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Clinically significant non-major depression in a community-dwelling elderly population: epidemiological findings
- Authors:
- CHEN Cheng-Sheng, CHONG Mian-Yoon, TSANG Hin-Yeung
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(6), June 2007, pp.557-562.
- Publisher:
- Wiley
The aim of this study was to investigate the 1-month prevalence, symptom profiles and demographic correlates in late-life clinically significant non-major depression (CSNMD) among a community-dwelling elderly population. One thousand five hundred subjects aged 65 years and older, who were randomly selected from three communities in Taiwan, received comprehensive psychiatric assessment by trained psychiatrists. Two categorical diagnoses of depressive disorder, including major depression and CSNMD, were made. The 1-month prevalence was calculated. Frequencies of depressive symptoms across CSNMD and major depression were compared. The risks of CSNMD based on demographic characteristics were estimated using multinominal logistic regression. The 1-month prevalence of CSNMD among the community-dwelling elderly was 8.8%. Symptoms of diminished interest, appetite changes, sleep disturbance, worthlessness or inappropriate guilt, trouble in concentrating or indecisiveness, and suicidal thoughts or acts were less frequent in CSNMD than in major depression, but symptoms of depressed mood, psychomotor changes, and fatigue or loss of energy were as frequent in both categories of illness. CSNMD shares similar demographic risks, such as living in an urban area, female gender and low educational status, with major depression. CSNMD is common among community-dwelling elders in Taiwan, and with its identical demographic characteristics, but qualitatively different presentation, the authors suggest CSNMD may be considered part of a spectrum of severe late life depressions with a distinct manifestation. Major depression and CSNMD may share common demographic characteristics with different manifestation. It is concluded that late-life depression is a dimensional disease.
Factors associated with antidepressant use in depressed and non-depressed community-dwelling elderly: the three-city study
- Authors:
- SOUDRY Agnes, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(3), March 2008, pp.324-330.
- Publisher:
- Wiley
The aim of this study was to identify factors associated with antidepressant use in non-depressed and depressed elderly persons, assuming that they varied according to clinical status. The authors studied 7,868 French community-dwelling subjects aged 65 years and over. The Center for Epidemiological Studies-Depression scale and the Mini International Neuropsychiatric Interview were used to define three groups: non-depressed, high depressive symptoms and current major depressive disorder. Separate analyses were performed to identify the factors which were associated with antidepressant use in each group. Antidepressant use (55% selective serotonin re-uptake inhibitors, 25% tricyclic antidepressants, 20% other types) increased from 4.9% in non-depressed subjects to 17.3% in subjects with high depressive symptoms (HDS) and 33.6% of in those with current major depressive disorder (MDD). The factors associated with antidepressant use varied according to depression status. In particular, men with current MDD were more often treated with antidepressants than women whereas, in both the HDS and the non-depressed groups, antidepressant use was, as has been observed elsewhere, more frequent in women. Gender also had a strong modifying effect on the relationship between antidepressant use and history of major depression. Finally, the direction of the association between antidepressant use and cognitive performance varied according to depression status. This study showed that the direction and strength of the association between antidepressant use and demographic and health-related factors varied according to the severity of depression symptoms. Further studies are needed to clarify the relationship between gender and cognition and antidepressant use.
Predicting 6-week treatment response to escitalopram pharmacotherapy in late-life major depressive disorder
- Authors:
- SAGHAFI Ramin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(11), November 2007, pp.1141-1146.
- Publisher:
- Wiley
Approximately half of older patients treated for major depressive disorder (MDD) do not achieve symptomatic remission and functional recovery with first-line pharmacotherapy. This study aims to characterize sociodemographic, clinical, and neuropsychologic correlates of full, partial, and non-response to escitalopram monotherapy of unipolar MDD in later life. One hundred and seventy-five patients aged 60 and older were assessed at baseline on demographic variables, depression severity, hopelessness, anxiety, cognitive functioning, co-existing medical illness burden, social support, and quality of life (disability). Subjects received 10 mg/d of open-label escitalopram and were divided into full (n = 55; 31%), partial (n = 75; 42.9%), and non-responder (n = 45; 25.7%) groups based on Hamilton depression scores at week 6. Univariate followed by multivariate analyses tested for differences between the three groups. Non-responders to treatment were found to be more severely depressed and anxious at baseline than both full and partial responders, more disabled, and with lower self-esteem than full responders. In general partial responders resembled full responders more than they resembled non-responders. In multivariate models, more severe anxiety symptoms (both psychological and somatic) and lower self-esteem predicted worse response status at 6 weeks. Among treatment-seeking elderly persons with MDD, higher anxiety symptoms and lower self-esteem predict poorer response after six weeks of escitalopram treatment.
Acculturation and self-esteem among older Mexican Americans
- Authors:
- MEYLER D., STIMPSON J. P., PEEK M. K.
- Journal article citation:
- Aging and Mental Health, 10(2), March 2006, pp.182-186.
- Publisher:
- Taylor and Francis
Several researchers have examined how acculturation shapes the self-esteem of adolescents, but few studies have looked at the influence of acculturation for older Mexican Americans. The aim of this study was to examine how language acculturation shaped the self-esteem of older Mexican Americans. The data come from the baseline wave (N?=?3050) of the ongoing Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE), a multistage area probability sample conducted in 1993 and 1994. Research revealed that language acculturation is positively associated with self-esteem. However, depressive symptoms mediate and moderate the association of acculturation on self-esteem. Language acculturation among older Mexican Americans is positively associated with self-esteem, even when individuals experience depressive symptoms. Findings suggest that acculturation influences multiple dimensions of mental health.
Prevalence of depressive symptoms and syndromes in later life in ten European countries: the SHARE study
- Authors:
- CASTRO-COSTA Erico, et al
- Journal article citation:
- British Journal of Psychiatry, 191(11), November 2007, pp.393-401.
- Publisher:
- Cambridge University Press
The EURO–D, a12-item self-report questionnaire for depression, was developed with the aim of facilitating cross-cultural research into late-life depression in Europe. The aim was to describe the national variation in depression symptoms and syndrome prevalence across ten European countries. The EURO–D was administered to cross-sectional nationally representative samples of noninstitutionalised persons aged 50 years (n=22 777). The effects of age, gender, education and cognitive functioning on individual symptoms and EURO–D factor scores were estimated. Country-specific depression prevalence rates and mean factor scores were re-estimated, adjusted for these compositional effects. The prevalence of all symptoms was higher in the Latin ethno-lingual group of countries, especially symptoms related to motivation. Women scored higher on affective suffering; older people and those with impaired verbal fluency scored higher on motivation. The prevalence of individual EURO–D symptoms and of probable depression (cut-off score 4) varied consistently between countries. Standardising for effects of age, gender, education and cognitive function suggested that these compositional factors did not account for the observed variation.
Falls of the elderly are associated with burden of caregivers in the community
- Authors:
- KUZUYA Masafumi, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(8), August 2006, pp.740-745.
- Publisher:
- Wiley
Little attention has been paid to the impact on caregivers who provide care to a family member who has falls. The purpose of the current study was to determine whether falls of care recipients are associated with caregivers' burden. A cross-sectional study of 1874 community-dwelling care recipients and 1478 caregivers was conducted. We examined the characteristics of care recipients and caregivers, including demographic characteristics, depressive mood as assessed by the Geriatric Depression Scale (GDS-15), the basic activities of daily living (bADL), fall history in the past 6 months, and physician-diagnosed chronic diseases to determine whether there was an association with caregivers' burden as assessed by the Zarit Burden Interview (ZBI). A total of 567 care recipients (30.3%) had a history of falls in the past 6 months. The mean ZBI score of caregivers with falls was significantly higher than that of caregivers without falls. There were negative correlations between the ZBI score and recipient bADL score and positive correlations between the ZBI score and GDS-15 scores of the recipient and caregiver, the level of severity of dementia, and the Charlson comorbidity index. Male recipient, fall history, behavioral disturbance, and dementia had significantly higher ZBI scores than those of controls. The stepwise multiple regression analyses found that the GDS-15 score of caregivers and recipients, level of severity of dementia, bADL score, and fall history were independently associated with the ZBI score. Among the community-dwelling frail elderly, falls are associated with caregiver burden even when controlling for various possible confounding factors
Depression among elderly Korean immigrants: exploring socio-cultural factors
- Authors:
- LEE Hee Y., MOON Ailee, KNIGHT Bob G.
- Journal article citation:
- Journal of Ethnic and Cultural Diversity in Social Work, 13(4), 2004, pp.1-26.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study examined predictors of depression in a sample of 95 elderly Korean immigrants aged 60 or over in the USA. Depression among Korean immigrants was hypothesized to be associated with socio-demographic and cultural factors, including health status, gender, education, financial status, acculturation level, familism, social support, especially from the family, and family relationships. A face-to-face interview was conducted in Korean using a structured questionnaire. Depression in this study was measured using the Center for Epidemiological Studies of Depression (CES-D) Scale. A substantial percentage of the sample was experiencing a high level of depression. In multiple regression analyses, perceived health status and education were significant predictors among socio-demographic factors. Among cultural factors, acculturation status was not a significant predictor; however, positive support from the family and family relationships were significantly associated with depression. The role of family as a risk factor for depression in older Korean immigrants and implications for mental health policy, programs, and future research are discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan
- Authors:
- LEE Yunhwan, SHINKAI Shoji
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(6), June 2005, pp.576-586.
- Publisher:
- Wiley
Cognitive impairment and depressive symptoms impose a heavy burden on the care of the elderly in Japan and Korea, two of the fastest aging nations in Asia. The purpose of this study was to examine and compare factors associated with cognitive impairment and depressive symptoms among older persons in the two countries. In 2002, representative samples of community-dwelling people aged 65 and older were selected among residents in Anyang, Korea and Yoita, Japan. Mini-Mental State Examination and Geriatric Depression Scale were used to assess the elderly's mental status. Sociodemographics, physical function, chronic conditions, social support, and health behaviours were examined to identify significant associations. The prevalence of cognitive impairment in older adults was 17.0 percent in Anyang and 14.6 percent in Yoita. The rates for depressive symptoms were 15.2 percent and 19.8 percent, respectively. Overall, functional capacity was the universal factor significantly associated with mental conditions. Self-rated health and social support were also found to be independently associated with depressive symptoms in the study subjects. Differences in the patterns of association by community, however, were notable for other characteristics. For example, in factors associated with cognitive impairment, sociodemographic factors such as age, gender, and education were significant among Koreans, whereas socio-behavioural factors such as obesity, social support and hospitalization experience were found to be significant for older Japanese residents. Concludes that similarities in the patterns of association indicate the need for joint explorations into the role these factors play in affecting the mental health of older persons. Socioeconomic and regional differentials, however, may account for the disparity in the associations observed, suggesting the importance of developing mental health programs sensitive to the older individual's culture.
Prevalence and correlates of depression in late life: a population based study from a rural Greek town
- Authors:
- PAPADOPOULOS F. C., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(4), April 2005, pp.350-357.
- Publisher:
- Wiley
Depression in late life is common and has serious consequences on function, medical co-morbidity, quality of life, and use of medical services. The aim was to estimate the age- and gender-specific prevalence of depression among people over 60 years of age, and to examine correlates of depression, in particular the relationship between depression and cognitive impairment. From a total of 965 inhabitants, aged over 60 years, in Velestino, a rural town in central Greece, 608 were accessible and constituted the target population. During a five-month period in 2000, a trained health visitor interviewed all study participants. The interview covered socio-demographic characteristics, medical history, and administration of the 15-question Geriatric Depression Scale (GDS-15) and the Mini Mental Scale Examination instrument (MMSE). The prevalence of mild or more severe depression (GDS7) was 27%, while the prevalence of moderate to severe depression (GDS11) was 12%. Increasing age, female gender, lower education, and being currently unmarried were associated with higher risk of depression in univariate regression models, but these associations disappeared after controlling for cognitive function, except for the association with marital status. Cognitive impairment was strongly associated with increased risk for depression. The co-morbid presence of digestive, neurological and heart conditions was also associated with increased risk for depression, while cancer was not. In a rural Greek area, the prevalence of depression in late life is high. Depression was more common among unmarried individuals, those with significant cognitive impairment, and in association with specific medical conditions.
Antidepressant drug prescribing among elderly subjects: a population-based study
- Authors:
- PERCUDANI Mauro, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.114-118.
- Publisher:
- Wiley
The patterns of antidepressant drug prescribing have rarely been studied in large and geographically defined populations of elderly subjects. In the present study we examined the prevalence and distribution of antidepressant prescribing in Lombardy, a northern Italy region with more than one and a half million elderly inhabitants. The authors used the Regional Administrative Database of Lombardy. This database includes all prescriptions reimbursed by the National Health System in the population living in this region. All antidepressant prescriptions dispensed to subjects aged 65 years or above during 2001 were extracted and prevalence data calculated by dividing antidepressant users by the total number of male and female residents in each age group. During the 12 months surveyed 153,706 subjects were dispensed one or more prescriptions of antidepressants, yielding a prevalence of use of 9.49 subjects per 100 inhabitants (95% confidence interval 9.44, 9.53). Although the proportion of chronic users slightly decreased with age, more than 35% of those older that 85 years were moderate or chronic antidepressant users. General practitioners issued the majority of antidepressant prescriptions, and most antidepressant users were also dispensed agents for medical disorders. The very high rates of antidepressant drug prescribing detected in late life suggest the need of characterising these subjects in terms of medical and psychiatric characteristics, needs and quality of life. It also suggests the need for pragmatic clinical trials, carried out in the general practice, with the aim of assessing whether antidepressants are effective in these conditions.