depression using the CES_D- 9. Results Loneliness is associated with depressive symptoms pre-pandemic; and changes in level of loneliness between FUP1 and the COVID Exit survey, adjusting for covariates. No interaction between loneliness and caregiving, and with multimorbidity, on depressive symptoms were observed, and several covariates exhibited associations with depressive symptoms. Discussion Strong support is found for an association between loneliness on depressive symptoms among older adults during the pandemic. Public health approaches addressing loneliness could reduce the burden of depression on older populations.

New determinants of mental health: the role of noise pollution. A narrative review

Urbanisation processes and anthropogenic actions led to a significant increase in pollution levels, with relevant consequences on global health. In particular, noise pollution demonstrated an association with cardiovascular, metabolic, and respiratory diseases. Furthermore, increasing evidence underlined the possible role of air and noise pollution in the development of psychiatric disorders. In this narrative review, evidence concerning the relationship between noise pollution and the emergence of psychiatric symptoms or psychiatric disorders is summarised. After the literature search process was completed, 40 papers were included in the present review. The exposure to road-, rail-, and air- traffic represented a risk factor for the emergence of affective disorders. This could also be mediated by the occurrence of circadian rhythms disturbances or by noise annoyance and noise sensitivity, both influencing psychological well-being and health-related quality of life. Fewer studies concentrated on special populations, particularly pregnant women and children, for whom noise pollution was confirmed as a risk factor for psychopathology. The better clarification of the complex interaction between noise pollution and mental health may help to identify subjects at risk and targeting specific prevention and intervention strategies in the urban environment.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.

Emotion regulation strategies and difficulties in older adults: A systematic review

OBJECTIVES

The purpose of this systematic review was to assess the types of emotion regulation (ER) strategies used and difficulties in emotion regulation experienced by older adults, within the theoretical frameworks proposed by Gross, and by Gratz and Roemer, respectively.

METHODS

A systematic search was conducted using principal electronic scientific databases (PubMed, Scopus, and Web of Science). The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines.

RESULTS

The final number of articles included was 44. Older adults reported a higher use of adaptive ER strategies, as well as fewer difficulties in ER, compared with younger adults. Findings from this review also suggest that the use of maladaptive ER strategies can also expose older adults to psychological distress, and may affect their adaptation to negative disease-related outcomes more common in later life.

CONCLUSIONS

Older adults generally showed a greater emotional control compared with younger subjects. Adaptive control strategies, rather than maladaptive control strategies, were correlated with more positive outcomes for psychological distress and adaptation to chronic diseases.

CLINICAL IMPLICATIONS

Understanding the nature of ER processes in older adults may contribute to implement tailored interventions aimed at reinforcing adaptive ER processes.

Electroencephalogram signals emotion recognition based on convolutional neural network-recurrent neural network framework with channel-temporal attention mechanism for older adults

Reminiscence and conversation between older adults and younger volunteers using past photographs are very effective in improving the emotional state of older adults and alleviating depression. However, we need to evaluate the emotional state of the older adult while conversing on the past photographs. While electroencephalogram (EEG) has a significantly stronger association with emotion than other physiological signals, the challenge is to eliminate muscle artifacts in the EEG during speech as well as to reduce the number of dry electrodes to improve user comfort while maintaining high emotion recognition accuracy. Therefore, we proposed the CTA-CNN-Bi-LSTM emotion recognition framework. EEG signals of eight channels (P3, P4, F3, F4, F7, F8, T7, and T8) were first implemented in the MEMD-CCA method on three brain regions separately (Frontal, Temporal, Parietal) to remove the muscle artifacts then were fed into the Channel-Temporal attention module to get the weights of channels and temporal points most relevant to the positive, negative and neutral emotions to recode the EEG data. A Convolutional Neural Networks (CNNs) module then extracted the spatial information in the new EEG data to obtain the spatial feature maps which were then sequentially inputted into a Bi-LSTM module to learn the bi-directional temporal information for emotion recognition. Finally, we designed four group experiments to demonstrate that the proposed CTA-CNN-Bi-LSTM framework outperforms the previous works. And the highest average recognition accuracy of the positive, negative, and neutral emotions achieved 98.75%.

Different Areas of Chronic Stress and Their Associations with Depression

Background: Research shows a connection between stress and depression, but there is little differentiation between areas of stress, making it difficult to identify and address specific areas in the context of public health measures. We utilized a multi-dimensional approach to chronic stress to better understand the relationship between different areas of stress and depression. Methods: We conducted linear regression analyses and used data from a sub-sample of the LIFE-Adult-Study (N = 1008) to analyze the connection between nine different areas of chronic stress (TICS) and depression (CES-D). In the second analysis, we controlled for sociodemographic variables, personality, physical activity, and social support. Results: There was a significant positive association between the stress domains Excessive Demands from Work, Lack of Social Recognition, Social Isolation, and Chronic Worrying and depression and a significant negative association between Pressure to Perform and depression. After adding control variables, only Pressure to Perform, Social Isolation, and Chronic Worrying remained significant predictors. Conclusions: By focusing on the connections between chronic stress and depression, researchers can help identify the areas that matter most and contribute to the creation of meaningful and efficient interventions. On the basis of our results, measures for the prevention of depression that focus on the reduction of worrying and social isolation are recommended.

Remote Monitoring and Holistic Care of Home-Isolated COVID-19 Positive Healthcare Workers Through Digital Technology During the Omicron (B1.1.529) Wave: A Prospective Cohort Study From India

Background

Remote monitoring through digital technology offers a promising solution for the diverse medical, psychological and social issues that plague patients with COVID-19 under home-isolation, but remain neglected due to a lack of streamlined medical services for these patients.

Methods

This prospective cohort study determined the feasibility of remote telemonitoring of healthcare workers with mild COVID-19 under home isolation during the Omicron (B1.1.529) wave and characterized their clinico-demographic profile. A holistic monitoring model comprising of mandatory phone calls at the beginning and end of isolation, assisted by home oximetry, predesigned google forms, and opt-in software-based (eSanjeevani OPD) teleconsultation was employed. Factors associated with development of symptomatic disease were also determined.

Results

Out of 100 COVID-19 positive healthcare workers under home-isolation, data for 94 participants was available [median age 27(20–52) years, 56(60%) females]. 93(99%) patients were previously vaccinated for COVID-19 (median time from last dose = 248 days); 34(36%) had a past history of COVID-19. Fever (67%), myalgia (69%), sore throat/dry cough (70%), and running nose (45%) were the most common symptoms. No patient progressed to moderate-severe disease or required care escalation during the remote monitoring period. Most participants reported several additional psychosocial concerns which were adequately addressed. Symptomatic patients had higher BMI (24.1 vs. 21.8kg/m2, p = 0.01) compared to asymptomatic patients. Age, past infection with COVID-19, and time since last vaccine dose were not different between symptomatic and asymptomatic patients.

Conclusion

COVID-19 patients under home isolation have multi-faceted medical and psychosocial issues which can be holistically managed remotely through digital technology.

Associations of PM2.5 and road traffic noise with mental health: Evidence from UK Biobank

BACKGROUND

The associations of atmospheric particulate matter with diameters of 2.5 μm or less (PM2.5) and road traffic noise with mental disorders in men and women are not well studied.

OBJECTIVES

We aim to examine the cross-sectional associations of PM2.5 and road traffic noise with mental disorders in men and women.

METHODS

The baseline data of the UK Biobank study (2006-2010) were used. Mental disorders including symptoms of nerves, anxiety, tension or depression (NATD), major depression, and bipolar disorder were assessed by validated questions. Verified models were used to estimate PM2.5 and road traffic noise.

RESULTS

A total of 334,986 participants with measurements of NATD and 90,706 participants with measurements of major depression and bipolar disorder were included in the analysis. After adjusting for covariates, the odds for the risk of NATD symptoms increased by 2.31 (95% CI: 2.15-2.50) times per 10 μg/m³ increase in PM2.5. The odds for the risk of major depression and bipolar disorder increased by 2.26 and 4.99 times per 10 μg/m³ increase in PM2.5. On the other hand, higher road traffic noise exposure was significantly associated with a higher risk of NATD symptoms (Decile 6-8 (54.9-57.8 dB), OR: 1.03, 95% CI: 1.01-1.06; Decile 9-10 (≥57.8 dB), OR: 1.04, 95% CI: 1.01-1.07) and bipolar disorder (Decile 2-5 (52.1-54.9 dB), OR: 1.26, 95% CI: 1.00-1.59; Decile 6-8 (54.9-57.8 dB), OR: 1.30, 95% CI: 1.02-1.65; Decile 9-10 (≥57.8 dB), OR: 1.54, 95% CI: 1.21-1.97). Interestingly, a negative association was observed between moderate road traffic noise and major depression (Decile 2-5 (52.1-54.9 dB), OR: 0.95, 95% CI: 0.90-1.00). Interactions between PM2.5 exposure with age, gender, and sleeplessness for NATD symptoms were observed (P < 0.05), while interactions between road traffic noise exposure with age and gender were observed (P < 0.05).

CONCLUSIONS

We found a positive association between PM2.5 and mental disorders. Meanwhile, we found a positive association of road traffic noise with NATD symptoms and bipolar disorder and a negative association of moderate road traffic noise with major depression. Also, the effect modifications of these associations by age, gender, or sleeplessness may exist.

Less Social Participation Is Associated With a Higher Risk of Depressive Symptoms Among Chinese Older Adults: A Community-Based Longitudinal Prospective Cohort Study

OBJECTIVE

We aimed to examine the association between social participation and depressive symptoms among Chinese older people aged 65 years or above to supplement limited studies in China on this topic.

METHODS

This community-based longitudinal prospective cohort study used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, baseline in 2014 and a follow-up in 2018). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Social participation was assessed using a composite index by considering the frequency for the two types of social activity: organized social activities and informal activities. Pearson's χ² test was used to correlate the characteristics of participants with social participation or depressive symptoms. Log-binomial regression models were used to assess the association between social participation and the risk of depressive symptoms.

RESULTS

The incidence of depressive symptoms was 28.8% among 2,200 participants in 2018 after a 4-year follow-up. Participants with no social participation (32.6%), organized social activities (30.6%), or informal social activities (31.2%) were more likely to have depressive symptoms. After the adjustment of demographic factors, socioeconomic status, lifestyle habits, and health status, in comparison with older people who often engaged in social participation, organized social activities, and informal social activities, the risk of depressive symptoms was 45% [adjusted risk ratio (aRR): 1.45, 95% CI: 1.16-1.82], 42% (aRR: 1.45, 95% CI: 1.02-2.00), and 29% (aRR: 1.29, 95% CI: 1.02-1.99) higher among older people with no social participation and who never engaged in organized social activities and informal social activities, respectively.

CONCLUSIONS

This study showed that the lack of social participation, including organized social activities and informal social activities, was associated with a higher risk of depressive symptoms after 4 years among older adults in China. Our findings shed lights into the feasibility of promoting social participation to reduce the risk of depressive symptoms and promote longevity and healthy aging among older adults.

Pre-pandemic individual- and community-level social capital and depressive symptoms during COVID-19: A longitudinal study of Japanese older adults in 2019-21

During a pandemic, it is important to know whether social capital can mitigate the risk of mental disorders, given the restrictions on social interactions. However, evidence using longitudinal data is scarce. This study examined the association between pre-pandemic social capital and depressive symptoms during COVID-19 among older adults. We used longitudinal data from the Japan Gerontological Evaluation Study (JAGES), including 8291 participants aged 65 or older who were physically and cognitively independent and not depressed at baseline. We conducted baseline and follow-up mail surveys in ten municipalities in Japan from November 2019 to January 2020 (pre-pandemic period) and from November 2020 to February 2021 (pandemic period), respectively. We measured depressive symptoms using the 15-item Geriatric Depression Scale. Social capital was measured with three validated subscales, namely, civic participation, social cohesion, and reciprocity. We performed a multilevel logistic regression analysis to examine the association. A total of 1089 (13.1%) participants newly developed depressive symptoms during the pandemic. The logistic regression showed that pre-pandemic individual-level social cohesion (odds ratio = 0.79, 95% confidence interval: 0.73 to 0.86) and reciprocity (0.89, 0.82 to 0.96) and community-level reciprocity (0.93, 0.88 to 0.98) were negatively associated with the odds of depressive symptoms. Even after adjusting for declines in social capital during the pandemic, the observed associations of pre-pandemic social capital remained. Fostering social cohesion and reciprocity may increase resilience to mental disorders during a pandemic of infectious disease.

Factors Affecting Depression in Middle-Aged and Elderly Men Living Alone: A Cross-Sectional Path Analysis Model

The main objectives of this cross-sectional study were to determine the relationship between socioeconomic status (SES) and depression and to estimate the mediating effects of social network satisfaction, self-esteem, and perceived health status among middle-aged and elderly men living alone, based on the reserve capacity model. Secondary data from a sample of 394 middle-aged and elderly men aged 45 years or older from the 15th Korea Welfare Panel Study (KOWEPS) were analyzed. A path analysis model was constructed to evaluate the relationship among SES, social network satisfaction, self-esteem, perceived health status, and depression. The path analysis exhibited significant direct effects of social network satisfaction, self-esteem, and perceived health status on depression and significant indirect effects of SES on depression. There was no direct effect of SES on depression. Social network satisfaction and self-esteem had significant mediating effects of SES on depression. Among middle-aged and elderly men, intrapersonal reserves, which are psychosocial factors including social network satisfaction, self-esteem, and perceived health status, showed more association with depression than tangible reserves such as SES. This suggests that interventions promoting self-esteem and perceived health status could prevent depression.

Influence of "Face-to-Face Contact" and "Non-Face-to-Face Contact" on the Subsequent Decline in Self-Rated Health and Mental Health Status of Young, Middle-Aged, and Older Japanese Adults: A Two-Year Prospective Study

This study aims to identify the independent influence of face-to-face contact (FFC) and non-face-to-face contact (NFFC) on the subsequent decline in self-rated health and mental health status by age. A total of 12,000 participants were randomly selected among residents in the study area, and 1751 of them responded to both the 2016 and 2018 mail surveys. The participants were subsequently classified into three age groups (25-49: Young adults; 50-64: Mid-aged adults; and 65-84: Older adults). Social contact was assessed by computing the frequencies of FFC and NFFC. Multiple logistic regression analysis showed the risk of social contact on the decline in self-rated health and World Health Organization-Five Well-Being Index. Both FFC and NFFC were significantly associated with maintaining mental health; however, the impacts of FFC on mental health were more significant than that of NFFC among older adults and young adults. Compared with the no contact group, FFC was significantly associated with maintaining self-rated health in mid-aged adults. The influence of FFC and NFFC on health differed by age group.

The impact of socioeconomic status, general health and oral health on Health-Related Quality of Life, Oral Health-Related Quality of Life and mental health among Polish older adults

BACKGROUND

The study aims to evaluate the impact of socioeconomic status, general health and oral health parameters on Health-Related Quality of Life (HRQoL), Oral Health-Related Quality of Life (OHRQoL) and mental health in elderly urban residents of South-Western Poland.

METHODS

The 500 residents of Wroclaw, aged 65 and older provided demographic and personal information as well as their medical history. A patient's oral condition were determined based on the clinical oral examination.Quality of Life was assessed using Euro-Quality of Life (EQ-5D), Oral Health Impact Profile-14 (OHIP-14) and Patient Health Questionnaire (PHQ-9).The association between exposure (socioeconomic status, general health and oral health) and outcome (HRQoL, OHRQoL and mental health variables) were analyzed with the use of four models: P - Poisson model, NB-Negative Binomial model, ZIP - Zero Inflated Poisson model, ZINB - Zero Inflated Negative Binomial model.

RESULTS

The best model turned out to be the ZINB model, in which a negative binomial distribution in the count equation is assumed. In this model, only 13 independent variables had a significant effect on HRQoL, OHRQoL, and mental health. HRQoL assessed with the EQ-5D is significantly influenced by: living conditions 0.133 (95% CI: 0.001, 0.267, p = 0.049), income -0.348 (95%CI: -0.466, -0.230, p < 0.001), diabetes mellitus 0.437 (95%CI: 0.250, 0.624, p < 0.001), myocardial infarction 0.454 (95% CI: 0.151, 0.757, p = 0.003), stroke 0.543 (95%CI: 0.094, 0.992, p = 0.018) and renal disease 0.466 (95% CI: 0.206, 0.726, p < 0.001). Factors negatively affecting OHRQOL are: the need for oral treatment 0.278 (95%CI: 0.104, 0.452, p = 0.002), the number of missing teeth 0.053 (95%CI: 0.039, 0.067, p < 0.001) and gender 0.271 (95%CI: 0.015, 0.527, p = 0.038) and age -0.025 (95%CI: -0.042, -0.008, p = 0.003). An important factor influencing the level of depression assessed by the PHQ-9 questionnaire may be the material condition -0.225 (95%CI: -0.349, -0.101, p < 0.001). It should be emphasized that living with other people may be a factor that significantly increases the probability of avoiding the occurrence of depression symptoms.

CONCLUSION

The study concerning elderly residents of the macroregion in Poland found the impact of socioeconomic, general health and oral health parameters on Health-Related Quality of Life, Oral Health-Related Quality of Life and mental health. Research on the quality of life of the elderly at the local level allowed to assess the factors linked to quality of life of older adults.

APOIO SOCIAL E SINTOMAS DEPRESSIVOS EM IDOSOS ATENDIDOS EM UM AMBULATÓRIO

RESUMO Objetivo: avaliar o apoio social, rastrear os escores indicativos de depressão e identificar se há associação do apoio social com os escores e as variáveis sociodemográficas. Método: estudo transversal e analítico, realizado no Ambulatório de Especialidades do Idoso em São Paulo. Foram selecionados 133 idosos no período de fevereiro de 2019 a julho de 2021. Na coleta de dados, utilizou-se um questionário estruturado, com informações sociodemográficas, clínicas, ter ou não cuidador e foram aplicados os instrumentos: Miniexame do estado mental, Escala de Depressão Geriátrica, Katz, Lawton, Escala de apoio Social. Resultados: a idade média dos participantes do estudo foi de 74,2 anos, mulher (72,9%), casada (35,3%), branca (70,7%), aposentadas (74,5%), quatro anos de estudos (31,6%), renda de até um salário-mínimo (30,8%) hipertensas (73,6%), diabéticas (38,3%) e dislipidêmicas (31,5%). Observou-se que em todos os domínios da escala de apoio social a maior parte dos entrevistados teve percepção de apoio alto. Evidenciou-se que a maior frequência de pessoas idosas com quadro psicológico normal eram aquelas com maior frequência de percepção de apoio alto nos domínios emocional e interação social positiva. Conclusão: o estudo pode evidenciar que pessoas idosas que apresentaram percepção de apoio social baixo foram as que apresentaram mais sintomas depressivos. Portanto, ao evidenciar e conhecer o perfil sociodemográfico do serviço pode-se favorecer o planejamento do cuidado prestado pela equipe multiprofissional e propor ações estratégicas para integralidade do cuidado.

SOCIAL SUPPORT AND DEPRESSIVE SYMPTOMS IN OLDER ADULSTS TREATED IN AN OUTPATIENT SERVICE

ABSTRACT Objective: to assess social support, to screen the scores indicative of depression, and to identify if social support is associated in any way with the scores and with the sociodemographic variables. Method: a cross-sectional and analytical study conducted at a Specialty Outpatient Service for Older Adults in São Paulo. A total of 133 aged individuals were selected from February 2019 to July 2021. During data collection, a structured questionnaire with diverse sociodemographic and clinical information was used, as well as having a caregiver or not; in addition, the following instruments were applied: Mini-Mental State Examination, Geriatric Depression Scale, Katz, Lawton and Social Support Scale. Results: the study participants' mean age was 74.2 years old, they were mostly women (72.9%), married (35.3%), white-skinned (70.7%) and retired (74.5%), they had four years of study (31.6%) and incomes up to one minimum wage (30.8%), and they were hypertensive (73.6%), diabetic (38.3%) and dyslipidemic (31.5%). It was observed that, in all the Social Support Scale domains, most of the interviewees perceived high support. It was evidenced that the highest frequency of aged people with normal psychological state corresponded to those with the highest frequency of high support perception in the Emotional and Positive social interaction domains. Conclusion: the study was able to evidence that aged people with a low perception of social support were the ones that presented more depressive symptoms. Therefore, by evidencing and knowing the sociodemographic profile of the service, it is possible to favor planning of the care provided by the multiprofessional team and propose strategic actions for comprehensive care.

Developing a nomogram for predicting the depression of senior citizens living alone while focusing on perceived social support

BACKGROUND

Although the number of senior citizens living alone is increasing, only a few studies have identified factors related to the depression characteristics of senior citizens living alone by using epidemiological survey data that can represent a population group.

AIM

To evaluate prediction performance by building models for predicting the depression of senior citizens living alone that included subjective social isolation and perceived social support as well as personal characteristics such as age and drinking.

METHODS

This study analyzed 1558 senior citizens (695 males and 863 females) who were 60 years or older and completed an epidemiological survey representing the South Korean population. Depression, an outcome variable, was measured using the short form of the Korean version CES-D (short form of CES-D).

RESULTS

The prevalence of depression among the senior citizens living alone was 7.7%. The results of multiple logistic regression analysis showed that the experience of suicidal urge over the past year, subjective satisfaction with help from neighbors, subjective loneliness, age, and self-esteem were significantly related to the depression of senior citizens living alone (P < 0.05). The results of 10-fold cross validation showed that the area under the curve of the nomogram was 0.96, and the F1 score of it was 0.97.

CONCLUSION

It is necessary to strengthen the social network of senior citizens living alone with friends and neighbors based on the results of this study to protect them from depression.

Loneliness during the COVID-19 Pandemic: A Comparison between Older and Younger People

The precautionary measures and uncertainties surrounding the COVID-19 pandemic have serious psychological impacts on peoples' mental health. We used longitudinal data from Hiroshima University to investigate loneliness before and during the pandemic among older and younger people in Japan. We provide evidence that loneliness among both older and younger people increased considerably during the pandemic. Although loneliness among younger people is more pervasive, the magnitude of increase in loneliness during the pandemic is higher among older people. Our logit regression analysis shows that age, subjective health status, and feelings of depression are strongly associated with loneliness before and during the pandemic. Moreover, household income and financial satisfaction are associated with loneliness among older people during the pandemic while gender, marital status, living condition, and depression are associated with loneliness among younger people during the pandemic. The evidence of increasing loneliness during the pandemic is concerning for a traditionally well-connected and culturally collectivist society such as Japan. As loneliness has a proven connection with both physical and mental health, we suggest immediate policy interventions to provide mental health support for lonely people so they feel more cared for, secure, and socially connected.