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Journal article

Inclusion/exclusion criteria in late life depression antidepressant efficacy trials

Authors:
ZIMMERMAN Mark, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 32(9), 2017, pp.1009-1016.
Publisher:
Wiley-Blackwell

Objective: The generalisability of antidepressant efficacy trials (AETs) has been questioned. No studies have examined the inclusion/exclusion criteria used in placebo-controlled studies of late life depression and compared them to the criteria used in non-late life AETs. Method: The authors conducted a comprehensive literature review of placebo-controlled AETs published from January, 1995 through December, 2014. They compared the inclusion/exclusion criteria used in the 18 studies of late life depression to those used in non-late life depression. Results: There were nine inclusion/exclusion criteria that were used in more than half of the late life depression AETs: minimum severity on a symptom severity scale (100.0%), significant suicidal ideation (77.8%), psychotic features during the current episode of depression or history of a psychotic disorder (94.4%), history of bipolar disorder (77.8%), diagnosis of alcohol or drug abuse or dependence (83.3%), presence of a comorbid nondepressive, nonsubstance use Axis I disorder (55.6%), episode duration too short (66.7%), and an insufficient score on a cognitive screen (88.3%) or the presence of a cognitive disorder (55.6%). There were some differences between the late life and non-late life depression studies—use of a screening measure of cognitive functioning, presence of a cognitive disorder such as dementia, and the minimum depression severity cutoff score required at baseline. Conclusions: The inclusion/exclusion criteria in AETs of late life depression were generally similar to the criteria used in non-late life depression (Edited publisher abstract)

Journal article

Association between depression and resilience in older adults: a systematic review and meta-analysis

Authors:
AVILA Maria Priscila Wermelinger, LUCCHETTI Alessandra Lamas Granero, LUCCHETTI Giancarlo
Journal article citation:
International Journal of Geriatric Psychiatry, 32(3), 2017, pp.237-246.
Publisher:
Wiley-Blackwell

Objective: The objective of this study is to determine whether resilience is associated with depressive symptoms in geriatric populations. Method: A systematic review and meta-analysis were performed (up to March 2015) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis recommendations on three databases (PubMed/Medline, Scopus, and Web of Science) with no language restrictions, using a Boolean expression. For inclusion in the study, articles had to assess the older population (60 years or older), assess both depressive and resilience symptoms, and investigate the association between these two variables. Articles not employing validated resilience and depression scales or assessing populations younger than 60 years were excluded. The quality of the selected studies was assessed using the Quality Assessment Tool for Quantitative Studies. Results: A total of 1094 articles were retrieved from the three databases, 367 of which were duplicates and therefore excluded, giving 727 articles for analysis. Of these articles, seven met the eligibility criteria. All of the included articles were observational and cross-sectional, found an inverse relationship between depression and resilience, and were conducted in three countries: the USA, China, and Belgium. A moderate inverse correlation was found on the meta-analysis (r = −0.35, 95% confidence interval: −0.41 to −0.28). Conclusion: Few studies were found on this subject in the older population. An association between greater resilience and less depressive symptomatology was identified, albeit based on cross-sectional studies. These results highlight the need for further studies in the area and the importance of fostering the use of interventions to promote resilience in older adults as a means of preventing and managing depressive symptoms in this population. (Publisher abstract)

Journal article

Prospective associations between sedentary behaviour and incident depressive symptoms in older people: a 15-month longitudinal cohort study

Authors:
TSUTSUMIMOTO Kota, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 32(2), 2017, pp.193-200.
Publisher:
Wiley-Blackwell

Objective: This study aimed to investigate whether sitting time, as a form of sedentary behaviour, is related to incident depressive symptoms in older people. Methods: This study included 3503 participants (mean age 71.7 years, 50.1% female) from the ‘Obu Study of Health Promotion for the Elderly' cohort study. At baseline and then 15 months later, the participants reported their status of depressive symptoms using the 15-item Geriatric Depression Scale. During the baseline assessment, the participants were also asked about their sedentary behaviour on weekdays over the past 7 days and, from there, categorised into three groups (<240, 240–480, ≥480 min/day). Demographic data and the other health behaviours were also assessed at the baseline. Results: Cross-sectional analysis revealed that 437 participants (12.0%) had depressive symptoms. In a prospective analysis, the logistic regression model revealed that the odds ratio for depressive symptom incidence was higher in participants who, at baseline, spent 480 min or more per day sitting, and in those who spent 240-480 min in comparison with those who spent less than 240 min. Conclusions: Sedentary behaviour significantly affects the risk of incident depressive symptoms. Further research is needed to develop an intervention strategy to manage depressive symptoms, as the second most common cause of burden of disease among older adults. (Edited publisher abstract)

Journal article

Towards a new conceptualization of depression in older adult cancer patients: a review of the literature

Authors:
SARACINO Rebecca M., ROSENFELD Barry, NELSON Christian J.
Journal article citation:
Aging and Mental Health, 20(12), 2016, pp.1230-1242.
Publisher:
Taylor and Francis

Objectives: This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer. Method: PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer. Results: The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms. Conclusions: Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed. (Edited publisher abstract)

Journal article

A systematic review and meta-analysis of music therapy for the older adults with depression

Authors:
ZHOA K., et al
Journal article citation:
International Journal of Geriatric Psychiatry, 31(11), 2016, pp.1188-1198.
Publisher:
Wiley-Blackwell

Objectives: To determine the efficacy of music therapy in the management of depression in the elderly. Method: A systematic review and meta-analysis of randomised controlled trials. Change in depressive symptoms was measured with various scales. Standardised mean differences were calculated for each therapy–control contrast. Results: A comprehensive search yielded 2,692 citations; 19 articles met inclusion criteria. Meta-analysis suggests that music therapy plus standard treatment has statistical significance in reducing depressive symptoms among older adults. Conclusions: This systematic review and meta-analysis suggests that music therapy has an effect on reducing depressive symptoms to some extent. However, high-quality trials evaluating the effects of music therapy on depression are required. (Edited publisher abstract)

Journal article

The impact of executive function on response to cognitive behavioral therapy in late-life depression

Authors:
GOODKIND Madeleine S., et al
Journal article citation:
International Journal of Geriatric Psychiatry, 31(4), 2016, pp.334-339.
Publisher:
Wiley-Blackwell

Objective: Late-life depression (LLD) is a common and debilitating condition among older adults. Cognitive behavioural therapy (CBT) has strong empirical support for the treatment of depression in all ages, including in LLD. In teaching patients to identify, monitor, and challenge negative patterns in their thinking, CBT for LLD relies heavily on cognitive processes and, in particular, executive functioning, such as planning, sequencing, organising, and selectively inhibiting information. It may be that the effectiveness of CBT lies in its ability to train these cognitive areas. Methods: Participants with LLD completed a comprehensive neuropsychological battery before enrolling in CBT. The current study examined the relationship between neuropsychological function prior to treatment and response to CBT. Results: When using three baseline measures of executive functioning that quantify set shifting, cognitive flexibility, and response inhibition to predict treatment response, only baseline Wisconsin Card Sort Task performance was associated with a significant drop in depression symptoms after CBT. Specifically, worse performance on the Wisconsin Card Sort Task was associated with better treatment response. Conclusions: These results suggest that CBT, which teaches cognitive techniques for improving psychiatric symptoms, may be especially beneficial in LLD if relative weaknesses in specific areas of executive functioning are present. (Publisher abstract)

Journal article Full text available online for free

Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions

Authors:
ESIWE Collins, et al
Journal article citation:
Age and Ageing, 44(5), 2015, pp.771-775.
Publisher:
Oxford University Press

Background: Depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). Methods: One hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination—Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). Results: A threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. Conclusion: The two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases. (Publisher abstract)

Journal article Full text available online for free

Physical exercise for late-life major depression

Authors:
MURRI M. Belvederi, et al
Journal article citation:
British Journal of Psychiatry, 207(3), 2015, pp.235-242.
Publisher:
Royal College of Psychiatrists

Aims: Interventions including physical exercise may help improve the outcomes of late-life major depression, but few studies are available. This study aimed to investigate whether augmenting sertraline therapy with physical exercise leads to better outcomes of late-life major depression. Method: Primary care patients (465 years) with major depression were randomised to 24 weeks of higher-intensity, progressive aerobic exercise plus sertraline (S+PAE), lower-intensity, non-progressive exercise plus sertraline (S+NPE) and sertraline alone. The primary outcome was remission (a score of ≤10 on the Hamilton Rating Scale for Depression). Results: A total of 121 patients were included. At study end, 45% of participants in the sertraline group, 73% of those in the S+NPE group and 81% of those in the S+PAE group achieved remission (P = 0.001). A shorter time to remission was observed in the S+PAE group than in the sertraline-only group. Conclusions: Physical exercise may be a safe and effective augmentation to antidepressant therapy in late-life major depression. (Publisher abstract)

Journal article

The relationship between depression and frailty syndrome: a systematic review

Authors:
BUIGUES Cristina, et al
Journal article citation:
Aging and Mental Health, 19(9), 2015, pp.762-772.
Publisher:
Taylor and Francis

Objectives: Frailty is a geriatric syndrome characterised by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Frailty and depressive symptoms are common issues facing older adults and may be associated. It is not clear if the depression facilitates the appearance of frailty syndrome or vice versa or these two coexist independently in the same individuals. Method: Searches were conducted in several databases (Embase, PubMed, CINAHL, Scopus, and PsycINFO) for papers published between November 2003 to February 2014 about frailty syndrome and depression in people aged 65 and older. The reference lists of from the articles retrieved were also pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on the prevalence and co-occurrence of frailty and depression in older individuals and of frailty criteria among depressed patients. Results: Depression and frailty occur in a significant proportion of frail older individuals. Common pathophysiological alterations and biomarkers in the two syndromes have been recently described. Conclusion: Studies on the causal relationship between the two syndromes are clearly necessary in the future. (Edited publisher abstract)

Journal article

Moderating effect of communication difficulty on the relationship between depression and pain: a study on community-dwelling older adults in Hong Kong

Authors:
CHAN Wallace Chi Ho, KWAN Chi Wai, CHI Iris
Journal article citation:
Aging and Mental Health, 19(9), 2015, pp.829-834.
Publisher:
Taylor and Francis

Objectives: This study examined the relationship between depression and pain, and the moderating effect of communication difficulty on this relationship, among community-dwelling older adults in Hong Kong. Method: Logistic regression was used to analyse secondary data regarding 12,402 Chinese older adults applying for long-term care service in Hong Kong in 2012. Results: Approximately 30% of participants were depressed and 37% experienced communication difficulty. Depression was associated with increased pain. Communication difficulty was found to moderate the relationship between depression and pain. Pain scores increased more when individuals who experienced communication difficulty reported being depressed, compared to those who did not experience communication difficulty. Conclusion: The moderating effect of communication difficulty may be explained by the interaction between depression and communication difficulty. Participants who were depressed and concurrently experienced communication difficulty may be more likely to catastrophise their pain and may tend to report or experience more pain. Health care professionals need to be aware of the different effects of communication difficulty on the pain experiences of older adults. Psychosocial intervention may be provided to minimize older adults’ communication barriers to pain management. (Edited publisher abstract)

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