Poststroke depression among the Chinese elderly in a rural community

Depressive symptoms and health service utilization among Chinese middle-aged and older adults: a national population-based longitudinal survey

Objectives

This study aimed to (1) examine the cross-sectional and longitudinal relationships between depressive symptoms and health services utilization among Chinese middle-aged and older adults; and (2) evaluate whether there exists a rural–urban difference in such relationships.

Methods

Data was obtained from China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015, a nationally representative survey of 13,551 adults aged 45 years and above in China.

Results

Depressive symptoms were positively associated with a greater likelihood of outpatient and inpatient health services utilization. This association was consistent across rural and urban settings, indicating the robustness of such findings across geographic areas.

Conclusions

Findings indicate that depressive symptoms are significantly associated with both in-patient and out-patient health service utilization among Chinese adults. Screening for depressive symptoms needs to be incorporated in these care settings in China.

Association between dry eye and depressive symptoms in an elderly Chinese population in Taiwan: the Shihpai Eye Study

BACKGROUND

Dry eye may impact quality of life and daily activities and depression is a widespread illness. Many studies showed the two diseases often coexist. However, studies were limited to retrospective chart review. This study aimed to investigate the association between dry eye and depressive symptoms in an older Asian population.

METHODS

The Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects 65 years of age and older in Shihpai, Taipei, Taiwan. Residents fulfilling these criteria were randomly selected to be invited to participate in the study, which included a questionnaire and an eye examination conducted between July 1, 1999 and December 31, 2000.

RESULTS

Of the 2045 subjects recruited, 1361 (66.6%) completed the examination. 8.8% (95% confidence interval (CI): 7.3-10.3%) of the participants were diagnosed to have depressive symptoms. Under multivariate analysis, depressive symptoms were significantly associated with frequent symptoms of dry eye (odds ratio (OR): 1.97, 95% CI: 1.36-2.92; p < 0.001). None of the dry eye signs was associated with depressive symptoms. For participants reporting frequent symptoms, tear-film break-up time ≤ 10 s (OR: 2.06, 95% CI: 1.38-3.05; p < 0.001), Schirmer test score ≤ 5 mm (OR: 2.01, 95% CI: 1.33-3.03; p < 0.001), and meibomian gland disease (OR: 1.99, 95% CI: 1.31-3.01; p = 0.001) were significantly related to depressive symptoms. Fluorescein staining of the cornea was not correlated to depressive symptoms in participants with dry eye symptoms.

CONCLUSIONS

Depressive symptoms are more highly correlated with dry eye symptoms than dry eye signs.

Incidence and risk factors of poststroke depression in patients with acute ischemic stroke: A 1-year prospective study in Taiwan

BACKGROUND

Poststroke depression (PSD) is one of the most frequent and devastating neuropsychiatric consequences of stroke. The purpose of this study was to investigate the incidence and risk factors for PSD in a general hospital in Taiwan.

METHODS

One hundred and one patients with ischemic stroke were enrolled initially, and 91 (90.1%) completed the 1-year study. Assessments were performed at baseline, and at the 1st, 3rd, 6th, 9th, and 12th month after enrolment. The definition of PSD was in accordance with the diagnostic criteria of major depressive episode in the Diagnostic and Statistical Manual, fourth edition (DSM-IV).

RESULTS

The accumulated incidence rates of PSD at the 1st, 3rd, 6th, and 9th, month were 4%, 8%, 9%, and 10%, respectively, and the overall incidence at 1 year was 11%. In multivariate regression analysis, female gender, higher depression score, and severity of stroke were significant risk factors. In subgroup analysis, a higher depression score was significantly associated with PSD, regardless of gender; however, stroke severity was a risk factor only in the female group.

CONCLUSION

The 1-year incidence of PSD was 11%, based on the DSM-IV diagnostic criteria. More attention should be paid to patients with more risk factors to enable earlier detection and intervention.

An investigation into the utility of the Stroke Aphasic Depression Questionnaire (SADQ) in care home settings

Objective: To assess the utility of the Stroke Aphasia Depression Scale (SADQ) to identify emotional distress among individuals living in a care home setting.

Design: A prospective comparison of the SADQ and the depression subsection of the Hospital Anxiety and Depression Scale (HADS).

Setting: Care homes in Oxfordshire.

Participants: Eighty-two care home residents without major communication or cognitive problems.

Measures: Participants completed the HADS. The SADQ was completed on behalf of each resident by his or her principal carer.

Results: Spearman's rank correlation between the two measures was statistically significant (r=0.447, P B< 0.01). Receiver operator characteristics plots revealed an optimal cut-off point of 14 on the SADQ which gave sensitivity and specificity of 77% and 78% respectively.

Conclusion: The SADQ, an observational measure, can identify emotional distress in non-aphasic patients in a care home setting. It would be reasonable to use it with people with communication and cognitive problems who are unable to take part in conventional assessments.

Depression among stroke survivors: a community-based, prospective study from Kolkata, India

OBJECTIVE

Post-stroke depression (PSD) is a disabling entity among stroke survivors (SS). Longitudinal studies on PSD, essential to determine its prognosis, are lacking from developing countries. This prospective study was undertaken to assess the prevalence, natural history, and correlates of depression among SS in an Indian community.

METHODS

From a community based stroke registry, SS were assessed annually for cognition, disability, and depression using Bengali validated scales. PSD was diagnosed if score on geriatric depression scale was greater than or equal to 21. Complex sample strategy was considered when calculating prevalence of post stroke depression. An age- and sex-matched case-control study was undertaken to determine the odds of depression in SS.

RESULTS

Prevalence of PSD was 36.98% (95% confidence interval [CI]: 31.89%-42.06%) among 241 patients assessed at baseline. About 17% developed depression annually and a similar proportion had spontaneous improvement. Peak rate of PSD was beyond 3 months and continued up to 18 months after stroke. Compared to the non-depressed group, PSD subjects were significantly older, had higher age at first stroke, less education, lower socioeconomic status, and greater cognitive impairment and disability. Education had a protective role. Mortality in PSD was nearly twice that in non-depressed patients, though not significant statistically (hazard ratio: 1.84; 95% CI: 0.90-3.77). Compared with controls, odds ratio of PSD was 19.95 (95% CI: 10.09-39.47).

CONCLUSIONS

Approximately one-third of SS develop PSD, similar to developed countries. Prevalence remains stable annually. Delayed peak of PSD suggested later realization of underlying disability. Predictors of PSD have been described and higher literacy was protective in this study.

Time course of depression and one-year prognosis of patients with stroke in mainland China

AIMS

To investigate the incidence of depression at different time points within the first year after stroke in mainland China and to identify risk factors related to a poor 1-year prognosis in stroke patients.

METHODS

Subjects with acute cerebrovascular diseases were recruited and enrolled from 56 hospitals in mainland China between April 2008 and April 2010. Demographic data, previous disease history, and clinical data were collected. Four follow-up visits were occurred within the first year after stroke. The modified Rankin Scale ≥ 2 represents an unfavorable prognosis. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition and was divided into persistent, recurrent and transient types.

RESULTS

The 1-year cumulative incidence of depression in stroke patients was 41.8%. Logistic regression analysis showed that the 1-year prognosis level was associated with age, disability before onset, neurological functional deficit level at admission, and a range of depression types. The odds ratio for persistent depression is the highest (OR = 7.615, P < 0.0001, 95% confidence interval 5.011-11.572).

CONCLUSIONS

In our study, depression occurred in >40% of patients within the first year after stroke. Persistent depression is the first independent determinant of prognosis during the first year after stroke.

Predictors of the depressive symptomatology of the family caregivers of Chinese stroke patients in Hong Kong

The aim of this cross-sectional study was to determine the socio-demographic and clinical factors associated with depressive symptoms in the family caregivers of Hong Kong Chinese stroke patients. One hundred and twenty-three patients at a stroke clinic and their family caregivers formed the study sample. The depressive symptoms of both the patients and their family caregivers were rated with the Chinese version of the 15-item Geriatric Depression Scale (GDS). Participants' socio-demographic data and clinical characteristics served as the independent variables in relation to the caregivers' GDS scores. Patients' and caregivers' somatic and psychological conditions were measured with 10 scales. In univariate analysis, caregivers' GDS scores were significantly correlated with certain of their characteristics [Modified Life Event Scale (MLES), Cumulative Illness Rating Scale (CIRS) and Lubben Social Network Scale (LSNS) scores, sex and being a housewife] and those of the patients (GDS score and being a housewife). Multiple regression analysis showed caregivers' MLES and CIRS scores and patients' GDS scores to be independent correlates of caregivers' GDS scores. Adverse events encountered by caregivers in the past 6 months, their current health problems and patients' depressive symptoms were found to be the principal factors associated with caregivers' depressive symptoms.

The impact of foreign caregiving on depression among older people in Taiwan: model testing

AIM

  This article is a report of a study of predicting the factors that influence depression in the older people in Taiwan. Background.  In 1991, Taiwan opened the labour market to foreign caregivers for the older people who needed long-term care. With the differences in language, culture and lifestyle between foreign caregivers and older people in Taiwan, it was hypothesized that the older people would not be able to relate to them, and therefore become depressed.

METHODS

  The data were collected from 116 Taiwanese older people from July to September, 2005. Path analysis using multiple regression analyses was conducted to estimate the direct and indirect effects of caregiving communication, activities of daily living, income and social support on depression among older people in Taiwan. To evaluate the hypotheses for this research, bi-variate linear regression and multiple regression analyses were used.

RESULTS/FINDINGS

  The results indicated that the level of activities of daily living (β = -0·201, P = 0·010), care-giving communication (β = -0·272, P = 0·002) income (β = -0·305, P = 0·000) and social support (β = -0·276, P = 0·002) were the predictors of depression in older people in Taiwan. Social support was a mediating factor for caregiving communication and depression. Furthermore, foreign caregiver care was not correlated with depression among older people in Taiwan.

CONCLUSIONS

  The findings influence the public awareness of depression in older people, and provide the foundational information to influence the policy makers of Taiwan to evaluate the foreign caregiver policy.

Decreased serum brain-derived neurotrophic factor (BDNF) is associated with post-stroke depression but not with BDNF gene Val66Met polymorphism

BACKGROUND

Decreased brain-derived neurotrophic factor (BDNF) has been demonstrated in animal models and patients with depression. However, little is known about changes in BDNF in post-stroke depression (PSD). This study investigated the changes in serum BDNF in patients with PSD, and evaluated whether serum concentrations of BDNF were associated with BDNF gene Val66Met polymorphism.

METHODS

PSD patients were diagnosed in accordance with DSM-IV criteria, and the severity of depression was evaluated with the Hamilton Rating Scale for depression. Serum BDNF was measured twice, first at 7 days after the onset of stroke and then at 3-6 months after stroke. Val66Met polymorphisms of the BDNF gene were determined using the polymerase chain reaction-restriction fragment length polymorphism method. BDNF concentrations and Val66Met polymorphisms were also measured in 30 healthly controls.

RESULTS

A total of 93 patients admitted as a result of first time acute ischemic stroke were included. During the 6-month follow-up, 35 patients (37.6%) were diagnosed with PSD. Serum BDNF concentrations were decreased in PSD patients at 3-6 months after stroke (p < 0.05). The serum BDNF concentrations were not associated with BDNF gene Val66Met polymorphisms in either patients or healthy controls.

CONCLUSIONS

Serum concentrations of BDNF decrease in PSD patients and BDNF may play an important role in the pathogenesis of PSD. However, Val66Met polymorphisms are not associated with serum concentrations of BDNF. The mechanism of decreased serum BDNF requires further study.

Depressive symptoms and risk factors in Chinese patients with premature ventricular contractions without structural heart disease

HYPOTHESIS

Our objective was to study depressive symptoms and potential risk factors in Chinese persons with premature ventricular contractions (PVCs) without structural heart disease.

METHODS

The Zung self-rating depression scale (ZSDS) was used to assess depressive symptoms. Correlations between depressive symptoms and sociodemographic and medical factors were analyzed by logistic regression.

BACKGROUND

Prevalence of depressive symptoms in coronary heart disease (CHD) is higher that in the general population and those for the majority of other chronic symptoms in patients with premature ventricular contractions (PUCS).

RESULTS

Of 1,144 patients with PVCs (488 males, 656 females), age 51 +/- 23 years, disease duration 1 mo - 23 y, a total of 309 (27%) patients were categorized as having depressive symptoms. Depressive symptoms increased with age, income, education level, nationality, PVC count/24h, society support, and settlement type (p < 0.05). Univariate logistic regression showed that being female, level of education, age, settlement type, and PVC count/24h significantly correlated with depressive symptoms (p < 0.05). Multivariate logistic regression indicated that 5 variables-female sex, education level, settlement type, age, and PVC count/24h significantly and independently related with depressive symptoms (p < 0.05).

CONCLUSIONS

In the Chinese population, depressive symptoms in subjects with PVCs were frequent. The village settlement type, female sex, age, PVC count/24h, and education level were independent risk factors for depressive symptoms. Further research on the relationship between PVCs and depressive symptoms in China is necessary.

Severity of depression risk predicts health outcomes and recovery following surgery for hip-fractured elders

This study examined how depression risk interfaces with health outcomes of hip-fractured patients during the first year after hospital discharge. Physical function recovery and health outcome trajectories were much poorer for hip-fractured elders with persistent depression risk than for those with transitory and no risk for depression.

INTRODUCTION

This study examined how depression risk interfaces with the trajectories of physical activities and health-related quality of life (HRQoL) among hip-fractured elderly patients during the first 12 months after hospital discharge.

METHODS

Based on 12-month scores for the Chinese version of Geriatric Depression Scale, patients over age 60 years (N = 147) were classified as (a) at persistent risk for depression, (b) at transitory risk for depression, and (c) at no risk for depression. Outcomes were measured by the Chinese Barthel Index and Medical Outcomes Study Short Form, Taiwan version, and analyzed by the generalized estimating equations approach.

RESULTS

Patients who were at persistent risk for depression (n = 46, 31.3%) had much less chance of recovering activities of daily living (OR = 0.16, CI = 0.06-0.42) and walking ability (OR = 0.09, CI = 0.04-0.21) than patients at no risk for depression (n = 36, 24.5%). The trajectories of SF-36 scores for the physical and mental health summary scales were significantly different among the three depression groups; those "at persistent risk for depression" were the poorest and those "at no risk for depression" were the best.

CONCLUSION

These results may provide a reference for developing timely assessments and interventions for hip-fractured elders at risk of depression.

Predictors of psychological and somatic components of poststroke depression: a longitudinal study

PURPOSE

Depression after stroke is common and increases morbidity and mortality in the first years after stroke onset. Nevertheless, little is known about the role of psychosocial factors on the etiology of depression in early as well as in the late poststroke stages. The aim of our study was to investigate the influence of stroke survivors' mental impairment as well as the quality of their social relationships on the development of poststroke depression (PSD).

METHOD

The study used a longitudinal design. Eighty-one German stroke patients were investigated twice, directly after discharge (on the average of 3 months after stroke onset) and 1 year later. Hierarchical regression analyses and cross-lagged partial correlation analyses tested direct and indirect mediating effects of potential predictors on poststroke depressive symptoms.

RESULTS

Time 1 patients' perceived cognitive and emotional functioning predicted psychological depressive symptoms at Time 2. Quality of patients' social relationships mediated the effect of the stroke-related emotional deficits on depression.

CONCLUSION

In contrast to the previous research, the study provided more evidence for causal influence of different risk factors on PSD. Results support the biopsychosocial model of PSD. Early and late PSD seem to be based on partially different etiological mechanisms.

Determinants of depression in chronic stroke: a prospective cohort study

PURPOSE

The aim of the study was to identify factors that are significantly related to depression in chronic stroke patients.

METHODS

Prospective cohort study of stroke patients admitted for rehabilitation. A total of 165 first ever stroke patients over 18 years of age were assessed at one and three years post stroke. Depression was determined by the Centre for Epidemiologic Studies Depression Scale (CES-D). Patients with scores >/=16 were classified as depressed. Bivariate and multivariate logistic regression analyses were used to identify prognostic factors for depression.

RESULTS

At three years post stroke, 19% of the patients were depressed. Bivariate analysis showed significant associations between post-stroke depression and type of stroke, fatigue, motor function of the leg and arm, activities of daily living (ADL) independency and instrumental ADL. Multivariate logistic regression analysis showed that depression was predicted by one-year instrumental ADL and fatigue. Sensitivity of the model was 63%, while specificity was 85%.

CONCLUSIONS

The present prospective cohort study showed that depression three years after stroke can be predicted by instrumental ADL and fatigue one year post stroke. Recognition of prognostic factors in patients at risk may help clinicians to apply interventions aimed at preventing depression in chronic stroke.

Associated factors of post-stroke depression among Hong Kong Chinese: A longitudinal study

The aim of this study was to explore associated factors of post-stroke depression (PSD) among Chinese first-time stroke patients. A 6-month prospective design was adopted with data collected by face-to-face interviews and physical assessment at two observation time points: T1, within 48 h of admission to the rehabilitation hospitals and T2, 6 months after the first interview in the subject's current place of residence. The prevalence of PSD at T1 and T2 was found to be 69% and 48% respectively. Backward linear regression showed that five variables explained 55% of the variance of PSD at T2. Participants who had a higher level of depression at T2 tended to have a higher level of functional disability, less social companionship and poorer informational support. Those who had been homemaker at pre-morbid state and those who exhibited a higher level of depressive symptoms at T1 showed a higher level of depression at T2. The results of this study suggest that PSD could be a psychological condition arising from the disabling consequences and altered family roles caused by a stroke.

Vascular risk factors and incident late-life depression in a Korean population

BACKGROUND

Causal relationships between vascular factors and late-life depression are controversial.

AIMS

To investigate prospective associations between risk factors for vascular disease and incidence of late-life depression.

METHOD

Of 661 community participants aged 65 years or over, without depression at baseline, 521 (79%) were re-evaluated 2 years later. At baseline and follow-up, a diagnostic interview for depression was carried out and information on vascular status, disability and cognitive function was gathered.

RESULTS

Pre-existing heart disease, incident stroke and lower baseline high-density lipoprotein cholesterol level were significantly associated with incidence of late-life depression, independently of disability and cognitive function.

CONCLUSIONS

These results provide some support for a vascular aetiology of late-life depression. However, important risk factors for cerebrovascular disease such as hypertension and diabetes were not implicated, and the associations with lipid levels might still be explained by affective states earlier in life.

Factor structure of the Chinese version of the Geriatric Depression Scale

Depression is common in patients following stroke and has been found to be related to the degree of functional disability, recovery and engagement in rehabilitation. Consequently, screening for depression is crucial in this group in order to facilitate the delivery of appropriate psychological support. The current study sought to determine key psychometric properties of the Chinese version of the Geriatric Depression Scale (GDS) in this group. Three versions of the GDS were evaluated, these being the 30-item original measure (GDS-30), the short-form version comprising 15 items (GDS-SF) and a recently developed innovative four-item version (GDS-4). Confirmatory factor analysis revealed the GDS-30 and GDS-SF to offer an acceptable fit to data suggesting utility of these measures for screening. However, the GDS-4 offered a poor fit to the data, suggesting this measure was an inadequate measure of depression in this clinical group. Further, though GDS-30 and GDS-SF measures revealed good internal consistency, the performance of the GDS-4 was marginal. However, all GDS-derived measures demonstrated excellent convergent and divergent validity. It is concluded that the GDS-30 is a useful and appropriate screening instrument in this group. Further, the GDS-SF shows promise in terms of development as a multidimensional measure of depression that may have predictive and outcome monitoring potential. The psychometric shortcomings of the GDS-4 strongly suggest that this measure is unsuitable for screening in this clinical group.

Depressive symptoms in long-term care residents in Taiwan

AIM

This paper reports a study to investigate the prevalence of and risk factors for depressive symptoms in elders in long-term care facilities in Taiwan.

BACKGROUND

Depression has been identified as a major health concern and is very common among frail elders in Western nursing homes. It is under-diagnosed, and may be associated with eating difficulties and subsequent malnutrition, functional ability and sociodemographic factors. There have been no previous studies of these issues in Taiwan.

METHODS

Residents of 18 long-term care facilities were recruited. Those able to communicate in the Mandarin or Taiwanese dialect, resided in long-term care facilities including skilled nursing facilities and intermediate care facilities, and who scored three or above on the Short Portable Mental Status Questionnaire were selected. Data were collected using the Geriatric Depression Scale, Barthel Index and Masticatory Index, and age, duration of institutionalization, and level of impaired swallowing were also measured.

RESULTS

The number of participants identified as depressed was 267 (52.05%). There was no significant difference noted relating to age, gender, duration of institutionalization, type of institution, mental status and masticatory ability between the depressed and non-depressed groups, but significant differences of functional status and impaired swallowing between the two groups were found. However, functional status, impaired swallowing, and type of institution were three independent factors associated with depressive symptoms after controlling for all other factors.

CONCLUSIONS

Future studies on the detection of symptoms of depression should use a validated observational measure to overcome under-reporting of symptoms by the frailest residents.

Prevalence of and Factors Associated with Poststroke Depression: A Malaysian Study

This study investigated the prevalence of depression 3-6 months poststroke and examined specific factors associated with depression in a stroke population of the University Malaya Medical Centre, Kuala Lumpur, Malaysia. It was hypothesised that poststroke depression (PSD) is prevalent in the poststroke population of University Hospital Malaysia and that PSD is significantly correlated with demographics, educational background, medical history, rehabilitation attendance, traditional medicine use, prestroke and poststroke activities, religiousness, activities of daily living, and social support. The study group comprised 80 patients admitted to the hospital with stroke of any etiology. Mean patient age was 56.8 years (standard deviation +/- 12.5 years). The results were derived by comparing the 80 stroke patients with 80 controls matched for age, sex, race, and medication use. Results were also derived from comparisons between depressed and nondepressed members of the stroke population (n = 80). The diagnosis of depression was based on the Zung Self-Rating Scale and confirmed by a psychiatrist, based on DSM-IV criteria. Interviews were conducted based on a 26-item questionnaire, modified Barthel Index, and Social Resources Scale were used to assess which factors correlated with depression. Depression was found to be common among Malaysians 3-6 months after stroke. A total of 66% of the patients were depressed, with depression considered mild in 51% and moderate to severe in 15%. It was demonstrated that the occurrence of depression was significantly correlated with age, ethnicity, noncontinuance of prestroke lifestyles, and poor performance in the activities of daily living rating.

Poststroke depression in Chinese patients: frequency, psychosocial, clinical, and radiological determinants

This study attempted to evaluate the psychosocial, clinical, and radiological predictors of poststroke depression (PSD) in Chinese patients. One hundred eighty-nine patients participated in the study. Three months after the index stroke, a psychiatrist administered the Structured Clinical Interview for DSM-IV to all of the patients and made a DSM-IV diagnosis of depression. In addition, a host of demographic, clinical, and radiological variables were examined. Thirty-one (16.4%) of the patients had a diagnosis of PSD that included major depression (n=11, 5.8%,), minor depression (n=16, 8.5%), or dysthymia (n=4, 2.1%). Univariate analysis revealed that PSD was associated with female gender, a lower level of education, a lower Lubben Social Network Scale (LSNS) score, subcortical infarcts, and lesions in the anterior cerebral artery (ACA) territory, and the Modified Life Event Scale (MLES) score was borderline for statistical significance. Multivariate logistic regression analysis suggested that female gender, a high MLES score, and subcortical and ACA lesions were independent risk factors for PSD and that a high LSNS score was a protective factor.

Detecting depression in Chinese stroke patients: a pilot study comparing four screening instruments

OBJECTIVE

To determine which screening instrument is most suitable for detecting depression in Chinese stroke patients.

METHOD

A random sample of 60 Chinese subjects recruited from consecutively admitted patients with first-ever stroke to a rehabilitation facility were assessed using the Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the Geriatric Depression Scale (GDS). Psychiatric diagnoses, which served as a benchmark for the comparison of screening instruments, were made using the SCID-DSM-III-R. Rating instruments were compared with respect to response rate, sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves.

RESULTS

The VAMS was not useful in screening for depression in Chinese stroke patients while both the HADS and the GDS demonstrated satisfactory accuracy in detecting depression in Chinese stroke patients.

CONCLUSIONS

Screening instruments for poststroke depression are culture-specific and even scales well established in other cultures should be tested before being used in clinical practice and research.

The effects of reminiscence on depressive symptoms and mood status of older institutionalized adults in Taiwan

OBJECTIVE

This study examined the effects of reminiscence on depressive symptoms and mood status of elderly people residing in long-term care facilities.

METHODS

A longitudinal quasi-experimental design was conducted, using two equivalent groups for pre-post test and purposive sampling. Each subject was administered pre- and post- tests at a 4 month interval, but subjects in the experimental group underwent weekly individual reminiscence therapy. Geriatric Depression Scale short form (GDS-SF) and Apparent Emotion Rating Scale (AER) were used as study instruments.

RESULTS

Forty-eight subjects completed the study, with 25 in the experimental group and 23 in the control group. The experimental findings indicated that the experimental group demonstrated fewer depressive symptoms (p < 0.05) and better mood status (p = 0.05) on the post-test comparing to the control group.

CONCLUSION

These warranted that reminiscence therapy is a recommended therapy for older people who reside in care facilities. It can provide a basis for planning geriatric care in community to promote the well being and quality of life of older people.

Depressive symptoms and risk factors in Chinese persons with type 2 diabetes

BACKGROUND

Our objective was to study depressive symptoms and potential risk factors in Chinese persons with type 2 diabetes.

METHODS

Zung self-rating depression scale (ZSDS) was used to scan depressive symptoms. Correlation between depressive symptoms and sociodemographic and medical factors were analyzed by logistic regression.

RESULTS

Of 222 patients with type 2 diabetes (115 males, 107 females, age 56.36 +/- 12.67 years, disease duration 7.36 +/- 6.32 years), a total of 51 (23.0%) patients were categorized as having depressive symptoms. Percentage of depressive symptoms in females was higher than in males (29.0% vs. 17.6%, chi(2)=4.2, p <0.05). Percentage of depressive symptoms increased with increase of diabetes duration, HbA(1c), TC, TG, and number of chronic diabetic complications. Univariate logistic regression showed that diabetes duration, number of chronic diabetic complications, HbA(1c), female gender, and TC were significantly correlated with depressive symptoms (p <0.05). Multivariate logistic regression analysis indicated that variables, i.e., diabetes duration, number of chronic diabetic complications, HbA(1C), and female gender were significantly and independently associated with depressive symptoms (p <0.05).

CONCLUSIONS

In this Chinese population, depressive symptoms in subjects with type 2 diabetes were frequent. Diabetes duration, number of chronic diabetic complications, HbA(1C), and female gender were independent risk factors for depressive symptoms. Further research on the relationship between diabetes and depressive symptoms in China was necessary.

Screening post-stroke depression in Chinese older adults using the hospital anxiety and depression scale

Little is known about the performance of the Hospital Anxiety and Depression Scale (HADS) in screening post-stroke depression (PSD) in Chinese older adult patients. One hundred Chinese geriatric patients with first-ever stroke, consecutively admitted to a rehabilitation facility, were assessed by occupational therapists using the depression subscale of the HADS. Psychiatric diagnoses, which served as the benchmark for judging the usefulness of HADS in screening PSD, were made using the Structured Clinical Interview for DSM-III-R (SCID-DSM-III-R) supplemented by all available clinical information. The optimal cut-off point of HADS was 6/7. The sensitivity, specificity, positive and negative predictive value of the HADS, and the area under the receiver operating characteristic curve, were 88%, 53%, 0.28, 0.96 and 0.75, respectively. The HADS does not appear to be a useful tool in screening for PSD in Chinese older adults.

Vascular disease/risk and late-life depression in a Korean community population

BACKGROUND

Associations between vascular risk factors and late-life depression are controversial.

AIMS

To investigate the association between measures of vascular disease/risk and depression and confounding and effect modification by APOE genotype and cognitive function.

METHOD

In a Korean community population aged 65+ (n=732), diagnosis of depression (Geriatric Mental State Schedule) and information on vascular status, disability, APOE genotype and cognitive function were obtained.

RESULTS

Previous stroke and lower high-density lipoprotein cholesterol level (but neither hypertension nor diabetes) were significantly associated with depression (independently of disability and cognitive function). These associations were stronger in participants with borderline cognitive impairment, although not to a significant extent.

CONCLUSIONS

Except for previous stroke and an atherogenic lipid profile, associations between depression and other common risk factors for cerebrovascular disease were not evident.

Depression in older Chinese migrants to Auckland

OBJECTIVE

This study was conducted to identify risk factors for depressive symptomatology among older Chinese migrants.

METHOD

One hundred and sixty-two Chinese migrants aged 55 years or older, living in the community and recruited via Chinese community organizations and general practitioners, were interviewed using a Chinese version of the Geriatric Depression Scale and measures of stressful life events, morbid conditions, self-rated health, acculturation, social support and service utilization.

RESULT

Twenty-six percent of participants met the criteria for depressive symptomatology. No recent migrants showed symptoms of depression. Multiple logistic regression analysis showed that lower emotional support, greater number of visits to a doctor, difficulties in accessing health services and low New Zealand cultural orientation increased the risk of showing symptoms of depression.

CONCLUSION

Significant numbers of older Chinese migrants appear to be depressed or at risk for depression and, while participants with depressive symptoms consulted general practitioners more than their counterparts without such symptoms, they reported greater difficulty in accessing health services. The findings point to the need for further epidemiological study of this growing sector of the population and investigation of the nature of its engagement with health services. Social support and aspects of acculturation may play a significant role in preventing depression. This also requires further investigation.

Psychiatric morbidity in first time stroke patients in Hong Kong: a pilot study in a rehabilitation unit

OBJECTIVE

There is a paucity of data on post-stroke psychiatric morbidity in Chinese populations. We examined the frequency of post-stroke psychiatric morbidity in Chinese first time stroke patients, including depressive and anxiety disorders, mania, and psychosis.

METHODS

One hundred and fifty-seven patients following their first stroke, who were consecutively admitted to a rehabilitation unit, participated in this prospective, cross-sectional study. All subjects were interviewed by a qualified psychiatrist using the SCID-DSM-III-R. Subjects' cognitive function, neurological status, and level of functioning were also measured. Twenty-five (92.6%) of the subjects with the diagnosis of depression were followed up 6.0 +/- 3.9 months after the initial assessment.

RESULTS

The frequency of all depressive disorders was 17.2%. Major depressive episodes, adjustment disorder with depressed mood, dysthymia, and generalized anxiety disorder were diagnosed in 7.6%, 8.2%, 1.3% and 0.6% of the subjects, respectively. No cases of other anxiety disorders, mania or psychosis were found. The majority of depressed subjects were in remission at the follow-up assessment.

CONCLUSION

The low morbidity of affective disorders and their relatively favourable short-term outcome in Chinese first time stroke patients warrants further investigation.

Psychosocial risk factors in poststroke depression: a systematic review

OBJECTIVE

To review systematically the psychosocial risk factors for poststroke depression.

METHODS

Medline was searched using the key words "poststroke depression" (PSD) for the period January 1, 1966, to June 30, 2000; using the key words "cerebrovascular disease" and "depression" it was searched from June 1, 1996, to June 30, 2000. Corollary articles were obtained from the bibliographies. Inclusion criteria were as follows: original research in French or English; prospective, case-control or cross-sectional study design; assessment of PSD in the first 6 months following the stroke; an acceptable definition of depression; an acceptable definition of stroke; and at least one psychosocial risk factor. Interrater reliability was tested for the selection and quality of the articles. A qualitative risk factor analysis was conducted.

RESULTS

The risk factors most consistently associated with PSD are a past history of depression, past personal psychiatric history, dysphasia, functional impairments, living alone, and poststroke social isolation. Risk factors not associated with PSD are dementia and cognitive impairment. Controversial risk factors are age, socioeconomic status (SES), prior social distress, dependency in regard to activities of daily living (ADL), and sex.

CONCLUSIONS

Over approximately 30 years, some 25 qualitative studies have addressed psychosocial risk factors for PSD. Further studies should aim for quantitative analysis. The results suggest that identifying psychiatric history and preventing social deterioration and impairment should be part of multidisciplinary efforts to care for poststroke patients.

Depressive symptoms among poststroke patients in Japan: frequency distribution and factor structure of the GDS

OBJECTIVE

The present study examined the nature, prevalence, and covariates of depressive symptoms among home-dwelling poststroke patients in Japan using the Geriatric Depression Scale Short Form (GDS-1). Poststroke results were compared with those of elderly with affective disorders and with those of healthy nonstroke elderly.

METHODS

Poststroke patients (n = 101) who did not also have a diagnosis of Alzheimer's dementia, were identified from patient records at seven randomly selected hospitals with outpatient rehabilitation clinics in a metropolitan area in western Japan and invited to participate in the study. All instruments were interview-administered.

RESULTS

GDS scores did not correlate with age, sex, education, functional dependence, aphasia, paralysis or presence of other chronic illnesses. However, GDS scores did correlate significantly with self-rated general health and poststroke duration. Compared with the frequency distribution in a psychiatric sample, poststroke patients had higher positive affect and lower depressed mood but similar social withdrawal scores. The factor structure of the poststroke sample differed from that of nonstroke elderly in that depressed mood items loaded with items for energy loss and memory problems.

CONCLUSION

Despite the fact that 62% of subjects scored > or = 6 on the GDS, none were currently receiving assessment and/or treatment for their depressive symptoms. The frequency distribution and factor structure suggest that poststroke GDS scores reflect endorsement of functional losses such as decreased energy and impaired memory and subsequent feelings of helplessness, boredom and social withdrawal rather than decreased positive affect. Treatment should focus on dealing with these issues.

Post-stroke depression: an update

Those caring for stroke victims should be aware of new developments in our understanding of depression following stroke, its diagnosis, prevalence, pathophysiology, clinical features, and treatment. Appropriate diagnosis and treatment will improve quality of life, self-care independence, and mortality.

Research into the specificity of depression after stroke: a review on an unresolved issue

Iwo decades of research have failed to generate consistent insight into the specificity of poststroke depression (PSD). This is, at least in part, caused by methodological difficulties. Differences in symptom profile between PSD and depression with no or another medical cause were described, but no specific and unequivocal clinical picture has been established so far. Prevalence rates of PSD varied largely between studies. In community based studies using standardised diagnostic instruments for depression, relatively low prevalence rates were reported compared to inpatient or rehabilitation studies. PSD occurs most frequently in the first few months after stroke, while a new incidence peak may occur 2-3 years after stroke. Two systematic reviews on the relation between lesion location and depression did not support the claim that left hemisphere lesions are a risk factor for PSD. A new concept of vascular depression has been proposed, which relates depression in the elderly to acute or chronic damage to the cerebral vascular system. Future efforts should aim at increasing the uniformity of study designs, assessment tools should be further improved for use in cognitively impaired patients and appropriate control groups should be defined to study the characteristic features of PSD.

Screening for depressive symptoms among post-stroke outpatients in Eastern Hungary

Patients were consecutively enrolled in a cross-sectional study to determine the severity of depressive symptoms and the rate of treated depression in a patient population returning to a stroke outpatient service during a 10-week period for a regular check-up examination after their stroke. Of the 143 stroke patients, 119 fulfilled the inclusion criteria. The 13-item Beck Depression Inventory was used to screen for depressive symptoms. The score was at least 5 in 53%, 10 or above in 26%, and 15 or above in 11% of patients. Severity of depressive symptoms did not depend on gender, age, time elapsed from stroke, or the site of the cerebral lesion. Most patients with considerable depressive symptoms did not receive antidepressant medication at the time of the screening.

Screening for depressive symptoms in the acute phase of stroke

Depressive symptoms can often be observed after stroke. We prospectively evaluated patients at a stroke unit in order to determine the occurrence and severity of depressive symptoms in the acute phase of stroke in 82 patients 7 +/- 2 days after admission to the stroke unit. Severity of stroke was evaluated by the Scandinavian and Orgogozo scales and the Barthel index. Severity of depressive symptoms was measured by the 13-item Beck scale. Mean age of the patients was 65.8 years. No gender difference was observed in the severity of stroke or depressive symptoms. DSM-IV criteria of adjustment disorder with depressed mood were fulfilled by 27% of the patients. In this group, stroke was significantly more severe by the Barthel, Orgogozo, and Scandinavian scales (p < 0.001). Whereas Beck score was at least 10 in 19.5%, severe depressive symptoms (Beck score > or = 15) occurred in less than 5% of patients with acute stroke. Those who could not walk by themselves or who were aphasic had significantly higher mean Beck scores (6.3 +/- 5.1 vs 2.4 +/- 3.1, p < 0.001, and 7.0 +/- 5.8 vs 3.4 +/- 3.9, p = 0.002). Significant correlation was found between the severity of stroke and that of the depressive symptoms (r = -0.56, -0.58, and -0.54 for the Scandinavian, Orgogozo, and Barthel scales, p < 0.001).