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ABSTRACT: Previous research has uncovered relationships between religion/spirituality and depressive disorders. Proposed mechanisms through which religion may impact depression include decreased substance use and enhanced social support. Little investigation of these topics has occurred with adolescent psychiatric patients, among whom depression, substance use, and social dysfunction are common.
145 subjects, aged 12-18, from two psychiatric outpatient clinics completed the Beck Depression Inventory-II (BDI-II), the Fetzer multidimensional survey of religion/spirituality, and inventories of substance abuse and perceived social support. Measures were completed again six months later. Longitudinal and cross-sectional relationships between depression and religion were examined, controlling for substance abuse and social support.
Of thirteen religious/spiritual characteristics assessed, nine showed strong cross-sectional relationships to BDI-II score. When perceived social support and substance abuse were controlled for, forgiveness, negative religious support, loss of faith, and negative religious coping retained significant relationships to BDI-II. In longitudinal analyses, loss of faith predicted less improvement in depression scores over 6 months, controlling for depression at study entry.
Self-report data, clinical sample.
Several aspects of religiousness/spirituality appear to relate cross-sectionally to depressive symptoms in adolescent psychiatric patients. Findings suggest that perceived social support and substance abuse account for some of these correlations but do not explain relationships to negative religious coping, loss of faith, or forgiveness. Endorsing a loss of faith may be a marker of poor prognosis among depressed youth.
Journal of affective disorders 06/2009; 120(1-3):149-57. · 3.76 Impact Factor
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ABSTRACT: The objective of the study was to determine whether spousal caregiving and bereavement increases caregiver depressive symptoms. We followed 1,967 community-dwelling elderly couples from the 1993 Health and Retirement Study (HRS) until 2002 (five bi-annual surveys) or death. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. Adjusted depressive symptoms were higher for females for three of the four caregiving arrangements tested (as were unadjusted baseline levels). Depressive symptoms were lowest when neither spouse received caregiving (adjusted CESD of 2.97 for males; 3.44 for females, p<0.001). They were highest when females provided care to their husband with assistance from another caregiver, (4.01) compared to (3.37; p<0.001) when males so cared for their wife. A gender by caregiving arrangements interaction was not significant (p=0.13), showing no differential effect of caregiving on CESD by gender. Depressive symptoms peaked for bereaved spouses within three months of spousal death (4.67; p<0.001) but declined steadily to 2.75 (p<0.001) more than 15 months after death. Depressive symptoms initially increased for the community spouse after institutionalization of the care recipient, but later declined. We conclude that caregiving increases depressive symptoms in the caregiver, but does not have a differential effect by gender. Increases in depressive symptoms following bereavement are short-term.
Aging and Mental Health 01/2008; 12(1):100-7. · 1.37 Impact Factor
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ABSTRACT: The prevalence of depression in end-stage renal disease (ESRD) patients on hemodialysis has not been definitively determined. We examined the prevalence of depression and the sensitivity, specificity, positive, and negative likelihood ratios (+LR and -LR) of self-report scales using the physician-administered Structured Clinical Interview for Depression (SCID) as the comparison. Ninety-eight consecutive patients completed the Beck Depression Inventory (BDI) and the Center for Epidemiological Study of Depression (CESD) scales. A physician blinded to BDI and CESD scores administered the SCID. Receiver/responder operating characteristic curves determined the best BDI and CESD cutoffs for depression. Depressed patients had more co-morbidities and lower quality of life, P<0.05. The prevalence of depression by SCID was 26.5% and of major depression was 17.3%. The CESD cutoff with the best diagnostic accuracy was 18, with sensitivity 69% (95% confidence interval (CI) (51%, 87%)), specificity 83% (95% CI (74%, 92%)), positive predictive value (PPV) 60%, negative predictive value (NPV) 88%, +LR 4.14, and -LR 0.37. The best BDI cutoff was 14, with sensitivity 62% (95% CI (43%, 81%)), specificity 81% (95% CI (72%, 90%)), PPV 53%, NPV 85%, +LR 3.26, and -LR 0.47. Self-report scales have high +LR but low -LR for diagnosis of depression. When used for screening, the threshold for depression should be higher for ESRD compared with non-ESRD patients. Identifying depression using physician interview is important, given the low -LR of self-report scales.
Kidney International 05/2006; 69(9):1662-8. · 6.61 Impact Factor
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ABSTRACT: In order to better understand aging, longitudinal studies are run in which participants are evaluated repeatedly and selected end-points (e.g., score on a cognitive screen, falls, occurrence/reoccurrence of a condition) are examined. The objective of the present paper is primarily to describe the methods available that take into account correlation between binary outcomes, and in particular to model the association of binary outcomes after controlling for covariates by using an implementation of generalized estimating equations (GEE) called 'alternating logistic regression' (ALR). In GEE, association within longitudinal outcomes is accounted for but not estimated. Alternating logistic regression, however, basically enables simultaneous estimation of pair-wise odds ratios of outcomes within a cluster, while accounting for the dependence of the outcome on covariates. A sub-sample (n=2458) from a community-based sample of Duke Established Populations for Epidemiologic Studies of the Elderly is used. In the example used here, logistic regression using GEE and ALR is used to model binary outcomes at three time points (baseline, three and six years later) and to control for covariates in a representative community-based sample 65 years of age and older (n=2458). The outcomes indicate any problem versus no problem on a five-item activities of daily living (ADL) scale in a community sample. The ALR model, however, provides insight into decline in ADL from baseline to each of the time-points whereas GEE does not. In both controlled and uncontrolled analyses, decline in ADL over three and six-year intervals (baseline to three years later, baseline to six years and three years post-baseline to six years post-baseline) is significant.
Aging and Mental Health 06/2005; 9(3):196-200. · 1.37 Impact Factor
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ABSTRACT: Longitudinal data generate correlated observations. Ignoring correlation can lead to incorrect estimation of standard errors, resulting in incorrect inferences of parameters. In the example used here, standard logistic regression, a population-averaged (PA) model fit using generalized estimating equations (GEE), and random-intercept models are used to model binary outcomes at baseline, three and six years later. The outcomes indicate cognitive impairment versus no cognitive impairment in a sample of community dwelling elders. The models include both time-invariant (age, gender) and time-varying (time, interactions with time) covariates. The absolute estimates from random-intercept models are larger than those of both standard logistic and GEE models. Compared to the model fit using GEE that accounts for time dependency, standard logistic regression models overestimate standard errors of time-varying covariates (such as time, and time by problems with activities of daily living), and underestimate the standard errors of time-invariant covariates (such as age and gender). The standard errors from the random-intercept model are larger than those from logistic regression and GEE models. The choice of models, GEE or random-intercept, depends on the research question and the nature of the covariates. Population-averaged methods are appropriate when between-subjects effects are of interest, and random-effects are useful when subject-specific effects are important.
Aging and Mental Health 11/2003; 7(6):462-8. · 1.37 Impact Factor
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ABSTRACT: Little attention has been paid to examining the extent to which alternative statistical models may facilitate identification of persons with dementia. Using a sub-sample of the Duke Established Populations for Epidemiologic Studies of the Elderly, two analytical approaches were compared: logistic regression (which focuses on identifying specific characteristics predictive here of dementia), and recursive partitioning methods using tree-based models (which permit identification of the characteristics of those groups with high dementing disorder). In the stepwise multiple logistic regression model which included as potential predictors, gender, age, history of chronic health conditions, scales of basic and instrumental activities of daily living (IADL), and cognitive status, only IADL and cognitive status were significant predictors, with cognitive status the single most important factor. The classification tree approach, which permits identification of the characteristics of those groups with particularly high dementia rates, identified cognitive status as the most important criterion for dementia (as did logistic regression analysis). Among those without cognitive impairment, older age was a risk factor, confirming findings consistently reported in the literature. Among the cognitively impaired, IADL was an important risk factor. Those with five or more IADL problems were further classified into two risk groups, based on number of ADL problems. While classification tree analysis encourages identification of groups at risk, logistic regression encourages targeting of specific characteristics.
Aging and Mental Health 10/2003; 7(5):383-9. · 1.37 Impact Factor
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ABSTRACT: Evidence suggests that individuals with early and mid-stage Parkinson disease (PD) have diminished range of motion (ROM). Spinal ROM influences the ability to function. In this investigation, the authors examined available spinal ROM, segmental excursions (the ROM used) during reaching, and their relationships in community-dwelling adults with and without PD.
The subjects were 16 volunteers with PD (modified Hoehn and Yahr stages 1.5-3) and 32 participants without PD who were matched for age, body mass index, and sex.
Range of motion of the extremities was measured using a goniometer, and ROM of the spine was measured using the functional axial rotation (FAR) test, a measure of unrestricted cervico-thoracic-lumbar rotation in the seated position. Motion during reaching was determined using 3-dimensional motion analysis. Group differences were determined using multivariable analysis of variance followed by analysis of variance. Contributions to total reaching distance of segmental excursions (eg, thoracic rotation, thoracic lateral flexion) were determined using forward stepwise regression.
Subjects with PD as compared with subjects without PD had less ROM (FAR of 98.2 degrees versus 110.3 degrees, shoulder flexion of 151.9 degrees versus 160.1 degrees) and less forward reaching (29.5 cm versus 34.0 cm). Lateral trunk flexion and total rotation relative to the ground contributed to reaching, with the regression model explaining 36% of the variance.
These results contribute to the growing body of evidence demonstrating that spinal ROM is impaired early in PD.
Physical Therapy 09/2001; 81(8):1400-11. · 3.11 Impact Factor
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ABSTRACT: When trying to predict breast cancer screening, it may be important to understand the relationships between perceived breast cancer risks and worries about getting breast cancer. This study examines the extent to which women's worries about breast cancer correlate with perceptions of both absolute (assessment of own) and comparative (self versus other) 10-year and lifetime risks. As part of a larger randomized intervention trial concerning hormone replacement therapy, 581 women participated in a telephone baseline survey to assess their perceptions of breast cancer risks and worries. Worries about getting breast cancer in the next 10 years and in one's lifetime were related positively to both absolute and comparative 10-year and lifetime risks. The magnitude of these relationships did not differ by time frame. Worry about breast cancer is a function of both how a woman views her own risk and how she compares her risk with that of other women. Some practitioners may encourage women to get screened for breast cancer by using emotional appeals, such as heightening women's worries about breast cancer by using risk information. Our data suggest that they should give careful consideration how best to combine, if at all, information about absolute and comparative risks. For example, if the motivation to screen is based on a sequential assessment of risk beginning with comparative and then absolute risk, creating communications that heighten perceived risk on both of these risk dimensions may be needed to evoke sufficient worry to initiate breast cancer screening.
Cancer Epidemiology Biomarkers & Prevention 10/2000; 9(9):973-5. · 4.12 Impact Factor
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ABSTRACT: One area of research that requires further elaboration is the relationship between impairments and functional limitations. By identifying specific contributors to functional limitations, it may be possible to establish intervention strategies, including exercise approaches, that can delay or ameliorate decline in function. The association between impaired spinal flexibility and functional limitations has not been studied in depth. The purposes of this study were to determine (a) the associations between spinal flexibility and functional limitations; (b) the relative contribution of spinal flexibility to specific functional limitations; and (c) how disease state (Parkinson's disease [PD] vs no PD) modified these relationships.
Participants included 251 community-dwelling adults, 56 of whom were with diagnosed PD and 195 were without PD or other specific disorders. Measures included spinal flexibility (i.e., functional axial rotation [FAR]) and configuration (i.e., thoracic kyphosis and lumbar lordosis), functional limitations (i.e., functional reach, supine-to-stand time, 10-m walk, and 360 degrees turn).
Canonical correlation (Can R) demonstrated significant associations between spinal measures and functional limitations (Can R = .488, p = .0001). After controlling for age, gender, race, body mass index, comorbidity, confidence, and depression, a multivariate regression model demonstrated that spinal flexibility contributed significantly to functional reach (R2 = .334 for the overall model, p = .0001). Based on the parameter estimate of 0.026, the results prediet that FAR accounts for a 4.6-inch difference in reach distance between the least and most flexible of the participants. In addition, there were significant differences between almost all measurements for the PD compared with the non-PD participants.
Results clearly implicate spinal flexibility as a contributor to functional reach, a measure of functional limitation and an established measure of balance control. Further work is needed to determine the extent to which spinal flexibility can be improved and the effect of that improvement on balance.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 09/2000; 55(8):M441-5. · 4.60 Impact Factor
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ABSTRACT: This study examined inappropriate drug use defined by updated criteria among respondents in the second and third in-person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. Information about sociodemographics, health status, access to health care, and drug use was determined by in-home interviews. Drug use was coded for therapeutic class and appropriateness by applying explicit criteria. Among participants, 27% of the second and 22.5% of the third in-person wave took one or more inappropriate agents. Of these drugs, the most common therapeutic classes were central nervous system and cardiovascular. Longitudinal multivariate analyses found that persons taking several prescription drugs, those having continuity of care, those who previously took inappropriate drugs, and those with many health visits were most likely (p<0.05) to use inappropriate drugs. We conclude that inappropriate drug use is common among community-dwelling elderly.
Pharmacotherapy 05/2000; 20(5):575-82. · 2.90 Impact Factor
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ABSTRACT: Clinicians and researchers frequently quantify impairments and functional ability to monitor patient's symptoms and progress. For some patients, such as those with Parkinson's disease (PD), symptoms can fluctuate from day to day, making reliable measurement difficult. Multiple measures then may be required to obtain reliable data. Decisions must be made, balancing the optimum measurement schedule to obtain "good reliability" against burden to the patient. This investigation demonstrates the use of Generalizability Theory in determining the testing schedule when designing an experiment involving patients with known fluctuations of symptoms. In this investigation we use "Functional Axial Rotation" (FAR), a measure of spinal flexibility, to illustrate the use of Generalizability Theory for designing an experiment using participants who have PD. Measurements of FAR were taken on 13 participants, aged 60 or older, who were in early and mid-stages of PD. Three measurements were obtained on each of two consecutive days, and repeated on two consecutive days a week later, giving a total of 12 measures of FAR for each individual. Four sources of variation (subject, week, day and trial) were employed to estimate the reliability of FAR under several designs. Assuming different schedules of measures across weeks, days and trials, the estimated reliability of FAR for four measurements is in the range of 0.75 to 0.83, and for eight measurements in the range of 0.82 to 0.86. We discuss the use of this type of analysis in the determination of the optimum measurement design for experiments involving subjects with known fluctuations.
Aging (Milan, Italy) 03/2000; 12(1):29-34.
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ABSTRACT: To characterize typical spinal motions that occur during standing reach and to describe differences in spinal motions and center of pressure displacements during reach between younger and older healthy adults.
Exploratory, cross sectional investigation utilizing video motion and biomechanics force platform analysis.
Standing reach provides a means for assessing both arm function and balance control in the context of a common functional activity. The interaction between age-related declines in spinal mobility and the spinal motion occurring during reach is poorly understood. The characterization of spinal motions during task performance for healthy subjects of different age groups is an important first step for understanding the relationship between impairments and physical performance in disabled populations.
Thirty-four subjects ages 20-36 and 33 subjects ages 60-76 participated. Video motion and force plate analysis were used to characterize spinal motion and center of pressure displacements during the functional reach test for younger and older subjects.
Spinal motion during standing reach was characterized by forward trunk flexion, lateral trunk flexion, thoracolumbar rotation, and lower body rotation. Younger and older subjects differed (P = 0.05) in the amount of forward trunk flexion and thoracolumbar rotation which occurred but not lower body rotation. Younger subjects displaced their center of pressure further forward (P = 0.0001) and through a greater percentage of their initial base of support (P = 0.0001) than older subjects.
This study provides the first multiplanar characterization of spinal motion used during standing reach. Significant differences for a number of variables existed between younger and older subjects.
Clinical Biomechanics 05/1999; 14(4):271-9. · 2.07 Impact Factor
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ABSTRACT: People with Parkinson's disease (PD) have a progressive loss of function eventually leading to severe disability. Although PD would be expected to have a profound impact on an individual's psychosocial health, there is relatively limited research on its psychosocial effect. The purposes of this study were (a) to examine the relationships between physical disability, depression, and control beliefs and quality of life in people with PD and (b) to characterize how these psychosocial variables differ by stage of disease.
Eighty-six individuals from five stages based on clinical disability, ages 51-87, were interviewed. Established instruments were used to measure physical disability, depression, and control beliefs. Quality of life (QOL) was rated on a 5-point Likert scale.
A multivariable regression model including physical disability, stage of disease, depression, mastery, and health locus of control predicted QOL (R2 = 0.48), with mastery as the only significant predictor (p = .0001). There were significant differences by PD stage for all variables (p < .05).
Mastery predicted quality of life in individuals with PD even when depression and physical disability were included in the model. Differences in psychosocial variables by stage of PD suggest that the psychosocial profile of PD patients may change as the disease progresses.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 05/1999; 54(4):M197-202. · 4.60 Impact Factor
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ABSTRACT: The authors evaluated a consecutive sample of 542 elderly hospital patients for depression; of these, 160 depressed and 171 nondepressed patients were followed up for a median of 47 weeks after discharge. A subset of 113 depressed patients had significant physical disability. Depressed patients saw physicians more frequently, particularly during the 9- to 12-month period after hospital discharge. Depressed patients also had higher rates of rehospitalization and spent more days in the nursing home. These findings persisted after physical health status was controlled. Patients who remained both depressed and physically disabled during the follow-up period used the most general-medical services during the year after hospital discharge, but did not see mental health specialists any more frequently than those whose depression and physical disability improved. These results underscore the importance of diagnosing and treating depression during and after hospital discharge to increase quality of life and possibly reduce health service use.
American Journal of Geriatric Psychiatry 02/1999; 7(1):48-56. · 3.64 Impact Factor
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ABSTRACT: Authors examined effects of depressive symptoms on after-discharge survival of hospitalized medically ill male veterans. Psychosocial and physical health evaluations were performed on a consecutive sample of 1,001 patients ages 20-39 (16%) and 65-102 years (84%). Subjects or surviving family members were later contacted by telephone, and Cox proportional-hazards regression modeled the effects of depressive symptoms on time-to-death, controlling for demographics and social, psychiatric, and physical health. Follow-up was obtained on all 1,001 patients (average observation time, 9 years), during which 667 patients died (67%). Patients with depressive symptoms were significantly less likely to survive. For every 1-point increase on the 12-item Brief Carroll Depression Rating Scale (BCDRS), the hazard of dying increased by 10% (P<0. 0001). Age did not significantly affect the association between depressive symptoms and mortality. Depressive symptoms during acute hospitalization are a predictor of shortened survival.
American Journal of Geriatric Psychiatry 01/1999; 7(2):124-31. · 3.64 Impact Factor
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Journal of the American Dietetic Association 12/1998; 98(11):1328-30. · 3.59 Impact Factor
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ABSTRACT: The effectiveness of an exercise intervention for people in early and midstage Parkinson's disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described.
Fifty-one men and women, aged 55-84 years, identified through advertisement, local support groups, and local neurologists were enrolled into a randomized, controlled trial. Subjects were assigned randomly to an intervention or a usual care arm (i.e., no specific exercise). Of the original 51 participants, 46 completed the randomized, controlled trial. Participants in the exercise arm (n = 23) received individual instruction three times per week for 10 weeks. Participants in the usual care arm (n = 23) were "wait listed" for intervention.
Changes over 10 weeks in spinal flexibility (i.e., functional axial rotation) and physical performance (i.e., functional reach, timed supine to stand) were the primary outcome measures.
MANOVA conducted for the three primary outcome variables demonstrated significant differences (P < or = .05) between the two groups. Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group. There was no significant difference in supine to sit time.
Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD.
Journal of the American Geriatrics Society 11/1998; 46(10):1207-16. · 3.74 Impact Factor
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ABSTRACT: The authors examined whether depression is associated with greater use of health services by elderly medical patients before and during hospitalization.
Depression and recent use of health services were assessed in 542 patients aged 60 or over who were consecutively admitted to university medical services. Depression was measured by using the Center for Epidemiologic Studies Depression Scale, the Hamilton Depression Rating Scale, and the depressive disorders section of the National Institute of Mental Health Diagnostic Interview Schedule, which was administered by a psychiatrist.
After age, sex, race, education, and severity of medical illness were controlled for, Hamilton depression score significantly predicted hospital days in the past year, hospital days and total inpatient days (hospital plus nursing home) in the past 3 months, and number of outpatient medical visits in the past 3 months. Depressed patients had more hospital days in the past year and had more hospital days, total inpatient days, and outpatient medical visits in the past 3 months than did nondepressed patients. Associations between depression and length of index hospital stay, home health visits, nursing home days, and number of prescription medications disappeared when severity of medical illness was controlled. Mental health visits were no more common among depressed than nondepressed patients.
Depressed elderly medical inpatients used more hospital and outpatient medical services than nondepressed patients, but they did not receive more mental health services. Efforts by primary care physicians and third-party payers to identify and treat depression in this population are needed.
American Journal of Psychiatry 08/1998; 155(7):871-7. · 12.54 Impact Factor
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ABSTRACT: Physical therapists need objective measures that can be used reliably with a variety of subject groups to document upper quadrant function. Two aspects of upper quadrant motion, shoulder protraction and thoracolumbar rotation, are assessed routinely in clinical practice, but no standard measurement techniques have been reported. We hypothesized that there would be significant differences, by age and state of health, for both shoulder protraction and thoracolumbar rotation. The purposes of this study were: 1) to develop measurement approaches for shoulder protraction and thoracolumbar rotation; 2) to determine if there are significant differences in these motions for four subject groups: healthy young, healthy elders, functionally limited elders, and people with Parkinson's disease; and 3) to describe between-rater and within-rater reliability for these measures. Fifty-five subjects participated in this investigation. All subjects were rated by a physical therapist and two research assistants. Using an analysis of variance followed by Scheffe's post hoc analysis, significant differences were demonstrated between the groups. Between-rater and within-rater reliability ranged from ICCs of 0.54 to 0.95. Clinicians can use these measures to quantify aspects of upper quadrant function treated routinely in physical therapy practice. These measures also have applicability for researchers.
Journal of Orthopaedic and Sports Physical Therapy 06/1997; 25(5):329-35. · 3.00 Impact Factor
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ABSTRACT: Parkinson's disease (PD) is characterized by rigidity, postural instability, bradykinesia, and tremor, as well as other musculoskeletal impairments and functional limitations. The purpose of this investigation was to determine the reliability and stability of measures of impairments and physical performance for people in the early and middle stages of PD, Subjects. Thirteen men and 2 women in Hoehn and Yahr stages 2 and 3 of PD participated. Their mean age was 74.5 years (SD = 5.7, range = 64-84).
Thirteen impairment-level variables and 8 physical performance variables were measured. Measurements were taken on two consecutive days and again a week later on the corresponding two consecutive days. Reliability and stability were assessed using analysis of variance and intraclass correlation coefficients (ICCs).
Test-retest reliability (ICCs) of variables ranged from .69 (hamstring muscle length) to .97 (lumbar flexion). Intraclass correlation coefficients were .85 or greater for 10 of the variables.
The results suggest that in the early and middle stages of PD, many of the measures of impairment and physical performance are relatively stable.
Physical Therapy 02/1997; 77(1):19-27. · 3.11 Impact Factor
