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Effectiveness of subjective support-focused cognitive behavioral therapy on depressive symptoms among (pre)frail community-dwelling older adults: A randomized controlled trial
Purpose of review
Depression and physical illnesses have long been recognized as risk factors for suicidal behaviour in late life. Qualitative studies have previously identified frailty as being an issue in late life suicidal behaviour, but quantitative studies have been lacking. Establishing the role frailty plays in suicidal behaviour in late life has implications for suicide prevention.
Recent findings
Depression and frailty are closely linked in late life, with genetic and social factors suggesting bidirectional causality. Frailty is associated with an increased risk of suicidal ideation and suicide attempts that is likely enhanced by chronicity, depression, and social factors, such as living and eating alone. In contrast, suicide is associated with lower levels of frailty.
Summary
Suicide rates peak in late life with depression a consistently identified risk factor along with numerous diverse factors that include physical health and social issues. In investigating the relationship between physical health and suicidal behaviour, frailty has been neglected until recently. Interventions that reduce or prevent frailty and associated depression, such as physical training and nutritional management interventions, might have a role in preventing suicidal behaviour. Further research is required to elucidate the different associations reported between frailty and suicidal ideation/attempts and frailty and suicide.
Subjective support-focused cognitive behavioral therapy (SS-CBT) could increase subjective support among (pre)frail community-dwelling older adults, however, the underlying mechanisms remain unclear. We conducted a randomized controlled trial, in which the SS-CBT group (n = 50) received SS-CBT once a week for eight weeks and the wait-list control group (n = 50) received no intervention. The dependent variable was subjective support, and potential mediators included self-esteem, gratitude, cognitive distortions, interpersonal competence and rumination. Measurements took place before and after the intervention. We found that interpersonal competence mediated the effectiveness of SS-CBT on both perceived support availability (β = 2.030, 95%CI = 1.164, 3.081) and perceived support adequacy (β = 6.37, 95%CI = 3.52, 9.74), while self-esteem only mediated the effectiveness of SS-CBT on perceived support availability (β = 1.621, 95%CI = 0.502, 2.843). Gratitude, cognitive distortions, and rumination neither mediated the effectiveness of SS-CBT on perceived support availability nor on perceived support adequacy. These findings highlight self-esteem and interpersonal competence as the mechanisms through which SS-CBT increases subjective support, especially perceived support availability. This implicates that the SS-CBT should exclusively emphasize the apparent active ingredients (self-esteem and interpersonal competence) to promote its efficiency.
Gruppenpsychotherapie kann als Modalität neue Behandlungskapazitäten für die psychotherapeutisch unterversorgte Gruppe älterer Patient*innen schaffen. Die bisherige Evidenz in Form von einzelnen Studien und systematischen Reviews deutet auf gute Wirksamkeit der Gruppentherapie hin, dabei ist ein bisheriger Forschungsfokus die Behandlung von Depression bei älteren Personen. Durch die Begegnung mit anderen älteren Patientinnen, die sich in der gleichen Lebensphase befinden und ebenfalls mit den Herausforderungen des Älterwerdens konfrontiert sind, kann eine positive Altersidentität gefördert werden. Außerdem können Gruppenteilnehmer einen adaptiven Umgang mit typischen Herausforderungen des Älterwerdens erlernen. Gruppenformate können zudem zu einer Stärkung der ohnehin oft positiven Generationenidentität beitragen. Eine Herausforderung besteht darin, dass es schneller zu einer Affektansteckung und-überflutung kommen kann, und die Theory-of-Mind-Fähigkeiten im Alter abnehmen. Als praktische Unterstützung können Kliniker*innen auf das Behandlungsmanual Ageing Wisely zurückgreifen, das in mehreren Studien gute Wirksamkeit und Überlegenheit gegenüber aktiven Kontrollgruppen zur Reduktion von depressiven und Angstsymptomen im Alter demonstrieren konnte. Zukünftige Forschung sollte sich auch der Frage widmen, ob und wie virtuelle Gruppentherapien eine wirksame und akzeptable Intervention für (mobilitätseingeschränkte) ältere Personen darstellen können.
Background:
Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing.
Aim:
To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population.
Methods:
A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide).
Results:
Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms.
Conclusion:
To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.
Introduction: Social isolation and loneliness (SI/L) are growing problems with serious health implications for older adults, especially in light of the COVID-19 pandemic. We examined transcripts from semi-structured interviews with 97 older adults (mean age 83 years) to identify linguistic features of SI/L.
Methods: Natural Language Processing (NLP) methods were used to identify relevant interview segments (responses to specific questions), extract the type and number of social contacts and linguistic features such as sentiment, parts-of-speech, and syntactic complexity. We examined: (1) associations of NLP-derived assessments of social relationships and linguistic features with validated self-report assessments of social support and loneliness; and (2) important linguistic features for detecting individuals with higher level of SI/L by using machine learning (ML) models.
Results: NLP-derived assessments of social relationships were associated with self-reported assessments of social support and loneliness, though these associations were stronger in women than in men. Usage of first-person plural pronouns was negatively associated with loneliness in women and positively associated with emotional support in men. ML analysis using leave-one-out methodology showed good performance (F1 = 0.73, AUC = 0.75, specificity = 0.76, and sensitivity = 0.69) of the binary classification models in detecting individuals with higher level of SI/L. Comparable performance were also observed when classifying social and emotional support measures. Using ML models, we identified several linguistic features (including use of first-person plural pronouns, sentiment, sentence complexity, and sentence similarity) that most strongly predicted scores on scales for loneliness and social support.
Discussion: Linguistic data can provide unique insights into SI/L among older adults beyond scale-based assessments, though there are consistent gender differences. Future research studies that incorporate diverse linguistic features as well as other behavioral data-streams may be better able to capture the complexity of social functioning in older adults and identification of target subpopulations for future interventions. Given the novelty, use of NLP should include prospective consideration of bias, fairness, accountability, and related ethical and social implications.
Background:
Both theoretical and empirical evidence supports the potential of modest financial incentives to increase the reach of evidence-based weight control programs. However, few studies exist that examine the best incentive design for achieving the highest reach and representativeness at the lowest cost and whether or not incentive designs may be valued differentially by subgroups that experience obesity-related health disparities.
Methods:
A discrete choice experiment was conducted (n = 1232 participants; over 90% of them were overweight/obese) to collect stated preference towards different financial incentive attributes, including reward amount, program location, reward contingency, and payment form and frequency. Mixed logit and conditional logit models were used to determine overall and subgroup preference ranking of attributes. Using the National Health and Nutrition Examination Survey data sample weights and the estimated models, we predicted US nationally representative participation rates by subgroups and examined the effect of offering more than one incentive design. External validity was checked by using a completed cluster randomized control trial.
Results:
There were significant subgroup differences in preference toward incentive attributes. There was also a sizable negative response to larger incentive amounts among African Americans, suggesting that higher amounts would reduce participation from this population. We also find that offering participants a menu of incentive designs to choose from would increase reach more than offering higher reward amounts.
Conclusions:
We confirmed the existence of preference heterogeneity and the importance of subgroup-targeted incentive designs in any evidence-based weight control program to maximize population reach and reduce health disparities.
Background
Cognitive behavioural therapy (CBT) is a widely used treatment for depression. However, limited resource availability poses several barriers to patients seeking access to care, including lengthy wait times and geographical limitations. This has prompted health care services to introduce electronically delivered CBT (eCBT) to facilitate access. Although previous reviews have compared the effects of eCBT to face-to-face CBT, there is an overall lack of adequately powered and up-to-date evidence in the literature to provide a reliable comparison between the two modes of administration. The purpose of this study is to evaluate the effects of eCBT compared to face-to-face CBT through a systematic review of the literature.
Methods
To be eligible for this review, studies needed to be randomized controlled trials evaluating the clinical effectiveness of any form of eCBT compared to face-to-face CBT. These encompassed studies evaluating a wide range of outcomes including severity of symptoms, adverse outcomes, clinically relevant outcomes, global functionality, participant satisfaction, quality of life, and affordability. There were no restrictions on participant age or sex.
We searched MEDLINE, EMBASE, Psych Info, Cochrane CENTRAL and CINAHL databases from inception to February 20th, 2020 using a comprehensive search strategy. All stages of literature screening and data extraction were completed independently in duplicate. Data extraction and risk of bias analyses, including GRADE ratings, were conducted on studies meeting inclusion criteria. Qualitative measures are reported in a narrative summary. We pooled quantitative data in meta-analyses to provide an estimated summary effect. This review adheres to PRISMA reporting guidelines.
Findings
In total, we included 17 studies in our analyses. Our results demonstrated that eCBT was more effective than face-to-face CBT at reducing depression symptom severity (Standardized mean difference [SMD]: −1.73; 95% confidence interval [CI]: −2.72, −0.74; GRADE: moderate quality of evidence). There were no significant differences between the two interventions on participant satisfaction (SMD 0.13 95%; CI −0.32, 0.59; GRADE: low quality of evidence). One RCT reported eCBT to be less costly than face-to-face CBT (GRADE: low quality of evidence). Results did not differ when stratified by subgroups such as participant age and study location.
Interpretation
Although we found eCBT to have moderate evidence of effectiveness in reducing symptoms of depression, high heterogeneity among studies precludes definitive conclusions for all outcomes. With the current reliance and accessibility of technology to increasing number of people worldwide, serious consideration in utilizing technology should be given to maximize accessibility for depression treatments. Our results found eCBT is at least as effective as face to face CBT, thus eCBT should be offered if preferred by patients and therapists.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Objective:
We examined the modifying effects of social support on depressive symptoms and health-related quality of life (QoL) in patients receiving coping skills training (CST).
Method:
We considered the modifying effects of social support in the Coping Effectively with Heart Failure clinical trial, which randomized 179 heart failure (HF) patients to either 4 months of CST or usual care enhanced by HF education (HFE). CST involved training in specific coping techniques, whereas HFE involved education about HF self-management. Social support was assessed by the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory, QoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and depression was assessed with the Beck Depression Inventory-II (BDI-II).
Results:
Linear regression models revealed a significant Intervention Group × Baseline Social Support interaction for change in KCCQ total scores (p = .006) and BDI-II scores (p < .001). Participants with low social support assigned to the CST intervention showed large improvements in KCCQ scores (M = 11.2, 95% CI [5.7, 16.8]), whereas low-social-support patients assigned to the HFE controls showed no significant change (M = -0.8, 95% CI [-7.2, 5.6]). Similarly, BDI-II scores in participants with low social support in the CST group showed large reductions (M = -8.7, 95% CI [-11.3, -6.1]) compared with low-social-support HFE participants (M = -3.0, 95% CI [-6.0, -0.1]).
Conclusions:
HF patients with low social support benefit substantially from telephone-based CST interventions. Targeting HF patients with low social support for behavioral interventions could prove to be a cost-effective strategy for improving QoL and reducing depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Traditionally, evidence-based treatments for depression have focused on negative symptoms. Different authors describe the need to include positive affect as a major target of treatment. Positive psychology aims to fill this gap. Reaching everyone in need is also important, and Internet-based interventions can help in this task. The present study is a secondary analysis derived from a randomized controlled trial aimed to test the efficacy of an Internet-based intervention for patients with depressive symptoms. This intervention consisted of an 8-module Internet-based program that combined four modules based on cognitive-behavioral therapy strategies and four modules based on positive psychology strategies. The main goal of this secondary analysis is to report the data collected after each module from the participants who completed the intervention, explore the changes throughout the intervention process, and examine the changes observed in the different variables before versus after the introduction of the positive psychology component. A total of 103 patients completed the intervention. At pre-, post-intervention, and post-module evaluations, they completed positive and negative affect, depression, and anxiety measures. Negative affect and anxiety decreased significantly during the implementation of the cognitive-behavioral therapy and positive psychology modules. However, depression and positive affect improved only after the introduction of the positive psychology modules. This is the first study to explore, throughout the intervention process (module by module), the incorporation of a positive psychology component in an Internet-based program. Results suggest that positive psychology techniques might have an impact on clinical symptomatology, and they emphasize the need to include these techniques to achieve a more profound change in positive functioning measures.
Clinical Trial Registration: NCT02148354 (http://ClinicalTrials.gov/ct2/show/NCT02148354).
Objective:
Social support and social integration have been linked to lower rates of morbidity and mortality. However, the biological mechanisms responsible for such links need greater attention to advance theory and unique intervention opportunities. The main aim of this article was to conduct a meta-analytic review of the association between social support-social integration and inflammatory cytokines (e.g., interleukin-6, C-reactive protein) and test several proposed moderators from prior qualitative reviews.
Method:
A literature search was conducted using the ancestry approach and with databases PsycINFO, Medline, and EMBASE by crossing the exact keywordssocial supportorsocial integrationwithinflammation. The review identified 41 studies with a total of 73,037 participants.
Results:
The omnibus meta-analysis showed that social support-social integration were significantly related to lower levels of inflammation (Zr = -.073). These results were not moderated by the operationalization of social relationships or the type of population, cytokine, and design.
Conclusions:
These data suggest that inflammation is at least one important biological mechanism linking social support and social integration to the development and course of disease. Future work should continue to build on this review and address next-generation questions regarding antecedent processes, mechanisms, and other potential moderators. (PsycINFO Database Record
Background/Objective: Sleep insufficiency, which affects more than 45% of the world's population, has a great importance when considering older adults. Thus, this research tested a mediation hypothesis, through a path analysis, which explains how depression relates to the quality of life considering the effects of sleep quality in older adults. Method: A sample of 187 community-dwelling Portuguese older adults answered questionnaires about sociodemographic status (age, gender, highest level of education completed, family status, sports activities, health, and retirement status), quality of life, sleep quality, and depression. Descriptive and path analysis statistics were performed considering the results of the normality test. Results: The sample has health characteristics and presents adequate sleep duration. Sleep quality acted as a mediator between depression and the quality of life in older adults, considering the variation of gender and health. This suggests that it is important to establish self-care practices, namely sleep quality, to intervene in the ageing process. Conclusions: It is important to consider sleep quality associated with depression for older adults and to test interventions to minimize health impacts. Also, more researches are needed about the primary prevention in sleep quality relating to depression.
Background:
Physical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown.
Methods:
A cohort of 378 older persons (?60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination.
Results:
For each additional frailty component, the odds of non-remission was 1.24 [95% CI=1.01-1.52] (P=040). Linear mixed models showed that only improvement of the motivational (P<001) subscale and the somatic subscale (P=003) of the IDS over time were dependent on the frailty severity.
Conclusions:
Physical frailty negatively impacts the course of late-life depression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment.
One theory of age-related cognitive decline proposes that changes within the default mode network (DMN) of the brain impact the ability to successfully perform cognitive operations. To investigate this theory, we examined functional covariance within brain networks using regional cerebral blood flow data, measured by 15O-water PET, from 99 participants (mean baseline age 68.6 ± 7.5) in the Baltimore Longitudinal Study of Aging collected over a 7.4 year period. The sample was divided in tertiles based on longitudinal performance on a verbal recognition memory task administered during scanning, and functional covariance was compared between the upper (improvers) and lower (decliners) tertile groups. The DMN and verbal memory networks (VMN) were then examined during the verbal memory scan condition. For each network, group differences in node-to-network coherence and individual node-to-node covariance relationships were assessed at baseline and in change over time. Compared with improvers, decliners showed differences in node-to-network coherence and in node-to-node relationships in the DMN but not the VMN during verbal memory. These DMN differences reflected greater covariance with better task performance at baseline and both increasing and declining covariance with declining task performance over time for decliners. When examined during the resting state alone, the direction of change in DMN covariance was similar to that seen during task performance, but node-to-node relationships differed from those observed during the task condition. These results suggest that disengagement of DMN components during task performance is not essential for successful cognitive performance as previously proposed. Instead, a proper balance in network processes may be needed to support optimal task performance.
Defines the self-concept as a set of cognitive structures (self-schemas) that provide for individual expertise in particular social domains. Two studies were conducted with 62 male undergraduates with self-reported masculinity schemas (schematics) and 58 male undergraduates without schemas (aschematics) to examine the information-processing consequences of this expertise for the perception of others. Ss viewed a film and were required to unitize the film into segments, describe the actor, and recall the actor's behavior. Findings show that, in the unitizing task, schematics consistently divided a schema-relevant film about another person into larger units than did aschematics. In reconstructing the film sequence, schematics made more global conjectures about the personality and motivation of the target individual, implying an instance of expert performance, in which the self-schema provided the schematics with an interpretive framework for organizing the schema-relevant behavior of others. When given instructions to attend to the details of behavior, schematics made smaller units, whereas the performance of the aschematics did not vary. The role of the self-concept in the perception of others is seen to vary systematically with whether self or other is the cognitive reference point and the conditions associated with each are delineated. (68 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article revisits two classical issues in experimental methodology: experimenter bias and demand characteristics. We report a content analysis of the method section of experiments reported in two psychology journals (Psychological Science and the Journal of Personality and Social Psychology), focusing on aspects of the procedure associated with these two phenomena, such as mention of the presence of the experimenter, suspicion probing, and handling of deception. We note that such information is very often absent, which prevents observers from gauging the extent to which such factors influence the results. We consider the reasons that may explain this omission, including the automatization of psychology experiments, the evolution of research topics, and, most important, a view of research participants as passive receptacles of stimuli. Using a situated social cognition perspective, we emphasize the importance of integrating the social context of experiments in the explanation of psychological phenomena. We illustrate this argument via a controversy on stereotype-based behavioral priming effects.
This article describes 2 studies testing hypotheses that perceived social support operates in part as a cognitive personality construct. Both studies found that perceived support manifested a pattern of correlations more similar to cognitive variables than did support received from the environment and that the relation between perceived support and psychological distress was reduced substantially when the cognitive personality variables were controlled statistically. Study 2 also tested hypotheses generated from schema theory that perceived support would be related to the interpretation and recall of novel supportive behaviors. As predicted, low-perceived-support students interpreted novel supportive behaviors more negatively than high-support students and remembered a lower proportion of behaviors perceived as helpful. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) researchers and scholars carry assumptions about the characteristics of these therapies, and the extent to which they differ from one another. This article examines proposed differences between CBT and ACT for anxiety disorders, including aspects of treatment components, processes, and outcomes. The general conclusion is that the treatments are more similar than distinct. Potential treatment mediators and issues related to the identification of mediators are considered in depth, and directions for future research are explored.
In two longitudinal studies, the authors examined the direction of the relationships between trait gratitude, perceived social support, stress, and depression during a life transition. Both studies used a full cross-lagged panel design, with participants completing all measures at the start and end of their first semester at college. Structural equation modeling was used to compare models of direct, reverse, and reciprocal models of directionality. Both studies supported a direct model whereby gratitude led to higher levels of perceived social support, and lower levels of stress and depression. In contrast, no variable led to gratitude, and most models of mediation were discounted. Study 2 additionally showed that gratitude leads to the other variables independently of the Big Five factors of personality. Overall gratitude seems to directly foster social support, and to protect people from stress and depression, which has implications for clinical interventions.
Tested a preventive intervention in which peer telephone dyads were developed for low-income, community-living, elderly women with low perceived social support. After an initial assessment, respondents were randomly assigned to either an assessment-only control or received 10 weeks of friendly staff telephone contact. After a second assessment, participants receiving the staff contact were randomly assigned to continue that contact or were paired in dyads to continue phone contact with one another. Dependent variables were measures of perceived social support, morale, depression, and loneliness. All groups, particularly the staff contact group, showed some improvement in mental health scores over time, but there were no significant differences between intervention groups, or between intervention and assessment-only control groups. The results suggest that participation in the study and in personal assessment interviews at home were probably morale enhancing, and that additional telephone contact did not significantly add to that effect. Evidence also indicates that, in this sample, low perceived family support was significantly related to poor mental health, so it is possible that a program designed to increase friend support may have been the wrong intervention.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
The purpose of this article is to determine whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (a) whether a measure assesses support structure or function, and (b) the degree of specificity (vs. globality) of the scale. By structure we mean simply the existence of relationships, and by function we mean the extent to which one’s interpersonal relationships provide particular resources. Special attention is paid to methodological characteristics that are requisite for a fair comparison of the models. The review concludes that there is evidence consistent with both models. Evidence for a buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a person’s degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications of these conclusions for theories of social support processes and for the design of preventive interventions are discussed.
Four studies explored the effects of self-focused rumination vs. distraction on dysphoric and nondysphoric students' retrieval of autobiographical memories. Dysphorics induced to ruminate subsequently recalled more negatively biased autobiographical memories in free recall (Study 1) and in response to prompts for memories (Study 2) than either dysphorics who first distracted themselves from their mood or nondysphoric controls. In Study 3, dysphoric rumination led students to recall negative events as occurring relatively frequently in their lives and positive events as occurring relatively infrequently. In Study 4, judges scored transcripts of participants' thoughts as expressed aloud while engaging in rumination or distraction. Codings revealed that dysphoric ruminators spontaneously generated memories that were more negative than those of the other three groups. Implications of a ruminative response style for progress in therapy, as well as for enhancing dysphoria and negatively biased cognitive processes, are discussed.
Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment.
To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI.Design, Setting, and
Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers. Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression (HRSD); LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI). Random allocation was to usual medical care or CBT-based psychosocial intervention.
Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks.
Composite primary end point of death or recurrent MI; secondary outcomes included change in HRSD (for depression) or ESSI scores (for LPSS) at 6 months.
Improvement in psychosocial outcomes at 6 months favored treatment: mean (SD) change in HRSD score, -10.1 (7.8) in the depression and psychosocial intervention group vs -8.4 (7.7) in the depression and usual care group (P<.001); mean (SD) change in ESSI score, 5.1 (5.9) in the LPSS and psychosocial intervention group vs 3.4 (6.0) in the LPSS and usual care group (P<.001). After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9%) and psychosocial intervention (75.8%). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups (depression, LPSS, and depression and LPSS patients).
The intervention did not increase event-free survival. The intervention improved depression and social isolation, although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients.
We examined the relationship between the character strength of kindness and subjective happiness (Study 1), and the effects of a counting kindnesses intervention on subjective happiness (Study 2). In Study 1, participants were 175 Japanese undergraduate students and in Study 2, participants were 119 Japanese women (71 in the intervention group and 48 in the control group). Results showed that: (a) Happy people scored higher on their motivation to perform, and their recognition and enactment of kind behaviors. (b) Happy people have more happy memories in daily life in terms of both quantity and quality. (c) Subjective happiness was increased simply by counting one's own acts of kindness for one week. (d) Happy people became more kind and grateful through the counting kindnesses intervention. Discussion centers on the importance of kindness in producing subjective happiness.
Background and objectives:
Frailty is associated with depression in older adults, and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression.
Research design and methods:
This cross-sectional study was conducted among 1779 community-dwelling older adults aged 60 and over. Frailty, social support and depressive symptoms were measured by the Physical Frailty Phenotype (PFP), Social Support Rating Scale (SSRS), and 5-item Geriatric Depression Scale (GDS-5), respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain.
Results:
Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson-Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset.
Discussion and implications:
Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.
Background
Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.
Aim
To estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.
Method
We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.
Results
A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.
Conclusion
Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.
Declaration of interest
None.
Introduction Depression in old age is associated with functional disabilities, cognitive impairment, lower self-rated quality of life, and increased mortality. The aim of the study was to reveal the prevalence of depression and to investigate the characteristics of patients treated with antidepressants.
Methods We analyzed data from the Bruneck Study 2010. All participants completed a clinical examination, cognitive screening, the 30-item Geriatric Depression Scale (GDS) (cutoff score of>8 to define relevant depressive symptoms), and the World Health Organization quality of life questionnaire (WHO-QoL). Group differences were calculated using binary logistic regression analysis.
Results Out of 456 participants (mean age of 73.1±8.2 years), 22.1% showed depressive symptoms, and out of these, 30% were taking antidepressants. The depressed group compared to the GDS ≤8 group showed significantly lower WHO-QoL (p<0.001) and Mini Mental State Examination (p=0.015) score. Further, 13% of the latter compared to the GDS>8 group received antidepressants, and these had a lower WHO-QoL score (p<0.033).
Discussion Depressive symptoms are frequent in the elderly population. Our results confirm the negative influence of depressive symptoms on cognition and quality of life. Patients with somatic comorbidities are likely to receive more antidepressant medication.
Objective:
To cross-culturally adapt and test the FRAIL scale in Chinese community-dwelling older adults.
Design:
Cross-sectional study.
Methods:
The Chinese FRAIL scale was generated by translation and back-translation. An urban sample of 1235 Chinese community-dwelling older adults was enrolled to test its psychometric properties, including convergent validity, criterion validity, known-group divergent validity, internal consistency and test-retest reliability.
Results:
The Chinese FRAIL scale achieved semantic, idiomatic, and experiential equivalence. The convergent validity was confirmed by statistically significant kappa coefficients (0.209-0.401, P < .001) of each item with its corresponding alternative measurement, including the 7th item of the Center for Epidemiologic Studies-Depression Scale, the Timed Up and Go test, 4-m walking speed, polypharmacy, and the Short-Form Mini Nutritional Assessment. Using the Fried frailty phenotype as an external criterion, the Chinese FRAIL scale showed satisfactory diagnostic accuracy for frailty (area under the curve = 0.91). The optimal cut-point for frailty was 2 (sensitivity: 86.96%, specificity: 85.64%). The Chinese FRAIL scale had fair agreement with the Fried frailty phenotype (kappa = 0.274, P < .001), and classified more participants into frailty (17.2%) than the Fried frailty phenotype (3.9%). More frail individuals were recognized by the Chinese FRAIL scale among older and female participants than their counterparts (P < .001), respectively. It had low internal consistency (Kuder-Richardson formula 20 = 0.485) and good test-retest reliability within a 7- to 15-day interval (intraclass correlation coefficient = 0.708).
Conclusions:
The Chinese FRAIL scale presents acceptable validity and reliability and can apply to Chinese community-dwelling older adults.
Gratitude interventions have been proposed as beneficial practices for improving myriad positive outcomes, and are promoted in self-help literature. The current work examined gratitude interventions’ effects with meta-analytic techniques to synthesize findings of thirty-eight studies, totaling 282 effect sizes. Fifty-six separate meta-analyses examined outcome effects for: gratitude versus neutral comparison at postintervention and delayed follow-up; gratitude versus negative comparison at post and follow-up; and gratitude versus positive comparison at post and follow-up. Results show that gratitude interventions can lead to improvements for numerous outcomes, including happiness, but do not influence others. Their unique benefits may be overemphasized in the literature.
Background
We investigated the effect of multi-domain lifestyle (physical, nutritional, cognitive) interventions among frail and pre-frail community-living older persons on reducing depressive symptoms. Method
Participants aged 65 and above were randomly allocated to 24 weeks duration interventions with nutritional supplementation (N=49), physical training (N=48), cognitive training (N=50), combination intervention (N=49) and usual care control (N=50). Depressive symptoms were assessed by the Geriatric Depression Scale (GDS-15) at baseline (0M), 3 month (3M), 6 month (6M) and 12 month (12M). ResultsMean GDS scores in the control group increased from 0.52 (0M) and 0.54 (3M) to 0.74 (6M), and 0.83 (12M). Compared to the control group, interventions showed significant differences (Δ=change) at 6M for cognitive versus control (Δ=-0.39, p=0.021, group*time interaction p=0.14); physical versus control (Δ =-0.37, p=0.026, group*time interaction p=0.13), and at 12M for nutrition versus control (Δ =-0.46, p=0.016, group*time interaction p=0.15). The effect for combination versus control was significant at 6M (Δ =-0.43, p=0.020) and 12M (Δ =-0.51, p=0.005, group*time interaction p=0.026). Estimated 12-month cumulative incidence of depressive symptoms (GDS≥2) relative to control were OR=0.38, p=0.037 (nutrition); OR=0.71, p=0.40 (cognitive); OR=0.39, p=0.042 (physical training) and OR=0.38, p=0.037 (combination). Changes in gait speed and energy level were significantly associated with changes in GDS scores over time. Conclusion
Multi-domain interventions that reverse frailty among community-living older persons also reduce depressive symptomatology. Public health education and programmatic measures combining nutritional, physical and cognitive interventions for at-risk frail older people may likely benefit psychological wellbeing.
• In earlier reports, we demonstrated that in patients with recurrent unipolar depression, survival time without a new episode of major depression following discontinuation of medication was significantly and positively related to continued interpersonal psychotherapy (IPT). To determine whether the prophylactic benefit of monthly sessions of IPT was a function of specific features of the intervention, we examined the contribution of the quality of IPT sessions to the length of the well interval in this 3-year maintenance trial. Therapy sessions were rated on specificity and purity of interpersonal interventions. Analysis of these ratings indicated that psychotherapy that was more specifically interpersonal was associated with significantly increased survival time. Patients whose therapy sessions were rated above the median on specificity of IPT had a median survival time of almost 2 years, while those below the median had a median survival time of less than 5 months. We concluded that when patient and therapist are able to maintain a high level of interpersonal focus, monthly sessions of IPT have substantial prophylactic benefit.
This study aimed to examine the cross-sectional and longitudinal relationships between physical frailty at baseline and depressive symptoms at baseline and at follow-up.
Four-year prospective study.
Communities in the South East Region of Singapore.
We analyzed data of 1827 older Chinese adults aged 55 and above in the Singapore Longitudinal Aging Study-I.
The frailty phenotype (based on Fried criteria) was determined at baseline, depressive symptoms (Geriatric Depression Scale ≥5) at baseline and follow-ups at 2 and 4 years.
The mean age of the population was 65.9 (standard deviation 7.26). At baseline, 11.4% (n = 209) had depressive symptoms, 32.4% (n = 591) were prefrail and 2.5% (n = 46) were frail. In cross-sectional analysis of baseline data, the adjusted odds ratios (OR)s and 95% confidence intervals controlling for demographic, comorbidities, and other confounders were 1.69 (1.23-2.33) for prefrailty and 2.36 (1.08-5.15) for frailty, (P for linear trend <.001). In longitudinal data analyses, prospective associations among all participants were: prefrail: OR = 1.86 (1.08-3.20); frail: OR = 3.09 (1.12-8.50); (P for linear trend = .009). Among participants free of depressive symptoms at baseline, similar prospective associations were found: prefrail OR = 2.26 (1.12-4.57); frail: OR = 3.75 (1.07-13.16); (P for linear trend = .009).
These data support a significant role of frailty as a predictor of depression in a relatively younger old Chinese population. Further observational and interventional studies should explore short-term dynamic and bidirectional associations and the effects of frailty reversal on depression risk.
Background: Much evidence has accumulated over the last three decades that low social support is related to both mental and physical health. Despite this large and convincing literature, reviewers have noted that there exists remarkably little evidence that social support can be increased by an appropriate intervention. This study reports on the development and evaluation of a new intervention for social support which takes account of the stress-buffering and direct effect models. Method: Eighty-one individuals scoring low on social support were randomly allocated to the intervention or a waiting-list control condition. Treatment consisted of 10 weekly sessions administered in a group format, and 49 participants (nine males) completed assessments at the beginning and end of a 10-week period, and at 10-week follow-up (intervention condition only). Results: The intervention proved to be successful at increasing functional support but not structural support. The intervention was also successful in increasing the social skill of self-disclosure, and decreasing depression. Gains made between pre- and post-treatment were maintained at 10-week follow-up. Conclusions: Based on published analyses of the effects of social support on health, the results imply that the intervention would be useful for stress-buffering purposes, but not for the general health-promoting effects that are associated with good social integration.
Depression is frequently encountered in hospitalized elderly persons. Studies have found an independent association between depressive symptoms, mortality and functional decline. Only a few studies look specifically at other potential effects of depressive symptoms, such as subsequent hospital readmission or nursing home admission. In this study, we aim to investigate the association between the presence of depressive symptoms and nursing home placement, hospital admission and mortality in a group of geriatric outpatients receiving rehabilitation.
All community dwelling elderly patients with no history of depression or cognitive impairment who were new attendances of a geriatric day hospital of a regional hospital in Hong Kong were recruited. Baseline demographic data, medical comorbidities, functional status and presence of depressive symptoms defined as a Geriatric Depression Scale score of more than 8 were recorded. Outcome variables were mortality, nursing home admission and unplanned hospital admission rate at 1 year.
Two hundred and nine subjects were included with a mean age of 77.4 years (standard deviation, 7.6). There was no statistically significant difference on mortality at 1 year and nursing home admission. However, depressed subjects were found to have increased risk of hospital admission (odds ratio = 2.67, 95% confidence interval = 1.31, 5.32) and have more episodes of unplanned hospital admission (odds ratio = 1.52, 95% confidence interval = 1.1, 2.12).
Elderly patients with depressive symptoms are associated with increased risk of hospital admission and greater inpatient service utilization, independent of their functional status. These results emphasize the need to improve the management of depressive symptoms and heighten the recognition and treatment of depression in the elderly population.
Frailty is a common and central problem of old age. Recent research has defined frailty as an accumulation of deficits or as a distinct clinical syndrome involving specific comorbid physical disorders and functional impairment, but the psychological aspects of frailty have received little attention. It is proposed that the onset of frailty is associated with an identity crisis, a psychological stage of adult development termed the "frailty identity crisis." This framework could be useful to focus attention on the psychological aspects of frailty for research and clinical purposes. Early detection, management, and counseling of individuals experiencing the frailty identity crisis has implications for the health and quality of life of frail individuals, their loved ones and caregivers, and society.
Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.
A 6-month long preventive intervention program for newly separated persons was designed on the basis of an analysis of the literature that identified the major stressful elements in the separation experience. Following the implementation of the program, its impact was assessed by contrasting persons who were assigned to the program (n = 100) with newly separated persons who were randomly selected to serve as a no-treatment control group (n = 50). Of the nine dependent measures of adjustment used in this evaluation, five significant posttreatment differences were found, in each case favoring the intervention group. The nature of these significant differences is particularly encouraging in light of the preventively oriented objectives of the intervention program. Detailed analysis of program characteristics resulted in the identification of desirable program modifications that could be implemented when the program is reinstituted.
The authors conducted a 2-year study of postbereavement adaptation in 162 widows. Sixty-eight were paired with a widow contact who provided emotional support and practical assistance. The differences between the women receiving intervention and the controls at 6, 12, and 24 months after bereavement suggested that those receiving intervention followed the same general course of adaptation as control subjects but that the rate of achieving landmark stages was accelerated for the intervention group. The Goldberg General Health Questionnaire and two indices derived from the study questionnaire confirmed the hypothesized "pathway" of adaptation" through intra- and interpersonal adaptation to resolution of overall distress and the effectiveness of the intervention.
Investigated the effects of a 13-week preventive, psychoeducational intervention program to improve perceived social support. Fifty-one, low-perceived support, community residents were randomly assigned to an intervention or wait-list control condition. Intervention subjects received training in social skills and cognitive reframing regarding the self and social relations. The intervention led to increased perceived social support from family, but not from friends. As hypothesized by social cognition models, increases in perceived support appeared to be mediated by changes in self-esteem and frequency of self-reinforcement. Further, such changes in cognition about the self were larger than the changes observed for perceived support, suggesting that it may be easier to change cognition about the self than perceptions of support.
To develop and test the effectiveness of a 5-item version of the Geriatric Depression Scale (GDS) in screening for depression in a frail community-dwelling older population.
A cross-sectional study.
A geriatric outpatient clinic at the Sepulveda VA Medical Center, Sepulveda, California.
A total of 74 frail outpatients (98.6% male, mean age 74.6) enrolled in an ongoing trial.
Subjects had a comprehensive geriatric assessment that included a structured clinical evaluation for depression with geropsychiatric consultation. A 5-item version of the GDS was created from the 15-item GDS by selecting the items with the highest Pearson chi2 correlation with clinical diagnosis of depression. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for the 15-item GDS and the new 5-item scale.
Subjects had a mean GDS score of 6.2 (range 0-15). Clinical evaluation found that 46% of subjects were depressed. The depressed and not depressed groups were similar with regard to demographics, mental status, educational level, and number of chronic medical conditions. Using clinical evaluation as the gold standard for depression, the 5-item GDS (compared with the 15-item GDS results shown in parentheses) had a sensitivity of .97 (.94), specificity of .85 (.83), positive predictive value of .85 (.82), negative predictive value of .97 (.94), and accuracy of .90 (.88) for predicting depression. Significant agreement was found between depression diagnosis and the 5-item GDS (kappa = 0.81). Multiple other short forms were tested, and are discussed. The mean administration times for the 5- and 15-item GDS were .9 and 2.7 minutes, respectively.
The 5-item GDS was as effective as the 15-item GDS for depression screening in this population, with a marked reduction in administration time. If validated elsewhere, it may prove to be a preferred screening test for depression.
The American Geriatrics Society sponsored a working conference in January 2004, funded by the National Institute on Aging, to establish the state of the art in frailty research and to set a research agenda for the future. The invited participants included senior basic biologists, epidemiologists, geneticists, and clinical investigators who study aging-related issues. This article summarizes the central theoretical observations on frailty and research needs and opportunities presented and discussed at this conference, and lays out an agenda for future research on frailty.
To test the effectiveness of a five-item version of the Geriatric Depression Scale (GDS) for the screening of depression in community-dwelling older subjects, hospitalized older patients, and nursing home residents.
A cross-sectional study.
A geriatric acute care ward, a geriatric outpatient clinic, and a nursing home.
One hundred eighty-one cognitively intact older subjects.
All the participants had a comprehensive geriatric assessment including a neuropsychological evaluation by a geriatrician experienced in the management of depression. The five-item GDS was compared with the 15-item version of the GDS using the clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria as the criterion standard. The sensitivity, the specificity, the overall accuracy, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The agreement between each of two different versions of the GDS and the clinical diagnosis and the test-retest and the interrater reliability of the five-item scale were also evaluated.
In the whole sample, 48.1% of the subjects were depressed. The five-item GDS had a sensitivity of 0.94 (0.91-0.98), a specificity of 0.81 (0.75-0.87), a positive predictive value of 0.81 (0.75-0.87), a negative predictive value of 0.94 (0.90-0.97), a positive likelihood ratio of 4.92 (4.39-5.5), and a negative likelihood ratio of 0.07 (0.06-0.08). The five-item GDS and the 15-item GDS showed a significant agreement with the clinical diagnosis of depression (kappa = 0.74 for both scales). The five-item GDS had good interrater reliability (kappa = 0.88) and test-retest reliability (kappa = 0.84). Similar values were obtained in each setting and in both sexes.
The five-item GDS is as effective as the 15-item GDS for the screening of depression in cognitively intact older subjects.
Health service utilization and costs of depressive symptoms in late life: a systematic review
- Luppa
Self-compassion and forgiveness
- Neff