Natural history of male psychological health, XIV: Relationship of mood disorder vulnerability to physical health

Depression and frailty in later life: a synthetic review

BACKGROUND

Many of the symptoms, consequences, and risk factors for frailty are shared with late-life depression. However, thus far, few studies have addressed the conceptual and empirical interrelationships between these conditions. This review synthesizes existing studies that examined depression and frailty among older adults and provides suggestions for future research.

METHODS

A search was conducted using PubMed for publications through 2010. Reviewers assessed the eligibility of each report and abstracted information on study design, sample characteristics, and key findings, including how depression and frailty were conceptualized and treated in the analysis.

RESULTS

Of 133 abstracted articles, 39 full-text publications met inclusion criteria. Overall, both cross-sectional (n = 16) and cohort studies (n = 23) indicate that frailty, its components, and functional impairment are risk factors for depression. Although cross-sectional studies indicate a positive association between depression and frailty, findings from cohort studies are less consistent. The majority of studies included only women and non-Hispanic Whites. None used diagnostic measures of depression or considered antidepressant use in the design or analysis of the studies.

CONCLUSIONS

A number of empirical studies support for a bidirectional association between depression and frailty in later life. Extant studies have not adequately examined this relationship among men or racial/ethnic minorities, nor has the potential role of antidepressant medications been explored. An interdisciplinary approach to the study of geriatric syndromes such as late-life depression and frailty may promote cross-fertilization of ideas leading to novel conceptualization of intervention strategies to promote health and functioning in later life.

Facing the Music or Burying Our Heads in the Sand?: Adaptive Emotion Regulation in Midlife and Late Life

Defenses that keep threatening information out of awareness are posited to reduce anxiety at the cost of longer-term dysfunction. By contrast, socioemotional selectivity theory suggests that preference for positively-valenced information is a late-life manifestation of adaptive emotion regulation. Using longitudinal data on 61 men, we examined links between emotion regulation indices informed by these distinct conceptualizations: defenses in earlier adulthood and selective memory for positively-valenced images in late-life. Use of avoidant defenses in midlife predicted poorer memory for positive, negative, and neutral images nearly 4 decades later. Late-life satisfaction was positively linked with midlife engaging defenses but negatively linked at the trend level with concurrent positive memory bias.

What's love got to do with it? Social functioning, perceived health, and daily happiness in married octogenarians

This study examined day-to-day links between perceived health and happiness and between time spent with others and happiness in 47 older adult couples over an 8-day period. Marital satisfaction and time spent with others were explored as potential moderators of links between health and happiness. For both men and women, hierarchical linear modeling revealed daily links between more time spent with others and greater happiness. Daily links between time spent with one's partner and happiness were strongly moderated by marital satisfaction. For both men and women, marital satisfaction buffered day-to-day links between poorer perceived health and a decline in happiness, but time spent with others did not. This study provides support for the role of marital satisfaction in protecting older adults' happiness from daily fluctuations in perceived physical health and for the influence of social connections in promoting happiness in the lives of older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Octogenarian Reports of Lifetime Spiritual Experiences: Types of Experience and Early Life Predictors

This study assessed lifetime histories of discrete spiritual experiences recalled by 144 octogenarian men studied since adolescence and 80 spouses. Women were more likely to report discrete spiritual experiences, as were those from higher socioeconomic backgrounds and those judged more open to experience as young adults. Factor analysis revealed four types of experiences related to beauty/nature, negative life events, protection by a sacred other, and traditional religious settings. Men from better childhood environments more commonly reported spiritual experiences concerning negative life events. Those with serious childhood illnesses were less likely to report experiences of feeling protected by a sacred other.

Smoking trajectories, health, and mortality across the adult lifespan

This study extends research on the association between smoking behavior and chronic disease by following a cohort from the time of initiation of regular smoking patterns into old age and by examining the association of lifetime smoking trajectories with chronic disease and mortality. Participants consisted of 232 males selected from the Harvard classes of 1942-1944 and followed biennially through 2003. Five distinct smoking trajectories were identified based on the age at which participants quit daily smoking. Participants following smoking trajectories with later cessation had a higher likelihood of developing lung disease and lived shorter lives than those who quit smoking at an earlier age. This study confirms that the earlier a smoker quits, the greater the health benefits, and that these benefits are observed even decades after smoking cessation. Additionally, by showing different survival rates between trajectory groups 25 and 40 years after quitting, the results run counter to previous work that has found no difference in mortality between smokers and non-smokers 15 years after cessation.

The natural history of male mental health: health and religious involvement

In prior studies, the effect of religious involvement upon physical health has shown generally positive results, but these studies have been marred by confounders. The 65-year-old US prospective Study of Adult Development has offered an opportunity to repeat these studies with somewhat better control over confounders. The physical and mental health of 224 Harvard University sophomores was monitored for 65 years. Their religious involvement from church attendance to private spirituality was prospectively monitored every 2-4 years from age 47 to 85. In this analysis we focus on the male respondent. We found that religious involvement, no matter how measured was uncorrelated with their late life physical, mental and social well-being. The exception was that the 44 men with major depression or with multiple negative life events were twice as likely to manifest high religious involvement as men with the least "stress." If these findings can be generalized, they suggest that religious involvement may exert the greatest mental health benefits on people with the fewest alternative social and personal resources.

Self-medication of mental health problems: new evidence from a national survey

OBJECTIVE

To evaluate the association between past 30-day use of alcohol, marijuana, and other illicit drugs and past year unmet need for and use of mental health care.

DATA SOURCE

A subsample of 18,849 respondents from the 2001 National Household Survey on Drug Abuse and the 2002 National Survey on Drug Use and Health. Subjects were between the ages of 18 and 65 years and had least one past year mental disorder symptom and no past year substance dependency.

STUDY DESIGN

Logistic regressions of past 30-day substance use on past 12-month unmet need for mental health care and past 12-month use of mental health services controlling for clinical and sociodemographic characteristics. Predicted probabilities and corresponding standard errors are reported.

PRINCIPAL FINDINGS

Use of illicit drugs other than marijuana increased with unmet need for mental health care (4.4 versus 3.2 percent, p=.046) but was not reduced with mental health-care use. Heavy alcohol use was not associated with increased unmet need for mental health care, but was higher among individuals with no mental health care use (4.4 percent versus 2.7 percent, p<.001). By contrast, marijuana use did not appear associated with either unmet need or mental health care use.

CONCLUSIONS

Substance use varies with past year unmet need for mental health care and mental health care use in ways consistent with the self-medication hypothesis. Results suggest that timely screening and treatment of mental health problems may prevent the development of substance-use disorders among those with mental disorders. Further research should identify subgroups of individuals for whom timely and appropriate mental health treatment would prevent the development of substance-use disorders.