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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
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)
The longitudinal relationship between mental health disorders and chronic disease for older adults: a population-based study
- Authors:
- CHEN Chun-Min, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.1017-1026.
- Publisher:
- Wiley
Objective: Although mental health disorders in older adults are common, their relationship with chronic disease and the influence of chronic disease on the development of mental health disorders over time is not well understood. This longitudinal study investigated the change in status of mental health disorders and chronic disease, as well as their interrelationships, over time. Methods: Participants included community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Mental health disorders were scored using the Short Psychiatric Evaluation Schedule, and chronic disease(s) status was recorded during consecutive biennial data collection waves. The autoregressive latent trajectory model and parallel latent growth curve model were used for data analysis. Results: The study findings suggest that in older people pre-existing mental health disorders and/or chronic disease(s) will predispose them to developing significantly more mental health disorders and/or chronic diseases respectively. The study findings also suggest that pre-existing mental health disorders can significantly contribute to the development of chronic disease over time, and that pre-existing chronic disease(s) significantly can contribute to the development of mental health disorders over time, indicating a reciprocal interrelationship. Conclusions: The authors' findings suggest that it in addition to monitoring and treating chronic disease(s) in older people, it is also important to monitor and treat their mental health disorders. Doing so will result in overall better health outcomes and will facilitate a better quality of life as they age. (Publisher abstract)
Neural basis for the relationship between frequency of going outdoors and depressive mood in older adults
- Authors:
- SAKURAI Ryota, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(6), 2017, p.589–595.
- Publisher:
- Wiley
Objective: Low frequency of going outdoors (e.g. being homebound) is associated with depressive mood; however, the underlying neural mechanism of this association is unclear. The authors therefore investigated the neural substrate involved in the relationship between frequency of going outdoors and depressive mood using positron emission tomography (PET), focusing on the frontal lobe and the limbic system. Methods: One hundred fifty-eight community-dwelling older adults aged 65–85 years underwent PET with 18F-fluorodeoxyglucose to evaluate regional cerebral metabolic rates of glucose normalised in reference to cerebellar glucose metabolic value (normalized-rCMRglc) in six regions of interest. The authors also assessed depressive mood, frequency of going outdoors, and potential covariates. Depressive mood was assessed using the Geriatric Depression Scale (GDS). Results: The proportion of participants who reported low frequency of going outdoors (LG, every 2–3 days or less) was 36.1%. The LG group showed significantly higher GDS scores than those who reported high (once a day or more) frequency of going outdoors. A multiple linear regression analysis adjusted for potential covariates showed higher GDS scores were associated with lower normalised-rCMRglc in the ventrolateral prefrontal and orbitofrontal cortices. Adjusting for frequency of going outdoors, the association between GDS score and normalized-rCMRglc in the orbitofrontal cortex was attenuated. Conclusions: The authors' results suggest that the orbitofrontal cortex may mediate the relationship between low frequency of going outdoors and depressive mood among community-dwelling older adults. These findings may help disentangle the role of going outdoors in regulating brain function to improve and/or maintain mental health among community-dwelling older adults (Edited publisher abstract)
Frailty and incident depression in community-dwelling older people: results from the ELSA study
- Authors:
- VERONESE Nicola, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.e141-e149.
- Publisher:
- Wiley
Objective: Frailty and pre-frailty are two common conditions in the older people, but whether these conditions could predict depression is still limited to a few longitudinal studies. In this paper, we aimed to investigate whether frailty and pre-frailty are associated with an increased risk of depression in a prospective cohort of community-dwelling older people. Methods: Four thousand seventy-seven community-dwelling men and women over 60 years without depression at baseline were included from the English Longitudinal Study of Ageing. Frailty status was defined according to modified Fried's criteria (weakness, weight loss, slow gait speed, low physical activity and exhaustion) and categorized as frailty (≥3 criteria), pre-frailty (1–2 criteria) or robustness (0 criterion). Depression was diagnosed as ≥4 out of 8 points of Center for Epidemiologic Studies Depression Scale, after 2 years of follow-up. Results: Over a 2-year follow-up, 360 individuals developed depression. In a logistic regression analysis, adjusted for 18 potential baseline confounders, pre-frailty (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.54–1.46; p = 0.64) and frailty (OR = 1.22; 95% CI, 0.90–1.64; p = 0.21) did not predict the onset of depression at follow-up. Among the criteria included in the frailty definition, only slow gait speed (OR = 1.82; 95% CI, 1.00–3.32; p = 0.05) appeared to predict a higher risk of depression. Conclusions: Among older community dwellers, frailty and pre-frailty did not predict the onset of depression during 2 years of follow-up, when accounting for potential confounders, whilst slow gait speed considered alone may predict depression in the older people. (Publisher abstract)
Big Five personality characteristics are associated with depression subtypes and symptom dimensions of depression in older adults
- Authors:
- KOOREVAAR A.M.L., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.e132-e140.
- Publisher:
- Wiley
Objective: This study examined the associations of personality characteristics with both subtypes and symptom dimensions of depression in older adults. Methods: Three hundred and seventy-eight depressed older adults participated in the Netherlands Study of Depression in Older Persons. Personality characteristics were assessed by the NEO-Five Factor Inventory. Subtypes and symptom dimensions of depression were determined using the Composite International Diagnostic Interview and the Inventory of Depressive Symptomatology (IDS). Multinomial logistic regression analyses were performed to examine the associations between personality and atypical, melancholic, and unspecified subtypes of major depression. Linear regression analyses examined the associations between personality and the IDS mood, somatic, and motivation symptom dimensions. The analyses were adjusted for confounders and additionally adjusted for depression severity. Results: Neuroticism, Extraversion, Conscientiousness, and Agreeableness were associated with specified (atypical or melancholic) major depression compared with unspecified major depression in the bivariate analyses but lost their significance after adjustments for functional limitations and severity of depression. Neuroticism was positively associated with the IDS mood and motivation symptom dimensions, also in the adjusted models. Further, Extraversion and Agreeableness were negatively associated with the IDS mood symptom dimension, and Extraversion and Conscientiousness were negatively associated with the IDS motivation symptom dimension. None was associated with the IDS somatic symptom dimension. Conclusions: This study demonstrated the association of personality characteristics with mood and motivational symptoms of late-life depression. The lacking ability of personality to differentiate between melancholic and atypical depression seems to be largely explained by severity of depressive symptoms (Publisher abstract)
Aging perceptions and self-efficacy mediate the association between personality traits and depressive symptoms in older adults
- Authors:
- O'SHEA D.M., DOTSON V.M., FIEO R.A.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1217-1225.
- Publisher:
- Wiley
Objective: Personality traits have been shown to be predictors of depressive symptoms in late life. The authors examined whether other more modifiable sources of individual differences such as self-efficacy and self-perceptions of ageing would mediate the association between personality traits and depressive symptoms in older adults. Method: Data were obtained from 3,507 older adult participants who took part in the 2012 Health and Retirement Study. The “Big Five” personality traits, self-efficacy, ageing perceptions, and depressive symptoms were assessed. Mediation analyses tested the hypothesis that self-efficacy and ageing perceptions would mediate the relationship between personality traits and depressive symptoms. Results: All five personality traits were significant predictors of depressive symptoms. Neuroticism was positively associated with depressive symptoms and had the greatest effect compared with the other personality traits. There was a significant indirect effect of neuroticism, extraversion, and conscientiousness on depressive symptoms (including both mediators). The mediating effect of ageing perceptions on the relationship between neuroticism and depressive symptoms was the strongest compared with self-efficacy, accounting for approximately 80% of the total indirect effect. Conclusion: The authors results provide support for interventions aimed at improving self-perceptions related to efficacy and ageing in order to reduce depressive symptoms in older adults. (Edited publisher abstract)
Imagining transitions in old age through the visual matrix method: thinking about what is hard to bear
- Author:
- LIVENG Anne
- Journal article citation:
- Journal of Social Work Practice, 31(2), 2017, pp.155-170.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Dominant discourses of ageing are often confined to what is less painful to think about and therefore idealise or denigrate ageing and later life. The authors present findings from an exploratory psychosocial study, in a Nordic context, into three later-life transitions: from working life to retirement, from mental health to dementia and from life to death. Because, for some, these topics are hard to bear and therefore defended against and routinely excluded from everyday awareness, the authors used a method led by imagery and affect – the visual matrix – to elicit participants’ free associative personal and collective imagination. Through analysis of data extracts, on the three transitions, we illustrate oscillations between defending against the challenges of ageing and realism in facing the anxieties it can provoke. A recurring theme includes the finality of individual life and the inter-generational continuity, which together link life and death, hope and despair, separation and connectedness (Edited publisher abstract)
The influence of thoughts of death and suicidal ideation on the course of depression in older depressed patients
- Authors:
- BOGERS Ista C.H.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(8), 2017, pp.882-891.
- Publisher:
- Wiley
Objective: Thoughts of death are not regularly included in diagnostic instruments and rarely examined separately from thoughts of suicide. This exploratory study examined whether thoughts of death and thoughts of suicide affect the course of late-life depressive disorders. Methods: In 378 depressed older persons, thoughts of death and thoughts of suicide were assessed using questions from the Composite International Diagnostic Interview. After 2 years, the presence of a DSM-IV-TR diagnosis of minor or major depression or dysthymia was assessed with the Composite International Diagnostic Interview. The Inventory of Depressive Symptomatology was administered every 6 months up till 3-year follow-up. Results: Multinomial logistic regression showed that thoughts of death as well as thoughts of suicide predicted double depression at follow-up (OR = 2.14 [95% CI: 1.04–4.40] and OR = 6.47 [95% CI: 2.22–3.02], respectively), compared with patients without these thoughts. Results became non-significant when adjusted for baseline depression severity (OR = 1.17 [95% CI: 0.52–2.63] and OR = 2.57 [95% CI: 0.79–8.84], respectively). Mixed linear models showed that severity of depression was lowest in the reference group, while symptoms decreased more over time in those with either thoughts of death or suicide. Conclusions: Patients with thoughts of death or with thoughts of suicide were more severely depressed at baseline and follow-up, with the highest risk of being depressed at follow-up for patients with thoughts of suicide. These associations could be explained by baseline depression severity. The results suggest that thoughts of death and thoughts of suicide are important risk markers in predicting the course of depression. (Publisher abstract)
Is the naturalistic course of depression in older people related to received support over time? Results from a longitudinal population-based study
- Authors:
- HOUTJES Wim, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(6), 2017, pp.657-663.
- Publisher:
- Wiley
Objectives: To test the interrelation of the naturalistic course of depression in older people with long-term support received. Design: Longitudinal cohort study. Methods: A sample of 277 adults age 55–85 years participating in the Longitudinal Aging Study Amsterdam, with clinically relevant depressive symptoms at baseline (scores ≥16 on the Center for Epidemiological Studies Depression Scale) were followed up over a period of 13 years. General estimating equations were used to examine the relation between depression course and emotional/instrumental support received over time. In addition, partner status, gender, and age were tested as modifiers. Results: A 2-way interaction between depression courses types and time showed significant differences in instrumental support received over time in older people with a late-life depression. Three-way interactions showed that associations between depression course and support variables were modified by gender and partner status. Conclusion: Both men and singles, with a chronic course of depression may be at risk to lose emotional and instrumental support over time. Professional attention is needed to prevent a chronic course of late-life depression, and to preserve personal social networks. (Publisher abstract)
Mental health first aid for the elderly: a pilot study of a training program adapted for helping elderly people
- Authors:
- SVENSSON Bengt, HANSSON Lars
- Journal article citation:
- Aging and Mental Health, 21(6), 2017, pp.595-601.
- Publisher:
- Taylor and Francis
Objectives: Epidemiological studies have shown a high prevalence of mental illness among the elderly. Clinical data however indicate both insufficient detection and treatment of illnesses. Suggested barriers to treatment include conceptions that mental health symptoms belong to normal ageing and lack of competence among staff in elderly care in detecting mental illness. A Mental Health First Aid (MHFA) training programme for the elderly was developed and provided to staff in elderly care. The aim of this study was to investigate changes in knowledge in mental illness, confidence in helping a person, readiness to give help and attitudes towards persons with mental illness. Method: Single group pre-test–post-test design. Results: The study group included staff in elderly care from different places in Sweden (n = 139). Significant improvements in knowledge, confidence in helping an elderly person with mental illness and attitudes towards persons with mental illness are shown. Skills acquired during the course have been practiced during the follow-up. Conclusions: The adaption of MHFA training for staff working in elderly care gives promising results. Improvements in self-reported confidence in giving help, attitudes towards persons with mental illness and actual help given to persons with mental illness are shown. However, the study design allows no firm conclusions and a randomised controlled trail is needed to investigate the effectiveness of the programme. Outcomes should include if the detection and treatment of mental illness among the elderly actually improved. (Edited publisher abstract)