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The feasibility and effectiveness of brief interventions to prevent depression in older subjects: a systematic review
- Authors:
- COLE Martin G., DENDUKURI Nandini
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1019-1025.
- Publisher:
- Wiley
MEDLINE, PsycINFO and HealthStar were searched for potentially relevant articles published from January 1966 to June 2003, January 1974 to June 2003 and January 1975 to June 2003, respectively. The bibliographies of relevant articles were searched for additional references. Ten studies met the following five inclusion criteria: original research, subjects mean age 50 years or more, controlled trial of a brief ( < 12 weeks) intervention to prevent depression, determination of depression status 12 months or more after enrolment, use of an acceptable definition of depression. The validity of studies was assessed according to six criteria. To examine feasibility we tabulated study enrolment, completion and compliance rates. To examine effectiveness we tabulated differences in depression symptom outcome scores between intervention and control groups or, when possible, absolute (ARR) and relative (RRR) risk reductions for depression. Only two of the ten trials met all of the validity criteria. Study enrolment rates were 21 to 100% (median 72.5%); study completion rates were 46% to 100% (median 85%); compliance rates were 29% to 100% (median 87%). Five of the ten trials had positive results: in two trials there were statistically significant differences in depression symptom outcome scores favoring the intervention group; in three trials ARRs were 2.3% to 45% (median 17%); RRRs were 45% to 71% (median 61%). Some types of brief interventions appear to have the potential to prevent depression in older subjects. Despite the methodologic limitations of the trials and this systematic review, these findings may guide efforts to develop and evaluate brief interventions to prevent depression in this population.
Elderly suicide and the 2003 SARS epidemic in Hong Kong
- Authors:
- CHAN San Man Sandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(2), February 2006, pp.113-118.
- Publisher:
- Wiley
Hong Kong was struck by the community outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003. In the same year, the elderly suicide rate in Hong Kong showed a sharp upturn from a previous downward trend. Secondary analyses using Poisson Regression Models on the suicide statistics from the Census and Statistics Department of the Hong Kong Government were performed. In a Poisson Regression Model on the annual suicide rates in elders aged 65 and over in years 1986-2003, 2002 served as the reference year. Suicide rates in 1986-1997 were significantly higher than the reference year, with an Incident Rate Ratio (IRR) of 1.34 to 1.61. However, rates in 1998-2001 did not differ from the reference year significantly, representing stabilization of suicide rates for 4 years after 1997. The elderly suicide rate increased to 37.46/100,000 in 2003, with an IRR of 1.32 (p = 0.0019) relative to 2002. Such trend is preserved when female elderly suicide rates in 1993-2003 were analyzed, while suicide rates in elderly men and younger age groups did not follow this pattern. Mechanistic factors such as breakdown of social network and limited access to health care might account for the findings. These factors could have potentiated biopsychosocial risk factors for suicide at individual levels, particularly in elderly. Female elders, by way of their previous readiness to utilize social and health services instituted in the past decade, are thus more susceptible to the effects of temporary suspension of these services during the SARS epidemic. The SARS epidemic was associated with increased risk of completed suicide in female elders, but not in male elders or the population under 65 years of age.
Anxiety and the risk of death in older men and women
- Authors:
- VAN HOUT Hein P., et al
- Journal article citation:
- British Journal of Psychiatry, 185(11), November 2004, pp.399-404.
- Publisher:
- Cambridge University Press
There are inconsistent reports as to whether people with anxiety disorders have a higher mortality risk. The aim was to determine whether anxiety disorders predict mortality in older men and women in the community. Longitudinal data were used from a large, community-based random sample (n=3107) of older men and women (55–85 years) in The Netherlands, with a follow-up period of 7.5 years. Anxiety disorders were assessed according to DSM–III criteria in a two-stage screening design. In men, the adjusted mortality risk was 1.78 (95% CI 1.01–3.13) in cases with diagnosed anxiety disorders at baseline. In women, no significant association was found with mortality. The study revealed a gender difference in the association between anxiety and mortality. For men, but not for women, an increased mortality risk was found for anxiety disorders.
Vascular disease/risk and late-life depression in a Korean community population
- Authors:
- KIM Jae-Min, et al
- Journal article citation:
- British Journal of Psychiatry, 185(8), August 2004, pp.102-107.
- Publisher:
- Cambridge University Press
Associations between vascular risk factors and late-life depression are controversial. The aim was to investigate the association between measures of vascular disease/risk and depression and confounding and effect modification by APOE genotype and cognitive function. In a Korean community population aged 65+ (n=732), diagnosis of depression (Geriatric Mental State Schedule) and information on vascular status, disability, APOE genotype and cognitive function were obtained. Previous stroke and lower high-densitylipoprotein cholesterol level (but neither hypertension nor diabetes) were significantly associated with depression (independently of disability and cognitive function). These associations were stronger in participants with borderline cognitive impairment, although not to a significant extent. Except for previous stroke and an atherogenic lipid profile, associations between depression and other common risk factors for cerebrovascular disease were not evident.
Risk indicators of depression in residential homes
- Authors:
- EISSES A. M. H., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.634-640.
- Publisher:
- Wiley
In a cross-sectional study risk indicators for depressive symptoms (Geriatric Depression Scale) were examined in bivariate and multivariate analyses, four hundred and seventy-nine elderly subjects from 11 residential homes took part in the study. Functional impairment, loneliness, higher education levels, a family history of depression and neuroticism are associated with depressive symptom. The risk indicators of depression found in residential homes are similar to those in the community.
Neurosis and mortality in persons aged 65 and over living in the community: a systematic review of the literature
- Authors:
- DEWEY Michael E., CHEN Chih-Mei
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.554-557.
- Publisher:
- Wiley
No previous attempt has been made to synthesise information on mortality and neurosis in older people. Our objective was to estimate the influence on mortality of various types of neurosis in the older population. Data sources were: Medline; Embase; and personal files. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Studies which sampled from a larger age range were also included if it was possible to retrieve results about those aged 65 and over. Samples from health care facilities were excluded. Effect sizes were extracted from the papers and if they were not included in the published papers effect sizes were calculated if possible. No attempt was made to contact authors for missing data. We found seven reports (six of which used a neurosis diagnosis and one which used a symptom scale). Using Fisher's method we found an increase in mortality which was not significant (p = 0.08). There have been few studies, and the evidence is weakly in favour of an increased mortality risk.
Depression in late-life: shifting the paradigm from treatment to prevention
- Authors:
- WHYTE Ellen M., ROVNER Barry
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(8), August 2006, pp.746-751.
- Publisher:
- Wiley
Late-life depression is very common and is associated with high rates of morbidity and mortality. While the field of geriatric psychiatry is focused on depression treatment, prevention is an enticing option. Prevention of late-life depression would decrease both emotional suffering and depression-associated morbidity and mortality and may decrease dependence on non-mental health professionals to detect depression and to initiate a treatment referral. This paper will review current thinking on prevention research with a particular focus on its application to late-life depression. To illustrate these issues, we discuss recent and ongoing clinical trials of interventions to prevent depression in two populations of older persons: those with age-related macular degeneration (AMD) and those with cerebrovascular disease.
Comorbidity of depression and anxiety in nursing home patients
- Authors:
- SMALLBRUGGE Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.218-222.
- Publisher:
- Wiley
The aim was to assess the occurrence and risk indicators of depression, anxiety, and comorbid anxiety and depression among nursing home patients and to determine whether depression and anxiety are best described in a dimensional or in a categorical classification system. DSM and subthreshold anxiety disorders, anxiety symptoms, major and minor depression and depressive symptoms were assessed in 333 nursing home patients of somatic wards of 14 nursing homes in the north west of the Netherlands with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Geriatric Depression Scale (GDS). Comorbidity was studied along a severity gradient. Logistic regression analyses were carried out to identify demographic, health-related, psychosocial and care-related correlates of anxiety and depression.The prevalence of pure depression (PD) was 17.1%, of pure anxiety (PA) 4.8%, and of comorbid anxiety and depression (CAD) 5.1%. Comorbidity increased dependent on severity of both anxiety and depression. Different patterns of risk indicators were demonstrated for PA, PD and CAD for the investigated baseline characteristics. Comorbidity of anxiety and depression is most prevalent in the more severe depressive and anxious nursing home patients. The gradual increase of comorbidity of anxiety and depression dependent on the levels of severity of depression and anxiety suggests that for nursing home patients a dimensional classification of depression and anxiety is more appropriate than a categorical one. The observed differences in patterns of risk indicators for PA, PD and CAD support a distinguishing of anxiety and depression. Future studies are needed to assess the effect of treatment of PA, PD and CAD in nursing home patients.
Relationship of exercise and other risk factors to depression of Alzheimer's disease: the LASER-AD study
- Authors:
- REGAN Ciaran, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.261-268.
- Publisher:
- Wiley
Depression is common in Alzheimer's disease (AD; 5-35%). It is associated with increased disability, cost of care and carer burden. Exercise is known to be associated with a lower prevalence of depression across the age range but little is known about its relationship to depression in AD. The aim was to investigate exercise and putative risk factors for depression in a community based sample of people with AD representative of the range of cognitive impairment found in the population with dementia. Information was collected from 224 people with AD and their caregiver using standardised cognitive, psychological and behavioural instruments. Exercise levelswere classified into three categories: absent, moderate, and vigorous, using the previous two weeks exercise levels to confirm regularity and recency. 9/51 (17.6%) depressed participants took exercise compared with 76/173 (43.9%) non-depressed [odds ratio (OR) = 2.9, confidence interval (CI) = 1.5-5.6, p = 0.001]. Not taking part in other activities (hobbies and interests) was associated with depression but less so than lack of exercise. Independent predictors of depression were: lack of exercise (p < 0.001, OR = 3.4, CI = 1.7-7.2), taking cholinesterase inhibitors (p < 0.05, OR = 2.4, CI = 1.2-4.9) and having less involvement in hobbies or interests (p < 0.05, OR = 1.2, CI = 1.0-1.5). None of the traditional risk factors for depression in older people were associated with depression in AD. Taking regular exercise may protect against depression in AD.
Object naming and semantic fluency among individuals with genetic risk for Alzheimer's disease
- Authors:
- MILLER Karen J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(2), February 2005, pp.128-136.
- Publisher:
- Wiley
This study longitudinally examined the object naming and semantic fluency of individuals who are at risk for developing Alzheimer's disease (AD) by virtue of having APOE-4 or a family history of AD. A total of 108 participants (40 with a family history of AD and 43 with APOE-4) completed the Boston Naming Test and the Animal Naming task at initial assessment and after two years. At baseline, object naming was significantly lower for those with both risk factors, but those with either risk factor had significantly lower scores at follow-up. Semantic fluency (animal naming) was reduced among subjects with the APOE-4 allele at baseline, but it was not associated with either risk factor at follow-up. These deficits may be associated with a prodromal risk for AD and may serve as pre-symptomatic markers for the development of AD.