1
|
Xie Y, Ma M, Wang W. Trajectories of depressive symptoms and their predictors in Chinese older population: Growth Mixture model. BMC Geriatr 2023; 23:372. [PMID: 37328803 PMCID: PMC10276362 DOI: 10.1186/s12877-023-04048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Given the rapidly rising proportion of the older population in China and the relatively high prevalence of depressive symptoms among this population, this study aimed to identify the trajectories of depressive symptoms and the factors associated with the trajectory class to gain a better understanding of the long-term course of depressive symptoms in this population. METHODS Data were obtained from four wave's survey of the China Health and Retirement Longitudinal Study (CHARLS). A total of 3646 participants who aged 60 years or older during baseline survey, and completed all follow-ups were retained in this study. Depressive symptoms were measured using the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Growth mixture modelling (GMM) was adopted to identify the trajectory classes of depressive symptoms, and both linear and quadratic functions were considered. A multivariate logistic regression model was used to calculate the adjusted odds ratios (ORs) of the associated factors to predict the trajectory class of participants. RESULTS A four-class quadratic function model was the best-fitting model for the trajectories of depressive symptoms in the older Chinese population. The four trajectories were labelled as increasing (16.70%), decreasing (12.31%), high and stable (7.30%), and low and stable (63.69%), according to their trends. Except for the low and stable trajectory, the other trajectories were almost above the threshold for depressive symptoms. The multivariate logistic regression model suggested that the trajectories of chronic depressive symptoms could be predicted by being female, living in a village (rural area), having a lower educational level, and having chronic diseases. CONCLUSIONS This study identified four depressive symptom trajectories in the older Chinese population and analysed the factors associated with the trajectory class. These findings can provide references for prevention and intervention to reduce the chronic course of depressive symptoms in the older Chinese population.
Collapse
Affiliation(s)
- Yaofei Xie
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Mengdi Ma
- Wuhan Blood Center, Wuhan, Hubei, China.
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
2
|
Nogami W, Nakagawa A, Katayama N, Kudo Y, Amano M, Ihara S, Kurata C, Kobayashi Y, Sasaki Y, Ishikawa N, Sato Y, Mimura M. Effect of Personality Traits on Sustained Remission Among Patients with Major Depression: A 12-Month Prospective Study. Neuropsychiatr Dis Treat 2022; 18:2771-2781. [PMID: 36465145 PMCID: PMC9717585 DOI: 10.2147/ndt.s384705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Major depression is a heterogeneous disorder. Therefore, careful evaluation and comprehensive assessment are crucial elements for achieving remission. Personality traits influence prognosis and treatment outcomes, but there is not enough evidence on the association between personality traits and sustained remission (SR). Hence, the present study aimed to evaluate the relationship between personality traits and SR among patients with major depression. PATIENTS AND METHODS The 12-month prospective study evaluated 77 patients diagnosed with major depressive disorder. All patients underwent a comprehensive assessment, including the Temperament and Personality Questionnaire (T&P) at baseline, and depression severity was measured at baseline as well as six and 12 months. SR was defined as remission (the GRID-Hamilton Depression Rating Scale [GRID-HAMD17] score ≦ 7) at both the 6- and 12-month follow-up. We compared eight T&P construct scores at baseline between the SR and non-SR groups. Multivariable logistic regression analyses were performed to determine the T&P personality traits related to SR. RESULTS Patients who achieved SR had a lower T&P personal reserve and lower T&P rejection sensitivity. Further, lower scores on the T&P personal reserve trait were independently associated with higher rates of SR among patients with major depression. Patients who achieved SR had a shorter duration of the current depressive episode and milder severity of depression at baseline. CONCLUSION A lower level of personal reserve predicted a higher probability of SR in the treatment of depression. Extended observations in naturalistic follow-up settings with larger sample sizes are required to better understand the personality traits affecting SR in patients with depression.
Collapse
Affiliation(s)
- Waka Nogami
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Nariko Katayama
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuka Kudo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Gunma Hospital, Gunma, Japan.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mizuki Amano
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Toyosato Hospital, Ibaraki, Japan
| | - Sakae Ihara
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Chika Kurata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Kobayashi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Sasaki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Natsumi Ishikawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Department of Child Psychiatry, the University of Tokyo Hospital, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Trajectories of middle-aged and elderly people's chronic diseases Disability Adjusted Life Years (DALYs): cohort, socio-economic status and gender disparities. Int J Equity Health 2021; 20:179. [PMID: 34344369 PMCID: PMC8335861 DOI: 10.1186/s12939-021-01517-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The accelerated aging trend brought great chronic diseases burdens. Disabled Adjusted Life Years (DALYs) is a novel way to measure the chronic diseases burden. This study aimed to explore the cohort, socioeconomic status (SES), and gender disparities of the DALYs trajectories. METHODS A total of 15,062 participants (55,740 observations) comes from China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. Mixed growth curve model was adopted to predict the DALYS trajectories in 45-90 years old people influenced by different birth cohorts and SES. RESULTS We find significant cohort, SES (resident place, education level and income) disparities differences in the chronic diseases DALYs. For individuals of earlier cohort, DALYs are developed in a late age but grow fast with age but reversed for most recent cohorts. Living in urban, having higher SES level will decrease the growth rate with age, but converges for most recent cohorts. Meanwhile, DALYs disparities of resident place and education level show gender differentials that those for female are narrowed across cohort but for male are not. CONCLUSIONS The cohort effects on chronic diseases DALYs are accumulated with China's unique social, and political settings. There are large inequalities in early experiences, SES and DALYs. Efforts of reducing these inequalities must focus on the lower SES individuals and those living in rural areas, which greatly benefit individuals from recent cohorts.
Collapse
|
4
|
Abstract
OBJECTIVES To establish a structural equation model for exploring the direct and indirect relationships of depressive symptoms and their associated factors among the Chinese elderly population. DESIGN A cross-sectional research. The 2015 data from the China Health and Retirement Longitudinal Study (CHARLS) were adopted. SETTING CHARLS is an ongoing longitudinal study assessing the social, economic, and health status of nationally representative samples of middle-aged and elderly Chinese residents. PARTICIPANTS A total of 5791 participants aged 60 years and above were included. MEASUREMENTS Depressive symptoms were used as the study outcome. Sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration were used as predictors. Confirmatory factor analysis was first conducted to test the latent variables. Structural equation model was then utilized to examine the associations among latent variables and depressive symptoms. RESULTS The mean age of the participants was 68.82 ± 6.86 years, with 55.53% being males. The total prevalence of depressive symptoms was 37.52%. The model paths indicated that sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration were directly associated with depressive symptoms, and the effects were 0.281, 0.509, -0.067, and -0.162, respectively. Sociodemographic characteristics, unhealthy habits, and sleep duration were indirectly associated with depressive symptoms, mediating by poor health status. Their effects on poor health status were -0.093, 0.180, and -0.279, respectively. All paths of the model were significant (P < 0.001). The model could explain 40.9% of the variance in the depressive symptoms of the Chinese elderly population. CONCLUSIONS Depressive symptoms were significantly associated with sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration among Chinese elderly population. The dominant predictor of depressive symptoms was poor health status. Targeting these results might be helpful in rationally allocating health resources during screening or other mental health promotion activities for the elderly.
Collapse
|
5
|
Xie Y, Ma M, Wu W, Zhang Y, Zhang Y, Tan X. Dose-response relationship between intergenerational contact frequency and depressive symptoms amongst elderly Chinese parents: a cross-sectional study. BMC Geriatr 2020; 20:349. [PMID: 32933472 PMCID: PMC7490477 DOI: 10.1186/s12877-020-01751-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022] Open
Abstract
Background Given the high prevalence of depressive symptoms amongst the elderly Chinese population and the significance of intergenerational contact in this demographic group, the purpose of this study was to examine the association and dose–response relationship between the frequency of intergenerational contact and depressive symptoms. Methods Data were obtained from the third wave of the China Health and Retirement Longitudinal Study. A total of 5791 participants at age 60 or older were included in this study. Depressive symptoms were defined by the 10-item version of the Centre for Epidemiologic Studies Depression Scale. Intergenerational contact included in-person meeting and remote connecting, and they were analysed separately. Intergenerational contact frequency was classified into ten categories and then treated as a continuous variable for analysis. We performed univariate and multivariate logistic regressions to identify risk covariables. Restrictive cubic spline analysis was used to examine the dose–response relationship between intergenerational contact frequency and the outcome of depressive symptoms. Results Both the frequency of meeting and the frequency of connecting with children were independently associated with depressive symptoms in the elderly, and the odds ratios for depressive symptoms increased with decreasing frequencies (P < 0.01). There was a negative dose–response relationship between intergenerational contact frequency and depressive symptoms. The odds of depressive symptoms steadily decreased with increasing frequency of meeting with their children. Following an initial increase, the odds rapidly decreased as the frequency of connecting with children increased with an inflection point at once a monthly. Both associations were nonlinear (P < 0.001). Conclusions Our findings revealed a negative dose–response relationship between intergenerational contact frequency and depressive symptoms in the elderly Chinese population. Thus, future health interventions should consider cultural norms in shaping the mental well-being of Chinese elderly persons.
Collapse
Affiliation(s)
- Yaofei Xie
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Mengdi Ma
- Wuhan Blood Center, No.8 of Baofeng One Road, Wuhan, 430000, China
| | - Wenwen Wu
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Yupeng Zhang
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Yuting Zhang
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China
| | - Xiaodong Tan
- Wuhan University, No.115 of Donghu Road, Wuhan, 430000, China.
| |
Collapse
|
6
|
Choi EPH, Wan EYF, Kwok JYY, Chin WY, Lam CLK. The mediating role of sleep quality in the association between nocturia and health-related quality of life. Health Qual Life Outcomes 2019; 17:181. [PMID: 31829192 PMCID: PMC6907224 DOI: 10.1186/s12955-019-1251-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
Background Even though the negative impacts of nocturia on sleep quality and health-related quality of life (HRQOL) have been documented in previous research, their interrelationship has been poorly studied. This study aimed to explore whether nocturia would affect sleep quality, which in turn affects HRQOL. Methods Participants aged 40 and above were randomly recruited from a Hong Kong public primary care clinic. Participants were asked to report the average number of nocturia (waking up at night to void) pisodes per night over a 1-month period. The Pittsburgh Sleep Quality Index (PSQI) and the 12-Item Short Form Health Survey version 2 (SF-12 v2) were administered. The mediation analysis was tested using multistage regression approach and bootstrap method. Results Of the 500 subjects who completed the survey, 31.2% reported symptomatic nocturia (having ≥2 nocturia episodes per night), and 60.4% experienced poor sleep quality (a PSQI global score > 5). Respondents with symptomatic nocturia had a poorer HRQOL in the domains of physical functioning (PF), role physical (RP) and social functioning (SF), general health (GH), vitality (VT) and physical component summary (PCS) of the SF-12 v2 than those without. Compared with the respondents without poor sleep quality, those with poor sleep quality had poorer HRQOL across all domains and summaries of the SF-12 v2. Mediation analysis found that sleep quality fully mediated the association between nocturia and the PF, RP and SF domains of the SF-12 v2, respectively, and partially mediated the association between nocturia and the GH, VT and PCS domains of the SF-12 v2, respectively. Conclusions We found that sleep quality mediated the association between nocturia and HRQOL. To enhance the HRQOL of patients with nocturia, clinicians should not only focus on nocturia symptoms, but also on their sleep quality.
Collapse
Affiliation(s)
- Edmond Pui Hang Choi
- School of Nursing, University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, University of Hong Kong, Pokfulam, Hong Kong.,Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong
| | - Jojo Yan Yan Kwok
- School of Nursing, University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, University of Hong Kong, Pokfulam, Hong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
7
|
Chin WY, Wan EYF, Dowrick C, Arroll B, Lam CLK. Tree analysis modeling of the associations between PHQ-9 depressive symptoms and doctor diagnosis of depression in primary care. Psychol Med 2019; 49:449-457. [PMID: 29697038 DOI: 10.1017/s0033291718001058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to explore the relationship between patient self-reported Patient Health Questionnaire-9 (PHQ-9) symptoms and doctor diagnosis of depression using a tree analysis approach. METHODS This was a secondary analysis on a dataset obtained from 10 179 adult primary care patients and 59 primary care physicians (PCPs) across Hong Kong. Patients completed a waiting room survey collecting data on socio-demographics and the PHQ-9. Blinded doctors documented whether they thought the patient had depression. Data were analyzed using multiple logistic regression and conditional inference decision tree modeling. RESULTS PCPs diagnosed 594 patients with depression. Logistic regression identified gender, age, employment status, past history of depression, family history of mental illness and recent doctor visit as factors associated with a depression diagnosis. Tree analyses revealed different pathways of association between PHQ-9 symptoms and depression diagnosis for patients with and without past depression. The PHQ-9 symptom model revealed low mood, sense of worthlessness, fatigue, sleep disturbance and functional impairment as early classifiers. The PHQ-9 total score model revealed cut-off scores of >12 and >15 were most frequently associated with depression diagnoses in patients with and without past depression. CONCLUSIONS A past history of depression is the most significant factor associated with the diagnosis of depression. PCPs appear to utilize a hypothetical-deductive problem-solving approach incorporating pre-test probability, with different associated factors for patients with and without past depression. Diagnostic thresholds may be too low for patients with past depression and too high for those without, potentially leading to over and under diagnosis of depression.
Collapse
Affiliation(s)
- Weng-Yee Chin
- Department of Family Medicine & Primary Care,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong
| | - Eric Yuk Fai Wan
- Nuffield Department of Population Health,University of Oxford,Oxford,UK
| | - Christopher Dowrick
- Institute of Psychology Health and Society,University of Liverpool,Liverpool,UK
| | - Bruce Arroll
- Department of General Practice and Primary Health Care,Faculty of Medical and Health Sciences,University of Auckland,Auckland,New Zealand
| | - Cindy Lo Kuen Lam
- Department of Family Medicine & Primary Care,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong
| |
Collapse
|
8
|
Kwon E, Kim B, Lee H, Park S. Heterogeneous Trajectories of Depressive Symptoms in Late Middle Age: Critical Period, Accumulation, and Social Mobility Life Course Perspectives. J Aging Health 2017; 30:1011-1041. [PMID: 28553816 DOI: 10.1177/0898264317704540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study investigated patterns of depressive symptoms and whether socioeconomic status (SES) across the life course affects these trajectories using the critical period, accumulation, and social mobility models. METHOD This study uses data from 8,532 adults, age 51 to 64, collected over 12 years from the Health and Retirement Study (observations = 25,887). A latent class analysis was performed to examine distinct depressive symptom trajectories; life course models were studied with multinomial logistic regression. RESULTS Four heterogeneous latent classes were identified for depression: Declining, Low, Increasing, and High and Increasing. The High and Increasing group was associated with a disadvantaged childhood SES, accumulated exposure to socioeconomic risks, and persistent SES disadvantage supporting the three life course models. DISCUSSION There was evidence of distinct profiles of depressive symptoms in late middle age and of interrelated life course mechanisms underlying the influences of childhood SES on later life depression.
Collapse
Affiliation(s)
| | - BoRin Kim
- 2 University of New Hampshire, Durham, USA
| | | | - Sojung Park
- 4 Washington University in St. Louis, Missouri, USA
| |
Collapse
|
9
|
Wang PW, Lin HC, Yang YHC, Hsu CY, Chung KS, Wu HC, Yen CF. Gender and Age Effects on the Trajectory of Depression in Opioid Users during Methadone Maintenance Treatment. Front Psychiatry 2017; 8:288. [PMID: 29321749 PMCID: PMC5733537 DOI: 10.3389/fpsyt.2017.00288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Both heroin use and depression are significant health problems. Methadone maintenance treatment (MMT) can be of great benefit to heroin users. However, changes in the level of depression in heroin users during MMT are not clear. Gender and age are also important factors in the development of depression, and whether gender and age moderate changes in depression in heroin users during MMT warrants further study. This study aimed to explore: (1) the trajectory of depression in opioid users during MMT and (2) the moderating effects of gender and age on the trajectory of depression in opioid users receiving MMT. METHOD A total of 294 intravenous heroin users were recruited into this 9-month observational study. The level of depression was measured at the intake interview and at follow-up interviews every 3 months. A latent growth model was used to analyze the trajectory of the level of depression among the participants. RESULTS Depression improved rapidly during the first 3 months of MMT and slowly after the first 3 months in both the female and male heroin users. There was no gender difference in the level of depression at each follow-up point. The level of depression in the female heroin users decreased faster than that in the male heroin users. In addition, the level of depression in the younger heroin users decreased faster than that in the older subjects. CONCLUSION Depression in female and younger heroin users improved more rapidly than in male and older subjects, respectively.
Collapse
Affiliation(s)
- Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Chi Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Chih-Yao Hsu
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Kuan-Sheng Chung
- Department of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Department of Community Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|