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Yuan Y, Lin S, Huang X, Li N, Zheng J, Huang F, Zhu P. The identification and prediction of frailty based on Bayesian network analysis in a community-dwelling older population. BMC Geriatr 2022; 22:847. [PMID: 36368951 PMCID: PMC9652858 DOI: 10.1186/s12877-022-03520-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background We have witnessed frailty, which characterized by a decline in physiological reserves, become a major public health issue in older adults. Understanding the influential factors associated with frailty may help prevent or if possible reverse frailty. The present study aimed to investigate factors associated with frailty status and frailty transition in a community-dwelling older population. Methods A prospective cohort study on community-dwelling subjects aged ≥ 60 years was conducted, which was registered beforehand (ChiCTR 2,000,032,949). Participants who had completed two visits during 2020–2021 were included. Frailty status was evaluated using the Fried frailty phenotype. The least absolute shrinkage and selection operator (LASSO) regression was applied for variable selection. Bayesian network analysis with the max-min hill-climbing (MMHC) algorithm was used to identify factors related to frailty status and frailty transition. Results Of 1,981 subjects at baseline, 1,040 (52.5%) and 165 (8.33%) were classified as prefrailty and frailty. After one year, improved, stable, and worsening frailty status was observed in 460 (35.6%), 526 (40.7%), and 306 (23.7%) subjects, respectively. Based on the variables screened by LASSO regression, the Bayesian network structure suggested that age, nutritional status, instrumental activities of daily living (IADL), balance capacity, and social support were directly related to frailty status. The probability of developing frailty is 14.4% in an individual aged ≥ 71 years, which increases to 20.2% and 53.2% if the individual has balance impairment alone, or combined with IADL disability and malnutrition. At a longitudinal level, ADL/IADL decline was a direct predictor of worsening in frailty state, which further increased the risk of hospitalization. Low high-density lipoprotein cholesterol (HDL-C) and diastolic blood pressure (DBP) levels were related to malnutrition, and further had impacts on ADL/IADL decline, and ultimately led to the worsening of the frailty state. Knowing the status of any one or more of these factors can be used to infer the risk of frailty based on conditional probabilities. Conclusion Older age, malnutrition, IADL disability, and balance impairment are important factors for identifying frailty. Malnutrition and ADL/IADL decline further predict worsening of the frailty state. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03520-7.
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Lopez AO, Martinez MN, Garcia JM, Kunik ME, Medina LD. Self-report depression screening measures for older Hispanic/Latin American adults: A PRISMA systematic review. J Affect Disord 2021; 294:1-9. [PMID: 34252863 PMCID: PMC8410643 DOI: 10.1016/j.jad.2021.06.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/26/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assessing depression symptoms in Hispanic/Latin American (H/Ls) older adults, a group at high risk for depression, is nuanced due to the influence of cultural characteristics in symptom expression and manifestation. Little is known about the psychometric properties of available measures when used with this population. METHODS We conducted a two-stage systematic review of available depression assessment tools. We first identified self-report measures designed for use with adults. We then identified studies where at least one of such measures was used with older H/Ls that reported psychometric properties for the measure(s) used. RESULTS Only 3 measures were identified for use with older H/Ls: the BDI, GDS, and CES-D. However, few data were found to support the validity of the BDI, and the CES-D was not consistently valid across cultural groups. The GDS was found appropriate, though its performance varied based on race/ethnicity, nationality, and cutoff scores. The CES-D and GDS also demonstrated varying psychometric properties based on study setting (research versus clinical) and target population (inpatient psychiatric patients versus community-dwelling individuals). LIMITATIONS The number of articles that met criteria for inclusion in our review was small, and there was variation among samples of the few studies included. CONCLUSIONS Currently available self-report depression screening measures have acceptable applicability among older H/Ls, but their utility may vary based on their intended use. Modified cutoff scores may be beneficial in maximizing the utility of these measures when given to diverse older adults.
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Affiliation(s)
- Andrea Ochoa Lopez
- Department of Psychology, University of Houston, Houston, TX, United States
| | | | - Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Mark E Kunik
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, United States.
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Brañez-Condorena A, Soriano-Moreno DR, Navarro-Flores A, Solis-Chimoy B, Diaz-Barrera ME, Taype-Rondan A. Accuracy of the Geriatric Depression Scale (GDS)-4 and GDS-5 for the screening of depression among older adults: A systematic review and meta-analysis. PLoS One 2021; 16:e0253899. [PMID: 34197527 PMCID: PMC8248624 DOI: 10.1371/journal.pone.0253899] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Geriatric Depression Scale (GDS) is a widely used instrument to assess depression in older adults. The short GDS versions that have four (GDS-4) and five items (GDS-5) represent alternatives for depression screening in limited-resource settings. However, their accuracy remains uncertain. OBJECTIVE To assess the accuracy of the GDS-4 and GDS-5 versions for depression screening in older adults. METHODS Until May 2020, we systematically searched PubMed, PsycINFO, Scopus, and Google Scholar; for studies that have assessed the sensitivity and specificity of GDS-4 and GDS-5 for depression screening in older adults. We conducted meta-analyses of the sensitivity and specificity of those studies that used the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases-10 (ICD-10) as reference standard. Study quality was assessed with the QUADAS-2 tool. We performed bivariate random-effects meta-analyses to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI) at each reported common cut-off. For the overall meta-analyses, we evaluated each GDS-4 version or GDS-5 version separately by each cut-off, and for investigations of heterogeneity, we assessed altogether across similar GDS versions by each cut-off. Also, we assessed the certainty of evidence using the GRADE methodology. RESULTS Twenty-three studies were included and meta-analyzed, assessing eleven different GDS versions. The number of participants included was 5048. When including all versions together, at a cut-off 2, GDS-4 had a pooled sensitivity of 0.77 (95% CI: 0.70-0.82) and a pooled specificity of 0.75 (0.68-0.81); while GDS-5 had a pooled sensitivity of 0.85 (0.80-0.90) and a pooled specificity of 0.75 (0.69-0.81). We found results for more than one GDS-4 version at cut-off points 1, 2, and 3; and for more than one GDS-5 version at cut-off points 1, 2, 3, and 4. Mostly, significant subgroup differences at different test thresholds across versions were found. The accuracy of the different GDS-4 and GDS-5 versions showed a high heterogeneity. There was high risk of bias in the index test domain. Also, the certainty of the evidence was low or very low for most of the GDS versions. CONCLUSIONS We found several GDS-4 and GDS-5 versions that showed great heterogeneity in estimates of sensitivity and specificity, mostly with a low or very low certainty of the evidence. Altogether, our results indicate the need for more well-designed studies that compare different GDS versions.
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Affiliation(s)
- Ana Brañez-Condorena
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | - David R. Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | | | - Blanca Solis-Chimoy
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | - Mario E. Diaz-Barrera
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, SOCEMUNT, Trujillo, Peru
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- * E-mail:
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Shon EJ. Measurement equivalence of the Kessler 6 Psychological Distress Scale for Chinese and Korean immigrants: Comparison between younger and older adults. Int J Methods Psychiatr Res 2020; 29:e1823. [PMID: 32172536 PMCID: PMC7301282 DOI: 10.1002/mpr.1823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 02/09/2020] [Accepted: 02/26/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The Kessler 6 (K6) Psychological Distress Scale is a well-known instrument to screen for psychological distress of general populations. It is critical to perform the equivalence test of the K6 for Asian immigrant subgroups. METHODS The 2012 California Health Interview Survey data were used (N = 1,210; Chinese = 640, Koreans = 570). Among 1,210, 734 were younger (18-64 years) and 476 were older (65+) adults. It was examined whether parameters in the measurement model is equivalent across the two groups, using multiple-group analysis. The equivalence tests for Chinese and Koreans were separately performed based on different age groups (younger [18-64] vs. older [65+]). RESULTS The younger group had good model fit (X2 = 41.27 [df = 16, p = .001], X2 /df = 2.58, Comparative Fit Index [CFI] = 0.99, Goodness of Fit Index [GFI] = 0.98, root mean square error or approximation [RMSEA] = 0.05, standardized root mean residual [SRMR] = 0.03), and the older group also showed good model fit (X2 = 41.70 [df = 16, p < .001], X2 /df = 2.61, CFI = 0.98, GFI = 0.97, RMSEA = 0.06, SRMR = 0.04). The model for older group indicated measurement noninvariance between Chinese and Korean immigrants (ΔX2 = 17.86, Δdf = 5, p = .003, CFI = 0.972, ΔCFI = 0.009). The items "hopeless," "restless," and "depress," were significantly nonequivalent between the two groups. CONCLUSIONS Clinicians/researchers should be aware of the potential risk for misclassification when they screen psychological distress of Chinese or Korean older immigrants. Professionals should pay attention to cross-cultural comparability when interpreting results from the K6.
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Affiliation(s)
- En-Jung Shon
- Department of Family Science and Social Work, College of Education, Health and Society, Miami University in Ohio, Oxford, Ohio, USA
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Ali GC, Ryan G, De Silva MJ. Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review. PLoS One 2016; 11:e0156939. [PMID: 27310297 PMCID: PMC4911088 DOI: 10.1371/journal.pone.0156939] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/23/2016] [Indexed: 11/19/2022] Open
Abstract
Background A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations. Methods A systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools. Results 153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts. Conclusions Of the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders. We recommend that, wherever possible, a chosen screening tool should be validated against a gold standard diagnostic assessment in the specific context in which it will be employed.
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Affiliation(s)
- Gemma-Claire Ali
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre for Global Mental Health, London, United Kingdom
- * E-mail:
| | - Grace Ryan
- Centre for Global Mental Health, London, United Kingdom
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary J. De Silva
- Centre for Global Mental Health, London, United Kingdom
- Department of Population, Environment and Health, Wellcome Trust, London, United Kingdom
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Jiang CQ, Loerbroks A, Lam KBH, Bosch JA, Thomas GN, Zhang WS, Cheng KK, Lam TH, Adab P. Mental health and asthma in China: the Guangzhou Biobank Cohort Study. Int J Behav Med 2014; 20:259-64. [PMID: 22297917 DOI: 10.1007/s12529-012-9222-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is consistent evidence of the co-occurrence of poor mental health and asthma in Western populations. Since the experience and expression of mental health is partly culturally determined, it is of interest to examine if similar associations are found in other cultural settings. In that regard, very little is known about the association between mental health and asthma in Asian countries, such as China. PURPOSE The aim of this study was to investigate the relationship between mental health and asthma in a large sample from China. METHOD We used data from the Guangzhou Biobank Cohort Study phase 3 (n = 9,280). Participants reported physician-diagnosed asthma. Mental health measures included the 15-item Chinese version of the Geriatric Depression Scale (GDS-C) and the SF-12 Mental Component Summary (MCS) score. We compared the prevalence of asthma by GDS-C and MCS scores by estimating prevalence ratios (PRs) and their corresponding 95% confidence intervals (95% CI), using Poisson regression. RESULTS Compared to those without depression, the prevalence of asthma was higher in those with moderate or severe depression levels (PR = 2.63, 95% CI = 1.58–4.40 and PR = 4.43, 95% CI = 1.62–12.09, p for trend ≤0.0001). The prevalence of asthma increased by 46% with every 1 standard deviation increase of the GDS-C score (PR = 1.46, 95% CI = 1.24–1.73). The MCS score was not associated with asthma. CONCLUSION Depressive symptoms were associated with asthma prevalence in a Chinese population. Further research into the mechanism and potential directions of causality is warranted.
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Affiliation(s)
- Chao Qiang Jiang
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Yu J, Li J, Cuijpers P, Wu S, Wu Z. Prevalence and correlates of depressive symptoms in Chinese older adults: a population-based study. Int J Geriatr Psychiatry 2012; 27:305-12. [PMID: 21538538 DOI: 10.1002/gps.2721] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/28/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE In China, the rapid socioeconomic transition and the consequential traditional culture change had significant influences on Chinese older-adult depression. In the present study, the prevalence, the potential risk, and the protective factors of depression in the Chinese older population were investigated. METHODS A cross-sectional survey was conducted with a nationwide representative Chinese sample of 4945 older adults; the Center for Epidemiologic Studies Depression Scale (CES-D) was used as the measurement tool for depressive symptoms. Demographic and other self-reported related factors were taken into consideration. RESULTS The prevalence of self-reported depressive symptoms (CES-D ≥ 16) in the total study population was 39.86% (pre-old: 39.95%, young-old: 39.84%, old-old: 39.65%, oldest-old: 45.19%); CES-D score was significantly higher in the oldest-old group than in the three younger groups. Furthermore, multiple regression analysis indicated that age itself was not an effective predictor for depressive symptoms, whereas family support and health status explained most of the variation. CONCLUSIONS The present study found a higher prevalence of depression in the Chinese older population compared with those reported two decades ago. Family support and health status were the most significant protective factors for depression in Chinese older adults. Traditional Chinese culture, which values family significantly and contributed to the previously reported lower prevalence rate, changed dramatically, which may explain the current higher prevalence. In addition to the deterioration of family support, the worsening of health status is another significant factor.
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Affiliation(s)
- Jing Yu
- Center on Aging Psychology, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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So ES, Chin YR, Lee IS. Relationship Between Health-related Behavioral and Psychological Factors and Cardiovascular and Cerebrovascular Diseases Comorbidity Among Korean Adults With Diabetes. Asian Nurs Res (Korean Soc Nurs Sci) 2011; 5:204-9. [PMID: 25030521 DOI: 10.1016/j.anr.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 11/18/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE This study aims to explore the relationships between health-related behavioral and psychological factors and cardiovascular and cerebrovascular diseases (CCVD) comorbidities among Korean adults with diabetes mellitus (DM). METHODS Data included in the Fourth Korean National Health and Nutrition Examination Survey were used. This study compared three groups: those diagnosed with DM only, DM and hypertension, DM, hypertension and CCVD using multinomial logistic regression analyses and the classification and regression tree (CART) model. RESULTS Weight control (OR = 4.01) and depression (OR = 2.37) are related with increased odds of having hypertension and CCVD comorbidity in those with DM. The CART model suggested that the high prevalence risk groups for hypertension or CCVD comorbidities were diabetic adults aged between 51 and 69 with a body mass index of 25 and above and those aged 70 and above. CONCLUSION For effective control of CCVD comorbidities among diabetic Korean adults, psychological support for depression and weight control need to be prioritized when managing DM. Weight control intervention needs to be reinforced for DM patients aged between 51 and 69 and that even if BMI is below 25, the occurrence of comorbidities needs to be carefully monitored for DM patients aged 70 or older.
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Affiliation(s)
- Eun Sun So
- Suwon Women's College, Suwon, South Korea
| | - Young Ran Chin
- Korea Health Industry Development Institute, Chungcheongbuk-do, South Korea
| | - In Sook Lee
- College of Nursing, Seoul National University, Seoul, South Korea
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Chao SF. Assessing social support and depressive symptoms in older Chinese adults: a longitudinal perspective. Aging Ment Health 2011; 15:765-74. [PMID: 21838514 DOI: 10.1080/13607863.2011.562182] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study examined the relationship between social support and depression in a national longitudinal sample in Taiwan. This study integrates previous literature and develops a predictive model involving seven components of social support - social network size, network composition, frequency of social contact, proximity, types of support received, helping others, and satisfaction with social support. METHOD A total of 4049 elders who were interviewed up to five times over a 14-year period from the 'Surveys of Health and Living Status of Elderly' (SHLSE) in Taiwan served as the subjects of this study. Random effects modeling was used to analyze the data. RESULTS Greater network size, broader networks, more frequency of contact, living with a married son, receiving instrumental, emotional and financial support, providing financial and short-term instrumental support to others, and higher satisfaction with support were all associated with fewer depressive symptoms. Providing physical care was related to higher levels of depression. Of the social support measures, satisfaction with support emerged as the most powerful predictor of elders' depression. CONCLUSION This investigation provides evidence that each aspect of social support accounts for a certain portion of the concept and emphasizes the importance of distinguishing different dimensions of social support. Also, the inconsistent findings between the current study and the Chinese literature reminds future investigators that the effect of social support on depression may differ among Chinese elderly in different communities, even through they share the same cultural origin.
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Affiliation(s)
- S F Chao
- Department of Social Work, Tzu Chi University, Taiwan.
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