Neighborhood Environment, Residential Satisfaction, and Depressive Symptoms Among Older Adults in Residential Care Homes

Prevalence and risk factors of depression among elderly people in nursing homes from 2012 to 2022: a systematic review and meta-analysis

OBJECTIVES

To determine a pooled prevalence of depression and its influencing factors among nursing home residents.

METHOD

PsycINFO, PubMed, Embase, and Web of Science were searched for studies investigating the prevalence and risk factors of late-life depression among nursing home residents between January 2012 and November 2022. Two reviewers independently completed the literature screening, data extraction and quality assessment. A random-effects model was utilized to pool the prevalence of depression and summarize the influencing factors.

RESULTS

This meta-analysis included 48 studies involving 28,501 participants. The pooled prevalence of depressive mood and major depressive disorder was 53% and 27%, respectively. The rate of depressive mood is higher in lower-middle-income countries (60.0%), compared with high- (53.0%) and upper-middle-income countries (44.0%). The rate of depressive mood (35.0%) is higher among females than male (19.0%). Depression was influenced by factors, including male (OR = 0.28), insufficient income (OR = 3.53), comorbidities (OR = 2.66), pain (OR = 2.67; r = 0.31), functional disability (r = 0.33), loneliness (r = 0.43), number of chronic health problems (r = 0.18), social support (r = -0.28), activities of daily living (r = -0.43), subjective health (r = -0.28), autonomy (r = -0.41), environment (r = -0.50) and physical (r = -0.57) and psychological health (r = -0.65).

CONCLUSION

The prevalence of depressive mood is high among nursing home residents, especially in lower-middle-income countries. It is influenced by factors including gender, income, social support, daily activities, environment, physical and psychological health and autonomy. Understanding those factors can provide evidence-based recommendations for improved awareness, prevention and better management of late-life depression.

Built Environment, Natural Environment, and Mental Health

Mental health disorders have become a global problem, garnering considerable attention. However, the root causes of deteriorating mental health remain poorly understood, with existing literature predominantly concentrating on socioeconomic conditions and psychological factors. This study uses multi-linear and geographically weighted regressions (GWR) to examine the associations between built and natural environmental attributes and the prevalence of depression in US counties. The findings reveal that job sprawl and land mixed use are highly correlated with a lower risk of depression. Additionally, the presence of green spaces, especially in urban area, is associated with improved mental health. Conversely, higher concentrations of air pollutants, such as PM2.5 and CO, along with increased precipitation, are linked to elevated depression rates. When considering spatial correlation through GWR, the impact of population density and social capital on mental health displays substantial spatial heterogeneity. Further analysis, focused on two high depression risk clustering regions (northwestern and southeastern counties), reveals nuanced determinants. In northwestern counties, depression rates are more influenced by factors like precipitation and socioeconomic conditions, including unemployment and income segregation. In southeastern counties, population demographic characteristics, particularly racial composition, are associated with high depression prevalence, followed by built environment factors. Interestingly, job growth and crime rates only emerge as significant factors in the context of high depression risks in southeastern counties. This study underscores the robust linkages and spatial variations between built and natural environments and mental health, emphasizing the need for effective depression treatment to incorporate these multifaceted factors.

The sleep patterns and their associations with mental health among nursing home residents: a latent profile approach

BACKGROUND

Nursing home residents commonly experience poor sleep conditions. However, few studies have explored the potential sleep patterns among nursing home residents. This study aimed to identify the sleep patterns in nursing home residents, compare residents' characteristics across sleep patterns, and examine the relationships between sleep patterns and residents' mental health (i.e., depressive and anxiety symptoms).

METHODS

This cross-sectional study was conducted in 27 nursing homes in Jinan, China, from March to June 2018. In total, 353 participants were recruited via convenience sampling, and of which, 326 completed the survey. A latent profile analysis was performed to identify sleep patterns based on the seven dimensions of the Pittsburgh Sleep Quality Index. Bivariate analyses were conducted to compare residents' characteristics among the sleep patterns. Mixed-effects logistic regression analyses were adopted to investigate the relationships between sleep patterns and residents' mental health.

RESULTS

Three sleep patterns were identified, including 'good sleepers', 'poor sleepers without hypnotic use', and 'poor sleepers with hypnotic use'. Residents' gender, education, pain, instrumental activities of daily living, and number of chronic conditions were significantly differentiated across the sleep patterns. Compared with 'good sleepers', 'poor sleepers without hypnotic use' were significantly associated with more depressive symptoms (OR = 3.73, 95% CI = 2.09, 6.65, p < 0.001), but not with anxiety symptoms (OR = 2.04, 95% CI = 0.97, 4.29, p = 0.062); whereas 'poor sleepers with hypnotic use' had significantly more depressive (OR = 5.24, 95% CI = 2.54, 10.79, p < 0.001) and anxiety symptoms (OR = 5.02, 95% CI = 2.13, 11.83, p < 0.001).

CONCLUSIONS

This study reveals three distinct sleep patterns in nursing home residents and their significant associations with residents' mental health. These findings can inform future research to develop appropriate and tailored intervention strategies for improving sleep and promoting mental health for nursing home residents.

Mediating effects of meaning in life on the relationship between family care, depression, and quality of life in Chinese older adults

Background

The study explored sources of meaning in older adults and the action path among family care, meaning in life, quality of life, and depression.

Materials and methods

We investigated 627 older adults using the Sources of Meaning in Life Scale for the Elderly (SMSE), the Family Care Index (APGAR), the Center for Epidemiological Studies Depression Scale-10 (CES-D-10), and the EuroqOL-5 Dimensions (EQ-5D).

Results

Scores categorized 454 older adults with good family function, 99 with moderate, and 47 with severe family dysfunction; 110 older adults had depression. The structural equation model showed that family care affected the quality of life and depression by influencing meaning, and depression had a significant negative effect on the quality of life (P &lt; 0.05). The model was a good fit for the data (χ2/df = 3.300, SRMR = 0.0291, GFI = 0.975, IFI = 0.971, TLI = 0.952, CFI = 0.971, RMSEA = 0.062).

Conclusion

Meaning in life is an intermediary factor that affects depression and quality of life in older adults. Family care had a significant positive impact on SMSE and a negative influence on depression. The SMSE effectively clarifies the sources of meaning in life and can be used to improve meaning and promote mental health in older adults.

Long-Term Air Pollution, Genetic Susceptibility, and the Risk of Depression and Anxiety: A Prospective Study in the UK Biobank Cohort

BACKGROUND

Depression and anxiety are two mental disorders that are often comorbid. However, the associations of long-term air pollution exposure with depression and anxiety remain inconclusive.

OBJECTIVE

We conducted a cross-sectional and prospective study to examine the associations of ambient exposure to particulate matter (PM) with a diameter of ≤2.5μm (PM2.5), ≤10μm (PM10), and 2.5-10μm (PMcoarse), nitrogen oxides (NOx), and nitrogen dioxide (NO2) with the risk of depression and anxiety in the UK Biobank.

METHODS

This study included 398,241 participants from the UK Biobank, 128,456 of whom participated the 7-y online mental health survey. A total of 345,876 individuals were free of depression and anxiety at baseline; of those, 16,185 developed incident mental disorders during a median of 8.7 y of follow-up. Depression and anxiety were assessed using hospital admission records and mental health questionnaires. Associations of air pollution with prevalent and incident mental disorders were examined using logistic regression and Cox regression models, respectively.

RESULTS

Elevated levels of the five air pollutants were associated with higher odds of mental disorders at baseline. Levels of four pollutants but not PMcoarse were also associated with higher odds and risks of mental disorders during follow-up; specifically, hazard ratios [HR, 95% confidence interval (CI)] of an interquartile range increase in PM2.5, PM10, NOx, and NO2 for incident mental disorders were 1.03 (95% CI: 1.01, 1.05), 1.06 (95% CI: 1.04, 1.08), 1.03 (95% CI: 1.01, 1.05), and 1.06 (95% CI: 1.04, 1.09), respectively. An air pollution index reflecting combined effects of pollutants also demonstrated a positive association with the risk of mental disorders. HR (95% CI) of incident mental disorders were 1.11 (95% CI: 1.05, 1.18) in the highest quintile group in comparison with the lowest quintile of the air pollution index. We further observed that the associations between air pollution and mental disorders differed by a genetic risk score based on single nucleotide polymorphisms previously associated with genetic susceptibility to mental disorders in the UK Biobank cohort.

DISCUSSION

To our knowledge, this research is one of the largest cohort studies that demonstrates an association between mental health disorders and exposure to long-term air pollution, which could be further enhanced by genetic predisposition. https://doi.org/10.1289/EHP10391.

Optimism and subjective well-being in nursing home older adults: The mediating roles of gratitude and social support

OBJECTIVES

To examine the level of subjective well-being (SWB) and the mediating roles of gratitude and social support in the relationship between optimism and SWB amongst older Chinese people in nursing homes.

METHODS

A total of 354 older adults in Chinese nursing homes completed the World Health Organization's well-being index, Life Orientation Test-Revised, Gratitude Questionnaire-Six-Item Form, and Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to evaluate the relationships between optimism, gratitude, social support and SWB.

RESULTS

The mean SWB score of the older people was (63.14 ±15.31), with 21.0% of subjects reporting low SWB. Gratitude and social support in serial partially mediated the relationship of optimism with SWB (total indirect effect: Standardized β = 0.157, 95% CI [0.109,0.216], p<0.001).

CONCLUSION

These findings provide good evidence for the inter-relationship mechanism amongst the protective factors of SWB, suggesting the need to prioritize positive psychological nursing interventions to promote SWB in older people in residential care.

Associations between water, sanitation, and depression among older people in Ghana: empirical evidence from WHO-SAGE Wave 2 survey

BACKGROUND

While depression is the most frequent psychiatric disorder among the older adults, the use of water and sanitation has been associated with both physical and psychological adverse outcomes. We investigated the associations of water and sanitation with depressive symptoms among older adults in Ghana.

METHODS

The study used data from 4,735 participants in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 2 of adults aged ≥50 years. Major depressive episode (MDE) was assessed using the World Mental Health Survey version of the Composite International Diagnostic Interview and we classified water and sanitation sources based on the Joint Monitoring Program. Multivariate logistic regressions evaluated the associations.

RESULTS

Approximately 7.3% of respondents reported a MDE, 90% and 78% used improved water sources and sanitation facilities respectively, and 77% shared sanitation facilities. Individuals who used unimproved water sources and unimproved sanitation were 1.6 and 1.3 times more likely to report MDE respectively. Also, sex-based analysis showed that the effect of the use of unimproved water and sanitation on depression was much appreciable and more substantial among women compared to men.

CONCLUSIONS

The findings suggest the importance of water and sanitation to the well-being of older people, particularly among women. Policies targeted at improving the mental health in old age should include water and sanitation.

Prevalence of depression among older adults living in care homes in China: A systematic review and meta-analysis

OBJECTIVES

Despite the large number of older adults living in care homes in China, the reported prevalence of depression in such settings has varied greatly, while its pooled overall prevalence has remained unknown. In response, our systematic review and meta-analysis were designed to provide accurate, comprehensive evidence of the prevalence of geriatric depression in care homes in China.

METHODS

Literature searches were conducted independently by two investigators in English- and Chinese-language databases from database inception through January 2020. The prevalence of depressive symptoms in late life was analyzed with a random effects model.

RESULTS

In 69 studies addressing older adults living in care homes in China, the pooled overall prevalence of depressive symptoms was 36.8% (95% CI, 32.7%-41.1%). Respective estimates for mild and moderate-to-severe depressive symptoms were 29.1% (95% CI, 25.2%-32.7%) and 9.1% (95% CI, 7.5%-11.0%). Subgroup analyses revealed significant differences in the prevalence of late-life depression in care homes according to the type of care home, the individual's socioeconomic status, and the measurement instrument(s) used. Meta-regression analysis indicated that the prevalence of late-life depression among older adults living in care homes generally rose from 1991 to 2019.

CONCLUSIONS

Given the high prevalence of geriatric depression in China's care homes, future studies should examine its risk and protective factors in those settings.

Relationship between fine particulate air pollution and hospital admissions for depression: a case-crossover study in Taipei

There are few apparent studies regarding the association between fine particulate matter (PM_2.5) air pollution and development of depression. Data obtained from epidemiological studies are inconsistent and controversial. The aim of this case-crossover study was to examine the association between short-term exposure to PM_2.5 alone and in combination with other pollutants and frequency of hospitalizations for depression from 2009 to 2013 in Taipei, Taiwan. In the single pollutant model without adjustment for other pollutants, 17% and 4% increase in admissions attributed to depression correlated with interquartile range (IQR) rise in PM_2.5 levels was noted on warm and cool days, respectively. Data were also analyzed using two-pollutant models and it was found that on warm days, the association continued to be significant after including one of the following pollutants: sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃) or carbon monoxide (CO). On cool days, the significance was lost. In conclusion, the relationship between ambient outdoor PM_2.5 exposure and rates of hospitalization for depression appeared to be temperature dependent in Taipei. Further research is needed to verify these observations as well as to distinguish the relative contributions of PM_2.5 and temperature to development for hospital admissions for depression.

Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery

Neighborhood environment plays an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have rarely been examined. This nonexperimental, cross-sectional study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 years and older were selected from the Health and Retirement Study. Using ordinary least squares regressions, this study shows that neighborhood social cohesion was negatively associated with mobility limitations (B  =  -0.04, p < .01). A Sobel test of mediation indicated that this relationship was significantly mediated by depressive symptoms (z  =  -9.10, p < .001) and mastery (z  =  -8.86, p < .001). Findings suggest that neighborhood cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. Future research should disentangle the temporal ordering of the mediators.

Community Environment Perception on Depression: The Mediating Role of Subjective Social Class

Depression has become a major social issue of global concern, which has seriously threatened the quality of an individual’s life. Although the relationship between community environment and depression has aroused heated debate, the empirical research on the relationship between community environment perception and public depression is still relatively insufficient. Data for this study are from China Family Panel Studies in 2016, which were conducted by the institute of Social Science Survey, Peking University. This paper has tested group differences in the influence of community environment on public depression, as well as the mediating role of subjective social class between community environment perception and depression, so as to further explore the social psychological effect of community environment. The empirical study found that there are group differences in the impacts of community environment perception on depression. Specifically, men, rural residents, and people aged 60 and under are more likely to be depressed which were affected by the perception of community environment. Furthermore, we have found that the subjective social class can partly mediate community environment perception and depression. That is to say, the perception of community environment can induce depression by influencing the individual’s subjective social class. Among them, community living environment and community public facilities have the greatest impact, community emotional attachment and community security situation have the second impact, and neighborhood mutual aid and neighborhood relationship have the least impact. In other words, the community environment is deeply endowed with a social psychological effect. To ameliorate the public’s depression, it is necessary to consider the construction of community physical environment and the cultivation of harmonious community culture as powerful measures not to be ignored. In short, the important role of community environmental intervention in alleviating the public’s depression caused by social class cognition deserves attention.

Association between ozone air pollution levels and hospitalizations for depression in Taipei: a time-stratified case-crossover study

Epidemiologic studies reported an association between exposure to ambient air pollutants and increased mortality rate attributed to suicide and suicide attempts. The investigation sought to determine whether there is an association between short-term ambient ozone (O₃) level exposure and daily hospital admissions for depression in Taipei from 2009 to 2013 using a time-stratified case-crossover design. In our single-pollutant model (with no adjustment for other pollutants), the % increase in daily hospital admissions for depression was 12% on warm days and 30% on cool days, per interquartile range (IQR) rise in O₃ levels, respectively. Ozone levels were significantly correlated with daily number of depression admissions both on warm and cool days. In our two-pollutant models, O₃ levels remained significant after adjusting for other air pollutants, including particulate matter (PM₁₀, PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO) both on warm and cool days. Although O₃ levels tended to be higher on warm days, admissions for depression were higher on cool days, suggesting that the relationship between O₃ concentrations and depression may be affected by temperature. Further study is needed to better understand these findings.

Association between poor sleep quality and depression symptoms among the elderly in nursing homes in Hunan province, China: a cross-sectional study

OBJECTIVES

To examine the association between the prevalence of poor sleep quality and depression symptoms among the elderly in the nursing homes of Hunan province in China.

DESIGN, SETTING AND PARTICIPANTS

This was a cross-sectional study investigating 817 elderly people from 24 nursing homes in China's Hunan province.

MAIN OUTCOME MEASURES

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) such that poor sleep quality was defined as PSQI Score >5. In addition, depression symptoms were assessed using the Geriatric Depression Scale (GDS). Linear regression models and binary logistic regression models were used to analyse the relationship between the prevalence of poor sleep quality and depression symptoms.

RESULTS

The mean PSQI Score was 8.5±4.9, and the prevalence of poor sleep quality was 67.3%. Additionally, the mean GDS Score was 9.8±7.5, and the prevalence of depression symptoms was 36.0%. Elderly people with poor sleep quality had increased GDS Score (mean difference=2.54, 95% CI 1.66 to 3.42) and increased risk of depression symptoms (OR=3.19, 95% CI 2.04 to 4.98) after controlling for demographics, chronic disease history, lifestyle behaviours, social support, activities of daily living and negative life events.

CONCLUSIONS

The prevalence of poor sleep quality was relatively high, and this was associated with increased depression symptoms. Therefore, poor sleep quality could be speculated as a marker of current depression symptoms in the elderly.

Ambient air pollution and depression: A systematic review with meta-analysis up to 2019

Although epidemiological studies have evaluated the associations of ambient air pollution with depression, the results remained mixed. To clarify the nature of the association, we performed a comprehensive systematic review and meta-analysis with the Inverse Variance Heterogeneity (IVhet) model to estimate the effect of ambient air pollution on depression. Three English and four Chinese databases were searched for epidemiologic studies investigating associations of ambient particulate (diameter ≤ 2.5 μm (PM_2.5), ≤10 μm (PM₁₀)) and gaseous (nitric oxide (NO), nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂) and ozone (O₃)) air pollutants with depression. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated to evaluate the strength of the associations. We identified 22 eligible studies from 10 countries of the world. Under the IVhet model, per 10 µg/m³ increase in long-term exposure to PM_2.5 (OR: 1.12, 95% CI: 0.97-1.29, I²: 51.6), PM₁₀ (OR: 1.04, 95% CI: 0.88-1.25, I²: 85.7), and NO₂ (OR: 1.05, 95% CI: 0.83-1.34, I²: 83.6), as well as short-term exposure to PM_2.5 (OR: 1.01, 95% CI: 0.99-1.04, I²: 51.6), PM₁₀ (OR: 1.01, 95% CI: 0.98-1.04, I²: 86.7), SO₂ (OR: 1.03, 95% CI: 0.99-1.07, I²: 71.2), and O₃ (OR: 1.01, 95% CI: 0.99-1.03, I²: 82.2) was not significantly associated with depression. However, we observed significant association between short-term NO₂ exposure (per 10 µg/m³ increase) and depression (OR: 1.02, 95% CI: 1.00-1.04, I²: 65.4). However, the heterogeneity was high for all of the pooled estimates, which reduced credibility of the cumulative evidence. Additionally, publication bias was detected for six of eight meta-estimates. In conclusion, short-term exposure to NO₂, but not other air pollutants, was significantly associated with depression. Given the limitations, a larger meta-analysis incorporating future well-designed longitudinal studies, and investigations into potential biologic mechanisms, will be necessary for a more definitive result.