Depression in adult women: age changes and cohort effects

Changes in gender disparities of depressive symptoms among middle-aged and older adults in China: an age-period-cohort analysis

PURPOSE

Depression is one of the most common mental disorders and substantially decreases socioemotional well-being and health-related quality of life. Analyzing temporal patterns in depressive symptoms can reveal emerging risks that require attention and have implications for mental health promotion. The present study disentangled age, period, and cohort (APC) effects on trends in depressive symptoms and their gender disparities among China's nationally representative samples of middle-aged and older adults.

METHODS

Using four-wave data (2011, 2013, 2015, and 2018) from the China Health and Retirement Longitudinal Study (N = 65455), APC effects were quantified based on the hierarchical APC model. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to measure depressive symptoms.

RESULTS

Depressive symptoms increased during late life and stabilized after reaching an advanced age. After further adjusting for individual characteristics, depressive symptoms exhibited a negative trend with advancing age. The mean levels of depressive symptoms remained stable during the study period. Depressive symptoms varied significantly across cohorts, with those born in 1949-1951 having the most severe depressive symptoms. Significant life-course and cohort variations existed in the gender gaps in depressive symptoms. Although women had higher mean scores on the CES-D-10 scale throughout the life course, the gender gaps in depressive symptoms gradually narrowed with age, as depressive symptoms decreased more rapidly among women. A widening trend in gender gaps in depressive symptoms was found among those born after the mid-1950s, mainly driven by a notable decline in depressive symptoms among men CONCLUSIONS: The convergence of living conditions between genders in late life, as a result of traditional Chinese culture, may have narrowed the gender gap in depressive symptoms. However, given the widening gender disparities in depressive symptoms among younger cohorts, more attention should be paid to women's mental health in the context of China's rapid socioeconomic development.

Age, Period, and Cohort Effects of Internalizing Symptoms Among US Students and the Influence of Self-Reported Frequency of Attaining 7 or More Hours of Sleep: Results From the Monitoring the Future Survey 1991-2019

Adolescent internalizing symptoms have increased since 2010, whereas adequate sleep has declined for several decades. It remains unclear how self-reported sleep attainment has affected internalizing-symptoms trends. Using 1991-2019 data from the Monitoring the Future Study (n ~ 390,000), we estimated age-period-cohort effects in adolescent internalizing symptoms (e.g., loneliness, self-esteem, self-derogation, depressive affect) and the association with yearly prevalence of a survey-assessed, self-reported measure of attaining ≥7 hours of sleep most nights. We focused our main analysis on loneliness and used median odds ratios to measure variance in loneliness associated with period differences. We observed limited signals for cohort effects and modeled only period effects. The feeling of loneliness increased by 0.83% per year; adolescents in 2019 had 0.68 (95% CI: 0.49, 0.87) increased log odds of loneliness compared with the mean, which was consistent by race/ethnicity and parental education. Girls experienced steeper increases in loneliness than boys (P < 0.0001). The period-effect median odds ratio for loneliness was 1.16 (variance = 0.09; 95% CI: 0.06, 0.17) before adjustment for self-reported frequency of getting ≥7 hours sleep versus 1.07 (variance = 0.02; 95% CI: 0.01, 0.03) after adjustment. Adolescents across cohorts are experiencing worsening internalizing symptoms. Self-reported frequency of <7 hours sleep partially explains increases in loneliness, indicating the need for feasibility trials to study the effect of increasing sleep attainment on internalizing symptoms.

Associations Between Religion/Spirituality, Family Characteristics, and Mental Health Among Parents with Children with Developmental Delay

INTRODUCTION

Parenting children with intellectual and developmental disabilities can be stressful; however, families with religious beliefs may have positive ways of viewing their family. This study explored the associations between religious and spiritual involvement (RSI), family characteristics, parent mental health, and child adaptive and problem behaviours among 180 primary caregivers and their 3-year-old children with developmental delay (DD).

METHOD

This study investigated if RSI was related to family characteristics, parent depression and stress, and if RSI predicted parent mental health after accounting for child and family characteristics.

RESULTS

Associations between RSI, family characteristics (parent age, education, income) and parenting stress, but not depression, were found. RSI did not predict parent mental health after accounting for relevant child and family characteristics.

CONCLUSION

RSI may play an important role in the mental health of parents of children with developmental delay; however, other child and contextual factors relate strongly to parent wellbeing.

Depression in women and men, cumulative disadvantage and gender inequality in 29 European countries

Macro-sociological theories stress the contribution of gender inequality to this gender gap in depression, while cumulative advantage/disadvantage theory (CAD) reminds us that mental health inequalities accumulate over the life course. We explore the complementarity of both perspectives in a variety of European countries using data of the European Social Survey (2006 2012, 2014, N of countries = 29; N of men = 53,680 and N of women = 63,103) and using an 8-item version of the CES-D. Results confirm that the relevance of gender stratification for the mental health of women and men in Europe depends on age. The gender gap is nearly absent amongst adults in their twenties in the most gender equal countries, while an impressive gender gap is present amongst older adults in gender unequal countries, in accordance with CAD theory. These effects occur on top of the mental health consequences of taking up work and family roles at various life stages. The convergence of the results predicted by gender stratification and cumulative disadvantage theories strengthen the case for the link between gender, disadvantage and depression.

Prevalence and potential determinants of subthreshold and major depression in the general population of Qatar

BACKGROUND

There is a paucity of epidemiological studies of depression in war-free Arab countries. This study estimated the prevalence and potential determinants of Subthreshold (SUBDE) and Major Depressive Episode (MDE) in migrants and non-migrants typical of Qatar and neighboring Gulf countries.

METHODS

A telephone survey of a probability-based sample of 2,424 participants was conducted in February 2017. The sample was divided based on nationality and income: Low-Income Migrants (LIMs), High Income Migrants (HIMs), and non-migrants or Qatari Nationals (QNs). Participants completed the nine-item Physician Health Questionnaire (PHQ-9). Ethnicity, sociodemographics, health- and work-related information was collected. Bivariate and multinomial logistic regression analyses were used.

RESULTS

Overall prevalence of any depression ranged between 4.2% (95% CI: 3.3-5.3) and 6.6% (95% CI: 5.4-7.9) for a cut-off of 12 and 10, respectively. The diagnostic algorithm for SUBDE and MDE resulted in estimates of 5.5% (95% CI: 4.4-6.8) and 3.6% (95% CI: 2.8-4.5), respectively. SUBDE, but not MDE rates, were significantly increased in LIMs (OR=2.96, p = 0.004) and HIMs (OR = 2.00, p = 0.014) compared with non-migrants. Arab ethnicity was significantly associated with SUBDE: relative to South Asians (OR = 3.77, p < 0.001) and other ethnicities (OR = 3.61, p = 0.029). Arab ethnicity was significantly associated with MDE: relative to South Asians (OR = 10.42, p < 0.001) and South East Asians (OR = 3.54, p = 0.007).

LIMITATIONS

Clinical diagnostic interviews for depression were not included.

CONCLUSION

Using the PHQ-9, depression prevalence in Qatar was comparable to general population estimates from Western countries. Migrant status and ethnicity were associated with SUBDE and MDE with implications for early screening and community intervention.

Sociodemographic correlates of depressive symptoms: a cross-sectional analytic study among healthy urban Ghanaian women

BACKGROUND

Studies on healthy individuals that show minor signs of distress and depression-but that are not significant enough to be debilitating or to report to the hospital for treatment-are rare. Our primary objective was to measure the prevalence of depressive symptoms and sociodemographic correlates among healthy women 18 years and above in urban Accra, Ghana.

METHOD

We used secondary data from the Women's Health Study of Accra, Wave 1 (WHSA-1), a large scale, analytic, cross-sectional study conducted in Accra, Ghana involving 3183 women. The presence or absence of depressive symptoms within the past 30 days was estimated from the average score on three common symptoms of depression: sleep, anxiety, and sadness. The explanatory variables were age-group, socioeconomic level, marital status, ethnicity, religion, education, employment, and parity. Frequencies and means were used to summarize categorical and continuous variables, respectively. Logistic regression analyses were employed to determine the predictors of depressive symptoms.

RESULTS

The prevalence of depressive symptoms within the previous 30 days was 26.5% (95% CI: 25.0-28.1). Women 55 years and older were more likely than women between the ages of 18 and 24 to experience depressive symptoms (AOR 2.8, 95% CI: 2.0-4.0, p < 0.001), whilst women between the ages of 35 and 54 were 1.95 times more likely than women between the ages of 18 and 24 to experience depression (AOR 1.95, 95% CI: 1.40-2.70, p < 0.001). Self-employed women were less likely to report depressive symptoms compared to the unemployed (AOR 0.70, 95% CI: 0.56-0.87, p < 0.01). Akans were less likely to experience depressive symptoms compared to Ga women (AOR 0.75, 95% CI: 0.61-0.92, p < 0.01). Non-orthodox Christians were more likely to report depressive symptoms compared to Orthodox Christians (AOR 1.32, 95% CI: 1.09-1.60, p < 0.01).

CONCLUSION

The prevalence of symptoms of depression among healthy urban Ghanaian women is high. Older women, those with low education, and unemployed women appear to be at higher risk for depression and therefore should be targeted for interventions. Groups at risk for depression-especially older adults or individuals under economic strain-should be targeted for mood assessment as part of routine medical care.

Secular trends in the prevalence of major and subthreshold depression among 55-64-year olds over 20 years

BACKGROUND

Studying secular trends in the exposure to risk and protective factors of depression and whether these trends are associated with secular trends in the prevalence of depression is important to estimate future healthcare demands and to identify targets for prevention.

METHODS

Three birth cohorts of 55-64-year olds from the population-based Longitudinal Aging Study Amsterdam were examined using identical methods in 1992 (n = 944), 2002 (n = 964) and 2012 (n = 957). A two-stage screening design was used to identify subthreshold depression (SUBD) and major depressive disorder (MDD). Multinomial logistic regression analyses were used to identify secular trends in depression prevalence and to identify factors from the biopsychosocial domains of functioning that were associated with these trends.

RESULTS

Compared with 1992, MDD became more prevalent in 2002 (OR 1.90, 95% CI 1.10-3.28, p = 0.022) and 2012 (OR 1.80, 95% CI 1.03-3.14, p = 0.039). This was largely attributable to an increase in the prevalence of chronic diseases and functional limitations. Socioeconomic and psychosocial improvements, including an increase in labor market participation, social support and mastery, hampered MDD rates to rise more and were also associated with a 32% decline of SUBD-rates in 2012 as compared with 2002 (OR 0.68, 95% CI 0.48-0.96, p = 0.03).

CONCLUSIONS

Among late middle-aged adults, there is a substantial net increase of MDD, which is associated with deteriorating physical health. If morbidity and disability continue to increase, a further expansion of MDD rates may be expected. Improving socioeconomic and psychosocial conditions may benefit public health, as these factors were protective against a higher prevalence of both MDD and SUBD.

Effects of social integration on depressive symptoms in Korea: analysis from the Korean Longitudinal Study of Aging (2006–12)

Objectives The effects of a range of types of social integration and patterns of change in social integration over time were examined directly in relation to depressive symptoms in a large sample of the Korean population aged ≥45 years. Methods Data from the Korean Longitudinal Study of Aging (KLoSA) between 2006 and 2012 were assessed using longitudinal data analysis. We included 10 242 research subjects at baseline (2006) and based the primary analysis on generalised linear mixed models to examine association between social integration and depressive symptom. Results The odds ratio (OR) for depressive symptoms in individuals at the lowest level of social integration was 1.539-fold higher (95% confidence interval (CI) 1.360–1.742) that that for those at highest level of social integration. Results of subgroup analysis according to gender revealed a similar trend. A five-class linear solution fit the data best; Class 1 (lowest constant social integration level, 10.5% of the sample) was significantly associated with the highest risk of depressive symptoms (OR 1.933, 95% CI 1.706–2.190). Conclusions The results of the present study provide a scientific basis for the specific association between the level of social integration and changes in social integration pattern with the risk of depressive symptoms in current practice. Therefore, interventions to provide emotional support for older adults via social integration may be important to protect against depressive symptoms. What is known about the topic? Although there has been considerable discussion about social integration among old adults, few studies related to effect of social integration on depression have been conducted. What does this paper add? The findings of the present study indicate that a high level of social integration is inversely related to depressive symptoms and is also associated with a substantial positive effect on depressive symptoms among individuals aged ≥45 years. What are the implications for practitioners? This paper provides evidence showing that it is useful to assess indicators of both social and emotional loneliness, which have been theorised to correspond to low social integration.

Re-evaluating gender differences in self-rated health: The importance of cohort

Research examining gender differences in self-rated health (SRH) has typically not distinguished between age and cohort-related changes in the health of men and women over time. Using longitudinal data from the Panel Study of Income Dynamics, this study finds gender diffegrences in SRH may actually be an artifact of cohort. Prior to examining health across cohorts, women reported worse health than men. With the introduction of cohort to the models, no gender difference was found except in the earliest cohort (born 1924-1933). Historical context is therefore critical to understanding the health trajectories of women and men, which are not uniform across cohorts.

Secular trends in the prevalence of dementia and depression in Swedish septuagenarians 1976-2006

BACKGROUND

It is not clear whether the prevalence of dementia and depression among the elderly has changed during the past 30 years.

METHOD

Population-based samples from Gothenburg, Sweden were examined with identical psychiatric and neuropsychiatric examinations at age 70 years in 1976-1977 (n = 404, response rate 78.8%) and 2000-2001 (n = 579, response rate 66.4%), and at age 75 in 1976-1977 (n = 303, response rate 78%) and 2005-2006 (n = 753, response rate 63.4%). Depression was diagnosed according to DSM-IV and dementia according to Kay's criteria. General linear models (GLMs) were used to test for differences between groups.

RESULTS

Dementia was related to age but not to birth cohort or sex. Major depression was related to sex (higher in women) but not to birth cohort or age. Minor depression was related to birth cohort, sex (higher in women), age (higher at age 75) and the interaction effect of birth cohort × age; that is, the prevalence of minor depression increased with age in the 2000s but not in the 1970s. Thus, the prevalence of minor depression was higher in 2005-2006 than in 1976-1977 among 75-year-olds for both men (12.4% v. 3.7%) and women (19.1% v. 5.6%) whereas there were no birth cohort differences at age 70.

CONCLUSIONS

Secular changes were observed only for minor depression, which is considered to be related more to psychosocial factors than major depression. The high prevalence of minor depression in later-born birth cohorts emphasizes the importance of detecting minor depression in the elderly.

Late-life depressive symptoms: prediction models of change

BACKGROUND

Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms.

METHODS

Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms.

RESULTS

A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations.

CONCLUSIONS

New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms.

LIMITATIONS

The study has not included clinical evaluations and nutritional assessments.

Temperament, Character, and Depressive Symptoms during Pregnancy: A Study of a Japanese Population

Background. To examine the effects of temperament and character domains on depression during pregnancy. Methods. We examined 601 pregnant women using a questionnaire that included the Edinburgh Postnatal Depression Scale (EPDS), the Temperament and Character Inventory (TCI), and demographic variables. Results. In a hierarchical regression analysis, severity of depression during pregnancy was predicted by the women's negative response towards the current pregnancy, low self-directedness, and high harm avoidance, persistence, and self-transcendence. Conclusion. Depression during pregnancy is predicted by personality traits as well as women's negative attitudes towards the current pregnancy.

Reappraising the relationship between maternal age and postpartum depression according to the evolutionary theory: Empirical evidence from a survey in primary health services

BACKGROUND

Postpartum depression (PPD) is a widespread worldwide phenomenon, but its etiology remains unclear. This study reappraised how evolutionary theory could explain PPD as an adaptation through investigating the relationship between maternal age and PPD, and if this relationship is modified according to the number of children at home.

METHODS

A cross-sectional study carried out in five primary health care units included 811 participants randomly selected among mothers of children up to five postpartum months in Rio de Janeiro, Brazil. Postpartum depression was defined by scores above 11 on Edinburgh Postnatal Depression Scale (EPDS), and statistical analysis was based on multivariate logistic regression models.

RESULTS

One hundred and ninety-seven (24.3%, CI 95% 21.3-27.2) participants were classified as PPD positives. Maternal age was significantly associated to PPD (OR=0.96, p-value=0.019) independently of socioeconomic and reproductive characteristics, conjugal status or substance consumption by the couple. Thus, for each additional year, a reduction of 4% in the chance of developing PPD could be anticipated, effect which was not modified by the number of children at home (p-value=0.602).

LIMITATIONS

Information on social support was not included in this analysis since its relationship with maternal mental health would be better evaluated in a prospective fashion.

CONCLUSIONS

These findings suggest that adaptive mechanisms shaped through human generations persist contributing to the development of PPD in contemporary societies. According to this evolutionary approach, as maternal age advances the reproductive potential diminishes and, consequently, mothers are less prone to develop PPD and reduce investment in new offspring.

Depressive symptoms in the Belgian population: disentangling age and cohort effects

OBJECTIVE

Although the association between age and depression has been previously demonstrated, uncertainty remains because of the confounding relationship existing between age and cohort. A study by Yang (J Health Soc Behav 48(1):16, 2007) has evidenced important cohort effects and age-by-cohort interactions in depressive symptoms among US citizens. A crucial limitation, however, is that this study confines itself to elderly population. The objective of the present study is to bring further clarification to the association between age, cohort membership and depressive symptoms, by analyzing a sample with a wider age range.

METHODS

The Panel Study of Belgian Households is a prospective longitudinal survey, following adults ages 25-74, annually from 1992 to 2002. Missing data were replaced using multiple imputation, allowing for a complete dataset (N = 7,000) at each wave. Respondents were classified into one of five birth cohorts: 1918-1927; 1928-1937; 1938-1947; 1948-1957; 1958-1967. Frequency of depressive symptoms was reported using a modified version of the Health and Daily Living form. Growth curve modeling was used to determine the effect of age and cohort on depression trajectory.

RESULTS

All cohorts differed significantly from one another, with recent cohorts always obtaining the highest mean HDL-depression score. The intensity of depressive symptoms increases linearly with age, but significant age-by-cohorts interactions were detected, indicating that the relationship between age and depression varies across cohorts. No evidence of a WW2 effect was found.

CONCLUSION

The association between age and depression has to take cohort membership into account. Cohort replacement effects explain the increase in depression in Belgium.

Socioeconomic pathways to depressive symptoms in adulthood: evidence from the National Longitudinal Survey of Youth 1979

The existence of a direct effect of early socioeconomic position (SEP) on adult mental health outcomes net of adult SEP is still debated. This question demands the explicit modeling of pathways linking early SEP to adult SEP and mental health. In light of this background, we pursue two objectives in this study. First, we examine whether depressive symptoms in adulthood can be fit in a trajectory featuring both an intercept, or baseline range of depressive symptoms that varied between individuals, and a slope describing the average evolution of depressive symptoms over the years. Second, we estimate the direct and indirect pathways linking early SEP, respondents' education and adult household income, with a particular focus on whether early SEP retains a significant direct effect on the trajectory of depressive symptoms once adult SEP is entered into the pathway model. Drawing from 29 years of cohort data from the National Longitudinal Survey of Youth 1979, a survey that has been following a national probability sample of American civilian and military youth (Zagorsky and White, 1999), we used structural equation models to estimate the pathways between parents' education, respondent's education, and latent growth curves of household income and depressive symptoms. We found that the effect of parents' education was entirely mediated by respondent's education. In turn, the effect of respondent's education was largely mediated by household income. In conclusion, our findings showed that the socioeconomic attainment process that is rooted in parents' education and leads to respondent's education and then to household income is a crucial pathway for adult mental health. These results suggest that increasing educational opportunities may be an effective policy to break the intergenerational transmission of low socioeconomic status and poor mental health.

Direct and indirect transmission of relationship functioning across generations

Relationship functioning is assumed to propagate across subsequent generations, but most studies have lacked appropriate methodologies to test this assumption prospectively. In a randomly selected sample of youth (N = 821) followed prospectively for over 25 years across multiple generations, we examined the association of romantic engagement (i.e., emotional involvement and closeness) between parents with offspring romantic relationship quality. We tested two developmental pathways linking parents' romantic engagement with offspring adult romantic relationship quality, the first operating via parenting practices, and the second operating via adolescent depression. Parents' romantic engagement predicted offspring romantic relationship quality a mean of 17 years later, net age and socioeconomic status. Results supported a developmental pathway from parents' romantic engagement at offspring mean age 14, to parenting at offspring mean age 16, to offspring socioemotional functioning at mean age 22, and offspring romantic relationship quality at mean age 33. However, the influence of parents' romantic engagement on offsprings' adult romantic relationship quality does not appear to operate via a pathway of adolescent depression. Implications for prevention are discussed.

Trajectory of depression symptoms and related factors in later life--a population based study

BACKGROUND

A number of studies of elderly depression have examined the association between depression and its related factors; however, they did not observe how the development of related factors influenced elderly depression over time. This study aims to understand the rising trajectory of depressive symptoms found in elderly male and female, and whether the causation of depression due to related factors would be heterogeneous between male and female over a decade from 1993 to 2003.

METHOD

This study uses the data from the "Survey of Health and Living Status of the Elderly in Taiwan". A total of 1017 elderly Taiwanese, aged 60 and over, completed four survey modules. The latent growth curve model and general growth mixture model were used to identify the trajectories of depression symptoms, and to assess their related factors in the elderly male and female in Taiwan during the 10 year survey study.

RESULT

The results showed that a rising trajectory of depressive symptoms came about for both Taiwan elderly male and female over ten years. We also found that in the trajectories of depressive symptoms between elderly male and female across four waves of data, the results were heterogeneous. The trajectory of depressive symptoms in males was affected by perceived health and disability; the trajectory of depressive symptoms in females was influenced by disability and social support.

CONCLUSION

These findings demonstrated that the final depressive symptoms of the elderly would differ from the elderly with developmentally different depressive related factors. The findings also highlighted the developmental trajectories of depressive symptom in terms of their related factors in the elderly.

Trajectories of emotional well-being in mothers of adolescents and adults with autism

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families.

Changes in women's alcoholic, antisocial, and depressive symptomatology over 12 years: a multilevel network of individual, familial, and neighborhood influences

In a sample of 273 adult women and their families, we examined the effects of women's psychopathology history, their social support, their husbands' and children's symptomatology, family stress, and neighborhood environment on their alcohol problems, antisocial behavior, and depression over a 12-year period during their 30s and early 40s. Women's alcohol problems and antisocial behavior decreased but their depression symptoms increased over time. Women's disorder history and their partners' parallel symptomatology were associated with their symptoms. For women's antisocial behavior, their own history of alcoholism and their partners' alcohol problems were also significant risk factors. Higher levels of social support were associated with lower levels of depression in women. Children's externalizing behavior was positively correlated with their mothers' alcohol problems and antisocial behavior, whereas children's internalizing behavior was positively correlated with their mothers' depression. Neighborhood residential instability was associated with higher levels of alcoholic and depressive symptomatology in women. Intervention efforts might target women with young children by improving social support, educational or professional training opportunity, access to family counseling, and neighborhood environment.

Assessing and Managing Women With Depression: A Midwifery Perspective

Women are at disproportionate risk for depression. Depression often goes untreated because of lack of recognition by providers. The Institute of Medicine maintains that primary care providers are essential in the management of mental health disorders. The assessment and management of depression in women are sensitive topics and may require advanced training and skills.

Registered nurses' perceptions of health and safety related to their intention to leave

This study examined perceptions of general and emotional health among a statewide sample of nurses, and their assessment of employers' workplace health and safety initiatives. These variables and demographic data were then used to model predictors of intention to leave their work positions. A survey was mailed to all registered nurses in one state. Fifty-three percent responded (n = 3,955). Findings suggested marked differences in perception of emotional health by age, with younger nurses reporting less positive perceptions of their emotional health. Perceptions of employers' safety and health initiatives varied by age, setting, and work role. Predictors of intention to leave included lower perceived emotional health among younger nurses and employer safety initiatives for both age groups. This exploratory study suggests a relationship among employer health and safety practices, nurses' emotional health, and intention to leave. Implications for occupational health nurses are detailed.

Registered Nurses' Perceptions of Health and Safety Related to Their Intention to Leave

This study examined perceptions of general and emotional health among a statewide sample of nurses, and their assessment of employers' workplace health and safety initiatives. These variables and demographic data were then used to model predictors of intention to leave their work positions. A survey was mailed to all registered nurses in one state. Fifty-three percent responded ( n = 3,955). Findings suggested marked differences in perception of emotional health by age, with younger nurses reporting less positive perceptions of their emotional health. Perceptions of employers' safety and health initiatives varied by age, setting, and work role. Predictors of intention to leave included lower perceived emotional health among younger nurses and employer safety initiatives for both age groups. This exploratory study suggests a relationship among employer health and safety practices, nurses' emotional health, and intention to leave. Implications for occupational health nurses are detailed.

Transitions to adulthood and psychological distress in young adults born 12 years apart: constraints on and resources for development

BACKGROUND

Later transitions to adult roles and responsibilities have been linked with better psychological well-being yet psychological distress has risen despite young people making the transition to adulthood at older ages over recent years.

METHOD

We examine the role of structural constraints and adolescent resources in the relationship between the timing of transitions and psychological distress in early adult life in the 1958 National Child Development Study and the 1970 British Cohort Study. Graphical chain models were used to examine the influences on timing of four key transitions and their relationship with psychological distress (Malaise Inventory). The role of structural factors at birth (gender, social class) and adolescent resources (psychosocial problems, exam grades) were modelled.

RESULTS

An earlier transition to adult roles was associated with an increased risk for psychological distress but so was failing to make some key transitions. Structural constraints had negative effects on successful development. Persistent social class and gender inequalities in psychological distress were evident in both cohorts. Social class constraints were mediated by educational resources whereas gender constraints were mediated by psychosocial resources. The influence of structural constraints on the timing of transitions to adult roles was more complex with evidence of positive and negative mediation and moderation effects.

CONCLUSIONS

Delaying transition to adulthood promotes psychological health but failure of transition to independent living is associated with psychological distress. Life-course transitions are constrained by social origin and gender and possibly economic environment. Adolescent resources help young adults to make timely transitions to adult roles.

Molecular epidemiology of major depressive disorder

Major depressive disorder causes significant morbidity, affecting people's ability to work, function in relationships, and engage in social activities. Moreover, major depressive disorder increases the risk of suicidal ideation, attempted suicide and death by completed suicide. There is evidence that chronic stress can cause major depressive disorder. As for genetic factors, only minor susceptibility genes have been reliably identified. The serotonin system provides a logical source of susceptibility genes for depression, because this system is the target of selective serotonin reuptake-inhibitor drugs that are effective in treating depression. The 5-hydroxytryptamine (serotonin) transporter (5-HTT) has received particular attention because it is involved in the reuptake of serotonin at brain synapses. One common polymorphic variant of the 5-HTT-linked polymorphic region (5-HTTLPR), which affects the promoter of the 5-HTT gene, causes reduced uptake of the neurotransmitter serotonin into the presynaptic cells in the brain. The authors discussed the relationship between genetic polymorphisms and major depressive disorder, with special emphasis on the 5-HTTTLPR polymorphism. As the 5-HTTLPR polymorphism was significantly associated with an increased risk of major depressive disorder, the 5-HTT gene may be a candidate for a major depressive disorder susceptibility gene. As major depressive disorder is a multifactorial disease, an improved understanding of the interplay of environmental and genetic polymorphisms at multiple loci may help identify individuals who are at increased risk for major depressive disorder. Hopefully, in the future we will be able to screen for major depressive disorder susceptibility by using specific biomarkers.

Psychiatric emergency services for the U.S. elderly: 2008 and beyond

In 2011 the oldest baby boomers will turn age 65. Although healthcare researchers have started to examine the future preparedness of the healthcare system for the elderly, psychiatric emergency services (PES) have been widely overlooked. Research is needed to address PES need and demand by older patients, assess the consequences of this need or demand, and establish recommendations to guide PES planning and practice. The authors examined journal articles, review articles, textbooks, and electronic databases related to these topics. The authors outline the current PES environment in terms of facilities, characteristics, and visits, and discuss current geriatric patient PES use. Factors expected to impact future use are examined, including sociodemographic characteristics, psychiatric illness prevalence, cohort effects, medical comorbidity, mental healthcare resources and utilization, and stigma. Consequences of these on future psychiatric care and well-being of the elderly are then explored, specifically, greater acute services need, more suicide, strained delivery systems, increased hospitalization, and greater costs. The following are proposed to address likely future PES shortcomings: enhance service delivery, increase training, standardize and improve PES, prioritize finances, and promote research. The degree to which the geriatric mental healthcare "crisis" develops will be inversely related to the current system's response to predictable future needs.

No clear evidence of an association between plasma concentrations of n-3 long-chain polyunsaturated fatty acids and depressed mood in a non-clinical population

Previous research suggests that low n-3 long-chain polyunsaturated fatty acid (n-3PUFA) status is associated with higher levels of depression in clinical populations. This analysis aimed to investigate the relationship between depressed mood and n-3PUFA status in a non-clinical population. The analysis was conducted on data collected as part of a large randomized controlled trial investigating the impact of n-3PUFA supplementation on depressed mood in a community-based population. On entry into the trial, data on depressed mood were collected using the Depression, Anxiety and Stress Scales (DASS) and the Beck Depression Inventory (BDI). Plasma concentrations of various n-3PUFAs and n-6 long-chain polyunsaturated fatty acids (n-6PUFAs) were obtained from fasting venous blood samples, and various demographics were also measured. Using regression, there was no evidence of an association between either measure of depressed mood and any of the measures of n-3PUFA status or of n-6PUFA:n-3PUFA ratios. Clear associations were also not found when demographic factors were included in the analyses. These findings suggest that n-3PUFAs may not have a role in the aetiology of minor depression. This is also consistent with the results of other studies that have not demonstrated an association between depressed mood and n-3PUFA status in non-clinical populations and epidemiological studies that have not demonstrated an association between depressed mood and n-3PUFA intake in these populations.

Effects of mindful and non-mindful exercises on people with depression: a systematic review

PURPOSE

An emerging body of evidence has shown the therapeutic effect of both mindful and non-mindful physical exercises on the treatment of depression. The purpose of this study is to examine the effectiveness of mindful and non-mindful physical exercises as an intervention in managing depression or depressive symptoms based on a systematic literature review.

METHODS

Our review was conducted among five electronic databases to identify randomized controlled trials (RCTs), which tested the effects of mindful or/and non-mindful physical exercises on depression. Studies were classified according to the baseline depression status of participants and its relation to allocation concealment, blinding at outcome assessment, follow-up, and whether intention to treat analysis was employed.

RESULTS

The results based on 12 RCTs indicated that both the mindful and non-mindful physical exercises were effective in their short-term effect in reducing depression levels or depressive symptoms. However, most of studies had methodological problems that only small sample size was used, and the maintenance effects of physical exercise were not reported. Specific comparisons between RCTs on mindful and non-mindful exercises were not performed because of the limitations on the designs.

CONCLUSIONS

We recommend that more well-controlled studies have to be conducted in the future to address the short- and long-term effects of physical exercise on alleviating depression. Efforts should be focused on unveiling the differential effects of mindful and non-mindful exercises on depression and the underlying mechanisms of their therapeutic action.

Depression as a major component of public health for older adults

Although public health is often conceptualized only as the prevention of physical illness, recent data suggest that mental illnesses are increasingly relevant to the mission of disease prevention and health promotion. Projections are that by 2020, depression will be second only to heart disease in its contribution to the global burden of disease as measured by disability-adjusted life years. Also, as the population ages, successive cohorts of older adults will account for increasingly larger segments of the U.S. population. We present the diagnostic criteria for, prevalence of, and risk factors for depressive disorders among older adults; the challenges of recognizing and treating depression in this population; the cost-effectiveness of relevant public health interventions; and the public health implications of these disorders.

Looking Beyond Nativity: The Relation of Age of Immigration, Length of Residence, and Birth Cohorts to the Risk of Onset of Psychiatric Disorders for Latinos

Past studies yield inconsistent results regarding risk of psychopathology for U.S. Latinos by nativity possibly due to differences across immigrants in their age of arrival to the U.S., their length of residence in the U.S., or birth-cohort differences. This paper seeks to document the relation of age of arrival, time in the U.S., and cohort effects on the risk of onset of psychiatric disorders using a nationally representative sample of 2554 Latinos in the coterminous United States. Risk of onset of psychiatric disorders was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI, Kessler & Ustun, 2004). Findings indicate that Latino immigrants have lower risks of onset for some psychiatric disorders in their country of origin, but once in the U.S., Latino immigrants appear to experience similar risks of onset as U.S.-born Latinos of the same age. The longer Latino immigrants remain in their country of origin, the less cumulative risk of onset they experience, resulting in lower lifetime rates of disorders. These findings could potentially be due to variation in cultural and social norms and expectations across geographical contexts, differences in family structure and gender roles, as well as artifactual-level explanations.

Obesity and psychopathology in women: a three decade prospective study

OBJECTIVE

To evaluate prospective associations between elevations in body mass index (BMI) at average age 27 and generalized anxiety disorder (GAD) and major depressive disorder (MDD) at average age 59 in a community sample of women.

DESIGN

Three waves of data collected over three decades were drawn from mothers in the Children in the Community (CIC) Study. Binary logistic regression was used to estimate predictive effects of two BMI cutpoints (> or =30 and > or =25) on GAD and MDD independent of other risks for psychopathology.

SUBJECTS

The 544 mothers who were interviewed in the original wave of the CIC Study in 1975 and in the first and most recent follow-up waves in 1983 and 2002-2005.

MEASUREMENTS

Information about height and weight was obtained by self-report in face-to-face interviews. GAD and MDD were assessed by structured interview covering DSM-IV diagnostic criteria. Other potential risk factors examined included age, race, education, prior depressive symptoms and marital status, chronic disease, social support and financial strain concurrent with GAD and MDD.

RESULTS

A baseline BMI > or =30 significantly increased the odds for subsequent GAD and MDD by 6.27 and 5.25 times, respectively, after adjusting for other significant risk factors. Odds of GAD also increased significantly given a baseline BMI > or =25 (by 2.44 times); however this association was not independent of other significant risk factors. Predictive associations between a baseline BMI > or =30 and MDD were not attenuated by attained BMI assessed at outcome.

CONCLUSION

Findings extend existing evidence of the mental health consequences of obesity in a representative sample of mothers, and suggest that obesity may have long-term implications for mental distress in women at a clinical level over the adult years.

A survey on anxious and depressive complaints of Brazilian women

BACKGROUND

Affective disorders and symptoms are very prominent among women. However specific complaints and symptoms may vary in different cultures.

METHODS

A survey on the most common complaints from Brazilian women, identified as anxious or depressive symptoms, was performed with a focus group of 6 psychiatrists. The results are shown and a narrative review of manifestations of anxious and depressive symptoms in Latin American women are reported.

RESULTS

Complaints and symptoms of depression and anxiety are associated with some ethnic and socio-cultural factors. The overlap between depression and anxiety is substantial.

LIMITATIONS

The authors concluded that there is still insufficient quantitative scientific evidence, allowing a clear view of this subject.

CONCLUSIONS

There have been suggestions that ethnic, cultural, and economic conditions seem to play an important role in presentation of depressive and anxious symptoms.

Child-rearing anxiety and its correlates among Japanese mothers screened at 18-month infant health checkups

OBJECTIVE

To examine the level of child-rearing anxiety and to explore the variables correlated with child-rearing anxiety in a city in Japan.

DESIGN

Cross-sectional study.

SAMPLE

From July to September 2003, 371 mothers who visited community health centers in a city in Tokyo Metropolis for their child's 18-month health checkups.

MEASUREMENTS

Child-rearing anxiety was measured by the child-rearing anxiety scale. Questions in a self-reported questionnaire were on maternal variables, including maternal background information, child variables, and family system variables such as the presence of social support, and utilization of parenting support services. Also included within the questionnaire was the General Health Questionnaire-12.

RESULTS

Hierarchical multiple linear regression analysis revealed that mothers with higher child-rearing anxiety had less childcare satisfaction, more depressive symptoms, more worries about the child, less support from the husband, and less social support.

CONCLUSION

To identify mothers with high child-rearing anxiety in Japan, the infant health checkups should be utilized as an opportunity for screening, focusing on variables regarding mothers. Public health nurses can provide the necessary support after gaining an understanding of issues confronting mothers to prevent child-rearing anxiety and child abuse.

Is old age depressing? Growth trajectories and cohort variations in late-life depression

Findings in previous research on the association of old age and depression are inconsistent due to a confounding of age changes and cohort differences. Using data from an accelerated longitudinal design from the National Institute of Aging Established Populations for Epidemiologic Studies of the Elderly, this study addresses three questions: (1) Does the age growth trajectory show an increase in depressive symptoms in late life? (2) Is there cohort heterogeneity in levels of depressive symptoms and age growth trajectories of depressive symptoms? (3) What social risk factors are associated with these effects? Results show evidence of substantial cohort variation in depression. There is also evidence for an age-by-cohort interaction effect. Specifically, depression declined with age more rapidly for earlier cohorts. The growth trajectories can be accounted for by factors associated with historical trends in education, life course stages, health decline, differential survival, stress, and coping resources.

Depressed mood and n-3 polyunsaturated fatty acid intake from fish: non-linear or confounded association?

There is increasing evidence of an association between low dietary intake of essential n-3 long chain polyunsaturated fatty acids (n-3 EFAs) and depressed mood. This study aimed to evaluate this association in a large population-based sample of UK individuals. N-3 EFA intake (intake from fish alone, and from all sources (fish and supplements)), depressed mood (assessed using the short-form Depression, Anxiety and Stress Scales) and demographic variables (sex, age, Index of Multiple Deprivation (IMD) based on postal code, and date of questionnaire completion) were obtained simultaneously by self-report questionnaire (N = 2982). Using polynomial regression, a non-linear relationship between depressed mood and n-3 EFA intake from fish was found, with the incremental decrease in depressed mood diminishing as n-3 EFA intake increased. However, this relationship was attenuated by adjustment for age and IMD. No relationship between depression and n-3 EFA intake from all sources was found. These findings suggest that higher levels of n-3 EFA intake from fish are associated with lower levels of depressed mood, but the association disappears after adjustment for age and social deprivation, and after inclusion of n-3 EFA intake from supplements. This study does have a number of limitations, but the findings available suggest that the apparent associations between depressed mood and n-3 EFA intake from fish may simply reflect a wider association between depressed mood and lifestyle.

Correlates of mothers' persistent depressive symptoms: a national study

PURPOSE

The purpose of this study was to examine the prevalence, persistence, and correlates of mothers' depressive symptoms over a 5-year period in a nationally representative sample of the United States population.

METHOD

Data from 2235 mothers in the National Survey of Families and Households, Wave I, 1987-1988, and Wave II, 1992-1994, were analyzed. Outcome measures were scores on the Center for Epidemiological Studies Depression Scale (CES-D, 12-item version) and a validated three-item depression screen.

RESULTS

One fifth of study mothers had positive CES-D scores and almost half (48%) had negative CES-D scores in both waves. Wave I risk factors for persistent "positive" CES-D scores were maternal age less than 30 years (24%), African-American (33%), never married (26%) or divorced (32%), education less than high school (35%), and indigent (32%). Adjusted odds ratios (AOR) and 95% confidence intervals for persistent "positive" versus persistent "negative" CES-D scores were: age less than 30 years (Wave I), AOR = 1.64, (1.22-2.21); unmarried (Wave II), AOR = 2.60, (1.89-3.56); education less than high school (Wave II), AOR = 2.18, (1.41-3.38); and indigent (Wave II), AOR = 2.09 (1.36-3.21).

DISCUSSION

About one fifth of the study sample reported high depressive symptoms twice over a 5-year period. Depression in women, especially mothers, is an urgent public health problem.

Age-period-cohort analysis of Swiss suicide data, 1881-2000

At the end of the 19(th) century, male suicide rates in Switzerland were as high as the respective rates in recent decades, whereas female suicide rates were distinctly lower. An age-period-cohort analysis was performed to provide more information about the gender-specific changes over the last century. Suicide mortality has been reported in Switzerland since 1876 when the standardised registration of mortality data began. The analysed data cover the period 1881-2000. The statistical analyses were based on log-linear models and data aggregated by 10-year age-intervals and 10-year period intervals. The results indicate similar age and period effects in males and females. The estimates representing age-specific risk increase steadily with age, with intermediate plateaus in the 20s and the 50s. The period-specific estimates follow the economic cycles. The birth cohort effects are stronger in males and weaker in females. In the males' estimates, there is a peak in cohorts born around 1840 and a low in cohorts born some 60-100 years later. The estimates increased again in generations born after World War II. In females, the birth cohort estimates are low in cohorts born in the first half of the 19(th) century and increase until the first half of the 20(th) century. Birth cohort effects remain an intriguing topic in epidemiology of suicide. A better understanding of birth cohort effects might open new doors to suicide prevention.

Mental health, places and people: a multilevel analysis of economic inactivity and social deprivation

Using data on 24,975 respondents to the Welsh Health Survey 1998 aged 17-74 years, we investigated associations between individual mental health status measured using the SF-36 instrument, social class, economic inactivity and the electoral division Townsend deprivation score. In a multilevel modelling analysis, we found mental health was significantly associated with the Townsend score after adjusting for composition, and this effect was strongest in respondents who were economically inactive. Further contextual effects were shown by significant random variability in the slopes of the relation between mental health and economic inactivity at the electoral division level. Our results suggest that the places in which people live affect their mental health, supporting NHS policy that multi-agency planning to reduce inequalities in mental health status should address the wider determinants of health, as well as services for individual patients.

Using individual growth model to analyze the change in quality of life from adolescence to adulthood

Background

The individual growth model is a relatively new statistical technique now widely used to examine the unique trajectories of individuals and groups in repeated measures data. This technique is increasingly used to analyze the changes over time in quality of life (QOL) data. This study examines the change from adolescence to adulthood in physical health as an aspect of QOL as an illustration of the use of this analytic method.

Methods

Employing data from the Children in the Community (CIC) study, a prospective longitudinal investigation, physical health was assessed at mean ages 16, 22, and 33 in 752 persons born between 1965 and 1975.

Results

The analyses using individual growth models show a linear decline in average physical health from age 10 to age 40. Males reported better physical health and declined less per year on average. Time-varying psychiatric disorders accounted for 8.6% of the explained variation in mean physical health, and 6.7% of the explained variation in linear change in physical health. Those with such a disorder reported lower mean physical health and a more rapid decline with age than those without a current psychiatric disorder. The use of SAS PROC MIXED, including syntax and interpretation of output are provided. Applications of these models including statistical assumptions, centering issues and cohort effects are discussed.

Conclusion

This paper highlights the usefulness of the individual growth model in modeling longitudinal change in QOL variables.

Dual work and family roles and depressive symptoms in two birth cohorts of women

BACKGROUND

Rising depression rates in more recent cohorts of women have been attributed in part to their increased participation in dual family and work roles.

METHOD

This study examined associations among depressive symptoms, age, and work and marital status in two cohorts of women, all mothers, born between 1931 and 1944 (preboomers) or between 1945 and 1958 (baby boomers), assessed at comparable ages.

RESULTS

Being married (vs. divorced) was related to less depression within and across cohorts, whereas working was related to more depression in preboomers only. Moreover, divorced working preboomers were significantly more depressed than women in most other role status groups within and across cohorts. Depression scores declined across age among working women in the combined cohorts; however, that association held only for baby boomers when cohorts were analyzed separately. Among divorced working women, that decline was significantly greater in baby boomers than preboomers.

CONCLUSIONS

These cohort differences support a call for new social policies that address the mental health needs of women and their children.

Women's Psychological Distress in Midadulthood: The Role of Childhood Parenting Experiences

Abstract. This study explored the role of parental family structure, perceived father figure's involvement, and perceived mother figure's involvement in childhood in women's psychological distress in midadulthood. Six hundred and seventeen 28-59-year-old women with secondary school age children from three areas in South England completed the GHQ-12, scales retrospectively assessing mother's involvement and father's involvement, and items on parental family structure, educational attainment, social class (housing tenure), family size (number of children under age 21 in the household), partner status, employment status, and age. It was found that, even after controlling for current sociodemographic confounding variables, mother's involvement and father's involvement were negatively related to psychological distress. Parental family structure was unrelated to psychological distress. Family structure did not moderate the relationship between parental involvement and daughters' psychological distress, and the effect of father's involvement on a daughter's psychological distress did not vary with the level of mother's involvement.