No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Risk factors for anxiety and depression in the elderly: A review
Abstract
Although a number of studies have examined risk factors for anxiety and depression at a later age, there have been no systematic comparisons of risk profiles across studies. Knowledge on such risk profiles may further our understanding of both the etiology and early recognition of these highly prevalent disorders. This paper gives a comprehensive overview and compares risk factors associated with anxiety and depression in the elderly.
The databases MEDLINE, PsycINFO and Sociological Abstracts were systematically searched, and relevant English-language articles from January 1995 to December 2005 were reviewed. Cross-sectional and longitudinal studies on risk factors in elderly from a community or primary care setting were included. The associations between risk factors and pure anxiety or depressive symptoms or disorders were summarized and compared.
The abstracted risk factors from studies on anxiety (N=17) and depression (N=71) were clustered into the categories biological, psychological and social. Although risk factors for anxiety and depression showed many similarities, some differences were found. Biological factors may be more important in predicting depression, and a differential effect of social factors on depression and anxiety was found.
Due to a high heterogeneity between studies, no meta-analysis could be conducted.
There is considerable overlap between the risk profiles for anxiety and depression in the elderly, which suggests a dimensional approach on the interrelationship between anxiety and depression is more appropriate. To improve the recognition and preventive mental health programs, a clearer understanding of differentiating etiological factors will be needed.
... However, within samples of older people, a number of factors will influence the obtained estimates of incidence or prevalence. Should the sample not be population representative and/or appropriately randomly selected, variability in genetics (Demirkan et al., 2011); personality traits such as neuroticism (Fiske et al., 2009); demographics -gender, age, marrital status, etc. (e.g., Renn et al., 2020); financial situation (e.g., Byles et al., 2012;Vink et al., 2008); religiosity and socialbility/social support levels (e.g., Beekman et al., 1998Beekman et al., , 2000Child & Lawton, 2020;E. Curran et al., 2019); trauma exposure (e.g., Förster et al., 2018); lifestyle and health-related factors (N. ...
... Consistent with the adult literature, being female in early or later old age is a risk factor for higher levels of depression (Chou, 2008;Cole & Dendukuri, 2003;Fang et al., 2019;Gureje et al., 2008;Kaji et al., 2010;Luijendijk et al., 2008;Nakulan et al., 2015;Smit et al., 2006), anxiety (Lieb et al., 2005;Renn et al., 2020;Vink et al., 2008;Wolitzky-Taylor et al., 2010; and nonspecific psychologic distress, henceforth referred to as ...
... Inadequate income or debt has been associated with higher depression, anxiety and distress symptoms in older populations (Byles et al., 2012;Marshall et al., 2021;Muhammad et al., 2021;Pothisiri & Vicerra, 2021;Vink et al., 2008). Higher household spending is also independently associated with worse mental health outcomes (Rai et al., 2013). ...
Background: Late life is typically accompanied by unique physical and mental health challenges. Fewer older people are diagnosed with mood or anxiety-specific disorders than their younger counterparts. However, older people score more highly than younger people on symptom screens indicating high levels of clinically relevant depressive, anxiety, and nonspecific psychological distress symptoms which cause high morbidity, mortality, disability, and poor quality of life. The unique presentation of late life psychiatric syndromes, such as depression and anxiety, remain largely unaddressed in existing psychiatric nosology and measurement techniques, as do depictions of depression and anxiety across diverse cultural contexts. Very few studies exist investigating either the descriptive epidemiology of depression and anxiety among older adults living in low-middle income countries (LMIC) or the unique challenges of mental health measurement in LMIC contexts. This dissertation contributes to this developing evidence base by providing a critical analysis of point prevalence estimates of depression, anxiety, and nonspecific psychological distress (distress) symptoms in two samples of Indonesian rural older persons. Methods: We enumerated greater than or equal to 60-year-olds in 12 Indonesian rural villages as part of the Ageing in Rural Indonesia Study in 2015/16 (N=2526; sample 1). We re-enumerated two of the 12 villages surveyed in 2015 in 2017 (N=536; sample 2). Depressive and distress symptoms were each measured using three scales: PHQ-8/9, CES-D, GDS, and K6, DQ5 and SRQ-20 respectively. Anxiety symptoms were evaluated with the GAD-7. Classical Test Theory and Item Response Theory were used to investigate the psychometric properties of symptom screens. We also undertook mixed effects modelling and Moderated Nonlinear Factor Analysis to identify sources of variability in prevalence estimates. Results: Commonly used cut points of short symptom screens used to approximate diagnostic depressive disorders produced estimates that typically lacked comparability (e.g., sample 2 point-prevalence 3.2%-39.9%). Psychometric analysis further identified mental health scales with better (PHQ-8/9, GAD-7, K6, DQ5) and poorer (GDS, SRQ) construct validity. Sources of variability in point prevalence estimates of depression, anxiety and distress symptoms were identified, and related to study design, cognitive ability, marital status, financial means, level of social support, lifestyle, and health related status. Pervasive non-invariance was identified in participant responses to scale items related to gender, literacy, and ethnicity. However, when modelled, measurement non-invariance did not substantially modify means. Females, respondents with lower literacy levels, and Batak and Sundanese sample villages had significantly higher levels of depression, anxiety, and distress symptoms. Conclusion: The practice of using existing mental health symptom screens combined with commonly used cut points as proxies for depression and anxiety in older rural Indonesians and other diverse populations should be avoided. Rigorous psychometric and diagnostic validation evidence should be ascertained. In the interim, better performing symptom screening tools (i.e., PHQ-8/9, GAD-7, K6, DQ5) may be used as measures of continuous symptom severity. Future research should focus on evaluating the distinctive and overlapping features of mental ill-health in specific subpopulations of Indonesians.
... The findings of female sex as a risk factor are supported by comparable results of prior studies (Gureje et al., 2011;Luppa et al., 2012;Bee-Horng et al., 2010;Chou, 2008;Vink et al., 2008). We found a 49% increased risk for women compared to men, which is within the range reported by Djernes (2006) -between 1.3 and 3.4 (odds ratios, OR). ...
... Our findings of ApoE4 status and depression support results of a prior review (Vink et al., 2008), which found insignificant results of ApoE4 in two longitudinal studies (Blazer et al., 2002;Henderson et al., 1997), while an association between ApoE4 and depression was found in crosssectional studies (Nebes et al., 2001;Vink et al., 2008). However, another cross-sectional study showed that this association disappears when stratifying for Alzheimer's disease (Slifer et al., 2009). ...
... Our findings of ApoE4 status and depression support results of a prior review (Vink et al., 2008), which found insignificant results of ApoE4 in two longitudinal studies (Blazer et al., 2002;Henderson et al., 1997), while an association between ApoE4 and depression was found in crosssectional studies (Nebes et al., 2001;Vink et al., 2008). However, another cross-sectional study showed that this association disappears when stratifying for Alzheimer's disease (Slifer et al., 2009). ...
Introduction
Only a few studies have investigated incidence and risk factors of depression in the highest age groups. This study aims to determine incidence rates as well as risk factors of incident depressive symptoms in latest life, adjusting for the competing event of mortality.
Methods
Data of a prospective, longitudinal, multi-centered cohort study conducted in primary care – the AgeCoDe-/AgeQualiDe study. 2436 GP patients aged 75+ years were assessed from baseline to sixth follow-up every 18 months and from seventh to ninth follow-up every 10 months. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (cut-off ≥6). Competing risk regression models were used to assess determinants of incident depressive symptoms, taking care of accumulated mortality.
Results
The incidence of depressive symptoms was 39 per 1000 person-years (95% CI 36–42; last observed exit 13.26 person-years at risk). In a competing risk regression model, female sex, unmarried family status, subjective cognitive decline as well as vision and mobility impairment were significant risk factors of incident depression.
Limitations
Excluding individuals with a lack of ability to provide informed consent at baseline may have influenced the incidence of depression. Depressive symptoms were not assessed by DSM criteria. Furthermore, in studies with voluntary participation, participation bias can never be completely avoided.
Conclusion
Findings provide a better understanding of risk and protective factors of depressive symptoms in the oldest age taking mortality as a competing event into account. Addressing this aspect in future research may yield new insights in that research field.
... A nxiety disorders, particularly generalised anxiety disorder and agoraphobia are common in the elderly but these conditions are often ignored and undertreated (Vink et al, 2008). Comorbidity with depression often results in poorer treatment outcomes (Diefenbach and Goethe, 2006). ...
... Therapy. Pergamon Press, New York JCN KEY POINTS Anxiety disorders, particularly generalised anxiety disorder (GAD) and agoraphobia are common in the elderly, but these conditions are often ignored and undertreated (Vink et al, 2008). ...
Anxiety disorders are common amongst elderly housebound clients and are undertreated with detrimental effects to this population. Effective treatment for anxiety includes access to a talking therapy. Cognitive behavioural therapy (CBT) for anxiety is proven to be successful and has a low r elapse rate. Elderly housebound clients have poor access to talking therapies which compounds existing health inequalities. District and community nurses could be instrumental in enabling elderly housebound clients to have access to CBT approaches for the treatment of anxiety at an early stage, which could gr eatly improve outcomes.
... Depression in older adults is a serious public health issue globally, and may have a profound effect on every aspect of life, including school performance, work productivity, relationships with family and friends, and community involvement. The in uence of individual factors on depressive symptoms among older adults have previously been examined by many researchers [13][14][15][16][17][18][19]. These factors encompass demographic characteristics (e.g., gender, age, level of education, marital status, and residence), health status (e.g., self-rated health (SRH) and chronic diseases), and lifestyle factors (e.g., drinking, smoking, and exercise). ...
... In China, the implementation of HCBSs occurred later than that in Western countries. However, since 2008, a series of policies have been implemented to not only encourage the provision of HCBSs at the national level, but also promote healthy ageing [19,36,37]. Due to the implementation and rapid promotion of national policies, the provision of HCBSs has increased dramatically from 26.10-62.01% ...
Background
As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have become of increasing importance in China. However, few studies have assessed the impact of HCBSs utilization on depressive symptoms among older adults. This study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults.
Methods
This study included 7,787 older adults (≥ 60years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, “What kind of HCBSs were being utilized in their community?”. Data were analyzed using generalized hierarchical linear models.
Results
Of the 7,787 participants, 20.1% (n = 1,567) reported they utilized HCBSs, and 36.7% (n = 2,859) were currently with depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.189, 95% CI:1.043–1.356, p < 0.01) among older adults. Additionally, the depressive symptoms were associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health, smoking, and provincial GDP per captia.
Conclusions
This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is important that the government provides targeted HCBSs at the community level to address the unmet care needs of older adults to reduce the occurrence of negative emotions and consequently the depressive symptoms.
... Under such conditions, the loss of homeostasis leads to the eventual development of diseases that might exacerbate depression. Vink et al (2008) (37) also consider these variables in their systematic assessments of risk profiles for anxiety and depression in the elderly across studies. ...
... Under such conditions, the loss of homeostasis leads to the eventual development of diseases that might exacerbate depression. Vink et al (2008) (37) also consider these variables in their systematic assessments of risk profiles for anxiety and depression in the elderly across studies. ...
Objective: To estimate the prevalence and factors associated with depression among the geriatric population in rural Nepal.
Materials and Methods: A community-based cross-sectional study design was conducted in Thabang Rural Municipality of Rolpa District. A total
of 405 elderly persons above the age of 60 years were interviewed. The respondents were administered through the Geriatric Depression Scale
(GDS-15) and sociodemographic questionnaire. Logistic regression analysis was used to determine the factors associated with geriatric depression.
Results: The prevalence of depression was found to be 68.04%. Sociodemographic characteristics such as age (OR 2.25; 95% CI 1.27 to 3.98,
p<0.005), gender (OR 2.60; 95% CI 1.27 to 3.98, p<0.005), presence of chronic disease (OR 2.79; 95% CI 1.64 to 4.76, p<0.001), income sufficiency
(OR 2.81; 95% CI 1.69 to 4.68, p<0.001), and health service access (OR 4.72; 95% CI 2.75 to 8.11, p<0.001) were significantly associated with
geriatric depression.
Conclusion: The present study suggests that as depression is a significant issue amongst the elderly, standard routine health screening activities
should be conducted. The study suggests stakeholders to design strategies that encourage healthy aging in Nepal
... Yet, incidence of clinically significant non-major forms of depression increases steadily with advancing age. Risk factors for developing depression after age 65 are similar to those in younger individuals and include being female, unmarried, poor, having chronic physical illness, social isolation, a history or family history of depression, etc. (Vink et al, 2008). Additional risk factors that are particularly important in older adults include loss and grief, loneliness, and care-taking responsibilities. ...
... Additional risk factors that are particularly important in older adults include loss and grief, loneliness, and care-taking responsibilities. Other risk factors that increase the likelihood of depression in the medically ill elderly include presence of cognitive impairment, age greater than 75, poor social support, active alcohol abuse, and lower educational attainment (Vink et al, 2008). ...
Mental illness is one of the leading causes of disability, not only for those who suffer from it but also for their caregivers. There is an increased prevalence of mental illness in recent times, and a shortage of mental health professionals to address the demands. This hugely imbalanced demands-to-resources has resulted in mental health professionals being overstretched for their availability of services. Overwhelming exhaustion, burnout, and stress related to the nature of work which requires deep personal and emotional contact with the patient can negatively impact mental health professionals' emotional wellbeing. These stressors can impede mental health professionals from maintaining their emotional health and psychological well-being. However, the mental health of mental health professionals has been largely ignored as evidenced by the dearth of studies. The present paper attempts to summarize the research on mental health professionals and their mental health, to shed light on the issues faced by mental health professionals.
... In older people, depressive symptomatology is usually related to loss of pairs and relationships, loss of family and occupational roles, low economic resources, physical health deterioration, weak social support networks and loneliness [8][9][10][11]. Disability, decreased functional capacity and quality of life [8] are examples of the negative consequences of this health condition. Moreover, depressive symptomatology in older people emerges at a stage of life in which higher difficulties related to chronic diseases (comorbidity and multimorbidity) arise, directly impacting the loss of autonomy and isolation [8]. ...
... Social isolation and the absence of a social support network are risk factors for violence against older persons, emphasizing the association between psychological and emotional violence [27]. Adverse economic, social, and health conditions are recognized to increase the severity of depressive symptoms and the overall risk of developing depression [8][9][10][11]28] and, in consequence, leave the older person more susceptible to being a victim of violence [29,30]. Moreover, in the present study, older people with depressive symptomatology were up to eight times more likely to experience violence than those without symptomatology. ...
Background
Mental disorders are highly prevalent in older people, being depression a predominant disorder. Evidence points to a possible relationship between depression and violence against older people. Nonetheless, the role of the depressive symptomology severity in the risk of violence against older people remains unclear. Thus, this study’s main objective was to analyze the relationship between geriatric depressive symptomatology and the risk of violence against older people.
Methods
This exploratory study involved 502 community-dwelling older persons aged 65 to 96 years (73.3 ± 6.5). Measures were performed using the Geriatric Depression Scale and the Risk Assessment of Violence against the Non-Institutionalized Elderly scale.
Results
One hundred nineteen older people (23.7%) had mild/moderate depressive symptomology, and twenty-six (5.2%) had severe depressive symptomology. There were significant relationships between the severity of depressive symptomatology and the risk of violence ( p < 0.05). The presence of depressive symptomatology increased the likelihood of being victims of violence, particularly among women (odds ratio: 2–8, p < 0.05).
Conclusions
The severity of depressive symptomatology plays an essential role in the risk of violence against community-dwelling older people. Moreover, it was found that older persons with depression symptomatology were at higher risk of being victims of violence. Our study findings support the need for protective measures within mental health national or regional policies to prevent depression and violence against community-dwelling older people.
... This means that the worse the cognitive function, the higher the risk of depressive symptoms in the future. Several longitudinal studies have provided evidence that cognitive decline precedes the onset of depressive symptoms [66]. Clinically speaking, cognitive impairment has several pathophysiological mechanisms, such as disturbances in the hypothalamic-pituitary-adrenal axis and abnormalities in brain-derived neurotrophic signaling [67], which as risk factors might lead to increased chances of future depressive symptoms. ...
The purpose of this study was to investigate the relationship between cognitive function and depressive symptoms among Chinese adults aged 40 years and above, as well as the series of multiple mediating effects of Instrument Activities of Daily Living disability and life satisfaction on this relationship. The data was obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2013–2018), including 6466 adults aged 40 years and above. The mean age of the adults was 57.7 ± 8.5. The SPSS PROCESS macro program was conducted to examine the mediating effects. The results indicated that there was a significant association between cognitive function and depressive symptoms five years later (B = −0.1500, 95%CI: −0.1839, −0.1161), which could also be demonstrated through three mediation pathways: (1) the mediating pathway through IADL disability (B = −0.0247, 95%CI: −0.0332, −0.0171); (2) the mediating pathway through life satisfaction (B = 0.0046, 95%CI: 0.0000, 0.0094); and (3) the chain mediation pathway through IADL disability and life satisfaction (B = −0.0012, 95%CI: −0.0020, −0.0003). Both IADL disability and life satisfaction have been proven to be crucial mediators for the relationship between cognitive function and depressive symptoms five years later. It is necessary to improve individuals’ cognitive function and reduce the negative impact of disability on them, which is important to enhance their life satisfaction and prevent depressive symptoms.
... Plusieurs recherches ont montré que les symptômes d'anxiété et de dépression étaient différents, et ce particulièrement aux âges élevés (Curran et al., 2020). En outre, les facteurs de risque associés à l'anxiété et à la dépression aux âges élevés diffèrent (Vink et al., 2008). Plusieurs études ont montré que les troubles anxieux étaient moins corrélés à l'insertion dans des réseaux de sociabilités et à la qualité des relations sociales qu'à des facteurs spécifiques de vulnérabilité tels que les événements traumatiques (Santini et al., 2017;Beekman et al., 1998). ...
En dépit de la féminisation du marché du travail, l’inactivité professionnelle est un statut d’emploi surreprésenté dans les parcours de vie féminins, dont le lien avec l’état de santé reste insuffisamment compris. En combinant méthodes quantitatives à partir de deux bases de données longitudinales (SIP, Constances) et méthodes qualitatives à partir de 30 récits de vie, cette thèse vise à identifier dans quels cas l’inactivité professionnelle est liée à un vieillissement en bonne ou mauvaise santé chez les femmes, en distinguant ses temporalités, et les configurations professionnelles, familiales, sociales dans lesquelles elle s'inscrit. Je montre d’abord que les trajectoires d’emploi marquées par des périodes d’inactivité professionnelle longues, définitives, ou répétées, accompagnent une moins bonne santé mentale après 50 ans. En revanche, les femmes qui ont connu des interruptions temporaires, même longues, sont en meilleure santé que celles qui ont connu des trajectoires d’emploi continues, mais instables, caractérisées par des expositions professionnelles ou par des difficultés d’articulation travail/famille. À côté de ces caractéristiques de l’emploi, l’histoire conjugale et la position sociale définissent aussi les trajectoires d’emploi critiques, en jouant sur les arbitrages entre inactivité professionnelle et emploi, et sur les coûts économiques et symboliques de l’inactivité professionnelle. L’absence de conjoint aux âges élevés, un faible niveau de revenus ou de diplôme, renforcent le désavantage de santé mentale lié à l’inactivité professionnelle longue ou définitive, et aux allers-retours dans l’emploi.
... De uma maneira geral, a ocorrência da depressão está associada a fatores de riscos que incluem viver sozinho, pertencer ao sexo feminino, consumir bebida alcoólica em excesso, ter baixo nível socioeconômico, ter doença física crônica e ter histórico pessoal ou familiar de depressão (VINK; AARTSEN; SCHOEVERS, 2008). A ocorrência de luto familiar, o comprometimento cognitivo e a perda da mobilidade funcional são outros fatores fortemente associados à ocorrência de depressão (VINK; AARTSEN; SCHOEVERS, 2008;BRUCE, 2002). Dentre os fatores protetores incluem-se apoio social, realização de atividades sociais, sobretudo voluntariado, atividades físicas e participação em atividades religiosas (HONG; HASCHE; BOWLAND, 2009;KOENING, 2007). ...
Os objetivos deste estudo foram avaliar o grau de dependência e/ou independência nas atividades de vida diária e verificar a existência de sintomas depressivos em idosos praticantesde atividades físicas (AF) participantes em um projeto de extensão universitária. A amostra foi intencional com 46 idosos – 36 mulheres e 10 homens. A grande maioria era caucasiana(82,6%); aposentada (89,2%); casada (58,7%); morava acompanhada (73,9%); e recebia mais de dois salários-mínimos (71,7%). O projeto tinha frequência de dois encontros semanais, sendo que um dos grupos realizava treinamento combinado e o outro realizava ginástica. Em relação à capacidade funcional, 43 idosos (93,5%) relataram não ter dificuldades em realizar atividades de vida diária e 3 (6,5%) relataram ter incontinência urinária. Considerando a Escala de Depressão Geriátrica, somente 6 (13,0%) apresentaram sintomas de depressão leve. A prática de AF e a decorrente socialização podem ser métodos não farmacológicos para auxiliar na prevenção ou no tratamento da depressão.
... The presence of comorbidities and the number of diseases were significantly associated with both anxiety and depression in this study, and older adults with three or more comorbidities were found to be more likely to develop psychological health problems. This is in line with previous studies [12,14,59], which found that unhealthy older adults were more likely to experience anxiety and depression, while older adults without chronic illnesses generally had better overall mental health. Liu [60] noted that when older adults experience complications related to chronic diseases, their probability of depression will increase nearly twofold with each increase in the number of chronic diseases. ...
Background
Older adults’ psychological health is a public health issue that cannot be ignored, especially when these psychological health problems and related factors change across different social backgrounds because of rapid changes in traditions and family structures and the epidemic responses after the outbreak of COVID-19 in China. The aim of our study is to determine the prevalence of anxiety and depression and their associated factors among community-dwelling older adults in China.
Methods
A cross-sectional study was conducted from March to May 2021 with 1173 participants aged 65 years or above from three communities in Hunan Province, China who were selected using convenience sampling. A structured questionnaire including sociodemographic characteristics, clinical characteristics, the Social Support Rating Scale (SSRS), the 7-Item Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire-9 Item (PHQ-9) was used to collect relevant demographic and clinical data and to measure social support status, anxiety symptoms, and depressive symptoms, respectively. Bivariate analyses were conducted to explore the difference in anxiety and depression based on samples’ different characteristics. The multivariable logistic regression analysis was performed to test for significant predictors of anxiety and depression.
Results
The prevalence of anxiety and depression were 32.74% and 37.34%, respectively. Multivariable logistic regression analysis revealed that being female, being unemployed before retirement age, lacking physical activity, having physical pain, and having three or more comorbidities were significant predictors for anxiety. Subjective social support and support utilization were significant protective factors. Regarding depression, religion, lacking physical activity, having physical pain, having three or more comorbidities were found to be significant predictors. Support utilization was a significant protective factor.
Conclusions
The study group showed a high prevalence of anxiety and depression. Gender, employment status, physical activity, physical pain, comorbidities, and social support were associated with psychological health problems of older adults. These findings suggest that governments should focus on the psychological health problems of older adults by raising community awareness of issues related to older adults’ psychological health. They should also screen for anxiety and depression among high-risk groups and encourage individuals to seek supportive counseling.
... Discrimination and stigma related to obesity can cause significant distress among obese people [19,20]. Furthermore, obesity may have detrimental effects on health and quality of life [21][22][23]. Both pathways could eventually lead to DAS disorders. ...
Background: Mental disorders like Depression, Anxiety, and Stress (DAS) are extremely prevalent in developed countries. DAS disorders are hypothesized to be associated with obesity, the relationship between the two conditions, however, is not conclusive. The aims of this study were to explore the association between obesity and DAS disorders among university students at Rajshahi City. Methods: Cross-sectional survey designs were used with students from Rajshahi University (RU) and Varendra University (VU). The data were collected from 738 randomly selected students from RU and VU. DAS Scale-42 (DASS-42) items were intended to measure DAS. We conducted bivariate and multivariate analyses of obesity and DAS disorders, as well as other socio-demographic variables. Results: An examination of cross-sectional data indicated a significant connection between obesity and stress disorders. The larger odds of obesity were found for severe and extremely severe levels of DAS disorder compared to normal and mild types. Conclusion: Obesity appears to be positively associated with DAS disorders on a moderate level of evidence. There still remains a question concerning the role of obesity severity and DAS level. Obesity cannot be ruled out as a causal factor in DAS disorders. Further, clinical research is recommended.
... Furthermore, mechanisms linking depression and socioeconomic status change during the life-course . For example, during working age, job loss is closely associated with depression (Catalano et al., 2011), while chronic physical conditions and poor social integration are especially important in older ages Vink et al., 2008). It has been suggested that not income itself is associated with depression, but related constructs such as financial strain (Zimmerman and Katon, 2005) and that not absolute income, but rather the relative rank of one's income explains the association with depressive symptoms (Osafo Hounkpatin et al., 2015). ...
... Additionally, loneliness can contribute to depression (8). Unfavorable socioeconomic situations are determinants of social health, and poor social conditions (living alone, low income, little social interaction, and a lack of care) raise the risk of depression in the population, particularly among the elderly (9)(10)(11). Depression, one of the main causes of disability worldwide, is a mental health disorder characterized by chronic sorrow, loss of interest or pleasure in formerly valued or pleasant activities, sleep and eating difficulties, exhaustion, and poor concentration (12,13). ...
Background
Living alone is one of the most common psychosocial factors that may have an impact on lifestyle management and health status. Although many previous cross-sectional studies have found that living alone increases the risk of depression. However, this risk has rarely been assessed on the basis of longitudinal studies. Therefore, we will explore this relationship on the basis of longitudinal studies.
Methods
We systematically searched Pubmed, Embase, and Cochrane databases up to May 2022. Adjusted odds ratios (ORs), and 95% confidence intervals (CIs) were pooled by a random-effects model using an inverse variance method.
Results
Seven studies (six cohort studies and one case-control study) were included in our study. A total of 123,859 without a history of psychosis individuals were included, and the proportion of females was 65.3%. We applied a random-effects model to minimize the heterogeneity. Overall, the pooled data suggest that people living alone are associated with an increased risk of depression compared to those who do not live alone (OR 1.42, 95%CI 1.19–1.70).
Conclusion
Compared to people who live with others, living alone increases the risk of depression. Only cross-sectional studies and a few longitudinal studies currently support this association; more high-quality studies will be required in the future to confirm this causal association.
... Depression is a common condition in older adults that causes a higher risk of morbidity, disability, and mortality (Djernes, 2006;Vink et al., 2008). The high prevalence of depression is particularly worrisome due to its negative consequences such as decreased overall quality of life and satisfaction, cognitive decline, and suicide (Alexopoulos, 2005). ...
This study explored how different types of daily experiences (leisure activity, eudaimonic behaviors) and select habits and dispositions (neuroticism, dispositional depression, physical activity level), are related to situational well-being (situational depression, immediate positive affect) among older adults from a community center. Six hundred thirty-eight situational experience sampling observations were provided by 19 participants ranging in age from 59 to 81 years (M = 68.68, SD = 7.17). Each participant was signaled on five randomly selected occasions each day for seven consecutive days. Upon receiving a signal, participants completed questionnaires measuring their activity participation and situational well-being at the time of the signal. Significant predictors of situational depression included leisure activity, neuroticism, and physical activity level. For immediate positive affect, leisure activity, eudaimonic behaviors, and dispositional depression were significant predictors. These findings suggest that active leisure participation and engaging in eudaimonic behaviors can promote situational well-being of older adults.
... Selain itu, kecemasan tersebut juga dikarenakan oleh karaktersitik kepribadian partisipan yang cenderung mandiri, pekerja keras, dan selalu optimis. Hal ini sejalan dengan hasil penelitian yang dilakukan oleh Vink et al., (2008) yang menemukan bahwa lansia seringkali mengalami kecemasan dikarenakan oleh berbagai faktor seperti ciri -ciri atau karakteristik kepribadian, strategi coping atau pemecahan masalah yang kurang baik, riwayat kesehatan psikologis sebelumnya, kualitas relasi sosial dan juga peristiwa kehidupan yang dialami oleh lansia. ...
Lansia dengan diabetes melitus tipe 2 cenderung memiliki kesehatan psikologis kurang baik yang ditandai dengan adanya kecemasan. Salah satu cara yang dapat dilakukan untuk meningkatkan kesehatan psikologis lansia dengan diabetes melitus tipe 2 yaitu dengan latihan progressive muscle relaxation. Penelitian ini bertujuan untuk mengetahui pengaruh progressive muscle relaxation pada peningkatan kesehatan psikologis lansia dengan diabetes melitus tipe 2. Penelitian ini menggunakan desain eksperimental kasus tunggal. Teknik pengumpulan data dengan menggunakan teknik wawancara dan observasi. Partisipan penelitian merupakan seorang lansia laki – laki dengan diabetes melitus tipe 2 yang berusia 60 tahun. Progressive muscle relaxation diberikan 4 kali pertemuan selama 1 bulan dengan durasi 15 – 20 menit per pertemuan. Hasil penelitian menunjukkan bahwa progressive muscle relaxation memiliki dampak positif terhadap kesehatan psikologis khususnya tingkat kecemasan lansia dengan diabetes melitus tipe 2. Progressive muscle relaxation yang dilakukan secara terus menerus akan sangat bermanfaat pada kesehatan fisik dan juga kesehatan psikologis khususnya menurunkan tingkat kecemasan lansia dengan diabetes melitus tipe 2.
... In old age, depression involves biological, psychological and social factors. Risk factors for developing depression after age 65 are similar to those in younger individuals and include being female, unmarried, poor, having chronic physical illness, social isolation, loss and grief, loneliness, care-taking responsibilities and a history or family history of depression (Djernes, 2006;Vink, Aartsen, Schoevers, 2008). Several studies have shown that up to 23% of elderly patients suffer from depression or depressive symptoms (Glasser, Stearns, de Kemp, van Hout, Hott, 1994). ...
Background: Ageing has a major impact on mental health. The prevalence of mental disorders can actually increase with age. Previous studies have demonstrated that among elderly the prevalence of mental disorders is high, with almost 20% in elderly aged 65 years and older. It was recently reported that almost one-third of people aged 95 yearsfulfilled criteria for a psychiatric disorder:Materials & Methods: the study was conducted at a primary health care center located in rural area. Data was collected from elderly patients attending a primary health care center in a rural area & were screened for cognitive impairment by using mini mental state examination (MMSE). Patients who had MMSE score more than 24 were studied. Then socio-demographic data sheet a semi-structured Performa was applied followed by geriatric depression scale (GDS). Results: Majoritity of our sample showed moderate followed by mild level of depression. However 8 cases were
found having severe depression. Majority of our participated patients abused nicotine
(including smoked and/or smokeless tobacco) i,e. 51.85% (42.6%+9.3%). our study
reported the significant family history of psychiatry illness in the sample. Majority of the
sample belonged to the age group of 60-65 years of age with having more female
participants and were married. Most of the participants were unemployed and were
dependent on others for their needs. Conclusion: Depression in elderly is frequently under
diagnosed or ignored because depressive symptoms are taken as normal manifestation resulting from the aging process. But these symptoms may lead to loss of independence and aggravation of pre-existent pathological conditions. The aim of this study was to determine the prevalence of depression, and associated socio-demographic factors among older adult patients attending a primary health care centre. It helps the mental health` professionals so as to achieve better results in terms of faster and accelerated recovery.
... Depression has a destructive effect on quality of life, physical and psychological health and is a significant obstacle to healthy aging [4][5][6][7]. Risk factors of depression among older adults are often considered to be such prolonged stressors as increasing social isolation, significant interpersonal losses deteriorating health and physical abilities, loss of income, and related financial stress [8][9][10][11]. And while some of these factors cannot be reversed, some areas where intervention is possible receive relatively less attention. ...
Risk factors for depression in older adults include significant interpersonal losses, increasing social isolation, and deteriorating physical abilities and health that require healthcare. The effects of unmet healthcare needs on depression in older adults are understudied. This study aimed to analyze the association between unmet healthcare needs and symptoms of depression, sleep, and antidepressant medication while controlling for other significant factors among older adults. For this study, we used a multinational database from The Survey of Health, Ageing and Retirement in Europe (SHARE), containing data of individuals aged 50 and older. The final sample used in this research consisted of 39,484 individuals from 50 to 100 years (mean − 71.15, SD ± 9.19), 42.0 percent of whom were male. Three path models exploring relationships between symptoms of depression at an older age and unmet healthcare needs were produced and had a good model fit. We found that unmet healthcare needs were directly related to depression, activity limitations were related to depression directly and through unmet healthcare needs, whereas financial situation mostly indirectly through unmet healthcare needs. We discuss how depression itself could increase unmet healthcare needs.
... As a result, retirement-related transitions often amplify and are amplified by the complex risk factors of late-life depression. 14,15 Psychosocial risk factors, such as poor life satisfaction, selfperceived health, economic security, social connectedness, and spiritual well-being, may impair coping strategies and resources to manage difficult situations. 16 Additionally, biological risk factors, reflective of overall immunological, metabolic, and cardiovascular diseases that are common in later life, can impact neurobiological pathways and increase susceptibility to depression. ...
As a major life transition characterized by changes in social, behavioral, and psychological domains, retirement is associated with numerous risk factors that can contribute to the development of depression in later life. Understanding how these risk factors intersect with overall health and functioning can inform opportunities for mental health promotion during this transition. The objective of this review is to summarize the literature on risk and protective factors for depression during retirement transitions, discuss challenges related to appropriate management of depression in later life, and describe opportunities for prevention and intervention for depression relating to retirement transitions, both within and beyond the health care system. Key implications from this review are that 1) the relationship between depression and retirement is multifaceted; 2) while depression is a common health condition among older adults, this syndrome should not be considered a normative part of aging or of retirement specifically; 3) the existing mental health specialty workforce is insufficient to meet the depression management needs of the aging population, and 4) therefore, there is a need for interprofessional and multidisciplinary intervention efforts for preventing and managing depression among older adults. In sum, both healthcare providers, public health practitioners, and community organizations have meaningful opportunities for promoting the mental health of older adults during such major life transitions.
... The ICD-10 criteria reported hat anxiety manifestations include physical manifestations such as dizziness, muscular tension, palpitations, and epigastric discomfort with persistent nervousness [15] . Among common risk factors for anxiety are functional and cognitive disorders, traumatic events, poorer social support networks, and loneliness [16] . All of these risk factors are correlated with hearing impairment [17,18] . ...
Purpose: With an increasing incidence for hearing impairment, it is necessary to search for the psychological impact on patients. Anxiety prevalence may be raised in people with hearing impairment. This study aimed to evaluate the prevalence of anxiety in hearing loss patients. Methods A case control study included 100 subjects: 50 controls and 50 subjects diagnosed with hearing loss of variable types, degree, and causes. They underwent audiological and Modified Arabic Beck anxiety inventory questionnaire evaluation. First Pure-Tone Audiometry (PTA) was performed in all frequencies to determine the type and level of hearing impairment, then Beck anxiety inventory questionnaire (Modified Arabic form) was done. Results The sample collected showed results of 42% single sided hearing loss while, 58% was bilaterally affected. Anxiety was estimated in 68% of hearing impairment patient with a percentage of 41% male and 59% females. Conclusion Anxiety is a very prevalent problem facing not only subjects with hearing impairment, but also affects a noticeable ratio of apparently normal subjects. So, the psychological assessment and support are needed to be in mind.
... Depression tends to worsen with age [2] and can cause mortality by suicide or medical illnesses [3]. Factors known to be related to depression in older adults include gender (women in particular), chronic somatic illnesses, disability, poor social support, and bereavement [4][5][6]. ...
Objectives:
Previous studies have shown that people with multimorbidity have a higher risk of depression than those without multimorbidity. However, few studies have examined the association between depression and multimorbidity in men and women separately. Since the rates of depression and multimorbidity are different in men and women, it is necessary to examine whether sex differences manifest in their association.
Methods:
This study included 30,138 participants (aged ≥65 years) from the National Survey of Older Koreans (2011-2017). Depression was defined using the Korean version of the Geriatric Depression Scale (SGDS-K). Multimorbidity was defined as people who had more than two chronic diseases, including arthritis, diabetes, heart disease, hypertension, pulmonary disease, cancer, stroke, or osteoporosis. Multiple logistic regression analysis was performed to determine the association between depression and multimorbidity.
Results:
It was found that 22.17% and 30.67% of the men and women, respectively, had depression. People with multimorbidity had a higher risk of depression than those without chronic conditions, specifically, the difference in men's risk was greater than the difference in women's risk. In particular, age was considered a moderator for women. While the effects of pulmonary disease, stroke, and cancer stood out in the integrated analysis, sex differences were discovered in the number of chronic conditions that the individuals had with heart disease.
Conclusion:
There are sex differences in the association between multimorbidity and depression among older Korean adults. Therefore, sex-appropriate care should be provided to reduce depression in older adults with multimorbidity.
... Besides the obvious risks connected with such a situation, there is also evidence supporting the association between isolation (a measurable lack of social relationships)/loneliness (perceived social isolation) and poor mental health [12]. In particular, living in isolation is linked to highly prevalent mental disorders in the elderly population, such as anxiety and depression [51], as well as to some degrees of cognitive impairment and dementia [5,50]. In turn, said disorders, as well as isolation itself in older adults, negatively affect their health, including all-cause mortality [34,39,47]. ...
An intelligent system intended to provide assistance to an elderly user in their home is presented. This multi-agent system is designed to monitor the interaction between the user and other agents, and regulate itself based on the estimated level of mental engagement of the user in order to contribute to help them maintain adequate levels of awareness and interaction with their home environment. The agents are devices programmed to preserve the security, comfort and health of the user, who is also conceptualized as one of the agents in the system. The user engagement level is estimated through fuzzy inference, that is, by means of a set of fuzzy membership functions and rules applied over the interaction of the user with different categories of agents. The system incorporates several dozen agents and is tested using two different datasets of real interactions between users and devices in their home environments. A uniform parameter configuration yielded very positive results for diverse scenarios and subsequently the parameters of the system were automatically optimized to show that improved performance, in the form of a more efficient system regulation and increased certainty in adjustment estimation, is obtained.
... Meta-analyses have shown that chronic diseases, functional impairment, reduced social support, and stressful life events are most frequently associated with depression onset in this age demographic. 7,8 However, meta-analytic approaches are vulnerable to bias related to methodological differences of the summarized studies (e.g., differences in data quality, heterogeneous selection criteria, dissimilarities across measurement instruments). Moreover, interactions among risk/ protective factors are notoriously difficult to test in a comprehensive way using conventional parametric statistical models because the number of possible interactions increases exponentially with each additional predictor. ...
Background: The high prevalence of depression in a growing aging population represents a critical public health
issue. It is unclear how social, health, cognitive, and functional variables rank as risk/protective factors for depression
among older adults and whether there are conspicuous differences among men and women.
Methods: We used random forest analysis (RFA), a machine learning method, to compare 56 risk/protective factors
for depression in a large representative sample of European older adults (N = 67,603; ages 45-105y; 56.1% women;
18 countries) from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 6). Depressive symptoms
were assessed using the EURO-D questionnaire: Scores ≥ 4 indicated depression. Predictors included a broad array
of sociodemographic, relational, health, lifestyle, and cognitive variables.
Findings: Self-rated social isolation and self-rated poor health were the strongest risk factors, accounting for 22.0%
(in men) and 22.3% (in women) of variability in depression. Odds ratios (OR) per +1SD in social isolation were
1.99x, 95% CI [1.90,2.08] in men; 1.93x, 95% CI [1.85,2.02] in women. OR for self-rated poor health were 1.93x,
95% CI [1.81,2.05] in men; 1.98x, 95% CI [1.87,2.10] in women. Difficulties in mobility (in both sexes), difficulties in
instrumental activities of daily living (in men), and higher self-rated family burden (in women) accounted for an
additional but small percentage of variance in depression risk (2.2% in men, 1.5% in women).
Interpretation: Among 56 predictors, self-perceived social isolation and self-rated poor health were the most salient
risk factors for depression in middle-aged and older men and women. Difficulties in instrumental activities of daily
living (in men) and increased family burden (in women) appear to differentially influence depression risk across
sexes.
... Although a few high-performance models were reported in studies where the cohorts only track for less than 5 years [2,[17][18][19], prediction accuracy was limited when applied to a followup of more than 5 years. Many risk factors of readmission (such as a greater impairment in self-care, more severe symptoms, more persistent illnesses, treatment patterns, bad adherence to anti-depression medications, biomarkers of neuroimaging, blood, and sleep, etc.) have been identified [4,20]. Such findings have been beneficial in constructing clinical evidence of readmission. ...
Patients with major depressive disorder (MDD) are at high risk of psychiatric readmission while the factors associated with such adverse illness trajectories and the impact of the same factor at different follow-up times remain unclear. Based on machine learning (ML) approaches and real-world electronic medical records (EMR), we aimed to predict individual psychiatric readmission within 30, 60, 90, 180, and 365 days of an initial major depression hospitalization. In addition, we examined to what extent our prediction model could be made interpretable by quantifying and visualizing the features that drive the predictions at different follow-up times. By identifying 13,177 individuals discharged from a hospital located in western China between 2009 and 2018 with a recorded diagnosis of MDD, we established five prediction-modeling cohorts with different follow-up times. Four different ML models were trained with features extracted from the EMR, and explainable methods (SHAP and Break Down) were utilized to analyze the contribution of each of the features at both population-level and individual-level. The model showed a performance on the holdout testing dataset that decreased over follow-up time after discharge: AUC 0.814 (0.758–0.87) within 30 days, AUC 0.780 (0.728–0.833) within 60 days, AUC 0.798 (0.75–0.846) within 90 days, AUC 0.740 (0.687–0.794) within 180 days, and AUC 0.711 (0.676–0.747) within 365 days. Results add evidence that markers of depression severity and symptoms (recurrence of the symptoms, combination of key symptoms, the number of core symptoms and physical symptoms), along with age, gender, type of payment, length of stay, comorbidity, treatment patterns such as the use of anxiolytics, antipsychotics, antidepressants (especially Fluoxetine, Clonazepam, Olanzapine, and Alprazolam), physiotherapy, and psychotherapy, and vital signs like pulse and SBP, may improve prediction of psychiatric readmission. Some features can drive the prediction towards readmission at one follow-up time and towards non-readmission at another. Using such a model for decision support gives the clinician dynamic information of the patient’s risk of psychiatric readmission and the specific features pulling towards readmission. This finding points to the potential of establishing personalized interventions that change with follow-up time.
... Besides, the comorbidity was associated with poorer course trajectories of diseases and was more harmful than the single symptom of depression or anxiety. For instance, comorbid anxiety and depression could increase the risk of other diseases, and patients with the comorbidity had a higher risk of suicidal ideations and/or behaviors [6,7] Notably, more recent studies on mental health have mainly focused on vulnerable groups, such as unpaid people [8,9] and victims of violence [10]. Yet, few scholars have paid close attention to the mental health status of sexual minorities. ...
Background and objective: Depression and anxiety are
the most common mental disorders for human health, especially for gay men. This
study aimed to assess the status and characteristics of Chinese gay men who were
vulnerable to depression, anxiety, or the comorbidity of the two disorders.
Material and methods: A total of 367 samples from a cross-sectional
survey conducted between November and December 2017 were included. The Chinese
version of SCL-90-R was used to measure the levels of anxiety and depression. The
unadjusted associations of demographic characteristics with anxiety, depression,
and comorbidity were evaluated by chi-square test. The most predictive factors of
the respondents’ depression, anxiety and the comorbidity were identified using
multivariable logistic regression models.
Results: The prevalence rates of depression, anxiety, and comorbidity
were 36.51%, 27.79%, and 26.16%, respectively among gay men. Age, being the
only child at home, personal monthly income, sexual orientation disclosure
status, and source of participants were related to the prevalence of depression,
anxiety, and comorbidity (all p < 0.05).
Conclusions: Depression and/or anxiety are highly prevalent among
Chinese gay men. Prevention strategies should be developed to target the related
factors in the gay men population to thwart or slow down the situation. It is
also crucial for social and family members to increase the acceptance of Chinese
gay men.
... By contrast, the link between non-working (mostly retirement in our case) and mental health was unclear in the literature [19]. Finally, chronic diseases are well-known predictors of depression and anxiety among the elderly [20]. ...
Objectives: Recent literature points out that elderly people are psychologically resilient to COVID-19, but the studies were performed in specific contexts. We measured the link between the worsening of mental health symptoms, the epidemiologic situation, and control measures among European people aged 50 or older.
Methods: We used data from the 2020 wave of SHARE, merged with Oxford COVID-19 Government Response Tracker data ( n = 38,358). We modeled the risk of worsening of depression, anxiety, sleeping trouble, and loneliness symptoms’ self-perception, as functions of control measures and 7-days death incidence, using logistic regressions.
Results: The worsening of anxiety and depression perception were more common (16.2 and 23.1%, respectively), compared to that of sleeping troubles and loneliness (8.1 and 11.5%, respectively). The worsening of depression and anxiety perception was negatively related to the rigor of control measures. The seven-days death incidence was positively linked to all symptoms except sleeping troubles.
Conclusion: Older people were the most exposed to death risk and were affected psychologically by the COVID-19 epidemiological situation; yet control measures were protective (or neutral) to their mental health condition.
... Physical aging induces miserable symptoms in the elderly and causes depression, a negative psychological state accompanied by psychological problems, and decreased physical function. Depression in old age makes the daily life of the elderly difficult due to the feeling of helplessness [21]. Unlike other age groups, depressive symptoms in the elderly are more pronounced than atypical symptoms and complaints of depressed emotions, with physical symptoms and cognitive decline. ...
The elderly are more prone to develop depression from physical, psychological, and economic changes, and 25.7% of the United Arab Emirates’ (UAE) elderly population suffer from depression. Color therapy is a widely accepted treatment to solve the depressive symptoms of the elderly. The color preference of the Seniors’ Happiness Centre—in Ajman UAE—a residential space for the elderly, could improve the quality of life, including depression symptoms. This paper explored the relationship between the color preference of the resident bedroom space and the depressive symptoms. As a methodology, using color images as stimuli, the physiological and psychological responses of the 86 elderly participants to the proposed color preference of the resident bedroom interiors—observed through a viewing box to simulate 3D space perception—were compared and analyzed to investigate the relationship between the color preference and depression by a survey with the Geriatric Depression Scale (GDS) and Electroencephalogram (EEG) measurement. The results showed that the elderly’s preference for warm colors is higher than that of cold colors, and each room needs a different color scheme because the elderly, 65 and above, have different visual characteristics. There was no significant difference between the left and right alpha wave values of the prefrontal cortex of the participant group. The main reason is that the brain waves are minute electrical signals and appear different from person to person. The color scheme on one side of the wall with increased saturation seemed to improve depressive symptoms effectively. It was found that psychologically, healthy elderly reacted positively to the single-color scheme of the Blue cool color, but elderly with depression reacted well to the contrast color scheme of the Blue-Yellow/Red cool color. This study will serve as critical data to propose more color preferences for the Seniors’ Happiness Center suitable for the elderly by studying the response to more diverse colors in the UAE.
... Several potential confounders related to demographic characteristics, socioeconomic circumstances, social support, and family characteristics were adjusted for in all multivariate analyses. The majority of these variables are known to be associated with grandparental childcare provision (Di Gessa et al. 2016a;Hank and Buber 2009;Igel and Szyklik 2011) as well as with the main dependent variables under study (Vink et al. 2008;Webb et al. 2011). We controlled for age and age squared to account for non-linear relationships with the outcome variables; sex; and ethnicity (White vs non-White participants due to data constraints in ELSA). ...
Objectives
Policies aiming at reducing rates of hospitalisation and death from COVID-19 encouraged older people to reduce physical interactions. For grandparents in England, this meant that provision of care for grandchildren was allowed only under very limited circumstances. Evidence also suggests that reduced face-to-face interactions took a toll on mental health during the pandemic. This study aims to investigate whether changes in grandchild care provision during the pandemic impacted grandparents’ mental health.
Methods
Using pre-pandemic data from Wave 9 (2018/19) and the second Covid-19 sub-study (November/December 2020) of the English Longitudinal Study of Ageing, we first describe changes in grandparenting since the start of the pandemic to then investigate, using regression models, associations between changes in grandparenting and mental health (depression, quality of life, life satisfaction) during the pandemic, while controlling for pre-pandemic levels of the outcome variables. Results: About 10% of grandparents stopped altogether to look after grandchildren during the pandemic, with 22% reporting an overall decrease in the amount of grandchild care provided and 20% an increase or similar levels. Compared to grandparents who mostly maintained unchanged their grandchild care provision, those who stopped altogether and those who mostly reduced the amount of grandchild care provided were more likely to report poorer mental health, even accounting for pre-pandemic health.
Discussion
While measures to limit physical contact and shield older people were necessary to reduce the spread of COVID-19, policymakers should acknowledge potential adverse consequences for mental health among grandparents who experienced changes in their roles as grandchild caregivers.
... It is associated with several adverse outcomes, such as an increased risk of dementia (Jorm, 2001); physical disability (Lenze et al., 2001); mortality (Rodda et al., 2011); and increased healthcare utilisation and cost (Benderly et al., 2019). Many researchers have previously explored the influence factors of depression among older adults (Blazer, 2003;Chau et al., 2019;Chen et al., 2011;Rodda et al., 2011;Steck et al., 2018;Tengku Mohd et al., 2019;Vink et al., 2008). These factors encompass demographic characteristics (e.g., gender, age, level of education, marital status, and residence); health status (e.g., activities of daily living [ADL] and instrumental activities of daily living [IADL]); lifestyle (drinking, smoking, and exercise); and social support (e.g., living arrangements). ...
Few studies have assessed the association between perceived availability of homeand community-based services (HCBSs) and self-reported depression among Chinese
older adults, which the present study attempts to rectify. This cross-sectional study
enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal
Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies
Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the
number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between
perceived availability of HCBSs and depression in older adults. Perceived daily life
assistance was found to be negatively associated with depression symptoms among
Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55–
0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60–0.79), p < 0.001], while perceived
levels of medical care services, emotional support and social services, and other were
not associated with depression symptoms in rural or urban areas. Our primary finding
was that providing daily life assistance at the community level may help to meet more
older adults’ daily needs, thus potentially decreasing the risk of depression.
... Policy documents -International [23], national [24,25] and regional policy documents [26] on falls prevention in older people -National health policy literature [27][28][29] Clinical guidance -National Institute for Health and Care Excellence (NICE) guidelines [30, 31] -American Geriatrics Society/British Geriatrics Society guidelines [32] -Health Quality and Safety Commission in New Zealand review (2020) [33] General falls literature -Research on prevalence [23,[34][35][36][37][38] and impact of falls [34,[39][40][41][42][43][44][45][46][47] on older people, and on effectiveness of falls interventions [48][49][50][51][52][53][54] then discussed by both researchers (SC, SMH) and the summary was updated accordingly. ...
Background
There is growing acknowledgement of the need for a phased approach to scaling up health interventions, beginning with an assessment of ‘scalability’, that is, the capacity of an individual intervention to be scaled up. This study aims to assess the scalability of a multi-component integrated falls prevention service for community-dwelling older people and to examine the applicability of the Intervention Scalability Assessment Tool (ISAT). The ISAT consists of 10 domains for consideration when determining the scalability of an intervention, and each domain comprises a series of questions aimed at examining readiness for scale-up.
Methods
Multiple methods were used sequentially as recommended by the ISAT: a review of policy documents, results from a service evaluation and falls-related literature; one-to-one interviews (n = 11) with key stakeholders involved in management and oversight of the service; and a follow-up online questionnaire (n = 10) with stakeholders to rate scalability and provide further feedback on reasons for their scores.
Results
Three of the ISAT domains were rated highly by the participants. Analysis of the qualitative feedback and documents indicated that the issue of falls prevention among older people was of sufficient priority to warrant scale-up of the service and that the service aligned with national health policy priorities. Some participants also noted that benefits of the service could potentially outweigh costs through reduced hospital admissions and serious injuries such as hip fracture. The remaining domains received a moderate score from participants, however, indicating considerable barriers to scale-up. In the qualitative feedback, barriers identified included the perceived need for more healthcare staff to deliver components of the service, for additional infrastructure such as adequate room space, and for an integrated electronic patient management system linking primary and secondary care and to prevent duplication of services.
Conclusions
Plans to scale up the service are currently under review given the practical barriers that need to be addressed. The ISAT provides a systematic and structured framework for examining the scalability of this multi-component falls prevention intervention, although the iterative nature of the process and detailed and technical nature of its questions require considerable time and knowledge of the service to complete.
Objective:
Depression is more common in patients with chronic inflammatory diseases, but whether inflammatory bowel disease (IBD), a chronic, relapsing immune-mediated disease, is associated with a higher risk of depression remains uncertain.
Method:
We studied 497,134 participants in the UK Biobank, including 3561 IBD patients. Multivariate Cox proportional risk models were constructed to investigate the risk associated with IBD and depression adjusting for potential confounding factors including sociodemographic, lifestyle, and family history variables.
Results:
The average age of participants was 56.54 ± 8.09 years; 54.3% were female and 90.4% were white. Over a mean follow-up period of 13.3 years, the cumulative incidence of depression was 8.2% (95% CI: 7.3%-9.1%) in IBD patients compared with 4.9% (95% CI: 4.9%-5.0%) in individuals without IBD. Compared with non-IBD participants, the adjusted hazard ratio (HR) for depression among IBD patients was 1.56 (95% CI: 1.39-1.76), with an adjusted HR of 1.54 (95% CI: 1.25-1.90) in Crohn's disease and 1.52 (95% CI: 1.30-1.78) in ulcerative colitis, respectively.
Conclusion:
IBD patients had a significantly higher risk of depression than non-IBD participants after adjusting for multiple confounding factors. We recommend screening for depression in middle-aged adults with IBD and no established history of depression.
Background:
Current measures of food insecurity focus on economic access to food, but not on the physical aspect of food insecurity that captures the inability to access food or prepare meals. This is particularly relevant among the older adult population who are at higher risk of functional impairments.
Objectives:
The aim of this study is to develop a short-form Physical Food Security (PFS) tool among older adults using statistical methods based on Item Response Theory (Rasch) model.
Methods:
Pooled data from adults ages 60 years and older of the National Health and Nutrition Examination Survey (NHANES) (2013-2018) (n = 5892) were used. The PFS tool was derived from physical limitation questions included in the Physical Functioning Questionnaire of NHANES. Item severity parameters, fit and reliability statistics and residual correlation between items were estimated using Rasch model. Construct validity of the tool was assessed by examining associations with the Healthy Eating Index score (HEI-2015), self-reported health, self-reported diet quality, and economic food insecurity, using weighted multivariable linear regression analysis, controlling for potential confounders.
Results:
A 6-item scale was developed which had adequate fit statistics and high reliability (0.62). It was categorized based on raw score severity into high, marginal, low and very low PFS. Very low PFS was associated with respondent's self-reported poor health (OR=23.8; 95% CI:15.3, 36.9; P<0.0001), self-reported poor diet (OR=3.9; 95% CI: 2.8, 5.5; P<0.0001), low and very low economic food security (OR=6.08; 95% CI: 4.23, 8.76; P<0.0001) and with lower mean HEI-2015 index score, in comparison to older adults with high PFS (54.5 vs 57.5, P=0.022).
Conclusions:
The proposed 6-item PFS scale captures a new dimension of food insecurity that can inform on how older adults experience food insecurity. The tool will require further testing and evaluation in larger and different contexts to demonstrate its external validity.
Objective:
Lower awareness of age-related gains (AARC-gains) and higher awareness of age-related losses (AARC-losses) may be risk factors for depressive and anxiety symptoms. We explored whether: (1) Baseline AARC-gains and AARC-losses predict depressive and anxiety symptoms at one-year follow-up; (2) age and rumination moderate these associations; (3) levels of AARC-gains and AARC-losses differ among individuals with different combinations of current and past depression and/or with different combinations of current and past anxiety.
Methods:
In this one-year longitudinal cohort study participants (N = 3386; mean age = 66.0; SD = 6.93) completed measures of AARC-gains, AARC-losses, rumination, depression, anxiety, and lifetime diagnosis of depression and anxiety in 2019 and 2020. Regression models with tests of interaction were used.
Results:
Higher AARC-losses, but not lower AARC-gains, predicted more depressive and anxiety symptoms. Age did not moderate these associations. Associations of lower AARC-gains and higher AARC-losses with more depressive symptoms and of higher AARC-losses with more anxiety symptoms were stronger in those with higher rumination. Individuals with both current and past depression reported highest AARC-losses and lowest AARC-gains. Those with current, but not past anxiety, reported highest AARC-losses.
Conclusion:
Perceiving many age-related losses may place individuals at risk of depressive and anxiety symptoms, especially those who frequently ruminate.
Cognitive behavioural therapy (CBT) is well established as a treatment of known efficacy with older people but most of this evidence comes from studies looking at depression. The outcome literature for CBT with older people with anxiety contains a number of methodological concerns and while CBT for late life anxiety is efficacious when compared to waiting list controls there are concerns that the evidence is less compelling when compared with active controls. Hence there is a case that CBT for late life anxiety has not as yet fulfilled its potential with older people. The paper here presents a very brief overview of the evidence-base, but augments this with real life outcomes for CBT with anxious older people. A short discussion follows.
Background:
The number of older adults living alone has increased significantly. Depression is one of the significant mental health problems they face; classifying depressive conditions into homogeneous subgroups can help discover hidden information.
Methods:
The data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analysis (LPA) was used to identify depression subgroups among elderly living alone, Chi-square tests and Kruskal-Wallis tests were used to univariate analysis, multinomial logistic regression was used to analyze the related factors.
Results:
1831 older adults living alone were identified and classified as low-level (30.4 %), moderate-level (55.3 %) and high-level (14.4 %). All variables, except age, were significant in the univariate analysis. Multinomial logistic regression showed that not participating in exercise, sometimes interacting with friends, anxiety symptoms, and impaired IADL were associated with the moderate- and high-level of depression in older adults living alone; good or fair self-rated health and life satisfaction were associated with the low-level of depression in older adults living alone. Anxiety symptoms were associated with high-level of depression in older adults living alone compared to moderate-level; good or fair self-rated health and life satisfaction were associated with moderate-level of depression in older adults living alone.
Limitations:
The CES-D-10 cannot fully determine the presence of depression in elderly people living alone at high-level.
Conclusions:
In future primary health care, it would be more meaningful to provide targeted interventions for different subgroups of depression in older adults living alone.
Objective: Previous research in various countries has found that employment-family trajectories characterized by early or single motherhood, or weak ties to employment, are associated with poor well-being among older women. Our paper explores whether this differs (1) in France, characterized by a high female employment rate and supportive family policies; (2) across dimensions of well-being. Method: We used the Health and Occupational Itinerary survey to identify 10 common patterns of employment-family trajectories (derived from multi-channel sequence analysis) and analysed their association with six indicators of well-being in 2010 (N = 2882 50-78 years old women). Results: Continuous full-time employment is associated with better well-being, except for women who had a first child around 24 years old, who reported increased anxiety and lack of support. Discussion: Employed mothers' well-being seems to be protected in a context of family friendly policies, but we identified one group with lower well-being, which merits further study.
Background
Numerous studies reported higher levels of mental health issues during the COVID-19 pandemic but only a minority used repeated measurements. We investigated change in depressive symptoms in the Czech ageing cohort and the impact of pre-existing and COVID-19-related stressors.
Methods
We used data on 2853 participants (mean age 73.4 years) from the Czech part of the prospective Health, Alcohol and Psychosocial factors In Eastern Europe cohort that participated in postal questionnaire surveys before (September 2017–June 2018) and during the pandemic (October 2020–April 2021). Participants reported their depressive symptoms using the Centre for Epidemiological Studies-Depression Scale including 10 (CESD-10) tool. A principal component analysis (PCA) was used to create representative components of the pandemic-related stressors. The impact of the stressors on change in depressive symptoms was tested using multivariable linear regression, after adjustment for age and potential confounders.
Results
Three patterns of the pandemic-related stressors (‘financial stressors’, ‘social and perception stressors’ and ‘death and hospitalisation stressors’) were extracted from the PCA. The mean CESD-10 score increased from 4.90 to 5.37 (p<0.001). In fully adjusted models, significantly larger increases in depression score were reported by older people (β=0.052; p=0.006), those with poor self-rated health (β=0.170; p<0.001), those who experienced death or hospitalisation of a close person (β=0.064; p<0.001), social deprivation (β=0.057; p<0.001), delays in healthcare (β=0.048; p=0.005) and those who suffered from COVID-19 (β=0.045; p=0.008).
Conclusion
This study confirms an increase in depressive symptoms in older persons during the pandemic and identified several pandemic-related risk factors suggesting that public health policies should address this vulnerable group by adopting the preventing strategies.
Objectives:
To evaluate a magic recreation program to reduce depressive symptoms in institutionalized older adults.
Methods:
We conducted a pilot randomized controlled trial in which participants were assigned to either a magic group (n = 6) or a control group with usual activities (n = 6). The magic group received a 6-week magic recreation program. The data were analyzed by generalized estimating equations in terms of intention-to-treat analysis. A sensitivity analysis was conducted by examining the complete case analysis.
Results:
The magic recreation program significantly improved the scores of Patient Health Questionnaire-9 in the magic group (Wald χ 2 = 8.816, p = 0.004, Cohen's d = 1.51, power = 0.9968). The results of the sensitivity analysis were consistent with the results of primary analysis.
Conclusions:
The 6-week magic recreation program reduced depressive symptoms among institutionalized older adults with minor depressive symptoms.
Zusammenfassung
Ziel der Studie Das Ziel dieser Studie ist es, zu untersuchen, inwiefern innerdeutsche Migration (Binnenmigration) mit allgemeiner psychischer Belastung, Somatisierung, Depressivität und Angst assoziiert ist.
Methode Daten aus zwei bevölkerungsrepräsentativen Befragungen (2020 und 2021; N=4922) wurden genutzt, um mit Hilfe von linearen Regressionsanalysen den Einfluss von Binnenmigration auf psychische Gesundheit zu untersuchen. Die allgemeine psychische Belastung mit den Dimensionen Somatisierung, Depressivität und Angst wurde mit der Kurzform des Brief Symptom Inventory (BSI-18) erfasst. Außerdem wurden soziodemographische Merkmale (Geschlecht, Alter, Partnerschaft, Haushaltsäquivalenzeinkommen und Bildung) kontrolliert.
Ergebnisse Binnenmigrierte vom Osten in den Westen berichteten, auch nach Kontrolle der soziodemografischen Faktoren, signifikant höhere Werte in der allgemeinen psychischen Belastung, Somatisierung, Depressivität und Angst als Personen, die im Osten aufgewachsen und geblieben sind. Es wurden keine Unterschiede gefunden zwischen Binnenmigrierten vom Westen in den Osten und Personen, die im Westen aufwuchsen und zur Zeit der Befragung noch im Westen lebten.
Fazit Der Vergleich von psychischer Gesundheit in den neuen und alten Bundesländern sollte Binnenmigration als wichtigen Faktor berücksichtigen. Unsere Ergebnisse zeigen, dass sich insbesondere bei den Binnenmigrierten von Ost nach West eine erhöhte psychische Belastung findet.
Objectives
This study aimed to evaluate the effect of exercise on anxiety in cancer patients using systematic review and meta-analysis of randomized control trials.
Methods
For this study, three databases including PubMed, Scopus, and the Cochrane Library were searched by using keywords. In addition, a hand search was performed on Google Scholar. Mean and standard deviation were extracted from each study and then converted to Hedges’ g. Analyzes were performed using random-effects methods. Heterogeneity was assessed in studies using chi-squared and I².
Result
Finally, 31 randomized control trial studies were selected to enter the meta-analysis. Cancer patients who exercise are less anxious than controls and the Hedges’ g was equal to –0.37 (CI –0.55 to –0.19; p < 0.001).
Discussion
It is necessary to consider the issue of necessary interventions for anxiety in treatment protocols and interventions for cancer patients, and exercise in the meantime can be beneficial.
Background and aim
Arterial stiffening – a process that is largely due to intimal thickening, collagen disposition or elastin fragmentation – significantly contributes to cardiovascular events and mortality. There is also some evidence that it may negatively affect physical function. This study aimed to evaluate whether arterial stiffness was associated with measures of walking capacity in a large, population-based sample of highly aged older adults.
Methods
A population-based sample of 910 community-dwelling adults (aged 75, 80, or 85 years) were investigated in a cross-sectional observational study. Pulse wave velocity (PWV), a surrogate marker of arterial stiffness, was estimated based on the oscillometric recording of pulse waves at the brachial artery site. Walking capacity was assessed by 10-meter habitual walking speed, 10-meter maximum walking speed, and six-minute walk distance. We used multiple linear regression models to examine possible associations between PWV and parameters of walking capacity, and we adjusted the models for sex, age, socioeconomic status, anthropometry, physician-diagnosed diseases, prescription medication, smoking history, physical activity, and mean arterial pressure. Continuous variables were modelled using restricted cubic splines to account for potential nonlinear associations.
Results
Mean (standard deviation) 10-meter habitual walking speed, 10-meter maximum walking speed, and six-minute walk distance were 1.3 (0.2) m/s, 1.7 (0.4) m/s, and 413 (85) m, respectively. The fully adjusted regression models revealed no evidence for associations between PWV and parameters of walking capacity (all p-values >0.05).
Conclusion
Our results did not confirm previous findings suggesting a potential negative association between arterial stiffness and walking capacity in old age. Longitudinal studies, potentially taking additional confounders into account, are needed to disentangle the complex relationship between the two factors.
Healthy aging is associated with decline in social, emotion, and identity perception, which is frequently attributed to deterioration of structures involved in social inference. It is believed that this decline is unlikely to be a result of perceptual aberrations due to intact (corrected) visual acuity. Nevertheless, the present studies examine whether more particular perceptual aberrations may be present in healthy aging, that could in principle contribute to such difficulties. The present study examined the possibility that particular deficits in configural processing impair the perception of faces in healthy aging. Across two signal detection experiments, we required a group of healthy older adults and matched younger adults to detect changes in images of faces that could differ either at the local, featural level, or in configuration of these features. In support of our hypothesis, older adults were particularly impaired in detecting configural changes, relative to detecting changes in features. The impairments were found for both upright and inverted faces and were similar in a task with images of inanimate objects (houses). Drift diffusion modelling suggested that this decline related to reduced evidence accumulation rather than a tendency to make configural judgments based on less evidence. These findings indicate that domain-general problems processing configural information contribute to the difficulties with face processing in healthy aging, and may in principle contribute to a range of higher-level social difficulties – with implications also for other groups exhibiting similar patterns in perception and understanding.
One of the main pillars of religion has been in the development and establishment of religious beliefs and practices for its adherents. The present chapter assessed ten components of religious practices and beliefs across the four major religious groups and its interaction across identity, age and gender. Significantly, religious beliefs and practices irrespective of the faith of the believers yielded above-average scores on each aspect of the measure. Thus, religion and its various facets continue to play an important role in the daily lives of Indians yet religious identity is voiced and maintained in different ways. High scores for religious beliefs and practices were noted for all three age groups thereby demonstrating the significance of religion in the lives of participants. Significant gender differences for private religious practices and commitment. Engagement of females in private religious practices was almost invariant across the three developmental stages.
Depression and anxiety, as the two most prevalent psychiatric disorders, pose a huge challenge to the quality of life of the elderly. Using a sample of 7,721 elderly from the latest Chinese Longitudinal Health and Longevity Survey (CLHLS), the present study intended to explore the association between mental health and socioeconomic status, physical functional disability, and cognitive impairment among Chinese elderly by adopting multivariate logistic regression analyses. The results revealed that depression, anxiety, and their comorbidity are significantly higher in the elderly with instrumental activities of daily living (IADL) disability, cognitive impairment, financial strain, and living alone. Findings of the study will provide implications for policymakers, social workers, and individual caregivers to develop necessary intervention measures to improve the mental health of the elderly and promote successful aging.
This chapter discusses the specific factors that play a role in depression in older people, including the large heterogeneity of the concept, its clinical presentations, diagnostic procedures and identification of risk factors, consequences, and treatment of depression in late life. However, compared to the Diagnostic and Statistical Manual (DSM), 4th ed, Text Revision, a number of changes have been made to the DSM‐5, with a putative impact on the classification of depression in late life. The concept of 'vascular depression', which has established the aetiological connection between cerebral vascular damage and depression, was described by Post in the 1960s. The differential diagnosis of depression and apathy syndrome in the presence of a developing neurodegenerative disorder, Parkinson's disease, or dementia is often extremely difficult. The majority of older adults, who attempt suicide or die, suffer from depression. Psychotherapy should be considered in older people with depression on the same grounds as in younger adults.
Objective
To describe the risk of postoperative delirium and long-term psychopathology (depression, anxiety or post-traumatic stress syndrome (PTSS)) in older adults.
Methods
255 elderly patients (≥ 65 years) undergoing major surgery (planned surgical time > 60 min) in a tertiary hospital were compared to 76 non-surgical controls from general practice. Patients were assessed twice daily for postoperative delirium using the Confusion Assessment Method (CAM(-ICU)), nursing delirium screening scale (NuDESC) and validated chart review. Before surgery and 3 and 12 months thereafter, the participants filled in the Hospital Anxiety and Depression Scale (HADS), the Geriatric Depression Scale (GDS-15) and the Post-Traumatic Stress Syndrome-14-Questions Inventory (PTSS-14). Non-surgical controls filled in the same questionnaires with similar follow-up.
Results
Patients were more often male, had higher American Society of Anesthesiologists scores and more often had a spouse compared to controls (p < 0.005). Forty-three patients (18%) developed postoperative delirium, who were significantly older, had higher ASA scores and lower estimated IQ scores compared to the patients who did not develop delirium (p < 0.05). There were no differences in psychopathology at baseline and 3-month follow-up between patients and controls. At 12-months, surgical patients less frequently scored positive for depression (7% versus 16%) and anxiety (2% versus 10%) compared to nonsurgical controls (p < 0.05). We did not observe differences in occurrence of psychopathology between patients who had and had not developed postoperative delirium.
Conclusion
Our results suggest that the older surgical population, with or without postoperative delirium, does not appear to be at greater risk of developing psychopathology.
Why does this paper matter?
The older surgical population does not appear to be at greater risk of developing psychopathology, neither seems this risk influenced by the occurrence of postoperative delirium.
Background:
Physical, psychological, and social changes in the aging lead to new needs in the care of the elderly. The Camberwell Assessment of Need for the Elderly (CANE) evaluates older adults' care needs. This study aimed to assess the types of needs of the elderly using the CANE questionnaire.
Study design:
A systematic review.
Methods:
This systematic review included all cross-sectional studies. International databases, including Web of Sciences, Medline, Scopus, and ProQuest were searched up to June 2021. Such keywords as aged OR ageing OR "older adults" OR "older people" OR "older person" OR elderly, AND need OR "needs assessment" OR "met needs" OR "unmet needs" were used to design the search strategy. A 95% CI was calculated using the exact method, and the meta-analysis of proportion (metaprob) module was used for data analysis.
Results:
In total, 769 studies were retrieved in this review. At the following stages, 760 articles were excluded upon checking the duplicates; moreover, the titles and abstracts did not meet the eligibility criteria. Finally, nine studies remained. The mean±SD age of 2200 participants was obtained at 78.4±5.9 years. The highest and lowest met needs were related to the physical (45%) and social (21%) dimensions, respectively. Furthermore, the highest unmet needs were observed in the physical and social dimensions (0.07%), and the lowest unmet needs were related to the psychological and environmental dimensions (0.04%).
Conclusions:
The CANE is sensitive enough to identify unmet needs in different samples and settings. Therefore, a new care model and appropriate interventions for the elderly can be designed based on the CANE results.
Background
Elderly individuals who experience falls suffer from higher levels of anxiety because of physical or mental injury. This study examined the association between falls and anxiety among elderly Chinese individuals. It also explored the mediating roles of functional ability and social participation in the link between falls and anxiety.
Methods
The analytical sample included 8233 elderly people aged 60 and above, and prospective data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Anxiety was evaluated by a 7-item Generalized Anxiety Disorder (GAD-7) scale, and falls were determined by self-report. The association between falls and anxiety was assessed by linear regression. Mediation analysis was used to explore the potential mediating roles of functional ability and social participation on the association between falls and anxiety.
Results
Suffering falls predicted higher anxiety levels among elderly individuals (B = 0.608, 95% CI: 0.471, 0.746). Functional ability and social participation play partial mediating roles in the association between falls and anxiety, and the mediating effects were 0.036 (95% CI: 0.020, 0.058) and 0.005 (95% CI: 0.003, 0.014), respectively. The serial mediating effect of functional ability and social participation on the association between falls and anxiety was 0.003 (95% CI: 0.002, 0.005).
Limitations
This study is based upon cross-sectional data, which limit inferring causality.
Conclusions
This study suggests that policy-makers should explore how to encourage elderly individuals who experience falls to restore functional ability and participate in appropriate social activities to alleviate anxiety.
A model in which cerebrovascular disease contributes to the pathogenesis of depression in later life was the basis of the authors' hypothesis that cerebrovascular risk factors at intake are independently associated with depression at 1-year follow-up.
The subjects were 247 patients aged 60 years or older in primary care practices. The study measures were completed at intake and 1-year follow-up. Multiple regression techniques were used to determine the independent association of initial cerebrovascular risk factors with depressive symptoms and diagnoses at 1 year.
The authors found that the severity of initial cumulative cerebrovascular risk factors was significantly independently associated with 1-year depressive symptoms and diagnoses, but not after also controlling for overall medical burden.
The results lend some support to the cerebrovascular model of depression.
Community based findings regarding the prevalence of late life depression in The Netherlands are scarce. Internationally there is no consensus on basic issues, such as how depression in later life should be defined and measured, and consequently, about the prevalence of depression in later life. By defining and measuring depression at both a syndrome and diagnostic level of caseness in one study, these differences could be resolved. In a large (3056 subjects) random sample of older (55-85) adults, living in three regions of The Netherlands, it appeared that depression was a common disorder (prevalence 14,9%). However, only in a minority of cases the symptoms fulfilled rigorously applied DSM-III criteria for major depression (prevalence 2,0%). The prevalence of all other depressive disorders (minor depression) was 12,9%. Comparing major to minor depression showed large differences in distribution of risk factors. It appeared that major depression is more often an exacerbation of a chronic-intermittent mood disorder, with roots in long-standing personal vulnerability factors. Minor depression is more often a reaction to the stresses, commonly experienced in later life.
A randomly selected sample of 549 women age 55 years and older and 2,669 women age 18–34 years was interviewed via telephone to determine prevalences of physical and sexual assault, posttraumatic stress disorder (PTSD) symptomatology, and depression. Prevalences of sexual and physical assaults were lower in older compared to younger women. In addition, given a trauma, prevalences and proportionate risk of posttraumatic psychopathology and depression were also lower for older, relative to younger women. Specifically, multivariate analyses revealed that sexual assault predicted only PTSD avoidance in older adults, but all forms of PTSD symptomatology and depression in younger adult women. Similarly, physical assault predicted only PTSD re-experiencing symptoms in older women, but all forms of PTSD symptoms and depression in younger women. Self-reported health status was not associated with any increased risk of psychopathology, and low income predicted increased avoidance and depression only in younger women.
To test a diathesis-stress model of psychopathology, the authors examined the rates of current and lifetime psychiatric disorders in 82 spouse caregivers of Alzheimer's disease (AD) patients and 86 demographically matched controls. Caregivers and controls did not differ in the prevalence of disorders before the onset of care recipients' AD (or during a similar time period for the controls); caregivers experienced more depressive-anxiety disorders after the onset of patient's AD than controls. This study strongly supported the 3 key components of a diathesis-stress interaction. First, caregivers with a psychiatric history prior to the onset of patient's AD were more likely than caregivers with no history to receive a diagnosis after the onset of AD. Second, a similar relationship existed for controls. Finally, caregivers with a psychiatric history were more likely to experience a recurrence after the onset of AD than controls with a psychiatric history. These findings indicate that the diathesis of psychiatric history and the stress of caregiving interact, resulting in the observed group differences in the prevalence of psychiatric disorders.
This study examined the interrelationships among anxiety, personality disorders, and coping strategies in anxious older adults , nonanxious older adults , and anxious younger adults . Younger participants were college students and older participants were community-based family members of the students or recruits from local senior centers. Participants completed the Coolidge Axis II Inventory, the Coping Orientations to Problems Experienced scale, and the Brief Symptom Inventory. Results indicated that the prevalence of generalized anxiety states was relatively low and similar in both older and younger groups and dependent on measurement scale and criterion. At least one personality disorder was found in 61% of the older persons group; obsessive-compulsive, schizoid, and avoidant were the most frequently assigned personality disorders. Anxious older adults had elevated rates of dependent and avoidant personality disorder compared with nonanxious older adults. Younger anxious persons were found to have significantly greater personality dysfunction compared with older anxious persons. Finally, coping differences existed between older anxious and older nonanxious adults and between older anxious and younger anxious adults. Implications for diagnosis and treatment of anxiety in older adults were discussed.
The purpose of this study was to examine the comorbidity of and communality of risk factors associated with major depressive disorder and anxiety disorders in later life.
A random age- and sex-stratified community-based sample (N=3,056) of the elderly (age 55-85 years) in the Netherlands was studied. A two-stage screening design was used, with the Center for Epidemiologic Studies Depression Scale as a screening instrument and the National Institute of Mental Health Diagnostic Interview Schedule as a criterion instrument. Risk factors were measured with well-validated instruments and represented a broad range of vulnerability and stress-related factors associated with anxiety and depression. Multivariate analyses examined risk factors associated with pure major depressive disorder, pure anxiety disorders, and comorbid conditions.
Comorbidity was highly prevalent: 47.5% of those with major depressive disorder also met criteria for anxiety disorders, whereas 26.1% of those with anxiety disorders also met criteria for major depressive disorder. While the only variables associated with pure major depressive disorder were younger age and external locus of control, risk factors representing a wide range of both vulnerability and stress were associated with pure anxiety disorders. External locus of control was the only common factor. The group with anxiety disorders plus major depressive disorder had a distinct risk factor profile and may represent those with a more severe disorder.
Although high levels of comorbidity between major depressive disorder and anxiety disorders were found, comparing risk factors associated with pure major depressive disorder and pure anxiety disorders revealed more differences than similarities. Anxiety disorders in later life merit separate study.
Most research on the association between sleep disturbances and depression has looked at cross-sectional data. The authors used two waves of data from a panel study of community residents aged 50 years or more to investigate this issue prospectively.
Data on symptoms of major depressive episodes and sleep problems were examined for a subgroup of the 1994 and 1995 surveys of the Alameda County (California) Study (N=2,370). The authors examined the effects of age, gender, education, marital status, social isolation, functional impairment, financial strain, and alcohol use. Depression was measured with 12 items that covered the DSM-IV diagnostic criteria for major depressive episodes, including insomnia and hypersomnia.
The prevalences were 23. 1% for insomnia and 6.7% for hypersomnia in 1994. Sleep was a significant correlate of depression, as were being female, older age, social isolation, low education, financial strain, and functional impairment. When sleep problems and depression were examined prospectively, with controls for the effects of the other variables, sleep problems in 1994 predicted depression in 1995. However, other symptoms of major depressive episodes-anhedonia, feelings of worthlessness, psychomotor agitation/retardation, mood disturbance, thoughts of death-were much stronger predictors of future major depression.
Sleep disturbance and other symptoms that are diagnostic for major depression are strongly associated with the risk of future depression. Sleep disturbance appears to be a less important predictor of depression. More epidemiologic research is needed on the relative contributions of the range of depressive symptoms to the risk of clinical depression.
We examined relationships among positive, negative, and depressive symptoms in schizophrenia and major depression with psychosis.
Patients with schizophrenia (n = 17) and major depression and psychotic features (n = 25), with no prior psychopharmacologic treatment were assessed on scales measuring positive psychotic, negative, and depressive symptoms.
Analyses revealed the depressive symptoms positively correlated with anhedonia/asociality and avolition/apathy in both patient groups. Positive psychotic symptoms significantly correlated with depressive symptoms in the schizophrenic group.
Several specific symptoms used in defining both depressive and negative syndrome constructs appear to be shared. The relationship between positive symptoms and depression in schizophrenia and not psychotic depression suggests the severity of depression may be involved in this relationship.
A companion paper reported a very strong cross-sectional association between handicap and late-life depression. Adjusting for handicap weakened associations between sociodemographic variables and depression. It was unclear whether handicap was a confounder, or a useful summary variable, mediating the effect of a range of sociodemographic disadvantages. This paper focuses on the cross-sectional relationship between depression and demographic variables, social support, and life events.
A community survey of all residents over the age of 65 years of an electoral district in London, UK.
There was a moderate association between SHORT-CARE pervasive depression and the number of life events experienced over the previous year. Personal illness, bereavement and theft were the most salient events. There was a stronger, graded, relationship between the number of social support deficits (SSDs) and depression. Number of SSDs also related to age, handicap, loneliness and use of homecare services. Loneliness was itself strongly associated with depression; odds ratio 12.4 (7.6-20.0).
Problems of collinearity, and the cross-sectional design of the study limited interpretation of the exact nature of the relationship between social support, loneliness, handicap and depression. However, the clustering of these four factors can be used to define a large part of the elderly population with a poor quality of life. An important avenue for future research will be the development and implementation of population intervention strategies designed to address some or all of these problems among older people in general.
Terms such as risk, risk factors, and especially the term cause are inconsistently and imprecisely used, fostering scientific miscommunication and misleading research and policy. Clarifying such terms is the essential first step. We define risk and a risk factor (protective factor) and their potency, set out the conceptual basis of the methods by which risk factors are identified and potency demonstrated, and propose criteria for establishing the status of a risk factor as a fixed or variable marker or a causal risk factor. All definitions are based on the state of scientific knowledge (empirical documentation), rather than on hypotheses, speculations, or beliefs. We discuss common approaches and pitfalls and give a psychiatric research example. Imprecise reports can impede the search for understanding the cause and course of any disease and also may be a basis of inadequate clinical or policy decision-making. The issues in risk research are much too important to tolerate less than precise terminology or the less than rigorous research reporting that results from imprecise and inconsistent terminology.
Most research examining age as a risk factor for depression has been based on cross-sectional data. To investigate the effect of aging on rates of depression prospectively, the authors used two waves of data from a panel study of community residents 50 years old and older.
Data on symptoms of major depressive episodes were examined for the 1994 and 1995 cohorts of the Alameda County Study. The authors examined age, gender, marital status, education, financial strain, chronic medical conditions, functional impairment, cognitive problems, life events, neighborhood problems, social isolation, and social support. Depression was measured with 12 items covering DSM-IV diagnostic criteria for major depressive episodes.
Point prevalence of major depressive episodes was 8.7% in 1994 and 9.0% in 1995. Among the subjects 60 years old and older, there was a tendency toward higher prevalence in 1995. The highest prevalence rates in 1994 and in 1995 were among those 80 years old and older. Subjects who were depressed in 1994 were at greater risk for depression in 1995. When the effects of age and other psychosocial risk factors in 1994 were controlled, there were no significant age effects on depression in 1995. Multivariate analyses demonstrated that the initial age effects were due mainly to chronic health problems and functional impairment. Gender, chronic health conditions, problems with activities of daily living, cognitive problems, neighborhood problems, and social isolation in 1994 all were significant predictors of depression in 1995.
Healthy, normally functioning older adults are at no greater risk for depression than younger adults. What seem to be age-related effects on depression are attributable to physical health problems and related disability.
Study objectives: Depression and falls are two common conditions that impair the health of older people. Both are relatively underdiagnosed and undertreated problems in primary care. The study objective was to investigate whether there was a common set of risk factors that could predict an increased risk of both falls and depression. Design: This was a cohort study drawn from a primary care clinic, with a one year follow up. Dependent measures included: reporting two or more falls in the past year and a score of 7 or over on the S-GDS (Short Geriatric Depression Scale). A parsimonious set of risk factors was selected that predicted both outcomes based on a series of discriminant function analyses. Participants and setting: The setting was a primary care clinic serving a mixed socioeconomic population, in Beer Sheva, Israel. The sample included 283 General Sick Fund members, aged 60 and over, who completed both baseline assessments and one year follow up interviews. Main results: At the one year follow up, 12% of the sample reported frequent falls in the past year and 25.5% of the sample screened positive for depressive symptoms. A set of five risk factors that included: poor self rated health, poor cognitive status, impaired ADL, two or more clinic visits in the past month, and slow walking speed (g10 seconds over five metres) was successful at discriminating between fallers and non-fallers (86% discrimination) and between those with and without depressive symptoms (76%). For every risk factor added, there was a significant increase in the proportion of respondents who had depressive symptoms. A similar result was found for falls. Conclusions: These results show that there is a common set of risk factors that increase the risk of two common outcomes in geriatric medicine, falls and depression. For a general practitioner or a geriatric physician, it might be easier to detect these risk factors than to diagnose depression or high risk for falls. When these risk factors are detected in patients the physician can then be more active in direct probing about depression and falls.
Background
Accurate assessment of the natural history of late-life depression requires frequent observation over time. In later life, depressive disorders fulfilling rigorous diagnostic criteria are relatively rare, while subthreshold disorders are common. The primary aim was to study the natural history of late-life depression, systematically comparing those who did with those who did not fulfill rigorous diagnostic criteria.Methods
Within the Longitudinal Aging Study Amsterdam, a large cohort of depressed elderly persons (n = 277) was identified and followed up for 6 years, using14 observations. Depression was measured using self-reports (the Center for Epidemiological Studies Depression Scale) and diagnostic interviews (the Diagnostic Interview Schedule). The natural history was assessed for symptom severity(Center for Epidemiological Studies Depression Scale score), symptom duration, clinical course type, and stability of diagnoses.Results
The average symptom severity remained above the 85th percentile of the population average for 6 years. Symptoms were short-lived in only 14%. There were remissions in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32% (percentages do not total 100 because of rounding). Comparing the outcome, there was a clear gradient in which those with subthreshold disorders had the best outcome, followed by those with major depressive disorder, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases, while this group was at high risk of developing DSM affective disorders.Conclusions
The natural history of late-life depression in the community is poor. DSM affective disorders are relatively rare among elderly persons, but do identify those with the worst prognosis. However, subthreshold depression is serious and chronic in many cases.
Previous studies assessing protective effects of physical activity on depression have had conflicting results; one recent study argued that excluding disabled subjects attenuated any observed effects. The authors' objective was to compare the effects of higher levels of physical activity on prevalent and incident depression with and without exclusion of disabled subjects. Participants were 1,947 community-dwelling adults from the Alameda County Study aged 50-94 years at baseline in 1994 with 5 years of follow-up. Depression was measured using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Washington, DC: American Psychiatric Association, 1994). Physical activity was measured with an eight-point scale; odds ratios are based upon a one-point increase on the scale. Even with adjustments for age, sex, ethnicity, financial strain, chronic conditions, disability, body mass index, alcohol consumption, smoking, and social relations, greater physical activity was protective for both prevalent depression (adjusted odds ratio (OR) = 0.90, 95% confidence interval (Cl): 0.79, 1.01) and incident depression (adjusted OR = 0.83, 95% Cl: 0.73, 0.96) over 5 years. Exclusion of disabled subjects did not attenuate the incidence results (adjusted OR = 0.79, 95% Cl: 0.67, 0.92). Findings support the protective effects of physical activity on depression for older adults and argue against excluding disabled subjects from similar studies.
Background
High rates of low health literacy among elderly populations along with a high prevalence of chronic conditions may lead to increased levels of depression symptomatology. We sought to determine whether older adults with inadequate health literacy were more likely to report depressive symptoms and whether health literacy was an independent predictor of depression symptomatology.
Methods
A total of 3260 new Medicare enrollees 65 years or older were interviewed in person between June and December 1997 from 4 managed care plans (853 in Cleveland, Ohio, 498 in Houston, Tex, 975 in South Florida, and 934 in Tampa, Fla). Depression symptoms were measured by the Geriatric Depression Scale.
Results
Overall, 13% of respondents were classified as depressed. Individuals with inadequate health literacy had 2.7 times the odds (95% confidence interval, 2.2-3.4) of being depressed compared with individuals with adequate health literacy skills. However, after controlling for health status with multiple logistic regression, individuals with inadequate health literacy were not more likely to be depressed (adjusted odds ratio, 1.2; 95% confidence interval, 0.9-1.7). Individuals who had less social support, exercised less than twice a week, drank alcohol heavily, or had poor health status (at least 3 health conditions, physical limitations, or fair or poor self-rated health) had significantly higher odds of depression symptomatology.
Conclusions
Although individuals with inadequate health literacy were more than twice as likely to report depressive symptoms, this was mostly explained by their worse health status. The strong relation between depression symptoms and poor health status suggests the need to research interventions to improve mental and physical health concurrently. The influence of particular interventions on depression, such as referral to community support contacts and recommendations for an exercise program, needs to be further evaluated.
Terms such as risk, risk factors, and especially the term cause are inconsistently and imprecisely used, fostering scientific miscommunication and misleading research and policy. Clarifying such terms is the essential first step. We define risk and a risk factor (protective factor) and their potency, set out the conceptual basis of the methods by which risk factors are identified and potency demonstrated, and propose criteria for establishing the status of a risk factor as a fixed or variable marker or a causal risk factor. All definitions are based on the state of scientific knowledge (empirical documentation), rather than on hypotheses, speculations, or beliefs. We discuss common approaches and pitfalls and give a psychiatric research example. Imprecise reports can impede the search for understanding the cause and course of any disease and also may be a basis of inadequate clinical or policy decision-making. The issues in risk research are much too important to tolerate less than precise terminology or the less than rigorous research reporting that results from imprecise and inconsistent terminology.
Objective: The aims of this study were to describe the prevalence of mental disorders among elderly patients in primary care and to compare diagnoses from psychiatric interview with diagnoses in medical records.
Method: Patients aged 70 years and above attending a primary care centre (N=350) were studied using a psychiatric and medical record examination.
Results: The prevalence of mental disorder according to the psychiatric interview was 33% (16% dementia, 17% other mental disorders). Only 49% of these had any psychiatric diagnosis in case records and 17–38% received specific treatments. The frequency of psychiatric symptoms among those with no mental disorder was between 1% and 66%. Patients with mental disorders were more often females, had more visits to a doctor, more diagnoses in medical records, and were prescribed more drugs.
Conclusion: Mental disorders and symptoms are common among the elderly in primary care. More effort should be made to increase the recognition rate.
This study examined the relationship of depression to the sixteen scales constituting the Sixteen Personality Factor Questionnaire (16PF) by samples of elderly found in retirement communities and private residences. Scale two of the MMPI and the Geriatric Depression Scale (GDS) served as measures of depression in the prediction of the 16 PF scores. From the one hundred and two subjects who participated in the investigation, a multiple regression analysis indicated that depression scores were negatively related to Factor C (Ego Strength), Factor E (Dominance), Factor F (Impulsivity), Factor H (Boldness), and Factor Q3 (Ability to Bind Anxiety). Results were interpreted as indicating that geriatric-depression could be best conceptualized as a depressive-somatic phenomenon, the onset, severity, and longevity of which depended upon three distinct factors: (1) personality predispositions, (2) health factors, and (3) demographic factors.
In this study, the influence of religiosity, self-efficacy, and family-of-origin on depression was examined. In addition, the associations of race, gender, and age on these variables were analyzed. A total of 81 older persons, 56% white and 44% black, and approximately the same number of males and females, were recruited from public housing, a senior citizens organization, and a private community dwelling. Results indicated that a number of associations were significant between race, gender, religion, and age. No gender or race differences were associated with self-efficacy or depression. Multiple regression analysis was utilized to examine the role of self-efficacy, family-of-origin, and religiosity on depression of older adults. Significant causal effects were found for the influence of religiosity and family-of-origin on self-efficacy and the influence of self-efficacy on depression.
This study examines the fear of crime reported by a community sample of elderly cases of phobic disorder, compared with age- and sex-matched controls. The cases expressed more fear for personal safety and fear of property crime than did the controls, and fear of crime was regarded as a more serious problem by the cases. Cases reported more personal experience of victimization than did the controls. After controlling for this variable, there was no difference between the groups with regard to fear of property crime; but among non-victimized subjects the cases remained significantly more fearful for personal safety. Cases also reported higher rates of physical ill health than did the controls. When this was controlled, the only significant difference between groups was greater fear for personal safety in unwell cases compared to unwell controls. The groups did not differ in their judgements about local crime rates, but the cases were less likely to consider themselves capable of self-defence. These findings suggest that phobic disorders in old age are associated with greater perceived personal vulnerability, and that this contributes to a significant proportion of the problematic fear of crime in this age group.
This article is a broad review of psychological literature that addresses the prevalence, consequences, and psychological treatment of anxiety in older adults. Psychological treatments, including relaxation, cognitive-behavioral therapy, psychodynamic therapy, and life review, are explored as alternatives to pharmacological approaches to treatment of anxiety. Several anxiety associated conditions are discussed: dementia, depression, phobias, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Case histories illustrate the effectiveness of psychological intervention for treatment of anxiety in the elderly. Included is a comprehensive list of manuals for anxiety treatment procedures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The predictive value of health, health behaviour and functional ability for the occurrence of depression in elderly Finns is described using a longitudinal design. The persons determined as not being depressed (DSM-III criteria) in an epidemiological study in 1984–85 were interviewed and examined in a follow-up study in 1989–90 (N=679). The risk factors were analysed by contrasting the persons depressed in 1989–90 with those not depressed.Of the symptoms, recurrent falling and a loss of appetite in men, and palpitation, dyspnoea at rest, tremor in the hands, nausea, dizziness, recurrent falling, apathy and feebleness, fatigue and weakness, restlessness and sight disturbances in women predicted depression. Certain depressive symptoms, such as crying spells, psychomotor agitation, irritability, self-deprecation and suicidal thoughts in men, and sadness, tachycardia, a loss of concentration, psychomotor retardation and indecisiveness in women, also predicted depression. Numerous somatic and psychosomatic symptoms and numerous depressive symptoms were risk factors for women. Old age, poor self-perceived health, dependence on outside help in negotiating stairs and dependence on outside help in washing oneself were risk factors for men. A previous episode of depression was a predictor in both sexes. Sex was not related to the risk of depression. Both in men and women, an impairment of functional abilities during the follow-up was related to depression. A decline of self-perceived health, an occurrence of a serious disease and a decrease in the amount of physical exercise among women and moving into long-term institutional care and a decline of self-perceived health during the follow-up among men were associated with a greater risk. The occurrence of genitourinary diseases in men and the occurrence of vascular, cerebrovascular, thyroid or neurological disease in women during the follow-up were related to a high risk. The results support the hypotheses of a multifactorial aetiology and a relapsing and episodic course of depression in old age.
To study the prevalence and risk factors of anxiety disorders in the older (55-85) population of The Netherlands.
The Longitudinal Aging Study Amsterdam (LASA) is based on a random sample of 3107 older adults, stratified for age and sex, which was drawn from the community registries of 11 municipalities in three regions in The Netherlands. Anxiety disorders were diagnosed using the Diagnostic Interview Schedule in a two-stage screening design. The risk factors under study comprise vulnerability, stress and network-related variables. Both bivariate and multivariate statistical methods were used to evaluate the risk factors.
The overall prevalence of anxiety disorders was estimated at 10.2%. Generalized anxiety disorder was the most common disorder (7.3%), followed by phobic disorders (3.1%). Both panic disorder (1.0%) and obsessive compulsive disorder (0.6%) were rare. These figures are roughly similar to previous findings. Ageing itself did not have any impact on the prevalence in both bivariate and multivariate analyses. The impact of other factors did not change much with age. Vulnerability factors (female sex, lower levels of education, having suffered extreme experiences during World War II and external locus of control) appeared to dominate, while stresses commonly experienced by older people (recent losses in the family and chronic physical illness) also played a part. Of the network-related variables, only a smaller size of the network was associated with anxiety disorders.
Anxiety disorders are common in later life. The risk factors support using a vulnerability-stress model to conceptualize anxiety disorders. Although the prevalence of risk factors changes dramatically with age, their impact is not age-dependent. The risk factors indicate which groups of older people are at a high risk for anxiety disorders and in whom active screening and treatment may be warranted.
Objective. Anxiety disorders have been reported to decrease with age, while anxiety feelings have been reported to be as common as in younger age groups. In order to further explore this relationship and variables associated with anxiety, a population of very elderly persons was examined.Methods. 966 persons, aged 78 years and over, underwent an examination by a physician including a structured psychiatric interview.Results. Anxiety feelings are strongly associated with psychiatric disturbances (anxiety disorders and depressive disorders). Moreover, the feelings were associated with dementia, a history of psychiatric disorders (most often depression), being female and being dissatisfied with social network. Few of those with a psychiatric disorder were adequately treated, in spite of the fact that most of them had seen a physician during the past month.Conclusions. After excluding an anxiety disorder, one of the most important things to consider in a very old person with anxiety is whether depression is present or not. Generally, there is a need for more education of physicians concerning the common mental disorders in the elderly in order to improve their management. © 1998 John Wiley & Sons, Ltd.
We have investigated the tribological properties of a novel perfluoropolyether (PFPE) lubricant truncated on one end by a hydroxyl group and on the other end by a cyclotriphosphazene derivative. A measurement of the friction force as a function of molecular weight indicates that the dynamic clearance between the slider and the disk can be reduced by 1.5 nm by decreasing the molecular weight from 5300 to 2400 g/mol. However, the thermodynamic film stability of the novel PFPE lubricants, as determined by surface energy measurements and ellipsometric imaging of lubricant dewetting, becomes increasingly unstable at lower film thicknesses with decreasing molecular weight. Measurements conducted on lubricant mobility indicate that the novel PFPE lubricants are relatively immobile compared to the Zdol perfluoropolyether lubricants and hence resist film thinning to a greater degree. These data provide the direction for the optimization of the molecular weight of these novel PFPE lubricants.
Population-based studies suggest substantial co-morbidity between physical illness and depression in late-life. However, a causal relationship has not been established. If a relationship exists, it is important to establish which aspects of poor health determine risk for depression, and which factors confer vulnerability or resilience in the face of poor health. We investigate the role of disablement, measured as impairment, disability and handicap.
A prospective population-based cohort study, comprising an index assessment and 1 year follow-up, of all residents aged 65 years or over, of an electoral ward in London, UK (N = 889).
The prevalence of SHORT-CARE pervasive depression was 17.7% at index assessment. The 1 year onset rate for pervasive depression was 12.0%, and the 1 year maintenance rate 63.2%. There was a high mortality rate among the depressed. Disablement, particularly handicap was the most important predictor of the onset of depression (population attributable fraction, 0.69). Lack of contact with friends was a direct risk factor but also modified the association between handicap and depression. Marriage was protective for men, but a risk factor for women. Maintenance of depression was predicted by low levels of social support and social participation, rather than by disablement.
It seems likely that disablement, specifically handicap, is the chief cause of onsets of depression in late-life. Genetic predisposition, early adversity and serious life events may play a less prominent role than in earlier life. Effective prevention of late-life depression requires attention at the structural level to the sources of handicap within communities.
Synopsis
The notions of loss and danger are briefly described. Two groups of raters in London and Canberra were shown to be reliable in rating the degree of loss and the degree of danger associated with a sample of life events previously rated as ‘severe’ on a contextual measure of long-term threat. The life events were reported by 164 young women attending a general practitioner in London. The women were interviewed by a psychiatrist using the Present State Examination. Their psychiatric symptoms were rated by a team of raters who were ignorant of the life events reported by the young women. Three types of cases of psychiatric disorder of recent onset were diagnosed: depression, anxiety, and mixed depression/anxiety. The frequency of life events reported by these three types of cases as occurring in the year before the onset of their disorder was compared with the frequency of events in the same time period reported by a group of women without severe psychiatric disorder. The results were used to argue that severe loss was a causal agent in the onset of depressive disorder and severe danger was a causal agent in the onset of anxiety states in this sample. Cases of mixed depression/anxiety were more likely to report both a severe loss and a severe danger before onset. This supported the argument for recognizing a distinct group of mixed disorders in the classification of depressive illnesses.
It is argued that two major symptom dimensions underlie common mental disorders. These are depression related symptoms on the one hand, and anxious symptoms on the other. Each of these symptom dimensions is relate to a set of social variables, but an individual patient may have social factors present that are associated with each symptom dimension, thus producing an overlapping of symptoms. Another reason why the symptom dimensions overlap is that depression and anxiety relate to reward and punishment systems respectively, and these systems are necessarily reciprocally related to one another. Finally, each of these systems is related to abnormal activities in both nor-adrenergic and 5-hydroxytryptaminergic neurones. It is argued that in order to produce a useful model for common disorders one should distinguish between three groups of factors: those producing vulnerability to anxious or depressive symptoms, those factors releasing symptoms at a particular time, and those factors which determine how long illness lasts. These three groups of factors are respectively called vulnerability, destabilisation and restitution.
This study examined reports of a history of psychiatric illness related to age and depression in 4051 community residents aged 65-84. Depression was twice as common among subjects with a history of psychiatric illness before age 65. 78% of depressed subjects reported no history. The rate of reported history was inversely proportionate to the subjects actual age. This did not appear to be due to recollection bias but it did match the proportions previously reported to result from excess mortality of individuals with a psychiatric history. A psychiatric history may be an important risk factor for late-life depression but in the aging process after age 65 it may become increasingly uncommon.
In both clinical and epidemiological samples, major depression (MD) and generalised anxiety disorder (GAD) display substantial comorbidity. In a prior analysis of lifetime MD and GAD in female twins, the same genetic factors were shown to influence the liability to MD and to GAD. A follow-up interview in the same twin cohort examined one-year prevalence for MD and GAD (diagnosed using a one-month minimum duration of illness). Bivariate twin models were fitted using the program Mx. High levels of comorbidity were observed between MD and GAD. The best-fitting twin models, when GAD was diagnosed with or without a diagnostic hierarchy, found a genetic correlation of unity between the two disorders. The correlation in environmental risk factors was +0.70 when GAD was diagnosed non-hierarchically, but zero when hierarchical diagnoses were used. Our findings provide further support for the hypothesis that in women, MD and GAD are the result of the same genetic factors. Environmental risk factors that predispose to 'pure' GAD episodes may be relatively distinct from those that increase risk for MD.
Although categorical diagnoses are valued by clinicians and those wishing to collect homogeneous groups of patients for research projects, in the field of non-psychotic mental disorders they correspond poorly to actual clinical syndromes. Indeed, patients often satisfy several sets of categorical criteria simultaneously. A more parsimonious representation of symptomatology can be obtained by using a dimensional model for symptoms-with two correlated axes corresponding to anxiety and depression for ratings derived from the Present State Examination. The Composite International Diagnostic Interview is likely to produce a third dimension-so-matic symptoms-because of a radically different symptom content. Preliminary data analysis indicates that the somatic symptoms dimension correlates with both anxiety and depression. Symptomatic individuals in particular areas of dimensional space will satisfy several criteria for categorical diagnoses, and thus display comorbidity. However, evidence that these disorders are distinct is far from persuasive, as they appear to share several common causes.