Reynolds, Charles F
The elderly population is growing at a rapid rate and currently constitutes more than 12% of the United States' population. Within the next 30 years, the number of elderly persons is expected to more than double, creating a concerning situation regarding provision of healthcare services. Depression is a prevalent and underrecognized disorder in older adults and is associated with both increased healthcare utilization and suicide. Treatment of depression improves quality of life and reduces functional decline and suicidal ideation. Maintenance therapy for depression is commonly overlooked and must be emphasized for management of depression in elderly patients. First-line treatment options include selective serotonin reuptake inhibitors (SSRIs), one of which, paroxetine, has been studied extensively in older adults. The findings of studies that have evaluated the efficacy of paroxetine demonstrate successful treatment of depression and long-term relapse prevention in this population. With the significant personal and societal burden that is associated with major depression in the elderly, appropriate treatment is important and must be incorporated into standard practices by healthcare professionals.
Knöchel, Christian; Alves, Gilberto; Friedrichs, Benedikt; Schneider, Barbara; Schmidt-Rechau, Anna; Wenzlera, Sofia; Schneider, Angelina; Prvulovic, David; Carvalho, André F.; Oertel-Knöchel, Viola
The current Review article provides a narrative review about the neurobiological underpinnings and treatment of treatment resistant late-life depression (TRLLD). The manuscript focuses on therapeutic targets of late-life depression, which include pharmacological, psychological, biophysical and exercise treatment approaches. Therefore, we summarize available evidences on that kind of therapies for patients suffering from late-life depression. The search for evidences of therapeutic options of late-life depression were done using searching websites as “pubmed”, and using the searching terms “depression”, “late-life depression”, “treatment”, “biophysical therapy”, “exercise therapy”, “pharmacological therapy” and “psychological therapy”. To the end, we summarize and discuss current data, providing some directions for further research. Treatment recommendations for elderly depressive patients favour a multimodal approach, containing psychological, pharmacological and secondary biophysical therapeutic options. Particularly, a combination of psychotherapy and antidepressant medication reflects the best therapeutic option. However, mostly accepted and used is the pharmacological treatment although evidence suggests that the drug therapy is not as effective as it is in younger depressive patients. Further studies employing larger samples and longer follow-up periods are necessary and may focus on comparability of study designs and involve novel approaches to establish the validity and reliability of multimodal treatment programs. PMID:26467408
Blazer, Dan; And Others
The paper reports results of one project from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) Program: the Duke ECA study (also known as the Piedmont Health Survey). To determine if depressive symptoms are different in the depressed elderly, 46 community subjects, over 60 years of age with a current diagnosis of…
García-Peña, Carmen; Wagner, Fernando A.; Sánchez-García, Sergio; Espinel-Bermúdez, Claudia; Juárez-Cedillo, Teresa; Pérez-Zepeda, Mario; Arango-Lopera, Victoria; Franco-Marina, Francisco; Ramírez-Aldana, Ricardo; Gallo, Joseph
Background Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. Methods Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item Geriatric Depression Scale, and a score of 11 was used as cutoff point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. Results 7,882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR .971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR .581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. Conclusions New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. Limitations The study has not included clinical evaluations and nutritional assessments PMID:23731940
Oishi, Sabine M; Shoai, Rebecca; Katon, Wayne; Callahan, Christopher; Unützer, Jürgen; Arean, Patricia; Callahan, Christopher; Della Penna, Richard; Harpole, Linda; Hegel, Mark; Noel, Polly Hitchcock; Hoffing, Marc; Hunkeler, Enid M; Katon, Wayne; Levine, Stuart; Lin, Elizabeth H B; Oddone, Eugene; Oishi, Sabine; Unützer, Jürgen; Williams, John
groups and semi-structured individual interviews with all Depression Clinical Specialists (DCSs) working with Project IMPACT (Improving Mood: Promoting Access to Collaborative Treatment), a study testing a collaborative care intervention for late life depression, to examine integration of the intervention model into primary care. DCSs described key intervention components, including supervision from a psychiatrist and a liaison primary care provider, weekly team meetings, computerized patient tracking, and outcomes assessment tools as effective in supporting patient care. DCSs discussed details of protocols, training, environmental set-up, and interpersonal factors that seemed to facilitate integration. DCSs also identified research-related factors that may need to be preserved in the real world. Basic elements of the IMPACT model seem to support integration of late life depression care into primary care. Research-related components may need modification for dissemination.
Zurkovsky, Lilia; Taylor, Warren D.; Newhouse, Paul A.
Depression is associated with impairments to cognition and brain function at any age, but such impairments in the elderly are particularly problematic because of the additional burden of normal cognitive aging and in some cases, structural brain pathology. Individuals with late-life depression exhibit impairments in cognition and brain structural integrity, alongside mood dysfunction. Antidepressant treatment improves symptoms in some but not all patients, and those who benefit may not return to the cognitive and functional level of nondepressed elderly. Thus, for comprehensive treatment of late-life depression, it may be necessary to address both the affective and cognitive deficits. In this review, we propose a model for the treatment of late-life depression in which nicotinic stimulation is used to improve cognitive performance and improve the efficacy of an antidepressant treatment of the syndrome of late-life depression. The cholinergic system is well-established as important to cognition. Although muscarinic stimulation may exacerbate depressive symptoms, nicotinic stimulation may improve cognition and neural functioning without a detriment to mood. While some studies of nicotinic subtype specific receptor agonists have shown promise in improving cognitive performance, less is known regarding how nicotinic receptor stimulation affects cognition in depressed elderly patients. Late-life depression thus represents a new therapeutic target for the development of nicotinic agonist drugs and parallel treatment of cognitive dysfunction along with medical and psychological approaches to treating mood dysfunction may be necessary to ensure full resolution of depressive illness in aging. PMID:23933385
Nyer, Maren; Doorley, James; Durham, Kelley; Yeung, Albert S; Freeman, Marlene P; Mischoulon, David
Late-life depression remains challenging to treat. One major limitation to treatment is the concern over medication-related side effects to which the elderly are especially vulnerable. Also, because many elderly people are already taking multiple medications for medical conditions, there is the concern over drug-drug interactions. This article reviews various complementary and alternative medicine interventions for late-life depression, including natural remedies, exercise, yoga, tai chi, massage therapy, music therapy, and religion and spirituality.
Marijnissen, Radboud M; Naudé, Petrus J W; Comijs, Hannie C; Schoevers, Robert A; Oude Voshaar, Richard C
Both visceral obesity and depression are associated with impaired health and excess mortality, possibly through overlapping pathophysiological mechanisms like adipose tissue derived inflammatory markers. These results, however, are primarily based on population-based surveys, often restricted to a young population and depression severity scales instead of patients with established diagnosis of depressive disorder. We examined the relation between waist circumference and late-life depression using the baseline data of The Netherlands Study of Depression in Older people (NESDO). Psychopathology has been assessed with Composite International Diagnostic Interview version 2.1. Adjusted for age, sex, education, lifestyle (smoking, alcohol, physical activity), drug use, cognition and chronic diseases as well as adjusted for body mass index (BMI), analysis of covariance showed that depressed older patients (n=376) had a significantly lower waist circumference (WC) compared to their non-depressed comparisons (n=130): estimated marginal mean (SE)=93.9 (0.5) versus 97.8 (0.8) cm (F=15.9; df=1467; p<.001). Multiple linear regression analyses within the depressed group showed that both, depression severity (Inventory of Depressive Symptoms) as well as duration-related depression characteristics (age of onset, duration of illness, life-time comorbid dysthymia), were associated with the WC. Only the severity of depressive symptoms remained significant after further adjusted for the BMI. Interestingly, a recently discovered adipokine, Neutrophil Gelatinase-Associated Lipocalin (NGAL), was associated with late-life depression, but only in the subgroup of patients with a pathologically increased WC. Population-based findings on the positive association between obesity and depressive symptoms can thus not be generalised to a clinical sample of depressed older patients. The impact of the WC on course and treatment outcome of late-life depression should be examined in clinical samples
Mathur, Sonal; Sharma, Mahendra Prakash; Bharath, Srikala
Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF). The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression. PMID:27512325
van der Meij, Annemarie; Comijs, Hannie C; Dols, Annemieke; Janzing, Joost G E; Oude Voshaar, Richard C
Brain-Derived Neurotrophic Factor (BDNF) serum levels are abnormally low in depressed patients as compared to healthy controls and normalize with SSRI treatment. The aim of this study is to examine serum BDNF levels in late-life depression, stratified for SSRI usage, and to explore the relation between BDNF levels and specific depression characteristics as well as between BDNF levels and early and recent life stressors in late-life depression. We assessed serum BDNF levels in 259 depressed patients not using an SSRI, 99 depressed patients using an SSRI and 119 non-depressed controls (age range 60-93 years). Depressive disorders were diagnosed with the Composite International Diagnostic Interview (CIDI, version 2.1). Serum BDNF levels were significantly higher in depressed patients who used an SSRI compared to depressed patients not using SSRIs and compared to non-depressed controls, when adjusted for age, sex, life style characteristics, cognitive functioning and somatic comorbidity. Recent life-events, assessed with the List of Threatening Events-Questionnaire, were significantly associated with lower BDNF levels in non-depressed subjects only. Although a summary score of early traumatization (before the age of 16 years) was not associated with serum BDNF levels in any of the three groups, we found an interaction between a history of severe physical abuse and SSRI usage in the depressed group. Interestingly, higher serum levels of BDNF in depressed patients using SSRIs were only found in those patients without a history of severe childhood abuse and not in those with a history of severe childhood abuse.
Late life depression is often associated with a poor response to antidepressants; therefore an alternative strategy for therapy is required. Although several studies have reported that phosphatidylserine (PS) may be effective for late life depression and that omega-3 fatty acids DHA and EPA have also proven beneficial for many higher mental functions, including depression, no concrete conclusion has been reached. This study was performed to clarify the effect of PS and omega-3 fatty acid-containing supplement for late life depression by not only clinical evaluation but also salivary cortisol levels. Eighteen elderly subjects with major depression were selected for the study. In all, insufficient improvement had been obtained by antidepressant therapy for at least 6 months. The exclusion criteria from prior brain magnetic resonance images (MRI) included the presence of structural MRI findings compatible with stroke or other gross brain lesions or malformations, but not white matter hypersensitivities. They took a supplement containing PS 100 mg, DHA 119 mg and EPA 70 mg three times a day for 12 weeks. The effects of the supplement were assessed using the 17-item Hamilton depression scale (HAM-D17) and the basal levels and circadian rhythm of salivary cortisol. The study adopted them as indices because: salivary cortisol levels are high in patients with depression, their circadian rhythm related to salivary cortisol is often irregular, and these symptoms are alleviated as depression improves. The mean HAM-D17 in all subjects taking the supplement was significantly improved after 12 weeks of taking the supplement. These subjects were divided into 10 non-responders and 8 responders. The basal levels and circadian rhythm of salivary cortisol were normalized in the responders while not in non-responders. PS and omega-3 fatty acids, or other elements of the supplement, may be effective for late life depression, associated with the correction of basal levels and circadian
Chen, Cheng-Sheng; Chiang, I-Chan; Li, Chun-Wei; Lin, Wei-Chen; Lu, Chia-Ying; Hsieh, Tsyh-Jyi; Liu, Gin-Chung; Lin, Hsiu-Fen; Kuo, Yu-Ting
The primary goal of this study was to examine the biochemical abnormalities of late-life major depression by using 3-tesla (3-T) proton magnetic resonance spectroscopy ((1)H-MRS). The antidepressant effects on the biochemical abnormalities were investigated as well. Study participants were 27 elderly patients with major depressive disorders (among which 9 were on antidepressant medication) and 19 comparison elderly subjects. (1)H-MRS spectra were acquired from voxels that were placed in the left frontal white matter, left periventricular white matter, and left basal ganglia. Ratios of N-acetylaspartate (NAA), choline (Cho) and myo-inositol to creatine were calculated. Patients with late-life major depressive disorder had a significantly lower NAA/creatine ratio in the left frontal white matter, and higher Cho/creatine and myo-inositol/creatine ratios in the left basal ganglia when compared with the control subjects. The myo-inositol correlated with global cognitive function among the patients. The biochemical abnormalities in late-life major depressive disorder were found on the left side of the frontal white matter and the basal ganglia. Neuron degeneration in the frontal white matter and second messenger system dysfunction or glial dysfunction in the basal ganglia are suggested to be associated with late-life depression.
Martínez-Cengotitabengoa, Mónica; Carrascón, Lucía; O’Brien, John T.; Díaz-Gutiérrez, María-José; Bermúdez-Ampudia, Cristina; Sanada, Kenji; Arrasate, Marta; González-Pinto, Ana
Depressive disorders appear relatively frequently in older patients, and therefore represent an important disease burden worldwide. Given the high levels of inflammatory parameters found in depressed elderly patients, the “inflammaging” hypothesis is gaining strength. In this systematic review, we summarize current evidence regarding the relationship between inflammatory parameters and late-life depression, with a unique focus on longitudinal studies to guarantee temporality. According to the data summarized in this review, the levels of some proinflammatory parameters—especially interleukin (IL)-8, IL-6, and tumor necrosis factor (TNF)-α—could serve as biomarkers for the future development of depressive symptoms in elderly patients. Proinflammatory cytokines seem to be associated with the future development of clinically significant depression, irrespective of baseline scores, thus indicating that inflammation temporally precedes and increases depression risk. As insufficient research has been conducted in this field, further prospective studies are clearly warranted. PMID:27918465
Baba, Kanako; Baba, Hajime; Noguchi, Iwahide; Arai, Reiko; Suzuki, Toshihito; Mimura, Masaru; Arai, Heii
The authors aimed to investigate whether remitted adult and elderly major depressive disorder patients show different patterns of executive dysfunction. Executive functions of 20 euthymic major depressive disorder patients and 29 healthy comparison subjects were evaluated using the Behavioral Assessment of the Dysexecutive Syndrome. Relative to adult patients and healthy comparison subjects, euthymic elderly patients were more impaired in the subtest of Modified Six Elements. Since the regions most implicated in this subtest are the medial prefrontal, the anterior cingulate, and the dorsolateral prefrontal areas, the authors conclude that dysfunctions of such frontal neural networks remain unresolved even in the remission phase of late-life depression.
Meltzer, Carolyn Cidis; Price, Julie C; Mathis, Chester A; Butters, Meryl A; Ziolko, Scott K; Moses-Kolko, Eydie; Mazumdar, Sati; Mulsant, Benoit H; Houck, Patricia R; Lopresti, Brian J; Weissfeld, Lisa A; Reynolds, Charles F
Depression in late life carries an increased risk of dementia and brittle response to treatment. There is growing evidence to support a key role of the serotonin type 1A (5-HT(1A)) receptor as a regulator of treatment response, particularly the 5-HT(1A) autoreceptor in the dorsal raphe nucleus (DRN). We used [11C]WAY 100635 and positron emission tomography (PET) to test our hypothesis that 5-HT(1A) receptor binding in the DRN and prefrontal cortex is altered in elderly depressives and that these measures relate to treatment responsivity. We studied 17 elderly subjects with untreated (nonpsychotic, nonbipolar) major depression (four men, 13 women; mean age: 71.4+/-5.9) and 17 healthy control subjects (eight men, nine women; mean age: 70.0+/-6.7). Patients were subsequently treated with paroxetine as part of a clinical trial of maintenance therapies in geriatric depression. [11C]WAY 100635 PET imaging was acquired and binding potential (BP) values derived using compartmental modeling. We observed significantly diminished [11C]WAY 100635 binding in the DRN in depressed (BP = 2.31+/-0.90) relative to control (BP = 3.69+/-1.56) subjects (p = 0.0016). Further, the DRN BP was correlated with pretreatment Hamilton Depression Rating Scores (r = 0.60, p = 0.014) in the depressed cohort. A trend level correlation between DRN binding and time to remission (r = 0.52, p = 0.067) was observed in the 14 depressed patients for whom these data were available. Our finding of decreased [11C]WAY 100635 binding in the brainstem region of the DRN in elderly depressed patients supports evidence of altered 5-HT(1A) autoreceptor function in depression. Further, this work indicates that dysfunction in autoreceptor activity may play a central role in the mechanisms underlying treatment response to selective serotonin reuptake inhibitors in late-life depression.
Bjørkløf, Guro Hanevold; Kirkevold, Marit; Engedal, Knut; Selbæk, Geir; Helvik, Anne-Sofie
Articles describing older persons’ experiences of coping with severe depression are, to our knowledge, lacking. This article is methodologically grounded in phenomenological hermeneutics, inspired by Paul Ricoeur, and applies a descriptive design with in-depth interviews for producing the data. We included 18 older persons, 13 women and 5 men, with a mean age of 77.9 years, depressed to a severe or moderate degree, 1–2 weeks after admission to a hospital for treatment of depression. We found the metaphor “being in a vice” to capture the essence of meaning from the participants’ stories, and can be understood as being stuck in an immensely painful existence entirely dominated by depression in late life. This is the first article where coping in older men and women experiencing the most severe phase of depression is explored. PMID:26119368
Agudelo, Christian; Aizenstein, Howard J; Karp, Jordan F; Reynolds, Charles F
Late-life depression (LLD) is a growing public and global health concern with diverse clinical manifestations and etiology. This literature review summarizes neuroimaging findings associated with depression in older adults and treatment-response variability. LLD has been associated with cerebral atrophy, diminished myelin integrity, and cerebral lesions in frontostriatal-limbic regions. These associations help explain the depression-executive dysfunction syndrome observed in LLD, and support cerebrovascular burden as a pathogenic mechanism. Furthermore, this review suggests that neuroimaging determinants of treatment resistance also reflect cerebrovascular burden. Of the theoretical etiologies of LLD, cerebrovascular burden may mediate treatment resistance. This review proposes that neuroimaging has the potential for clinical translation. Controlled trials may identify neuroimaging biomarkers that may inform treatment by identifying depressed adults likely to remit with pharmacotherapy, identifying individualized therapeutic dose, and facilitating earlier treatment response measures. Neuroimaging also has the potential to similarly inform treatment response variability from treatment with aripiprazole (dopamine modulator) and buprenorphine (opiate modulator).
Wilson, Robert S.; Boyle, Patricia A.; Capuano, Ana W.; Shah, Raj C.; Hoganson, George M.; Nag, Sukriti; Bennett, David A.
Objective To test the hypothesis that late-life depression is associated with dementia related pathology. Method Older participants (n=1,965) in 3 longitudinal clinical-pathologic cohort studies who had no cognitive impairment at baseline underwent annual clinical evaluations for a mean of 8.0 years (SD = 5.0). We defined depression diagnostically, as major depression during the study period, and psychometrically, as elevated depressive symptoms during the study period, and established their relation to cognitive outcomes (incident dementia, rate of cognitive decline). A total of 657 participants died and underwent a uniform neuropathologic examination. We estimated the association of depression with 6 dementia related markers (tau tangles, beta-amyloid plaques, Lewy bodies, hippocampal sclerosis, gross and microscopic infarcts) in logistic regression models. Results In the full cohort, 9.4% were diagnosed with major depression and 8.6% had chronically elevated depressive symptoms, both of which were related to adverse cognitive outcomes. In the 657 persons who died and had a neuropathologic examination, higher beta-amyloid plaque burden was associated with higher likelihood of major depression (present in 11.0%; odds ratio = 1.392, 95% confidence interval = 1.088, 1.780) but not with elevated depressive symptoms (present in 11.3%; odds ratio = 0.919, 95% confidence interval = 0.726, 1.165). None of the other pathologic markers was related to either of the depression measures. Neither dementia nor antidepressant medication modified the relation of pathology to depression. Conclusion The results do not support the hypothesis that major depression is associated with dementia related pathology. PMID:26237627
MacFall, James R; Taylor, Warren D; Rex, David E; Pieper, Steve; Payne, Martha E; McQuoid, Douglas R; Steffens, David C; Kikinis, Ron; Toga, Arthur W; Krishnan, K Ranga Rama
White matter hyperintense lesions on T2-weighted images are associated with late-life depression. Little work has been carried out examining differences in lesion location between elderly individuals with and without depression. In contrast to previous studies examining total brain white matter lesion volume, this study examined lobar differences in white matter lesion volumes derived from brain magnetic resonance imaging. This study examined 49 subjects with a DSM-IV diagnosis of major depression and 50 comparison subjects without depression. All participants were age 60 years or older. White matter lesion volumes were measured in each hemisphere using a semiautomated segmentation process and localized to lobar regions using a lobar atlas created for this sample using the imaging tools provided by the Biomedical Informatics Research Network (BIRN). The lobar lesion volumes were compared against depression status. After controlling for age and hypertension, subjects with depression exhibited significantly greater total white matter lesion volume in both hemispheres and in both frontal lobes than did control subjects. Although a similar trend was observed in the parietal lobes, the difference did not reach a level of statistical significance. Models of the temporal and occipital lobes were not statistically significant. Older individuals with depression have greater white matter disease than healthy controls, predominantly in the frontal lobes. These changes are thought to disrupt neural circuits involved in mood regulation, thus increasing the risk of developing depression.
This study used longitudinal data to examine the effects of spousal illness on depressive symptoms among middle-aged and older married individuals and the extent to which the adverse effects of illness in a spouse were mitigated by 2 psychological resources, mastery and self-esteem. Using 1,704 married participants who were 51 years of age on average, depressive symptoms were compared in 4 groups varying in their experience of spousal health transitions: those whose spouse remained ill at T1 and T2, those whose spouse declined in health from T1 to T2, those whose spouse's health improved from T1 to T2, and those whose spouse remained healthy at both time points. Mixed analyses of covariance showed that, as hypothesized, having a spouse who became or remained ill over time was linked to greater depressed affect by T2, whereas having a spouse improve in health was associated with a decline in depressive symptomatology. Moderated regression analyses indicated that while higher mastery and self-esteem were linked to lower depressed affect in general, these resources were especially protective against depressed affect for those whose spouse remained ill at both time points. These findings are at the intersection of life course theory and the stress process model highlighting the contextual forces in and the interconnectedness of individual development as well as the plasticity and resilience evident in adaptation to stress during mid and late life.
Cakir, Sibel; Senkal, Zeynep
Background Second-generation antipsychotics (SGAs) have been used in the augmentation of treatment-resistant depression. However, little is known about their effectiveness, tolerability, and adverse events in the treatment of late-life depression, which were the aim of this study. Methods The retrospective data of patients aged >65 years who had a major depressive episode with inadequate response to antidepressant treatment and had adjuvant SGA treatment were analyzed. The outcome measures were the number of the patients who continued to use SGAs in the fourth and twelfth weeks, adverse events, and changes in symptoms of depression. Results Thirty-five patients were screened: 21 (60%) had quetiapine, twelve (34.28%) had aripiprazole, and two (5.71%) had olanzapine adjuvant treatment. The mean age was 72.17±5.02 years, and 65.7% of the patients were women. The mean daily dose was 85.71±47.80 mg for quetiapine, 3.33±1.23 mg for aripiprazole, and 3.75±1.76 mg for olanzapine. The Geriatric Depression Scale scores of all patients were significantly decreased in the fourth week and were significant in the aripiprazole group (P=0.02). Of the 35 patients, 23 (65.7%) patients discontinued the study within 12 weeks. The frequency of adverse events was similar in all SGAs, and the most common were sedation, dizziness, constipation, and orthostatic hypotension with quetiapine, and akathisia and headache because of aripiprazole. Conclusion This study indicates that dropout ratio of patients with SGAs is high, and a subgroup of patients with late-life depression may benefit from SGAs. Effectiveness is significant in aripiprazole, and adverse events of SGAs were not serious but common in elderly patients. PMID:27672315
Butters, Meryl A; Klunk, William E; Mathis, Chester A; Price, Julie C; Ziolko, Scott K; Hoge, Jessica A; Tsopelas, Nicholas D; Lopresti, Brian J; Reynolds, Charles F; DeKosky, Steven T; Meltzer, Carolyn C
There is increasing evidence for an empiric link between late-life depression and Alzheimer disease (AD). The neuropathology of AD, previously only confirmed at autopsy, may now be detectable in vivo using selective imaging ligands for beta-amyloid. Positron emission tomography (PET) with [11C] 6-OH-BTA-1 [Pittsburgh Compound-B (PiB)] has shown high tracer retention in cortical areas in patients with clinical diagnoses of probable AD and low retention in age-matched controls. We also previously reported variable PiB retention in patients with mild cognitive impairment (MCI). In this study, we used PiB-PET to evaluate whether amyloid is present in elders with treated major depression, many of whom have persistent cognitive impairment. We evaluated 9 subjects with remitted major depression [3M: 6F, mean (SD) age=71.8(5.7) y]. Seven of the 9 depressed subjects also met criteria for the diagnosis of MCI. PiB-PET data from healthy elders [n=8; mean (SD) age=71.5(3.0) y] were used for comparison. PET was acquired with arterial sampling and PiB retention was quantified using magnetic resonance imaging-guided cortical regions and graphical analysis of time-activity data; arterial line failure led to exclusion of 1 depressed subject. The data demonstrated variably elevated PiB retention. PiB retention in the 2 depressed subjects with normal cognitive ability was in the range of nondepressed cognitively normal subjects. PiB retention in 3 of the 6 depressed subjects with MCI fell in the range of subjects with AD. PiB retention in the remaining 3 depressed subjects with cooccurring MCI was variable and generally was intermediate to the other subjects. Our findings are consistent with and supportive of the hypothesis that depression may herald the development of AD in some individuals.
Hsu, Jonathan H.; Daskalakis, Zafiris J.
Opinion Statement Recurrence, relapse and resistance to first-line therapies are common and pervasive issues in the treatment of depression in older adults. As a result, brain stimulation modalities are essential treatment options in this population. The majority of data for the effectiveness of brain stimulation modalities comes from electroconvulsive therapy (ECT) studies. Current ECT trials are focused on prolonging response after a successful course and mitigating the cognitive adverse effects. Newer forms of brain stimulation have emerged; unfortunately, as with most advances in medicine older adults have not been systematically included in clinical trials. Repetitive transcranial magnetic stimulation has demonstrated efficacy in younger adults and there is emerging data to support its use in late-life depression (LLD). It will be imperative that older adults be included in future transcranial direct current stimulation and magnetic seizure therapy clinical trials. Unclear efficacy results are a concern for both vagus nerve stimulation and deep brain stimulation. PMID:27398288
Blumberger, Daniel M; Hsu, Jonathan H; Daskalakis, Zafiris J
Opinion Statement Recurrence, relapse and resistance to first-line therapies are common and pervasive issues in the treatment of depression in older adults. As a result, brain stimulation modalities are essential treatment options in this population. The majority of data for the effectiveness of brain stimulation modalities comes from electroconvulsive therapy (ECT) studies. Current ECT trials are focused on prolonging response after a successful course and mitigating the cognitive adverse effects. Newer forms of brain stimulation have emerged; unfortunately, as with most advances in medicine older adults have not been systematically included in clinical trials. Repetitive transcranial magnetic stimulation has demonstrated efficacy in younger adults and there is emerging data to support its use in late-life depression (LLD). It will be imperative that older adults be included in future transcranial direct current stimulation and magnetic seizure therapy clinical trials. Unclear efficacy results are a concern for both vagus nerve stimulation and deep brain stimulation.
Leal, Stephanie L; Noche, Jessica A; Murray, Elizabeth A; Yassa, Michael A
Episodic memory deficits are evident in late-life depression (LLD) and are associated with subtle synaptic and neurochemical changes in the medial temporal lobes (MTL). However, the particular mechanisms by which memory impairment occurs in LLD are currently unknown. We tested older adults with (DS+) and without (DS-) depressive symptoms using high-resolution fMRI that is capable of discerning signals in hippocampal subfields and amygdala nuclei. Scanning was conducted during performance of an emotional discrimination task used previously to examine the relationship between depressive symptoms and amygdala-mediated emotional modulation of hippocampal pattern separation in young adults. We found that hippocampal dentate gyrus (DG)/CA3 activity was reduced during correct discrimination of negative stimuli and increased during correct discrimination of neutral items in DS+ compared to DS- adults. The extent of the latter increase was correlated with symptom severity. Furthermore, DG/CA3 and basolateral amygdala (BLA) activity predicted discrimination performance on negative trials, a relationship that depended on symptom severity. The impact of the BLA on depressive symptom severity was mediated by the DG/CA3 during discrimination of neutral items, and by the lateral entorhinal cortex (LEC) during false recognition of positive items. These results shed light on a novel mechanistic account for amygdala-hippocampal network changes and concurrent alterations in emotional episodic memory in LLD. The BLA-LEC-DG/CA3 network, which comprises a key pathway by which emotion modulates memory, is specifically implicated in LLD. © 2017 Wiley Periodicals, Inc.
Marano, Christopher M.; Workman, Clifford I.; Lyman, Christopher H.; Munro, Cynthia A.; Kraut, Michael A.; Smith, Gwenn S.
Objectives Recent positron emission tomography studies of cerebral glucose metabolism have identified the functional neural circuitry associated with mood and cognitive responses to antidepressant treatment in late life depression (LLD). The structural alterations in these networks are not well understood. The present study used magnetic resonance (MR) imaging and voxel-based morphometry (VBM) to evaluate the association between grey matter volumes and changes in mood symptoms and cognitive function with treatment with the antidepressant citalopram. Design Open label trial with baseline brain MR scan. Mood and cognitive assessments performed at baseline and during citalopram treatment. Setting Outpatient clinics of an academic medical center. Participants 17 previously unmedicated patients age 55 or older with a major depressive episode and 17 non-depressed comparison subjects. Intervention 12 week trial of flexibly dosed citalopram. Measurements Grey matter volumes, Hamilton Depression Rating Scale, California Verbal Learning Test, Delis–Kaplan Executive Function System™. Results In LLD, higher grey matter volumes in the cingulate gyrus, superior and middle frontal gyri, middle temporal gyrus and precuneus was associated with greater mood improvement. Higher grey matter volumes in primarily frontal areas were associated with greater improvement in verbal memory and verbal fluency performance. Conclusions Associations with antidepressant induced improvements in mood and cognition were observed in several brain regions previously correlated with normalization of glucose metabolism after citalopram treatment in LLD. Future studies will investigate molecular mechanisms underlying these associations (e.g. beta-amyloid, inflammation, glutamate). PMID:24238925
Hoeft, Theresa J.; Hinton, Ladson; Liu, Jessica; Unützer, Jürgen
Considerable progress has been made in the treatment of late-life depression over the past 20 years, yet considerable gaps in care remain. Gaps in care are particularly pronounced for older men, certain racial and ethnic minority groups or those with comorbid medical or mental disorders. We reviewed the peer-reviewed literature and conducted interviews with experts in late-life depression to identify promising directions for effectiveness research to address these gaps in care. We searched PubMed, PsychInfo and CINHAL databases between January 01, 1998 – August 31, 2013 using terms related to late-life depression and any of the following: epidemiology, services organization, economics of care, underserved groups including health disparities, impact on caregivers, and interventions. The results of this selective review supplemented by more current recommendations from national experts highlight three priority research areas to improve health services for late-life depression: focusing on the unique needs of the patient through patient-centered care and culturally sensitive care, involving caregivers outside the traditional clinical care team, and involving alternate settings of care. We build on these results to offer five recommendations for future effectiveness research that hold considerable potential to advance intervention and health services development for late-life depression. PMID:26525996
Johnson, Daniel P.; Whisman, Mark A.; Corley, Robin P.; Hewitt, John K.; Rhee, Soo Hyun
The association between stressful life events and depression has been consistently supported in the literature; however, studies of the developmental trajectories of these constructs and the nature of their association over time are limited. We examined trajectories of depressive symptoms and negative dependent life events and the associations…
Alexopoulos, George S.; Manning, Kevin; Kanellopoulos, Dora; McGovern, Amanda; Seirup, Joanna K.; Banerjee, Samprit; Gunning, Faith
Background Executive processes consist of at least two sets of functions: one concerned with cognitive control and the other with reward-related decision making. Abnormal performance in both sets occurs in late-life depression. This study tested the hypothesis that only abnormal performance in cognitive control tasks predicts poor outcomes of late-life depression treated with escitalopram. Methods We studied older subjects with major depression (N=53) and non-depressed subjects (N=30). Executive functions were tested with the Iowa Gambling Test (IGT), Stroop Color/Word test, Tower of London, and Dementia Rating Scale-Initiation/Perseveration Domain (DRS-IP). After a 2-week placebo washout, depressed subjects received escitalopram (target daily dose: 20 mg) for 12 weeks. Results There were no significant differences between depressed and non-depressed subjects on executive function tests. Hierarchical cluster analysis of depressed subjects identified a Cognitive Control Cluster (abnormal Stroop, Tower, DRS-IP), a Reward-Related Cluster (IGT), and an Executively Unimpaired Cluster. Decline in depression was greater in the Executively Unimpaired (t=−2.09, df=331, p=0.0375) and the Reward-Related Cluster (t=−2.33, df=331,p=0.0202) than the Cognitive Control Cluster. The Executively Unimpaired Cluster (t=2.17, df=331, p=0.03) and the Reward-Related Cluster (t=2.03, df=331, p=0.0433) had a higher probability of remission than the Cognitive Control Cluster. Conclusions Dysfunction of cognitive control functions, but not reward-related decision making, may influence the decline of symptoms and the probability of remission of late-life depression treated with escitalopram. If replicated, simple to administer cognitive control tests may be used to select depressed older patients at risk for poor outcomes to SSRIs who may require structured psychotherapy. PMID:26169527
Alexopoulos, George S.; Hoptman, Matthew J.; Kanellopoulos, Dora; Murphy, Christopher F.; Lim, Kelvin O.; Gunning, Faith M.
Background Abnormalities have been identified in the Cognitive Control Network (CCN) and the default mode network (DMN) during episodes of late-life depression. This study examined whether functional connectivity at rest (FC) within these networks characterize late-life depression and predict antidepressant response. Methods 26 non-demented, non-MCI older adults were studied. Of these, 16 had major depression and 10 had no psychopathology. Depressed patients were treated with escitalopram (target dose 20 mg) for 12 weeks after a 2-week placebo phase. Resting state timeseries was determined prior to treatment. FC within the CCN was determined by placing seeds in the dACC and the DLPFC bilaterally. FC within the DMN was assessed from a seed placed in the posterior cingulate. Results Low resting state FC within the CCN and high FC within the DMN distinguished depressed from normal elderly subjects. Beyond this “double dissociation”, low resting state FC within the CCN predicted low remission rate and persistence of depressive symptoms and signs, apathy, and dysexecutive behavior after treatment with escitalopram. In contrast, resting state FC within the DMN was correlated with pessimism but did not predict treatment response. Conclusions If confirmed, these findings may serve as a signature of the brain’s functional topography characterizing late-life depression and sustaining its symptoms. By identifying the network abnormalities underlying biologically meaningful characteristics (apathy, dysexecutive behavior, pessimism) and sustaining late-life depression, these findings can provide a novel target on which new somatic and psychosocial treatments can be tested. PMID:22425432
Andreescu, Carmen; Butters, Meryl A; Begley, Amy; Rajji, Tarek; Wu, Minjie; Meltzer, Carolyn C; Reynolds, Charles F; Aizenstein, Howard
Multiple brain morphometric changes have been reported in late-life depression (LLD), mostly in studies comparing volumes of circumscribed brain areas. The aim of our study is to characterize the volumetric changes of multiple gray matter regions in relation to age of onset/duration of illness. We predicted that the association of gray matter volumes with total duration of illness and age of onset would differ depending on whether the region was susceptible to the toxic effects of chronic exposure to cortisol or to the vascular/neurodegenerative changes accompanying prodromal dementia. Seventy-one elderly depressed subjects were studied along with thirty-two comparison subjects. High-resolution T1-weighted brain MRIs were processed using an automated labeling pathway technique. To protect against type-I error, we combined the right and left hemisphere volume data. We sampled 24 regions of interest (ROIs). We used the primary visual cortex volume to normalize for individual variations in brain size. LLD Subjects had smaller volumes than non-depressed subjects in 17 of the 24 examined ROIs. Shorter duration of illness and later age of onset was correlated with smaller volumes of parahippocampal area and parietal inferior area. A later age of onset was also correlated with smaller volumes of several frontal and temporal areas, cingulum, and putamen. Our findings support a dementia prodrome model more strongly than a toxic stress model in this group of subjects. However, it remains likely that both processes as well as other factors contribute to the heterogeneity of volumetric brain changes in LLD.
Ladin, Keren; Daniels, Norman; Kawachi, Ichiro
Purpose: Socioeconomic inequality has been associated with higher levels of morbidity and mortality. This study explores the role of absolute and relative deprivation in predicting late-life depression on both individual and country levels. Design and Methods: Country- and individual-level inequality indicators were used in multivariate logistic…
Stansbury, Kim L.
African-American clergy's ability to recognize late-life depression and their capacity to provide support with this illness have been neglected in the literature. Using a mental health literacy framework, the purpose of this research was to explore African-American clergy's knowledge of and treatments for late-life depression. In-depth interviews…
Seripa, Davide; Pilotto, Andrea; Paroni, Giulia; Fontana, Andrea; D'Onofrio, Grazia; Gravina, Carolina; Urbano, Maria; Cascavilla, Leandro; Paris, Francesco; Panza, Francesco; Padovani, Alessandro; Pilotto, Alberto
It has been suggested that the serotonin or 5-hydroxytriptamine (5-HT) transporter (5-HTT) and its gene-linked polymorphic region (5-HTTLPR) are selective serotonin reuptake inhibitor (SSRI) response modulators in late-life depression (LLD), and particularly in late-life major depressive disorder (MDD). Previous studies differed in design and results. Our study aimed to investigate the solute carrier family 6 (neurotransmitter transporter and serotonin) member 4 (SLC6A4) gene locus, encoding 5-HTT and SSRI treatment response in late-life MDD. For a prospective cohort study, we enrolled 234 patients with late-life MDD to be treated with escitalopram, sertraline, paroxetine or citalopram for 6 months. The SLC6A4 polymorphisms rs4795541 (5-HTTLPR), rs140701 and rs3813034 genotypes spanning the SLC6A4 locus were investigated in blinded fashion. No placebo group was included. We assessed responder or non-responder phenotypes according to a reduction in the 21-item version of the Hamilton Depression Rating Scale (HDRS-21) score of ⩾ 50%. At follow-up, 30% of the late-life MDD patients were non-responders to SSRI treatment. No time-course of symptoms and responses was made. A poor response was associated with a higher baseline HDRS-21 score. We observed a significant over-representation of the rs4795541-S allele in the responder patients (0.436 versus 0.321; p = 0.023). The single S-allele dose-additive effect had OR = 1.74 (95% CI 1.12-2.69) in the additive regression model. Our findings suggested a possible influence of 5-HTTLPR on the SSRI response in patients with late-life MDD, which is potentially useful in identifying the subgroups of LLD patients whom need a different pharmacological approach.
Byun, Min Soo; Choe, Young Min; Sohn, Bo Kyung; Yi, Dahyun; Han, Ji Young; Park, Jinsick; Choi, Hyo Jung; Baek, Hyewon; Lee, Jun Ho; Kim, Hyun Jung; Kim, Yu Kyeong; Yoon, Eun Jin; Sohn, Chul-Ho; Woo, Jong Inn; Lee, Dong Young
Previous literature suggests that Alzheimer's disease (AD) process may contribute to late-life onset depression (LLOD). Therefore, we investigated the association of LLOD with cerebral amyloidosis and neuronal injury, the two key brain changes in AD, along with vascular risks. Twenty nine non-demented individuals who first experienced major depressive disorder (MDD) after age of 60 years were included as LLOD subjects, and 27 non-demented elderly individuals without lifetime experience of MDD were included as normal controls (NC). Comorbid mild cognitive impairment (MCI) was diagnosed in 48% of LLOD subjects and in 0% of NC. LLOD, irrespective of comorbid MCI diagnosis, was associated with prominent prefrontal cortical atrophy. Compared to NC, LLOD subjects with comorbid MCI (LLODMCI) showed increased cerebral 11C-Pittsburg compound B (PiB) retention and plasma beta-amyloid 1–40 and 1–42 peptides, as measures of cerebral amyloidosis; and, such relationship was not observed in overall LLOD or LLOD without MCI (LLODwoMCI). LLOD subjects, particularly the LLODwoMCI, had higher systolic blood pressure (SBP) than NC. When analyzed in the same multiple logistic regression model that included prefrontal gray matter (GM) density, cerebral amyloidosis, and SBP as independent variables, only prefrontal GM density showed a significant independent association with LLOD regardless of MCI comorbidity status. Our findings suggest AD process might be related to LLOD via prefrontal neuronal injury in the MCI stage, whereas vascular processes—SBP elevation, in particular—are associated with LLOD via prefrontal neuronal injury even in cognitively intact or less impaired individuals. PMID:27790137
Smoski, Moria J.; LaBar, Kevin S.; Steffens, David C.
Objectives The present study compares the effectiveness of two strategies, reappraisal and distraction, in reducing negative affect in older adults induced by focusing on personally relevant negative events and stressors. Participants included 30 adults with MDD and 40 never-depressed (ND) comparison participants ages 60 and over (mean age = 69.7 years). Design and Measurements Participants underwent three affect induction trials, each followed by a different emotion regulation strategy: distraction, reappraisal, and a no-instruction control condition. Self-reported affect was recorded pre- and post-affect induction, and at one-minute intervals during regulation. Results Across groups, participants reported greater reductions in negative affect with distraction than reappraisal or the no-instruction control condition. An interaction between group and regulation condition indicated that distraction was more effective in reducing negative affect in the MDD group than the ND group. Conclusions These results suggest that distraction is an especially effective strategy for reducing negative affect in older adults with MDD. Finding ways to incorporate distraction skills into psychotherapeutic interventions for late-life MDD may improve their effectiveness, especially for short-term improvement of affect following rumination. PMID:24021222
Guerra, M.; Prina, A.M.; Ferri, C.P.; Acosta, D.; Gallardo, S.; Huang, Y.; Jacob, K.S.; Jimenez-Velazquez, I.Z.; Llibre Rodriguez, J.J.; Liu, Z.; Salas, A.; Sosa, A.L.; Williams, J.D.; Uwakwe, R.; Prince, M.
Background Current estimates of the prevalence of depression in later life mostly arise from studies carried out in Europe, North America and Asia. In this study we aimed to measure the prevalence of depression using a standardised method in a number of low and middle income countries (LMIC). Methods A one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was assessed and compared using ICD-10 and EURO-D criteria. Results Depression prevalence varied across sites according to diagnostic criteria. The lowest prevalence was observed for ICD-10 depressive episode (0.3 to 13.8%). When using the EURO-D depression scale, the prevalence was higher and ranged from 1.0% to 38.6%. The crude prevalence was particularly high in the Dominican Republic and in rural India. ICD-10 depression was also associated with increased age and being female. Limitations Generalisability of findings outside of catchment areas is difficult to assess. Conclusions Late life depression is burdensome, and common in LMIC. However its prevalence varies from culture to culture; its diagnosis poses a significant challenge and requires proper recognition of its expression. PMID:26544620
Guerra, Mariella; Ferri, Cleusa P.; Sosa, Ana Luisa; Salas, Aquiles; Gaona, Ciro; Gonzales, Victor; de la Torre, Gabriela Rojas; Prince, Martin
Background The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide. Aims To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America. Method A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM–IV and ICD–10 criteria, Geriatric Mental State–Automated Geriatric Examination for Computer Assisted Taxonomy (GMS–AGECAT) algorithm and EURO–D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD–10 depression. Results For DSM–IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD–10 depressive episode between 4.5% and 5.1%, for GMS–AGECAT depression between 30.0% and 35.9% and for EURO–D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD–10 and DSM–IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD–10 depressive episode. Conclusions The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector. PMID:19949200
Paroni, Giulia; Seripa, Davide; Fontana, Andrea; D'Onofrio, Grazia; Gravina, Carolina; Urbano, Maria; Addante, Filomena; Lozupone, Madia; Copetti, Massimiliano; Pilotto, Alberto; Greco, Antonio; Panza, Francesco
Klotho protein, encoded by the Klotho gene (KL) at locus 13q12, is an antiaging hormone-like protein playing a pivotal role in cell metabolism homeostasis and associated to longevity and age-related diseases. In particular, altered cell metabolism in central nervous system may influence the behavior of serotoninergic neurons. The role of KL in the response to treatment with selective serotonin reuptake inhibitors (SSRIs) in late-life depressive syndromes and late-life major depressive disorder (MDD) is unclear. We genotyped three single-nucleotide polymorphisms (SNPs) of KL in 329 older patients with diagnosis of late-life MDD, treated with SSRIs and evaluated with the Hamilton Rating Scale for Depression 21-items (HRSD-21) at baseline and after 6 months. A reduction ≥50 and <10 % in HDRS-21 score was considered as response or nonresponse to therapy, respectively, and the values of reduction between 10 and 49 % as poor responders. After 6 months of SSRI treatment, 176 patients responded, 54 patients did not respond and 99 patients showed a poor response. Ordinal logistic models showed a significant association between mutation of SNP rs1207568 and responders and, similarly, for each unitary risk allele increase overlapping results were found. Conversely, a significantly higher frequency of the minor genotype of SNP rs9536314 was found in nonresponders. Considering the pre-post differences of HRSD-21 scores as a continue variable, we confirmed a significant improvement of depressive symptoms after treatment in patients carrying at least one minor allele at rs1207568 and a worse response in patients homozygous for the minor allele at rs9536314. Our results were the first that suggested a possible role of KL in the complex pathway of SSRI response in late-life MDD.
Penkunas, Michael J; Hahn-Smith, Stephen
IMPACT (Improving Mood--Promoting Access to Collaborative Treatment) has a large body of evidence demonstrating its effectiveness for treating late-life depression in clients enrolled in a clinical research study, but little is known about how well the collaborative care model translates into treatment provided in a public mental health setting. This evaluation examines the influence of clinical and demographic characteristics in 112 older adults treated for late-life depression through publicly funded IMPACT in a large San Francisco Bay Area county. Depression severity decreased for 85% of clients between enrollment and treatments' end and 46% of clients realized a 50% reduction in symptom severity. Depression severity at enrollment, number of treatment sessions attended, ethnicity, and gender reliably predicted depression severity at the end of treatment. Men, clients attending more therapy sessions, and clients without substance abuse diagnoses had an increased likelihood of realizing a 50% reduction in symptoms. Results highlight the success of this evidence-based treatment program offered through the public mental health system but suggest that the demographic and clinical characteristics of the population being treated must be considered when adopting evidence-based practices.
Meeks, Suzanne; Woodruff-Borden, Janet; Depp, Colin A
Research has shown impressive support for tripartite models of anxiety and depression that include a common factor of negative affect, and the unique factors positive affect and arousal. It is not clear whether this structure extends into later life. The current study used confirmatory factor analysis to model the structural relationship of anxiety and depression in two samples of older adults: a large probability sample (N = 1429) and a smaller convenience sample (N = 210). Across all analyses, a correlated, two-factor, psychometric model was most parsimonious. The tripartite model could be fit to the data, but added no explanatory power; in some cases a one-factor model also fit. The results suggest that there is a unitary factor of "distress" that incorporates anxiety and depression, but that the structure is not consistent with factor structures found in younger samples. Instead, the broad constructs may be represented in a more complex manner among older adults, and are less easily differentiated.
Ryan, Joanne; Artero, Sylvaine; Carrière, Isabelle; Maller, Jerome J; Meslin, Chantal; Ritchie, Karen; Ancelin, Marie-Laure
A number of genome-wide association studies (GWAS) have investigated risk factors for major depressive disorder (MDD), however there has been little attempt to replicate these findings in population-based studies of depressive symptoms. Variants within three genes, BICC1, PCLO and GRM7 were selected for replication in our study based on the following criteria: they were identified in a prior MDD GWAS study; a subsequent study found evidence that they influenced depression risk; and there is a solid biological basis for a role in depression. We firstly investigated whether these variants were associated with depressive symptoms in our population-based cohort of 929 elderly (238 with clinical depressive symptoms and 691 controls), and secondly to investigate associations with structural brain alterations. A number of nominally significant associations were identified, but none reached Bonferroni-corrected significance levels. Common SNPs in BICC1 and PCLO were associated with a 50% and 30% decreased risk of depression, respectively. PCLO rs2522833 was also associated with the volume of grey matter (p=1.6×10(-3)), and to a lesser extent with hippocampal volume and white matter lesions. Among depressed individuals rs9870680 (GRM7) was associated with the volume of grey and white matter (p=10(-4) and 8.3×10(-3), respectively). Our results provide some support for the involvement of BICC1 and PCLO in late-life depressive disorders and preliminary evidence that these genetic variants may also influence brain structural volumes. However effect sizes remain modest and associations did not reach corrected significance levels. Further large imaging studies are needed to confirm our findings.
Parisi, Jeanine M; Xia, Jin; Spira, Adam P; Xue, Qian-Li; Rieger, Marin L; Rebok, George W; Carlson, Michelle C
The association between lifestyle activities and incident depressive symptoms was examined within the Women's Health and Aging Study II. Measures of activity and depressive symptoms were collected on four occasions, spanning six-years. Discrete-time Cox proportional hazards models were employed to examine the effects of baseline activity on depressive symptoms over time. Overall, activity was not associated with incident depressive symptoms. When specific activity domains were examined, greater participation in creative activities was associated with a reduced risk of depressive symptoms (hazard ratio = 0.92; CI 95% 0.87, 0.98). Further longitudinal research between diverse activities and incident depressive symptoms is warranted.
Liu, Angela Y; Rajji, Tarek K; Blumberger, Daniel M; Daskalakis, Zafiris J; Mulsant, Benoit H
Late-life mental illness is a growing concern. Current medications have limited efficacy and are associated with safety concerns. A variety of brain stimulation approaches offers alternative treatments. We performed a systematic literature search on the efficacy and safety of brain stimulation in late-life mental illnesses, excluding unipolar nonpsychotic depression. Studies on deep brain stimulation, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and vagal nerve stimulation that enrolled exclusively older adults (≥65 years) or analyzed older adults as a separate group were included. The search identified 1,181 publications, of which 43 met the above inclusion criteria: 24 were related to the treatment of non-unipolar depression (ECT: 21; rTMS: 2; ECT and rTMS: 1), 14 related to dementia (ECT: 7[2 of these studies were also related to depression]; vagal nerve stimulation: 2; rTMS: 4; deep brain stimulation: 1), and 7 to schizophrenia (ECT: 7). These studies reported a high degree of variability in efficacy and safety with promising results in general, particularly in the treatment of dementia and schizophrenia. Most publications were limited by small sample sizes, lack of control conditions, and lack of randomization. Large studies with a randomized controlled design or other designs such as crossover or off-on-off-on are needed. In contrast to the empiric and nonspecific use of ECT, future studies using modalities other than ECT could focus on novel biologically based interventions that target specific circuitry. These interventions could also be combined with other non-brain stimulation treatments for possible synergistic effects.
Flint, A. J.
OBJECTIVE: To review the epidemiology, clinical characteristics, and treatment of anxiety disorders in late life. QUALITY OF EVIDENCE: Epidemiologic and comorbidity data are derived from well designed random-sample community surveys. There are virtually no controlled data specific to treatment of anxiety in the elderly. Guidelines for treating anxiety disorders in late life, therefore, must be extrapolated from results of randomized controlled trials conducted in younger patients. MAIN MESSAGE: Generalized anxiety disorder and agoraphobia account for most cases of anxiety disorder in late life. Late-onset generalized anxiety is usually associated with depressive illness and, in this situation, the primary pharmacologic treatment is antidepressant medication. Most elderly people with agoraphobia do not give a history of panic attacks; exposure therapy is the preferred treatment for agoraphobia without panic. CONCLUSIONS: Physicians need to make more use of antidepressant medication and behavioural therapy and less use of benzodiazepines in treating anxiety disorders in late life. PMID:10587775
Angelini, Viola; Klijs, Bart; Smidt, Nynke; Mierau, Jochen O.
Background Depression among older adults (i.e., the 50+) is a major health concern. The objective of this study is to investigate whether growing up with a parent suffering from mental health problems is associated with depressive symptoms in late-adulthood and how this association is influenced by life-course socio-economic, health and lifestyle factors in childhood and late adulthood. Methods We used life-history data from the SHARE survey, consisting of 21,127 participants living in 13 European countries. Symptoms of depression were assessed using the EURO-D scale. Parental mental health was assessed by asking respondents to report whether any of their parents had mental health problems during the respondents’ childhood. Logistic regression models were used to assess the association between parental mental health status and depression. Variables on childhood and late-life socio-economic, health and lifestyle factors were sequentially added to the model to assess the extent to which this association is influenced by life-course circumstances. Results Individuals who were exposed during childhood to a parent with mental health problems suffered from depressive symptoms more often in late adulthood than those who were not (OR 1.76, 95% CI: 1.43–2.17). Adjustment for life-course socio-economic, health and lifestyle factors in childhood and late adulthood diminished this association to an OR of 1.54 (95% CI: 1.24–1.90) and OR of 1.45 (95% CI: 1.16–1.82), respectively. Conclusion Our results indicate a substantial association between parental mental health problems in childhood and depression in late adulthood and that this association is partly explained by childhood as well as late adulthood socio-economic, health and lifestyle factors. PMID:27936078
Depression is a common psychiatric disorder with devastating effects on the older Hispanic population. This review synthesizes the research on depression among older Hispanics in the United States to educate and provide direction for further research and practice. A literature search of PubMed, CINAHL, and PsycINFO databases was conducted. Article titles, abstracts, and texts of articles were scanned for those that met the inclusion criteria for this review. Inclusion criteria included the following: research studies published between 2000 and 2012; studies published in the English language; studies about depression that included older Hispanics (50 years old and older) who resided in the United States; and studies about depression, acculturation, and other associated stressors that may contribute to depression in this population. The results of this review indicate that acculturation, associated stressors, health-related factors, and psychosocial factors may have a negative impact on older Hispanics' mental health. More research is needed to further explore Hispanics' perceptions and experiences of depression as well as the cultural dimensions of Hispanic depression. The cultural formulation can be a useful framework for assessment, prevention, and treatment of older Hispanics with depression. Knowledge regarding depression and what causes it can lead to better assessment practices, early detection, and culturally sensitive interventions, care and services.
White, Megan E.; Shih, Josephine H.
The purpose of this study was to extend the research on co-rumination and depressed mood by examining the impact of co-rumination on depressed mood on a daily basis while controlling for the effects of daily stress events in a sample of late adolescents. Two-hundred and seventy-nine predominantly Caucasian college students (95 male, 184 female)…
Vasudev, Akshya; Arena, Amanda; Burhan, Amer M; Ionson, Emily; Hirjee, Hussein; Maldeniya, Pramudith; Wetmore, Stephen; Newman, Ronnie I
Late-life depression affects 2-6% of seniors aged 60 years and above. Patients are increasingly embracing non-pharmacological therapies, many of which have not been scientifically evaluated. This study aimed to evaluate a category of meditation, automatic self-transcending meditation (ASTM), in alleviating symptoms of depression when augmenting treatment as usual (NCT02149810). The preliminary results of an ongoing single-blind randomised controlled trial comparing a training programme involving ASTM with a wait-list control indicate that a 12-week ASTM programme may lead to significantly greater reductions in depression and anxiety severity. As such, ASTM may be an effective adjunctive therapy in the treatment of late-life depression.
Steffens, David C.; Manning, Kevin J.; Wu, Rong; Grady, James J.; Fortinsky, Richard H.; Tennen, Howard A.
Background We sought to investigate the relationship between neuroticism and depression in an elderly cohort. In this paper, we describe the methods of an NIMH-supported study and present findings among the cohort enrolled to date. Methods We used the NEO Personality Inventory to assess neuroticism, and we employed several cognitive neuroscience-based measures to examine emotional control. Results Compared with a group of 27 non-depressed older control subjects, 33 older depressed subjects scored higher on measures of state and trait anxiety and neuroticism. On our experimental neuroscience-based measures, depressed subjects endorsed more negative words compared with controls on an emotional characterization test. In addition, we found a significant group-by-congruency effect on an emotional interference test where subjects were asked to identify the face’s emotional expression while ignoring the words “fear” or “happy” labeled across the face. Conclusion Thus, in this preliminary work, we found significant differences in measures of neuroticism and emotional controls among older adults with and without depression. PMID:26323208
Holm, Margo B.; Raina, Ketki D.; Reynolds, Charles F.; Rogers, Joan C.
OBJECTIVE. We sought to understand activity choices of older adults when they were depressed. METHOD. Each community-dwelling participant (n = 27) completed one semistructured interview while in recovery for at least 3 mo. but less than 7 mo. Transcripts were coded to identify relevant themes. RESULTS. Six themes emerged that explained activities participants continued while depressed, and four themes described activities they stopped. CONCLUSION. Older adults maintained many instrumental activities of daily living while depressed, and some actively adapted activities so they could continue them. Some intentionally stopped activities to direct limited energy to their highest priority activities. To guide effective intervention, it is critical for occupational therapy practitioners to complete a client-centered qualitative assessment to understand what and, most important, why activities are continued or stopped. Each theme for activities continued and activities stopped lends itself to intervention strategies. PMID:25184470
Lamar, Melissa; Charlton, Rebecca; Zhang, Aifeng; Kumar, Anand
Verbal memory deficits attributed to late life depression (LLD) may result from executive dysfunction that is more detrimental to list-learning than story-based recall when compared to healthy aging. Despite these behavioral dissociations, little work has been done investigating related neuroanatomical dissociations across types of verbal memory performance in LLD. We compared list-learning to story-based memory performance in 24 non-demented individuals with LLD (age ~ 66.1 ± 7.8) and 41 non-demented/non-depressed healthy controls (HC; age ~ 67.6 ± 5.3). We correlated significant results of between-group analyses across memory performance variables with brain volumes of frontal, temporal and parietal regions known to be involved with verbal learning and memory. When compared to the HC group, the LLD group showed significantly lower verbal memory performance for spontaneous recall after repeated exposure and after a long-delay but only for the list-learning task; groups did not differ on story-based memory performance. Despite equivalent brain volumes across regions, only the LLD group showed brain associations with verbal memory performance and only for the list-learning task. Specifically, frontal volumes important for subjective organization and response monitoring correlated with list-learning performance in the LLD group. This study is the first to demonstrate neuroanatomical dissociations across types of verbal memory performance in individuals with LLD. Results provide structural evidence for the behavioral dissociations between list-learning and story-based recall in LLD when compared to healthy aging. More specifically, it points toward a network of predominantly anterior brain regions that may underlie the executive contribution to list-learning in older adults with depression.
This study used longitudinal data to examine the effects of spousal illness on depressive symptoms among middle-aged and older married individuals and the extent to which the adverse effects of illness in a spouse were mitigated by 2 psychological resources, mastery and self-esteem. Using 1,704 married participants who were 51 years of age on…
Oude Voshaar, R C; Derks, W J; Comijs, H C; Schoevers, R A; de Borst, M H; Marijnissen, R M
A low plasma 25-OH vitamin D3 level is a universal risk factor for a wide range of diseases and has also been implicated in late-life depression. It is currently unknown whether the biologically active form of vitamin D, that is, 1,25-(OH)2 vitamin D3, is also decreased in late-life depression, or whether vitamin D levels correlate with specific depression characteristics. We determined plasma 25-OH vitamin D3, 1,25-(OH)2 vitamin D3 and parathormone levels in 355 depressed older persons and 124 non-depressed comparison subjects (age 60 years). Psychopathology was established with the Composite International Diagnostic Interview 2.1, together with potential confounders and depression characteristics (severity, symptom profile, age of onset, recurrence, chronicity and antidepressant drug use). Adjusted for confounders, depressed patients had significantly lower levels of 25-OH vitamin D33 (Cohen's d =0.28 (95% confidence interval: 0.07-0.49), P=0.033) as well as 1,25-(OH)2 vitamin D3 (Cohen's d =0.48 (95% confidence interval: 0.27-0.70), P<0.001) than comparison subjects. Of all depression characteristics tested, only the use of tricyclic antidepressants (TCAs) was significantly correlated with lower 1,25-(OH)2 vitamin D3 levels (Cohen's d =0.86 (95% confidence interval: 0.53-1.19), P<0.001), but not its often measured precursor 25-OH vitamin D3. As vitamin D levels were significantly lower after adjustment for confounders, vitamin D might have an aetiological role in late-life depression. Differences between depressed and non-depressed subjects were largest for the biologically active form of vitamin D. The differential impact of TCAs on 25-OH vitamin D3 and 1,25-(OH)2 vitamin D3 levels suggests modulation of 1-α-hydroxylase and/or 24-hydroxylase, which may in turn have clinical implications for biological ageing mechanisms in late-life depression.
Miller, Mark D.
Complicated grief (CG) is a syndrome that affects 10% to 20% of grievers regardless of age, although proportionally more will face the death of loved ones in late life, CG is characterized by preoccupying and disabling symptoms that can persist for decades such as an inability to accept the death, intense yearning or avoidance, frequent reveries, deep sadness, crying, somatic distress, social withdrawal, and suicidal ideation. This syndrome is distinct from major depression and post-traumatic stress disorder, but CG maybe comorbid with each. This communication will focus on the impact of CG in late life (over age 60) and will include a case vignette for illustrating complicated grief therapy. PMID:22754292
This purpose of this study is to examine two constructs that have been largely overlooked in the study of religious involvement among older people: parental religious socialization practices and feelings of connectedness with others. The data are from an ongoing nationwide survey of older people. Findings from a latent variable model that was designed to examine the two focal constructs provides support for the following relationships:(1) older people whose parents encouraged them to become more involved in religion are more likely to attend worship services; (2) older people whose parents promoted religious involvement and older individuals who attend church more often are more likely to report that they see a fundamental connection among all human beings; (3) older adults who feel more closely connected to others will be more likely to forgive people for the things they have done; and (4) older people who are more forgiving are likely to experience fewer symptoms of depression over time.
This purpose of this study is to examine two constructs that have been largely overlooked in the study of religious involvement among older people: parental religious socialization practices and feelings of connectedness with others. The data are from an ongoing nationwide survey of older people. Findings from a latent variable model that was designed to examine the two focal constructs provides support for the following relationships:(1) older people whose parents encouraged them to become more involved in religion are more likely to attend worship services; (2) older people whose parents promoted religious involvement and older individuals who attend church more often are more likely to report that they see a fundamental connection among all human beings; (3) older adults who feel more closely connected to others will be more likely to forgive people for the things they have done; and (4) older people who are more forgiving are likely to experience fewer symptoms of depression over time. PMID:22468116
Lebedeva, Aleksandra K.; Westman, Eric; Borza, Tom; Beyer, Mona K.; Engedal, Knut; Aarsland, Dag; Selbaek, Geir; Haberg, Asta K.
Objective: Late-life depression (LLD) is associated with development of different types of dementia. Identification of LLD patients, who will develop cognitive decline, i.e., the early stage of dementia would help to implement interventions earlier. The purpose of this study was to assess whether structural brain magnetic resonance imaging (MRI) in LLD patients can predict mild cognitive impairment (MCI) or dementia 1 year prior to the diagnosis. Methods: LLD patients underwent brain MRI at baseline and repeated clinical assessment after 1-year. Structural brain measurements were obtained using Freesurfer software (v. 5.1) from the T1W brain MRI images. MRI-based Random Forest classifier was used to discriminate between LLD who developed MCI or dementia after 1-year follow-up and cognitively stable LLD. Additionally, a previously established Random Forest model trained on 185 patients with Alzheimer’s disease (AD) vs. 225 cognitively normal elderly from the Alzheimer’s disease Neuroimaging Initiative was tested on the LLD data set (ADNI model). Results: MCI and dementia diagnoses were predicted in LLD patients with 76%/68%/84% accuracy/sensitivity/specificity. Adding the baseline Mini-Mental State Examination (MMSE) scores to the models improved accuracy/sensitivity/specificity to 81%/75%/86%. The best model predicted MCI status alone using MRI and baseline MMSE scores with accuracy/sensitivity/specificity of 89%/85%/90%. The most important region for all the models was right ventral diencephalon, including hypothalamus. Its volume correlated negatively with the number of depressive episodes. ADNI model trained on AD vs. Controls using SV could predict MCI-DEM patients with 67% accuracy. Conclusion: LDD patients developing MCI and dementia can be discriminated from LLD patients remaining cognitively stable with good accuracy based on baseline structural MRI alone. Baseline MMSE score improves prediction accuracy. Ventral diencephalon, including the hypothalamus
Lebedeva, Aleksandra K; Westman, Eric; Borza, Tom; Beyer, Mona K; Engedal, Knut; Aarsland, Dag; Selbaek, Geir; Haberg, Asta K
Objective: Late-life depression (LLD) is associated with development of different types of dementia. Identification of LLD patients, who will develop cognitive decline, i.e., the early stage of dementia would help to implement interventions earlier. The purpose of this study was to assess whether structural brain magnetic resonance imaging (MRI) in LLD patients can predict mild cognitive impairment (MCI) or dementia 1 year prior to the diagnosis. Methods: LLD patients underwent brain MRI at baseline and repeated clinical assessment after 1-year. Structural brain measurements were obtained using Freesurfer software (v. 5.1) from the T1W brain MRI images. MRI-based Random Forest classifier was used to discriminate between LLD who developed MCI or dementia after 1-year follow-up and cognitively stable LLD. Additionally, a previously established Random Forest model trained on 185 patients with Alzheimer's disease (AD) vs. 225 cognitively normal elderly from the Alzheimer's disease Neuroimaging Initiative was tested on the LLD data set (ADNI model). Results: MCI and dementia diagnoses were predicted in LLD patients with 76%/68%/84% accuracy/sensitivity/specificity. Adding the baseline Mini-Mental State Examination (MMSE) scores to the models improved accuracy/sensitivity/specificity to 81%/75%/86%. The best model predicted MCI status alone using MRI and baseline MMSE scores with accuracy/sensitivity/specificity of 89%/85%/90%. The most important region for all the models was right ventral diencephalon, including hypothalamus. Its volume correlated negatively with the number of depressive episodes. ADNI model trained on AD vs. Controls using SV could predict MCI-DEM patients with 67% accuracy. Conclusion: LDD patients developing MCI and dementia can be discriminated from LLD patients remaining cognitively stable with good accuracy based on baseline structural MRI alone. Baseline MMSE score improves prediction accuracy. Ventral diencephalon, including the hypothalamus
Karim, H T; Andreescu, C; Tudorascu, D; Smagula, S F; Butters, M A; Karp, J F; Reynolds, C; Aizenstein, H J
Previous studies in late-life depression (LLD) have found that patients have altered intrinsic functional connectivity in the dorsal default mode network (DMN) and executive control network (ECN). We aimed to detect connectivity differences across a treatment trial among LLD patients as a function of remission status. LLD patients (N=37) were enrolled into a 12-week trial of venlafaxine and underwent five functional magnetic resonance imaging resting state scans during treatment. Patients had no history of drug abuse, psychosis, dementia/neurodegenerative diseases or medical conditions with known effects on mood. We investigated whether there were differences in three networks: DMN, ECN and anterior salience network connectivity, as well as a whole brain centrality measure (eigenvector centrality). We found that remitters showed increases in ECN connectivity in the right precentral gyrus and decreases in DMN connectivity in the right inferior frontal gyrus and supramarginal gyrus. The ECN and DMN had regions (middle temporal gyrus and bilateral middle/inferior temporal/fusiform gyrus, respectively) that showed reversed effects (decreased ECN and increased DMN, respectively). Early changes in functional connectivity can occur after initial medication exposure. This study offers new data, indicating that functional connectivity changes differ depending on treatment response and can occur shortly after exposure to antidepressant medication.
Karim, H T; Andreescu, C; Tudorascu, D; Smagula, S F; Butters, M A; Karp, J F; Reynolds, C; Aizenstein, H J
Previous studies in late-life depression (LLD) have found that patients have altered intrinsic functional connectivity in the dorsal default mode network (DMN) and executive control network (ECN). We aimed to detect connectivity differences across a treatment trial among LLD patients as a function of remission status. LLD patients (N=37) were enrolled into a 12-week trial of venlafaxine and underwent five functional magnetic resonance imaging resting state scans during treatment. Patients had no history of drug abuse, psychosis, dementia/neurodegenerative diseases or medical conditions with known effects on mood. We investigated whether there were differences in three networks: DMN, ECN and anterior salience network connectivity, as well as a whole brain centrality measure (eigenvector centrality). We found that remitters showed increases in ECN connectivity in the right precentral gyrus and decreases in DMN connectivity in the right inferior frontal gyrus and supramarginal gyrus. The ECN and DMN had regions (middle temporal gyrus and bilateral middle/inferior temporal/fusiform gyrus, respectively) that showed reversed effects (decreased ECN and increased DMN, respectively). Early changes in functional connectivity can occur after initial medication exposure. This study offers new data, indicating that functional connectivity changes differ depending on treatment response and can occur shortly after exposure to antidepressant medication. PMID:27090303
Avari, Jimmy N; Alexopoulos, George S
Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.
Freitas, Mélanie; Rahioui, Hassan
Old age is likely to cause a crisis in one's life because of the vulnerabilities it brings up, acting as stressful elements disrupting the elder's feeling of security. It leads to the activation of what is called his attachment system, consisting in attachment styles and interpersonal emotional regulation strategies. To recover a higher sense of safety, the elder would refer to his attachment figures, that is to say closed people paying attention to him, showing towards him availability and consideration. However older adults particularly see their tolerance threshold lowered, regarding an accumulation of losses (true or symbolic) and stressful events within their lifetime. In a psychological and organic exhaustion phenomenon, the risk is to wear out the interpersonal emotional regulation strategies. These are as much vulnerabilities that may increase psychiatric decompensation, including depression. To resolve the tension of this period and to found a necessary secure feeling, the elder will have to redesign the attachment links previously settled and proceed to adjustments to this new context. The need of relational closeness comes back in the elders' attachment behaviour, counting on attachment figures not only to help their loneliness or dependency, but essentially to support them in a narcissist and affective way. That is why attachment theory enlightens the late life period, such as the new challenges older adults have to face. Many studies recognize its value in understanding the transition to old age, but without proposing conceptualization. We aim first to focus on attachment conception to say how much it is relevant with elderly, and then to describe specific terms of attachment within this population in order to better understand those patients. To finish, we must think about new therapeutic proposals taking into consideration the attachment perspective for a better understanding of old age transition.
Arena, Amanda; Burhan, Amer M.; Ionson, Emily; Hirjee, Hussein; Maldeniya, Pramudith; Wetmore, Stephen; Newman, Ronnie I.
Late-life depression affects 2–6% of seniors aged 60 years and above. Patients are increasingly embracing non-pharmacological therapies, many of which have not been scientifically evaluated. This study aimed to evaluate a category of meditation, automatic self-transcending meditation (ASTM), in alleviating symptoms of depression when augmenting treatment as usual (NCT02149810). The preliminary results of an ongoing single-blind randomised controlled trial comparing a training programme involving ASTM with a wait-list control indicate that a 12-week ASTM programme may lead to significantly greater reductions in depression and anxiety severity. As such, ASTM may be an effective adjunctive therapy in the treatment of late-life depression. Declaration of interest R.I.N. is Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing ASTM training. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703774
Taylor, Warren D.; Zhao, Zheen; Ashley-Koch, Allison; Payne, Martha E.; Steffens, David C.; Krishnan, Ranga R.; Hauser, Elizabeth; MacFall, James R.
Past work demonstrated that late-life depression is associated with greater severity of ischemic cerebral hyperintense white matter lesions, particularly frontal lesions. However, these lesions are also associated with other neuropsychiatric deficits, so these clinical relationships may depend on which fiber tracts are damaged. We examined the ratio of lesion to nonlesioned white matter tissue within multiple fiber tracts between depressed and nondepressed elders. We also sought to determine if the AGTR1 A1166C and BDNF Val66Met polymorphisms contributed to vulnerability to lesion development in discrete tracts. 3T structural MR images and blood samples for genetic analyses were acquired on 54 depressed and 37 nondepressed elders. Lesion maps were created through an automated tissue segmentation process and applied to a probabilistic white matter fiber tract atlas allowing for identification of the fraction of the tract occupied by lesion. The depressed cohort exhibited a significantly greater lesion ratio only in the left upper cingulum near the cingulate gyrus (F1,86 = 4.62, p = 0.0344), supporting past work implicating cingulate dysfunction in the pathogenesis of depression. In the 62 Caucasian subjects with genetic data, AGTR1 C1166 carriers exhibited greater lesion ratios across multiple tracts including the anterior thalamic radiation and inferior fronto-occipital fasciculus. In contrast, BDNF Met allele carriers exhibited greater lesion ratios only in the frontal corpus callosum. Although these findings did not survive correction for multiple comparisons, this study supports our hypothesis and provides preliminary evidence that genetic differences related to vascular disease may increase lesion vulnerability differentially across fiber tracts. PMID:22021115
Smagula, Stephen F; Wallace, Meredith L; Anderson, Stewart J; Karp, Jordan F; Lenze, Eric J; Mulsant, Benoit H; Butters, Meryl A; Blumberger, Daniel M; Diniz, Breno S; Lotrich, Francis E; Dew, Mary Amanda; Reynolds, Charles F
Personalizing treatment for late-life depression requires identifying and integrating information from multiple factors that influence treatment efficacy (moderators). We performed exploratory moderator analyses using data from a multi-site, randomized, placebo-controlled, double-blind trial of aripiprazole augmentation. Patients (n = 159) aged ≥60 years had major depressive disorder that failed to remit with venlafaxine monotherapy. We examined effect sizes of 39 potential moderators of aripiprazole (vs. placebo) augmentation efficacy using the outcome of percentage reduction in depressive symptom after 12 weeks. We then incorporated information from the individually relevant variables in combined moderators. A larger aripiprazole treatment effect was related to: white race, better physical function, better performance on Trail-Making, attention, immediate, and delayed memory tests, greater psychomotor agitation and suicidality symptoms, and a history of adequate antidepressant pharmacotherapy. A smaller aripiprazole treatment effect was observed in patients with: more pain and more work/activity impairment and libido symptoms. Combining information from race and Trail-Making test performance (base combined moderator (Mb*)) produced a larger effect size (Spearman effect size = 0.29 (95% confidence interval (CI): 0.15, 0.42)) than any individual moderator. Adding other individually relevant moderators in the full combined moderator (Mf*) further improved effect size (Spearman effect size = 0.39 (95% CI: 0.25, 0.52)) and identified a sub-group benefiting more from placebo plus continuation venlafaxine monotherapy than adjunctive aripiprazole. Combining moderators can help clinicians personalize depression treatment. We found the majority of our patients benefited from adjunctive aripiprazole, but a smaller subgroup that is identifiable using clinical measures appeared to benefit more from continuation venlafaxine plus placebo.
Li, Wenjun; Ward, B. Douglas; Liu, Xiaolin; Chen, Gang; Jones, Jennifer L; Antuono, Piero G.; Li, Shi-Jiang; Goveas, Joseph S.
Background The topological architecture of the whole-brain functional networks in those with and without late-life depression (LLD) and amnestic mild cognitive impairment (aMCI) are unknown. Aims To investigate the differences in the small-world measures and the modular community structure of the functional networks between patients with LLD and aMCI when occurring alone or in combination and cognitively healthy nondepressed controls. Methods Seventy-nine elderly participants [LLD (n = 23), aMCI (n = 18), comorbid LLD and aMCI (n = 13), and controls (n = 25)] completed neuropsychiatric assessments. Graph theoretical methods were employed on resting-state functional connectivity magnetic resonance imaging data. Results LLD and aMCI comorbidity was associated with the greatest disruptions in functional integration measures (decreased global efficiency and increased path length); both LLD groups showed abnormal functional segregation (reduced local efficiency). The modular network organization was most variable in the comorbid group, followed by LLD-only patients. Decreased mean global, local and nodal efficiency metrics were associated with greater depressive symptom severity but not memory performance. Conclusions Consider the whole brain as a complex network may provide unique insights on the neurobiological underpinnings of LLD with and without cognitive impairment. PMID:25433036
This study examines the process whereby functional disability amplifies depressive symptoms through decreasing perceived social support and psychological resources. The study analyzed two waves of panel data (1986 to 1992) of a large sample of older adults from the National Institutes of Aging Established Populations for Epidemiologic Studies of…
Shiroma, Paulo R.; Drews, Maureen S.; Geske, Jennifer R.; Mrazek, David A.
Objective Age at onset of first major depressive episode (MDE) does not necessarily translate into different treatment outcomes to antidepressants in late-life depression. The influence of genetic variants may affect this relationship. Design Post-hoc dataset analysis of the association between variants in the promoter region (indel, rs25531) and within intron 2 (Stin2 VNTR) of the SCL6A4 gene and treatment outcomes among older participants in the first treatment arm of the Sequenced Treatment Alternatives to Relieve Depression trial (STAR*D). Setting Participants were enrolled from 23 psychiatric and 18 primary care settings. Participants Two hundred twenty one, white-non Hispanic subjects, aged 60 to 75 years, with 16-item Quick Inventory of Depressive Symptomatology-Clinician Rating (QIDS-CR16) initial score ≥10, and who remained in the study for at least 6 weeks were genotyped. Intervention Citalopram treatment for up to 14 weeks Measurements Main outcome was remission rate defined as a score of ≤5 on the QIDS-CR16. Response was a secondary outcome defined as a reduction of ≥50% of baseline QIDS-CR16. Results Polymorphism in the indel promoter region was associated with remission among subjects whose first lifetime episode of major depression occurred later than age 55. In this group, subjects with L/L genotype had significantly higher remission (80% vs. 43%) as compared to those subjects with any other indel promoter genotype. Multivariate analysis demonstrated that the genetic effect of the indel promoter region on remission increases along with age at onset of MDE. Conclusions Variants in the indel promoter region of SLC6A4 gene have a more robust effect to antidepressant outcome among older subjects who experienced their first MDE at a later age. The mechanism of action of these variants remains to be determined. PMID:23973251
Tang, Tan; Yang, Xuemei; Zhang, Weijun; Wang, Xiaohua; Ji, Li; Xiao, Yun; Ma, Kun; Wang, Ying; Kong, Xianglei; Wang, Jianping; Liu, Jun; Xu, Qian; Tian, Donghua; Qu, Zhiyong
Background The delivery of mental health services in rural China has been notably limited due to lack of qualified mental health professionals among other impeding factors. A village doctor-based cognitive behavioral therapy intervention may be one way of improving accessibility. The purpose of this study was to explore the advantages and challenges of implementing this intervention, as delivered by trained village doctors, to treat late-life depression in rural China. Methods We conducted one focus group discussion with 10 village doctors, 10 individual interviews with each of the village doctors, and individual interviews with 19 older adults. The topic guides were advantages and challenges of the intervention program from the perspective of the village doctors and older adults. Interviews were audio-recorded, transcribed, coded using NVivo 8, and analyzed using thematic analysis. Results The village doctors stressed the importance of role-playing and using instructive manuals in the training. Proper supervision was also a key component of the program. The benefits received from the intervention for the village doctors and the elders were positive such that both the doctors and the older adults were willing to implement/receive this intervention. Cultural and political factors (renqing and perceived policy consideration) facilitated the elders’ access to mental health services. Challenges included a lack of real therapy (in contrast to role-playing) demonstrated in the training and lack of a step-by-step manual based on different types of problems encountered. Other impediments to the successful implementation of the intervention included the time constraints of village doctors and the presence of other people when conducting the intervention. Conclusions The present study has demonstrated that the intervention program is likely to be an acceptable geriatric depression intervention in rural China if several challenges are appropriately addressed. PMID:26371473
Pedersen, Cort; Leserman, Jane; Garcia, Nacire; Stansbury, Melissa; Meltzer-Brody, Samantha; Johnson, Jacqueline
Previously we found that late pregnancy total and free thyroxine (TT4, FT4) concentrations were negatively related to greater pre and/or postpartum depressive symptoms. In a much larger cohort, the current study examined whether these thyroid indices measured earlier in the third trimester (31-33 weeks) predict subsequent perinatal depression and anxiety ratings as well as syndromal depression. Thyroid-binding globulin (TBG) concentrations increase markedly during pregnancy and may be an index of sensitivity to elevated estrogen levels. TBG was examined in this study because prior findings suggest that postpartum depression is related to sensitivity to mood destabilization by elevated sex hormone concentrations during pregnancy. Our cohort was 199 euthyroid women recruited from a public health obstetrics clinic (63.8% Hispanic, 21.6% Black). After screening and blood draws for hormone measures at pregnancy weeks 31-33, subjects were evaluated during home visits at pregnancy weeks 35-36 as well as postpartum weeks 6 and 12. Evaluations included psychiatric interviews for current and life-time DSM-IV psychiatric history (M.I.N.I.-Plus), subject self-ratings and interviewer ratings for depression and anxiety (Edinburgh Postnatal Depression Scale, Montgomery-Ǻsberg Depression Rating Scale; Spielberger State-Trait Anxiety Inventory, Hamilton Anxiety Inventory), as well as a standardized interview to obtain life-time trauma history. Numerous covariates were included in all regression analyses. Trauma and major depression history were robustly significant predictors of depression and anxiety ratings over the study period when these variables were analyzed individually or in a combined model including FT4 or TBG (p<.001). When analyzed alone, FT4 levels were a less strong but still significant predictor of all depression and anxiety ratings (p<.05) while TBG levels was a significant or nearly significant predictor of most ratings. FT4, TBG and trauma history, but not
Naish, Josephine H; Baldwin, Robert C; Patankar, Tufail; Jeffries, Suzanne; Burns, Alistair S; Taylor, Christopher J; Waterton, John C; Jackson, Alan
There is growing evidence that microvascular angiopathy (MVA) plays an important role in the development of dementia and affective disorders in older people. At currently available image resolutions it is not possible to image directly the vascular changes associated with MVA, but the effects on blood and cerebrospinal fluid (CSF) flow may be detectable. The aim of this study was to investigate a potential biomarker for MVA based on MRI of abnormalities in CSF flow. Since there is considerable indirect evidence that treatment resistance in late-onset depressive disorder is related to MVA, we assessed the method in a group of 22 normal volunteers and 29 patients with responsive (N=21) or treatment-resistant (N=8) late-onset depressive disorder. Single-slice quantified phase-contrast (PC) images of cerebral blood and CSF flow were collected at 15 points over a cardiac cycle, and the resulting flow curves were parameterized. Significant differences in the CSF flow (width of systolic flow peak and diastolic flow volume, both P<0.01) through the cerebral aqueduct were observed for the group of treatment-resistant patients when compared to age matched controls. No significant difference was observed for a group of 21 patients with treatment-responsive depression. The findings support the hypothesis that MR measurement of CSF flow abnormalities provides a biomarker of MVA, and thus could have application in a wide range of age-related diseases.
Tamburo, Robert J.; Siegle, Greg J.; Stetten, George D.; Cois, C. Aaron; Butters, Meryl A.; Reynolds, Charles F.; Aizenstein, Howard J.
SUMMARY Objective The amygdalae have been a focus of mood disorder research due to their key role in processing emotional information. It has been long known that depressed individuals demonstrate impaired functional performance while engaged in emotional tasks. The structural basis for these functional differences has been investigated via volumetric analysis with mixed findings. In this study, we examined the morphometric basis for these functional changes in late-life depression (LLD) by analyzing both the size and shape of the amygdalae with the hypothesis that shape differences may be apparent even when overall volume differences are inconsistent. Methods Magnetic resonance imaging data were acquired from 11 healthy, elderly individuals and 14 depressed, elderly individuals. Amygdalar size was quantified by computing total volume and amygdalar shape was quantified with a shape analysis method that we have developed. Results No significant volumetric differences were found for either amygdala. Nevertheless, localized regions of significant shape variation were detected for the left and right amygdalae. The most significant difference was contraction (LLD subjects as compared to control subjects) in a region typically associated with the basolateral nucleus, which plays a key role in emotion recognition in neurobiologic models of depression. Conclusions In this LLD study, we have shown that, despite insignificant amygdalar volumetric findings, variations of amygdalar shape can be detected and localized. With further investigation, morphometric analysis of various brain structures may help elucidate the neurobiology associated with LLD and other mood disorders. PMID:19085964
DeLorenzo, C; Sovago, J; Gardus, J; Xu, J; Yang, J; Behrje, R; Kumar, J S D; Devanand, D P; Pelton, G H; Mathis, C A; Mason, N S; Gomez-Mancilla, B; Aizenstein, H; Mann, J J; Parsey, R V
The metabotropic glutamate receptor subtype 5 (mGluR5) has been implicated in the pathophysiology of mood and anxiety disorders and is a potential treatment target in major depressive disorder (MDD). This study compared brain mGluR5 binding in elderly patients suffering from MDD with that in elderly healthy volunteers using positron emission tomography (PET) and [11C]ABP688. Twenty elderly (mean age: 63.0±6.3) subjects with MDD and twenty-two healthy volunteers in the same age range (mean age: 66.4±7.3) were examined with PET after a single bolus injection of [11C]ABP688, with many receiving arterial sampling. PET images were analyzed on a region of interest and a voxel level to compare mGluR5 binding in the brain between the two groups. Differences in [11C]ABP688 binding between patients with early- and late-onset depression were also assessed. In contrast to a previously published report in a younger cohort, no significant difference in [11C]ABP688 binding was observed between elderly subjects with MDD and healthy volunteers. [11C]ABP688 binding was also similar between subgroups with early- or late-onset depression. We believe this is the first study to examine mGluR5 expression in depression in the elderly. Although future work is required, results suggest potential differences in the pathophysiology of elderly depression versus depression earlier in life. PMID:26645628
De Leo, Diego; Spathonis, Kym
Epidemiological studies of suicide in the elderly indicate that, in the last few decades, there has been a relevant increase in suicide rates in old age in a number of Asian and Latin nations, with an almost parallel decrease in Anglo-Saxon counties. Mental disorders, particularly depression, physical illness, personality traits such as hostility, hopelessness, the inability to verbally express psychological pain and dependency on others, recent life events and losses are all factors that may contribute to suicide in later life. Compared with suicide in other age groups, mors voluntaris in late life is associated with the use of highly lethal methods, less ambivalence and impulsivity, and more determination and intent to die. Accordingly, elderly suicidal individuals are more likely than younger subjects to complete rather than attempt suicide. Some evidence suggests also that the characteristics of elderly individuals who attempt suicide may not overlap with those who complete suicide. Death thoughts and suicidal ideations are relatively rare among mentally healthy elderly adults, and are less predominant in this age bracket. However, whether elderly suicidal behaviour exists along a continuum, progressing in severity from death thoughts and suicidal ideation to suicide attempts and completed suicide, remains unclear. Assisted suicide and euthanasia in the elderly have been associated with the desire to escape chronic physical pain and suffering caused by terminal illness, and to relieve mental anguish and feelings of hopelessness, depression and extreme "tiredness of life." The role of the family and those treating chronically ill members is crucial in the final stages of life, particularly when autonomy and the ability of the elderly individual to make end-of-life decisions are compromised. The main aspects associated with these controversial phenomena, particularly from a transcultural perspective, are reviewed in this article.
Lenze, Eric J.; Mulsant, Benoit H.; Blumberger, Daniel M.; Karp, Jordan F.; Newcomer, John W.; Anderson, Stewart J.; Dew, Mary Amanda; Butters, Meryl A.; Stack, Jacqueline A.; Begley, Amy E.; Reynolds, Charles F.
Summary Background Treatment-resistant major depressive disorder is common and potentially life-threatening in older persons, in whom little is known about the benefits and risks of augmentation pharmacotherapy. Methods We conducted a multi-site, placebo-controlled, randomized clinical trial to test the efficacy and safety of aripiprazole augmentation for older adults with treatment-resistant depression. We treated 468 participants aged 60 and older with current major depressive episode with venlafaxine extended-release (ER); 96 (20.5%) did not complete this open phase, 191 (40.8%) remitted, and 181 (38.7%) did not remit and were randomized to 12 weeks of double-blind augmentation with aripiprazole or placebo. The computer-generated randomization was done in blocks and stratified by site. The primary endpoint was remission, defined as Montgomery-Asberg Depression Rating Scale scores ≤10 (and at least two points below the score at the start of the randomized phase) at both of the final two consecutive visits. We also assessed resolution of suicidal ideation, and safety and tolerability with cardiometabolic and neurological measures. Analyses were conducted according to the intention-to-treat principle. This trial is registered with ClinicalTrials.gov, number NCT00892047. Findings Older adults on aripiprazole had a higher remission rate than those on placebo (44% versus 29%; odds ratio [OR]=2.0, 95% CI 1.1–3.7, p=0.03; number needed to treat [NNT]=6.6 [95% CI 3.5–81.8]). Overall, remission was stable during 12 additional weeks of continuation treatment. The resolution of suicidal ideation was more marked with aripiprazole than with placebo. Akathisia was the most common adverse effect (27% of participants on aripiprazole). Compared to placebo, aripiprazole was also associated with more Parkinsonism but not with treatment-emergent suicidal ideation, QTc prolongation, or increases in adiposity, glucose, insulin, or lipids. Interpretation In older adults who fail
Reinhardt, Michael M; Cohen, Carl I
Psychosis is one of the most common conditions in later life with a lifetime risk of 23 %. Despite its high prevalence, late-onset psychosis remains a diagnostic and treatment dilemma. There are no reliable pathognomonic signs to distinguish primary or secondary psychosis. Primary psychosis is a diagnosis of exclusion and the clinician must rule out secondary causes. Approximately 60 % of older patients with newly incident psychosis have a secondary psychosis. In this article, we review current, evidence-based diagnostic and treatment approaches for this heterogeneous condition, emphasizing a thorough evaluation for the "six d's" of late-life psychosis (delirium, disease, drugs dementia, depression, delusions). Treatment is geared towards the specific cause of psychosis and tailored based on comorbid conditions. Frequently, environmental and psychosocial interventions are first-line treatments with the judicious use of pharmacotherapy as needed. There is an enormous gap between the prevalence of psychotic disorders in older adults and the availability of evidence-based treatment. The dramatic growth in the elderly population over the first half of this century creates a compelling need to address this gap.
Doane, Leah D; Mineka, Susan; Zinbarg, Richard E; Craske, Michelle; Griffith, James W; Adam, Emma K
Alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning have been associated with major depression disorder (MDD) and some anxiety disorders. Few researchers have tested the possibility that high levels of recent life stress or elevations in negative emotion may partially account for the HPA axis alterations observed in these disorders. In a sample of 300 adolescents from the Youth Emotion Project, we examined associations between MDD and anxiety disorders, dimensional measures of internalizing symptomatology, life stress, mood on the days of cortisol testing, and HPA axis functioning. Adolescents with a past MDD episode and those with a recent MDD episode comorbid with an anxiety disorder had flatter diurnal cortisol slopes than adolescents without a history of internalizing disorders. Higher reports of general distress, a dimension of internalizing symptomatology, were also associated with flatter slopes. Negative emotion, specifically sadness and loneliness, was associated with flatter slopes and partially accounted for the associations between comorbid MDD and anxiety disorders and cortisol. The associations between past MDD and cortisol slopes were not accounted for by negative emotion, dimensional variation in internalizing symptomatology, or levels of life stress, indicating that flatter cortisol slopes may also be a "scar" marker of past experiences of MDD.
Ellison, James M; Kyomen, Helen H; Harper, David G
We have already entered a new, more exciting, and hopeful era in the treatment of late-life depression. The increasing numbers of older adults who are surviving to more advanced ages and the greater recognition of late-life depression’s prevalence and impact on quality of life emphasize how important it is to detect and treat this disorder. Our increasing repertoire of evidence-based psychotherapeutic, pharmacologic, and neurotherapeutic treatment interventions offers many treatment alternatives, allowing substantial individualization of treatment approach. Demonstration of the effectiveness of depression treatment in primary care suggests the feasibility of increasing our patients’ access to care. Growing appreciation of the pathophysiology of depression and its interrelationships with cognitive impairment may increase our ability to limit or delay certain aspects of cognitive impairment through more aggressive treatment of depression. Improved recognition and treatment of late-life depression holds great potential for improving physical and mental health in later life, reducing disability in later years, and improving quality of life.
Mathews, M A
A woman of 58 came for psychotherapy for the first time suffering from a depressive reaction precipitated by two mid-life events: the marriage of her daughter and the realization that her own cherished marital dream would never be fulfilled. She had postponed coming to terms with the disappointments of her marriage as long as she had had other objects. When these objects were lost, and the distance she had maintained to handle her feelings was threatened, she sought help. There was suggestive evidence that a collusive marital system had sustained an unsatisfactory relationship for 35 years. Her husband was described as an obsessive-compulsive character. His traits were both needed, feared, and resented by the patient, representing the rejected part of herself and aspects of her hated grandmother. Mrs. A. had character traits and a developmental history which supported a diagnosis of primitive hysterical personality. (This type has been described by Zetzel (1968) as "the so-called good hysteric.") The paucity of object relationships in her life, her poor work habits, her inability to tolerate affects were striking. The patient had identified with a pathological mother in a family dominated by rejecting and depreciating attitudes. The patient's use of the defense mechanisms of splitting, projection, and withdrawal as ways of dealing with ambivalence significantly interfered with her self-object differentiation and her capacity for intense emotional or physical intimacy. She could only love men whom she rescued or protected, a pattern consistent with the fact that she could not relate to equals or superiors. Yet she was unable to draw on a good identification with a nuturing mother, so as to really be able to give. There was too much hurt and uncontrolled anger when she was in the superior position with the kind of man who could not meet her dependency needs. Feeling unprotected, she had married a "strong" man, who she expected would meet her narcissistic and
van Vliet, Peter
High cholesterol levels are a major risk factor for cardiovascular disease, but their role in dementia and cognitive decline is less clear. This review highlights current knowledge on the role of cholesterol in late-life cognitive function, cognitive decline, and dementia. When measured in midlife, high cholesterol levels associate with an increased risk of late-life dementia and cognitive decline. However, when measured in late-life, high cholesterol levels show no association with cognitive function, or even show an inverse relation. Although statin treatment has been shown to associate with a lower risk of dementia and cognitive decline in observational studies, randomized controlled trials show no beneficial effect of statin treatment on late-life cognitive function. Lowering cholesterol levels may impair brain function, since cholesterol is essential for synapse formation and maturation and plays an important role in the regulation of signal transduction through its function as a component of the cell membrane. However, membrane cholesterol also plays a role in the formation and aggregation of amyloid-β. Factors that influence cholesterol metabolism, such as dietary intake, are shown to play a role in late-life cognitive function and the risk of dementia. In conclusion, cholesterol associates with late-life cognitive function, but the association is strongly age-dependent. There is no evidence that treatment with statins in late-life has a beneficial effect on cognitive function.
Jinnin, Ran; Okamoto, Yasumasa; Takagaki, Koki; Nishiyama, Yoshiko; Yamamura, Takanao; Okamoto, Yuri; Miyake, Yoshie; Takebayashi, Yoshitake; Tanaka, Keisuke; Sugiura, Yoshinori; Shimoda, Haruki; Kawakami, Norito; Furukawa, Toshi A; Yamawaki, Shigeto
Purpose Despite its clinical importance, adolescent subthreshold depression remains a largely neglected topic. The aims of this study were to accurately identify the natural course of depressive symptoms and the risk for developing major depressive episode (MDE) in late adolescents with subthreshold depression over 1 year. Patients and methods One hundred and seventy-two participants <20 years of age (mean age: 18.32 years, standard deviation: 0.50), who did not meet the full criteria for an MDE, were selected from 2,494 screened freshmen based on the Beck Depression Inventory, 2nd edition (BDI-II). We conducted a cohort study of three groups (low-, middle-, and high-symptom groups) divided based on BDI-II scores, over a 1 year period with the use of bimonthly assessments. Temporal changes of depressive symptoms were analyzed using linear mixed modeling and growth mixture modeling. Results First, we found that late adolescents with subthreshold depression (high depressive symptoms) were split between the increasing and decreasing depressive symptoms groups, whereas the majority of the less-symptoms group remained stable during 1 year. Second, in comparison with late adolescents with less depressive symptoms, those with subthreshold depression had an elevated risk of later depression. Conclusion Some late adolescents with subthreshold depression had increased depressive symptoms and developed an MDE during 1 year. Therefore, it is necessary for us to rigorously assess the changes in subthreshold depressive symptoms over time in late adolescents. PMID:28053534
The relationships between severe depression, life events and personality are complex. However, sexual abuse and maltreatment during childhood contribute towards vulnerability to depressive disorders. Maltreatment in childhood does not appear to be linked to any particular personality disorder. An < insecure > type of bonding appears to be a vulnerability factor both for anxiety and depressive disorders in adulthood.
Schmall, Vicki L.; And Others
This guide is designed to help readers understand depression and factors related to its onset in later life; recognize signs of depression and potential suicide; and know actions they can take if they suspect an older family member or friend may be depressed or contemplating suicide. Following a brief introduction, a chapter on depression…
Rozzini, Renzo; And Others
Investigated the relationship between somatic symptoms, depression, and life events (health status, function, social satisfaction, income) in a population of 1,201 elderly persons living at home. Found depression was the most important factor in the appearance of somatic complaints; however, life events were important cofactors in defining…
Luca, Antonina; Luca, Maria; Calandra2, Carmela
Eating disorders are a heterogeneous group of complex psychiatric disorders characterized by abnormal eating behaviours that lead to a high rate of morbidity, or even death, if underestimated and untreated. The main disorders enlisted in the chapter of the Diagnostic and Statistic Manual of Mental Disorders-5 dedicated to “Feeding and Eating Disorders” are: anorexia nervosa, bulimia nervosa and binge eating disorder. Even though these abnormal behaviours are mostly diagnosed during childhood, interesting cases of late-life eating disorders have been reported in literature. In this review, these eating disorders are discussed, with particular attention to the diagnosis and management of those cases occurring in late-life. PMID:25657852
Sechi, GianPietro; Antonio Cocco, Giovanni; Errigo, Alessandra; Deiana, Luca; Rosati, Giulio; Agnetti, Virgilio; Stephen Paulus, Kay; Mario Pes, Giovanni
Familiar Parkinson's disease has an age of onset from the second to the sixth decade, whereas Wilson's disease (WD) usually presents in the first decade of life. We studied three sisters with a form of very-late-onset major depression and parkinsonism with probable linkage to ATP7B gene. Molecular studies demonstrated a nucleotide deletion at the 5'UTR region in a single allele of ATP7B gene. They did not have a family history of WD, or markers indicative for copper deposition in peripheral tissues. We suggest that single allele mutations of ATP7B gene may confer a susceptibility for late-onset major depression and parkinsonism.
Calamari, John E.; Pontarelli, Noelle K.; Armstrong, Kerrie M.; Salstrom, Seoka A.
Although obsessive-compulsive disorder (OCD) has received increasing attention, the study and treatment of OCD in late life has been neglected. The obsessions and compulsions seen with older adults do not appear to differ from the symptoms experienced by other age groups, although developmental issues might influence symptom focus (e.g., memory…
Brenes, Gretchen A; McCall, W Vaughn; Williamson, Jeff D; Stanley, Melinda A
This article describes the development of Biblio and Telephone Therapy or BTT, a cognitive-behavioral treatment program for late-life anxiety disorders. Although studies have examined bibliotherapy for the treatment of late-life depression, none have studied it as a format for treating late-life anxiety. The application of this treatment to 4 older adults with Generalized Anxiety Disorder (GAD) and/or Panic Disorder (PD) is described and benefits, advantages and limitations are discussed.
Brenes, Gretchen A.; McCall, W. Vaughn; Williamson, Jeff D.; Stanley, Melinda A.
This article describes the development of Biblio and Telephone Therapy or BTT, a cognitive-behavioral treatment program for late-life anxiety disorders. Although studies have examined bibliotherapy for the treatment of late-life depression, none have studied it as a format for treating late-life anxiety. The application of this treatment to 4 older adults with Generalized Anxiety Disorder (GAD) and/or Panic Disorder (PD) is described and benefits, advantages and limitations are discussed. PMID:20661315
Ross, G. Webster; Sigurdsson, Sigurdur; Garcia, Melissa; Gudmundsson, Larus S.; Sveinbjörnsdóttir, Sigurlaug; Wagner, Amy K.; Gudnason, Vilmundur; Launer, Lenore J.
Objective: In the present study, we tested the hypothesis that having migraine in middle age is related to late-life parkinsonism and a related disorder, restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED). Methods: The AGES-Reykjavik cohort (born 1907–1935) has been followed since 1967. Headaches were classified based on symptoms assessed in middle age. From 2002 to 2006, 5,764 participants were reexamined to assess symptoms of parkinsonism, diagnosis of Parkinson disease (PD), family history of PD, and RLS/WED. Results: Subjects with midlife migraine, particularly migraine with aura (MA), were in later life more likely than others to report parkinsonian symptoms (odds ratio [OR]MA = 3.6 [95% CI 2.7–4.8]) and diagnosed PD (ORMA = 2.5 [95% CI 1.2–5.2]). Women with MA were more likely than others to have a parent (ORMA = 2.26 [95% CI 1.3–4.0]) or sibling (ORMA = 1.78 [95% CI 1.1–2.9]) with PD. Late-life RLS/WED was increased for headache generally. Associations were independent of cardiovascular disease and MRI-evident presumed ischemic lesions. Conclusions: These findings suggest there may be a common vulnerability to, or consequences of, migraine and multiple indicators of parkinsonism. Additional genetic and longitudinal observational studies are needed to identify candidate pathways that may account for the comorbid constellation of symptoms. PMID:25230997
Pike, Nancy A.; Evangelista, Lorraine S.; Doering, Lynn V.; Eastwood, Jo-Ann; Lewis, Alan B.; Child, John S.
Background Quality of life (QOL) in adolescents and adults who have undergone the Fontan procedure and are living with only 1 ventricle is presumed to be diminished. Objectives This study aimed to compare QOL, health status, and prevalence of depression in adolescents/adults after the Fontan procedure with healthy counterparts and to identify predictors of QOL in the Fontan group. Methods Using a comparative, cross-sectional design, 54 adolescents and adults with single ventricle congenital heart disease who have undergone the Fontan procedure were compared with 66 age-matched healthy counterparts. Quality of life, health status, depression, and social support were measured using the Satisfaction With Life Scale, Short Form Survey Version 2, Patient Health Questionnaire Depression Module, and Multidimensional Scale of Perceived Social Support. Clinical variables were abstracted from medical records. Predictors of QOL were determined using multiple linear regression. Results Adolescents and adults in the Fontan group reported lower physical health status (mean [SD] = 46.5 [9.3] vs mean [SD] = 55.9 [5.1], P < .001) and were more depressed (mean [SD] = 7.3 [5.9] vs mean [SD] = 4.5 [4.3], P < .004) than their healthy counterparts. There were no differences in QOL, mental health status, or social support between the 2 groups. Functional status (New York Heart Association class), depression, and social support accounted for 55% of the variance in QOL in the Fontan group. Conclusions Despite lower levels of physical health, the QOL of Fontan patients was comparable with that of their healthy counterparts; this finding contradicts previous proxy reports, self-reports, and assumptions that QOL is lower in patients with complex single ventricle congenital heart disease. However, because Fontan patients were more depressed than their healthy counterparts, the need for early screening and detection is warranted. PMID:21912272
Colbert, Sha Juan; Krause, Neal
The purpose of this study is to see whether witnessing a very violent act at any point in the life course is associated with depressive symptoms and alcohol use in late life. The data come from a nationwide probability sample of older adults (N = 1,498). The findings reveal that witnessing violence is associated with more symptoms of depression…
Tapia Granados, José A.; Diez Roux, Ana V.
Recent events highlight the importance of examining the impact of economic downturns on population health. The Great Depression of the 1930s was the most important economic downturn in the U.S. in the twentieth century. We used historical life expectancy and mortality data to examine associations of economic growth with population health for the period 1920–1940. We conducted descriptive analyses of trends and examined associations between annual changes in health indicators and annual changes in economic activity using correlations and regression models. Population health did not decline and indeed generally improved during the 4 years of the Great Depression, 1930–1933, with mortality decreasing for almost all ages, and life expectancy increasing by several years in males, females, whites, and nonwhites. For most age groups, mortality tended to peak during years of strong economic expansion (such as 1923, 1926, 1929, and 1936–1937). In contrast, the recessions of 1921, 1930–1933, and 1938 coincided with declines in mortality and gains in life expectancy. The only exception was suicide mortality which increased during the Great Depression, but accounted for less than 2% of deaths. Correlation and regression analyses confirmed a significant negative effect of economic expansions on health gains. The evolution of population health during the years 1920–1940 confirms the counterintuitive hypothesis that, as in other historical periods and market economies, population health tends to evolve better during recessions than in expansions. PMID:19805076
Abbaszadeh, Fatemeh; Kafaei Atrian, Mahboobe; Masoudi Alavi, Negin; Bagheri, Azam; Sadat, Zohreh; Karimian, Zahra
Background: Quality of life differs for different people in different situations and is related to one's self-satisfaction with life. Quality of life is affected by health status. Objectives: The current study examined the relationship between quality of life and depression in pregnant women in Kashan city. Patients and Methods: A Case - control study was performed on 112 depressed pregnant women (Case Group) and 353 Non-depressed pregnant women (Control Group) who referred to the prenatal health care centers of Kashan University of Medical Sciences .They completed Short Form 36 Health Survey (SF-36) to assess the quality of life and the Beck Depression Inventory to assess the level of depressive symptoms. T-test, chi-square and Pearson correlation coefficient statistical tests were used for data analysis. Results: The findings showed that there was an inverse relationship between quality of life and depression in pregnancy (P = 0.0001). Average scores in all eight domains of quality of life were significantly lower in depressed pregnant women compared to non- depressed women. The strongest relationship was observed between depression and vitality (r =-0.52, P = 0.0001), mental health (r = -0.50, P = 0.001) and social functioning (r =-0.38, P = 0.001). Conclusion: Depressed pregnant women had a lower quality of life. The proper management of depression during pregnancy can improve the quality of life in women. It is recommended that antenatal services integrate screening for depression into routine antenatal care. PMID:25414858
McCrae, Christina S; Ross, Amanda; Stripling, Ashley; Dautovich, Natalie D
Insomnia, the most common sleep disturbance in later life, affects 20%-50% of older adults. Eszopiclone, a short-acting nonbenzodiazepine hypnotic agent developed for the treatment of insomnia, has been available in Europe since 1992 and in the US since 2005. Although not yet evaluated for transient insomnia in older adults, eszopiclone has been shown to be safe and efficacious for short-term treatment (2 weeks) of chronic, primary insomnia in older adults (64-91 years). Clinical studies in younger adults (mean = 44 years) have shown eszopiclone can be used for 6-12 months without evidence of problems. Because the oldest participant in these longer-term trials was 69, it not known whether eszopiclone is effective for older adults [particularly the old old (75-84 years) and oldest old (85+)] when used over longer periods. This is unfortunate, because older individuals frequently suffer from chronic insomnia. Cognitive-behavioral therapy for insomnia, which effectively targets the behavioral factors that maintain chronic insomnia, represents an attractive treatment alternative or adjuvant to eszopiclone for older adults. To date, no studies have compared eszopiclone to other hypnotic medications or to nonpharmacological interventions, such as cognitive-behavioral therapy for insomnia, in older adults. All of the clinical trials reported herein were funded by Sepracor. This paper provides an overview of the literature on eszopiclone with special emphasis on its use for the treatment of late-life insomnia. Specific topics covered include pharmacology, pharmacodynamics, pharmacokinetics, clinical trial data, adverse events, drug interactions, tolerance/dependence, and economics/cost considerations for older adults.
Chen, Jie; Yu, Jing; Wu, Yun; Zhang, Jianxin
This study aimed to investigate the influences of pubertal timing and stressful life events on Chinese adolescents' depression and delinquency. Sex differences in these influences were also examined. A large sample with 4,228 participants aged 12-15 years (53% girls) was recruited in Beijing, China. Participants' pubertal development, stressful life events, depressive symptoms, and delinquency were measured using self-reported questionnaires. Both early maturing girls and boys displayed more delinquency than their same-sex on-time and late maturing peers. Early maturing girls displayed more depressive symptoms than on-time and late maturing girls, but boys in the three maturation groups showed similar levels of depressive symptoms. The interactive effects between early pubertal timing and stressful life events were significant in predicting depression and delinquency, particularly for girls. Early pubertal maturation is an important risk factor for Chinese adolescents' depression and delinquency. Stressful life events intensified the detrimental effects of early pubertal maturation on adolescents' depression and delinquency, particularly for girls.
Olden, Megan; Rosenfeld, Barry; Pessin, Hayley; Breitbart, William
Depression at the end of life is a common mental health issue with serious implications for quality of life and decision making. This study investigated the reliability and validity of one of the most frequently used measures of depression, the Hamilton Depression Rating Scale (HAM-D) in 422 patients with terminal cancer admitted to a palliative…
Monroe, Scott M.; Slavich, George M.; Gotlib, Ian H.
Three of the most consistently reported and powerful predictors of depression are a recent major life event, a positive family history for depression, and a personal history of past depressive episodes. Little research, however, has evaluated the inter-relations among these predictors in depressed samples. Such information is descriptively valuable and potentially etiologically informative. In the present article we summarize the existing literature and test four predictions in a sample of 62 clinically depressed individuals: (1) participants who experienced a major life event prior to onset would be less likely than participants who did not experience a major life event to have a positive family history for depression; (2) participants with a recent major life event would have fewer lifetime episodes of depression than would participants without; (3) participants with a positive family history for depression would have more lifetime episodes of depression than would participants with a negative family history for depression; and (4) we would obtain a 3-way interaction in which participants with a positive family history and without a major life event would have the most lifetime episodes, whereas participants with a negative family history and a major life event would have the fewest lifetime episodes. The first three predictions were confirmed, and the fourth prediction partially confirmed. These novel findings begin to elucidate the complex relations among these three prominent risk factors for depression, and point to avenues of research that may help illuminate the origins of depressive episodes. PMID:24308926
Monroe, Scott M; Slavich, George M; Gotlib, Ian H
Three of the most consistently reported and powerful predictors of depression are a recent major life event, a positive family history for depression, and a personal history of past depressive episodes. Little research, however, has evaluated the inter-relations among these predictors in depressed samples. Such information is descriptively valuable and potentially etiologically informative. In the present article we summarize the existing literature and test four predictions in a sample of 62 clinically depressed individuals: (1) participants who experienced a major life event prior to onset would be less likely than participants who did not experience a major life event to have a positive family history for depression; (2) participants with a recent major life event would have fewer lifetime episodes of depression than would participants without; (3) participants with a positive family history for depression would have more lifetime episodes of depression than would participants with a negative family history for depression; and (4) we would obtain a 3-way interaction in which participants with a positive family history and without a major life event would have the most lifetime episodes, whereas participants with a negative family history and a major life event would have the fewest lifetime episodes. The first three predictions were confirmed, and the fourth prediction partially confirmed. These novel findings begin to elucidate the complex relations among these three prominent risk factors for depression, and point to avenues of research that may help illuminate the origins of depressive episodes.
Holahan, Charles J.; Moos, Rudolf H.; Holahan, Carole K.; Cronkite, Ruth C.; Randall, Patrick K.
This study followed baseline samples of 424 unipolar depressed patients and 424 community controls across 10 years to investigate the association between depression and alcohol-related coping and to examine how life context vulnerabilities underlie the risk for depressed individuals to rely on drinking to cope. Findings supported all hypotheses.…
Andrade, Flávia Cristina Drumond; Wu, Fan; Lebrão, Maria Lúcia; Duarte, Yeda Aparecida de Oliveira
ABSTRACT OBJECTIVE To estimate life expectancy with and without depressive symptoms in older adults for the years 2000 and 2010. METHODS We evaluated individuals aged 60 years or older (n = 1,862 in 2000 and n = 1,280 in 2010), participants of the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Aging) study in in Sao Paulo, Southeastern Brazil. Depression was measured using the shorter version of the Geriatric Depression Scale (GDS-15); respondents scoring ≥ 6 were classified as having depression. Estimates of life expectancy with and without depression were obtained using the Sullivan method. RESULTS Data from 2000 indicate that 60-year-old men could expect to live, on average, 14.7 years without depression and 60-year-old women could expect to live 16.5 years without depression. By 2010, life expectancy without depression had increased to 16.7 years for men and 17.8 years for women. Expected length of life with depression differed by sex, with women expected to live more years with depression than men. CONCLUSIONS Between 2000 and 2010, life expectancy without depression in Sao Paulo increased. However, older adults in Brazil, especially older women, still face a serious burden of mental illness. PMID:27143612
Alaszewski, A; Manthorpe, J
The final paper of our series on principal figures in sociology examines the work of Anthony Giddens, a British sociologist who is still working. Major components of his analysis of late 20th century life are discussed.
Waldinger, Robert J.; Cohen, Shiri; Schulz, Marc S.; Crowell, Judith A.
Social ties are powerful predictors of late-life health and wellbeing. Although many adults maintain intimate partnerships into late life, little is known about mental models of attachment to spouses and how they influence aging. Eighty-one elderly heterosexual couples (162 individuals) were interviewed to examine the structure of attachment security to their partners and completed measures of cognition and wellbeing concurrently and 2.5 years later. Factor analysis revealed a single factor for security of attachment. Higher security was linked concurrently with greater marital satisfaction, fewer depressive symptoms, better mood, and less frequent marital conflicts. Greater security predicted lower levels of negative affect, less depression, and greater life satisfaction 2.5 years later. For women, greater security predicted better memory 2.5 years later and attenuated the link between frequency of marital conflict and memory deficits. Late in life, mental models of attachment to partners are linked to wellbeing concurrently and over time. PMID:26413428
Dykstra, Pearl A.; Wagner, Michael
Via a simultaneous analysis of different life course pathways (marital, occupational, and childbearing histories) and different outcomes, this article addresses the question When does childlessness matter in late life and how? Survey data from Amsterdam (N = 661) and Berlin, Germany (N = 516) are used. Lifelong childlessness results in smaller…
Burke, Taylor A; Hamilton, Jessica L; Abramson, Lyn Y; Alloy, Lauren B
Non-suicidal self-injury (NSSI) is the deliberate self-harm of one's tissue, engaged in without lethal intent, and occurs frequently among late adolescents. Although research has indicated that NSSI predicts depression, the potential psychosocial mechanisms through which engagement in NSSI makes one susceptible to future depressive symptoms remain unclear. The present study examined whether NSSI increases the risk of experiencing stressful life events, which, in turn, heightens the risk for subsequent depressive symptoms. Drawn from a sample specifically selected for adolescents at high and low risk for developing bipolar spectrum disorders, a total of 110 late-adolescents (mean age=18.74, SD=.69; 73% female) were administered measures of lifetime and past year engagement in NSSI and current depressive symptomatology. Approximately 6 months later, they completed a measure of depressive symptoms and a questionnaire and interview assessing life events that occurred over the 6-month interval. Results suggest that the frequency of lifetime and past year NSSI predicted the occurrence of interpersonal stressful life events beyond the effects of initial depressive symptoms, but only for late adolescent girls. Results further suggest that higher levels of interpersonal stressful life events mediated the relationship between NSSI frequency and prospective increases in depressive symptoms among girls.
Burke, Taylor A.; Hamilton, Jessica L.; Abramson, Lyn Y.; Alloy, Lauren B.
Non-suicidal self-injury (NSSI) is the deliberate self-harm of one’s tissue, engaged in without lethal intent, and occurs frequently among late adolescents. Although research has indicated that NSSI predicts depression, the potential psychosocial mechanisms through which engagement in NSSI makes one susceptible to future depressive symptoms remain unclear. The present study examined whether NSSI increases the risk of experiencing stressful life events, which, in turn, heightens the risk for subsequent depressive symptoms. Drawn from a sample specifically selected for adolescents at high and low risk for developing bipolar spectrum disorders, a total of 110 late-adolescents (mean age = 18.74, SD = .69; 73% female) were administered measures of lifetime and past year engagement in NSSI and current depressive symptomatology. Approximately 6 months later, they completed a measure of depressive symptoms and a questionnaire and interview assessing life events that occurred over the 6-month interval. Results suggest that the frequency of lifetime and past year NSSI predicted the occurrence of interpersonal stressful life events beyond the effects of initial depressive symptoms, but only for late adolescent girls. Results further suggest that higher levels of interpersonal stressful life events mediated the relationship between NSSI frequency and prospective increases in depressive symptoms among girls. PMID:26165966
Stranieri, Giuseppe; Carabetta, Carmelo
This paper describes the relationship between depression and the difficulties experienced in the postmodern world for human beings who must reconcile their consciousness of their own death and the feelings of powerlessness in the face of inevitable consequences. Depression and suicide are closely linked, and the consequences in terms of philosophy and psychology are described.
Wickrama, K. A. S.; Conger, Rand D.; Lorenz, Federick O.; Martin, Monica
Using prospective, longitudinal data from 467 youth over a 13-year period (late adolescence and young adulthood), the present study investigates three research questions: (1) to what extent do elevations in depressed mood continue (homotypic continuity) from adolescence to young adulthood, (2) to what extent do young adults’ socioeconomic attainments and failures sustain the depressed mood from adolescence to young adulthood and (3) to what extent do young adults’ socioeconomic attainments or failures mediate the continuity and discontinuity of depressive symptoms across this period? The results from our structural equation modeling (SEM) analyses suggest that continuity of depressive symptoms from late adolescence to young adulthood is mediated in part by economic and work achievements or failures of young adults after controlling for adolescent conduct disorder/antisocial behavior, parents’ psychopathology and family adversity. Additionally, the results indicate that the continuity of depressed mood across the early life course is conditioned (stabilized or disrupted) by young adult socioeconomic achievements or failures. PMID:21925725
Tannenbaum, Cara; Frank, Blye
Masculinity is a social construction that defines itself according to context. Older men constitute an unseen minority when it comes to their health, and thus the study of masculinity as it relates to health in older men requires deeper understanding. This article offers insights into how gender, health, and ageing interact for older men and explores how men negotiate the concept of masculinity in later life. The findings from two complementary studies are presented and discussed. The first study, a qualitative analysis of focus group discussions held with 48 community-dwelling older men, indicates that the desire to uphold hegemonic ideals of independence, self-reliance, and imperviousness to pain and illness are embedded in older men's health-related beliefs and behaviors. Ill health and help seeking are often perceived as a threat to the masculine identity, and taking action for health is considered only when health status jeopardizes independence. In the second study, more than 2,000 men aged 55 to 97 years responded to a postal survey on health behaviors and masculinity. Results of the survey indicated that age predicts health behaviors and health care seeking better than scores on a masculinity index, which tended to remain stable regardless of age. Both the qualitative and quantitative findings support the hypothesis that with age men will succeed in incorporating actions into their daily lives in a way that does not conflict with their perceived resilience to frailty and weakness, even if such actions involve seeking help for illness or adopting healthier lifestyle behaviors.
Sherman, Carey Wexler; Bauer, Jean W.
This qualitative study explores financial conflicts faced by late-life remarried wives providing care for their husbands with Alzheimer's disease. Interviews with 9 women identified intergenerational secrets and tensions regarding financial and inheritance decisions. Participants' remarried spouse status, underlying family boundary ambiguities,…
Carta, MG; Petretto, D; Adamo, S; Bhat, KM; Lecca, ME; Mura, G; Carta, V; Angermeyer, M; Moro, MF
Introduction: To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression. Methods: Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU. Results: The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores. Conclusions: Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time. PMID:23173011
Background Understanding the determinants of major depression in sub-Saharan Africa is important for planning effective intervention strategies. Objective To investigate the social and life-event determinants of major depressive disorder in the African socio-cultural context of rural Uganda. Methods A cross-section survey was carried out in 14 districts in Uganda from 1st June 2003-30th October 2004. 4660 randomly selected respondents (15 years and above) were interviewed. The primary outcome was the presence of major depressive disorder as assessed by the Hopkins Symptom Checklist (HSCL-25). Results The prevalence of major depressive disorder was 29.3% (95% confidence interval, 28.0%-30.6%). Factors independently associated with depression in both genders included: the ecological factor, district; age (increase with each age category after 35 years); indices of poverty and deprivation (no formal education, having no employment, broken family, and socio-economic classes III-V). Only a few adverse life events, notably those suggestive of a disrupted family background (death of a father in females and death of a mother in males) were associated with increased risk. Conclusion: Socioeconomic factors operating at both ecological and the individual level are the strongest independent determinants of depression. Adverse life events were less strongly associated with depression in this sample. PMID:19916062
Musbach, Joan W.
Presents a lesson plan for eighth-grade students where they learn about the Great Depression by studying rural life. Explains that the students explore farm records from June and December 1935 after reading an excerpt about rural life in the 1930s. Includes copies of the ledgers, photographs, and student handouts. (CMK)
Bulmash, Eric; Harkness, Kate L.; Stewart, Jeremy G.; Bagby, R. Michael
The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were…
The purpose of this study was to compare adolescents from Europe and Confucian Asia on measures of psychological constructs that reflect either maladjustment or positive outlook on life. Empirical findings are reported based on N = 7,167 secondary school students (15 years old) from Confucian Asia (Hong Kong, Singapore, South Korea, and Taiwan) and from Europe (Denmark, Finland, Netherlands, Serbia, and Latvia with 2 nationalities-Latvian and Russian). Participants' responses were used to assess several aspects of personality and psychopathology, in addition to well-being, social attitudes, and parental styles. Exploratory factor analysis of these measures produced 4 factors: Depression, Life Satisfaction, Toughness and Modesty. Adolescents from Confucian countries show higher levels of Depression and lower levels of Life Satisfaction in comparison to their European counterparts. The most potent influences on Depression and Life Satisfaction were found to be Toughness and Parental Warmth variables, both of which are, in turn, linked to differences between regions/cultures.
Sarıarslan, Hacı A.; Gulhan, Yıldırım B.; Unalan, Demet; Basturk, Mustafa; Delibas, Senol
Objective: To identify the level of depression, the level of life quality, and the relationship between these, in patients applying to sleep centers for various sleep problems. Methods: This cross-sectional study included 229 patients who applied for polysomnography at sleeping centers under supervision of the Neurology and Chest Diseases Clinics of Kayseri Education and Research Hospital, Kayseri, Turkey between June and August 2013. The data collection tools were a socio-demographical data form, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality of Life Scale (WHOQOL-BREF). For statistical analyses, the Student t-test, Kruskal-Wallis-variant analysis, and chi-square tests were used. Significance level was considered as p<0.05. Results: In our study, patients who were older aged, married, not working, and who had a chronic disease, and a severe depressive symptom were observed to have significantly poorer sleep quality. While patients with any chronic disease had significantly higher scores for total PSQI and depression, their physical, mental, and social WHOQOL-BREF scores were significantly lower. The PSQI total scores, and depression scores of the smoking patients were significantly higher for physical, mental, and social WHOQOL-BREF fields. There was a positive correlation between PSQI scores and BDI scores while there was a negative correlation among BDI, PSQI, and WHOQOL-BREF life quality sub-scale scores. Conclusions: Sleep quality was significantly poorer in patients who were older aged, married, not working, and who had a chronic disease, and a severe depressive symptom. There was a significantly negative correlation among depression, sleep quality, and life quality, while there was a significantly positive correlation between life quality and depression. PMID:26166591
Malone, Johanna C; Cohen, Shiri; Liu, Sabrina R; Vaillant, George E; Waldinger, Robert J
A growing body of research suggests that personality characteristics relate to physical health; however, this relation ship has primarily been tested in cross-sectional studies that have not followed the participants into old age. The present study utilizes data from a 70-year longitudinal study to prospectively examine the relationship between the adaptive defense mechanisms in midlife and objectively assessed physical health in late life. In addition to examining the direct effect, we test whether social support mediates this relation ship. The sample consisted of 90 men who were followed for over seven decades beginning in late adolescence. Health ratings from medical records were made at three time points (ages 70, 75, and 80). Defense mechanisms were coded from narratives by trained independent raters (Vaillant, Bond, & Vaillant, 1986). Independent raters assessed social supports between ages 50 and 70. More adaptive defenses in midlife were associated with better physical health at all three time points in late life. These relationships were partially mediated by social support. Findings are consistent with the theory that defense maturity is important for building social relationships, which in turn contribute to better late-life physical health. Psychological interventions aimed at improving these domains may be beneficial for physical health.
Li, Nan; Li, Weiran; Long, Haiyan
On the basis of subsidence history analysis and balanced cross-section analysis, the vertical uplift/subsidence history and horizontal extension/compression history of the north depression of the south Yellow Sea basin are quantitatively studied. The results show that the tectonic evolution of the north depression of the south Yellow Sea basin since late Cretaceous can be divided into a rifting phase (late Cretaceous to Paleogene) and a post-rifting phase (Neogene to Quaternary). The rifting phase can be further subdivided into an initial rifting stage (late Cretaceous), an intensive rifting stage (Paleocene), a rifting termination stage (Eocene), and an inversion-uplifting stage (Oligocene). Together, this division shows the characteristics of an episodic-evolved intracontinental rift-depression basin. The deformation of the north depression of the south Yellow Sea basin since late Cretaceous was mainly fault-related. The horizontal extension and tectonic subsidence were controlled by the activity of faults. The differential evolution of faults also caused variations in local uplift/subsidence movements and the regional heterogeneity in extension. The late Cretaceous initial rifting of the north depression of the south Yellow Sea basin is related to the Pacific-Eurasia convergence. From the Paleocene intensive rifting stage to present, the Pacific-Eurasia convergence and India-Eurasia convergence have played important roles in the evolution of this region.
Zilkens, Renate R.; Bruce, David G.; Duke, Janine; Spilsbury, Katrina; Semmens, James B.
Objective: To examine the association of mid-life exposure to several psychiatric disorders with the development of late-life dementia. Methods: A matched case-control study using Western Australian state-wide hospital inpatient, outpatient mental health and emergency records linked to death records. Incident dementia cases (2000-2009) aged 65 to 84 years were sex- and age-matched to an electoral roll control. Records as far back as 1970 were used to assess exposure to medical risk factors before age 65 years. Candidate psychiatric risk factors were required to be present at least 10 years before dementia onset to ensure direction of potential causality. Odds ratios were estimated using conditional logistic regression. Results: 13, 568 dementia cases (median age 78.7 years, 43.4% male) were matched to a control. Depression, bipolar disorder, schizophrenia, anxiety disorder and alcohol dependence were found to be significant and independent risk factors for late-life dementia after adjusting for diabetes, heart disease, cerebrovascular disease and smoking risk factors. The effect of a history of depression, schizophrenia and alcohol dependency on dementia risk varied with age, being strongest for earlier onset late-life dementia and waning at older ages. Conclusion: Severe depression, anxiety disorder, bipolar disorder, schizophrenia and alcoholic dependency disorder treated by specialists in psychiatric facilities in mid-life are important risk factors for late-life dementia. These psychiatric conditions need to be considered in future studies of the risk and prevention of late-life dementia. PMID:25115541
Slavich, George M; Monroe, Scott M; Gotlib, Ian H
Although exposure to early adversity and prior experiences with depression have both been associated with lower levels of precipitating life stress in depression, it is unclear whether these stress sensitization effects are similar for all types of stress or whether they are specific to stressors that may be particularly depressogenic, such as those involving interpersonal loss. To investigate this issue, we administered structured, interview-based measures of early adversity, depression history, and recent life stress to one hundred adults who were diagnosed with major depressive disorder. As predicted, individuals who experienced early parental loss or prolonged separation (i.e., lasting one year or longer) and persons with more lifetime episodes of depression became depressed following lower levels of life stress occurring in the etiologically-central time period of three months prior to onset of depression. Importantly, however, additional analyses revealed that these effects were unique to stressors involving interpersonal loss. These data highlight potential stressor-specific effects in stress sensitization and demonstrate for the first time that individuals exposed to early parental loss or separation, and persons with greater histories of MDD, may be selectively sensitized to stressors involving interpersonal loss.
Koleva, Hristina; Stuart, Scott
Depression in adolescent pregnancy is common but underrecognized and can be associated with negative medical outcomes. This brief report examines the relationship between depressive symptoms and various demographic and obstetrical risk factors, as well as the use of antidepressants in pregnant adolescents of late teenage years. Data were derived from a relatively large sample (506 women) recruited from university-based and community mental health centers in Iowa. A cross-sectional analysis did not reveal significant statistical associations between the risk factors and depressive symptoms (Beck Depression Inventory). Antidepressant use was very low (3.7 %), and adolescents with higher depression scores were more likely to take medications. In conclusion, screening for depression in pregnant adolescents should be universal, regardless of demographic and obstetrical risk factors, and promptly addressed.
Lapsley, Daniel K.; And Others
Epistemological loneliness refers to the isolation adolescents may experience as the result of cognitive relativism, ushered in by the emergence of formal operational thought. To examine the relationship between cognitive relativity, epistemological loneliness, and depression in adolescence, 108 adolescents (29 seventh graders, 29 ninth graders,…
Wu, Deqing; Park, Sang-Kyu; Cypser, James R.; Tedesco, Patricia M.; Phillips, Patrick C.; Johnson, Thomas E.
The large post-reproductive life span reported for the free-living hermaphroditic nematode, Caenorhabditis elegans, which lives for about 10 days after its 5-day period of self-reproduction, seems at odds with evolutionary theory. Species with long post-reproductive life spans such as mammals are sometimes explained by a need for parental care or transfer of information. This does not seem a suitable explanation for C elegans. Previous reports have shown that C elegans can regain fertility when mated after the self-fertile period but did not report the functional limits. Here, we report the functional life span of the C elegans germ line when mating with males. We show that C elegans can regain fertility late in life (significantly later than in previous reports) and that the end of this period corresponds quite well to its 3-week total life span. Genetic analysis reveals that late-life fertility is controlled by conserved pathways involved with aging and dietary restriction. PMID:21622982
Iglewicz, Alana; Meeks, Thomas W.; Jeste, Dilip V.
Psychosis is common in late life and exacts enormous costs to society, affected individuals, and their caregivers. A multitude of etiologies for late-life psychosis exist, the two most prototypical being schizophrenia and psychosis of Alzheimer’s Disease (AD). As such, this review will focus on the non-affective, neuropsychiatric causes of chronic psychosis in the elderly, specifically schizophrenia, delusional disorder, and the psychosis of AD and other dementias. As evidenced in this review, the current research regarding the onset and course of late-life schizophrenia reflects a more favorable prognosis than that painted by the Kraepelinian notion of schizoprenia as “dementia praecox.” Antipsychotics are useful in controlling the symptoms of late-life schizophrenia, but their use among older adults warrants increased vigilance because of older adults’ increased proclivity to side effects. Psychosocial interventions can be effective, usually in conjunction with medication. Meanwhile, psychosis of AD occurs in nearly half of people with AD and is associated with increased hospitalizations, institutionalization, caregiver distress, and mortality. Despite the profound consequences of psychotic symptoms associated with dementias, the extant literature does not afford clinicians clear, consistent guidance on how to provide optimal treatment to specific patients. Second generation antipsychotics are usually the choice treatment for psychosis, but the black box warning regarding their associated 1–2% increased absolute risk in stroke and overall mortality in patients with dementia complicates their use. Using second generation antipsychotics in low doses for brief periods and discontinuing them when possible is the best clinical practice for dementia-related psychosis. Psychosocial interventions for the treatment of psychosis with AD appear promising in empirical research, but more rigorous study is needed. PMID:21536160
Wu, L T; Anthony, J C
OBJECTIVES: This study builds on previous observations about a suspected causal association linking tobacco smoking with depression. With prospective data, the study sheds new light on the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. METHODS: The epidemiologic sample that was studied consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area, who were assessed at least twice from 1989 to 1994. A survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. RESULTS: Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood, but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. CONCLUSIONS: This evidence is consistent with a possible causal link from tobacco smoking to later depressed mood in late childhood and early adolescence, but not vice versa. PMID:10589312
Szapocznik, Jose; And Others
Depression is the single most widespread mental health problem facing the elderly, with pharmacotherapy the most frequent standard treatment modality for these patients. A psycho-therapeutic alternative to pharmacotherapy is Life Enhancement Counseling, a counseling approach matching therapeutic techniques to client characteristics and providing…
Late-life mood disorders and cognitive aging are the most common reasons for using complementary and alternative therapies. The amount of rigorous scientific data to support the efficacy of complementary therapies in the treatment of depression or cognitive impairment is extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (Hypericum perforatum), the use of fish oil, and, to a lesser extent, acupuncture and relaxation therapies. There is a need for further research involving randomized, controlled trials to investigate the efficacy of complementary and alternative therapies in the treatment of depression and cognitive impairment in late-life. This research may lead to the development of effective treatment and preventive approaches for these serious conditions. PMID:19956796
Freedman, Vicki A.; Martin, Linda G; Schoeni, Robert F; Cornman, Jennifer C
Investigations into the causes of declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the US Health and Retirement Study, we found for the 75 and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations. PMID:18222580
Lee, Yookyong; Fagan, Jay; Chen, Wan-Yi
Although fathers are increasingly a focus of attention in research, there is a dearth of research on depressive symptoms among fathers, especially young fathers with toddlers. This study used longitudinal data to examine what risk factors, including the age status of fathers (e.g., late adolescence, emerging adulthood, and adulthood), may be…
Zhu, Peng; Chen, Yu-Jiang; Hao, Jia-Hu; Ge, Jin-Fang; Huang, Kun; Tao, Rui-Xue; Jiang, Xiao-Min; Tao, Fang-Biao
We examined the relationship between maternal depressive symptoms in late pregnancy and Epstein-Barr virus reactivation before delivery. In this prospective observational study, prevalence of Epstein-Barr virus reactivation within one week before delivery was compared between 163 pregnant women with depressive symptoms at 33 to 34 weeks of gestation and a computer-generated control group of 163 pregnant healthy women without depressive symptoms. Depressive symptoms at 33 to 34 weeks of gestation were significantly related to the prevalence of Epstein-Barr virus reactivation before delivery after adjustment for potential confounders (adjusted OR = 2.74, 95%CI: 1.23–6.08). Compared to that in the control group, the prevalence of Epstein-Barr virus reactivation was higher in women with depressive symptoms accompanied by higher negative coping (24.2% compared with 7.9%; adjusted OR = 3.67, 95%CI: 1.47–9.16). Maternal depressive symptoms in late pregnancy are associated with Epstein-Barr virus reactivation, and this association could be moderated by maternal coping style. PMID:24172862
Brown, Cati G.; Brodsky, Jennifer; Cataldo, Janine K.
This study investigated lung cancer stigma, anxiety, depression and quality of life (QOL), and validated variable similarities between ever and never smokers. Patients took online self-report surveys. Variable contributions to QOL were investigated using hierarchical multiple regression. Patients were primarily Caucasian females with smoking experience. Strong negative relationships emerged between QOL and anxiety, depression and lung cancer stigma. Lung cancer stigma provided significant explanation of the variance in QOL beyond covariates. No difference emerged between smoker groups for study variables. Stigma may play a role in predicting QOL. Interventions promoting social and psychological QOL may enhance stigma resistance skills. PMID:24428251
Lenze, Shannon N.; Cyranowski, Jill M.; Thompson, Wesley K.; Anderson, Barbara; Frank, Ellen
Although much research has focused on the role of severe life events as risk factors for depression onset, less is known about the relationship between nonsevere life events and depression recurrence. The current study examined the cumulative effects of nonsevere and positive life events on depression recurrence in an outpatient sample of…
Ishioka, Yoshiko; Gondo, Yasuyuki; Masui, Yukie; Nakagawa, Takeshi; Tabuchi, Megumi; Ogawa, Madoka; Kamide, Kei; Ikebe, Kazunori; Arai, Yasumichi; Ishizaki, Tatsuro; Takahashi, Ryutaro
This study examined the associations between the complexity of an individual's primary lifetime occupation and his or her late-life memory and reasoning performance, using data from 824 community-dwelling participants aged 69-72 years. The complexity of work with data, people, and things was evaluated based on the Japanese job complexity score. The associations between occupational complexity and participant's memory and reasoning abilities were examined in multiple regression analyses. An association was found between more comple work with people and higher memory performance, as well as between more complex work with data and higher reasoning performance, after having controlled for gender, school records, and education. Further, an interaction effect was observed between gender and complexity of work with data in relation to reasoning performance: work involving a high degree of complexity with data was associated with high reasoning performance in men. These findings suggest the need to consider late-life cognitive functioning within the context of adulthood experiences, specifically those related to occupation and gender.
Amin, Syed; Khan, A.W.
Background: Mental, physical and social health, are vital strands of life that are closely interwoven and deeply interdependent. Mental disorders affect people of all countries and societies, individuals at all ages, women and men, the rich and the poor, from urban and rural environments. Depression is more likely following particular classes of experience – those involving conflict, disruption, losses and experiences of humiliation or entrapment. Many people living amidst the rages of conflict suffer from post-traumatic stress disorder. Objective: To determine the characteristics of depression in the population in Kashmir where a low-intensity-conflict has been going on for the last seventeen years. Methods: The non-combatant civilian population was surveyed. The Centre for Epidemiological Studies Depression (CES-D) Scale was used to measure symptoms of depression in community populations. Results: Due to continuing conflict in Kashmir during the last 18 years there has been a phenomenal increase in psychiatric morbidity. The results reveal that the prevalence of depression is 55.72%. The prevalence is highest (66.67%) in the 15 to 25 years age group, followed by 65.33% in the 26 to 35 years age group. The difference in the prevalence of depression among males and females is significant. Depression is much higher in rural areas (84.73%) as compared to urban areas (15.26%). In rural areas the prevalence of depression among females is higher (93.10 %) as compared to males (6.8%). Conclusion: Mental health is an integral part of overall health and quality of life. Effective evidence-based programs and policies are available to promote mental health, enhance resilience, reduce risk factors, increase protective factors, and prevent mental and behavioural disorders. Innovative community-based health programmes which are culturally and gender appropriate and reaches out to all segments of the population need to be developed. Substantial and sustainable improvements can
Marlow, M. S.; Scholl, D. W.; Buffington, E.C.; Boyce, R.E.; Alpha, T.R.; Smith, P.J.; Shipek, C.J.
Buldir Depression is a large, rectilinear basin that lies on the northern edge of the Aleutian Ridge and is aligned with the arcuate chain of active volcanoes on the ridge crest. The depression appears to be a volcanic-tectonic feature, which began to form in Late Tertiary time and which is still forming. It is a graben formed by extensional rifting and accompanied by contemporaneous volcanism on the Aleutian Ridge. Subsidence rates for the depression are estimated at 20-70 cm/1,000 years. Sediments in the depression are 300 m thick and are probably pelagic and turbidite deposits of Pleistocene age. The turbidites were apparently derived from the plateau area of the Aleutian Ridge surrounding the depression. Older sediments on the northern slope of the Aleutian Ridge have a maximum thickness of 550 m and are deformed and slumped toward the Bering Sea. These sediments are postulated to overlie a mid-flank terrace on the northern Aleutian Ridge that titled to the north during the formation of Buldir Depression. ?? 1970.
Müller, Hans-Georg; Chiou, Jeng-Min; Carey, James R; Wang, Jane-Ling
The relation between fertility and postmenopausal longevity is investigated for a sample of 1635 women from a historical (17th to 18th century) French-Canadian cohort who lived past the age of 50 years. We find that increased fertility is linked to increased rather than decreased postreproductive survival. Postreproductive life expectancy extension is found to be tied to late births. This finding sheds new light on the cost of reproduction and may be viewed as supporting a new paradigm that states that reproductive potential drives remaining longevity. The emerging reproductive potential concept complements the well-established cost of reproduction hypothesis. Alternative explanations for the observed association are also explored. A specific finding is that the degree to which mortality increases for 50-year-old mothers as a result of senescence is closely tied to the logarithm of the age of their youngest child. For example, 50-year-old mothers experience a mortality decrease of 38% and an increase of remaining lifetime of 3.93 years for every 10-fold decrease in the age of their youngest child. This amount of gain in remaining life expectancy would apply to a mother with a two-year-old child as compared with a mother with a 20-year-old offspring. We also find evidence for the existence of vulnerable periods in human life history that are characterized by phases of heightened mortality and are found to be tied to reproduction and senescence.
Cheung, Gary; Hatters Friedman, Susan; Sundram, Frederick
Homicide-suicide is a rare event, but it has a significant impact on the family and community of the perpetrator and victim(s). The phenomenon of late-life homicide-suicide has not been previously studied in New Zealand, and there is only limited data in the international literature. The aim of this study is to systematically review coroners' records of late-life homicide-suicides in New Zealand. After ethics approval was granted, the Coronial Services of New Zealand was approached to provide records of all closed cases with a suicide verdict (age 65+) over a five-year period (July 2007-December 2012). Of the 225 suicides, 4 cases of homicide-suicide were identified (an estimated incidence of 0.12 per 100,000 per persons year). All four perpetrators were men; three had been farmers. Their ages ranged from 65 to 82. One case occurred in the context of an underlying psychiatric illness (psychotic depression in bipolar disorder). Firearms were used in three cases. Two cases were categorized as spousal/consortial subtype, one case as filicide-suicide, and one case as siblicide-suicide. The prospect of major social upheaval in the form of losing their homes was present in all four cases. The findings of this case series were consistent with the limited existing literature on homicide-suicide. Age-related biopsychosocial issues were highlighted in this case series of late-life homicide-suicide. Additionally, evaluating firearm licences in high-risk groups may represent a prevention strategy.
Morin, C M; Kowatch, R A; Barry, T; Walton, E
Twenty-four older adults with persistent psychophysiological insomnia were randomly assigned to an immediate or a delayed cognitive-behavioral intervention in a waiting-list control group design. Cognitive-behavior therapy consisted of an 8-week group intervention aimed at changing maladaptive sleep habits and altering dysfunctional beliefs and attitudes about sleeplessness. Treatment was effective in reducing sleep latency, wake after sleep onset, and early morning awakening, and in increasing sleep efficiency. The magnitude of changes obtained on polysomnographic measures was smaller but in the same direction as that obtained on daily sleep diaries. Sleep improvements obtained by the immediate-treatment group were replicated with the delayed treatment condition. Therapeutic gains were well maintained at 3- and 12-month follow-ups. Clinical validation of outcome was obtained through collateral ratings from the patients and their significant others. The findings indicate that late-life insomnia can be effectively treated with nonpharmacological interventions.
Lloyd, S; Streiner, D; Shannon, S
Our goal was to determine the level of burnout, depression, life and job satisfaction of Canadian emergency physicians. Six instruments were administered: the emotional exhaustion, depersonalization, and personal accomplishment intensity subscales of the Maslach Burnout Inventory (MBI); the Centre for Epidemiologic Research Self-Report Depression Scale (CES-D); the Satisfaction With Life Scale (SWLS); and the Emergency Physician Job Satisfaction Measurement Instrument (EPJS). Forty-six percent of the sample fell within the medium to high level of emotional exhaustion, 93% within the medium to high range for depersonalization, and 79% within the medium to low range for personal accomplishment. Sixty-one percent were satisfied with their lives, and 75.5% were satisfied with their jobs. Multiple regression analysis showed that increased age, being a department head, and increased weeks of holiday per year were positive contributors to EPJS scores (P < 0.05). Involvement in medical education, increased clinical hours worked per year, and region of residence-Quebec were negative contributors to EPJS scores (P < 0.05). Involvement in medical education is a significant factor among physicians experiencing depressive symptomatology. Time away from clinical practice is important to job satisfaction and emotional well-being.
Crona, Lisa; Brådvik, Louise
This study is a follow-up of inpatients diagnosed with severe depression/melancholia between 1956 and 1969. During this period, all inpatients at the Department of Psychiatry, University Hospital, Lund, were rated on a multidimensional diagnostic schedule on discharge. There were 471 patients born from 1920 onward. In the present follow-up, 2006 to 2010, 169 survivors could be traced. They were asked to participate in the study involving a telephone interview, in which a structured life chart was used. Of the patients contacted, 16 were ill or confused and 3 did not remember ever being depressed, leaving 150 who could participate. Seventy-five of these agreed to participate in the study. Long-term course of depression was evaluated by cluster analysis and compared to background variables, such as heredity for depression, perceived parental rearing behaviour, and treatment of index depressive episode. Using a cluster analysis the patients could be separated into six clusters describing the course: i) single or few episodes followed by long-lasting remission; ii) single or few episodes followed by long-lasting remission, although shorter; iii) single or few episodes followed by late recurrence; iv) single or few episodes, but more frequently ill, followed by late recurrence; v) several episodes followed by lasting remission; vi) chronic course of episodes. Remission or recurrence could therefore occur even after more than a decade. In summary, there was a short-term course with or without recurrence or a chronic course with or without late remission. Heredity for depression was significantly related to a chronic course with or without late remission. PMID:25478118
Bruce, Alanna E; Cole, David A; Dallaire, Danielle H; Jacquez, Farrah M; Pineda, Ashley Q; LaGrange, Beth
In a sample of 299 children (grades 2, 4, and 6), we examined parenting and negative life events as predictors of depressive cognitions, specifically low self-perceived competence, depressive cognitive schemas, and depressogenic attributional style. We also examined developmental trends in these relations. Children completed measures of parenting, negative life events, and depressive cognitions. Parents also completed measures of parenting and negative life events. Consistent with our hypotheses, negative parenting and negative life events corresponded with higher levels of depressive cognitions, whereas positive parenting corresponded with lower levels of depressive cognitions. The relations between negative parenting and negative automatic thoughts were stronger for older children. Theoretical and practical implications are discussed.
King, Jennifer; Yourman, Lindsey; Ahalt, Cyrus; Eng, Catherine; Knight, Sara J.; Pérez-Stable, Eliseo J.; Smith, Alexander K.
OBJECTIVES To determine perceived quality of life in a diverse population of elderly adults with late-life disability. DESIGN Qualitative cross-sectional study. SETTING Community-dwelling participants were recruited from San Francisco’s On Lok Lifeways program, the first Program of All-inclusive Care for the Elderly. On Lok enrollees meet Medicaid criteria for nursing home placement. PARTICIPANTS Sixty-two elderly adults with a mean age of 78 and a mean 2.4 activity of daily living dependencies and 6.6 instrumental activity of daily living dependencies were interviewed. Respondents were 63% female, 24% white, 19% black, 18% Latino, 32% Chinese American, and 6% other race. MEASUREMENTS Elderly adults who scored higher than 17 points on the Mini-Mental State Examination were interviewed. Interviews were conducted in English, Spanish, and Cantonese. Respondents were asked to rate their overall quality of life on a 5-point scale. Open-ended questions explored positive and negative aspects of participants’ daily experiences. Interviews were analyzed using modified grounded theory and digital coding software. RESULTS Eighty-seven percent of respondents rated their quality of life in the middle range of the quality-of-life spectrum (fair to very good). Themes were similar across ethnic groups. Most themes could be grouped into four domains that dependent elderly adults considered important to their quality of life: physical (e.g., pain), psychological (e.g., depression), spiritual or religious (e.g., religious coping), and social (e.g., life-space). Dignity and a sense of control were identified as themes that are the most closely tied to overall quality of life. CONCLUSION Factors that influence quality of life in late-life disability were similar across ethnic groups. As the number of elderly adults from diverse backgrounds with late life disability increases in the United States, interventions should be targeted to maximize daily sense of control and dignity. PMID
Brinker, Jay K.; Roberts, Pamela; Radnidge, Belinda
This article describes the development and evaluation of The Game of Late Life--a novel education activity for the psychology of ageing. The game was designed to provide transformational learning where students imagine themselves as older adults and move through late life via a game board, encountering various life events along the way. One of the…
Georgiev, Svetoslav; Stein, Holly J.; Hannah, Judith L.; Bingen, Bernard; Weiss, Hermann M.; Piasecki, Stefan
The end of Permian time (252-251 Ma) hosts the largest mass extinction in Earth history, yet events heralding this global catastrophe remain intensely disputed. We present a chemostratigraphic marker, the 187Re/ 188Os ratio, which soars to unprecedented levels approaching the Permo-Triassic boundary. These ratios are tied to profound trace element changes and a precise Re-Os time record at 252 Ma preserved in black shales from East Greenland and the mid-Norwegian shelf. Within a 36-meter shale section, an 80-fold increase in Re concentrations (two-fold for Os) signals seawater conditions that became increasingly inhospitable to life. Unwavering initial 187Os/ 188Os ratios of 0.6 preclude mafic volcanism and meteorite impact as the direct cause of Late Permian anoxia. We argue that extraordinarily high 187Re/ 188Os ratios are the hallmark of simultaneously rising ocean temperature and acidity, leading to loss of oxygen and the stifling of life in latest Permian time.
Stüeken, Eva E.; Catling, David C.; Buick, Roger
Evidence in palaeosols suggests that life on land dates back to at least 2.76Gyr ago. However, the biogeochemical effects of Archaean terrestrial life are thought to have been limited, owing to the lack of a protective ozone shield from ultraviolet radiation for terrestrial organisms before the rise of atmospheric oxygen levels several hundred million years later. Records of chromium delivery from the continents suggest that microbial mineral oxidation began at least 2.48Gyr ago but do not indicate when the terrestrial biosphere began to dominate important biogeochemical cycles. Here we combine marine sulphur abundance data with a mass balance model of the sulphur cycle to estimate the effects of the Archaean and early Proterozoic terrestrial biosphere on sulphur cycling. We find that terrestrial oxidation of pyrite by microbes using oxygen has contributed a substantial fraction of the total sulphur weathering flux since at least 2.5Gyr ago, with probable evidence of such activity 2.7-2.8Gyr ago. The late Archaean onset of terrestrial sulphur cycling is supported by marine molybdenum abundance data and coincides with a shift to more sulphidic ocean conditions. We infer that significant microbial land colonization began by 2.7-2.8Gyr ago. Our identification of pyrite oxidation at this time provides further support for the appearance of molecular oxygen several hundred million years before the Great Oxidation Event.
Sajikumar, Sreedharan; Frey, Julietta U
Studies were performed to investigate whether electrically-induced long-term depression (LTD) within rat hippocampal slices in vitro shares any common cellular features with LTD in the intact animal, with particular emphasis being placed on mechanisms required for its late maintenance. Our initial studies have led to the development of stimulation protocols which are able to reliably produce different forms of LTD. Depending on the induction protocol applied, we are able to demonstrate a transient protein synthesis-independent early-LTD with a duration of up to 3-4 h, together with a de novo protein synthesis-dependent late-LTD lasting for at least 8 h. Furthermore, we are able to show input-specific LTD within the CA1 region, with expression shown only by those synapses specifically stimulated by a low-frequency protocol. These studies are important pre-requisites to investigate mechanisms of 'synaptic tagging' and 'late-associativity' during LTD.
Fukami, Kei; Yamagishi, Sho-ichi; Sakai, Kazuko; Kaida, Yusuke; Minami, Aki; Nakayama, Yosuke; Ando, Ryotaro; Obara, Nana; Ueda, Seiji; Wada, Yoshifumi; Okuda, Seiya
Late-onset hypogonadism (LOH) and depression contribute to cardiovascular disease (CVD) in male hemodialysis (HD) patients. Carnitine deficiency is frequently observed in HD patients, playing a role in CVD. We examined whether carnitine deficiency was independently associated with LOH and depression in these patients. Twenty-six male HD patients underwent determinations of serum levels of free carnitine and testosterone. Status of LOH and depression were evaluated by questionnaires using aging male symptoms' (AMS) scale and self-rating depression scale (SDS), respectively. Free carnitine and testosterone levels in male HD patients were significantly lower than those in age-matched healthy male subjects. Linear regression analysis showed that AMS scale was positively associated with SDS. Univariate regression analysis revealed that total carnitine (inversely), free carnitine (inversely) and HD duration were correlated with AMS scale. Multiple stepwise regression analysis revealed that free carnitine was an independent determinant of AMS scale. Furthermore, free carnitine was also independently correlated with SDS in male HD patients. This study demonstrated that decreased free carnitine levels were independently associated with AMS scale and SDS in male HD patients. The observations suggest that decreased free carnitine levels could be a marker and therapeutic target of LOH and depression in uremic men with HD.
Hankin, Benjamin L.; Young, Jami F.; Abela, John R. Z.; Smolen, Andrew; Jenness, Jessica L.; Gulley, Lauren D.; Technow, Jessica R.; Gottlieb, Andrea Barrocas; Cohen, Joseph R.; Oppenheimer, Caroline W.
Depression is a debilitating mental illness with clear developmental patterns from childhood through late adolescence. Here, we present data from the Gene Environment Mood (GEM) study, which used an accelerated longitudinal cohort design with youth (N = 665) starting in 3rd, 6th, and 9th grades, and a caretaker, who were recruited from the general community, and were then assessed repeatedly via semi-structured diagnostic interviews every 6-months over 3 years (7 waves of data) to establish and then predict trajectories of depression from age 8 to 18. First, we demonstrated that overall prevalence rates of depression over time, by age, gender, and pubertal status, in the GEM study closely match those trajectories previously obtained in past developmental epidemiological research. Second, we tested whether a genetic vulnerability-stress model involving 5-HTTLPR and chronic peer stress was moderated by developmental factors. Results showed that older aged adolescents with SS/SL genotype, who experienced higher peer chronic stress over 3 years, were the most likely to be diagnosed with a depressive episode over time. Girls experiencing greater peer chronic stress were the most likely to develop depression. PMID:26595469
Leckman-Westin, Emily; Cohen, Patricia R.; Stueve, Ann
Objective: Increased behavior problems have been reported in offspring of mothers with depression. In-home observations link maternal depressive symptoms (MDS) and mother-child interaction patterns with toddler behavior problems and examine their persistence into late childhood. Method: Maternal characteristics (N = 153) and behaviors of…
Suo, Chao; León, Irene; Brodaty, Henry; Trollor, Julian; Wen, Wei; Sachdev, Perminder; Valenzuela, Michael J
Cultivation of an active cognitive lifestyle, including diverse and challenging educational, occupational and cognitively-loaded leisure activities may be protective against development of dementia but the mechanisms underlying this link are not clear. We used the Lifetime Experiences Questionnaire (LEQ) to assess the structural brain correlates of cognitive lifestyle in the Sydney Memory and Aging Study, a large population-based cohort of originally 1037 non-demented elderly aged over 70 years of age. After excluding those without structural Magnetic Resonance Image data or Mild Cognitive Impairment at their most recent assessment, 151 cognitively intact subjects were studied. Whole-brain voxel based morphometric analysis found that higher total Lifetime Experiences Questionnaire scores are linked with increased grey matter volume in the medial temporal lobe, especially in the hippocampus. Through a series of more specific analyses, we found that supervisory and managerial experience in midlife was the dominant contributor to this effect. Furthermore, in those with longitudinal neuroimaging data (N=91), we measured hippocampal structural changes over a 2-3 year period by gold-standard manual tracing. The rate of hippocampal atrophy in late-life in those with high level supervisory experience in midlife was five-times slower than those with no midlife supervisory experience (p<0.001). Individual differences in intracranial volume, age, gender, physical activity, depressive symptoms, or apolipoprotein ε4 genetic status could not explain these findings, nor could specific lifestyle patterns in late life. For the first time, we reveal that managerial and supervisory experience during our working life is connected to hippocampal integrity after retirement, some 20-30 years later. Our results stimulate several questions about the nature of work-related effects on longterm behaviour, structural neuroplasticity and neuroprotection, and may help explain differences in
Meunier, J; Kölliker, M
Although inbreeding is commonly known to depress individual fitness, the severity of inbreeding depression varies considerably across species. Among the factors contributing to this variation, family interactions, life stage and sex of offspring have been proposed, but their joint influence on inbreeding depression remains poorly understood. Here, we demonstrate that these three factors jointly shape inbreeding depression in the European earwig, Forficula auricularia. Using a series of cross-breeding, split-clutch and brood size manipulation experiments conducted over two generations, we first showed that sib mating (leading to inbred offspring) did not influence the reproductive success of earwig parents. Second, the presence of tending mothers and the strength of sibling competition (i.e. brood size) did not influence the expression of inbreeding depression in the inbred offspring. By contrast, our results revealed that inbreeding dramatically depressed the reproductive success of inbred adult male offspring, but only had little effect on the reproductive success of inbred adult female offspring. Overall, this study demonstrates limited effects of family interactions on inbreeding depression in this species and emphasizes the importance of disentangling effects of sib mating early and late during development to better understand the evolution of mating systems and population dynamics.
Schacht, Jochen; Altschuler, Richard; Burke, David T.; Chen, Shu; Dolan, David; Galecki, Andrzej T.; Kohrman, David; Miller, Richard A.
A genetically heterogeneous population of mice was tested for hearing at 8, 18 and 22 months by auditory brainstem response (ABR), and genotyped at 128 markers to identify loci that modulate late life hearing loss. Half of the test mice were exposed to noise for 2 hr at age 20 months. Polymorphisms affecting hearing at 18 months were noted on chromosomes 2, 3, 7, 10, and 15. Most of these loci had effects only on responses to 48 kHz stimuli, but a subset also influenced the ABR at lower frequencies. Loci on chromosomes 4, 10, 12, and 14 had significant effects on hearing at 22 months in noise-exposed mice, and loci on chromosomes 10 and 11 had effects on mice not exposed to noise. Outer hair cell loss was modulated by polymorphisms on chromosomes 10, 11, 12, 17, and 19. Resistance to age-related hearing loss is thus modulated by a set of genetic effects, some age-specific, some frequency specific, some dependent on prior exposure to noise, and some of which compromise survival of cochlear hair cells. PMID:22305187
Steensma, C.; Loukine, L.; Orpana, H.; McRae, L.; Vachon, J.; Mo, F.; Boileau-Falardeau, M.; Reid, C.; Choi, B. C.
Abstract Introduction: Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population. Methods: We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007–2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex. Results: For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2–43.8) compared to 57.0 years (95% CI: 56.8–57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5–41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6–54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The
Cutler, David M.; Miller, Grant; Norton, Douglas M.
In recent decades, elderly Americans have enjoyed enormous gains in longevity and reductions in disability. The causes of this progress remain unclear, however. This paper investigates the role of fetal programming, exploring how economic progress early in the 20th century might be related to declining disability today. Specifically, we match sudden unexpected economic changes experienced in utero in America's Dust Bowl during the Great Depression to unusually detailed individual-level information about old-age disability and chronic disease. We are unable to detect any meaningful relationship between early life factors and outcomes in later life. We conclude that, if such a relationship exists in the United States, it is most likely not a quantitatively important explanation for declining disability today. PMID:17686988
Cutler, David M; Miller, Grant; Norton, Douglas M
In recent decades, elderly Americans have enjoyed enormous gains in longevity and reductions in disability. The causes of this progress remain unclear, however. This paper investigates the role of fetal programming, exploring how economic progress early in the 20th century might be related to declining disability today. Specifically, we match sudden unexpected economic changes experienced in utero in America's Dust Bowl during the Great Depression to unusually detailed individual-level information about old-age disability and chronic disease. We are unable to detect any meaningful relationship between early life factors and outcomes in later life. We conclude that, if such a relationship exists in the United States, it is most likely not a quantitatively important explanation for declining disability today.
Brossoie, Nancy; Roberto, Karen A.; Barrow, Katie M.
Purpose: The purpose of this study was to gain insight into public awareness of intimate partner violence (IPV) in late life by how individuals respond to incidents of IPV reported in the newspaper. Design and Methods: Using grounded theory techniques, online news items covering 24 incidents of IPV in late life, and the reader comments posted to…
Stikkelbroek, Yvonne; Bodden, Denise H. M.; Kleinjan, Marloes; Reijnders, Mirjam; van Baar, Anneloes L.
Background Depression during adolescence is a serious mental health problem. Difficulties in regulating evoked emotions after stressful life events are considered to lead to depression. This study examined if depressive symptoms were mediated by various cognitive emotion regulation strategies after stressful life events, more specifically, the loss of a loved one, health threats or relational challenges. Methods We used a sample of 398 adolescents (Mage = 16.94, SD = 2.90), including 52 depressed outpatients, who all reported stressful life event(s). Path analyses in Mplus were used to test mediation, for the whole sample as well as separately for participants scoring high versus low on depression, using multigroup analyses. Results Health threats and relational challenging stressful life events were associated with depressive symptoms, while loss was not. More frequent use of maladaptive strategies was related to more depressive symptoms. More frequent use of adaptive strategies was related to less depressive symptoms. Specific life events were associated with specific emotion regulation strategies. The relationship between challenging, stressful life events and depressive symptoms in the whole group was mediated by maladaptive strategies (self-blame, catastrophizing and rumination). No mediation effect was found for adaptive strategies. Conclusion The association between relational challenging, stressful life events and depressive symptoms was mediated by maladaptive, cognitive emotion regulation strategies. PMID:27571274
In the collection of essays On Late Style, Edward Said reflects on the new idiom achieved by great artists in their work near the end of their lives as "late style." Drawing on Adorno's essay on Beethoven's late style, Said also focuses on the aesthetic aspects of lateness. Defining the late works of artists as "a form of exile," however, Said moves beyond Adorno's aesthetic conception of late style. Highlighting the artist's abandonment of communication with the established social order, who achieves a contradictory, alienated relationship with it instead, Said compares artistic lateness with the experience of the subject in exile. Drawing on the analogy provided by Said, this article argues that the relationship between "self" and "other" in the different theoretical contexts of Postcolonial Studies and Age Studies can be usefully combined in the composite concept of "late style as exile." In order to explore how the concept of lateness correlates with that of exile, this contribution turns to theoretical and autobiographical texts by Edward Said.
Cuellar, Amy; Gershon, Anda
Synopsis A growing body of research suggests that the social environment exerts a powerful influence on the course of bipolar depression. We review longitudinal research to suggest that trauma, negative life events, social support deficits, and family difficulties are common and predict a more severe course of depression when present among those diagnosed with bipolar disorder. The triggers of bipolar depression overlap with those documented for unipolar depression, suggesting that many of the treatment targets for unipolar depression may be applicable for bipolar depression. PMID:26876320
Petersen, Isaac T; Bates, John E; Goodnight, Jackson A; Dodge, Kenneth A; Lansford, Jennifer E; Pettit, Gregory S; Latendresse, Shawn J; Dick, Danielle M
Caspi et al. (2003) found an interaction between the serotonin transporter polymorphism gene (5-HTTLPR) and stressful life events on depression. Subsequent attempts to replicate have been inconsistent. The present research included long allele variants modified by SNP rs25531 and tested the interaction on adolescents' trajectories of anxious/depressed symptoms, with consideration of possible age effects. Adolescents (N = 574), of whom 436 were genotyped, were followed from ages 12 to 17. Analyses demonstrated a G × E interaction in predicting the development of anxious/depressed symptoms. Specifically, adolescents with lower serotonin transcriptional efficiency (TE) genotypes whose mothers reported more stressful events were reported to show more anxious/depressed symptoms and greater increases in the development of symptoms of anxiety and depression than were higher TE adolescents, particularly at ages 16 and 17. Interactions did not differ by gender. Findings demonstrate that stress may affect adolescents' likelihood of experiencing anxious/depressed symptoms when they have a low serotonin TE (A/G-modified 5-HTTLPR) genotype and suggest that the vulnerability may be stronger in late than early adolescence.
Miyata, Shigeo; Kurachi, Masashi; Okano, Yoshiko; Sakurai, Noriko; Kobayashi, Ayumi; Harada, Kenichiro; Yamagata, Hirotaka; Matsuo, Koji; Takahashi, Keisuke; Narita, Kosuke; Fukuda, Masato; Ishizaki, Yasuki; Mikuni, Masahiko
We investigated transcriptomic markers of late-onset major depressive disorder (LOD; onset age of first depressive episode ≥ 50 years) from the genes expressed in blood cells and identified state-dependent transcriptomic markers in these patients. We assessed the genes expressed in blood cells by microarray and found that the expression levels of 3,066 probes were state-dependently changed in the blood cells of patients with LOD. To select potential candidates from those probes, we assessed the genes expressed in the blood of an animal model of depression, ovariectomized female mice exposed to chronic ultra-mild stress, by microarray and cross-matched the differentially expressed genes between the patients and the model mice. We identified 14 differentially expressed genes that were similarly changed in both patients and the model mice. By assessing statistical significance using real-time quantitative PCR (RT-qPCR), the following 4 genes were selected as candidates: cell death-inducing DFFA-like effector c (CIDEC), ribonuclease 1 (RNASE1), solute carrier family 36 member-1 (SLC36A1), and serine/threonine/tyrosine interacting-like 1 (STYXL1). The discriminating ability of these 4 candidate genes was evaluated in an independent cohort that was validated. Among them, CIDEC showed the greatest discriminant validity (sensitivity 91.3% and specificity 87.5%). Thus, these 4 biomarkers should be helpful for properly diagnosing LOD.
Hintsa, Taina; Jokela, Markus; Elovainio, Marko; Määttänen, Ilmari; Swan, Heikki; Hintsanen, Mirka; Toivonen, Lauri; Kontula, Kimmo; Keltikangas-Järvinen, Liisa
We examined whether long QT syndrome status moderates the association between stressful life events and depressive symptoms. Participants were 562 (n= 246 symptomatic) long QT syndrome mutation carriers. Depressive symptoms were measured with a modified version of the Beck's Depression Inventory. There was an interaction between long QT syndrome status and stressful life events on depressive symptoms. In the symptomatic long QT syndrome patients, stressful life events were associated with depressive symptoms (B= 0.24, p< 0.001). In the asymptomatic long QT syndrome mutation carriers, this association was 62.5 percent weaker (B= 0.09, p= 0.057). Compared to asymptomatic long QT syndrome mutation carriers, symptomatic long QT syndrome patients are more sensitive to the depressive effects of stressful life events.
Monroe, Scott M.; Torres, Leandro D.; Guillaumot, Julien; Harkness, Kate L.; Roberts, John E.; Frank, Ellen; Kupfer, David
Research has consistently documented the significance of severe life events for onset of major depression. Theory, however, suggests other forms of stress are relevant for depression's recurrence. Nonsevere life events were tested in relation to depression for 126 patients with recurrent depression in a 3-year randomized maintenance protocol. Life…
Zajitschek, Felix; Jin, Tuo; Colchero, Fernando; Maklakov, Alexei A
Diet effects on age-dependent mortality patterns are well documented in a large number of animal species, but studies that look at the effects of nutrient availability on late-life mortality plateaus are lacking. Here, we focus on the effect of dietary protein content (low, intermediate, and high) on mortality trajectories in late life in the fruit fly Drosophila melanogaster. According to the two theories that are mainly implicated in explaining the deceleration of mortality rate in late life (the heterogeneity/frailty theory and the Hamiltonian theory), we predict, in general, the occurrence of late-life mortality deceleration under most circumstances, independent of sex and dietary regime. However, the heterogeneity theory of late life is more flexible in allowing no mortality deceleration to occur under certain circumstances compared with the Hamiltonian theory. We applied a novel statistical approach based on Bayesian inference of age-specific mortality rates and found a deceleration of late-life mortality rates on all diets in males but only on the intermediate (standard) diet in females. The difference in mortality rate deceleration between males and females on extreme diets suggests that the existence of mortality plateaus in late life is sex and diet dependent and, therefore, not a universal characteristic of large enough cohorts.
Du, Lian; Wang, Jingjie; Meng, Ben; Yong, Na; Yang, Xiangying; Huang, Qingling; Zhang, Yan; Yang, Lingling; Qu, Yuan; Chen, Zhu; Li, Yongmei; Lv, Fajin; Hu, Hua
Early life stress (ELS) can alter brain function and increases the risk of major depressive disorder (MDD) in later life. This study investigated whether ELS contributes to differences in regional brain activity between MDD patients and healthy controls (HC), as measured by amplitude of low-frequency fluctuation (ALFF)/fractional (f)ALFF. Eighteen first-episode, treatment-naïve MDD patients and HC were assessed with the Childhood Trauma Questionnaire and resting-state functional magnetic resonance imaging. We compared ALFF/fALFF between MDD patients and HC, with or without controlling for ELS, and determined whether ELS level was correlated with regional brain activity in each group. After regressing out ELS, we found that ALFF increased in bilateral amygdala and left orbital/cerebellum, while fALFF decreased in left inferior temporal and right middle frontal gyri in MDD patients relative to controls. ELS positively correlated with regional activity in the left cerebellum in MDD and in the right post-central/inferior temporal/superior frontal cingulate, inferior frontal gyrus and bilateral cerebellum in HC. Our findings indicate that there is only very limited region showing correlation between ELS and brain activity in MDD, while diverse areas in HC, suggesting ELS has few impacts on MDD patients.
Du, Lian; Wang, Jingjie; Meng, Ben; Yong, Na; Yang, Xiangying; Huang, Qingling; Zhang, Yan; Yang, Lingling; Qu, Yuan; Chen, Zhu; Li, Yongmei; Lv, Fajin; Hu, Hua
Early life stress (ELS) can alter brain function and increases the risk of major depressive disorder (MDD) in later life. This study investigated whether ELS contributes to differences in regional brain activity between MDD patients and healthy controls (HC), as measured by amplitude of low-frequency fluctuation (ALFF)/fractional (f)ALFF. Eighteen first-episode, treatment-naïve MDD patients and HC were assessed with the Childhood Trauma Questionnaire and resting-state functional magnetic resonance imaging. We compared ALFF/fALFF between MDD patients and HC, with or without controlling for ELS, and determined whether ELS level was correlated with regional brain activity in each group. After regressing out ELS, we found that ALFF increased in bilateral amygdala and left orbital/cerebellum, while fALFF decreased in left inferior temporal and right middle frontal gyri in MDD patients relative to controls. ELS positively correlated with regional activity in the left cerebellum in MDD and in the right post-central/inferior temporal/superior frontal cingulate, inferior frontal gyrus and bilateral cerebellum in HC. Our findings indicate that there is only very limited region showing correlation between ELS and brain activity in MDD, while diverse areas in HC, suggesting ELS has few impacts on MDD patients. PMID:27138376
Sohn, Jee Hoon; Ahn, Seung Hee; Seong, Su Jeong; Ryu, Ji Min; Cho, Maeng Je
The nationwide prevalence of major depressive disorder in Korea is lower than most countries, despite the high suicide rate. To explain this unexpectedly low prevalence, we examined the functional disability and quality of life in community-dwelling subjects with significant depressive symptoms not diagnosable as depressive disorder. A total of 1,029 subjects, randomly chosen from catchment areas, were interviewed with the Center for Epidemiologic Studies Depression scale, Mini International Neuropsychiatric Interview, WHO Quality of Life scale, and the WHO Disability Assessment Schedule. Those with scores over 21 on the depression scale were interviewed by a psychiatrist for diagnostic confirmation. Among community-dwelling subjects, the 1-month prevalence of major depressive disorder was 2.2%, but the 1-month prevalence of depressive symptoms not diagnosable as depressive disorder was 14.1%. Depressive disorders were the cause of 24.7% of work loss days, while depressive symptoms not diagnosable as depressive disorder were the cause of 17.2% of work loss days. These findings support the dimensional or spectrum approach to depressive disorder in the community and might be the missing link between the apparent low prevalence of depressive disorder and high suicide rate in Korea.
Murray, Alison D.; McNeil, Christopher J.; Salarirad, Sima; Whalley, Lawrence J.; Staff, Roger T.
Context There have been many reports confirming the association between lower childhood socioeconomic circumstance and cardiovascular disease but evidence for links with cerebrovascular disease is contradictory. Hyperintensities on brain magnetic resonance imaging are associated with vascular risk factors, cognitive decline, dementia and death. However, the relationship between childhood socioeconomic circumstance and these lesions is unclear. Objective To test the hypothesis that childhood socioeconomic circumstance is associated with late life hyperintensity burden and that neither adult socioeconomic circumstance nor change in socioeconomic circumstance during life influence this effect. Design Cohort study Setting Community Participants 227 community dwelling members of the 1936 Aberdeen Birth Cohort aged 68 years, who were free from dementia. Main Outcome Measures Relationship between early life socioeconomic circumstance (paternal occupation) and abundance of late life brain hyperintensities. Results We find significant negative correlations between childhood socioeconomic circumstance and white matter hyperintensities (ρ = −0.18, P<0.01), and periventricular hyperintensities (ρ = −0.15, P<0.05), between educational attainment and white matter hyperintensities (ρ = −0.15, P<0.05) and periventricular hyperintensities (ρ = −0.17, P<0.05), and between childhood intelligence and periventricular hyperintensities (ρ = −0.14, P<0.05). The relationship is strongest for childhood socioeconomic circumstance and regional white matter hyperintensities, where there is a step change in increased burden from paternal occupation grades equivalent to a shift from “white collar” to “blue collar” paternal occupation. Significant correlations were also found between hypertension and hyperintensity burden in all brain regions (ρ = 0.15–0.24, P<0.05). In models that include hypertension, the magnitude of the effect of childhood
Mukherjee, Anita J; Diwan, Sadhna
Late-life immigration among seniors for purposes of family reunification is a growing phenomenon in developed countries. Using the World Health Organization's Quality of Life instrument short form (WHOQOL-BREF) and other psychosocial measures related to the political/legal context of immigration, and personal and environmental autonomy (mastery, immigration status, access to transportation, and language barrier), this study examined quality of life (QoL) in Asian Indian seniors (N = 109), who immigrated to the United States to reunite with their adult children. The sample scores on Overall QoL and QoL domains (physical and psychological health, social relationships, and environment) were similar to established norms. Although all QoL domains correlated significantly with Overall QoL at the bivariate level, multivariate analysis showed that only environmental domain contributed significantly to Overall QoL. Linear regressions indicated: Mastery contributed significantly to Overall QoL and all QoL domains; access to transport contributed to Overall QoL, physical health, and environmental QoL; immigration status (a proxy for political/legal context) contributed to environmental QoL whereas language barrier contributed to none. Implications for improving perceptions of QoL, mastery, access to transport and other services are discussed.
Stange, Jonathan P.; Alloy, Lauren B.; Flynn, Megan; Abramson, Lyn Y.
Objective Negative inferential style and deficits in emotional clarity have been identified as vulnerability factors for depression in adolescence, particularly when individuals experience high levels of life stress. However, previous research has not integrated these characteristics when evaluating vulnerability to depression. Method In the present study, a racially-diverse community sample of 256 early adolescents (ages 12 and 13) completed a baseline visit and a follow-up visit nine months later. Inferential style, emotional clarity, and depressive symptoms were assessed at baseline, and intervening life events and depressive symptoms were assessed at follow-up. Results Hierarchical linear regressions indicated that there was a significant three-way interaction between adolescents’ weakest-link negative inferential style, emotional clarity, and intervening life stress predicting depressive symptoms at follow-up, controlling for initial depressive symptoms. Adolescents with low emotional clarity and high negative inferential styles experienced the greatest increases in depressive symptoms following life stress. Emotional clarity buffered against the impact of life stress on depressive symptoms among adolescents with negative inferential styles. Similarly, negative inferential styles exacerbated the impact of life stress on depressive symptoms among adolescents with low emotional clarity. Conclusions These results provide evidence of the utility of integrating inferential style and emotional clarity as constructs of vulnerability in combination with life stress in the identification of adolescents at risk for depression. They also suggest the enhancement of emotional clarity as a potential intervention technique to protect against the effects of negative inferential styles and life stress on depression in early adolescence. PMID:23215673
Hassel, Alexander Jochen; Danner, Daniel; Schmitt, Marina; Nitschke, Ina; Rammelsberg, Peter; Wahl, Hans-Werner
Although a body of research has targeted predictors of well-being and depression in old age, the consideration of oral health-related quality of life (OHRQoL) as a predictor of these major psychosocial endpoints has been rare in the previous literature. The objective of this study was to test whether OHRQoL is associated with well-being and depression, after controlling for relevant confounders; also, the mediating role of subjective health, a major predictor of both well-being and depression, has been explored. OHRQoL was measured by two commonly used assessment instruments, the geriatric oral health assessment index (GOHAI) and oral health impact profile (OHIP); well-being was assessed by the Philadelphia Geriatric Center Morale Scale (PGCMS) and depression by the self-rating depression scale (SDS). We used a subsample of 197 participants from the older cohort (1930-1932) of the Interdisciplinary Longitudinal Study of Adult Development. Regression models and structural equations modeling (SEM) were used for the test for study variable relationships. Both GOHAI and OHIP revealed significant associations to both PGCMS and SDS at the bivariate level. In regression analyses considering gender, household situation, subjective health, and both OHRQoL indicators, only OHIP remained a significant predictor of well-being and depression. In addition, supportive evidence for a mediating role of subjective health regarding the linkage between OHRQoL and an overall latent construct of well-being was found in the SEM analysis. In conclusion, OHRQoL is significantly linked with well-being and depression in old age, while subjective health is able to mediate the relationship. The generally underrated role of OHRQoL with respect to well-being and depression in late adulthood deserves more attention.
The late life disability instrument (LLDI) was developed to assess limitations in instrumental and management roles using a small and restricted sample. In this paper we examine the measurement properties of the LLDI using data from the Lifestyle Interventions and Independence for Elders Pilot (LIFE...
Kobayashi, Minoru; Gushiken, Taichi; Ganaha, Yurika; Sasazawa, Yosiaki; Iwata, Shotaro; Takemura, Akiko; Fujita, Tsutomu; Asikin, Yonathan; Takakura, Minoru
This study investigated the reliability and validity of the Multidimensional Scale of Life Skills in Late Childhood, an instrument designed to measure a concept similar to "zest for living" in late childhood. A total of 1,888 elementary school students in the 4th, 5th, and 6th grades residing in urban and suburban areas as well as in…
Sanchez, Yadira M; Lambert, Sharon F; Ialongo, Nicholas S
Considerable research has documented associations between adverse life events and internalizing symptoms in adolescents, but much of this research has focused on the number of events experienced, with less attention to the ecological context or timing of events. This study examined life events in three ecological domains relevant to adolescents (i.e., family, peers, themselves) as predictors of the course of depressive symptoms among a community epidemiologically defined sample of 419 (47.2% females) urban African American adolescents. Given that youth depressive symptoms change over time, grade level was examined as a moderator. For males, the strength of associations between life events happening to participants, family life events, and peer life events and depressive symptoms did not change from grades 6-9. For females, the strength of the association between peer life events and depressive symptoms did not change over time, but the strength of associations between life events happening to participants and family life events and females' depressive symptoms decreased over time. Implications of the findings and directions for future research are discussed.
Zimmer, Zachary; Kaneda, Toshiko; Tang, Zhe; Fang, Xianghua
Social characteristics that differ by place of residence are consequential for health. To study implications of this among older adults in rural vs. urban China, this study employs data from the Beijing municipality, a region that has witnessed growth and gaps in development. Life and active life expectancy is assessed using a multistate life…
Iacovino, Juliette M; Bogdan, Ryan; Oltmanns, Thomas F
Personality predicts the occurrence of dependent stressful life events (SLE; i.e., events reliant, at least in part, on an individual's behavior). This process, termed stress generation, contributes to psychiatric outcomes, but its role in physical health is unknown. Data were included from 998 participants (aged 55-64) in the St. Louis Personality and Aging Network (SPAN) study. Assessments occurred every 6 months for 18 months. Neuroticism, impulsivity, and agreeableness were measured with the Revised NEO Personality Inventory. Dependent (e.g., divorce) and independent (e.g., family death) SLE occurring within 6 months following baseline were assessed with the List of Threatening Experiences and confirmed by interviews. Health problems occurring within a year after SLE were the outcome. Analyses examined whether neuroticism, impulsivity, and agreeableness indirectly predict the onset of new health problems through exposure to dependent SLE. Each personality trait was associated with dependent, but not independent, SLE. Only dependent SLE predicted new health problems. Each personality trait indirectly predicted the onset of new health problems through dependent SLE. Findings suggest that personality-driven stress generation influences physical health during late mid-life. Addressing personality in interventions may reduce the occurrence of SLE, in turn decreasing health risks.
Iacovino, Juliette M.; Bogdan, Ryan; Oltmanns, Thomas F.
Personality predicts the occurrence of dependent stressful life events (SLE; i.e., events reliant, at least in part, on an individual's behavior). This process, termed stress generation, contributes to psychiatric outcomes, but its role in physical health is unknown. Data were included from 998 participants (aged 55–64) in the St. Louis Personality and Aging Network (SPAN) study. Assessments occurred every 6 months for 18 months. Neuroticism, impulsivity, and agreeableness were measured with the Revised NEO Personality Inventory. Dependent (e.g., divorce) and independent (e.g., family death) SLE occurring within 6 months following baseline were assessed with the List of Threatening Experiences and confirmed by interviews. Health problems occurring within a year after SLE were the outcome. Analyses examined whether neuroticism, impulsivity, and agreeableness indirectly predict the onset of new health problems through exposure to dependent SLE. Each personality trait was associated with dependent, but not independent, SLE. Only dependent SLE predicted new health problems. Each personality trait indirectly predicted the onset of new health problems through dependent SLE. Findings suggest that personality-driven stress generation influences physical health during late mid-life. Addressing personality in interventions may reduce the occurrence of SLE, in turn decreasing health risks. PMID:25929195
McCrae, Christina S
Changing sleep architecture in the elderly may increase their vulnerability to comorbid insomnia. Common comorbid conditions include chronic pain, depression, nocturia, and neurologic conditions such as Parkinson's and Alzheimer's disease. Diagnosing and treating comorbid insomnia in an older population poses special challenges for clinicians given the variety of coexisting medical and psychological conditions, polypharmacy, and the potential adverse effects of the most commonly used medications for insomnia in this population. Thus, the use of nonpharmacologic treatments, such as cognitive behavior therapy and relaxation techniques, is recommended before any medical approaches.
Taylor, Warren D.; Aizenstein, Howard J.; Alexopoulos, George S.
The ‘Vascular Depression’ hypothesis posits that cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes. This hypothesis stimulated much research that has improved our understanding of the complex relationships between late-life depression (LLD), vascular risk factors, and cognition. Succinctly, there are well-established relationships between late-life depression, vascular risk factors, and cerebral hyperintensities, the radiological hallmark of vascular depression. Cognitive dysfunction is common in late-life depression, particularly executive dysfunction, a finding predictive of poor antidepressant response. Over time, progression of hyperintensities and cognitive deficits predicts a poor course of depression and may reflect underlying worsening of vascular disease. This work laid the foundation for examining the mechanisms by which vascular disease influences brain circuits and influences the development and course of depression. We review data testing the vascular depression hypothesis with a focus on identifying potential underlying vascular mechanisms. We propose a disconnection hypothesis, wherein focal vascular damage and white matter lesion location is a crucial factor influencing neural connectivity that contributes to clinical symptomatology. We also propose inflammatory and hypoperfusion hypotheses, concepts that link underlying vascular processes with adverse effects on brain function that influence the development of depression. Testing such hypotheses will not only inform the relationship between vascular disease and depression but also provide guidance on the potential repurposing of pharmacological agents that may improve late-life depression outcomes. PMID:23439482
Spinhoven, Philip; Elzinga, Bernet; Roelofs, Karin; Hovens, Jacqueline G F M; van Oppen, Patricia; Zitman, Frans G; Penninx, Brenda W J H
We investigated a) the concurrent impact of positive and negative life events on the course of depressive symptoms in persons remitted from depression and healthy controls, b) whether the impact of life events on symptom course is moderated by the history of depression and the personality traits of neuroticism and extraversion, and c) whether life events mediate possible relationships of history of depression and personality traits with symptom course. Using data from the Netherlands Study of Depression and Anxiety, we examined 239 euthymic participants with a previous depressive disorder based on DSM-IV and 450 healthy controls who completed a) baseline assessments of personality dimensions (NEO Five-Factor Inventory) and depression severity (Inventory of Depressive Symptoms [IDS]) and b) 1-year follow-up assessments of depression severity and the occurrence of positive and negative life events during the follow-up period (List of Threatening Events Questionnaire). Remitted persons reported higher IDS scores at 1-year follow-up than did the controls. Extraversion and positive and negative life events independently predicted the course of depressive symptoms. The impact of life events on symptom course was not moderated by history of depression or personality traits. The effect of extraversion on symptom course was partly caused by differential engagement in positive life events.
Vaughan, Leslie; Corbin, Akeesha L; Goveas, Joseph S
Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were “frailty”, “frail”, “frail elderly”, “depressive”, “depressive disorder”, and “depression”. Participants of included studies were ≥55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al’s criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral
Kalil, Ariel; Kunz, James
This longitudinal study tested the contribution of age and marital status at first birth to depressive symptomatology in early adulthood. Findings indicated that unmarried teenage childbearers displayed higher levels of depressive symptoms than women who first gave birth as married adults. The psychological health of married teenage mothers in…
SANTOS, Letácio José Freire; GARCIA, João Batista dos Santos; PACHECO, Jairo Sousa; VIEIRA, Érica Brandão de Morais; dos SANTOS, Alcione Miranda
Background The rectum cancer is associated with high rates of complications and morbidities with great impact on the lives of affected individuals. Aim To evaluate quality of life, pain, anxiety and depression in patients treated for medium and lower rectum cancer, submitted to surgical intervention. Methods A descriptive cross-sectional study. Eighty-eight records of patients with medium and lower rectum cancer, submitted to surgical intervention were selected, and enrolled. Forty-seven patients died within the study period, and the other 41 were studied. Question forms EORTC QLQ-C30 and EORTC QLQ-CR38 were used to assess quality of life. Pain evaluation was carried out using the Visual Analogical Scale, depression and anxiety were assessed through Depression Inventories and Beck's Anxiety, respectively. The correlation between pain intensity, depression and anxiety was carried out, and between these and the EORTC QLQ-C30 General Scale for Health Status and overall quality of life, as well as the EORTC QLQ-CR38 functional and symptom scales. Results Of the 41 patients of the study, 52% presented pain, depression in 47%, and anxiety in 39%. There was a marking positive correlation between pain intensity and depression. There was a moderate negative correlation between depression and general health status, and overall quality of life as well as pain intensity with the latter. There was a statistically significant negative correlation between future depression perspective and sexual function, and also a strong positive correlation between depression and sexual impairments. A positive correlation between anxiety and gastro-intestinal problems, both statistically significant, was observed. Conclusion Evaluation scales showed detriment on quality life evaluation, besides an elevated incidence of pain, depression, and anxiety; a correlation among these, and factors which influence on the quality of life of post-surgical medium and lower rectum cancer patients was
The main objective of this study was to examine the association between four types of adverse life events (family environment, separation, social adversity, and death) and the development of depressive symptoms among Puerto Rican youth. This was a secondary analysis using three waves (2000–2004) of interview data from the Boricua Youth Study of 10–13 year old Puerto Rican youth residing in New York and Puerto Rico with no depressive symptoms at baseline (n = 977). Depressive symptoms increased with an increase in social adversity, separation, death, and death events. Youth support from parents was a significant protective factor for all adverse events and parent coping was a protective factor in social adversity events. Relying on standard diagnostic tools is ideal to identify youth meeting the criteria for a diagnosis of depression but not useful to detect youth who present with subclinical levels of depression. Youth with sub-clinical levels of depression will not get treated and are at increased risk of developing depression later in life. Adverse life events are potentially relevant to use in conjunction with other screening tools to identify Puerto Rican youth who have subclinical depression and are at risk of developing depression in later adolescence. PMID:27788173
Alastalo, H; Räikkönen, K; Pesonen, A-K; Osmond, C; Barker, D J P; Heinonen, K; Kajantie, E; Eriksson, J G
Severe stress experienced in early life may have long-term consequences on adult physiological functions. We studied the long-term effects of separation on blood pressure levels in non-obese subjects who were separated temporarily in childhood from their parents during World War II (WWII). The original clinical study cohort consists of people born during 1934-1944 in Helsinki, Finland. This substudy includes 1361 non-obese subjects (body mass index <30 kg m(-2)). Of these, 192 (14.1%) had been evacuated abroad during WWII. The remaining subjects served as controls. Blood pressure levels and use of blood pressure medication were studied. The separated subjects had significantly higher systolic blood pressure values than the non-separated (148.6+21.5 vs 142.2+19.6 mm Hg, P<0.0001) in adult life. Those subjects separated in early childhood had markedly higher systolic and diastolic blood pressure values in adult life compared with the non-separated (154.6 vs 142.5 mm Hg; 95% confidence interval (CI) 2.6-14.7; P<0.005 and 90.8 vs 87.7 mm Hg; 95% CI 1.0-7.3; P<0.02, respectively). Systolic blood pressure was also higher in the group separated for a duration of <1 year (151.7 vs 142.2 mm Hg; 95% CI 0.0-12.4; P<0.05) compared with the non-separated. Besides being separated, age at separation and duration of separation also influenced blood pressure levels in adult life. This could be due to early hormonal and metabolic programming, during plastic periods in early life, influencing blood pressure levels in adult life.
Vitiello, Benedetto; Rohde, Paul; Silva, Susan; Wells, Karen; Casat, Charles; Waslick, Bruce; Simons, Anne; Reinecke, Mark; Weller, Elizabeth; Kratochvil, Christopher; Walkup, John; Pathak, Sanjeev; Robins, Michele; March, John
Obective: To test whether 12-week treatment of major depression improved the level of functioning, global health, and quality of life of adolescents. Method: The Treatment for Adolescents With Depression Study was a multisite, randomized clinical trial of fluoxetine, cognitive-behavioral therapy (CBT), their combination (COMB), or clinical…
Kwok, Sylvia Y. C. L.; Gu, Minmin; Kit, Katrina Tong Kai
Purpose: The study aims to examine the effectiveness of a positive psychology group-based intervention program, incorporating elements of hope and gratitude, in decreasing depression and increasing life satisfaction among primary school students in Hong Kong. Method: A total of 68 children, with the Depression score of Chinese Hospital Anxiety and…
Gnilka, Philip B.; Ashby, Jeffrey S.; Noble, Christina M.
This study examined the relationships between adaptive and maladaptive perfectionism, anxious and avoidant adult attachment styles, depression, hopelessness, and life satisfaction among a sample of 180 undergraduate students. Maladaptive perfectionism mediated the relationship between both forms of adult attachment and depression, hopelessness,…
Henry, Ryan G.; Miller, Richard B.; Giarrusso, Roseann
Although research has examined marital satisfaction in later life, little is known about the specific relationship challenges that older couples experience. Thus, the objective of the study was to explore the challenges older couples face. Data came from the USC Longitudinal Study of Generations. Qualitative analysis was conducted on 105 older…
Cutrona, Carolyn E.; Russell, Daniel W.; Brown, P. Adama; Clark, Lee Anna; Hessling, Robert M.; Gardner, Kelli A.
The authors tested neighborhood context, negative life events, and negative affectivity as predictors of the onset of major depression among 720 African American women. Neighborhood-level economic disadvantage (e.g., percentage of residents below the poverty line) and social disorder (e.g., delinquency, drug use) predicted the onset of major depression when controlling for individual-level demographic characteristics. Neighborhood-level disadvantage/disorder interacted with negative life events, such that women who experienced recent negative life events and lived in high disadvantage/disorder neighborhoods were more likely to become depressed than were those who lived in more benign settings, both concurrently and over a 2-year period. Neighborhood disadvantage/disorder can be viewed as a vulnerability factor that increases susceptibility to depression following the experience of negative life events. PMID:15709807
Begovic-Juhant, Ana; Chmielewski, Amy; Iwuagwu, Stella; Chapman, Lauren A
The purpose of this study was to explore body image, physical attractiveness, and femininity among survivors of breast cancer and to examine the effects of the aforementioned variables on depression and quality of life. The participants comprised 70 female survivors of breast cancer, ages between 23 and 79 years. They completed a questionnaire that includes Center for Epidemiological Studies Depression Scale, Functional Assessment of Cancer Therapy, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire--Breast Cancer, measuring depression, quality of life, and body image, respectively. On the depression scale, 56% of the participants had scores higher than 16; a score of 16 and above identifies participants with potential depression. Majority of women felt less attractive and less feminine. Low body image, attractiveness, and femininity positively correlated with depression and negatively with overall quality of life. The authors conclude that multidisciplinary health care services relevant to physical attractiveness and femininity of survivors of breast cancer may foster positive body image perceptions, reduced depression, and increased quality of life.
Adams, Tangeria R.; Rabin, Laura A.; Da Silva, Valdiva G.; Katz, Mindy J.; Fogel, Joshua; Lipton, Richard B.
Objectives Life satisfaction is an important component of overall well-being. Decline in life satisfaction is related to many adverse health outcomes including mortality. Methods We investigate the association of various psychosocial and health-related factors to life satisfaction in 237 non-demented community-dwelling older adults. Results Lower levels of depressive symptoms, less perceived stress, higher levels of social support, and better self-perceived general health were significantly associated with higher life satisfaction. Social support buffered the adverse impact of depressive symptoms on life satisfaction where more depressive symptoms were associated with much lower life satisfaction at low levels of social support than at high levels of social support. Discussion We discuss study implications, future research directions, and possible interventions that involve boosting social support in at-risk older adults. PMID:27418714
Kohler, Iliana V; Soldo, Beth J
We investigated the interplay between characteristics of early childhood circumstances and current socioeconomic conditions and health, focusing specifically on diabetes in mid and late life in Mexico. The analysis used data from the 2001 Mexican Health and Aging Study (MHAS), a large nationally representative study of Mexicans born before 1950. We analyzed the extent to which childhood conditions, such as exposure to infectious diseases, a poor socioeconomic environment, and parental education, affect the risk of diabetes in later life. Our results indicate that individuals age 50 and older who experienced serious health problems before age 10 have a higher risk of having late-life diabetes. There is a significant inverse relationship between maternal education and diabetes in late life of adult offspring. Individuals with better educated mothers have a lower risk of being diabetic after age 50. This relationship remains after controlling for other childhood and adult risk factors.
Psychological distress in high-school students was examined in relation to negative life events, long-lasting adversities and perceived social support from the family, friends and the school class. Academic problems increased the symptom levels of psychological distress, and social support from family and social support from friends reduced the symptoms among males and females. For females, social support from school class-mates and problems with parents and friends also had direct independent effects on symptom levels. An effect of the total number of long-lasting adversities was significantly stronger for females than males. The buffer hypothesis was supported: both an increase in social support from parents and social support from peers reduced the effect of negative life events.
Ribeiro, Pricila Cristina Correa; Lourenço, Roberto Alves
We examined whether women who had regular jobs throughout life performed better cognitively than older adult housewives. Linear regression was used to compare global cognitive performance scores of housewives (G1) and women exposed to work of low (G2) and high (G3) complexity. The sample comprised 477 older adult Brazilian women, 430 (90.4%) of whom had performed lifelong jobs. In work with data, the G2 group's cognitive performance scores were 1.73 points higher (p =.03), and the G3 group scored 1.76 points (p =.02) higher, than the G1. In work with things and with people, the G3 scored, respectively, 2.04 (p <.01) and 2.21 (p <.01) cognitive test points higher than the G1. Based on our findings we suggest occupation of greater complexity is associated with better cognitive performance in women later in life.
Downer, Brian; Estus, Steven; Katsumata, Yuriko; Fardo, David W.
Background: Previous research indicates that total cholesterol levels increase with age during young adulthood and middle age and decline with age later in life. This is attributed to changes in diet, body composition, medication use, physical activity, and hormone levels. In the current study we utilized data from the Framingham Heart Study Original Cohort to determine if variations in apolipoprotein E (APOE), a gene involved in regulating cholesterol homeostasis, influence trajectories of total cholesterol, HDL cholesterol, and total: HDL cholesterol ratio from midlife through late life. Methods: Cholesterol trajectories from midlife through late life were modeled using generalized additive mixed models and mixed-effects regression models. Results: APOE e2+ subjects had lower total cholesterol levels, higher HDL cholesterol levels, and lower total: HDL cholesterol ratios from midlife to late life compared to APOE e3 and APOE e4+ subjects. Statistically significant differences in life span cholesterol trajectories according to gender and use of cholesterol-lowering medications were also detected. Conclusion: The findings from this research provide evidence that variations in APOE modify trajectories of serum cholesterol from midlife to late life. In order to efficiently modify cholesterol through the life span, it is important to take into account APOE allele status. PMID:25325355
Raab, Phillip A; Mackintosh, Margaret-Anne; Gros, Daniel F; Morland, Leslie A
For Veterans with posttraumatic stress disorder (PTSD), depression is a highly comorbid condition. Both conditions have been associated with decreased quality of life, and research suggests that comorbid PTSD and depression may result in worse quality of life than PTSD alone. However, research is needed to elucidate the effect of comorbidity on a broader variety of quality of life domains. In this study, we used baseline data of 158 male combat Veterans taking part in a PTSD treatment trial and examined the unique relationships between quality of life domains and PTSD symptom clusters, major depressive disorder (MDD) diagnosis, and self-reported depressive symptoms. Veterans with comorbid PTSD-MDD reported significantly worse satisfaction-related quality of life than those with PTSD alone, although this finding was largely attributable to PTSD numbing symptoms. Subsequent analyses comparing the effect of numbing symptoms to depressive symptoms revealed that depression exerted a stronger influence, although numbing symptoms were still uniquely associated with quality of life. We discuss implications for treatment and research, as well as the need to address negative affect in Veterans with PTSD.
Fox, Jeremy K; Halpern, Leslie F; Ryan, Julie L; Lowe, Kelly A
Although the tripartite model reliably distinguishes anxiety and depression in adolescents, it remains unclear how negative affectivity (NA) and positive affectivity (PA) influence developmental pathways to internalizing problems. Based on models which propose that affectivity shapes how youth react to stress, the present study attempted to investigate the relative roles of NA, PA, and stressful life events in characterizing and differentiating adolescent anxiety and depression. A sample of adolescent females (N=63), including a sub-sample of adolescent mothers, completed measures of NA, PA, negative life event (NLE) occurrence, anxiety, and depression. Findings supported the tripartite model as a "temperamental reactivity to stress" approach. Anxious and depressive symptoms were predicted by a combination of high NA and high NLE occurrence. However, a combination of low PA and high NLE occurrence was uniquely linked to greater depressive symptoms. Implications of these findings for early identification and prevention programs are discussed.
De Fazio, Pasquale; Gaetano, Raffaele; Caroleo, Mariarita; Pavia, Maria; De Sarro, Giovanbattista; Fagiolini, Andrea; Segura-Garcia, Cristina
The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment is a particular challenge for clinicians. Although lithium is the treatment of choice for bipolar disorder (BD), its use in elderly population was recently questioned. This study provides a comprehensive review of literature on the efficacy and tolerability of lithium as a pharmacologic treatment for mania in elderly BD patients. We conducted a systematic review, based on PRISMA guidelines, of articles published between 1970 and August 2016 and indexed in the following databases: EMBASE, MEDLINE, Cochrane Library Databases and PsycINFO. The key words “age”, “late-life”, “geriatric”, “elderly”, and “older” were combined with words indicating pharmacologic treatments, such as lithium and other mood stabilizers and with the diagnostic terms “bipolar disorder” and “mania”. Fifteen out of 196 retrieved studies met our inclusion criteria. Seven studies evaluated both the efficacy and tolerability of lithium treatment in elderly BD patients; a further three evaluated only the efficacy and five assessed tolerability. Only limited data on the treatment of elderly BD patients are available, but evidence suggests that lithium is effective and tolerated in this subgroup of patients and thus should remain a first-line drug. It seems to be more effective at lower doses and close monitoring of plasma concentrations is necessary. PMID:28331326
Agostini, Francesca; Neri, Erica; Salvatori, Paola; Dellabartola, Sara; Bozicevic, Laura; Monti, Fiorella
This study aimed to identify different kinds of stressful life events and social support associated with antenatal depressive symptoms in a sample of pregnant Italian women. We conducted the study at a primary health-care centre in an urban area (northeast Italy). Mainly recruited at antenatal classes, 404 eligible pregnant women completed a socio-demographic questionnaire that included questions about the present pregnancy, the Edinburgh Depression Scale (EDS) to estimate the prevalence of depressive symptoms, the Multidimensional Scale of Perceived Social Support and List of Threatening Experiences Questionnaire to investigate the quality and nature of social support and recent negative life events. Of the 404 women, 60 (14.9 %) scored 13 or higher on the EDS. This group reported significantly lower social support from various sources-family, friends, and significant others; only in primiparous women were depressive symptoms significantly related to lower support from friends. Women with EDS scores equal or higher than 13 also reported a higher occurrence of recent stressful life events-specifically, death or a serious problem with a close friend or relative, unemployment, financial problems, and moving or housing difficulties. Regression analyses showed that women with high levels of social support or with a positive experience of pregnancy were less likely to experience antenatal depressive symptoms. Our results underscore the associations among antenatal depression, specific life stressors, and low social support from various sources. Clinical attention to these psychosocial correlates is recommended toward detecting vulnerability to antenatal depressive symptoms.
Antunes, Rogério Sarmento; de Macedo, Bárbara Gazolla; Amaral, Tammy da Silva; Gomes, Henrique de Alencar; Pereira, Leani Souza Máximo; Rocha, Fábio Lopes
OBJECTIVE: To describe the characteristics of pain, kinesiophobia and quality of life in patients with chronic low back pain and depression. METHODS: Cross-sectional study in which 193 individuals with chronic low back pain were included. The presence of depression was measured by the Beck Depression Inventory, using a cutoff validated by the Mini International Neuropsychiatric Interview. The intensity and quality of pain in the groups with and without depression were assessed by the McGill Questionnaire. The Tampa Scale for Kinesiophobia was applied to assess fear of movement. With respect to quality of life, the Medical Outcomes Study 36 was used. The statistical significance level was set at p <0.05. RESULTS: The prevalence of depression was 32.1%. The group with depression had worse scores in relation to pain, kinesiophobia and quality of life (physical functioning, rolephysical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. CONCLUSION: Patients with low back pain and depression had higher pain intensity, greater fear of movement and poorer quality of life. Level of Evidence III, Cross-sectional PMID:24453639
Fiske, Amy; Wetherell, Julie Loebach; Gatz, Margaret
Depression is less prevalent among older adults than among younger adults but can have serious consequences. Over half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are younger adults. Risk factors leading to the development of late life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support. PMID:19327033
Chen, Kelong; Fan, Yongping; Hu, Rui; Yang, Tao; Li, Kangning
The aim of this work is to investigate and analyze the main factors that influence the quality of life (QOL) of multiple sclerosis (MS) patients. The QOL (multiple sclerosis impact scale), disability (expanded disability status scale), fatigue (modified fatigue impact scale) and depression (Beck Depression Inventory) were assessed in 100 MS patients. Correlation analysis shows that QOL is positively correlated with disability status, fatigue and depression, i.e., the more severe the disability, fatigue and depression, the worse the QOL. Multiple linear regression analysis indicated that Expanded Disability Status Scale grade and fatigue have important predictive value on the somatic QOL of MS patients. On the other hand, depression and fatigue have important predictive value on the mental QOL of MS patients. The QOL of MS patients is influenced by various factors, nursing care that focuses on patient disability, fatigue and depression should be strengthened.
Li, Xiaomin; Jiang, Quanbao; Li, Shuzhuo; Feldman, Marcus W
China's middle-aged and older women suffer from poorer health than men. Using national baseline data from the China Health and Retirement Longitudinal Study (CHARLS), a survey conducted from 2011 to 2012, this article applies logistic models to investigate the association between female fertility history (parity, early childbearing, late childbearing) and middle-aged and late-life health. We find that parity is related to the mid-late-life health of women. Women with four children or more are more likely to suffer from activities of daily living (ADL) impairment and poorer self-rated health than those with one to three children. Early childbearing is associated with ADL impairment; however, the correlation is mediated by socioeconomic status. Early childbearing is related to self-rated health in later life by an indirect-only mediation effect via educational attainment and personal income.
de Araújo, Aurigena Antunes; Rebouças Barbosa, Rosa Angélica Silveira; de Menezes, Marília Stefani Souza; de Medeiros, Ingrid Iana Fernandes; de Araújo, Raimundo Fernandes; de Medeiros, Caroline Addison Carvalho Xavier
The institutionalization of elders can decrease the health status and quality of life in this population. The aim of this study was to analyze the socio-demographic, quality of life, family support, and comorbidities variables in institutionalized elders with and without symptoms of depression. This was a cross-sectional study in institutions for long permanence for the elderly in the State of Rio Grande do Norte, Brazil. Two institutionalized elderly groups were compared (138 elders: 69 with and 69 without depressive symptoms). The instruments used were: mini-mental state examination, geriatric depression scale in the reduced version, socio-demographic questionnaire, quality of life (World Health Organization Quality of Life abbreviated-WHOQOL-bref), and inventory of perception of family support. Elders with depressive symptoms had inferior quality of life than those without depressive symptoms. Other factors that negatively influenced the quality of life in this population include: low economic conditions, occurrence of comorbidities, and deficient family assistance. These results have important implications in the decision making process with regard to strategies for improving the health status of institutionalized elders.
Lemaître, Jean-François; Berger, Vérane; Bonenfant, Christophe; Douhard, Mathieu; Gamelon, Marlène; Plard, Floriane; Gaillard, Jean-Michel
Empirical evidence for declines in fitness components (survival and reproductive performance) with age has recently accumulated in wild populations, highlighting that the process of senescence is nearly ubiquitous in the living world. Senescence patterns are highly variable among species and current evolutionary theories of ageing propose that such variation can be accounted for by differences in allocation to growth and reproduction during early life. Here, we compiled 26 studies of free-ranging vertebrate populations that explicitly tested for a trade-off between performance in early and late life. Our review brings overall support for the presence of early-late life trade-offs, suggesting that the limitation of available resources leads individuals to trade somatic maintenance later in life for high allocation to reproduction early in life. We discuss our results in the light of two closely related theories of ageing-the disposable soma and the antagonistic pleiotropy theories-and propose that the principle of energy allocation roots the ageing process in the evolution of life-history strategies. Finally, we outline research topics that should be investigated in future studies, including the importance of natal environmental conditions in the study of trade-offs between early- and late-life performance and the evolution of sex-differences in ageing patterns.
Lemaître, Jean-François; Berger, Vérane; Bonenfant, Christophe; Douhard, Mathieu; Gamelon, Marlène; Plard, Floriane; Gaillard, Jean-Michel
Empirical evidence for declines in fitness components (survival and reproductive performance) with age has recently accumulated in wild populations, highlighting that the process of senescence is nearly ubiquitous in the living world. Senescence patterns are highly variable among species and current evolutionary theories of ageing propose that such variation can be accounted for by differences in allocation to growth and reproduction during early life. Here, we compiled 26 studies of free-ranging vertebrate populations that explicitly tested for a trade-off between performance in early and late life. Our review brings overall support for the presence of early-late life trade-offs, suggesting that the limitation of available resources leads individuals to trade somatic maintenance later in life for high allocation to reproduction early in life. We discuss our results in the light of two closely related theories of ageing—the disposable soma and the antagonistic pleiotropy theories—and propose that the principle of energy allocation roots the ageing process in the evolution of life-history strategies. Finally, we outline research topics that should be investigated in future studies, including the importance of natal environmental conditions in the study of trade-offs between early- and late-life performance and the evolution of sex-differences in ageing patterns. PMID:25833848
Cao, Wenjun; Guo, Chongzheng; Ping, Weiwei; Tan, Zhijun; Guo, Ying; Zheng, Jianzhong
The goal of the study was to assess the quality of life (QOL) and depression and provide further insights into the relationship between QOL and depression among community-dwelling elderly Chinese people. Baseline data were collected from 1168 older adults (aged ≥ 60) in a large, prospective cohort study on measurement and evaluation of health-promoting and health-protecting behaviors intervention on chronic disease in different community-dwelling age groups. QOL was assessed using the 26-item, World Health Organization Quality of Life, brief version (WHOQOL-BREF) and depression was assessed using the 30-item Geriatric Depression Scale (GDS). The mean WHOQOL-BREF score for all dimensions was approximately 60, with the highest mean value (61.92) observed for social relationships, followed by environment, physical health, and psychological health domains. In this cohort, 26.1% of elderly urban adults met GDS criteria for depression. There were negative correlations between physical health (Odds Ratio (OR) = 0.928, 95% Confidence Interval (CI): 0.910–0.946), psychological health (OR = 0.906, 95% CI: 0.879–0.934), environment (OR = 0.966, 95% CI: 0.944–0.989) and depression among elderly people. Those with depression were older, less educated, had a lower monthly income, and were more likely to report insomnia. All WHOQOL-BREF domains, with the exception of the social domain were negatively correlated with depression. PMID:27409627
Wariso, Bathsheba A; Guerrieri, Gioia M; Thompson, Karla; Koziol, Deloris E; Haq, Nazli; Martinez, Pedro E; Rubinow, David R; Schmidt, Peter J
The impact of depression on quality of life (QOL) and social support has neither been well characterized in clinical samples of women with perimenopausal depression (PMD) nor have the relative contributions of depression and other menopausal symptoms (e.g., hot flushes) to declining QOL been clarified. In this study, we compared QOL measures, social support, and functional disability in PMD and non-depressed perimenopausal women. We evaluated women aged 40-60 years who presented with menstrual cycle irregularity, elevated plasma FSH levels, and met criteria for perimenopause. A structured clinical interview was administered to determine the presence or absence of major and minor depression. Outcome measures included the Quality of Life Enjoyment Scale Questionnaire, the Sheehan Disability Scale, the Global Assessment of Functioning, the Social Adjustment Scale, and the Duke Social Support Index. Kruskal-Wallis tests and ANOVAs were used to compare outcome measures. Ninety women with PMD and 51 control women participated in this study. Women with PMD reported significantly decreased QOL, social support, and adjustment and increased disability compared with non-depressed perimenopausal women. Neither perimenopausal reproductive status alone nor the presence of hot flushes had a significant negative impact on QOL measures. PMD is accompanied by significant reductions in QOL, social support, and disability similar to depression in women at other stages of life. PMD may also contribute to decreased QOL in community- or clinic-based samples of perimenopausal women. It remains unclear whether the clinical characteristics we identified reflect pre-existing risk factors for depression during the perimenopause or the effects of a current depression. Future clinical and treatment studies in perimenopausal women should distinguish depressed women when outcome measures include QOL.
Zablotsky, Benjamin; Anderson, Connie; Law, Paul
Parents raising children with autism spectrum disorders (ASDs) have been shown to experience high levels of stress and report a lower quality of life. The current study examined the association between child autism symptomatology, mother's quality of life, and mother's risk for depression in a sample of 1,110 mothers recruited from a…
Jenkins, Sharon Rae; Belanger, Aimee; Connally, Melissa Londono; Boals, Adriel; Duron, Kelly M.
First-generation undergraduate students face challenging cross-socioeconomic cultural transitions into college life. The authors compared first- and non-first-generation undergraduate students' social support, posttraumatic stress, depression symptoms, and life satisfaction. First-generation participants reported less social support from family…
Robatmili, Somaye; Sohrabi, Faramarz; Shahrak, Mohammad Ali; Talepasand, Siavash; Nokani, Mostafa; Hasani, Mohaddese
This paper identifies the effectiveness of group logotherapy in reducing depression and increasing meaning in life levels of university students in Iran. A randomized controlled trial was conducted with a pre- post- and follow-up test design. The instruments used were the "Purpose in Life" (PIL) test and the "Beck Depression…
Reyes-Rodríguez, Mae Lynn; Rivera-Medina, Carmen L.; Cámara-Fuentes, Luis; Suárez-Torres, Alba; Bernal, Guillermo
Background The transition from adolescence to adulthood is associated with stressful adaptation experiences that may increase symptoms of depression. We explored the prevalence and sex differences of depressive symptoms and suicidal ideation in freshmen Latino college students in Puerto Rico, and identified stressful life events that could contribute to symptoms of depression. Methods Two thousand one hundred sixty-three freshmen college students from the University of Puerto Rico (UPR) public education system were assessed for depression symptoms using the Beck Depression Inventory (BDI) and stressful life events using open questions. Results Nine percent of the sample reported depression symptoms at a moderate or severe level (BDI ≥ 20). Chi square analyses revealed a significantly higher prevalence for three of the stressful life events in females than males: relocation (10.2% females vs. 7.3% males; X2 (1) = 4.13, p=.042), break-up of a significant relationship (25.3% females vs. 17.8% males; X2 (1) = 13.76, p<.001), and illness (11.2% females vs. 7.3% males; X2 (1) = 7.23, p=.007). The model that best explained the variance of BDI scores among females was the presence of suicide risk, relationship break-up, illness, and relocation for college, whereas for males a similar model without the relationship break-up variable resulted in a better fit. Conclusions Freshmen college students present a broad range of depression symptoms and certain stressful life events are associated with an increased prevalence of depression symptoms. Early detection of depression and tailored prevention programs should be developed to improve both mental health and academic performance among the college population. PMID:22939390
Collins, Amy Love; Glei, Dana A.; Goldman, Noreen
The objective of our study was to investigate whether life satisfaction and depressive symptoms are independent predictors of mortality in a non-Western sample of adults. The sample included 5,131 adults (aged 50 – 95 at baseline) in Taiwan who participated in the Survey of Health and Living Status of the Near Elderly and Elderly. There were 1,815 deaths recorded over a 10-year period. Higher life satisfaction significantly predicted lower risk of mortality after controlling for age, sex, education, marital status and health status. Depressive symptoms significantly predicted higher risk of mortality. A significant interaction with age revealed that the protective effect of life satisfaction weakened with age. The results suggest that life satisfaction and depressive symptoms independently predict mortality risk in adults. PMID:19739925
Smith, Matthew J; Greenberg, Jan S; Sciortino, Sarah A; Sandoval, Gisela M; Lukens, Ellen P.
Background Research suggests siblings of individuals with schizophrenia are at a heightened risk for depressive symptomatology. Research has not yet examined whether the strains of growing up with a brother or sister with schizophrenia contribute to this risk. This study examined whether early life course burdens associated with an emerging mental illness, and current objective and subjective caregiver burden predicted depressive symptoms in siblings of individuals with schizophrenia. Method Forty-one siblings of individuals with schizophrenia were recruited from a large study of schizophrenia neurobiology to complete a self-administered questionnaire and a neuropsychological test battery. Results Early life course burdens and current objective and subjective burdens explained incremental variance in depressive symptoms of siblings of individuals with schizophrenia after accounting for gender and global neurocognitive function. Higher levels of depressive symptoms among siblings were associated with perceptions of being stigmatized by the community (β=.37, p<.01), and perceiving that the brother or sister’s emerging illness negatively impacted the sibling’s social life during childhood and adolescence (β=.39, p<.01). Taking on adult responsibilities while the sibling was growing up was found to be protective against depressive symptoms in adulthood (β= −.36, p<.01). Conclusions Early life course burdens associated with having a sibling with schizophrenia and current subjective burden provide insight into psychosocial factors that may contribute to the risk for depression in this sibling group. Mental health service providers and psychoeducation programs would benefit by considering these factors when developing family-based interventions. PMID:27175217
Tyrrell, J; Paturel, L; Cadec, B; Capezzali, E; Poussin, G
An increasing number of older patients receive dialysis treatment to compensate for deficient kidneys due to end-stage renal disease (ESRD). Ethical questions arise about the benefits of dialysis when a patient appears unwilling or unable to comply with this treatment procedure. Such attitudes and behaviour may be due to psychological factors, but these are not routinely assessed. The purpose of this study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients (>70 years). A total of 51 outpatients receiving dialysis were assessed by psychologists, using a depression scale (MADRS), two cognitive tests (MMSE and BEC 96), and a quality of life questionnaire (NHP). Sixty percent of the patients were depressed, and between 30-47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired. The scores for self-reported quality of life varied widely within the sample. Cognitive impairment and depressive mood are often overlooked and underestimated in this population. Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients. The information obtained should assist staff as they reflect on individual cases where the benefits of continuing treatment are being examined.
Boeri, Miriam Williams; Sterk, Claire E.; Elifson, Kirk W.
Purpose Our knowledge regarding older users of illicit drugs is limited despite their increasing numbers. In this paper we apply a life course perspective to gain a further understanding of older adult drug use, specifically contrasting early- and late-onset heroin users. Design and Methods Qualitative data were collected from 29 older heroin users. Life course analysis focused on the users’ experiences across the life span. Results The findings suggest that those aging-into heroin use (late-onset) are disadvantaged compared to those who are maturing-in (early-onset) except in areas of health. Implications We propose that conceptualizing the use of heroin and other illicit drugs among older adults based on their life course trajectory will provide insights for social and health services, including drug treatment. PMID:18981280
Peñacoba-Puente, Cecilia; Fernández-de-Las-Peñas, César; González-Gutierrez, Jose L; Miangolarra-Page, Juan C; Pareja, Juan A
Our aim was to investigate the mediating or moderating role of anxiety and depression in the relationship between headache clinical parameters and quality of life in Chronic Tension-Type Headache (CTTH). Twenty-five patients diagnosed with CTTH according to the criteria of the International Headache Society were studied. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. Quality of life was assessed by means of the Medical Outcome Study (MOS) 36-Item Short-Form (SF-36) questionnaire. The Beck Depression Inventory (BDI-II) was used to assess depression, and the Trait Anxiety Scale (TA) from the State-Trait Anxiety Inventory was administered in order to assess anxiety. Moderating and mediating analyses were conducted with ordinary least squares multiple regression analysis using the SPSS General Linear Model procedure. Anxiety mediated the effect between headache frequency and quality of life, but not the effect of either headache intensity or duration. Anxiety totally mediated the effects of headache frequency on vitality, social functioning and mental health. On the other hand, depression modulated the effect in the mental health domain. The effect in the mental health domain was a function of the interaction between headache duration and depression (beta=-0.34, p<0.05), after controlling for age, gender, the main effects of headache duration, and depression. We did not find anxiety to be a moderating factor between intensity, frequency or duration of headache and perceived quality of life. Anxiety exerts a mediating effect, conditioning the relationship between headache frequency and some quality of life domains; depression seems to play an inherent role in the reduced quality of life of these patients, that is, it has a moderating effect.
Mazurka, R; Wynne-Edwards, K E; Harkness, K L
The strongest proximal predictors of depression onset in adolescence are stressful life events (SLEs). Changes in the hypothalamic-pituitary-adrenal (HPA) axis response to stress are theorized to mediate the etiological effect of SLEs on depression onset. The goal of the current study was to examine differences in the cortisol response to a laboratory-induced stressor between youth with versus without at least one SLE in the etiologically-central 3-month period prior to depression onset. One hundred adolescents (24 first-onset depression, 18 recurrent depression, and 58 non-depressed controls) had five salivary cortisol samples collected over the course of the Trier Social Stress Test (TSST). SLEs were assessed using a rigorous contextual interview and rating system. Among those with an SLE, youth on their first onset of depression had a flatter cortisol reactivity slope relative to non-depressed adolescents, and youth on a recurrent episode of depression had a steeper recovery slope relative to first-onsets and non-depressed adolescents. In contrast, no between-group differences were found among those with no SLE prior to onset. These results suggest that differences in the HPA axis response pattern may represent a neurobiological mechanism that distinguishes depressed and non-depressed groups but only for adolescents whose depression is precipitated by SLEs. Further, this neurobiological mechanism may play a different role in the very first episode of depression than it does in recurrent episodes.
Simonelli, Laura E.; Fowler, Jeffrey; Maxwell, G. Larry
Background Continuing symptoms and poor health following cancer treatments may alter meaning in life for cancer survivors. Gynecologic cancer survivors are particularly troubled with physical sequelae. In addition, for the most common sites of disease, such as breast and gynecologic cancers, the prevalence of depression is also high. Purpose This study tests meaning in life as a mechanism for the relationship between physical symptoms and depressive symptoms. Methods Gynecologic cancer survivors (N=260) participated. Measures of physical sequelae (nurse rated symptoms/signs, patient-reported gynecologic symptoms), meaning in life (harmony, life purpose, spirituality, and conversely, confusion and loss), and depressive symptoms were obtained at the time of a routine clinical follow-up visit 2–10 years following the completion of treatment. Latent variables were defined, and structural equation modeling tested a mediator model. Results Analyses support partial mediation. That is, survivors with more physical sequelae also reported lower levels of meaning in life, which was associated with higher levels of depressive symptoms. Conclusions Gynecologic cancer patients have been neglected in psychosocial research, and findings highlight the importance of existential issues in their lives. While many adjust well, those with persistent physical functioning deficits may experience depressive symptoms. By appreciating the role of meaning in their experience, we may help survivors foster their own growth and perspectives important for their future. PMID:18386113
Jungers, Christin M.
This article describes older adults' experiences of a late-life residential relocation from a home to a long-term health care setting. Findings from 14 participants who engaged in a focus group and/or an individual interview supported 8 major themes. Thematic experiences were related to precipitating factors prior to the move, risks and protective…
Adorno, Gail; Brownell, Gracie
U.S. Veterans have a higher prevalence of advanced lung cancer and poorer survival outcomes compared to the general population; yet, no studies exist which specifically explore the psychosocial and existential quality-of-life (QOL) of late-stage lung cancer among this population. This article presents the perspectives of older veterans (N = 12) living with late-stage lung cancer who were receiving chemotherapy, routine hospice care, or both concurrently. Based on individual interviews, themes associated with loss of functionality, close relationships, and communicative acts contributed to veterans' perceptions of diminished or enhanced QOL while living with advanced disease. An overarching theme, loss of the person I know myself to be, suggests that personhood is an important concept to consider in QOL assessment. While findings suggest that the experiences of older Veterans with late-stage lung cancer are similar to other populations of lung cancer patients, and persons with incurable cancer in general, further research regarding the influence of veteran identity at end-of-life is warranted. Further research is needed which explores the influence of a whole person approach to QOL during life-limiting illness and end-of-life decision-making, particularly while receiving late-stage cancer-directed therapy.
Boeri, Miriam Williams; Sterk, Claire E.; Elifson, Kirk W.
Purpose: Researchers' knowledge regarding older users of illicit drugs is limited despite the increasing numbers of users. In this article, we apply a life course perspective to gain a further understanding of older adult drug use, specifically contrasting early- and late-onset heroin users. Design and Methods: We collected qualitative data from…
Isherwood, Linda M.; King, Debra S.; Luszcz, Mary A.
Very little is known of the longitudinal changes that occur in contact with children and participation in social activities during late-life widowhood. Using data on social networks and activities drawn from the Australian Longitudinal Study of Ageing, trajectories of change in social engagement were modeled for 1,266 participants (mean age 76.7…
Barrera, Terri L.; Zeno, Darrell; Bush, Amber L.; Barber, Catherine R.; Stanley, Melinda A.
Generalized anxiety disorder (GAD) is common in older adults and, although cognitive behavioral therapy (CBT) is an efficacious treatment for late-life GAD, effect sizes are only moderate and attrition rates are high. One way to increase treatment acceptability and enhance current cognitive behavioral treatments for GAD in older adults might be to…
Brossoie, Nancy; Roberto, Karen A.; Barrow, Katie M.
Purpose: The purpose of this study was to gain insight into public awareness of intimate partner violence (IPV) in late life by how individuals respond to incidents of IPV reported in the newspaper. Design and Methods: Using grounded theory techniques, online news items covering 24 incidents of IPV in late life, and the reader comments posted to them were analyzed. The news items were examined for incident details, story framing, and reporting style. An open coding process (Charmaz, K. . Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage Publications.) was used to generate a comprehensive understanding of themes and patterns in the comments posted by readers. Results: Few posters indicated that incidents were episodes of IPV. As many posters struggled to make sense of incidents, they attempted to remove guilt from the perpetrator by assigning blame elsewhere. Comments were influenced by personal assumptions and perspectives about IPV, relationships, and old age; reporting style of the news items; and comments posted by other posters. Implications: Altering public views of IPV in late life requires raising awareness through education, reframing the ways in which information is presented, and placing greater emphasis on the context of the violence. By engaging interactive news media, reporters, participatory journalists, and policymakers can enhance public recognition and understanding of IPV in late life. PMID:22547086
Fischer, Barbara L.; Gunter-Hunt, Gail; Steinhafel, Courtney Holm; Howell, Timothy
Objective: Little data exist about ADHD in late life. While evaluating patients' memory problems, the memory clinic staff has periodically identified ADHD in previously undiagnosed older adults. The authors conducted a survey to assess the extent to which other memory clinics view ADHD as a relevant clinical issue. Method: The authors developed…
Background Poor mental health, especially due to depression, is one of the main public health problems. Early indicators of poor mental health in general population are needed. This study examined the relationship between long-term life dissatisfaction and subsequent mental health, including major depressive disorder. Method Health questionnaires were sent to a randomly selected population-based sample in 1998 and repeated in 1999 and 2001. In 2005, a clinically studied sub-sample (n = 330) was composed of subjects with (n = 161) or without (n = 169) repeatedly reported adverse mental symptoms at all three previous data collection times. Clinical symptom assessments were performed with several psychometric scales: life satisfaction (LS), depression (HDRS, BDI), hopelessness (HS), mental distress (GHQ), dissociative experiences (DES), and alexithymia (TAS). The long-term life dissatisfaction burden was calculated by summing these life satisfaction scores in 1998, 1999, 2001 and dividing the sum into tertiles. Psychiatric diagnoses were confirmed by SCID-I for DSM-IV in 2005. Logistic regression analyses were performed to assess the studied relationship. Results The previous life dissatisfaction burden associated with adverse socio-demographic, life style and clinical factors. In adjusted logistic regression analyses, it was independently and strongly associated with subsequent major depressive disorder in 2005, even when the concurrent LS score in 2005 was included in the model. Excluding those with reported major depressive disorder in 1999 did not alter this finding. Limitations MDD in 1999 was based on self-reports and not on structured interview and LS data in 2001-2005 was not available. Conclusions The life satisfaction burden is significantly related to major depressive disorder and poor mental health, both in cross-sectional and longitudinal settings. PMID:21861908
Vasilopoulou, Chrysoula; Bourtsi, Eirini; Giaple, Sophia; Koutelekos, Ioannis; Theofilou, Paraskevi; Polikandrioti, Maria
Material and Methods: The sample studied consisted of 395 hemodialysis patients. Data was collected by the completion of a specially designed questionnaire for the needs of the present study which apart from socio-demographic and clinical, it also included HADS scale to assess the level of anxiety and depression as well as the scale Missoula-VITAS Quality of Life Index (MVQOLI) to assess patients’ quality of life. Results: The results of this study showed that 47.8% had high anxiety levels and 38.2% had high levels of depression. The average total score of quality of life was found to be 17.14. It was also shown that the total score of quality of life presented statistically significant association with family status (p=0.007), educational level (p<0.001), the number of children (p=0.001), patients’ adherence to doctors’ orders (p=0.003) and proposed diet (p=0.002) and the relations of patients with healthcare professionals and the other patients (p<0.001). The multiple linear regression showed that the overall quality of life score was statistically associated with the levels of depression after adjusted for possible confounders. More specifically, it was found that total score of quality of life was 2.5 and 4.4 points lower for patients with moderate and high levels of depression, respectively, compared to patients with low levels of depression (p<0.001). Conclusions: Evaluation of anxiety and depression in conjunction with quality of life in hemodialysis patients should be an integral part of the therapeutic regimen. PMID:26234986
Christianson, Heidi Fowell; Weis, Jo M; Fouad, Nadya A
In this study, the question of whether using slightly illusionary, positive attributions of self, control, and meaning (e.g., cognitive adaptation theory), in the face of disconfirmatory evidence, facilitates quality of life in late-stage cancer patients was examined. Eighty late-stage cancer patients (Mean age = 59.7, SD = 12.5; 48.8% male, 51.2% female; varying cancer diagnoses) who recently failed or refused first line anti-neoplastic treatment completed questionnaires assessing meaning, control, self-esteem, and optimism, as well as physical and psychological quality of life. Findings suggest that greater self-esteem, control, and meaning predicted physical and psychological quality of life, with physical quality of life being influenced by control beliefs and psychological quality of life influenced by self-esteem. Optimism independently predicted physical quality of life and neither mediated nor moderated the relationship between cognitive adaptation and quality of life. Findings suggest that slightly positive, illusionary beliefs of self, control, and meaning predicted quality of life even in the presence of clear, disconfirmatory environmental evidence.
An, Tae-Gyu; Kim, Soo-Han; Kim, Ko-Un
[Purpose] The aim of this study was to assess the effects of transcranial direct current stimulation (tDCS) on depression and quality of life (QOL) in patients with stroke, by conducting conventional occupational therapy with and without tDCS on 20 patients each. [Subjects and Methods] The experimental group (N=20) received both tDCS and conventional occupational therapy, while the control group (N=20) received false tDCS and conventional occupational therapy. The treatment was conducted 20 times over a four-week period; each session was 30 minutes long. The Beck Depression Inventory (BDI) was administered to score the depression levels in patients before and after the intervention, while the stroke-specific quality of life (SS-QOL) was measured to compare the QOL. [Result] Following the intervention, the patients in the experimental group showed a significant decrease in depression and an increase in the QOL. In contrast, the control group showed no significant changes in depression or QOL. Our findings indicate that tDCS decreased depression while increasing QOL in patients with stroke. [Conclusion] In other words, our study confirmed that the application of tDCS during stroke rehabilitation improves the depression symptoms and QOL in patients. PMID:28356641
Sassoon, Stephanie A; Rosenbloom, Margaret J; Fama, Rosemary; Sullivan, Edith V; Pfefferbaum, Adolf
Alcoholism, HIV, and depressive symptoms frequently co-occur and are associated with impairment in cognition and life function. We administered the Beck Depression Inventory-II (BDI-II), measures of life function, and neurocognitive tests to 67 alcoholics, 56 HIV+ patients, 63 HIV+ alcoholics, and 64 controls to examine whether current depressive symptom level (significant, BDI-II>14 vs. minimal, BDI-II<14) was associated with poorer cognitive or psychosocial function in alcoholism-HIV comorbidity. Participants with significant depressive symptoms demonstrated slower manual motor speed and poorer visuospatial memory than those with minimal depressive symptoms. HIV patients with depressive symptoms showed impaired manual motor speed. Alcoholics with depressive symptoms showed impaired visuospatial memory. HIV+ alcoholics with depressive symptoms reported the poorest quality of life; alcoholics with depressive symptoms, irrespective of HIV status, had poorest life functioning. Thus, significant depressive symptoms were associated with poorer selective cognitive and life functioning in alcoholism and in HIV infection, even though depressive symptoms had neither synergistic nor additive effects on cognition in alcoholism-HIV comorbidity. The results suggest the relevance of assessing and treating current depressive symptoms to reduce cognitive compromise and functional disability in HIV infection, alcoholism, and their comorbidity.
Marmorstein, Naomi R.; Iacono, William G.; McGue, Matt
Aims To examine whether major depressive disorder (MDD) and substance use disorders (SUDs: specifically, nicotine dependence (ND), alcohol use disorders (AUDs), and cannabis use disorders (CUDs)) in parents predicted increased risk for these disorders in late adolescent–emerging adult offspring and, specifically, the extent to which the pattern of risk differed for adopted and non-adopted youth. Participants Late adolescent and emerging adult participants from the Sibling Interaction and Behavior Study (mean age=18.8), a community-based investigation of adopted and non-adopted adolescents, and their parents (adoptive parents of adopted youth, biological parents of non-adopted adolescents) were included. Measurements Structured interviews were used to assess these disorders. Findings (1) when the same disorder in parents and adolescents was examined, parental MDD was associated with increased risk for MDD among both adopted (p<.001) and non-adopted (p<.01) adolescents; in contrast, SUDs were associated with increased risk for the same SUD in non-adopted offspring (all p<.01). (2) When cross-SUD effects were examined, for the most part, each SUD was associated with increased risk for other SUDs among non-adopted but not adopted offspring (most p<.05). (3) When MDD-SUD associations were examined, parental ND and CUDs predicted increased risk for MDD in non-adopted (p<.001), but not adopted, adolescents. These effects tended to remain significant when adjusting for within-person comorbidity (p<.05). Conclusions Major depressive disorder in parents appears to be a risk factor for late adolescent-emerging adult major depressive disorder but not substance use disorder in offspring, with this risk being environmentally mediated. Substance use disorder in parents appears, via genetic mediation, to increase risk of substance use disorder in adolescent offspring, and cannabis and nicotine use disorders in parents similarly contribute to major depressive disorder in those
Alacacioglu, Ahmet; Yavuzsen, Tugba; Dirioz, Meliha; Yilmaz, Ugur
The aim of the present study is to investigate anxiety and depression levels and quality of life of Turkish breast cancer patients and their husbands with Beck depression, STAI scoring system, and EORTC-QLQ-C30 quality of life scale. Fifty-five patients with breast cancer undergoing chemotherapy who applied to Dokuz Eylul University Faculty of Medicine, Department of Oncology, and their husbands were included in this study. The series of forms including the questions regarding the demographic characteristics of the patient, Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and EORTC-QLQ-C30 (version 3) were completed during face-to-face interviews by trained interviewers for determination of the psychological status and quality of life of the patients. The mean Beck depression scores of patients and their husbands were 13 +/- 9.3 (range 2-46) and 7.9 +/- 5.7 (range 0-27) (P = 0.001). The mean STAI scores of patients and their husbands were 44.9 +/- 8.7 (range 20-58) and 41.7 +/- 8.0 (range 26-59) (P = 0.09).Twenty-nine percent of the patients and 5.4% of the husbands (Beck Depression scores > or = 17 points) were determined as depressive. It was determined that the EORTC-QLQ C30 physical and social function scales of the patients were significantly lower than their husbands. The difference of global quality of life scores and other function scales (role, cognitive, emotional function scales) between patients and their husbands were not significant. It was found that depression of breast cancer patients were significantly higher than their husbands. But there was no significant difference between the EORTC-QLQ C30 global quality of life scores and STAI scores of the breast cancer patients and their husbands.
Samek, Diana R; Wilson, Sylia; McGue, Matt; Iacono, William G
Few studies have investigated potential gender differences in the genetic and environmental influences on the prospective associations between parent-child conflict and later depression, a notable gap given substantial gender differences in rates of depression and suggestive evidence of differences in the etiology of depression among females and males. To fill this gap, we evaluated whether the prospective relationship between parent-child conflict and major depressive disorder symptoms varied as a function of parent-child gender composition. A combined twin and adoption sample was used (53% female; 85% European ancestry), containing 1,627 adolescent sibling pairs (789 monozygotic twin pairs, 594 dizygotic/full-biological pairs, 244 genetically unrelated pairs) with assessments at two time points in adolescence (approximate ages 15 and 18). Prospective associations between parent-child conflict and subsequent adolescent depression were explained predominately through common genetic influences for mother-daughter and mother-son pairs but less so for father-daughter and father-son pairs. Results support the notion that processes of gene-environment correlation involved in the prospective associations between parent-child conflict, and later adolescent depression appear to be less relevant to father-child relationships in comparison to mother-child relationships. Notably, results did not show that parent-child conflict was more relevant to the etiology of major depressive disorder (MDD) for girls than boys; gender differences in depression do not appear to be due to differences in the associations between parent-child conflict and child depression.
Dersch, Rick; Sarnes, Antonia A; Maul, Monika; Hottenrott, Tilman; Baumgartner, Annette; Rauer, Sebastian; Stich, Oliver
The prognosis and impact of residual symptoms on quality of life in patients with Lyme neuroborreliosis (LNB) is subject to debate. The aim of this study was to assess quality of life, fatigue, depression, cognitive impairment and verbal learning in patients with definite LNB and healthy controls in a case-control study. We retrospectively identified all patients diagnosed with definite LNB between 2003 and 2014 in our tertiary care center. Healthy controls were recruited from the same area. Patients and healthy controls were assessed for quality of life [Short Form (36) with subscores for physical and mental components (PCS, MCS)], fatigue (fatigue severity scale), depression (Beck depression inventory), verbal memory and learning and cognitive impairment (mini-mental state examination). 53 patients with definite LNB could be identified, of which 30 partook in the follow-up assessment. Estimates for quality of life, fatigue, depression, verbal memory and cognitive impairment did not differ statistically significantly between 30 patients with LNB and 35 healthy controls. Patients with residual symptoms had lower scores for quality of life (PCS) compared to patients without residual symptoms. Our results do not support the hypothesis that a considerable proportion of patients with antibiotically treated LNB develop a 'post Lyme syndrome' consisting of debilitating fatigue or cognitive impairment or have severe limitations of quality of life. However, some patients experience residual symptoms of LNB.
Renaud, Judith; Bédard, Emmanuelle
Background Visual impairment is more prevalent in the elderly and depression is common in this population. Although many studies have investigated depression or quality of life (QOL) in older adults with visual impairment, few have looked at the association between these two concepts for this population. The aim of this systematized review was to describe the association between depression and QOL in older adults with visual impairment. Methods A search was done using multiple electronic databases for studies addressing the relationship between QOL and depression in elders with visual impairment. The concept of QOL was divided into two different approaches, ie, QOL as achievement and QOL as subjective well-being. Comparison of QOL scores between participants with and without depression (Cohen’s d) and correlations between depression and QOL (Pearson’s r) were examined. Results Thirteen studies reported in 18 articles were included in the review. Nearly all of the studies revealed that better QOL was moderately to strongly correlated with less severe depressive symptoms (r = 0.22–0.68 for QOL as achievement; r = 0.68 and 0.72 for QOL as subjective well-being). Effect sizes for the QOL differences between the groups with and without depression ranged from small to large (d = 0.17 to 0.95 for QOL as achievement; no data for QOL as subjective well-being). Conclusion Additional studies are necessary to pinpoint further the determinants and mediators of this relationship. Considering the high prevalence rate of depression in this community and its disabling effects on QOL, interventions to prevent and treat depression are essential. More efforts are needed in clinical settings to train health care practitioners to identify depressed elders with visual impairment and provide appropriate treatment. PMID:23888110
Lawrence, Blake J; Gasson, Natalie; Kane, Robert; Bucks, Romola S; Loftus, Andrea M
This study examined whether activities of daily living (ADL) mediate the relationship between depression and health-related quality of life (HR-QOL) in people with Parkinson's disease (PD). A cross-sectional, correlational research design examined data from 174 participants who completed the Geriatric Depression Scale (GDS-15), Parkinson's Disease Questionnaire-39 (PDQ-39), and Unified Parkinson's Disease Rating Scale-section 2 (UPDRS-section 2 [ADL]). Multiple Regression Analysis (MRA) was used to examine the mediator model. Depression and ADL significantly (p<.001) predicted HR-QOL, and depression significantly (p<.001) predicted ADL. Whilst ADL did not impact on the relationship between depression and HR-QOL, there was a significant (p<.001) indirect effect of depression on HR-QOL via ADL, suggesting both direct and indirect (via ADL) effects of depression on HR-QOL. The magnitude of this effect was moderate (R2 = .13). People with PD who report depression also experience greater difficulty completing ADL, which impacts upon their HR-QOL. It is recommended that clinicians adopt a multidisciplinary approach to care by combining pharmacological treatments with psycho/occupational therapy, thereby alleviating the heterogeneous impact of motor and non-motor symptoms on HR-QOL in people with PD.
Sandman, Curt A.; Buss, Claudia; Head, Kevin; Davis, Elysia Poggi
Background Maternal depression is one of the most common prenatal complications. The consequences of fetal exposure to maternal depression are poorly understood. The aim of this study is to examine the association between fetal exposure to maternal depressive symptoms and cortical thickness in 6–9 year-old children. Methods A prospective, longitudinal study of maternal depressive symptoms at 19, 25 and 31 weeks gestation was followed by acquisition of a structural MRI scan in 81 children (86.1 ± 9.9 months). Results Significant (p<.01) cortical thinning in children primarily in the right frontal lobes was associated with exposure to prenatal maternal depression. The strongest association was at 25 weeks gestation; exposure to maternal depression at 25 gestational weeks was associated with cortical thinning in 19% of the whole cortex and 24% of the frontal lobes, primarily in the right superior, medial orbital and frontal pole regions of the prefrontal cortex (p<.01). The significant association between prenatal maternal depression and child externalizing behavior (p<.05) was mediated by cortical thinning in prefrontal areas of the right hemisphere. Conclusions The pattern of cortical thinning in children exposed to prenatal maternal depression is similar to patterns in depressed patients and in individuals with risk for depression. Exposure to prenatal depression coupled with subsequent cortical thinning was associated with presence of externalizing behavior in preadolescent children and may be prodromal markers of risk for dysphoria. Vulnerability to prenatal influences at 25 gestational weeks may result from the enormous growth and dramatic structural changes in the nervous system. PMID:25129235
Yang, Linsheng; Sun, Liang; Zhang, Zhihua; Sun, Yehuan; Wu, Hongyan; Ye, Dongqing
The aim of this study is to examine the mediating role of life events in the relation between Internet addiction and depression using an adolescent sample in China. A total of 3507 urban adolescent students were asked to complete the questionnaires including Young's Internet Addiction Scale, Adolescent Self-Rating Life Events Checklist, and Center for Epidemiologic Studies Depression Scale, Parent-Child Conflict Tactics Scales, and demographic characteristics. Path analyses demonstrated that life events fully mediated the relationship between Internet addiction and adolescent depression. Specificity for the mediating role of life events was demonstrated in comparison to alternative competing mediation models. The findings support our hypothesis that the effect of Internet addiction on adolescent depression is mediated by the life events. Further research is required to test the temporal relationship between Internet addiction and adolescent depression and explore mechanisms underlying the pathways leading to adolescent depression.
Diseases and Conditions Atypical depression By Mayo Clinic Staff Any type of depression can make you feel sad and keep you from enjoying life. However, atypical depression — also called depression with atypical features — means that ...
Dekker, Marielle C.; Ferdinand, Robert F.; van Lang, Natasja D. J.; Bongers, Ilja L.; van der Ende, Jan; Verhulst, Frank C.
Background: Limited information is available on gender differences and young-adult poor outcome in children and adolescents following distinct developmental trajectories of depressive symptoms. Methods: Parent information on depressive symptoms of 4- to 18-year-olds from an ongoing Dutch community-based longitudinal multiple-cohort study (N =…
Kolbert, Jered B.; Field, Julaine E.; Crothers, Laura M.; Schreiber, James B.
Although studies have found a relation between the use of relational aggression and depressive symptomatology, there is less evidence for the relation of the role of gender identity in these processes. Consequently, this study investigated the roles of social and relational aggression and feminine gender role identity in depressive symptoms among…
Slavich, George M.; Tartter, Molly A.; Brennan, Patricia A.; Hammen, Constance
Although exposure to a recent major life event is one of the strongest known risk factors for depression, many people who experience such stress do not become depressed. Moreover, the biological mechanisms underlying differential emotional reactions to social adversity remain largely unknown. To investigate this issue, we examined whether the endogenous opioid system, which is known to influence sensitivity to physical pain, is also implicated in differential risk for depression following socially painful targeted rejection versus non-targeted rejection life events. Adolescents (n = 420) enrolled in a large longitudinal birth cohort study had their recent stress exposure and current mental health status assessed using self-report and interview-based methods. Participants were also genotyped for the A118G polymorphism in the μ-opioid receptor gene (OPRM1, rs1799971), which has been found to influence neural and psychological responses to rejection, likely by affecting opioid receptor expression and signaling efficiency. As hypothesized, G allele carriers, who are known to exhibit less opioid receptor expression and signaling efficiency, were more severely depressed and twice as likely to meet criteria for major depressive disorder following a recent targeted rejection major life event (e.g., being broken up with, getting fired) relative to A/A homozygotes who experienced such stress. However, A118G genotype did not moderate the effects of other similarly severe major life events on depression. These data thus elucidate a biological pathway that may specifically influence sensitivity to social pain and rejection, which in turn has implications for understanding differential risk for depression and several other social stress-related disorders. PMID:25086307
Carlsson, Johanna; Wängqvist, Maria; Frisén, Ann
This study adds to the understanding of the dark side of identity development by investigating what it means to experience long-term identity diffusion during the late twenties. In a study of change and stability in identity status between ages 25 and 29 (N = 124; 63 women), seven participants were assigned to identity diffusion at both ages. Longitudinal analysis of interviews with these participants showed that long-term experiences of identity diffusion may be described through individuals' approach to changing life conditions, the extent to which they engage in meaning making, and how they develop their personal life direction. In questionnaires, participants reported few signs of psychological distress. Even so, qualitative analyses showed a general trend among participants to keep life on hold through decreased activity or increased haphazard activity in relation to changing life conditions, to make little new meaning, and in some cases to dissolve their personal life direction.
Leung, Beeto Wai-Chung; Moneta, Giovanni B.; Mcbride-Chang, Catherine
This study developed a dispositional path model of life satisfaction for community dwelling Chinese elderly living in Hong Kong. A sample of 117 elderly completed scales measuring life satisfaction, optimism, self-esteem, relationship harmony, self-construals, and perceived/expected health and financial status. Modeling revealed that life…
Hiranyatheb, Thanita; Nakawiro, Daochompu; Wongpakaran, Tinakon; Wongpakaran, Nahathai; Bookkamana, Putipong; Pinyopornpanish, Manee; Saisavoey, Nattha; Wannarit, Kamonporn; Satthapisit, Sirina; Tanchakvaranont, Sitthinant
Purpose Residual symptoms of depressive disorder are major predictors of relapse of depression and lower quality of life. This study aims to investigate the prevalence of residual symptoms, relapse rates, and quality of life among patients with depressive disorder. Patients and methods Data were collected during the Thai Study of Affective Disorder (THAISAD) project. The Hamilton Rating Scale for Depression (HAMD) was used to measure the severity and residual symptoms of depression, and EQ-5D instrument was used to measure the quality of life. Demographic and clinical data at the baseline were described by mean ± standard deviation (SD). Prevalence of residual symptoms of depression was determined and presented as percentage. Regression analysis was utilized to predict relapse and patients’ quality of life at 6 months postbaseline. Results A total of 224 depressive disorder patients were recruited. Most of the patients (93.3%) had at least one residual symptom, and the most common was anxiety symptoms (76.3%; 95% confidence interval [CI], 0.71–0.82). After 3 months postbaseline, 114 patients (50.9%) were in remission and within 6 months, 44 of them (38.6%) relapsed. Regression analysis showed that residual insomnia symptoms were significantly associated with these relapse cases (odds ratio [OR] =5.290, 95% CI, 1.42–19.76). Regarding quality of life, residual core mood and insomnia significantly predicted the EQ-5D scores at 6 months postbaseline (B =−2.670, 95% CI, −0.181 to −0.027 and B =−3.109, 95% CI, −0.172 to −0.038, respectively). Conclusion Residual symptoms are common in patients receiving treatment for depressive disorder and were found to be associated with relapses and quality of life. Clinicians need to be aware of these residual symptoms when carrying out follow-up treatment in patients with depressive disorder, so that prompt action can be taken to mitigate the risk of relapse. PMID:28003753
Kouris, Anargyros; Platsidaki, Eftychia; Christodoulou, Christos; Armyra, Kalliopi; Korkoliakou, Panagiota; Stefanaki, Christina; Tsatovidou, Revekka; Rigopoulos, Dimitrios; Kontochristopoulos, George
Background Bullous pemphigoid (BP) is a chronic, autoimmune blistering skin disease that affects patients' daily life and psychosocial well-being. Objective The aim of the study was to evaluate the quality of life, anxiety, depression and loneliness in BP patients. Methods Fifty-seven BP patients and fifty-seven healthy controls were recruited for the study. The quality of life of each patient was assessed using the Dermatology Life Quality Index (DLQI) scale. Moreover, they were evaluated for anxiety and depression according to the Hospital Anxiety Depression Scale (HADS-scale), while loneliness was measured through the Loneliness Scale-Version 3 (UCLA) scale. Results The mean DLQI score was 9.45±3.34. Statistically significant differences on the HADS total scale and in HADS-depression subscale (p=0.015 and p=0.002, respectively) were documented. No statistically significant difference was found between the two groups on the HADS-anxiety subscale. Furthermore, significantly higher scores were recorded on the UCLA Scale compared with healthy volunteers (p=0.003). Conclusion BP had a significant impact on quality of life and the psychological status of patients, probably due to the appearance of unattractive lesions on the skin, functional problems and disease chronicity. PMID:27828632
Sawant, Neena S.; Vanjari, Nakul A.; Khopkar, Uday; Adulkar, Satish
The precise cause of lichen planus is unknown, but the disease seems to be immunologically mediated. It is a psychocutaneous disorder. Due to scarcity of Indian studies in this field, we decided to study in patients of lichen planus the prevalence of depression and quality of life with comparison of the same in both the genders. Patients diagnosed as having lichen planus by consultant dermatologist were enrolled after informed consent and ethics approval. 45 patients were screened, of which 35 who satisfied the criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of dermatology life quality index and Beck's depression inventory. While 25% were depressed with females being more affected than males, quality of life was impaired in more than 90% patients. Impairment was maximum due to symptoms and illness feelings, disturbed daily activities, or work and time consumption in treatment. There was a strong association between depression and impairment in quality of life in both the genders. This study helps in early identification of psychological problems in lichen planus patients and in planning their future course of management, hence reducing the lack of productivity and improving the prognosis and quality of life. PMID:25802892
Chaudhury, Suprakash; Srivastava, Kalpana
Background. Despite, increasing number of percutaneous transluminal coronary angioplasty (PTCA) being performed, there is a paucity of Indian studies on the psychological effects of PTCA. Aim. To study the relation of anxiety, depression, and health related quality of life with outcome after PTCA. Methods. A total of 35 patients undergoing PTCA were included in the present project with their informed consent. All patients filled a specially designed proforma, the Hospital Anxiety and Depression Scale, Coronary Scale, Seattle Angina Questionnaire, and a health related quality of life measure (EQ 5D) one day before undergoing PTCA. Three days after PTCA patients were reassessed with the Hospital anxiety & depression scale, Seattle angina questionnaire and the EQ 5D. Results. Analysis showed that 46% had significant anxiety and 32.1% had significant depression before PTCA. Following successful PTCA, none of the patients had significant anxiety, and only 2 (3.6%) had significant depression. On the Seattle Angina Questionnaire, physical limitation reduced from 67.9 to 48. Disease perception improved from 21.2 to 37.1. On the EQ5D, the health status improved from 42.7 before PTCA to 78.7 after PTCA. Conclusion. Successful PTCA resulted in significant reduction in anxiety, depression, and physical limitation and improvement in disease perception and health status. PMID:24319368
González, Bertha Cecilia Salazar; Delgado, Leticia Hernández; Quevedo, Juana Edith Cruz; Gallegos Cabriales, Esther C
Mobility in older adults is essential to preserving their physical independence and health. Changes in mobility are related to cognitive, physical, and emotional factors, among others. We explored symptoms of depression as a mediator variable between chronic diseases and comorbidities and the outcomes of perceived health and life-space mobility in a convenience sample of 135 older Mexican adults. A cross-sectional design was used. Simple and multiple linear regression models were adjusted to verify the assumptions of mediation using Baron and Kenny's model. Chronic diseases and comorbidities served as independent variables in two separate models, perceived health and life-space mobility served as dependent variables, and depressive symptoms as the mediator variable. Results showed that perceived health and life-space mobility are affected by chronic diseases and comorbidities. However, when symptoms of depression enter the equation, the β coefficients decreased suggesting partial mediation. It is important to assess and treat depression symptoms in older adults rather than assuming that, at their age, depression is normal.
Swendsen, J D; Compagnone, P
This prospective study provided a direct comparison of French and American samples concerning a cognitive diathesis for depression. Using the Experience Sampling Method and identical measures across sites, subjects were signaled five times daily by electronic devices to provide in vivo reports of negative events, attributions, and depressed moods. After controlling for effects associating clinical and demographic variables, and despite differences attributable to national origin, attributional style emerged as a highly significant predictor of the numerous specific attributions made to negative events within the course of daily life. However, consistent with the cognitive mediation hypothesis, attributional style did not directly explain depression levels. The results are discussed in terms of the predictive power of cognitive and personality assessments in understanding the day-to-day experience of depression.
Koistinen, Eeva; Hintikka, Jukka
Introduction. The aim of this study is to assess how negative life events and adverse experiences with pregnancy, delivery, the infant(s), and breastfeeding cessation impact on postpartum depression (PPD), specifically in first lifetime and recurrent depression. Method. The study group comprised 104 mothers with a current episode of PPD and a control group of 104 mothers who did not have current PPD. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used for data collection. The course of the depression, adverse experiences, and breastfeeding were assessed by self-reports. Results. In age-adjusted multivariate analyses, mental and physical problems during pregnancy or delivery, postpartum problems with the infant and breastfeeding cessation, and negative life events during the previous 12 months were associated with postpartum depression. Eighteen percent (18%) of the mothers had first depression and 82% recurrent depression. Mental and physical problems during pregnancy or delivery were associated with both first lifetime and recurrent depression. Nevertheless, negative life events and infant/breastfeeding issues associated only with recurrent depression. Conclusion. Factors associated with pregnancy and delivery have an impact on PPD, but in recurrent depression other postnatal and psychosocial factors are also important risk factors. PMID:27847645
Shittu, Rasaki O.; Issa, Baba A.; Olanrewaju, Ganiyu T.; Mahmoud, Abdulraheem O.; Odeigah, Louis O.; Sule, Abdullateef G.
Background: People Living with HIV/AIDS (PLWHA) continue to face persistent and deep rooted social barriers. Incidentally, studies in social determinants of depression are very limited, necessitating this study, which examined social determinants of depression and the impact of these determinants on depression. Methods: This was a hospital based, cross sectional descriptive study of three hundred adult HIV/AIDS patients, attending the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, Nigeria. Depressive symptoms were measured by the PHQ-9 rating scale. Three variables of social determinants of depression: socio-economic status (years of school and self-reported economic status of family), social cohesion, and negative life events were examined. Results: The self-reported economic status of the family varied from good 35(11.7%), average 162(54%), and poor among 103(34.3%) of the respondents. Social cohesion was low in 199(66.3%), fair in 65(21.7%) and high among 36(12%) of the respondents. There was significant association between social cohesion, negative life events, and depression. Conclusion and Global Health Implications: Income was the most significant socio-economic determinant. Majority had very low social cohesion and more negative life events, while those with below average years of schooling were more depressed. These are statistically significant. Social determinants of depression should be given a lot of emphasis, when addressing the issue of depression, if we are to meaningfully tackle this increasing scourge in our society. PMID:27621970
Kruijt, Anne-Wil; Putman, Peter; Van der Does, Willem
Studies associating interactions of 5-HTTLPR and life adversities with depression have yielded equivocal results. Studying endophenotypes may constitute a more powerful approach. In the current study, it was assessed whether interactions of 5-HTTLPR with childhood emotional abuse (CEA) and recent negative life events (RNLE) affect possible cognitive endophenotypes of depression, namely, attention-allocation bias and the ability to recognise others' mind states in 215 young adults of North-West European descent. The ability to classify others' negative mind states was found to be increased with increasing RNLE in carriers of low-expressing Serotonin Transporter Linked Polymorphic Region (5-HTTLPR) alleles. Carriers of two low-expressing alleles also preferentially oriented attention towards negative information. Gene-environment interactions were not observed for attention allocation bias. No effects involving CEA were observed. These results suggest that low-expressing 5-HTTLPR alleles may confer increased risk for depression through enhanced recognition of negative facial expressions following RNLE.
Mahatme, S.S.; Dhavale, H.S.; Patkar, A.P.
SUMMARY 60 patients suffering from “Depression” attending the Psychiatry outpatient clinic in a general hospital were studied. The intensity of symptoms, and life stress events for 12 months prior to episode were obtained and compared on the basis of sex of patient. The findings of the study indicate that, the depressed patients had the severity of symptomatology positively correlated with the severity of stress. Thus with the increase in stress, the severity of symptoms would be on increase. The findings also indicated the distribution of more physical and affective symptoms in depressed females and more of behavioural symptoms in depressed males. It was seen that occurrence of undesirable life events which could be specific for Indian culture were perceived more than desirable events by the sample. PMID:21927402
Tolstoy, the author of two masterpieces, War and Peace and Anna Karenina, remains a writer of genius. Yet, after writing War and Peace, his existence had been torn apart by a serious depression. This depression, which was melancholic in character, almost destroyed him and, once he had finished Anna Karenina, led him to want to renounce not only sexuality but also literary creation and material possessions. Through examining Tolstoy's life and work, the author tries to uncover the underground paths of this depression, which emerged brutally in the middle of his life, and to understand why his creative genius dried up. Like Leonardo da Vinci, Tolstoy turned away from his artistic work, declaring that 'art is not only useless but even harmful', and thereafter devoted himself to philosophical, political and religious writings. These new sublimations would help him to recover his health.
Tolstoy, the author of two masterpieces, War and Peace and Anna Karenina, remains a writer of genius. Yet, after writing War and Peace, his existence had been torn apart by a serious depression. This depression, which was melancholic in character, almost destroyed him and, once he had finished Anna Karenina, led him to want to renounce not only sexuality but also literary creation and material possessions. Through examining Tolstoy's life and work, the author tries to uncover the underground paths of this depression, which emerged brutally in the middle of his life, and to understand why his creative genius dried up. Like Leonardo da Vinci, Tolstoy turned away from his artistic work, declaring that 'art is not only useless but even harmful', and thereafter devoted himself to philosophical, political and religious writings. These new sublimations would help him to recover his health.
Serafini, Gianluca; Montebovi, Franco; Lamis, Dorian A; Erbuto, Denise; Girardi, Paolo; Amore, Mario; Pompili, Maurizio
AIM: To investigate the potential associations among major depression, quality of life, and suicidal behavior in human immunodeficiency virus (HIV) patients. METHODS: A detailed MEDLINE search was carried out to identify all articles and book chapters in English published from January 1995 to January 2015. RESULTS: Based on the main findings, the prevalence of major depressive disorder (MDD) ranged from 14.0% to 27.2%. Furthermore, the prevalence of suicidal ideation varied from 13.6% to 31.0% whereas, attempted suicides were reported to range from 3.9% to 32.7%. Interestingly, various associated risk factors for both depression and suicide were identified in HIV patients. Finally, consistent associations were reported among MDD, suicidal ideation, and poor quality of life in individuals living with HIV. CONCLUSION: Although additional studies are needed to elucidate this complex association, our results suggest the importance of early detection of both MDD and suicidality in patients living with HIV. PMID:26279991
Choi, Namkee G; Jun, Jina
We examined the contents and intensities of both life regrets and pride among a convenience sample of 213 low-income older adults and the associations between the contents and intensities of life regrets and pride, on the one hand, and the older adults' current life stressors, coping resources and depressive symptoms, on the other. Regrets about education, career and marriage were common, but intensities of regrets were higher for issues related to finance/money, family conflict and children's problems, loss and grief, and health. Common sources of pride were related to children and parenting, career, volunteering/informal caregiving, long/strong marriage and personal growth/self. Controlling for current life stressors of disability, money worries, loneliness and overdependence on others for management of daily life, and coping resources of social support and religiosity, the intensities of loss-and-grief related regrets and the pride in long/strong marriage were significant predictors of the Geriatric Depression Scale (GDS) scores. However, the regrets and pride explained a small amount of the variance in the GDS scores, while the current life stressors explained a large portion of the variance.
Clouston, Sean; Lawlor, Andrea; Verdery, Ashton
This study examined the socioeconomic pathways linking partnership status to physical functioning, assessed using objective measures of late life physical functioning including peak flow and grip strength. Using Wave 4 of the Survey of Health, Ageing and Retirement in Europe (SHARE), we ran multilevel models to examine the relationship between partnership status and physical function in late life, adjusting for social-network characteristics, socioeconomic factors, and health behaviours. We found a robust relationship between partnership status and physical function. Incorporating social-network characteristics, socioeconomic factors, and health behaviours showed independent robust relationships with physical function. Co-variates attenuated the impact of cohabitation, separation, and widowhood on physical function; robust effects were found for singlehood and divorce. Sex-segregated analyses suggest that associations between cohabitation, singlehood, divorce, and widowhood were larger for men than for women. Results suggest that social ties are important to improved physical function. PMID:25222477
Schultz, Susan K; Moser, David J; Bishop, Jeffrey R; Ellingrod, Vicki L
Anxiety in late-life may functionally impair the older adult. In this study the polymorphic region 5HTTLPR of the SLC6A4 gene was examined in relation to phobic anxiety and cognitive function. Sixty-four community-dwelling older adults were genotyped for the 5HTTLPR polymorphism to examine whether late-life phobias are associated with the short (s) allele and whether cognitive impairment may precipitate phobic behaviors in association with the s allele. Our findings suggested that phobic anxiety symptoms are significantly related to lower cognitive function. However, in this sample we did not detect a significant association between phobic anxiety and the 5HTTLPR genotype. The interaction between age-related changes in cognition and anxiety remain an important area for future studies.
Clouston, Sean A P; Lawlor, Andrea; Verdery, Ashton M
This study examined the socioeconomic pathways linking partnership status to physical functioning, assessed using objective measures of late life physical functioning, including peak flow and grip strength. Using Wave 4 of the Survey of Health, Ageing and Retirement in Europe (SHARE), we ran multilevel models to examine the relationship between partnership status and physical function in late life, adjusting for social-network characteristics, socioeconomic factors, and health behaviours. We found a robust relationship between partnership status and physical function. Incorporating social-network characteristics, socioeconomic factors, and health behaviours showed independent robust relationships with physical function. Co-variates attenuated the impact of cohabitation, separation, and widowhood on physical function; robust effects were found for singlehood and divorce. Sex-segregated analyses suggest that associations between cohabitation, singlehood, divorce, and widowhood were larger for men than for women. Results suggest that social ties are important to improved physical function.
Ashby, Jeffrey S.; Noble, Christina L.; Gnilka, Philip B.
This study examined the relationship between adaptive and maladaptive perfectionism, stress, depression, and satisfaction with life in a sample of undergraduate women. The authors found that maladaptive perfectionists had lower satisfaction with life and higher stress and depression scores compared with adaptive perfectionists. Results also…
Luby, Joan L.; Belden, Andy C.; Spitznagel, Edward
Background: Family history of mood disorders and stressful life events are both established risk factors for childhood depression. However, the role of mediators in risk trajectories, which are potential targets for intervention, remains understudied. To date, there have been no investigations of mediating relationships between risk factors and…
Goksel Karatepe, Altlnay; Kaya, Taciser; Gunaydn, Rezzan; Demirhan, Aylin; Ce, Plnar; Gedizlioglu, Muhtesem
Aim: The aim of this study was to assess the quality of life (QoL) in patients with multiple sclerosis (MS), and to evaluate its association with disability and psychosocial factors especially depression and fatigue. Methods: Demographic characteristics, education level, disease severity, and disease duration were documented for each patient. QoL,…
Juhasz, Gabriella; Hullam, Gabor; Eszlari, Nora; Gonda, Xenia; Antal, Peter; Anderson, Ian Muir; Hökfelt, Tomas G. M.; Deakin, J. F. William; Bagdy, Gyorgy
Galanin is a stress-inducible neuropeptide and cotransmitter in serotonin and norepinephrine neurons with a possible role in stress-related disorders. Here we report that variants in genes for galanin (GAL) and its receptors (GALR1, GALR2, GALR3), despite their disparate genomic loci, conferred increased risk of depression and anxiety in people who experienced childhood adversity or recent negative life events in a European white population cohort totaling 2,361 from Manchester, United Kingdom and Budapest, Hungary. Bayesian multivariate analysis revealed a greater relevance of galanin system genes in highly stressed subjects compared with subjects with moderate or low life stress. Using the same method, the effect of the galanin system genes was stronger than the effect of the well-studied 5-HTTLPR polymorphism in the serotonin transporter gene (SLC6A4). Conventional multivariate analysis using general linear models demonstrated that interaction of galanin system genes with life stressors explained more variance (1.7%, P = 0.005) than the life stress-only model. This effect replicated in independent analysis of the Manchester and Budapest subpopulations, and in males and females. The results suggest that the galanin pathway plays an important role in the pathogenesis of depression in humans by increasing the vulnerability to early and recent psychosocial stress. Correcting abnormal galanin function in depression could prove to be a novel target for drug development. The findings further emphasize the importance of modeling environmental interaction in finding new genes for depression. PMID:24706871
In light of continuing disagreement, even at the meta-analytic level, as to whether the gene- × -environment (G×E) interaction involving 5-HTTLPR and stressful life events (SLEs) predicts depression, Bogdan and associates (this issue, Bogdan et al., 2014) sought to extend research on what has become a highly controversial general (GxE) and…
Viola, Reka; Lovas, Kornelia; Szabo, Zoltan; Czenner, Zsuzsanna; Meads, David M; Soos, Gyongyver; McKenna, Stephen P
The paper describes the adaptation and psychometric evaluation of the Hungarian version of the quality of life in depression scale. The adaptation procedure involved: bilingual translation; field-testing for face and content validity; and assessment of instrument's reliability and construct validity. The new language version was shown to be well-accepted by respondents and to have excellent psychometric properties.
DeForge, Bruce R.; Belcher, John R.; O'Rourke, Michael; Lindsey, Michael A.
This study explored the relationship between personal resources and previous adverse life events such as homelessness and depression. Participants were recruited from two church sponsored multisite social service centers in Anne Arundel County, Maryland. The interview included demographics and several standardized scales to assess history of…
Colarusso, C A
This is the sixth and final paper in a series by the author on the normative, intrapsychic experience of time throughout the life cycle. Time sense is understood to be shaped by the primary forces that influence development at all points in the life cycle: an amalgam of past temporal conceptualizations, current developmental themes, and environmental influences. After a summary of the development of time sense in infancy, childhood, adolescence, and young and middle adulthood, this paper focuses on the experience of time after age sixty. The effect of death awareness and death anticipation, life reviews, reminiscence, and object relationships is discussed, as is the emergence of late-life generativity and wisdom. These concepts are illustrated by clinical material from the analysis of seventy-year-old woman.
Bengtson, Angela M; Pence, Brian W; O'Donnell, Julie; Thielman, Nathan; Heine, Amy; Zinski, Anne; Modi, Riddhi; McGuinness, Teena; Gaynes, Bradley
Improving quality of life (QOL) for HIV-infected individuals is an important objective of HIV care, given the considerable physical and emotional burden associated with living with HIV. Although worse QOL has been associated with depression, no research has quantified the potential of improvement in depression to prospectively improve QOL among HIV-infected adults. We analyzed data from 115 HIV-infected adults with depression enrolled in a randomized controlled trial to evaluate the effectiveness of improved depression care on antiretroviral drug adherence. Improvement in depression, the exposure of interest, was defined as the relative change in depression at six months compared to baseline and categorized as full response (≥50% improvement), partial response (25-49% improvement), and no response (<25% improvement). Multivariable linear regression was used to investigate the relationship between improvement in depression and four continuous measures of QOL at six months: physical QOL, mental QOL, HIV symptoms, and fatigue intensity. In multivariable analyses, physical QOL was higher among partial responders (mean difference [MD] = 2.51, 95% CI: -1.51, 6.54) and full responders (MD = 3.68, 95% CI: -0.36, 7.72) compared to individuals who did not respond. Mental QOL was an average of 4.01 points higher (95% CI: -1.01, 9.03) among partial responders and 14.34 points higher (95% CI: 9.42, 19.25) among full responders. HIV symptoms were lower for partial responders (MD = -0.69; 95% CI: -1.69, 0.30) and full responders (MD = -1.51; 95% CI: -2.50, -0.53). Fatigue intensity was also lower for partial responders (MD = -0.94; 95% CI: -1.94, 0.07) and full responders (MD = -3.00; 95% CI: -3.98, -2.02). Among HIV-infected adults with depression, improving access to high-quality depression treatment may also improve important QOL outcomes.
Fisher, Helen L.; Cohen-Woods, Sarah; Hosang, Georgina M.; Uher, Rudolf; Powell-Smith, Georgia; Keers, Robert; Tropeano, Maria; Korszun, Ania; Jones, Lisa; Jones, Ian; Owen, Mike; Craddock, Nick; Craig, Ian W.; Farmer, Anne E.; McGuffin, Peter
Background An interaction between recent stressful life events (SLEs) and a serotonin transporter promoter polymorphism (5-HTTLPR) in depression has been inconsistently reported. Some of this variability may be due to a previous focus on sub-clinical depression, inclusion of individuals at the lower or upper ends of the age-span, or assumptions concerning the degree of dominance of the low expressing allele. Therefore, a large sample of patients with recurrent clinically diagnosed depression and controls screened for absence of depression was utilised to examine the moderating effect of each 5-HTTLPR genetic model on the association between SLEs and severe depressive episodes. Method A sample of 1236 recurrent unipolar depression cases and 598 age-matched, never psychiatrically ill controls completed the List of Threatening Experiences Questionnaire to assess the number of SLEs experienced in the 6 months prior to the most severe depressive episode (cases) or interview (controls). DNA extracted from blood or cheek swabs was genotyped for the short (s) and long (l) alleles of 5-HTTLPR. Results A greater number of SLEs were reported by cases than controls and this held across all genotypic groups. There was no main effect of 5-HTTLPR on depression and no evidence of interaction between total SLEs and any of the 5-HTTLPR genetic models. The results were the same for men and women. Limitations Utilisation of retrospective self-reported SLEs may have reduced the accuracy of the findings and the cross-sectional design prevents causal inference. Conclusions This study failed to find evidence of gene-environment interplay in recurrent clinical depression. PMID:21982504
Eggleston, Karen N.; Fuchs, Victor R.
The share of increases in life expectancy realized after age 65 was only about 20 percent at the beginning of the 20th century for the US and 16 other countries at comparable stages of development; but that share was close to 80 percent by the dawn of the 21st century, and is almost certainly approaching 100 percent asymptotically. This new demographic transition portends a diminished survival effect on working life. For high-income countries at the forefront of the longevity transition, expected lifetime labor force participation as a percent of life expectancy is declining. Innovative policies are needed if societies wish to preserve a positive relationship running from increasing longevity to greater prosperity. PMID:25076810
Kahana, Eva; Bhatta, Tirth; Lovegreen, Loren D.; Kahana, Boaz; Midlarsky, Elizabeth
Objectives We examined the influence of prosocial orientations including altruism, volunteering, and informal helping on positive and negative well-being outcomes among retirement community dwelling elders. Method We utilize data from 2 waves, 3 years apart, of a panel study of successful aging (N = 585). Psychosocial well-being outcomes measured include life satisfaction, positive affect, negative affect, and depressive symptomatology. Results Ordinal logistic regression results indicate that altruistic attitudes, volunteering, and informal helping behaviors make unique contributions to the maintenance of life satisfaction, positive affect and other well being outcomes considered in this research. Predictors explain variance primarily in the positive indicators of psychological well-being, but are not significantly associated with the negative outcomes. Female gender and functional limitations are also associated with diminished psychological well-being. Discussion Our findings underscore the value of altruistic attitudes as important additional predictors, along with prosocial behaviors in fostering life satisfaction and positive affect in old age. PMID:23324536
Besser, Lilah M; Alosco, Michael L; Ramirez Gomez, Liliana; Zhou, Xiao-Hua; McKee, Ann C; Stern, Robert A; Gunstad, John; Schneider, Julie A; Chui, Helena; Kukull, Walter A
Vascular risk factors (VRFs) have been associated with clinically diagnosed Alzheimer disease (AD), but few studies have examined the association between VRF and AD neuropathology (ADNP) in cognitively normal individuals. We used longitudinal data from the National Alzheimer's Disease Center's Uniform Data Set and Neuropathology Data Set to examine the association between VRF and ADNP (moderate to frequent neuritic plaques; Braak stage III-VI) in those with normal cognition. Our sample included 53 participants with ADNP and 140 without ADNP. Body mass index (BMI), resting heart rate (HR), and pulse pressure (PP) were measured at each visit; values were averaged across participant visits and examined annual change in BMI, PP, and HR. Hypertension, diabetes, and hypercholesterolemia were self-reported. In the multivariable logistic regression analyses, average BMI and HR were associated with lower odds of ADNP, and annual increases in HR and BMI were associated with higher odds of ADNP. A previously experienced decline in BMI or HR in late-life (therefore, currently low BMI and low HR) as well as a late-life increase in BMI and HR may indicate underlying AD pathology. Additional clinicopathological research is needed to elucidate the role of changes in late-life VRF and AD pathogenesis.
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... is in crisis, get help quickly. Reprints Share Depression Basics Download PDF Download ePub Order a free ... a serious but treatable mood disorder. What is depression? Everyone feels sad or low sometimes, but these ...
Aminisani, Nayyereh; Nikbakht, Hosseinali; Asghari Jafarabadi, Mohammad
Background The aim of this study was to examine the relationship between psychological distress and quality of life (QOL) dimensions in colorectal cancer (CRC) patients. Methods This cross-sectional study was conducted in the North of Iran. A total of 157 CRC survivors were selected from the registry database and included in this study. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS) and QOL was estimated using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ C-30). The association between the patients’ emotional functioning (EF) score on EORTC QLQ-C30 and their HADS scores was analysed through multiple linear regression. Results In statistical terms, there were significantly negative relationships between EF and HADS-A (anxiety), and between HADS-D (depression) and HADS-T (total score). However, compared with HADS-A, the correlation between HADS-D and other QOL dimensions was significantly higher. By the same token, depression rather than anxiety was more strongly associated with reduced QOL. Conclusions The EF dimension of the EORTC QLQ-C30 predominantly assesses anxiety; however, depression has a stronger impact on the global QOL of patients than anxiety. Therefore, the use of an additional instrument is recommended for the assessment of depression in outpatients with CRC. PMID:28280612
Tan, Shu Hui; Tang, Catherine; Ng, Winnie W N; Ho, Cyrus S H; Ho, Roger C M
Quality of Life (QOL) is reported to be lower for patients with depression than the general population. This study aims to investigate the mediational effects of protective resource factors (PSFs), such as depressive symptom management ability, self-efficacy, social support and problem-focused coping act, in the relationship between dysfunctional attitudes and QOL. It is hypothesized that these PSFs have different mediating strengths. Self-report questionnaires which aimed to determine the influences of these PSFs through a multiple mediation framework were completed by 80 depressed adult outpatients from the National University Hospital of Singapore. PSFs have different influence on mental and physical QOL. Depressive symptom management ability is the most important PSF mediating both domains and better problem-focused coping abilities demonstrate improvement in the physical domain of QOL. Self-efficacy and social support are shown to be non-significant mediators. The results suggest for future effective interventions to focus primarily on improving depression patients' symptom management ability and problem-focused coping skills to raise their life quality. Furthermore, findings from this study have implications on the future investigation of QOL as a unitary construct.
Dan, Amitava; Kumar, Suresh; Avasthi, Ajit; Grover, Sandeep
Depression in schizophrenia has been recognized as one of the important factors influencing the Quality of Life (QOL). For this study 60 patients with a clinical diagnosis of schizophrenia as per ICD-10 (DCR version) were divided into two groups (with and without depression) on the basis of their score on Calgary Depression Rating Scale for Schizophrenia (CDSS). Thereafter, all patients were assessed on Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on Lehman Quality of Life Interview (QOLI)-brief version for QOL, on World Health Organization Disability Assessment Schedule-II (WHODAS-II) for disability, on UKU Side Effect Rating Scale for side effects of drugs and on Social Support Questionnaire (SSQ) for perceived social support. The two (depressed and non-depressed schizophrenia) groups differed significantly on symptoms of general psychopathology of PANSS and disability as per WHODAS-II, with the depressed group scoring higher. In the total sample, positive symptoms and the symptoms of general psychopathology of PANSS had a strong negative correlation with all three (subjective, objective and combined) domains of QOL, whereas, disability and medication side effects had a negative correlation with subjective and combined domains of QOL. CDSS total score did not significantly correlate with QOL. General psychopathology symptoms of PANSS emerged as the sole significant predictor of subjective and combined QOL, while positive symptoms of PANSS emerged as the sole predictor of objective QOL. Hence, it can be concluded that general psychopathology on PANSS had significant effect whereas depression as rated on CDSS had no significant effect on QOL in patients with schizophrenia. Treatments to improve QOL in schizophrenia should focus on symptoms of general psychopathology of PANSS.
Michalak, Erin E; Tam, Edwin M; Manjunath, C V; Solomons, Kevin; Levitt, Anthony J; Levitan, Robert; Enns, Murray; Morehouse, Rachel; Yatham, Lakshmi N; Lam, Raymond W
Although a relatively large body of research has now accumulated concerning the relationship between quality of life (QoL) and nonseasonal depression, there is a dearth of information about QoL in seasonal affective disorder (SAD). The aim of this study was to compare perceived levels of broad ('generic') and health-related QoL in patients with seasonal and nonseasonal depression. Participants were 72 patients with SAD enrolled in an on-going multicentre study in Canada, and 72 patients with nonseasonal major depressive disorder (MDD) matched for severity of depression attending an outpatient psychiatric clinic in Vancouver, British Columbia. All participants completed two measures of QoL (the 20-item Medical Outcomes Study [MOS] Short-Form General Health Survey [SF-20] and the Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q]) at baseline prior to treatment. The results of the study indicated that both generic and health-related QoL were compromised in patients with SAD compared with general population norms. For example, mean Q-LES-Q scores (range 0-100, where higher scores indicate better QoL) were 44%, compared with scores of 83% reported for the general population. Patients with nonseasonal depression showed significantly poorer functioning in several domains on the SF-20, but no significant differences in Q-LES-Q scores emerged. Perceived QoL is impaired in patients with SAD. Degree of impairment between seasonal and nonseasonal depressives is equivalent when assessed using the Q-LES-Q, but significant inter-group differences are apparent in SF-20 domain scores. Future research is required to determine whether perceived QoL is improved by treatment interventions for seasonal depression such as light therapy or antidepressant medication.
Kindt, Karlijn C M; Kleinjan, Marloes; Janssens, Jan M A M; Scholte, Ron H J
Previous research has established that cognitive theory-based depression prevention programs aiming change in negative cognitive style in early adolescents do not have strong effects in universal settings. Although theories suggest that a negative cognitive style precedes depressive symptoms, empirical findings are mixed. We hypothesized that negative cognitive style may not predict depressive symptoms in adolescents with normative depressive symptoms. Depressive symptoms, negative cognitive style and dependent negative life events were assessed in young adolescents (N = 1343; mean age = 13.4 years, SD = 0.77; 52.3 % girls) at four time points over an 18-month period. Using a cross-lagged panel design, results revealed that depressive symptoms predicted a negative cognitive style but not vice versa. However, when including dependent negative life events as a variable, depressive symptoms did not prospect a negative cognitive style consistently. When dependent negative life events were used as a time-varying covariate, depressive symptoms and a negative cognitive style were not related. We concluded that negative cognitive style is not predictive of depressive symptoms in a community sample of young adolescents. Moreover, the findings suggest that longitudinal relationships between depressive symptoms and a negative cognitive style are not meaningful when dependent negative life events are not considered.
Habermas, Tilmann; Ott, Lisa-M; Schubert, Merve; Schneider, Beatrix; Pate, Anna
This study attempted to replicate negative bias and depressive explanatory style in depression using life narratives. The two central aspects of narrative, temporal succession and evaluation, were also explored. These aspects were tested for the first time using entire life narratives of 17 depressed inpatients and non-depressed controls matched for sex and educational level. Negative bias and depressive explanatory style were replicated as typical for the depressed group. Life narratives of depressed patients also deviated more from a linear temporal order and compared less frequently the past with the present. Contrary to expectations, the depressed did not differ in the overall frequency of evaluations. However, they used more past than present evaluations and more experience-near evaluations than cognitive evaluations, suggesting that they are more immersed in past experiences. It is concluded that negative bias and depressive explanatory style can be found also in a naturalistic narrative measure, and that depression affects the two major aspects of narrative. It is argued that life narratives, as measures close to everyday clinical practice and as the most encompassing form of self-representation, should complement more experimental procedures in the study of cognitive and communicative processes in psychopathology.
Krause, Neal; Hayward, R David
Research indicates that greater involvement in activities is essential for successful aging. The purpose of the current study is to examine a construct that motivates involvement in activities-finding interests in life. In the process, we also show how involvement in religion may help promote interests. In order to examine these issues, a conceptual model is tested that contains the following core hypotheses: (1) older people who go to church more often will be more likely to have stronger God-mediated control beliefs (i.e., the belief that God works together with people to resolve problems and reach desired goals); (2) older adults with a stronger sense of God-mediated control will be more likely to find things in life that are interesting; and (3) older individuals with more interests experience a greater sense of self-worth over time. Findings from a nationwide survey provide support for the key relationships described above.
Liddle, Jeannine L M; Parkinson, Lynne; Sibbritt, David W
The fourth age, as the last stage of life, represents a final challenge to find personal meaning in the face of changing capacities, illness and disability. Participation in valued activities is important for sustaining interest in life and has been associated with enhanced health and well-being. Art and craft activities are a popular form of participation amongst women in late life with growing international interest in the potential for these types of activities to maintain health and well-being and address problems of social isolation. Drawing on open text comments from 114 women enrolled in the Australian Longitudinal Study on Women's Health and in-depth interviews with 23 women all aged in their eighties, this paper explores the nature of older women's participation in art and craft activities and conceptualises links between participation in these activities and health and well-being in late life. Participation in art and craft activities is complex and dynamic, comprising cognitive and physical processes infused with emotion and occurs in the context of social relationships, physical spaces, physical ailments and beliefs about the value of the activities. By participating in art and craft activities, older women find purpose in their lives, contributing to their subjective well-being whilst helping and being appreciated by others. They develop a self view as enabled and as such take on new art and craft challenges, continue to learn and develop as art and craft makers and remain open to new possibilities.
Grenier, Amanda; Lloyd, Liz; Phillipson, Chris
Approaches to ageing that are organised around productivity, success, and active late life have contributed to views of dementia as an unsuccessful, failed or 'frailed' old age. Operating through dominant frameworks, socio-cultural constructs and organisational practices, the 'frailties' of the body and mind are often used to mark the boundaries of health and illness in late life, and shape responses accordingly. Our concern is that both the taken for granted and the 'imagined' can further marginalise persons who occupy the locations of dementia and disablement. This article analyses the extent to which frailty and dementia are better understood in the context of new forms of insecurity affecting the life course. Drawing on the concept of 'precarity', this article shifts debates on the 'fourth age' away from age or stage-based thinking, into a recognition of the shared vulnerability and responsibilities for care. The argument of this article is that 'precarity' represents a 'new form of ageing', notably as regards its impact on the upper extremes of the life course. The article concludes with a call for a response that is grounded in an acknowledgement of the fragility and limitations which affect human lives, this requiring grounding in inclusive forms of citizenship.
Atif, Muhammad; Bashir, Arslan; Saleem, Quratulain; Hussain, Rabia; Scahill, Shane; Babar, Zaheer-Ud-Din
Pharmaceutical companies have been known to pose stress and mental harassment on medical sales representatives (MSRs) in-order to increase pharmaceutical sales. This cross sectional descriptive study, conducted during November and December 2014 in the Lahore and Bahawalpur districts of Punjab, Pakistan, evaluates the Health-Related Quality of Life (HRQoL) and extent of depression among MSRs in Pakistan. The significant predictors of HRQoL and depression among the MSRs were also determined. Using a convenience sampling technique, all consenting MSRs (N = 318) of pharmaceutical companies were asked to self-complete the Short Form-36 (SF-36v2) Health Survey and Stanford Personal Health Questionnaire (PHQ-8). The standard scoring scheme for the SF36v2 and PHQ-8 questionnaires was used. The PHQ-8 scores showed that 16.4 % (n = 52) and 2.5 % of respondents were suffering from major depression and severe major depression, respectively. Being depressed and having difficulty in achieving sales targets were the factors independently associated with lower physical health. Similarly, depression, insufficient time for the family and monthly income less than 36,000 Pakistan Rupees were significant predictors of lower mental health. The factors associated with depression included insufficient time for the family and unsatisfactory behavior of the managers. Compromised mental health and the prevalence of depression among the MSRs suggest pharmaceutical companies need to devise health management strategies and interventions to ensure effective prevention and management of mental health problems among Pakistani MSRs.
Evans, Jonathan; Xu, Ke; Heron, Jon; Enoch, Mary-Anne; Araya, Ricardo; Lewis, Glyn; Timpson, Nic; Davies, Simon; Nutt, David; Goldman, David
Early adversity predicts anxiety and depression but variation in response to adversity is not understood. We investigated whether association between early adversity and emotional symptoms in young children differs according to variation of the COMT gene. The main outcome measure was the emotionality subscale of the Strengths and Difficulties Questionnaire (SDQ) completed by mothers for 8,431 children aged 6-7 years old in the Avon Longitudinal Study of Parents and Children. Adversity measures included exposure to maternal postpartum depressive symptoms and adverse life events for children. DNA from the children was genotyped for five COMT polymorphisms including the COMT Val158Met locus. Maternal depression increased the odds of high emotionality in the children, (OR 1.99, 95% CI 1.73-2.29, P < 0.001) as did life events score, (OR 1.21 for each s.d. increase in life event score, 95% CI 1.15-1.27, P < 0.001). There was no main effect of Val158Met genotype on emotional symptoms (OR for effect of each copy of the methionine allele was 1.04, 95% CI 0.97-1.10, P = 0.284). The relationship between adversity and emotional symptoms did not vary by genotype (G x E for maternal depression chi(2) = 3.17, P = 0.205; G x E for life events chi(2) = 1.69, P = 0.430). There was no main effect of COMT haplotype, nor was there an interaction with adversity. Early adversity predicts emotional symptoms in children aged 6-7 years. Although some studies indicate a role for COMT in emotionality, anxiety, and depression in adults, no direct effect or interaction of COMT genotype was observed in this large sample of young children.
Schütz, Erica; Sailer, Uta; Al Nima, Ali; Rosenberg, Patricia; Andersson Arntén, Ann-Christine; Archer, Trevor; Garcia, Danilo
Background. The affective profiles model categorizes individuals as self-fulfilling (high positive affect, low negative affect), high affective (high positive affect, high negative affect), low affective (low positive affect, low negative affect), and self-destructive (low positive affect, high negative affect). The model has been used extensively among Swedes to discern differences between profiles regarding happiness, depression, and also life satisfaction. The aim of the present study was to investigate such differences in a sample of residents of the USA. The study also investigated differences between profiles with regard to happiness-increasing strategies. Methods. In Study I, 900 participants reported affect (Positive Affect Negative Affect Schedule; PANAS) and happiness (Happiness-Depression Scale). In Study II, 500 participants self-reported affect (PANAS), life satisfaction (Satisfaction With Life Scale), and how often they used specific strategies to increase their own happiness (Happiness-Increasing Strategies Scales). Results. The results showed that, compared to the other profiles, self-fulfilling individuals were less depressed, happier, and more satisfied with their lives. Nevertheless, self-destructive individuals were more depressed, unhappier, and less satisfied than all other profiles. The self-fulfilling individuals tended to use strategies related to agentic (e.g., instrumental goal-pursuit), communal (e.g., social affiliation), and spiritual (e.g., religion) values when pursuing happiness. Conclusion. These differences suggest that promoting positive emotions can positively influence a depressive-to-happy state as well as increasing life satisfaction. Moreover, the present study shows that pursuing happiness through strategies guided by agency, communion, and spirituality is related to a self-fulfilling experience described as high positive affect and low negative affect.
Selfhout, M. H. W.; Branje, S. J. T.; Meeus, W. H. J.
This study examined friendship types in developmental trajectories of perceived closeness and balanced relatedness. In addition, differences between friendship types in the development of constructive problem solving and depression were examined. Questionnaire data of five annual waves were used from two adolescent cohorts (cohort 1: M = 12.41…
Richaud de Minzi, Maria Cristina
In this study, the author analyzed the relationship between (a) parenting and attachment and (b) self-competence, loneliness, and depression in children aged 8-12 years. The author administered (a) the Argentine Scale of Perception of the Relationships with Parents (M. C. Richaud de Minzi, 2004), (b) the Kerns' Security Scale (K. A. Kerns, L.…
Barrera, Terri L.; Cully, Jeffrey A.; Amspoker, Amber B.; Wilson, Nancy L.; Kraus-Schuman, Cynthia; Wagener, Paula D.; Calleo, Jessica S.; Teng, Ellen J.; Rhoades, Howard M.; Masozera, Nicholas; Kunik, Mark E.; Stanley, Melinda A.
Cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n = 101) and community-based (n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < .01), but not in Veterans (all ps > .05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps <.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support. PMID:26005839
Levecque, Katia; Van Rossem, Ronan; De Boyser, Katrien; Van de Velde, Sarah; Bracke, Piet
Previous research in the United States suggests that depression related to economic hardship decreases with age. We test whether this pattern can be generalized to other developed nations. Based on data from 23 countries in the European Social Survey (2006--2007), multilevel analyses show that the moderating role of age depends on the socio-political context. While the hardship--depression link is not significantly different across the life course in Nordic and Bismarckian regimes, the hardship--depression link increases with age in Southern and Eastern European countries and decreases with age in strength in Anglo-Saxon welfare states. Our findings suggest that welfare state regimes play a significant role in attenuating, boosting, or even reversing the health effects of social experiences such as economic hardship on aging. Health knowledge gained through research that ignores the socio-political context may be limited in terms of generalization.
Pluijm, S M F; Visser, M; Puts, M T E; Dik, M G; Schalk, B W M; van Schoor, N M; Schaap, L A; Bosscher, R J; Deeg, D J H
This study aimed to examine the association between unhealthy lifestyle in young age, midlife and/or old age and physical decline in old age, and to examine the association between chronic exposure to an unhealthy lifestyle throughout life and physical decline in old age. The study sample included 1297 respondents of the Longitudinal Aging Study Amsterdam (LASA). Lifestyle in old age (55-85 y) was assessed at baseline, while lifestyle in young age (around 25 y) and midlife (around 40 y) were assessed retrospectively. Lifestyle factors included physical activity, body mass index (BMI), number of alcohol drinks per week and smoking. Physical decline was calculated as change in physical performance score between baseline and six-year follow-up. Of the lifestyle factors present in old age, a BMI of 25-29 vs. BMI <25 kg/m2 (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.1-2.2) and a BMI of > or =30 vs. BMI <25 kg/m2 (OR 1.8; 95% CI 1.2-2.7) were associated with physical decline in old age. Being physically inactive in old age was not significantly associated with an increased risk of physical decline, however, being physically inactive both in midlife and in old age increased the odds of physical decline in old age to 1.6 (95% CI 1.1-2.4) as compared to respondents who were physically inactive in midlife and physically active in old age. Being overweight in both age periods was associated with an OR of 1.5 (95% CI 1.1-2.2). These data suggest that overweight in old age, and chronic exposure to physical inactivity or overweight throughout life increases the risk of physical decline in old age. Therefore, physical activity and prevention of overweight at all ages should be stimulated to prevent physical decline in old age.
Satterfield, Jason M.; Crabb, Rebecca
Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were…
Adib-Hajbaghery, M; Ahmadi, M; S, Poormansouri
Background Awareness of factors associated with quality of life (QOL) in patients with beta-Thalassemia major (β-TM) is necessary to develop clinical programs in order to improve social support and QOL in β-TM patients. This study aimed to examine QoL, depression, anxiety, and stress in β-TM patients in Ahvaz, Iran. Materials and Methods A cross-sectional study was conducted on173 β-TM patients aged ≥12 years (12-18=55, ≥19=118). Subjects were selected using a census method. Data collection instrument consisted of three parts including: demographic questions, SF-36 questionnaire and depression, anxiety, and stress scale (DAS-21). Results The participants obtained a mean score of 64.38±18.20 for QOL, 6.4±5.1 for depression, 4.8±3.9 for anxiety, and 7.3±4.9 for stress. Significant relationship was found between QOL and employment (P=0.02) and education level (P<0.001). Patients in the age group of 12-18 years old had higher mean scores in the majority of QoL dimensions than those aged ≤19. The mean scores of depression, anxiety, and stress were higher in patients aged ≤19. No significant correlation was observed between QOL and depression, anxiety, stress scores, and other demographic variables. Moreover, a significant inverse correlation was found between QOL and depression (P<0.001,r= -0.62), anxiety (P<0.001,r= -0.55), and stress scores (P<0.001, r= -0.5) . Conclusion This study showed that β-TM patients experienced a considerable decrease both in their overall QoL and in its dimensions. A majority of the β-TM patients were also suffered from mild to severe depression, anxiety, and stress. PMID:26985352
dos Santos, Ana Paula Ceré; Lazzari, Tássia Kirchmann
Background Much of the attention of tuberculosis (TB) programs is focused on outcomes of microbiological cure and mortality, and health related quality of life (HRQL) is undervalued. Also, TB patients have a significantly higher risk of developing depression and anxiety compared with those in the general population. We intend to evaluate the HRQL and the prevalence of symptoms of depression and anxiety in hospitalized patients with TB. Methods Cross-sectional study in a tertiary care hospital in Brazil. Adult patients with pulmonary TB that were hospitalized during the study period were identified and invited to participate. HRQL was measured using the Medical Outcomes Study Short Form-36 (SF-36) version 2. Hospital Anxiety and Depression Scale (HADS) was used to record symptoms of anxiety and depression. Results Eighty-six patients were included in the analysis. The mean age of all patients was 44.6±15.4 years, 69.8% were male, and 53.5% were white. Thirty-two patients (37.2%) were human immunodeficiency virus positive. Twenty-seven patients (31.4%) met study criteria for depression (HADS depression score ≥11) and 33 (38.4%) had anxiety (HADS anxiety score ≥11). Scores on all domains of SF-36 were significantly lower than the Brazilian norm scores (p<0.001). Conclusion The present study shows that TB patients may have a poor HRQL. Additionally, we found a possible high prevalence of depression and anxiety in this population. Health care workers should be aware of these psychological disorders to enable a better management of these patients. The treatment of these comorbidities may be associated with better TB outcomes. PMID:28119749
Danielsson, Louise; Rosberg, Susanne
Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants' experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression.
Danielsson, Louise; Rosberg, Susanne
Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants’ experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression. PMID:25956354
This study assesses the interaction between personal education and family background during childhood on depressive symptoms in later life by applying Ross & Mirowsky's resource substitution and structural amplification theory of health and education. OLS regression models are estimated using data from the "Survey of Health, Ageing and Retirement in Europe" (SHARE), which covers information on current social and health status as well as retrospective life histories from 20,716 respondents aged 50 or older from thirteen European countries. Higher education helps to overcome the negative consequences of a poor family background. Since people from poor families are less likely to attain higher educational levels, they lack exactly the resource they need in order to overcome the negative consequences their non-prosperous background has on depressive symptoms. Thus, low family background and low personal education amplify each other. Examining the processes described by theory of resource substitution and structural amplification over different age groups from midlife to old-age suggests that the moderating effect of education remains constant over age among people coming from a poor family background. However, there is some evidence for a decrease with age in the buffering effect of a well-off family background on depressive symptoms among the low educated group. Furthermore, the educational gap in depression diverges with age among individuals originating from a well-off family background. Taken together the results cautiously allude to the conclusion that three processes - cumulative (dis-)advantage, age-as-leveler, and persistent inequalities - might take place.
Al-Zaben, Faten Nabeel; Sehlo, Mohammad Gamal
This study assessed the relationship between parental punishment and depression as well as quality of life in children with primary monosymptomatic nocturnal enuresis (PMNE). A consecutive sample of 65 children (7-13 years) with PMNE and 40 healthy children, selected as controls (Group III), were included in the study. The children with PMNE were further sub-classified into two groups: Group I, which included children who received parental punishment for enuresis and Group II, which comprised children who were not punished for bedwetting. Depression and health-related quality of life (HRQL) were assessed among the three groups. The number of wet nights per week was significantly increased in Group I compared with Group II (P<.001). In addition, the severity of depressive symptoms increased in Group I as compared to the other two groups (P<.001). Similarly, the psychosocial HRQL lower in Group compared to the control group (Group III) (P<.001). Prior parental discipline, including corporal punishment (B=0.55, P=.008), as well as the frequency (B=0.73, P<.001) and duration of punishment (B=0.33, P=.02) were strong predictors of increased depressive symptom severity. It was also found that prior punishment (B=-0.42, P=.01) and the frequency (B=-0.62, P<.001) and duration of punishment (B=-0.34, P=.02) were strong predictors for poor psychosocial HRQL. Overall, parental punishment has a poor outcome in children with PMNE.
Rogers, Cynthia E.; Lenze, Shannon N.; Luby, Joan L.
Objective: Preterm children are at greater risk for psychiatric disorders, including anxiety disorders and attention-deficit/hyperactivity disorder (ADHD), than their term-born peers. Prior research has focused primarily on children born at early gestational ages. Less is known about the rate of psychiatric disorders among late preterm or early…
Schindler, R J; Cucio, C P
Management of dementia in older patients requires an individualized and multimodal approach that involves use of psychiatric, psychotherapeutic, psychosocial, and somatic tools and treatments, in addition to patient and family education. The progressive nature of dementia and the invariable presence of comorbidity complicates the management task, although symptoms characteristic of dementia's phases can provide helpful clinical clues to guide evolving care. In 1997, the American Psychiatric Association published the "Practice guideline for the treatment of patients with Alzheimer's disease and other dementias of late life." To date, this is the most comprehensive clinical guideline available to physicians caring for patients with Alzheimer's disease and other related dementias.
Herndon, James G; Paredes, Jamespaul; Wilson, Mark E; Bloomsmith, Mollie A; Chennareddi, Lakshmi; Walker, Margaret L
Menopause in women occurs at mid-life. Chimpanzees, in contrast, continue to display cycles of menstrual bleeding and genital swelling, suggestive of ovulation, until near their maximum life span of about 60 years. Because ovulation was not confirmed hormonally, however, the age at which chimpanzees experience menopause has remained uncertain. In the present study, we provide hormonal data from urine samples collected from 30 female chimpanzees, of which 9 were old (>30 years), including 2 above the age of 50 years. Eight old chimpanzees showed clear endocrine evidence of ovulation, as well as cycles of genital swelling that correlated closely with measured endocrine changes. Endocrine evidence thus confirms prior observations (cyclic anogenital swelling) that menopause is a late-life event in the chimpanzee. We also unexpectedly discovered an idiopathic anovulation in some young and middle-aged chimpanzees; this merits further study. Because our results on old chimpanzees validate the use of anogenital swelling as a surrogate index of ovulation, we were able to combine data on swelling and urinary hormones to provide the first estimates of age-specific rates of menopause in chimpanzees. We conclude that menopause occurs near 50 years of age in chimpanzees as it does in women. Our finding identifies a basic difference between the human and chimpanzee aging processes: female chimpanzees can remain reproductively viable for a greater proportion of their life span than women. Thus, while menopause marks the end of the chimpanzee's life span, women may thrive for decades more.
Wang, Yang; Liu, Fangnan; Jiang, Xiaoning; Xiao, Yun; Dong, Xuehan; Kong, Xianglei; Yang, Xuemei; Tian, Donghua; Qu, Zhiyong
Background Few studies have looked at the relationship between psychological and the mental health status of pregnant women in rural China. The current study aims to explore the potential mediating effect of negative automatic thoughts between negative life events and antenatal depression. Methods Data were collected in June 2012 and October 2012. 495 rural pregnant women were interviewed. Depressive symptoms were measured by the Edinburgh postnatal depression scale, stresses of pregnancy were measured by the pregnancy pressure scale, negative automatic thoughts were measured by the automatic thoughts questionnaire, and negative life events were measured by the life events scale for pregnant women. We used logistic regression and path analysis to test the mediating effect. Results The prevalence of antenatal depression was 13.7%. In the logistic regression, the only socio-demographic and health behavior factor significantly related to antenatal depression was sleep quality. Negative life events were not associated with depression in the fully adjusted model. Path analysis showed that the eventual direct and general effects of negative automatic thoughts were 0.39 and 0.51, which were larger than the effects of negative life events. Conclusions This study suggested that there was a potentially significant mediating effect of negative automatic thoughts. Pregnant women who had lower scores of negative automatic thoughts were more likely to suffer less from negative life events which might lead to antenatal depression. PMID:27977715
Approximately ten percent of the population suffers from a depressive illness each year. Although the economic cost is high, the cost in human suffering is immeasurable. To help educate the population about this disorder, this paper presents a definition of depression and its common manifestations. The symptoms that people often experience are…
Isralowitz, Richard; Spiegel, Svetlana; Reznik, Alex; Borkin, Sofia; Snir, Yoram
Immigrants from the Former Soviet Union tend to drink more frequently than other Israelis. However, little is known about alcohol consumption among older Former Soviet Union immigrants in Israel. In the current study, male and female Former Soviet Union immigrants residing in independent living facilities were studied to determine their patterns of alcohol use and attitudes toward drinking. Interviews were conducted using a modified version of the CAGE instrument. Findings show that men use alcohol more than women, believe they need to reduce consumption, and are more likely to be criticized and feel guilty about their drinking behavior. Additional research is needed to further understand the extent of improper alcohol use among late life immigrants and older people in the country. Such information should be applied to the development of policy and services that will address their quality of life needs.
Matarán-Peñarrocha, Guillermo A.; Castro-Sánchez, Adelaida María; García, Gloria Carballo; Moreno-Lorenzo, Carmen; Carreño, Tesifón Parrón; Zafra, María Dolores Onieva
Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patients diagnosed with fibromyalgia were randomly assigned to an intervention group (craniosacral therapy) or placebo group (simulated treatment with disconnected ultrasound). The treatment period was 25 weeks. Anxiety, pain, sleep quality, depression and quality of life were determined at baseline and at 10 minutes, 6 months and 1-year post-treatment. State anxiety and trait anxiety, pain, quality of life and Pittsburgh sleep quality index were significantly higher in the intervention versus placebo group after the treatment period and at the 6-month follow-up. However, at the 1-year follow-up, the groups only differed in the Pittsburgh sleep quality index. Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients. PMID:19729492
Matarán-Peñarrocha, Guillermo A; Castro-Sánchez, Adelaida María; García, Gloria Carballo; Moreno-Lorenzo, Carmen; Carreño, Tesifón Parrón; Zafra, María Dolores Onieva
Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patients diagnosed with fibromyalgia were randomly assigned to an intervention group (craniosacral therapy) or placebo group (simulated treatment with disconnected ultrasound). The treatment period was 25 weeks. Anxiety, pain, sleep quality, depression and quality of life were determined at baseline and at 10 minutes, 6 months and 1-year post-treatment. State anxiety and trait anxiety, pain, quality of life and Pittsburgh sleep quality index were significantly higher in the intervention versus placebo group after the treatment period and at the 6-month follow-up. However, at the 1-year follow-up, the groups only differed in the Pittsburgh sleep quality index. Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients.
Padovani, Mariana Theozzo; Martins, Marielza Regina Ismael; Venâncio, Alexandre; Forni, José Eduardo Nogueira
OBJECTIVE: This study aims to evaluate emotional factors such as anxiety and depression, and the Quality of Life of individuals with chronic persistent pain after amputation in order to identify the interindividual variation in response to pain. METHODS: This was a descriptive, exploratory and cross-sectional study with quantitative approach. Twenty seven patients were interviewed. The instruments have rated the sociodemographic, clinical and economic profile (semistructured interview) and the Quality of Life (generic Quality of Life questionnaire SF-12) and emotional factors (HAD scale) of the interviewed patients. RESULTS: It was identified that the most frequent amputations occur in males aged 18-38 years and are related to occupational accidents. The Quality of Life was compromised in both components of physical and mental health. Furthermore, anxiety levels were more prevalent in the range from aged 18 to 38 years old, while the levels of depression were most prevalent among the elderly (60 to 80 years old). CONCLUSION: The impairment of Quality of Life and change in the perception of body image has a major impact on adherence to the rehabilitation program and the functional prognosis. Therapeutic orientation is, therefore, critical after this type of surgery. Level of Evidence II, Descriptive and Exploratory Study. PMID:27069411
Wright, Nicola; Hill, Jonathan; Pickles, Andrew; Sharp, Helen
Background The precipitating role of life events in the onset of depression is well-established. The present study sought to examine whether life events hypothesised to be personally salient would be more strongly associated with depression than other life events. In a sample of women making the first transition to parenthood, we hypothesised that negative events related to the partner relationship would be particularly salient and thus more strongly predictive of depression than other events. Methods A community-based sample of 316 first-time mothers stratified by psychosocial risk completed interviews at 32 weeks gestation and 29 weeks postpartum to assess dated occurrence of life events and depression onsets from conception to 29 weeks postpartum. Complete data was available from 273 (86.4%). Cox proportional hazards regression was used to examine risk for onset of depression in the 6 months following a relationship event versus other events, after accounting for past history of depression and other potential confounders. Results 52 women (19.0%) experienced an onset of depression between conception and 6 months postpartum. Both relationship events (Hazard Ratio = 2.1, p = .001) and other life events (Hazard Ratio = 1.3, p = .020) were associated with increased risk for depression onset; however, relationship events showed a significantly greater risk for depression than did other life events (p = .044). Conclusions The results are consistent with the hypothesis that personally salient events are more predictive of depression onset than other events. Further, they indicate the clinical significance of events related to the partner relationship during pregnancy and the postpartum. PMID:26645963
Zuo, Wenyun; Smith, Felisa A; Charnov, Eric L
A major criticism of the "overkill" theory for the late Pleistocene extinction in the Americas has been the seeming implausibility of a relatively small number of humans selectively killing off millions of large-bodied mammals. Critics argue that early Paleoindian hunters had to be extremely selective to have produced the highly size-biased extinction pattern characteristic of this event. Here, we derive a probabilistic extinction model that predicts the extinction risk of mammals at any body mass without invoking selective human harvest. The new model systematically analyzes the variability in life-history characteristics, such as the instantaneous mortality rate, age of first reproduction, and the maximum net reproductive rate. It captures the body size-biased extinction pattern in the late Pleistocene and precisely predicts the percentage of unexpectedly persisting large mammals and extinct small ones. A test with a global late Quaternary mammal database well supports the model. The model also emphasizes that quantitatively analyzing patterns of variability in ecological factors can shed light on diverse behaviors and patterns in nature. From a macro-scale conservation perspective, our model can be modified to predict the fate of biota under the pressures from both climate change and human impacts.
Espejo, Emmanuel Peter; Hammen, Constance; Brennan, Patricia A.
The tendency to appraise naturally occurring life events (LEs) as having high negative impact may be a predisposing factor for the development of depression and anxiety disorders. In the current study, appraisals of the negative impact of recent LEs were examined in relationship to depressive and anxiety disorders in a sample of 653 adolescents…
Carozza, Jean-Michel; Llubes, Muriel; Danu, Mihaela; Faure, Elodie; Carozza, Laurent; David, Mélodie; Manen, Claire
The origin and evolution of the enclosed depressions (pans) of southern France during the period from the Late Glacial to the Holocene are discussed on the basis of new stratigraphical, geophysical and chronological (14C) data from the Canohès depression (Roussillon, Southern of France) and its nearby environment. The Canohès depression is non-karstic, excavated from Pliocene arkosic sands that were shaped by eolian erosion during cold stages of the Middle and Upper Pleistocene. The timing and controlling factors of eolian carving of the depression are discussed on the basis of geomorphological data, surrounding alluvial terrace chronology, preserved ledge within the depression and alluvial infill of the depression. Formation of the depression was controlled, locally, by climate variability and its consequences on vegetation and water table position and, regionally, by the sea base level. The enclosed depression probably started to form during MIS 6, reaching its maximum depth during MIS 2. Climate variability in the region is recorded in the depression's infill. The basal deposits are of fluvial origin and record the increase of moisture and temperature during the Early Late-Glacial. The first lacustrine deposits are observed during the Bölling/GI-1e stage, while continental sedimentation and drying occurred during the Alleröd and Younger Dryas stages. During the Early and Middle Holocene, lacustrine conditions prevailed, except during short periods of drying. The specific evolution of the Canohès depression as regards other such formations is discussed in light of regional deglaciation and climate chronology. A regional synthesis of eolian erosion is proposed.
Hunfeld, J A; Agterberg, G; Wladimiroff, J W; Passchier, J
Pregnant women with (n = 24) and without (n = 26) a previous pregnancy loss (> 16 weeks) due to congenital anomalies were compared on quality of life and anxiety. Pregnant women with a previous loss were divided into those with and those without a normal livebirth since the loss [cases+ (n = 6) and cases- (n = 18), respectively]. Psychological measurements were carried out before and after an ultrasound scan in the second trimester of the pregnancy. Women with a previous loss who had not delivered a healthy infant between the loss and the present pregnancy showed a lower quality of life as revealed by feelings of social isolation, negative emotional reactions, and pain than the other groups. In addition, they showed more pregnancy-related anxiety. The negative emotions were particularly present just before the anomaly scan. Feelings of social isolation, negative emotional reactions, pain, and pregnancy-related anxiety were significantly positively related to trait anxiety, irrespective of having experienced late pregnancy loss. The implications of this study are that the referring gynaecologist, physician, or midwife should be aware of the strong emotions and major concerns of women in a pregnancy subsequent to a late pregnancy loss. In addition, they should offer these women the opportunity to express their emotional distress.
Xiao, Zhiwen; Li, Xiaoming; Qiao, Shan; Zhou, Yuejiao; Shen, Zhiyong
This study collected data from 2987 people living with HIV in China and employed structural equation modeling to examine the relationships among social support, depression, and quality of life (QOL). Depression was the strongest predictor of the psychological, energy, and mobility aspects of QOL with β = -.70 (p < .001), β = -.47 (p < .001), and β = -.44 (p < .001), respectively. Emotional social support was a significant predictor of depression (β = -.12, p < .001), mobility (β = .20, p < .001), energy (β = .15, p < .001), and psychological aspect (β = .06, p < .05). Informational social support was a significant predictor of mobility (β = -.08, p < .01), energy (β = -.06, p < .05), and psychological aspect (β = -.07, p < .001). Functional social support was only negatively associated with mobility (β = -.16, p < .01). Therefore, depression had a negative effect on physical (perceived mobility and energy) and psychological (positive/negative feelings, thinking, learning, memory, and concentration) aspects of QOL. Emotional social support had both direct and indirect effects (through its buffering effect on depression) on better QOL. However, the associations between informational social support and the three aspects of QOL were negative; and informational social support did not have a buffering effect on depression. Functional social support was negatively associated with mobility, which means provision of functional support to PLHIV may not necessarily be associated with better QOL. The findings confirm that HIV/AIDS care in China should consider the conceptual differences between emotional, informational, and functional support.
Dashti-Khavidaki, Simin; Gharekhani, Afshin; Khatami, Mohammad-Reza; Miri, Elham-Sadat; Khalili, Hossein; Razeghi, Effat; Hashemi-Nazari, Seyed-Saeed; Mansournia, Mohammad-Ali
Depression and health-related quality of life (HRQoL) are closely interrelated among hemodialysis (HD) patients and associated with negative impacts on patients' clinical outcomes. Considering previous reports on clinical benefits of omega-3 fatty acids in major depression and HRQoL in other patient populations, this study examined effects of omega-3 fatty acids on depression and HRQoL in chronic HD patients. In this randomized placebo-controlled trial, 40 adult patients with a Beck Depression Inventory (BDI) score of ≥16 and HD vintage of at least 3 months were randomized to ingest 6 soft-gel capsules of either omega-3 fatty acids (180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid in each capsule) or corresponding placebo, daily for 4 months. At baseline and after 4 months, 2 questionnaires of BDI and the Medical Outcome Study 36-Item Short-Form Health Survey were completed by each patient. Although baseline BDI score was comparable between the 2 groups, it was significantly lower in the omega-3 group compared with the placebo group at the end of the study (P = 0.008). Except for mental health, social functioning, and general health, other domains of HRQoL showed significant improvement in the omega-3 group compared with the placebo group at month 4 of the study (P < 0.05 for all). Regression analysis revealed that ameliorated BDI score by omega-3 treatment had considerable role in the improvement of overall HRQoL score, physical and mental component dimensions, and score of physical functioning, role-physical, and bodily pain. Supplemental use of omega-3 fatty acids in HD patients with depressive symptoms seems to be efficacious in improving depressive symptoms and HRQoL.
Gordon, Jennifer L.; Rubinow, David R.; Eisenlohr-Moul, Tory A; Leserman, Jane; Girdler, Susan S.
Objective To examine the role of estradiol fluctuation in triggering depressive symptoms in the menopause transition and assess the role of recent very stressful life events (VSLEs) as a moderating factor in this relationship. Methods 52 euthymic women in the menopause transition or early postmenopause (age 45–60) who were assigned to the placebo arm of a randomized controlled trial of hormone therapy provided the data for this report. At enrollment, women’s experience of recent VSLEs, depressive symptoms, serum estradiol and progesterone were assessed. At months 1, 8 and 14, depressive symptoms and hormones were re-assessed and participants underwent a stressor battery involving a speech and a mental arithmetic task. Participants rated their feelings of anxiety, fear, anger and rejection. The standard deviation of estradiol provided an index of hormone variability over the entire 14 months. Results Greater estradiol variability across the 14 months predicted greater depressive symptoms at month 14, though only in women reporting a higher number of VSLEs at baseline (39% of women reported ≤1 recent event). Greater estradiol variability also predicted greater feelings of rejection to the laboratory stressor at months 8 and 14. Furthermore, among women reporting higher VSLEs at baseline, feelings of rejection in response to the laboratory stressor at month 8 predicted depressive symptoms at month 14. Conclusion These data suggest estradiol variability may enhance emotional sensitivity to psychosocial stress, particularly sensitivity to social rejection. Combined with VSLEs proximate to the menopause transition, this increased sensitivity may contribute to the development of depressed mood. PMID:26529616
Holahan, Charles J.; Schutte, Kathleen K.; Brennan, Penny L.; Holahan, Carole K.; Moos, Rudolf H.
Objective: Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. heavy episodic) in 20-year total mortality among late-life drinkers. Method: The sample comprised 1,121 adults ages 55–65 years. Alcohol consumption was assessed at baseline, and total mortality was indexed across 20 years. We used multiple logistic regression analyses controlling for a broad set of sociodemographic, behavioral, and health status covariates. Results: Among individuals whose high level of drinking placed them at risk, a heavy episodic drinking pattern did not increase mortality odds compared with a regular drinking pattern. Conversely, among individuals who engage in a moderate level of drinking, prior findings showed that a heavy episodic drinking pattern did increase mortality risk compared with a regular drinking pattern. Correspondingly, a high compared with a moderate drinking level increased mortality risk among individuals maintaining a regular drinking pattern, but not among individuals engaging in a heavy episodic drinking pattern, whose pattern of consumption had already placed them at risk. Conclusions: Findings highlight that low-risk drinking requires that older adults drink low to moderate average levels of alcohol and avoid heavy episodic drinking. Heavy episodic drinking is frequent among late-middle-aged and older adults and needs to be addressed along with average consumption in understanding the health risks of late-life drinkers. PMID:26098030
Saraçlı, Özge; Akca, Ayşe Semra Demir; Atasoy, Nuray; Önder, Özde; Şenormancı, Ömer; Kaygisız, İsmet; Atik, Levent
Objective Older people seek not only a longer life, but also a better quality of life (QOL). Our aim was to find out the relationship between QOL and socio-demographic factors, social activities, cognitive status, depression and anxiety symptoms among medically ill and hospitalized elderly people in Turkey. Methods Two hundred forty three patients age 65 years or older were examined. The Socio-demographic Data Survey, the Mini Mental State Examination (MMSE), the Geriatric Depression Scale-short form (GDS-15), the Beck Anxiety Inventory (BAI) and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) were applied to participants. The independent samples t-test and analysis of variance (ANOVA) were used to analyze quantitative data. Pearson’s correlation and linear regression analysis were performed. Results The total score for QOL was significantly higher for those who saw their family members and relatives frequently rather than rarely (p=0.002), who were always busy with social activities rather than rarely or never (p<0.001), who had more years of education (p=0.003), and who were frequently exercising (p=0.023). According to linear regression analysis, the WHOQOL-OLD total score increased by 0.295 and −0.936 units, while MMSE and GDS-15 scale scores increased one unit respectively (β=0.295, t=1.979, p=0.04; β=−0.936, t=−4.881, p<0.001). Conclusion Cognitive disabilities, depression, and other psychiatric problems along with medical disease negatively affect the QOL of elderly patients. While performing medical assessment regarding elders, detecting and treating cognitive disabilities and depression is very valuable in improving the QOL of elderly patients. PMID:26243848
Igarashi, Hiromi; Hasui, Chieko; Uji, Masayo; Shono, Masahiro; Nagata, Toshiaki; Kitamura, Toshinori
To simultaneously examine the impact of childhood abuse history on borderline personality traits, negative life events, and depression, undergraduate students (N=243) were studied by questionnaire surveys with one week intervals. Neglect and emotional abuse as well as sexual maltreatment predicted borderline personality traits and baseline depression. Baseline depression as well as the impact of negative life events occurring the week prior predicted depression a week later. However, after considering the baseline depression level, child abuse history failed to predict the follow-up depression level. Borderline personality traits did not moderate these findings. Childhood emotional and sexual abuse history may influence depression and borderline personality traits.
Aspis, Itay; Feingold, Daniel; Weiser, Mark; Rehm, Jurgen; Shoval, Gal; Lev-Ran, Shaul
Cannabis is the most widely used illicit substance among individuals with depressive disorders. This study aimed to evaluate whether among individuals with depressive disorders, higher frequency of cannabis use would be associated with poorer Quality of Life (QoL), based on a large nationally representative US sample. Individuals with depressive disorders (N=3416) were divided into categories according to no use (N=3096), occasional use (less than weekly, N=176) and regular (at least weekly, N=144) use of cannabis in the past 12 months. QoL was assessed using the Short-Form 12 (SF-12) questionnaire. Women who used cannabis regularly had a significantly lower SF-12 Mental Component Summary score (MCS) compared to non-users, with a mean difference of 0.4 Standard Deviations (SDs). Comparison of subscale scores showed no significant differences. No significant difference was noted when comparing women who used cannabis occasionally to non-users. No differences were found among men when comparing MCS and mental subscale scores of both regular and occasional users to non-users. Our findings highlight the importance of taking gender and the frequency of cannabis use into account, when assessing functional and emotional aspects of cannabis use among individuals with depressive disorders.
Fan, Jun-Yu; Chang, Bao-Luen; Wu, Yih-Ru
The aim of this study was to examine the relationships among depression, anxiety, sleep disturbances, Parkinson's disease (PD) symptoms, PD medications, and health-related quality of life (QOL) and to identify the predictors of health-related QOL in PD patients. To do this, we administered a battery of questionnaires and rating scales (validated Chinese versions), including the Unified Parkinson's Disease Rating Scale, 39-item Parkinson's Disease Questionnaire, Parkinson's Disease Sleep Scale-2, Beck Depression Inventory, and Beck Anxiety Inventory, to 134 patients with PD whose Minimental State Examination scores were ≥24. We found that patients who reported having poorer QOL had longer disease durations, more severe PD symptoms, higher Hoehn and Yahr stages, and higher levodopa dosages, as well as higher levels of anxiety and depression, more sleep disturbances, and poorer overall cognitive statuses. Among these variables, the cognitive status, dependency of activities of daily living, depression, and anxiety were identified as predictors of QOL in PD patients and were all significant and independent factors of poor QOL in PD patients. The clinicians should be aware of the effects of these factors on QOL and attempt to treat comorbid psychiatric conditions to improve the PD patients' QOL.
Cotrena, Charles; Branco, Laura Damiani; Kochhann, Renata; Shansis, Flávio Milman; Fonseca, Rochele Paz
This study aimed to identify profiles of functioning and quality of life (QOL) in depression (MDD), bipolar disorder (BD) and healthy adults, as well as the clinical, demographic and cognitive variables associated with each of these profiles. Participants completed the WHODAS 2.0 and WHOQOL-BREF, which were submitted to latent profile analysis. The four cluster solution provided the best fit for our data. Cluster 1 consisted mostly of healthy adults, and had the highest functioning and QOL. Clusters 2 contained older patients with subclinical depressive symptoms and psychiatric comorbidities, whose impairments in QOL and functioning were associated with mood symptoms and several cognitive abilities. Patients with MDD, BDI or BDII with mild to moderate depression, such as those in cluster 3, may benefit more significantly from interventions in cognitive flexibility, inhibition, planning, and sustained attention. Lastly, patients with mood disorders and clinically significant levels of depression, as well as a history of suicide attempts, like those in cluster 4, may benefit from interventions aimed at working memory, inhibitory control, and cognitive flexibility; that is, the three core executive functions. These findings should be further investigated, and used to guide treatments for patients with mood disorders and different patterns of functional impairment.
Chronic obstructive pulmonary disease (COPD) could have a negative impact on quality of life (QoL) and is associated with anxiety and depression in both patients and informal caregivers. The aim of this study was to examine the relationships between anxiety, depression and QoL of both Jordanian patients with COPD and their spouses. The selected design used in this study was a cross-sectional, descriptive, correlational design. A total of 67 patients and spouses were interviewed in 2011, using self-administered questionnaires. Descriptive statistical analysis was applied. Bivariate correlation analysis was undertaken to examine the relationship between variables. The results showed that patients and spouses with high levels of anxiety and depression reported a poor QoL. Patients had a lower QoL than their spouses. A better understanding of patient and spouse psychological wellbeing and QoL will provide nurses with the information needed in terms of developing strategies for reducing patients' and spouses' anxiety and depression and thus improve their QoL. The health-service agencies and government should improve policy by improving family-centred services for both patients and spouses.
Beblo, Thomas; Kater, Leona; Baetge, Sharon; Driessen, Martin; Piefke, Martina
Although patients with major depressive disorder (MDD) report severe memory impairment in their everyday life, memory tests indicate only moderate deficits. In order to clarify these conflicting observations, the present study aimed at the investigation of MDD patients' memory performance in a real everyday life situation. The study included 20 MDD patients and 20 healthy control subjects. Nonverbal memory was assessed by means of the Rey Complex Figure Test whereas verbal memory was assessed by the recall of a 20-item wordlist with supermarket products. For the assessment of everyday life memory, subjects had to purchase as many products as possible of the 20-item wordlist in a real supermarket. Furthermore, subjects were asked for memory complaints. MDD patients' performance in the supermarket resembled memory test results and was not significantly impaired. MDD patients' self-reports, however, indicated severe memory problems that clearly fell below their performance in the supermarket. This study helped to identify everyday life-related factors that do not impair MDD patients' cognitive performance beyond their performance in standard laboratory testing situations. These factors may not be relevant for remediation programs that are specifically developed for depressed patients.
... with other drugs to add to the other drugs ’ high or to deal with their side effects. Abusers take higher doses than people taking the drugs under a doctor ’ s supervision for therapeutic purposes. Depressants ...
Izci, Filiz; Fındıklı, Ebru; Camkurt, Mehmet Akif; Tuncel, Deniz; Şahin, Merve
The aim of this study was to investigate the impact of aggression levels on the quality of life (QoL) of epilepsy patients. This study was conducted on 66 volunteer control subjects, who were matched by age and sex to the patient group, which consisted of 66 patients who applied to the Psychiatry and Neurology clinics for outpatient treatment, were aged between 18 years and 65 years, and were diagnosed with epilepsy. A sociodemographic and clinical data form designed by us was distributed among the study participants, along with Buss–Perry Aggression Scale, Beck Anxiety Scale, Beck Depression Scale, and the Quality of Life Scale Short Form (SF-36). Compared with the control group, the patient group displayed higher scores in all subgroups of Buss–Perry Aggression Scale subscales at a statistically significant level (P<0.05). As per the SF-36 questionnaire, physical functioning, physical role disability, general health perception, social functioning, mental health perception, and pain subscales were statistically lower in the patient group (P<0.05). Significant links between Beck Depression Scale and Beck Anxiety Scale levels, as well as some subscales of QoL and aggression levels, were also determined. In conclusion, epilepsy patients experienced impaired QoL compared with the healthy control group and their QoL was further impaired due to increased levels of anxiety, depression, and aggression. PMID:27785037
Australia, like other countries in neo-liberal democracies, is grappling with the gendered health 'problem' of depression. More concerning is the issue of recovery and relapse, with depression being the third largest cause of disability-adjusted life years (DALY). In addition, advanced liberal discourses of health position recovery as an exercise of individual responsibility to return to a functioning and productive norm and prevent recurrence. This moral enterprise of health articulates a 'recovery imperative' which overlooks the gendered context which may have created the conditions for women's depression and may in turn impede their recovery. Drawing on insights from governmentality and feminist post-structuralism, the article critically examines the effects of normalized recovery discourses on women's subjectivities. Data for the study were collected between 2005 and 2007 through in-depth interviews with 31 mid-life Australian women. Three key themes; 'in' recovery, 'eight out of ten' recovered, and recovering the authentic self, illustrate how the 'recovery imperative' may be implicated in perpetuating the cycle of recovery and relapse.
Cano, Miguel Ángel; de Dios, Marcel A; Castro, Yessenia; Vaughan, Ellen L; Castillo, Linda G; Lorenzo-Blanco, Elma I; Piña-Watson, Brandy; Berger Cardoso, Jodi; Ojeda, Lizette; Cruz, Rick A; Correa-Fernandez, Virmarie; Ibañez, Gladys; Auf, Rehab; Molleda, Lourdes M
Research has indicated that Hispanics have high rates of heavy drinking and depressive symptoms during late adolescence. The purpose of this study was to test a bicultural transaction model composed of two enthnocultural orientations (acculturation and enculturation); and stressful cultural transactions with both the U.S. culture (perceived ethnic discrimination) and Hispanic culture (perceived intragroup marginalization) to predict alcohol use severity and depressive symptoms among a sample of 129 (men=39, women=90) late adolescent Hispanics (ages 18-21) enrolled in college. Results from a path analysis indicated that the model accounted for 18.2% of the variance in alcohol use severity and 24.3% of the variance in depressive symptoms. None of the acculturation or enculturation domains had statistically significant direct effects with alcohol use severity or depressive symptoms. However, higher reports of ethnic discrimination were associated with higher reports of alcohol use severity and depressive symptoms. Similarly, higher reports of intragroup marginalization were associated with higher depressive symptoms. Further, both ethnic discrimination and intragroup marginalization functioned as mediators of multiple domains of acculturation and enculturation. These findings highlight the need to consider the indirect effects of enthnocultural orientations in relation to health-related outcomes.
Cooke, Marie; Moyle, Wendy; Shum, David; Harrison, Scott; Murfield, Jenny
This randomized controlled trial investigated the effect of live music on quality of life and depression in 47 older people with dementia using the Dementia Quality of Life and Geriatric Depression Scale. The control/reading group reported higher mid-point feelings of belonging than the music group (F(1, 45) = 6.672, p < .05). Sub-analyses of >or= 50 per cent music session attendance found improvements in self-esteem over time (F(2, 46) = 4.471, p < .05). Participants with scores that were suggestive of increased depressive symptoms had fewer depressive symptoms over time (F(2, 22) = 8.129, p < .01). Findings suggest music and reading activities can improve self-esteem, belonging and depression in some older people with dementia.
Juruena, Mario Francisco; Werne Baes, Cristiane Von; Menezes, Itiana Castro; Graeff, Frederico Guilherme
Depression is a chronic, recurrent and long-term disorder characterized by high rates of impairment and several comorbidities. Early life stress (ELS) is associated with the increased risk for developing depression in adulthood, influences its clinical course and predicts a poorer treatment outcome. Stressful life events play an important role in the pathogenesis of depression, being well established as acute triggers of psychiatric illness. The vulnerability for developing depression is associated to changes in neurobiological systems related to stress regulation. The hypothalamic-pituitaryadrenal (HPA) axis responds to external and internal stimuli. Reported results indicate that stress in early phases of development can induce persistent changes in the response of the HPA axis to stress in adulthood, leading to a raised susceptibility to depression. These abnormalities appear to be related to the HPA axis deregulation in depression, partially due to an imbalance between glucocorticoid receptors (GR) and mineral ocorticoid receptors (MR). While most studies have consistently demonstrated that GR function is impaired in major depression (reduced GR-mediated feedback in HPA axis), data about the MR role in depression are still limited and contr oversial. Thus, in this review article we summarize the main reported findings about the consequences of ELS in HPA axis functioning and in the responsivity of MR/GR receptors in depression.
Di Battista, Ashley; Godfrey, Celia; Soo, Cheryl; Catroppa, Cathy; Anderson, Vicki
Traumatic brain injury is (TBI) a leading cause of morbidity and mortality in youth. Adult survivors of a severe pediatric TBI are vulnerable to global impairments, including greater employment difficulties, poor quality of life (HRQoL) and increased risk of mental health problems. When estimating the health related quality of life in adolescents, the presence of anxiety and depression and the quality of social relationships are important considerations, because adolescents are entrenched in social development during this phase of maturation. The influence of anxiety, depression and loneliness on health related quality of life in adolescent survivors of TBI has not been documented. This pilot study aimed to identify and measure the relationship between anxiety, depression and loneliness and perceived health related quality of life in adolescent survivors of a TBI. Method: mixed method/cohort pilot study (11 adolescents, mild to severe TBI; 9 parents), using self-report and proxy-report measures of anxiety, depression, health related quality of life, loneliness and clinical psychiatric interviews (adolescent only). Results: Self-reported depression was significantly correlated with self-reported HRQoL (rs  = −0.88, p<0.001). Age at injury was significantly correlated with self-reported HRQoL (rs  = −0.68, p = 0.02). Self-reported depression predicted self-reported HRQoL (R2 = 0.79, F [1, 10] = 33.48, p<0.001), but age at injury did not (R2 = 0.19, F [1, 10] = 2.09, p = 0.18). Conclusions: Our results suggest that depression is a predictor of health related quality of life in youth post-TBI. The possibility of using targeted assessment and therapy for depression post-TBI to improve health related quality of life should be explored. PMID:25010719
Efficacy of tibolone and raloxifene for the maintenance of skeletal muscle strength, bone mineral density, balance, body composition, cognitive function, mood/depression, anxiety and quality of life/well-being in late postmenopausal women ≥ 70 years: Study design of a randomized, double-blind, double-dummy, placebo-controlled, single-center trial
Jacobsen, Didy E; Samson, Monique M; Schouw, Yvonne T van der; Grobbee, Diederick E; Verhaar, Harald JJ
Background Postmenopausal women are prone to develop functional disabilities as a result of reduction in muscle strength and muscle mass caused by diminished levels of female sex hormones. While hormone replacement therapy may counteract these changes, conventional hormone replacement therapy is associated with potential harmful effects, such as an increased risk of breast cancer, and its prescription is not recommended. For this reason newer alternative drugs, such as tibolone, a synthetic steroid with estrogenic, progestogenic and androgenic activity, and raloxifene, a selective estrogen receptor modulator, may be more appropriate. This trial investigates the effect of tibolone and raloxifene on muscle strength. Methods We recruited 318 elderly women in our single-center randomized, double-blind, double-dummy, placebo-controlled trial. Participants were randomized to tibolone 1.25 mg (Org OD 14, Organon NV, the Netherlands) plus placebo, raloxifene 60 mg (Evista®, Eli Lilly, United States) plus placebo or two placebo tablets daily for 24 months. The primary aim is to determine if there is a difference between tibolone and placebo or if there is a difference between raloxifene and placebo. Primary endpoints are muscle strength and bone mineral density. The secondary endpoints are postural balance, body composition, cognitive function, anxiety, mood and quality of life. The secondary aim is to determine if there is a difference between tibolone and raloxifene. The measure of effect is the change from the baseline visit to the visits after 3 months, 6 months, 12 months, and 24 months. A follow-up measurement is planned at 30 months to determine whether any effects are sustained after cessation of the study. By December 2007 the blind will be broken and the data analyzed. Trial registration number NTR: 1232 PMID:18533987
Tian, Feng; Kopits, Ilona M.; Moed, Richard; Pardasaney, Poonam K.; Jette, Alan M.
Background. Having psychometrically strong disability measures that minimize response burden is important in assessing of older adults. Methods. Using the original 48 items from the Late-Life Function and Disability Instrument and newly developed items, a 158-item Activity Limitation and a 62-item Participation Restriction item pool were developed. The item pools were administered to a convenience sample of 520 community-dwelling adults 60 years or older. Confirmatory factor analysis and item response theory were employed to identify content structure, calibrate items, and build the computer-adaptive testings (CATs). We evaluated real-data simulations of 10-item CAT subscales. We collected data from 102 older adults to validate the 10-item CATs against the Veteran’s Short Form-36 and assessed test–retest reliability in a subsample of 57 subjects. Results. Confirmatory factor analysis revealed a bifactor structure, and multi-dimensional item response theory was used to calibrate an overall Activity Limitation Scale (141 items) and an overall Participation Restriction Scale (55 items). Fit statistics were acceptable (Activity Limitation: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.03; Participation Restriction: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.05). Correlation of 10-item CATs with full item banks were substantial (Activity Limitation: r = .90; Participation Restriction: r = .95). Test–retest reliability estimates were high (Activity Limitation: r = .85; Participation Restriction r = .80). Strength and pattern of correlations with Veteran’s Short Form-36 subscales were as hypothesized. Each CAT, on average, took 3.56 minutes to administer. Conclusions. The Late-Life Function and Disability Instrument CATs demonstrated strong reliability, validity, accuracy, and precision. The Late-Life Function and Disability Instrument CAT can achieve
Huprich, Steven K; Frisch, Michael B
The construct validity of the Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996) was examined through its relationship to the constructs of hope, optimism, and quality of life (QOL). Three hundred thirty-two undergraduate students were administered the DPDI and measures of the aforementioned constructs. As predicted, the DPDI negatively correlated with all measures. Individuals classified with a depressive personality disorder had significantly higher scores on measures of hope, optimism, and QOL compared to a control group. Stepwise regression analysis indicated that optimism, QOL, and one component of hope significantly predicted DPDI scores, although more variance was accounted for in women than men. These findings are explained in light of Carver and Scheier's (2000) explanation of optimism and its relationship to hope. In sum, it appears that the construct validity of the DPDI is supported within an undergraduate sample.
Litzelman, Kristin; Yabroff, K. Robin
Background Spouses of cancer survivors experience both positive and negative effects from caregiving. However, it is less clear what role spousal well-being may have on cancer survivors. This study aimed to determine the impact of spousal psychosocial factors on survivor depressed mood and whether this association differed by gender. Methods We examined longitudinal data on cancer survivors and their spouses (n=910 dyads) from the 2004-2012 Medical Expenditures Panel Survey and a matched sample of cancer-free dyads. Subjects reported depressed mood, psychological distress, and mental and physical health-related quality of life (HRQoL) at two time points (T1/T2). Dyadic multilevel models evaluated the impact of psychosocial factors at T1 on depressed mood at T2, controlling for sociodemographics, cancer type, survivor treatment status, and depressed mood at T1. Results Cancer survivors whose spouses reported depressed mood at T1 were 4.27 times more likely to report depressed mood at T2 (95% CI=2.01-9.07); this was stronger for female survivors (OR=9.49; 95% CI=2.42-37.20). Better spousal mental and physical HRQoL at T1 were associated with a 30% decrease in survivor depressed mood risk at T2. Most spillover effects were not observed in comparison dyads. Conclusion Depressed mood and poor HRQoL in spouses may increase the risk of depressed mood in cancer survivors. The risk may be especially strong for female survivors. Impact Identifying and improving spousal mental health and HRQoL problems may reduce the risk of depressed mood in cancer survivors. Future research should examine whether incorporating spousal care into psycho-oncology and survivorship programs improves survivor outcomes. PMID:26033755
KAYA AYGÜNOĞLU, Selma; ÇELEBİ, Arif; VARDAR, Nilgün; GÜRSOY, Esra
Introduction Fatigue is a subjective and non-specific symptom; therefore, evaluation of fatigue is quite difficult. Fatigue has been reported in 75%–87% of patients with multiple sclerosis (MS) and two-thirds of these patients indicated fatigue as one of the worst three common symptoms that they experienced. This study was conducted to measure the intensity, frequency and the characteristics of fatigue in patients with MS. Moreover, the effect of fatigue on the quality of life and its association with depression and disability were evaluated. Methods One hundred and twenty patients with multiple sclerosis (84 women and 36 men) were included in our study. The patients’ sociodemographic characteristics and their experiences on symptoms of fatigue were questioned. Presence and degree of fatigue were assessed using the fatigue severity scale (FSS). Disability status was detected with expanded disability status scale (EDSS). The Multiple Sclerosis Quality of Life (MSQoL-54) survey was conducted to evaluate the quality of life of patients and Beck Depression Inventory (BDI) was used to determine the current depression status. Patients were grouped into fatigue and non-fatigue groups based on FSS. Both groups were compared according to their age, sex, MS clinical types, course of the disease and scores of EDSS, BDI and MSQoL-54. Results Seventy percent of patients reported fatigue and 38% of these patients defined fatigue as their most disabling symptom. There was no correlation of fatigue with age, sex and disease duration. The correlation of fatigue and educational level was negative and weak (p<.05, r=−.214) and the correlation between fatigue and MS clinical types were significant but weak (p<.01, r=.228). Patients with fatigue had higher EDSS and BDI scores. In addition, FSS scores were found to be statistically meaningful and positively correlated with both EDSS and BDI scores (r=.404, r=.476, p<.01). Furthermore, our findings revealed that the quality of life
The Normalization of Brain 18F-fluorodeoxy-D-glucose Positron Emission Tomography Hypometabolism following Electroconvulsive Therapy in a 55-year-old Woman with Treatment-resistant Late Onset Depression: A Case Report
Bak, Jeongjae; Lee, Sang Mi; Kwon, Young-Joon; Shim, Se-Hoon; Kim, Joong Il
Major depressive disorder, especially in later life, has heterogeneous clinical characteristics and treatment responses. Symptomatically, psychomotor retardation, lack of energy, and apathy tends to be more common in people with late-onset depression (LOD). Despite recent advances in psychopharmacologic treatments, 20% to 30% of patients with mood disorders experience inadequate responses to medication, often resulting in a trial of electroconvulsive therapy (ECT). However, the therapeutic mechanism of ECT is still unclear. By using 18F-fluorodeoxy-D-glucose positron emission tomography-computed tomography (18F-FDG PET/CT), we can obtain the status of brain metabolism in patients with neuropsychiatric disorders and changes during psychiatric treatment course. The object of this case report is evaluating the effect of ECT on brain metabolism in treatment-refractory LOD by PET/CT and understanding the mode of action of ECT. In this case report, we presented a 55-year-old female patient who suffered psychotic depression that was resistant to pharmacological treatment. Several antidepressants and atypical anti-psychotics were applied but there was no improvement in her symptoms. The patient presented not only depressed mood and behaviors but also deficit in cognitive functions. We found decreased diffuse cerebral metabolism in her brain 18F-FDG PET/CT image. ECT resulted in amelioration of the patients’ symptoms and another brain PET imaging 7 weeks after the last ECT course showed that her brain metabolism was normalized. PMID:28138119
Kim, S-Y; Kim, S-W; Kim, J-M; Shin, I-S; Baek, H-J; Lee, H-S; Hwang, T-J; Yoon, J-S
Among reports on the psychological variables that influence quality of life (QoL), none has addressed the impact of personality on QoL in patients with haemophilia. We investigated the impact of psychosocial variables including depression and personality on QoL in patients with severe haemophilia. A cross-sectional survey examining psychosocial and clinical characteristics was administered to Korean patients with severe haemophilia. Personality traits were ascertained using the 10-item short version of the Big Five Inventory, which quantifies five personality dimensions including extraversion, agreeableness, conscientiousness, neuroticism and openness. Patient QoL and depression were measured by the World Health Organization Quality of Life-abbreviated version and the Beck Depression Inventory (BDI) respectively. Multivariate linear regression analyses were used for each domain to determine the impact of psychological variables on QoL. Of the 53 subjects who consented to participate, 46 cases were finally analysed. Multivariate linear regression analyses demonstrated that agreeableness was significantly and positively associated with the physical health domain of QoL. Openness was independently and positively associated with the psychological and social relationship domains of QoL. BDI scores were significantly and negatively associated with all four domains of the QoL. Persistent pain and joint impairment showed strong associations with all domains in a univariate analysis, but the impact was attenuated after adjusting for psychosocial variables. Personality and depression had strong impacts on QoL independent of physical status in patients with severe haemophilia. Providing psychological screening and intervention are recommended for enhancing QoL in patients with severe haemophilia.
Ono, Kotaro; Takaesu, Yoshikazu; Nakai, Yukiei; Shimura, Akiyoshi; Ono, Yasuyuki; Murakoshi, Akiko; Matsumoto, Yasunori; Tanabe, Hajime; Kusumi, Ichiro; Inoue, Takeshi
Background Recent studies have suggested that the interactions among several factors affect the onset, progression, and prognosis of major depressive disorder. This study investigated how childhood abuse, neuroticism, and adult stressful life events interact with one another and affect depressive symptoms in the general adult population. Subjects and methods A total of 413 participants from the nonclinical general adult population completed the Patient Health Questionnaire-9, the Child Abuse and Trauma Scale, the neuroticism subscale of the shortened Eysenck Personality Questionnaire – Revised, and the Life Experiences Survey, which are self-report scales. Structural equation modeling (Mplus version 7.3) and single and multiple regressions were used to analyze the data. Results Childhood abuse, neuroticism, and negative evaluation of life events increased the severity of the depressive symptoms directly. Childhood abuse also indirectly increased the negative appraisal of life events and the severity of the depressive symptoms through enhanced neuroticism in the structural equation modeling. Limitations There was recall bias in this study. The causal relationship was not clear because this study was conducted using a cross-sectional design. Conclusion This study suggested that neuroticism is the mediating factor for the two effects of childhood abuse on adulthood depressive symptoms and negative evaluation of life events. Childhood abuse directly and indirectly predicted the severity of depressive symptoms. PMID:28243100
Calleo, Jessica S; Bush, Amber L; Cully, Jeffrey A; Wilson, Nancy L; Kraus-Schuman, Cynthia; Rhoades, Howard M; Novy, Diane M; Masozera, Nicholas; Williams, Susan; Horsfield, Matthew; Kunik, Mark E; Stanley, Melinda A
To increase the sustainability of cognitive behavior therapy (CBT) in primary care for late-life anxiety, we incorporated nonexpert counselors, options for telephone meetings, and integration with primary care clinicians. This open trial examines the feasibility, satisfaction, and clinical outcomes of CBT delivered by experienced and nonexperienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). After 3 months of treatment, Cohen's d effect sizes for worry and anxiety ranged from 0.48 to 0.78. Patients treated by experienced and nonexperienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Preliminary results suggest that adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care.
The purpose of this study is to see whether emotional support from fellow church members is associated with self-forgiveness in late life. The data come from a longitudinal nationwide survey of older adults. An effort is made to contribute to the literature by comparing and contrasting the effects of two church-based support measures: the amount of emotional support that is provided by fellow church members and satisfaction with emotional support from co-religionists. The findings suggest that older study participants who are more satisfied with the emotional support they have received from the members of their church are more likely to forgive themselves than older people who are not satisfied with the emotional support they have received in church. In contrast, significant effects failed to emerge with the measure of the amount of received emotional support.
Rae, Michael J.; Butler, Robert N.; Campisi, Judith; de Grey, Aubrey D. N. J.; Finch, Caleb E.; Gough, Michael; Martin, George M.; Vijg, Jan; Perrott, Kevin M.; Logan, Barbara J.
The social and medical costs of the biological aging process are high and will rise rapidly in coming decades, creating an enormous challenge to societies worldwide. In recent decades, researchers have expanded their understanding of the underlying deleterious structural and physiological changes (aging damage) that underlie the progressive functional impairments, declining health, and rising mortality of aging humans and other organisms and have been able to intervene in the process in model organisms, even late in life. To preempt a global aging crisis, we advocate an ambitious global initiative to translate these findings into interventions for aging humans, using three complementary approaches to retard, arrest, and even reverse aging damage, extending and even restoring the period of youthful health and functionality of older people. PMID:20630854
van 't Land, Karine
Within late medieval learned medicine, natural death functioned both as a theoretical concept and as a goal for practice. Late medieval commentaries on Avicenna's Canon are used as source material in this study, in order to investigate the ways in which these learned medical authors envisaged natural death. The findings are compared to descriptions of natural death by natural philosophers, and to ideals of dying in broader medieval culture. According to the physicians, natural death was caused by the extinction of innate heat, due to a lack of innate moisture. They discussed natural death in relation to regimen, as the right regimen protected the body's heat and moisture, and thus helped a patient to keep natural death aloof. So, in order to think about natural death, the physicians turned to the whole of life, during which heat dried out moisture and regimens ought to be followed. By contrast, natural philosophers tended to focus on the moment of death itself. The comparison of natural death with the Good Death in broad medieval culture highlights the amoral nature of the natural death.
Ishida, Yasushi; Sakamoto, Naoko; Kamibeppu, Kiyoko; Kakee, Naoko; Iwai, Tsuyako; Ozono, Shuichi; Maeda, Naoko; Okamura, Jun; Asami, Keiko; Inada, Hiroko; Honda, Misato; Horibe, Keizo
To examine the late effects and health-related quality of life of childhood cancer survivors (CCS) after radiotherapy (RT), we performed a cross-sectional survey using self-rating questionnaires. The subjects were divided into 3 groups: CCS treated with or without RT, and a general population matched for age, gender, residential area, and work status. The numbers in each group were 113, 72, and 1,000, respectively. The median ages of CCS at diagnosis and the time of the survey were 8 and 22 years, respectively. The mean final heights of males and females were significantly lower in CCS with RT than in the other 2 groups. Risk factors for a short stature were total body irradiation (TBI) [odds ratio (OR) 17.8, p < 0.001], spinal irradiation (OR 8.31, p = 0.033), and an age younger than 10 years at diagnosis. Late effects were observed in 68% of CCS with RT compared with 36% of CCS without RT. Multivariate analysis revealed that TBI was significantly associated with endocrine dysfunction (OR 12.3), skull and spinal irradiation with cognitive dysfunction (OR 16.1 and 11.5, respectively), and spinal irradiation with a short stature (OR 14.1), respectively. Physical dysfunction, psychological stress, and problems of social adaptation were observed in >50% of CCS with RT.
Saeb, Sohrab; Zhang, Mi; Karr, Christopher J; Schueller, Stephen M; Corden, Marya E; Kording, Konrad P
Background Depression is a common, burdensome, often recurring mental health disorder that frequently goes undetected and untreated. Mobile phones are ubiquitous and have an increasingly large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms. Objective The objective of this study was to explore the detection of daily-life behavioral markers using mobile phone global positioning systems (GPS) and usage sensors, and their use in identifying depressive symptom severity. Methods A total of 40 adult participants were recruited from the general community to carry a mobile phone with a sensor data acquisition app (Purple Robot) for 2 weeks. Of these participants, 28 had sufficient sensor data received to conduct analysis. At the beginning of the 2-week period, participants completed a self-reported depression survey (PHQ-9). Behavioral features were developed and extracted from GPS location and phone usage data. Results A number of features from GPS data were related to depressive symptom severity, including circadian movement (regularity in 24-hour rhythm; r=-.63, P=.005), normalized entropy (mobility between favorite locations; r=-.58, P=.012), and location variance (GPS mobility independent of location; r=-.58, P=.012). Phone usage features, usage duration, and usage frequency were also correlated (r=.54, P=.011, and r=.52, P=.015, respectively). Using the normalized entropy feature and a classifier that distinguished participants with depressive symptoms (PHQ-9 score ≥5) from those without (PHQ-9 score <5), we achieved an accuracy of 86.5%. Furthermore, a regression model that used the same feature to estimate the participants’ PHQ-9 scores obtained an average error of 23.5%. Conclusions Features extracted from mobile phone sensor data, including GPS and phone usage, provided behavioral markers that were strongly related to depressive symptom severity. While these findings must
Sauvaget, Anne; Jiménez-Murcia, Susana; Fernández-Aranda, Fernando; Fagundo, Ana B.; Moragas, Laura; Wolz, Ines; Veciana De Las Heras, Misericordia; Granero, Roser; del Pino-Gutiérrez, Amparo; Baño, Marta; Real, Eva; Aymamí, Maria N.; Grall-Bronnec, Marie; Menchón, José M.
Background: The lifetime prevalence of problem or Gambling disorder (GD) in the elderly (i.e., those over 60 years old) is reported to range from 0.01 to 10.9%. Research has identified several specific risk factors and vulnerabilities in the elderly. Since the late 1990s, an increase in online GD has been observed in the youth population, whereas casinos, slot machines, and bingo seem to be the activities of choice among the elderly. Interestingly, online GD has not been described in the elderly to date. Case Description: We report an 83-year-old man who started online casino gambling from the age of 80 years, leading to debts that exceeded €30,000. He underwent a full clinical and neuropsychological assessment, without any evidence of cognitive impairment or any associated neurodegenerative disease. However, he had risk factors for GD, including adjustment disorder, stressful life events, previous offline casino GD when 50 years old, and dysfunctional personality traits. The change to online GD may have been due to his isolation, movement difficulties, and his high level of education, which facilitated his access to the Internet. Care management focused on individual cognitive-behavioral therapy. Conclusion: The prevalence of online GD may be underestimated among the elderly, and may increase among isolated old people with movement difficulties and ready access to the Internet. However, late-life GD should be considered a diagnosis of elimination, requiring a full medical, psychiatric (including suicide risk), and cognitive assessment. Specific therapeutic approaches need to be proposed and developed. PMID:26074835
Hsu, Chun Liang; Voss, Michelle W.; Best, John R.; Handy, Todd C.; Madden, Kenneth; Bolandzadeh, Niousha; Liu-Ambrose, Teresa
Background: Obesity is associated with vascular risk factors that in turn, may increase dementia risk. However, higher body mass index (BMI) in late life may be neuroprotective. The possible neural mechanisms underlying the benefit of higher BMI on cognition in older adults are largely unknown. Thus, we used functional connectivity magnetic resonance imaging (fcMRI) to examine: (1) the relationship between BMI and functional brain connectivity; and (2) the mediating role of functional brain connectivity in the association between baseline BMI and change in cognitive function over a 12-month period. Methods:We conducted a 12-month, prospective study among 66 community-dwelling older adults, aged 70 to 80 years, who were categorized as: normal weight (BMI from 18.50 to 24.99); overweight (BMI from 25.00 to 29.99); and obese (BMI ≥ 30.00). At baseline, participants performed a finger-tapping task during fMRI scanning. Relevant neural networks were initially identified through independent component analysis (ICA) and subsequently examined through seed-based functional connectivity analysis. At baseline and 12-months, we measured three executive cognitive processes: (1) response inhibition; (2) set shifting; and (3) working memory. Results:Obese individuals showed lower task-related functional connectivity during finger tapping in the default mode network (DMN) compared with their healthy weight counterparts (p < 0.01). Lower task-related functional connectivity in the DMN at baseline was independently associated with better working memory performance at 12-months (p = 0.02). Finally, DMN functional connectivity during finger tapping significantly mediated the relationship between baseline BMI and working memory at 12-months (indirect effect: −0.155, 95% confidence interval [−0.313, −0.053]). Conclusions:These findings suggest that functional connectivity of the DMN may be an underlying mechanism by which higher BMI confers protective effects to cognition in
Isling, Louise Krag; Boberg, Julie; Jacobsen, Pernille Rosenskjold; Mandrup, Karen Riiber; Axelstad, Marta; Christiansen, Sofie; Vinggaard, Anne Marie; Taxvig, Camilla; Kortenkamp, Andreas; Hass, Ulla
This study examined late-life effects of perinatal exposure of rats to a mixture of endocrine-disrupting contaminants. Four groups of 14 time-mated Wistar rats were exposed by gavage from gestation day 7 to pup day 22 to a mixture of 13 anti-androgenic and estrogenic chemicals including phthalates, pesticides, u.v.-filters, bisphenol A, parabens, and the drug paracetamol. The groups received vehicle (control), a mixture of all 13 chemicals at 150-times (TotalMix150) or 450-times (TotalMix450) high-end human exposure, or 450-times a mixture of nine predominantly anti-androgenic chemicals (AAMix450). Onset of puberty and estrous cyclicity at 9 and 12 months of age were assessed. Few female offspring showed significantly regular estrus cyclicity at 12 months of age in the TotalMix450 and AAMix450 groups compared with controls. In 19-month-old male offspring, epididymal sperm counts were lower than controls, and in ventral prostate an overrepresentation of findings related to hyperplasia was observed in exposed groups compared with controls, particularly in the group dosed with anti-androgens. A higher incidence of pituitary adenoma at 19 months of age was found in males and females in the AAMix450 group. Developmental exposure of rats to the highest dose of a human-relevant mixture of endocrine disrupters induced adverse effects late in life, manifested as earlier female reproductive senescence, reduced sperm counts, higher score for prostate atypical hyperplasia, and higher incidence of pituitary tumors. These delayed effects highlight the need for further studies on the role of endocrine disrupters in hormone-related disorders in aging humans.
Ma, Lina; Zhao, Xiaoling; Liu, Huizhen; Zhu, Hong; Yang, Wei; Qian, Yuying; Wang, Jieyu; Feng, Ming; Li, Yun
We aim to explore the influence of an antidepression medication on symptom scores and quality of life in elderly patients with benign prostatic hyperplasia accompanied by depression. We conducted a randomized controlled clinical trial which included 94 elderly patients with benign prostatic hyperplasia accompanied by depression in Xuan Wu Hospital and Beijing Boai Hospital during August 2008 to May 2012. The study was designed to compare outcomes related to patient quality of life (QoL). The patients were randomly assigned to one of two groups, consisting of a control group (n = 47) and a therapy group (n = 47), and were followed up for 3 months. The pre-treatment and post-treatment changes among patients in the two groups were compared using their respective IPSS symptom scores, HAM-D scores, and scores on the Short Form 36 Health Survey. Following treatment, the patient IPSS symptom scores in the therapy group were significantly lower than those in the control group (10.74 ± 4.72 vs. 16.42 ± 8.09, respectively; t = 4.157, P < 0.05). Additionally, each measured dimension of QoL was significantly higher in the therapy group [total score (69.12 ± 3.92) vs. (61.30 ± 3.51), P < 0.05]. The results show antidepression medication can improve the symptoms and quality of life among elderly patients with benign prostatic hyperplasia accompanied by depression. Our findings suggest that an antidepression medication should be included when treating elderly patients with benign prostatic hyperplasia.
Rask, Lene; Bendix, Laila; Harbo, Maria; Fagerlund, Birgitte; Mortensen, Erik L.; Lauritzen, Martin J.; Osler, Merete
Importance: Cognitive skills are known to decline through the lifespan with large individual differences. The molecular mechanisms for this decline are incompletely understood. Although leukocyte telomere length provides an index of cellular age that predicts the incidence of age-related diseases, it is unclear whether there is an association between cognitive decline and leukocyte telomere length. Objective: To examine the association between changes in cognitive function during adult life and leukocyte telomere length after adjusting for confounding factors such as education, mental health and life style. Design, Setting, and Participants: Two groups of men with negative (n = 97) and positive (n = 93) change in cognitive performance were selected from a birth cohort of 1985 Danish men born in 1953. Cognitive performance of each individual was assessed at age ~20 and 56 years. Leukocyte telomere length at age ~58 was measured using qPCR. Linear regression models were used to investigate the association between cognitive function and leukocyte telomere length. Results: Men with negative change in cognitive performance during adult life had significantly shorter mean leukocyte telomere length than men with positive change in cognitive performance (unadjusted difference β = −0.09, 95% CI −0.16 to −0.02, p = 0.02). This association remained significant after adjusting for smoking, alcohol consumption, leisure time activity, body mass index (BMI) and cholesterol (adjusted difference β = −0.09, 95% CI −0.17 to −0.01, p = 0.02) but was non-significant after adjusting for smoking, alcohol consumption, leisure time activity, BMI, cholesterol, current cognitive function, depression and education (adjusted difference β = −0.07, 95% CI −0.16 to −0.01, p = 0.08). Conclusion and Relevance: Preclinical cognitive changes may be associated with leukocyte telomere length. PMID:28018213
Eskin, Mehmet; Akyol, Ali; Çelik, Emine Yilmaz; Gültekin, Bülent Kadri
This study aimed at investigating social problem solving, perceived stress, depression, and life-satisfaction in patients with tension type and migraine headaches. Forty-nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self-report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T-tests, chi-square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life-satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life-satisfaction in patients suffering from primary headache.
Stroud, Nicole M; Minahan, Clare L
Background The purpose of this study was to compare fatigue, depression and quality of life scores in persons with multiple sclerosis who do (Exercisers) and do not (Non-exercisers) regularly participate in physical activity. Methods A cross-sectional questionnaire study of 121 patients with MS (age 25–65 yr) living in Queensland, Australia was conducted. Physical activity level, depression, fatigue and quality of life were assessed using the International Physical Activity Questionnaire, Health Status Questionnaire Short Form 36, Becks Depression Inventory and Modified Fatigue Impact Scale. Results 52 participants performed at least two 30-min exercise sessions·wk-1 (Exercisers) and 69 did not participate in regular physical activity (Non-exercisers). Exercisers reported favourable fatigue, depression and quality of life scores when compared to Non-exercisers. Significant weak correlations were found between both leisure-time and overall reported physical activity levels and some subscales of the quality of life and fatigue questionnaires. Additionally, some quality of life subscale scores indicated that regular physical activity had a greater benefit in subjects with moderate MS. Conclusion Favourable fatigue, depression and quality of life scores were reported by persons with MS who regularly participated in physical activity, when compared to persons with MS who were classified as Non-exercisers. PMID:19619337
Bird, Michael J; Parslow, Ruth A
Depression is one of the most common mental health disorders in older people. Sequelae include unnecessary suffering, excess physical and social disability, exacerbation of co-existing illness, earlier death, and overuse of services. There are currently no reported public health approaches to prevent late-life depression. Five risk factors appear susceptible to community-level prevention programs: recurrent depression, commonly undertreated precipitants, vascular disease, functional impairments, and metabolite abnormalities. We propose three broad but interacting prevention methods: increasing literacy about late-life depression, exercise, and dietary supplements.
Brown, Timothy A; Rosellini, Anthony J
The direct and interactive effects of neuroticism and stressful life events (chronic and episodic stressors) on the severity and temporal course of depression symptoms were examined in 826 outpatients with mood and anxiety disorders, assessed on 3 occasions over a 1-year period (intake and 6- and 12-month follow-ups). Neuroticism, chronic stress, and episodic stress were uniquely associated with intake depression symptom severity. A significant interaction effect indicated that the strength of the effect of neuroticism on initial depression severity increased as chronic stress increased. Although neuroticism did not have a significant direct effect on the temporal course of depression symptoms, chronic stress significantly moderated this relationship such that neuroticism had an increasingly deleterious effect on depression symptom improvement as the level of chronic stress over follow-up increased. In addition, chronic stress (but not episodic stress) over follow-up was uniquely predictive of less depression symptom improvement. Consistent with a stress generation framework, however, initial depression symptom severity was positively associated with chronic stress during follow-up. The results are discussed in regard to diathesis-stress conceptual models of emotional disorders and the various roles of stressful life events in the onset, severity, and maintenance of depressive psychopathology.
Chentsova-Dutton, Yulia E; Choi, Eunsoo; Ryder, Andrew G; Reyes, Jenny
The meanings of "anhedonia" and "depressed mood," the cardinal emotional symptoms of major depression, may be shaped by cultural norms regarding pleasure and sadness. Thirty-two European Americans, 26 Hispanic Americans, 33 Asian Americans, and 20 Russian Americans provided reports of (a) depressive symptoms, (b) momentary emotions and pleasure, and (c) global subjective well-being. Momentary reports were collected over 10 days using handheld personal digital assistants. Reports of anhedonia were associated with heightened levels of momentary low arousal negative emotions (e.g., sadness), whereas reports of depressed mood were associated with dampened levels of momentary positive emotions (e.g., happiness). Symptoms of anhedonia and depressed mood interacted in their associations with momentary pleasure. In addition, the associations of anhedonia and depressed mood with positive emotions and life satisfaction differed across cultural groups. Specifically, these symptoms were associated with dampened positive emotions in the Asian American group only. Additionally, anhedonia was associated with dampened global life satisfaction in the European American group only. These results suggest that reports of anhedonia and depressed mood cannot be interpreted at face value as specific and culture-free indicators of emotional deficits. Instead, they appear to signal changes in the balance of positive and negative emotions, with the exact nature of these signals shaped at least in part by cultural context. This conclusion has important consequences for the clinical interpretation of depressive symptoms in multicultural societies.
Holubova, Michaela; Prasko, Jan; Ociskova, Marie; Marackova, Marketa; Grambal, Ales; Slepecky, Milos
Background Self-stigma is a maladaptive psychosocial phenomenon that can affect many areas of patients’ lives and have a negative impact on their quality of life (QoL). This study explored the association between self-stigma, QoL, demographic data, and the severity of symptoms in patients with depressive disorder. Patients and methods Patients who met the International Classification of Diseases, 10th revision, research criteria for depressive disorder were enrolled in this cross-sectional study. All outpatients completed the following measurements: the Quality of Life Enjoyment and Satisfaction Questionnaire, the Internalized Stigma of Mental Illness Scale, demographic questionnaire, and the objective and subjective Clinical Global Impression-Severity scales that measure the severity of disorder. A total of 81 depressive disorder patients (with persistent affective disorder – dysthymia, major depressive disorder, or recurrent depressive disorder) and 43 healthy controls participated in this study. Results Compared with the healthy control group, a lower QoL was observed in patients with depressive disorder. The level of self-stigma correlated positively with total symptom severity score and negatively with QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and score of self-stigma were significantly associated with QoL. Conclusion This study suggests a lower QoL in patients with depressive disorder in comparison with healthy controls and a negative impact of self-stigma level on QoL in patients suffering from depressive disorders. PMID:27799775
Karatzias, Thanos; Jowett, Sally; Yan, Elsie; Raeside, Robert; Howard, Ruth
We set out to investigate the mediating roles of depression, resilience, smoking, and alcohol use, in the relationship between potentially traumatic life events and objective and subjective, physical and mental health in a single study. A face-to-face, population-based survey was conducted in Hong Kong (N = 1147). Information on health conditions and traumatic life events was obtained, and participants completed measures of subjective physical and mental health, depression, and resilience. Smoking and drinking were not significant mediators of the relationship between life events and both objective and subjective health. Depressive symptomatology was found to mediate the relationship between life threatening illness and subjective physical health, the relationship between abuse (physical and sexual) and subjective mental health, and the relationship between the death of a parent/partner and subjective mental health. Resilience was found to mediate the relationships between multiple traumatic life events and subjective physical and mental health. Our results indicate that psychological factors rather than biological are important mediators of the relationship between life events exposure and health. Our findings provide evidence that depressive symptomatology has a mediating role only in the case of specific potentially traumatic life events and that resilience is only a critical factor in the face of exposure to multiple traumatic events, rather than single events. Our results also indicate that behavioural factors, such as smoking and drinking, are not significant mediators of the relationship between life events and health.
Background Previous findings suggest that stressful life events have a causal relationship with depressive symptoms. However, to date little is known concerning the contribution of the number and severity of recent stressful life events on the prevalence of depressive symptoms among university students. The aim of this study was to investigate the prevalence of depressive symptoms and its association with the number and the severity of self-reported stressful life events among university students in Cyprus. Methods A descriptive correlational design with cross sectional comparison was used. The CES-D scale was applied for the assessment of depressive symptoms and the LESS instrument for stressful life events. Both scales were completed anonymously and voluntarily by 1.500 students (response rate 85%). Results The prevalence of mild to moderate depressive symptoms [CES-D score between 16 and 21] and of clinically significant depressive symptoms [CES-D score ≥ 22] were 18.8% and 25.3% respectively. There were statistically significant differences in clinically significant depressive symptoms by gender, with higher rates among women (x2 = 8.53, df = 1, p = 0.003). Higher scores on the LESS scale were associated with more frequent reports of clinical depressive symptoms (x2 = 70.63, df = 4, p < 0.001). Similarly, an association was found between the number of life events and clinical depressive symptoms (x2 = 40.06, df = 4, p < 0.001). Logistic regression analysis after adjusting for socio-demographic characteristics confirmed that the responders who reported a high number (n = 12–21) of stressful life events during the previous year (OR = 2.64 95% CI: 1.02, 6.83) and a severe degree of stress due to these events (total LESS score > 351, OR = 3.03 95% CI: 1.66, 5.39) were more likely to manifest clinical depressive symptoms. Conclusions The high frequency of occurrence of depressive symptoms among Cypriot
... crime punishable by hefty fines and jail time. How Can Someone Quit? Quitting depressants can be very difficult. A person who tries to stop taking the drugs can have tremors, breathing problems, and seizures, go into a coma, or even die. Because the body's systems get used to the ...
Tyrka, Audrey R.; Carpenter, Linda L.; Price, Lawrence H.
Rationale Prior reviews have examined how stress, broadly defined, interacts with genetic diathesis in the pathogenesis of internalizing (i.e., depressive and anxiety) disorders. Recent findings have suggested a unique role for early life stress (ELS) in the development of internalizing disorders, contributing to the rapid proliferation of research in this area. Objective This paper critically reviews studies in humans examining gene–environment interaction (GxE) effects of ELS on the risk for depression and anxiety, primarily from a candidate gene perspective. Major methodological challenges that are unique to such studies are considered. Results The majority of published studies have focused on candidates that regulate the serotonin system, especially the serotonin transporter. More recent work has addressed interactions of ELS with candidates from the hypothalamic-pituitary-adrenal axis and neurotrophin system. Available studies vary greatly with respect to definitions of ELS, examination of gene–gene interactions, consideration of gender effects, and attention to analytic limitations. Conclusions Overall, there is support for GxE effects of ELS on the risk for depressive and anxiety outcomes. Future studies of ELS in this context will require careful attention to methodologic considerations. Such studies would benefit from more systematic assessment of positive environmental factors (e.g., social support) and greater utilization of developmentally sensitive paradigms. PMID:21225419
Theeke, Laurie A; Goins, R Turner; Moore, Julia; Campbell, Heather
This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants' number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20-80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.
Xiao, Huimin; Yoon, Ju Young; Bowers, Barbara
Living arrangements are often assumed to be associated with health-related quality of life (HRQoL) among older adults. This study aimed to explore how living arrangements affect HRQoL. A cross-sectional survey was conducted to examine the relationships between HRQoL, activities of daily living (ADLs), depression, and living arrangements among older adults. A total of 220 community dwelling older adults and 231 nursing home residents completed the questionnaires. The path analysis indicated that the older adults' living arrangement did not directly influence their HRQoL, but it had indirect effects through ADLs and depression. The whole model explained 55% of the variance of HRQoL, which suggests that living in nursing homes does not directly cause older adults' poor HRQoL, but poor ADLs and more severe depression among nursing home residents lead to poor HRQoL. To improve their HRQoL, additional focus should be placed on maintaining ADLs and increasing community participation.
Boen, Courtney; Yang, Y. Claire
Given documented links between individual socioeconomic status (SES) and health, it is likely that—in addition to its impacts on individuals’ wallets and bank accounts—the Great Recession also took a toll on individuals’ disease and mortality risk. Exploiting a quasi-natural experiment design, this study utilizes nationally representative, longitudinal data from the National Social Life, Health, and Aging Project (NSHAP) (2005-2011) (N=930) and individual fixed effects models to examine how household-level wealth shocks experienced during the Great Recession relate to changes in biophysiological functioning in older adults. Results indicate that wealth shocks significantly predicted changes in physiological functioning, such that losses in net worth from the pre- to the post-Recession period were associated with increases in systolic blood pressure and C-reactive protein over the six year period. Further, while the association between wealth shocks and changes in blood pressure was unattenuated with the inclusion of other indicators of SES, psychosocial well-being, and health behaviors in analytic models, we document some evidence of mediation in the association between changes in wealth and changes in C-reactive protein, which suggests specificity in the social and biophysiological mechanisms relating wealth shocks and health at older ages. Linking macro-level conditions, meso-level household environments, and micro-level biological processes, this study provides new insights into the mechanisms through which economic inequality contributes to disease and mortality risk in late life. PMID:26773705
Boen, Courtney; Yang, Y Claire
Given documented links between individual socioeconomic status (SES) and health, it is likely that-in addition to its impacts on individuals' wallets and bank accounts-the Great Recession also took a toll on individuals' disease and mortality risk. Exploiting a quasi-natural experiment design, this study utilizes nationally representative, longitudinal data from the National Social Life, Health, and Aging Project (NSHAP) (2005-2011) (N = 930) and individual fixed effects models to examine how household-level wealth shocks experienced during the Great Recession relate to changes in biophysiological functioning in older adults. Results indicate that wealth shocks significantly predicted changes in physiological functioning, such that losses in net worth from the pre-to the post-Recession period were associated with increases in systolic blood pressure and C-reactive protein over the six year period. Further, while the association between wealth shocks and changes in blood pressure was unattenuated with the inclusion of other indicators of SES, psychosocial well-being, and health behaviors in analytic models, we document some evidence of mediation in the association between changes in wealth and changes in C-reactive protein, which suggests specificity in the social and biophysiological mechanisms relating wealth shocks and health at older ages. Linking macro-level conditions, meso-level household environments, and micro-level biological processes, this study provides new insights into the mechanisms through which economic inequality contributes to disease and mortality risk in late life.
Abbott, Robert D; Ross, G Webster; Petrovitch, Helen; Tanner, Caroline M; Davis, Daron G; Masaki, Kamal H; Launer, Lenore J; Curb, J David; White, Lon R
It is not known if constipation is associated with the preclinical phase of Parkinson's disease (PD), often characterized by the presence of incidental Lewy bodies (ILB). Such an association could provide evidence that constipation is an early symptom of PD. The purpose of this report is to examine the association between late-life bowel movement frequency and ILB. Bowel movement frequency was assessed from 1991 to 1993 in 245 men aged 71 to 93 years in the Honolulu-Asia Aging Study who later received postmortem examinations. All were without clinical PD and dementia. Brains were examined for ILB in the substantia nigra and locus ceruleus. Among the decedents, 30 men had ILB (12.2%). After age-adjustment, the percent of brains with ILB declined with increasing bowel movement frequency (P=0.013). For men with <1, 1, and >1 bowel movement/day, corresponding percents were 24.1, 13.5, and 6.5%. Findings persisted after additional adjustment for time to death, mid-life pack-years of smoking and coffee intake, physical activity, and cognitive function. Infrequent bowel movements are associated with ILB. Findings provide evidence that constipation can predate the extrapyramidal signs of PD. Constipation could be one of the earliest markers of the beginning of PD processes.
Fauth, Elizabeth B.; Gerstorf, Denis; Ram, Nilam; Malmberg, Bo
Developmental processes are inherently time-related, with various time metrics and transition points being used to proxy how change is organized with respect to the theoretically underlying mechanisms. Using data from 4 Swedish studies of individuals aged 70-100+ (N = 453) who were measured every 2 years for up to 5 waves, we tested whether…
Yin, Yingying; He, Xiaofu; Xu, Mingze; Hou, Zhenghua; Song, Xiaopeng; Sui, Yuxiu; Liu, Zhi; Jiang, Wenhao; Yue, Yingying; Zhang, Yuqun; Liu, Yijun; Yuan, Yonggui
To identify the association between the functional and structural changes of default mode network (DMN) underlying the cognitive impairment in Late-onset depression (LOD), 32 LOD patients and 39 normal controls were recruited and underwent resting-state fMRI, DTI scans, and cognitive assessments. Seed-based correlation analysis was conducted to explore the functional connectivity (FC) of the DMN. Deterministic tractography between FC-impaired regions was performed to examine the structural connectivity (SC). Partial correlation analyses were employed to evaluate the cognitive association of those altered FC and SC. Compared with controls, LOD patients showed decreased FC between DMN and the cingulo-opercular network (CON), as well as the thalamus. Decreased FA and increased RD of these fiber tracts connecting DMN with CON were found in LOD patient. The DMN-CON FC and the FA, RD of the fiber tracts were both significantly correlated with the cognitive performance. Therefore, the cognitive impairment in LOD might be associated with the decreased FC between the DMN and the CON, which probably resulted from the demyelination of the white matter. PMID:27886212
Torres, Karen Cecília; Araújo Pereira, Patrícia; Lima, Giselle Sabrina; Bozzi, Isadora Cristina; Rezende, Vitor Bortolo; Bicalho, Maria Aparecida; Moraes, Edgar Nunes; Miranda, Débora Marques; Romano-Silva, Marco Aurélio
Higher risk of dementia is expected for patients with late onset depression (LOD) history. The IL-10 polymorphisms are associated with Alzheimer disease (AD). On the other hand, there is no study associating IL-10 polymorphisms to LOD. This study aimed to investigate the -1082G/A polymorphism association in LOD, AD patients and controls and also the peripheral expression of IL-10 in CD4+ T cells. It was done in a case-control study comparing immune system phenotype and genetic polymorphism association among control individuals, LOD and AD patients. Participants were 569 subjects composed the genetics sample (249 AD, 222 LOD and 98 controls) from a tertiary medical center based on Belo Horizonte, Brazil. Flow cytometry analysis was performed in 55 people (22 AD patients, 11 LOD patients and 22 controls). A real time PCR for IL-10 SNP (rs 1800896) through genotyping analysis and flow cytometry evaluation of CD4+ T cells expressing IL-10 was done. An increased CD4+ T cells expressing IL-10 were detected only in the AD group. There was no difference detected in allele or genotype analysis for IL-10 polymorphism among LOD, AD patients or controls. IL-10 might have a role in the modulation of immune response in AD patients, however it is not presented in LOD population.
Bruheim, Kjersti; Guren, Marianne G.; Skovlund, Eva; Hjermstad, Marianne J.; Dahl, Olav; Frykholm, Gunilla; Carlsen, Erik; Tveit, Kjell Magne
Purpose: There is little knowledge on long-term morbidity after radiotherapy (50 Gy) and total mesorectal excision for rectal cancer. Therefore, late effects on bowel, anorectal, and urinary function, and health-related quality of life (QoL), were studied in a national cohort (n = 535). Methods and Materials: All Norwegian patients who received pre- or postoperative (chemo-)radiotherapy for rectal cancer from 1993 to 2003 were identified. Patients treated with surgery alone served as controls. Patients were without recurrence or metastases. Bowel and urinary function was scored with the LENT SOMA scale and the St. Marks Score for fecal incontinence and QoL with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). Results: Median time since surgery was 4.8 years. Radiation-treated (RT+) patients (n = 199) had increased bowel frequency compared with non-radiation-treated (RT-) patients (n = 336); 19% vs. 6% had more than eight daily bowel movements (p < 0.001). In patients without stoma, a higher proportion of RT+ (n = 69) compared with RT- patients (n = 240), were incontinent for liquid stools (49% vs. 15%, p < 0.001), needed a sanitary pad (52% vs. 13%, p < 0.001), and lacked the ability to defer defecation (44% vs. 16%, p < 0.001). Daily urinary incontinence occurred more frequently after radiotherapy (9% vs. 2%, p = 0.001). Radiation-treated patients had worse social function than RT- patients, and patients with fecal or urinary incontinence had impaired scores for global quality of life and social function (p < 0.001). Conclusions: Radiotherapy for rectal cancer is associated with considerable long-term effects on anorectal function, especially in terms of bowel frequency and fecal incontinence. RT+ patients have worse social function, and fecal incontinence has a negative impact on QoL.
Torres, Jacqueline M; Wong, Rebeca
This study applies life-course theories of latent (direct), pathway (indirect) and conditional effects in an analysis of childhood poverty on later-life depressive symptoms among older adults in Mexico. Data are from the 2001 Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults born before 1951 (n = 8696). Respondents had a mean of 3.6 past-week depressive symptoms and 71% had no household sanitation facilities before age 10; this measure served as a proxy for childhood poverty. Childhood poverty is significantly related to scores on an adapted 9-item CES-D scale in the full model (b = 0.27, p < 0.001). This effect is partially mediated by four adult socio-economic status measures, although decomposition analysis reveals the mediation effect to be primarily driven by educational achievement. These findings have important implications for Mexico's rapidly aging population as well as efforts for childhood poverty reduction and gains in education.
This study applies life-course theories of latent (direct), pathway (indirect) and conditional effects in an analysis of childhood poverty on later-life depressive symptoms among older adults in Mexico. Data are from the 2001 Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults born before 1951 (n=8696). Respondents had a mean of 3.6 past-week depressive symptoms and 71 % had no household sanitation facilities before age 10; this measure served as a proxy for childhood poverty. Childhood poverty is significantly related to scores on an adapted 9-item CES-D scale in the full model (b=0.27, p<0.001). This effect is partially mediated by four adult socio-economic status measures, although decomposition analysis reveals the mediation effect to be primarily driven by educational achievement. These findings have important implications for Mexico’s rapidly aging population as well as efforts for childhood poverty reduction and gains in education. PMID:23783887
Nordin, K; Wasteson, E; Hoffman, K; Glimelius, B; Sjödén, P O
Patients' satisfaction with life, viewed in terms of the discrepancy between the perceived attainment and subjective importance of various life values, is a less often studied phenomenon for understanding the psychological adaptation in cancer patients. The main aim of the present study is to investigate the relation between the degree of attainment and importance of life values on the one hand, and anxiety and depression, on the other. A consecutive series of 85 newly diagnosed patients with gastrointestinal (GI) cancers, 52 potentially cured and 33 with an advanced disease, and 26 spouses to the patients with an advanced disease participated. The patients and spouses of non-cured patients filled out questionnaires twice, close to the diagnosis and after 1 (non-cured patients) or 3 months. Overall, large discrepancies between the perceived attainment and importance of life values were associated with high anxiety and depression. For the patients (both cured and non-cured), the discrepancies decreased for several life values over time, as did anxiety and depression. For the spouses of the non-cured patients, there was no decrease either for life value discrepancies or for anxiety/depression. This suggests that patients, in contrast to their spouses, strive to achieve small discrepancies between the perceived attainment and importance of life values, as part of their adjustment to serious diseases, e.g. cancer.
McCarron, Robert M; Vanderlip, Erik R; Rado, Jeffrey
This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.
Guligowska, Agnieszka; Pigłowska, Małgorzata; Fife, Elizaveta; Kostka, Joanna; Sołtysik, Bartłomiej K; Kroc, Łukasz; Kostka, Tomasz
Objectives The study is a case-control analysis of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a relationship between nutrient deficiencies and these adverse changes. Patients and methods A total of 130 older subjects participated in the study: 65 with diagnosed depression (16 men and 49 women) and 65 age- and sex-matched controls without depression. All patients underwent comprehensive geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment, cognitive performance was evaluated by the Mini-Mental State Examination and physical functioning by the Timed “Up & Go” test and handgrip strength. The pattern of consumption of various nutrients was analyzed in detail. Results The differences in cognitive functioning observed between the groups were related to specific nutrient intake, as was handgrip strength to some extent. The differences in nutritional status, several functional tests and muscle strength were related to both the presence of depression and inappropriate consumption of certain nutrients. Conclusion The incidence of falls and poor quality of life may be partially associated with the presence of depression. The inappropriate intake of selected nutrients may impair the functioning and quality of life of older adults with depression, such as the excess consumption of sucrose and insufficient consumption of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients should be translated into dietary patterns which allow the individual patient to address these nutrient deficiencies. PMID:27822023
Satterfield, Jason M; Crabb, Rebecca
Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were deduced from the late-life depression literature, culturally adapted CBT protocols for racial minorities, and the emerging social and developmental psychological theories for lesbian, gay, and bisexual populations. Specific treatment interventions, processes, and outcomes are described to illustrate how these literatures may be used to provide more culturally appropriate and effective health care for the growing, older sexual minority population.
Diefenbach, Gretchen J.; Tolin, David F.; Gilliam, Christina M.; Meunier, Suzanne A.
Data suggesting that cognitive-behavioral therapy (CBT) is efficacious for late-life anxiety are accumulating; however, effectiveness has not been well established. Incorporating CBT for anxiety into home care is needed to facilitate access to evidenced-based treatment for a growing population of community-dwelling, functionally impaired elderly…
Juruena, Mario F
It is now broadly accepted that psychological stress may change the internal homeostatic state of an individual. During acute stress, adaptive physiological responses occur, which include hyperactivity of the HPA axis. Whenever there is an acute interruption of this balance, illness may result. The social and physical environments have an enormous impact on our physiology and behavior, and they influence the process of adaptation or 'allostasis'. It is correct to state that at the same time that our experiences change our brain and thoughts, namely, changing our mind, we are changing our neurobiology. Increased adrenocortical secretion of hormones, primarily cortisol in major depression, is one of the most consistent findings in neuropsychiatry. A significant percentage of patients with major depression have been shown to exhibit increased concentrations of cortisol, an exaggerated cortisol response to adrenocorticotropic hormone, and an enlargement of both the pituitary and adrenal glands. The maintenance of the internal homeostatic state of an individual is proposed to be based on the ability of circulating glucocorticoids to exert negative feedback on the secretion of hypothalamic-pituitary-adrenal (HPA) hormones through binding to mineralocorticoid (MR) and glucocorticoid (GR) receptors limiting the vulnerability to diseases related to psychological stress in genetically predisposed individuals. The HPA axis response to stress can be thought of as a mirror of the organism's response to stress: acute responses are generally adaptive, but excessive or prolonged responses can lead to deleterious effects. Evidence indicates that early-life stress can induce persistent changes in the ability of the HPA axis to respond to stress in adulthood. These abnormalities appear to be related to changes in the ability of hormones to bind to GR and MR receptors. First episodes may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain
Belayev, Linda Y; Mor, Maria K; Sevick, Mary Ann; Shields, Anne Marie; Rollman, Bruce L; Palevsky, Paul M; Arnold, Robert M; Fine, Michael J; Weisbord, Steven D
Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single-item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with HR-QOL and G-QOL. Overall, 286 patients completed 1417 PHQ-9 and SF-MPQ symptom assessments, 1361 SF-12 assessments, and 1416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β = -1.09; 95% confidence interval [CI]: -1.69, -0.50, P < 0.001); SF-12 mental HR-QOL scores (β = -4.52; 95% CI: -5.15, -3.89, P < 0.001); and G-QOL scores (β = -0.64; 95%CI: -0.79, -0.49, P < 0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β = -0.99; 95% CI: -1.30, -0.68, P < 0.001) and G-QOL scores (β = -0.12; 95%CI: -0.20, -0.05, P = 0.002); but not with SF-12 mental HR-QOL scores (β = -0.16; 95%CI: -0.050, 0.17, P = 0.34). In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL.
Wickrama, K A S; Conger, Rand D; Lorenz, Frederick O; Jung, Tony
Using prospective data from 485 adolescents over a 10-year period, the present study identifies distinct segments of depressive symptom trajectories--a nonsignificant slope during adolescence and a significant negative slope during the transition to adulthood. The study hypothesized that different age-graded life experiences would differentially influence these depressive symptom growth parameters. The findings show that early stressful experiences associated with family-of-origin SES affect the initial level of depressive symptoms. Experiences with early transitional events during adolescence explain variation in the slope of depressive symptoms during the transition to adulthood. The growth parameters of depressive symptoms and an early transition from adolescence to adulthood constrain young adult social status attainment. Consistent with the life-course perspective, family-of-origin adversity is amplified across the life-course by successively contingent adverse circumstances involving life-transition difficulties and poor mental health. The findings also provide evidence for intergenerational transmission of social adversity through health trajectories and social pathways.
Kaye, Erica C; Brinkman, Tara M; Baker, Justin N
As therapeutic and supportive care interventions become increasingly effective, growing numbers of childhood and adolescent cancer survivors face a myriad of physical and psychological sequelae secondary to their disease and treatment. Mental health issues, in particular, present a significant problem in this unique patient population, with depression affecting a sizable number of childhood and adolescent cancer survivors. Multiple key determinants impact a survivor's risk of developing depression, with variables traversing across biologic, individual, family, community, and global levels, as well as spanning throughout the life course of human development from the preconception and prenatal periods to adulthood. A multi-level life course conceptual model offers a valuable framework to identify and organize the diverse variables that modulate the risk of developing depression in survivors of childhood and adolescent cancer. This review describes the first multi-level life course perspective applied to development of depression in childhood and adolescent cancer survivors. This conceptual framework may be used to guide the investigation of mental health interventions for SCACs to ensure that key determinants of depression occurrence are adequately addressed across various levels and throughout the life trajectory.
Salmela-Aro, Katariina; Upadyaya, Katja; Hakkarainen, Kai; Lonka, Kirsti; Alho, Kimmo
Recent research shows an increased concern with well-being at school and potential problems associated with students' use of socio-digital technologies, i.e., the mobile devices, computers, social media, and the Internet. Simultaneously with supporting creative social activities, socio-digital participation may also lead to compulsive and addictive behavioral patterns affecting both general and school-related mental health problems. Using two longitudinal data waves gathered among 1702 (53 % female) early (age 12-14) and 1636 (64 % female) late (age 16-18) Finnish adolescents, we examined cross-lagged paths between excessive internet use, school engagement and burnout, and depressive symptoms. Structural equation modeling revealed reciprocal cross-lagged paths between excessive internet use and school burnout among both adolescent groups: school burnout predicted later excessive internet use and excessive internet use predicted later school burnout. Reciprocal paths between school burnout and depressive symptoms were also found. Girls typically suffered more than boys from depressive symptoms and, in late adolescence, school burnout. Boys, in turn, more typically suffered from excessive internet use. These results show that, among adolescents, excessive internet use can be a cause of school burnout that can later spill over to depressive symptoms.
AKPINAR, Abdullah; ÖZDAMAR ÜNAL, Gülin; ATAY, İnci Meltem; GÜNDOĞAR, Duru; ÖZÇANKAYA, Ramazan
Late-life onset manic attacks generally occur secondary to general medical conditions or drug use. Varenicline is an α4β2 nicotinic acetylcholine receptor partial agonist, used for the cessation of smoking. In this case report, we present a 67-year-old male patient with a new-onset manic episode following varenicline treatment. The patient’s manic symptoms started on the seventh day of varenicline treatment. His symptoms started on the 7th day of treatment. He was admitted to the psychiatric outpatient clinic since his symptoms did not improve despite discontinuing varenicline treatment. In the initial mental status examination, he scored 35/60 on the Young Mania Rating Scale (YMRS). On the twenty-fifth day of the hospitalization, the patient was discharged since his YMRS score improved (5/60). Varenicline may cause manic episodes in patients with bipolar disorder and in healthy individuals. An increasing number of serious psychiatric disorders are being reported due to varenicline treatment. Mental state examination before and during varenicline treatment seems necessary.
Calleo, Jessica S.; Bush, Amber L.; Cully, Jeffrey A.; Wilson, Nancy L.; Kraus-Schuman, Cynthia; Rhoades, Howard M.; Novy, Diane M.; Masozera, Nicholas; Williams, Susan; Horsfield, Matthew; Kunik, Mark E.; Stanley, Melinda A.
Objective To increase sustainability of Cognitive Behavior Therapy (CBT) in primary care for late-life anxiety, we incorporated non-expert counselors, options for telephone meetings, and integration with primary care clinicians. Method This open trial examines the feasibility, satisfaction and clinical outcomes of CBT delivered by experienced and non-experienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). Results Following 3 months of treatment, Cohen’s d effect sizes for worry and anxiety ranged from .48 to .78. Patients treated by experienced and non-experienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Conclusion Preliminary results suggest adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care. PMID:23588228
Petrovitch, Helen; Abbott, Robert D; Ross, G Webster; Nelson, James; Masaki, Kamal H; Tanner, Caroline M; Launer, Lenore J; White, Lon R
Constipation is associated with future risk of Parkinson's disease (PD) and with incidental Lewy bodies (LB) in the locus ceruleus or substantia nigra (SN). Our purpose is to examine the independent association between bowel movement frequency in late-life and postmortem SN neuron density. Bowel movement frequency was assessed in the Honolulu-Asia Aging Study from 1991 to 1993 in 414 men aged 71 to 93 years with later postmortem evaluations. Brains were examined for LB in the SN and locus ceruleus and neurons were counted in four quadrants from a transverse section of SN. In nonsmokers, neuron densities (counts/mm(2)) for men with >1, 1, and <1 bowel movement daily were 18.5, 18.8, 10.1 (P < 0.001) for dorsomedial; 15.3, 16.4, 10.2 (P < 0.03) for ventromedial; and 18.6, 18.3, 10.9 (P = 0.011) for ventrolateral quadrants. Relationships were not significant in the dorsolateral quadrant or in any quadrant among smokers. After adjustment for age, time to death, coffee drinking, tricep skinfold thickness, excessive daytime sleepiness, cognitive function, PD, and incidental LB, density ratios in nonsmokers with 1 or more bowel movement(s) daily were significantly higher compared to those with <1 daily. Constipation is associated with low SN neuron density independent of the presence of LB.
Hou, Zhenghua; Sui, Yuxiu; Song, Xiaopeng; Yuan, Yonggui
The intuitive association between cognitive impairment and aberrant functional activity in the brain network has prompted interest in exploring the role of functional connectivity in late-onset depression (LOD). The relationship of altered voxel-mirrored homotopic connectivity (VMHC) and cognitive dysfunction in LOD is not yet well understood. This study was designed to examine the implicit relationship between the disruption of interhemispheric functional coordination and cognitive impairment in LOD. LOD patients (N = 31) and matched healthy controls (HCs; N = 37) underwent neuropsychological tests and functional magnetic resonance imaging (fMRI) in this study. The intergroup difference of interhemispheric coordination was determined by calculating VMHC value in the whole brain. The neuro-behavioral relevancy approach was applied to explore the association between disrupted VMHC and cognitive measures. Receiver operating characteristic (ROC) curve analysis was used to determine the capability of disrupted regional VMHC to distinguish LOD. Compared to the HC group, significantly attenuated VMHC in the superior frontal gyrus (SFG), superior temporal gyrus (STG), posterior cerebellar lobe (CePL) and post- and precentral gyri were observed in the bilateral brain of LOD patients. The interhemispheric asynchrony in bilateral CePLs was positively correlated with the performance of trail making test B (TMT-B) in LOD patients (r = 0.367, P = 0.040). ROC analysis revealed that regions with abnormal VMHC could efficiently distinguish LOD from HCs (Area Under Curve [AUC] = 0.90, P < 0.001). Altered linkage patterns of intrinsic homotopic connectivity and impaired cognitive flexibility was first investigated in LOD, and it would provide a novel clue for revealing the neural substrates underlying cognitive impairment in LOD. PMID:27729858
Booth, Adam; Bastow, Ian; Magee, Craig; Keir, Derek; Corti, Giacomo; Jackson, Chris; Wilkinson, Jason
. This depth change corresponds to a plausible vertical subsidence rate of between 2-20 mma-1 and, assuming a 60° fault dip, a horizontal extension rate of 1-12 mma-1 during the deposition of the Houston Formation, consistent with recent geodetic constraints offered by Ar Rajehi et al. (2010). The borehole archive shows no evidence of significant magmatism anywhere in the survey area, and the characteristic reflectivity of igneous bodies is absent in the seismic data. Extension of this basin is, therefore, not obviously explained by dyke intrusion. We consider that the ˜500 m change in elevation of the Houston Formation is instead diagnostic of rapid stretching, possibly indicating a late period of non-magmatic extension in the transition to sea-floor spreading in the Danakil Depression.
Gison, Annalisa; Dall'Armi, Valentina; Donati, Valentina; Rizza, Federica; Giaquinto, Salvatore
Very little research on dispositional optimism (DO) has been carried out in the field of Parkinson's disease (PD). The present cross-sectional study, focusing on this personality trait, was performed with two main aims: i) to compare DO between patients with PD and a control group (CG); ii) to perform, in the PD group, a regression analysis including health-related variables, such as depression, anxiety, quality of life (QoL) and activities of daily living. Seventy PD participants and 70 healthy volunteers were enrolled in the study. The Mann-Whitney test was used to compare life orientation between the PD and CG groups. In the PD group, Pearson's correlation analysis was used to investigate the relationship between the measures of DO and the other variables. Means of log-linear regression were also used. Mean ratios adjusted for sex, age, education, and severity of disease were estimated, with relative 95% confidence intervals and p-values. The main results were as follows: i) no significant difference in DO was found between the PD participants and the CG; ii) DO was positively associated with QoL and emotional distress and inversely correlated with the Unified Parkinson's Disease Rating Scale; iii) DO was not correlated with disability. In conclusion, high DO predicts a satisfactory quality of life, low emotional distress and reduced disease severity in PD.
Yıkılkan, Hülya; Aypak, Cenk; Görpelioğlu, Süleyman
Family caregivers of patient in long-term care facilities often have high rates of stress, burden and psychological illness. A descriptive study was carried out with 63 caregivers. Caregivers were asked to complete a demographic questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Short form 36 (SF-36), which measures health related quality of life (QoL). The majority of caregivers were female (79.4%), and most often the daughter of the patient in long-term care (47.6%). The mean BDI score of the sample was 18.8, and the mean BAI score was 20.0. Almost all the mean scores referring to the QoL were decreased (lower than 50), with the exception of mental health. On the SF-36 questionnaire, the lowest scores were observed on the role-emotional, role-physical, social functioning and vitality scales of the SF-36.
Hou, Wen-Li; Chen, Chia-En; Liu, Hsiao-Ying; Lai, Yi-Yin; Lee, Hsin-Chun; Lee, Nan-Yao; Chang, Chia-Ming; Chen, Po-Lin; Ko, Wen-Chien; Shu, Bih-Ching; Ko, Nai-Ying
Few empirical studies have evaluated the mediating effects of quality of life (QoL) among people living with HIV/AIDS (PLWHA). The purposes of this study were to identify the predictors of QoL and to test the mediating effects of social support on depression and QoL among patients enrolled in an HIV case-management program in Taiwan. A cross-sectional, descriptive correlation design collected data from 108 HIV-infected individuals. Individuals were assessed using the Beck Depression Inventory II, the short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF), and the Multidimensional Scale of Perceived Social Support between September 2007 and April 2010. After adjusting for sociodemographic characteristics (including age, gender, and mode of transmission) and clinical information (including CD4 count and time since diagnosis with HIV), the study findings showed that QoL was significantly and positively correlated with both social support and the initiation of highly active antiretroviral therapy (HAART), and was negatively correlated with depression and time since diagnosis with HIV. The strongest predictors for QoL were depression followed by the initiation of HAART and social support, with an R(2) of 0.40. Social support partially mediated the relationship between depression and QoL. Health professionals should enhance HIV-infected individuals' social support to alleviate the level of depression and further increase the QoL among PLWHA.
Carpenter, Linda L; Tyrka, Audrey R; McDougle, Christopher J; Malison, Robert T; Owens, Michael J; Nemeroff, Charles B; Price, Lawrence H
Previous studies have reported elevated concentrations of cerebrospinal fluid (CSF) corticotropin-releasing factor (CRF) in patients with major depression. Elevations of CSF CRF have also been reported in adult laboratory animals exposed to the stress of brief maternal deprivation or maternal neglect in the neonatal or preweaning period. The present study was designed to determine whether major depression and a history of perceived early adversity in childhood are independently associated with elevated CSF CRF concentrations in adults. In this case-control study, 27 medication-free adults with major depression and 25 matched controls underwent standardized lumbar puncture for collection of a single CSF sample at 1200. Subjects provided data about significant adverse early-life experiences and rated their global perceived level of stress during pre-school and preteen years on a six-point Likert scale. The mean difference in CSF CRF between depressed patients and controls did not reach statistical significance. In a regression model, perceived early-life stress was a significant predictor of CSF CRF, but depression was not. Perinatal adversity and perceived adversity in the preteen adversity years (ages 6-13 years) were both independently associated with decreasing CSF CRF concentrations. The relationship observed between perceived early-life stress and adult CSF CRF concentrations in this study closely parallels recent preclinical findings. More work is needed to elucidate the critical nature and timing of early events that may be associated with enduring neuroendocrine changes in humans.
Geraedts, Victor Jacobus; Dimopoulou, Christina; Auer, Matthias; Schopohl, Jochen; Stalla, Günter Karl; Sievers, Caroline
Introduction: Remission criteria of acromegaly are based on biochemical variables, i.e., normalization of increased hormone levels. However, the established reduction in Quality of Life (QoL) is suggested to be independent of biochemical control. The aim of this study was to test which aspects predict QoL best in acromegaly. Methods/design: This is a prospective cohort study in 80 acromegalic patients, with a cross-sectional and longitudinal part. The main outcome measure was health-related QoL, measured by a generic and a disease-specific questionnaire (the SF-36 and AcroQoL). Main predictors were age, gender, biochemical control, disease characteristics, treatment modalities, and psychopathology. Results: Our cohort of 80 acromegalics had a mean age 54.7 ± 12.3 years with an average disease duration of 10.8 ± 10.0 years. Ratio macro-/microadenoma was 54/26. In adjusted mixed method models, we found that psychopathology significantly predicts QoL in acromegaly (in models including the variables age, gender, disease duration, tumor size, basal hormone levels, relevant treatment modalities, and relevant comorbidities), with a higher degree of psychopathology indicating a lower QoL (depression vs. AcroQoL: B = −1.175, p < 0.001, depression vs. SF-36: B = −1.648, p < 0.001, anxiety vs. AcroQoL: B = −0.399, p < 0.001, anxiety vs. SF-36: B = −0.661, p < 0.001). The explained variances demonstrate superiority of psychopathology over biochemical control and other variables in predicting QoL in our models. Discussion: Superiority of psychopathology over biochemical control calls for a more extensive approach regarding diagnosing depression and anxiety in pituitary adenomas to improve QoL. Depressive symptoms and anxiety are modifiable factors that might provide valuable targets for possible future treatment interventions. PMID:25610427
Background Mental disorders such as depression, anxiety and suicide represent an important public health problem in India. Elsewhere in the world a high prevalence of symptoms of common mental disorders have been found among people who inject drugs (PWID). Research in India has largely overlooked symptoms of common mental disorders among this high risk group. This paper reports on the results of a survey examining quality of life, depression, anxiety and suicidal ideation among adult males who inject drugs living in Delhi. Methods Participants (n = 420) were recruited from needle and syringe programs using time location sampling and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts and attempts within the past 12 months. Results The mean length of injecting career was 20.9 years indicating a sample of chronic injecting drug users, of whom only one-third (38%) were born in Delhi. The level of illiteracy was very high (62%), and just 2% had completed class 12. Scavenging / rag picking was the main form of income for 48%, and many were homeless (69%). One-third (33%) had been beaten up at least twice during the preceding 6 months, and many either never (45%) or rarely (27%) attended family events. We found a high prevalence of depressive (84%, cut-off ≥10) and anxiety (71%, cut-off score of ≥3) symptoms. Fifty-three percent thought about killing themselves in the past 12 months, and 36% had attempted to kill themselves. Conclusions Our findings revealed a socially excluded population of PWID in Delhi who have minimal education and are often homeless, leaving them vulnerable to physical violence, poverty, poor health, imprisonment and disconnection from family. The high prevalence of psychological distress found in this study has implications for
Matthews, Margaret M.; Hsu, Fang-Chi; Walkup, Michael P.; Barry, Lisa C.; Patel, Kushang V.; Blair, Steven N.
OBJECTIVES To determine whether the presence of high depressive symptoms diminished physical performance benefits after a comprehensive physical activity intervention in older adults. STUDY DESIGN A post-hoc analysis of data from the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study which was a single blind randomized controlled trial comparing a moderate intensity physical activity intervention (PA) with a successful aging control (SA). SETTING Multi-center U.S. sites participating in the LIFE-P trial. PARTICIPANTS LIFE-P trial participants included 424 sedentary, non-institutionalized adults (70–89 years). MEASUREMENTS Depressive symptoms were assessed by the Centers for Epidemiological Studies Depression Scale (CES-D). Physical performance tests included the Short Physical Performance Battery (SPPB) and 400 meter walk time (400 mw) at baseline, 6 and 12 months. RESULTS Of the participants, 15.8% had high depressive symptom scores (CES-D ≥ 14). For participants with low depressive symptoms, SPPB scores improved in the PA versus the SA group over 12 months (adjusted score difference: +0.70; p = <0.001 at 6 months and +0.58; p=0.004 at 12 months) while the 400 mw times improved in the PA group at 6 months (adjusted score difference −0.41 min.; p=0.021). For those with high depressive symptoms, a trend toward statistical improvement in the SPPB was observed in the PA versus SA group (adjusted score difference +0.76 (p=0.176) at 6 months and +0.94 (p=0.116) at 12 months). CONCLUSION The presence of high depressive symptoms did not substantially diminish physical performance benefits realized after a PA intervention in sedentary older adults. PMID:21391940
Bae, Hyun Sook; Kim, Sun Young; Ahnv, Hong Seok; Cho, Yeon Kyung
The aim of this study was to analyse effects that the degree of depression have on the life style variables, nutrient intake, iron indices and pregnancy outcome. Subjects were 114 pregnant women who were receiving prenatal care at a hospital in Seoul. We collected data for general characteristics and lifestyle variables from general survey instrument and for depression score from the questionnaire on depression. Dietary intakes of subjects were estimated by 24 hour dietary recall method. Also we analysed iron indices and pregnancy outcomes. We classified subjects by 10 point, which was the average depression score, into two groups [Low depression score group (LS) : High depression score group (HS)]. As to the intakes of total calcium, plant-calcium, plant-iron, potassium, total folate and dietary folate, LS group was far higher than HS group (P < 0.05, P < 0.05, P < 0.01, P < 0.001, P < 0.05, and P < 0.01, respectively). As to pre-pregnancy alcohol drinking, LS group had 41.9% in non-drinker, which was far higher than 28% in HS group in non-drinker (P < 0.05). As for drinking coffee during pre-pregnancy, pregnant women who don't drink coffee in LS group took 43.6%, which was higher than 38% in HS group (P < 0.01). Regarding delivery type, the cesarean section in LS group (18%) was significantly lower than that in HS group (45%) (P < 0.01). Bivariate analysis showed that birth weight was significantly associated with the gestational age (P < 0.01). The pregnant women with higher depression score tended to have undesirable life habit, which might affect negative pregnancy outcomes. A better understanding of how depression and intake of nutrients work together to modulate behavior will be benefit nutritional research.
Based on the transpersonal model of stress, the purpose of the study was to investigate the moderating effect of impulsivity on the relationship between stressful life events (SLE) and depression among first year university women. Impulsivity consists of tendencies towards lack of premeditation, lack of perseverance, urgency and sensation seeking.…
Chapin, Martha H.; Holbert, Donald
This study assessed whether persons with spinal cord injuries who were successfully rehabilitated differed from those who were not with regard to positive and negative affect, life satisfaction, and depression. An ex post facto research design compared persons with spinal cord injuries who were previously employed with persons with spinal cord…
Unver, Saban; Atan, Tulin; Cavusoglu, Gul; Erim, Vedat; Yamak, Bade
The purpose of this study is to compare the levels of life quality, depression and loneliness among the students of the Faculty of Sports Sciences (FSS), national wrestlers and non national wrestlers in terms of some demographic variables. The participants of the study included 37 students from the Faculty of Sports Sciences of Ondokuz Mayis…
Bazargan, Mohsen; Barbre, Ann R.
Examined prevalence and correlates of self-reported memory problems among 1,250 black elders. Over 48.3% of sample reported poor memory/forgetfulness as very or somewhat serious problem. Subjects with hearing impairments, higher number of stressful life events, higher level of depression, and poorer health were more likely to complain of memory…
Wickrama, K. A. S.; Conger, Rand D.; Lorenz, Frederick O.; Jung, Tony
Using prospective data from 485 adolescents over a 10-year period, the present study identifies distinct segments of depressive symptom trajectories--a nonsignificant slope during adolescence and a significant negative slope during the transition to adulthood. The study hypothesized that different age-graded life experiences would differentially…
In this study, the moderator effects of global self-esteem on the relationship between life satisfaction domains (family, friends and school) and depression in early adolescents were examined. The participants consisted of 255 students, aged from 11 to 15 years, from three junior high schools in Turkey. Data were collected using the Rosenberg…
Acun-Kapikiran, Necla; Körükçü, Özlem; Kapikiran, Sahin
The purpose of this study is to determine whether self-esteem in adolescence has a mediator role in the relationship between parental attitude and life satisfaction and depression. Data was collected from 360 secondary school students ages ranging from 11 to 14 (M = 12.67, SD= 0.97) out of which 216 of them were female and 144 male. The…
Yazdanshenas Ghazwin, Manijeh; Kavian, Mohammad; Ahmadloo, Mohsen; Jarchi, Alemeh; Golchin Javadi, Shaghayegh; Latifi, Sahar; Ghajarzadeh, Mahsa
Objective: The determinants of satisfaction of life (SWL) are poorly described among Iranian employed nurses. This study aimed to assess the effect of various factors including age, gender, marital status, depression, anxiety and stress on SWL among Iranian nurses. Method: Employed nurses in three teaching hospitals were invited to participate in this study. Ninety-four nurses (65 women and 29 men) participated in this study. Depression, anxiety, stress scale (DASS-21) was used to measure the related variables. Satisfaction with Life Scale (SWLS) was used to assess SWL. Multivariate analysis was utilized to examine the relationship between multiple variables. Results: A noticeable proportion of Iranian employed nurses were either dissatisfied or extremely dissatisfied with life (45%). Severe depression was related to lower scores of SWLS (P: 0.001, r = −0.32). The similar outcomes were detected between anxiety and stress scales, and SWLS (P: 0.023, r = −0.23 and P: 0.008, r = −0.27 for anxiety and stress, respectively). Although females were more vulnerable to depression (P: 0.010) and stress (P: 0.013), the overall effect of gender on SWL was insignificant (0.41). Satisfactions with financial power and work environment were associated with higher scores of SWLS (P: 0.030 and 0.042, respectively). Marital status was not related to severity of depression, anxiety, stress and SWLS (P: 0.39, 0.38, 0.80, and 0.61, respectively). Conclusion: This study revealed that poor satisfaction with financial status and work environment, depression, anxiety and stress are the major determinants of satisfaction with life among Iranian employed nurses. PMID:27437009
Martin, Jennifer L.; Fiorentino, Lavinia; Jouldjian, Stella; Josephson, Karen R.; Alessi, Cathy A.
OBJECTIVES To describe sleep patterns in older adults living in assisted living facilities (ALFs) and to explore the relationship between sleep disturbance and quality of life, functional status, and depression over 6 months of follow-up. DESIGN Prospective, observational cohort study. SETTING: Eighteen ALFs in the Los Angeles area. PARTICIPANTS: One hundred twenty-one ALF residents aged 65 and older (mean age 85.3, 86% female, 88% non-Hispanic white). MEASUREMENTS Data were collected at baseline and 3 and 6 months after enrollment. Data collected were demographics, physical and cognitive functioning, depression, quality of life, comorbidities, medications, and subjective (i.e., questionnaires) and objective (i.e., 3 days and nights of wrist actigraphy) measures of sleep. RESULTS Sixty-five percent of participants reported clinically significant sleep disturbance on the Pittsburgh Sleep Quality Index, and objective wrist actigraphy confirmed poor sleep quality. In regression analyses including sleep variables and other predictors, more self-reported sleep disturbance at baseline was associated with worse health-related quality of life (Medical Outcomes Study 12-item Short Form Survey Mental Component Summary score) and worse depressive symptoms five-item Geriatric Depression Scale at follow-up. Worse nighttime sleep (according to actigraphy) at baseline was associated with worse activities of daily living functioning and more depressive symptoms at follow-up. CONCLUSIONS Sleep disturbance is common in older ALF residents, and poor sleep is associated with declining functional status and quality of life and greater depression over 6 months of follow-up. Studies are needed to determine whether improving sleep in ALF residents will result in improvements in these outcomes. Well-established treatments should be adapted for use in ALFs and systematically evaluated in future research. PMID:20722819
McNair, F. E.
To understand the effects of depression on a patient's life, the physician must be aware how depression manifests itself. Somatic tension, strategies to relieve discomfort and social withdrawal must be recognized as symptoms of depression. An awareness of life situations which can give rise to these symptoms, as well as the effect of the physician's own reactions to the patient's depression, are helpful. PMID:21289767
Objectives. This study expands on previous research by examining the effects of prolonged grief disorder (PGD) symptoms and bereavement on diurnal cortisol patterns above and beyond depressive symptomatology. Methods. Drawing on information from 56 depressed older adults, 3 groups were compared: (1) a depressed nonbereaved group, (2) a depressed bereaved without elevated PGD symptoms group, and (3) a depressed bereaved with elevated PGD symptoms group. Multilevel modeling was used to examine differences in diurnal cortisol profiles between these 3 groups, controlling for demographic factors and depressive symptoms. Results. Results revealed that those who were bereaved had more dysregulated cortisol patterns, but PGD symptomatology seemed to have little effect. Subsidiary analysis with just the bereaved participants suggests that those who were recently widowed may have had greater cortisol dysregulation compared with other bereaved individuals in the sample. Discussion. These findings suggest that the circumstance of being bereaved may be associated with more dysregulated cortisol, regardless of PGD symptomatology. This pattern of results might reflect greater disturbance in daily routines among bereaved individuals and acute stress in the case of those experiencing the recent loss of a spouse, which leads to disruption in circadian rhythms and the diurnal cycle of cortisol. PMID:23740094
... unrelated to the reason for your appointment Key personal information, including any major stresses or recent life ... accompanied by delusions or hallucinations, which may involve personal inadequacy or other negative themes Catatonia — depression that ...
For 40 years the world has lived with the threat of nuclear war and, recently, with the possibility of nuclear power plant accidents. Although virtually every generation must confront various national or international crises, the threat of nuclear war is unprecedented in its destructive potential. This study is an attempt to assess attitudes and amount of distress associated with the ever-present threat of nuclear war and the possibility of accidents at nuclear power plants. The Nuclear Attitudes Questionnaire (NAQ) consists of 15 items and was administered to 722 young adults who have grown up in the nuclear age. The items were found to reflect four latent factors of nuclear concern, nuclear support, fear of the future, and nuclear denial, all of which in turn represent a second-order construct of nuclear anxiety. Women reported significantly more nuclear concern, less nuclear support, more fear of the future, and less nuclear denial than did men. In latent-variable models, nuclear anxiety was found to be significantly associated with less purpose in life, less life satisfaction, more powerlessness, more depression, and more drug use. It is concluded that the threat of nuclear war and accidents is significantly related to psychological distress and may disturb normal maturational development.
Rosińczuk, Joanna; Kołtuniuk, Aleksandra
Background Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease, and its incidence will increase as the global population ages. Due to the multitude of symptoms, this disease clearly has a significant impact on decreasing quality of life for those with PD. We aimed to evaluate the effect of selected variables on quality of life in people with idiopathic PD treated pharmacologically. Materials and methods This study was conducted among 50 patients with PD aged 47–85 years. The diagnostic survey method was applied to collect data with the use of the authors’ questionnaire and standardized questionnaires, including, Parkinson’s Disease Questionnaire (PDQ), Beck Depression Inventory, Instrumental Activities of Daily Living Scale, and Acceptance of Illness Scale. The results were statistically analyzed. Results Analysis of the study material showed that people who were more self-reliant were characterized by lower intensity of depressive symptoms (ρ=−0.567, P=0), were more likely to accept their illness (ρ=0.611, P=0), and assessed quality of life better in each of the studied domains of the PDQ. Illness acceptance correlated with the occurrence of depressive symptoms (ρ=−0.567, P=0) and significantly affected quality of life. Conclusion Factors such as depression, disease acceptance, and functional capacity have a significant impact on the subjective assessment of quality of life in patients with PD. Evaluation of these factors should be taken into account in the therapeutic process, to minimize their negative impact on quality of life in patients with PD. PMID:28356744
Gerstorf, Denis; Ram, Nilam; Mayraz, Guy; Hidajat, Mira; Lindenberger, Ulman; Wagner, Gert G; Schupp, Jürgen
Throughout adulthood and old age, levels of well-being appear to remain relatively stable. However, evidence is emerging that late in life well-being declines considerably. Using long-term longitudinal data of deceased participants in national samples from Germany, the United Kingdom, and the United States, we examined how long this period lasts. In all 3 nations and across the adult age range, well-being was relatively stable over age but declined rapidly with impending death. Articulating notions of terminal decline associated with impending death, we identified prototypical transition points in each study between 3 and 5 years prior to death, after which normative rates of decline steepened by a factor of 3 or more. The findings suggest that mortality-related mechanisms drive late-life changes in well-being and highlight the need for further refinement of psychological concepts about how and when late-life declines in psychosocial functioning prototypically begin. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Watkins, Daphne C.
Rarely are within-group differences among African American men explored in the context of mental health and well-being. Though current conceptual and empirical studies on depression among African American men exists, these studies do not offer a framework that considers how this disorder manifests over the adult life course for African American men. The purpose of this article is to examine the use of an adult life course perspective in understanding the complexity of depression for African American men. The proposed framework underscores six social determinants of depression (socioeconomic status, stressors, racial and masculine identity, kinship and social support, self-esteem and mastery, and access to quality health care) to initiate dialogue about the risk and protective factors that initiate, prolong, and exacerbate depression for African American men. The framework presented here is meant to stimulate discussion about the social determinants that influence depression for African American men to and through adulthood. Implications for the utility and applicability of the framework for researchers and health professionals who work with African American men are discussed. PMID:22105067
Patti, Francesco; Cacopardo, Manuela; Palermo, Filippo; Ciancio, Maria Rita; Lopes, Rossella; Restivo, Domenico; Reggio, Arturo
Only few publications have been reported on Health-related Quality of Life (HRQoL) in patients with multiple sclerosis (MS). EDSS is the most common outcome measure for either impairment or disability of MS, but it is not able to catch other aspects of MS impact on HRQoL. The authors performed a cross-sectional study on the group of all patients with MS who were diagnosed at least 4 years before 1998 in Catania (South Italy). One hundred and eighty patients out of 308 were enrolled in the study. SF-36 was used to catch the HRQoL of MS patients. EDSS, Beck Depression Inventory (BDI) and time since diagnosis were investigated as variables affecting the HRQoL of MS patients. The patients showed significant lower mean scores for all SF-36 health dimensions compared with sex- and age-adjusted scores in a general healthy Italian population (p<0.001). EDSS scores correlated only with physical functioning (r=-0.76 p<0.001). As expected, the more severe was the disease, the longer its duration and the lower the patients' skillness on HRQoL. BDI showed high partial correlations with all SF-36 health domains with r=-0.38 to -0.65 (p<0.001). This study showed that SF-36 is able to assess the HRQoL of MS patients. Depression strongly influenced the HRQoL of MS patients. EDSS and time since diagnosis also affected the HRQoL of MS patients. Our results are comparable with other European studies.
Pekkala, Timo; Hall, Anette; Lötjönen, Jyrki; Mattila, Jussi; Soininen, Hilkka; Ngandu, Tiia; Laatikainen, Tiina; Kivipelto, Miia; Solomon, Alina
Background and objective: This study aimed to develop a late-life dementia prediction model using a novel validated supervised machine learning method, the Disease State Index (DSI), in the Finnish population-based CAIDE study. Methods: The CAIDE study was based on previous population-based midlife surveys. CAIDE participants were re-examined twice in late-life, and the first late-life re-examination was used as baseline for the present study. The main study population included 709 cognitively normal subjects at first re-examination who returned to the second re-examination up to 10 years later (incident dementia n = 39). An extended population (n = 1009, incident dementia 151) included non-participants/non-survivors (national registers data). DSI was used to develop a dementia index based on first re-examination assessments. Performance in predicting dementia was assessed as area under the ROC curve (AUC). Results: AUCs for DSI were 0.79 and 0.75 for main and extended populations. Included predictors were cognition, vascular factors, age, subjective memory complaints, and APOE genotype. Conclusion: The supervised machine learning method performed well in identifying comprehensive profiles for predicting dementia development up to 10 years later. DSI could thus be useful for identifying individuals who are most at risk and may benefit from dementia prevention interventions. PMID:27802228
Li, Yunqing; Ferraro, Kenneth F.
Does volunteer participation reduce depressive symptoms among older people? Does depression influence whether older people will volunteer? Might nonrandom attrition in a longitudinal study bias the relationship between volunteering and depression? This research addresses these questions with three-wave data from the Americans' Changing Lives…
Hammerton, Gemma; Mahedy, Liam; Mars, Becky; Harold, Gordon T; Thapar, Anita; Zammit, Stanley; Collishaw, Stephan
Depression is common, especially in women of child-bearing age; prevalence estimates for this group range from 8% to 12%, and there is robust evidence that maternal depression is associated with mental health problems in offspring. Suicidal behaviour is a growing concern amongst young people and those exposed to maternal depression are likely to be especially at high risk. The aim of this study was to utilise a large, prospective population cohort to examine the relationship between depression symptom trajectories in mothers over the first eleven years of their child's life and subsequent adolescent suicidal ideation. An additional aim was to test if associations were explained by maternal suicide attempt and offspring depressive disorder. Data were utilised from a population-based birth cohort: the Avon Longitudinal Study of Parents and Children. Maternal depression symptoms were assessed repeatedly from pregnancy to child age 11 years. Offspring suicidal ideation was assessed at age 16 years. Using multiple imputation, data for 10,559 families were analysed. Using latent class growth analysis, five distinct classes of maternal depression symptoms were identified (minimal, mild, increasing, sub-threshold, chronic-severe). The prevalence of past-year suicidal ideation at age 16 years was 15% (95% CI: 14-17%). Compared to offspring of mothers with minimal symptoms, the greatest risk of suicidal ideation was found for offspring of mothers with chronic-severe symptoms [OR 3.04 (95% CI 2.19, 4.21)], with evidence for smaller increases in risk of suicidal ideation in offspring of mothers with sub-threshold, increasing and mild symptoms. These associations were not fully accounted for by maternal suicide attempt or offspring depression diagnosis. Twenty-six percent of non-depressed offspring of mothers with chronic-severe depression symptoms reported suicidal ideation. Risk for suicidal ideation should be considered in young people whose mothers have a history of
Tully, Phillip J; Baker, Robert A; Turnbull, Deborah A; Winefield, Helen R; Knight, John L
The specific syndromal aspects of depression and anxiety have not been explored in relation to changes in health related quality of life (HRQOL) after cardiac surgery. The purpose of this study was to examine the impact of general stress, depression and anxiety on HRQOL after coronary artery bypass graft (CABG) surgery. Utilizing a tripartite conceptual model of depression and anxiety, it was hypothesized that general stress symptoms, rather than unique depressive or anxiogenic symptoms, would be associated with lower HRQOL 6 months after CABG surgery. Elective CABG patients (n=226) completed baseline and postoperative self-report measures of negative emotions and HRQOL, and 193 patients completed these measures at 6-month follow-up. Multiple linear regression analyses and logit link analyses were performed to test the hypothesis. Elevated depression symptoms before and after surgery showed an association with lower and worse HRQOL for vitality and social role functioning and physical and general health. This study adds to previous research by outlining discrete associations between specific HRQOL domains, and is perhaps the first to test a theoretical model of depression and anxiety in relation to cardiac CABG patients' perceptions of HRQOL. These findings encourage further research on negative emotions and HRQOL in cardiac surgery patients and the practical implications of these findings are discussed.
de Ornelas Maia, Ana Claudia C.; Braga, Arthur de Azevedo; Paes, Flávia; Machado, Sergio; Carta, Mauro Giovanni; Nardi, Antonio Egidio; Silva, Adriana Cardoso
Background: Diabetes is associates with depression and impairment in Quality of Life (QoL). Objective: The objective is to define the frequencies of depressive and anxiety symptoms in a sample of patients diagnosed with type 1 and 2 diabetes, the amount of impairment of QoL and the weight of depression and anxiety in determining the QoL in such of patients. Methods: A total of 210 patients were divided into two groups (type 1 and type 2). Patients completed the HADS and WHOQoL-bref. Results: Groups showed a high prevalence of anxiety (type 1 = 60%, type 2 = 43.8%) and depression (type 1 = 52.4%, type 2 = 38.1%), both measures were significantly higher (p < 0.05) in diabetes type 1 patients. Type 1 patients also showed a QoL in the overall assessment and the physical, psychological and social relations domains. In both Type 1 and 2 diabetes poor QoL was found associated by anxiety and depression comorbidity. Conclusion: In overall diabetes patients depression and anxiety seems to be a determinant of poor QoL. PMID:23935696
Tutoglu, Ahmet; Boyaci, Ahmet; Koca, Irfan; Celen, Esra; Korkmaz, Nurdan
The aim of this study was to investigate the effects of the quality of life and psychological condition of female patients with fibromyalgia and their spouses on sexual function. A total of 32 female patients diagnosed with fibromyalgia and their spouses were analyzed. Thirty married couples were included in the study as the control group. The demographic data of the fibromyalgia patients were recorded, a visual analog scale was used to evaluate the level of pain, and the Fibromyalgia Impact Questionnaire was used to evaluate the impact of the symptoms on the quality of life of the patients. The quality of life of both the patients and the control group were evaluated using the Short Form 36 (SF-36), and psychological variables were evaluated using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory. Sexual function was assessed using the Female Sexual Function Index for female participants and the International Index of Erectile Function (IIEF) for male participants. The IIEF erectile dysfunction scores were significantly lower in the spouses of female patients with fibromyalgia than in the control group (p < 0.05), and the BDI scores were significantly higher in the spouses of the female patients with fibromyalgia (p < 0.05). Among the SF-36 scores, the emotional and physical roles were significantly lower in the spouses of the female patients with fibromyalgia (p = 0.003 and p = 0.004, respectively). In all spouses of FMS patients and controls, there was a significantly negative correlation between erectile function, the BDI score, and to be married with FMS patient and positive correlations between erectile function and emotional role, social function, mental health, SF-36 pain score, and general health (p < 0.05 for all). In a linear regression model, BDI, to be married with FMS patient and general health were found to affect erectile function (beta regression coefficient = -0.572, SE = 0.082, p = 0.001; beta regression coefficient = -0.332, SE = 1
Mandelli, Laura; Nearchou, Finiki A; Vaiopoulos, Chrysostomos; Stefanis, Costas N; Vitoratou, Silia; Serretti, Alessandro; Stefanis, Nicholas C
According to the stress-diathesis hypothesis, depression and suicidal behavior may be precipitated by psychosocial stressors in vulnerable individuals. However, risk factors for mental health are often gender-specific. In the present study, we evaluated common risk factors for female depression in association with depressive symptoms and suicidal ideation in a community sample of women. The sample was composed by 415 women evaluated for mood disorders (MDs), depressive symptoms and suicidal ideation by structured interviews and the Beck depression inventory II (BDI II). All women also filled in the Eysenck personality questionnaire to evaluate neuroticism and were interviewed for social contact frequency and stressful life events (SLEs). In the whole sample, 19% of the women satisfied criteria for MD and suicidal ideation was reported by 12% of the women. Though stressful life events, especially personal and interpersonal problems, and poor social network were associated with all the outcome variables (mood disorder, depressive symptomatology and suicidal ideation), neuroticism survived to all multivariate analyses. Social network, together with neuroticism, also showed strong association with depressive severity, independently from current depressive state. Though we were unable to compare women and men, data obtained from the present study suggest that in women neurotic traits are strongly related to depression and suicidal ideation, and potentially mediate reporting of stressful life events and impaired social network. Independently from a current diagnosis of depression, impaired social network increases depressive symptoms in the women.
Rodrigues, Giselle Helena de Paula; Gebara, Otavio Celso Eluf; Gerbi, Catia Cilene da Silva; Pierri, Humberto; Wajngarten, Mauricio
Background The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists. Objective Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life. Methods This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State. Results The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p < 0.001), lack of physical activity (p = 0.016), osteoarthritis (p < 0.001), cognitive impairment (p < 0.001), and major depression (p < 0.001). Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36. Conclusion Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression. PMID:26131699
ZHANG, Boyuan; DING, Xuefan; LU, Weihong; ZHAO, Jing; LV, Qinyu; YI, Zhenghui; ZHANG, Shaoping; CHEN, Yindi
Background Several studies of moderate-to-severe depression have shown that combined treatment with individual cognitive behavioral therapy (CBT) and antidepressant medication is better than either CBT or antidepressants alone. Less research has focused on the outcomes of group-CBT and antidepressants in persons with mild depression. Aim Evaluate the effects of group-CBT in combination with antidepressants on the quality of life and social functioning of outpatients with mild depression. Methods We randomized 62 outpatients with mild depression into a control group (n=30) that received antidepressant medication for 12 weeks and an intervention group (n=32) that received antidepressants and group-CBT for 12 weeks; both groups were then continued on antidepressants alone for one year. Blinded evaluators used Chinese versions of the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Social Disability Screening Schedule, Life Satisfaction Rating, Multidimensional Scale of Perceived Social Support, and Short Form Health Survey to assess participants after 12 weeks of treatment and at the end of one year of follow-up. Results Repeated measures analysis of variance showed that the depressive and anxiety symptoms of both groups improved significantly during treatment and that the improvement was greater in the CBT+antidepressant experimental group. Almost all of the social functioning, social support, and quality of life measures also showed significantly greater improvement in the CBT+antidepressant group than in the antidepressant-only group. Moreover, even after adjusting for differences in baseline demographic and clinical characteristics and for changes in the severity of depression and anxiety over time using an analysis of covariance, the greater improvement in the CBT+antidepressant group remained statistically significant both after the 12 weeks of group-CBT treatment and one year after the group CBT had ended. Conclusion Antidepressants alone or
Joshi, Namita; Khanna, Rahul; Shah, Ruchit M
This study purports to examine the relationship of depression with physical activity, disability, arthritis-attributable burden (joint limitation, work limitation, social activity limitation, and joint pain), and health-related quality of life (HRQOL) among arthritis patients. Data from the 2011 Behavioral Risk Factor Surveillance System, a nationally representative sample of noninstitutionalized adults in the United States, was used for the purpose of this study. Multivariable logistic regression was employed to address the study objectives. The final study sample included 167,068 arthritis patients, 45,459 of whom had comorbid depression. Arthritis patients with depression had lower odds of engaging in physical activity (odds ratio [OR]=1.070, confidence interval [CI] 1.006-1.139) and higher odds of being disabled (OR=1.411, CI 1.306-1.524). Arthritis patients with depression also had greater odds of arthritis-attributable joint limitations (OR=1.551, CI 1.460-1.648), work limitations (OR=1.506, CI 1.414-1.604), social activity limitations (OR=1.647, CI 1.557-1.742), and pain (OR=1.438, CI 1.364-1.517) as compared to those without depression. Arthritis patients with versus without depression had greater odds of poor general health status (OR=1.698, CI 1.586-1.819), physical HRQOL (OR=1.592, CI 1.486-1.704), mental HRQOL (OR=6.225, CI 5.768-6.718), and activity limitations (OR=2.345, CI 2.168-2.537). Study results indicate toward a negative functional impact of depression among arthritis patients. Policy makers should consider incorporating screening and management of depression into routine clinical care of arthritis patients.
Abramov, O.; Mojzsis, S. J.
We model thermal effects of impacts on the terrestrial lithosphere during the period of Late Heavy Bombardment (LHB), a putative ~100 Ma epoch of sharply elevated impactor flux that reached a maximum at ca. 3.9 Ga. The goals of this work include estimating the degree to which the crust was molten or thermally metamorphosed during the LHB and evaluating habitability during this time period. We created a stochastic cratering model which populates all or part of the Earth's surface with craters within a probability field of constraints derived from the lunar cratering record, the size/frequency distribution of the asteroid belt, and dynamical models. For each crater in the model, a temperature field was calculated using analytical expressions for shock-deposited heat and central uplift. The resulting thermal anomaly was then introduced into a 3-dimensional model of the lithosphere, and allowed to cool by conduction in the subsurface and radiation/convection at the atmosphere interface. Parameters tested in the model include the duration, mass flux, and average impact velocity during the LHB, mean lithospheric thickness, lithospheric composition, and the presence or absence of oceans. We also assessed habitability by monitoring habitable volumes for mesophile (~20-50° C), thermophile (~50-80° C), and hyperthermophile (~80-110° C) microbial life in what we term the "geophysical habitable zone"; the volume of inhabited crust within ~4 km of the surface. Results of this work indicate that most of the crust was not melted or thermally metamorphosed to a significant degree under any reasonable scenario evaluated. Smaller impactors (1-10 km) were as important as gigantic basin formers (100+ km) in terms of sterilizing the habitable zone in the near-surface due to their far greater numbers (~170,000 impactors in the 1-10 km diameter range versus ~30 impactors in the 100+ km diameter range). However, large basin-forming craters are nonetheless more thermally and
Sararoudi, Reza Bagherian; Motmaen, Maryam; Maracy, Mohammad Reza; Pishghadam, Elnaz; Kheirabadi, Gholam Reza
Background: Myocardial infarction (MI) is one of the major causes of death and disability worldwide, which can reduces quality of life in patients. Some disabilities are depression and anxiety which delay returning to work. The aim of this study was to evaluate the effect of illness perception focused intervention on quality of life, anxiety, and depression in MI patients. Materials and Methods: A randomized controlled trial study of 48 recently hospitalized MI patients was conducted (24 in intervention group and 24 in control group). Intervention group was trained to understand the disease by a mental health counselor in three half-an-hour sessions for three consecutive days. Data were collected from three questionnaires: hospital anxiety and depression scale, the World Health Organization Quality of Life Questionnaire (short form), and Illness Perceptions Questionnaire Brief at admission, 1.5, and 3 months postdischarge. Data were analyzed with ANOVA repeated measure. Results: The mean duration of returning to work was 28.7 ± 8.1 days in intervention groups and 46 ± 7.6 days in control group which was statistically significant (P < 0.001). Moreover, anxiety, depression, and illness perceptions score were significantly decreased in intervention groups which were 8.3 ± 3.3, 6.8 ± 3.5, and 36.5 ± 5 in intervention groups and 15.8 ± 2.1(P < 0.001), 17.1 ± 2.3 (P < 0.001), and 41.9 ± 4 (P < 0.001) in control group, respectively. Mean of quality of life subscales scores just physical health subscale showed a significant reduction after 3 months in the control group. Conclusion: Training MI patients to understand the disease in three half-an-hour sessions for 3 consecutive days can decrease the duration of returning to work, anxiety and depression, and increase illness perceptions which can make a better outcome. PMID:28331511
Bookwala, Jamila; Lawson, Brendan
Purpose: This study tested the applicability of the activity restriction model of depressed affect to the context of poor vision in late life. This model hypothesizes that late-life stressors contribute to poorer mental health not only directly but also indirectly by restricting routine everyday functioning. Method: We used data from a national…
Frost, Allison; Hoyt, Lindsay T; Chung, Alissa Levy; Adam, Emma K
Depression is a prevalent and debilitating illness facing many adolescents, especially adolescent girls, whose risk for this disorder is approximately twice that of boys. Many studies have identified mechanisms that place girls at higher risk for depression during adolescence. Few, however, have examined differences in the everyday emotional experiences of boys and girls with varying levels of depressive symptoms. Using the Experience Sampling Method, this study investigated the roles of gender and depressive symptomatology in the emotional experiences of a community sample of youth (11-18 year-olds) from the Sloan 500 Family Study. Females with higher levels of depressive symptoms were more likely than females with fewer depressive symptoms and all males to experience strong negative emotions and to attribute the cause of these emotions to other people. These results suggest that emotional reactivity in interpersonal contexts is especially important to understand gender differences in the daily experience of depressive symptoms.
McIlwrick, Silja; Pohl, Tobias; Chen, Alon; Touma, Chadi
Early-life stress (ELS) has been associated with lasting cognitive impairments and with an increased risk for affective disorders. A dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis, the body’s main stress response system, is critically involved in mediating these long-term consequences of adverse early-life experience. It remains unclear to what extent an inherited predisposition for HPA axis sensitivity or resilience influences the relationship between ELS and cognitive impairments, and which neuroendocrine and molecular mechanisms may be involved. To investigate this, we exposed animals of the stress reactivity mouse model, consisting of three independent lines selectively bred for high (HR), intermediate (IR), or low (LR) HPA axis reactivity to a stressor, to ELS and assessed their cognitive performance, neuroendocrine function and hippocampal gene expression in early and in late adulthood. Our results show that HR animals that were exposed to ELS exhibited an HPA axis hyper-reactivity in early and late adulthood, associated with cognitive impairments in hippocampus-dependent tasks, as well as molecular changes in transcript levels involved in the regulation of HPA axis activity (Crh) and in neurotrophic action (Bdnf). In contrast, LR animals showed intact cognitive function across adulthood, with no change in stress reactivity. Intriguingly, LR animals that were exposed to ELS even showed significant signs of enhanced cognitive performance in late adulthood, which may be related to late-onset changes observed in the expression of Crh and Crhr1 in the dorsal hippocampus of these animals. Collectively, our findings demonstrate that the lasting consequences of ELS at the level of cognition differ as a function of inherited predispositions and suggest that an innate tendency for low stress reactivity may be protective against late-onset cognitive impairments after ELS. PMID:28261058
This study has two central aims. Both are associated with self-expression, which is defined as the ability to fully utilize one's own talents and abilities. The first goal is to see if self-expression reduces depressive symptoms over time whereas the second aim is to see whether close companion friends help older people more fully utilize their…
Bohn, Annette; Berntsen, Dorthe
The authors investigated the relationship between the acquisition of cultural life scripts and the degree of coherence in children's and adolescents' life stories. Three groups of Danish school children aged 9 to 15 years participated. In 3 sessions, they wrote down a recently experienced single autobiographical event, their life story, and their cultural life script. Single-event and life stories were scored for coherence; life scripts were scored for normativity compared to an adult norm. Single-event stories and life stories were longer and more coherent in the older participants. Younger participants wrote significantly more coherent single-event stories than life stories. When controlling for age, single-event story coherence and global life story coherence did not correlate significantly, suggesting different developmental pathways. Life script normativity increased steadily across childhood and adolescence. Further, a significant relationship between the normativity of life scripts and the coherence of life stories, but not the coherence of single-event stories, was found.
Araya, Ricardo; Hu, Xianzhang; Heron, Jon; Enoch, Mary-Anne; Evans, Jonathan; Lewis, Glyn; Nutt, David; Goldman, David
There has been a large but inconsistent literature on interactions between the 5-HTTLPR polymorphism of the serotonin transporter gene and adversity on emotional disorders. We investigated these interactions in 4,334 children from a birth longitudinal cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). We measured emotional symptoms at 7 years with the Strengths and Difficulties Questionnaire. Mothers rated stressful life events between ages 5 and 7 years. Maternal depression was defined as a score > or =12 on the Edinburgh Postnatal Depression Scale at 2 or 8 months postnatally. Triallelic genoptyping of the 5-HTTLPR polymorphism was performed. We found strong associations between stressful life events (OR 1.19; 1.12-1.26; P < 0.01) and maternal postnatal depression (OR 1.91; 1.63-2.24; P < 0.01) with emotional symptoms in the children. There were no main 5-HTTLPR genotype effects or significant interactions between genotype and life events or maternal postnatal depression on emotional symptoms. There was marginal evidence (P = 0.08) for an interaction between stressful life events and genotype in boys only, with those in the low and high 5-HTTLPR expression groups showing stronger associations. In these 7-year-old children, we did not replicate previously reported G x E interactions between 5-HTTLPR and life events for emotional symptoms. Gene by environment interactions may be developmentally dependent and show variation depending on the type and levels of exposure and sex. Young cohorts are essential to improve our understanding of the impact of development on gene and environment interactions.
Lalor, Aislinn F.; Brown, Ted; Robins, Lauren; Lee, Den-Ching Angel; O’Connor, Daniel; Russell, Grant; Stolwyk, Rene; McDermott, Fiona; Johnson, Christina; Haines, Terry P.
The transition between extended hospitalization and discharge home to community-living contexts for older adults is a critical time period. This transition can have an impact on the health outcomes of older adults such as increasing the risk for health outcomes like falls, functional decline and depression and anxiety. The aim of this work is to identify and understand why older adults experience symptoms of depression and anxiety post-discharge and what factors are associated with this. This is a mixed methods study of adults aged 65 years and over who experienced a period of hospitalization longer than two weeks and return to community-living post-discharge. Participants will complete a questionnaire at baseline and additional monthly follow-up questionnaires for six months. Anxiety and depression and their resulting behaviors are major public health concerns and are significant determinants of health and wellbeing among the ageing population. There is a critical need for research into the impact of an extended period of hospitalization on the health status of older adults post-discharge from hospital. This research will provide evidence that will inform interventions and services provided for older adults after they have been discharged home from hospital care. PMID:27417775
Yanartas, O; Kani, HT; Bicakci, E; Kilic, I; Banzragch, M; Acikel, C; Atug, O; Kuscu, K; Imeryuz, N; Akin, H
Objective Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. Patients and methods Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. Results Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn’s disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. Conclusion In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn’s disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL. PMID:27069364
Takai, M; Takahashi, M; Iwamitsu, Y; Ando, N; Okazaki, S; Nakajima, K; Oishi, S; Miyaoka, H
Caregivers of patients with dementia often experience chronic and emotional strains, which may lead to emotional exhaustion and burnout. The objective of this study was to examine the relationships between burnout, depression, and quality of life in home caregivers of patients with dementia. The participants were 84 home caregivers (39 male; 45 female), and they were asked to complete three questionnaires: the Beck Depression Inventory Second Edition (BDI-II), the WHO Quality of Life 26 (WHO-QOL26), and the Pines Burnout Measure (BM). Results from a bivariate correlation showed that BM scores significantly correlated with the scores on BDI-II and WHO-QOL26. Results from ANOVA comparing the level of burnout with the scores on BDI-II and WHO-QOL26 revealed that there were differences between the burnout groups and the scores on BDI-II and WHO-QOL26. The higher levels of burnout were found to correspond to higher levels of depressive symptoms and lower QOL. These findings suggest that caregiver intervention to reduce burnout might benefit from strategies to reduce depression and increase QOL.
Field, Thalia S.; Doubal, Fergus N.; Johnson, Wendy; Backhouse, Ellen; McHutchison, Caroline; Cox, Simon; Corley, Janie; Pattie, Alison; Gow, Alan J.; Shenkin, Susan; Cvoro, Vera; Morris, Zoe; Staals, Julie; Bastin, Mark; Deary, Ian J.; Wardlaw, Joanna M.
It is unknown whether relations between early-life factors and overall health in later life apply to burden of cerebral small vessel disease (cSVD), a major cause of stroke and dementia. We explored relations between early-life factors and cSVD in the Lothian Birth Cohort, a healthy aging cohort. Participants were recruited at age 70 (N = 1091); most had completed a test of cognitive ability at age 11 as part of the Scottish Mental Survey of 1947. Of those, 700 participants had brain MRI that could be rated for cSVD conducted at age 73. Presence of lacunes, white matter hyperintensities, microbleeds, and perivascular spaces were summed in a score of 0-4 representing all MRI cSVD features. We tested associations with early-life factors using multivariate logistic regression. Greater SVD score was significantly associated with lower age-11 IQ (OR higher SVD score per SD age-11 IQ = .78, 95%CI 0.65-.95, p=.01). The associations between SVD score and own job class (OR higher job class, .64 95%CI .43-.95, p=.03), age-11 deprivation index (OR per point deprivation score, 1.08, 95%CI 1.00-1.17, p=.04), and education (OR some qualifying education, .60 95%CI .37-.98, p=.04) trended towards significance (p<.05 for all) but did not meet thresholds for multiple testing. No early-life factor was significantly associated with any one individual score component. Early-life factors may contribute to age-73 burden of cSVD. These relations, and the potential for early social interventions to improve brain health, deserve further study. PMID:27652981
Villoro, Renata; Merino, María; Hidalgo-Vega, Alvaro
Purpose This study estimates the health-related quality of life and the health care resource utilization of patients diagnosed with chronic depression (CD) in Spain. Patients and methods We used the Spanish National Health Survey 2011–2012, a cross-sectional survey representative at the national level, that selects people aged between 18 and 64 years (n=14,691). We estimated utility indices through the EuroQol five-dimensional descriptive system questionnaire included in the survey. We calculated percentage use of health care resources (medical visits, hospitalizations, emergency services, and drug consumption) and average number of resources used when available. A systematic comparison was made between people diagnosed with CD and other chronic conditions (OCCs). The chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were used to determine the statistical significance of differences between comparison groups. Multivariate analyses (Poisson regression, logistic regression, and linear regression) were also carried out to assess the relationship between quality of life and consumption of health care resources. Results Approximately, 6.1% of the subjects aged between 18 and 64 years were diagnosed with CD (average age 48.3±11 years, 71.7% females). After controlling for age, sex, and total number of comorbidities, a diagnosis of CD reduced utility scores by 0.09 (P<0.05) vs OCCs, and increased the average number of hospitalizations by 15%, the average number of days at hospital by 51%, and the average number of visits to emergency services by 15% (P<0.05). CD also increased the average number of visits to secondary care by 14% and visits to general practitioners by 4%. People with CD had a higher probability of consuming drugs than people with OCCs (odds ratio [OR]: 1.24, P<0.05), but only 38.6% took antidepressants. Conclusion People with CD had significantly lower health-related quality of life than people with OCCs. CD was associated with
Hindi, Fawzi; Dew, Mary Amanda; Albert, Steven M; Lotrich, Francis E; Reynolds, Charles F
Unipolar major depression is among the leading contributors to the global burden of illness-related disability, and is predicted to be the greatest contributor to illness burden by 2030. It is a matter of public health significance to identify people at high risk for depression and/or already mildly symptomatic, and to discover ways of implementing timely and rational risk reduction strategies to preempt major depression. In this article, the published literature is reviewed to summarize what is known about depression prevention in older adults, and, ultimately, to inform future research.
Oriol, Xavier; Miranda, Rafael; Acosta, Hedy C.; Mendoza, Michelle C.; Torres-Vallejos, Javier
Background From the social-ecological perspective, exposure to violence at the different developmental levels is fundamental to explain the dynamics of violence and victimization in educational centers. The following study aims at analyzing how these relationships are produced in the Peruvian context, where structural violence situations exist. Methods A multi-mediation structural model with 21,416 Peruvian adolescents (M = 13.69; SD = 0.71) was conducted to determine the influence of violence in the school environment on violence perceived within school and violence exercised by teachers. In addition, it was also intended to determine whether these violent relationships predict depression through loneliness, and bullying through peer victimization. The existence of differences between early and late adolescence was also verified. Results Results confirm that violence in the school setting has high influence on violence exercised by adolescents and teachers within the school. Teacher violence is the most important predictor of depression through loneliness, and encourages peer victimization and the emergence of aggressive behavior. Exposure to violence exercised by support sources—teachers and classmates—explains more than 90% of the total variance explained in bullying behavior. Differences were found between early and late adolescence models. Conclusion The high prevalence of structural violence in school settings facilitates the bullying/victimization dynamics within school. From a social-ecological perspective, this result suggests the importance of network cooperation at a mesosystem level, with teachers from educational centers playing a crucial role in the prevention of bullying/victimization. PMID:28358905
Mangion, Carmen M.
Much of the debates in late nineteenth-century Britain regarding the education of deaf children revolved around communication. For many Victorians, sign language was unacceptable; many proponents of oralism attempted to "normalise" the hearing impaired by replacing deaf methods of communication with spoken language and lipreading. While…
Diepstraten, Isabelle; du Bois-Reymond, Manuela; Vinken, Henk
In this article we build a theoretical framework with which to analyse trendsetting learning biographies; that is, biographies that are prototypical realisations of a cultural script about how young people learn and live in late modernity. In the current debate on lifelong learning in knowledge-based societies learners are interpreted in an…
Lee, Jimin; Kim, Sung-Soo; Jeong, Hye-Jin; Son, Chang-Nam; Kim, Ji-Min; Cho, Yong-Won; Kim, Sang-Hyon
Background/Aims Sleep disturbance is prime concern in patients with Behcet disease. The purpose of this study was to find out the effects of sleep quality, in Korean patients suffering from Behcet disease. We further investigated the relationship between depression, quality of life and the clinical findings of Behcet disease. Methods The study was performed by the cross-sectional design. Sleep quality was assessed by the Korean version of Pittsburgh sleep quality index (PSQI). Disease activity of Behcet disease was evaluated by Behcet disease current activity form (BDCAF). Depression was assessed by the Korean version of Beck depression inventory second edition (BDI-2). Quality of life was assessed by the Korean version of the Leeds Behcet disease quality of life measure (BDQoL). Results Among the 100 patients studied, 42% reported poor sleep quality (PSQI ≥ 9). These patients have a higher BDI-2, total BDCAF and pain visual analogue scale (VAS) score (p < 0.001, p = 0.022, and p = 0.005). Considering BDCAF, the frequency of genital ulcer was significantly higher (p = 0.01). Behcet was higher in females. The BDQoL was lower in poor sleeper group (p = 0.004 and p < 0.001). Among 7 PSQI components, daytime dysfunction was higher in patients with high disease activity (p = 0.03). Total PSQI score were strongly correlated with BDCAF, BDI-2, BDQoL, and pain VAS score (p = 0.02, p < 0.001, p < 0.001, and p < 0.001, respectively). Conclusions Low sleep quality is directly associated with disease activity, depression, and quality of life in Korean patients with Behcet disease. PMID:28192886
Glover, Matthew E.; Pugh, Phyllis C.; Jackson, Nateka L.; Cohen, Joshua L.; Fant, Andrew D.; Akil, Huda; Clinton, Sarah M.
Selective serotonin reuptake inhibitor (SSRI) antidepressants are the mainstay treatment for the 10–20% of pregnant and postpartum women who suffer major depression, but the effects of SSRIs on their children’s developing brain and later emotional health are poorly understood. SSRI use during pregnancy can elicit antidepressant withdrawal in newborns and increase toddlers’ anxiety and social avoidance. In rodents, perinatal SSRI exposure increases adult depression- and anxiety-like behavior, although certain individuals are more vulnerable to these effects than others. Our study establishes a rodent model of individual differences in susceptibility to perinatal SSRI exposure, utilizing selectively-bred Low Responder (bLR) and High Responder (bHR) rats that were previously bred for high versus low behavioral response to novelty. Pregnant bHR/bLR females were chronically treated with the SSRI paroxetine (10 mg/kg/day p.o.) to examine its effects on offspring’s emotional behavior and gene expression in the developing brain. Paroxetine treatment had minimal effect on bHR/bLR dams’ pregnancy outcomes or maternal behavior. We found that bLR offspring, naturally prone to an inhibited/anxious temperament, were susceptible to behavioral abnormalities associated with perinatal SSRI exposure (which exacerbated their Forced Swim test immobility), while high risk-taking bHR offspring were resistant. Microarray studies revealed robust perinatal SSRI-induced gene expression changes in the developing bLR hippocampus and amygdala (postnatal days 7–21), including transcripts involved in neurogenesis, synaptic vesicle components, and energy metabolism. These results highlight the bLR/bHR model as a useful tool to explore the neurobiology of individual differences in susceptibility to perinatal SSRI exposure. PMID:25451292
Glover, M E; Pugh, P C; Jackson, N L; Cohen, J L; Fant, A D; Akil, H; Clinton, S M
Selective serotonin reuptake inhibitor (SSRI) antidepressants are the mainstay treatment for the 10-20% of pregnant and postpartum women who suffer major depression, but the effects of SSRIs on their children's developing brain and later emotional health are poorly understood. SSRI use during pregnancy can elicit antidepressant withdrawal in newborns and increase toddlers' anxiety and social avoidance. In rodents, perinatal SSRI exposure increases adult depression- and anxiety-like behavior, although certain individuals are more vulnerable to these effects than others. Our study establishes a rodent model of individual differences in susceptibility to perinatal SSRI exposure, utilizing selectively bred Low Responder (bLR) and High Responder (bHR) rats that were previously bred for high versus low behavioral response to novelty. Pregnant bHR/bLR females were chronically treated with the SSRI paroxetine (10 mg/kg/day p.o.) to examine its effects on offspring's emotional behavior and gene expression in the developing brain. Paroxetine treatment had minimal effect on bHR/bLR dams' pregnancy outcomes or maternal behavior. We found that bLR offspring, naturally prone to an inhibited/anxious temperament, were susceptible to behavioral abnormalities associated with perinatal SSRI exposure (which exacerbated their Forced Swim Test immobility), while high risk-taking bHR offspring were resistant. Microarray studies revealed robust perinatal SSRI-induced gene expression changes in the developing bLR hippocampus and amygdala (postnatal days 7-21), including transcripts involved in neurogenesis, synaptic vesicle components, and energy metabolism. These results highlight the bLR/bHR model as a useful tool to explore the neurobiology of individual differences in susceptibility to perinatal SSRI exposure.
Background The aim of the study was to compare the change in quality of life over 32 weeks in depressed women assuming antidepressant drug with (experimental group) or without (control group) physical exercise from a study which results on objective dimension of outcome were already published. Methods Trial with randomized naturalistic control. Patients selected from the clinical activity registries of a Psychiatric University Unit. Inclusion criteria: female, between 40 and 60 years, diagnosis of Major Depressive Disorders (MMD, DSM-IV TR) resistant to ongoing treatment. Exclusion criteria: diagnosis of psychotic disorders; any contraindications to physical activity. 30 patients (71.4% of the eligible) participated to the study. Cases: 10 randomized patients undergoing pharmacological treatment plus physical activity. Controls: 20 patients undergoing only pharmacological therapy. Quality of life was measured by means of WHOQOL-Bref. Results The patients that made physical activity had their WHOQOL-Bref physical score improved from T0 to T8, the differences was statistically significant. In the control group WHOQOL-Bref physical remains the same and, consequentially, the difference between T0 and T8 do not reach any statistical significance. The perceived quality of life in the other domains did not change during the treatment in both groups. Thus no other differences were found between and within groups. Discussion and Conclusion The data presented in the previous paper found that physical activity seems a good adjunctive treatment in the long term management of patients with MDD. These new data indicated that physical activity may also improve the perceived physical quality of life. The dimensions related with social functioning, environment and psychical well being seem do not improved, unexpectedly, during the trial. Two objective dimension not strictly related to the depressive symptoms improved: social functioning and Clinical Global Impression, this
Johnson, Daniel P.; Rhee, Soo Hyun; Whisman, Mark A.; Corley, Robin P.; Hewitt, John K.
This multiwave longitudinal study tested two quantitative genetic developmental models to examine genetic and environmental influences on exposure to negative dependent and independent life events. Participants (N = 457 twin pairs) completed measures of life events annually from ages 9 to 16. The same genetic factors influenced exposure to…
Aydogan, Umit; Aydogdu, Aydogan; Akbulut, Halil; Sonmez, Alper; Yuksel, Servet; Basaran, Yalcin; Uzun, Ozcan; Bolu, Erol; Saglam, Kenan
Hypogonadotropic hypogonadism is defined as the failure in production of gonadal hormones, thus resulting in lower amounts of testosterone. Depression, anxiety and decreased quality of life are the most common psychopathological conditions in young hypogonadal men. The aim of the present study was to assess the still debated relationship with testosterone levels and psychological symptoms in young male patients with congenital hypogonadotropic hypogonadism (CHH). Thirty-nine young male patients with CHH and 40 age-matched healthy males were enrolled in the present study. The impact of testosterone replacement treatment (TRT) on the patients' anxiety and depression levels, sexual function and quality of life were assessed before and after 6 months of treatment using valid and reliable scales, including the Short Form-36 (SF-36), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Arizona Sexual Experiences (ASEX). Patients with CHH had significantly higher scores for BDI, BAI, and ASEX than the control subjects at baseline (p=0.011, p=0.036, p<0.001, respectively). The ASEX and BDI scores significantly improved after the TRT (p<0.001 for both), while the improvement in the BAI score was not statistically significant (p=0.135). When compared to the control group, treatment naïve hypogonadal patients had more severe symptoms of sexual dysfunction, anxiety, depression, and worse quality of life. After 6 months of TRT, we observed improvements in the above parameters, suggesting that low endogenous levels of testosterone might be related to the increased incidence of psychological symptoms.
Baytan, Birol; Aşut, Çiğdem; Çırpan Kantarcıoğlu, Arzu; Sezgin Evim, Melike; Güneş, Adalet Meral
Objective: With increasing survival rates in childhood acute lymphocytic leukemia (ALL), the long-term side effects of treatment have become important. Our aim was to investigate health-related quality of life, depression, anxiety, and self-image among ALL survivors. Materials and Methods: Fifty patients diagnosed with ALL and their siblings were enrolled. The Kovacs Children’s Depression Inventory, State-Trait Anxiety Inventory, Offer Self-Image Questionnaire, and Pediatric Quality of Life InventoryTM were used for collecting data. ANOVA tests were used to determine if there were any significant differences between groups. Results: ALL survivors had higher depression, more anxiety symptoms, lower quality of life, and more negative self-image when compared to their siblings. Conclusion: Continuous diagnostic and interventional mental health services might be necessary for possible emotional side effects of treatment during and after the treatment. Rehabilitation and follow-up programs should be implemented for children during and after treatment for ALL. PMID:27094799
This study examines the role of cumulative disadvantage mechanisms across the life course in the production of racial and ethnic disparities in depressive symptoms at midlife, including the early life exposure to health risk factors, the persistent exposure to health risk factors, and varying mental health returns to health risk factors across racial and ethnic groups. Using data from the over-40 health module of the National Longitudinal Study of Youth (NLSY) 1979 cohort, this study uses regression decomposition techniques to attend to differences in the composition of health risk factors across racial and ethnic groups, differences by race and ethnicity in the association between depressive symptoms and health risk factors, and how these differences combine within racial and ethnic groups to produce group-specific levels of—and disparities in—depressive symptoms at midlife. While the results vary depending on the groups being compared across race/ethnicity and gender, the study documents how racial and ethnic mental health disparities at midlife stem from life course processes of cumulative disadvantage through both unequal distribution and unequal associations across racial and ethnic groups. PMID:26047842
Chao, Shu-Yuan; Liu, Hsing-Yuan; Wu, Chiu-Yen; Jin, Suh-Fen; Chu, Tsung-Lan; Huang, Tzu-Shin; Clark, Mary Jo
The need to provide quality mental health care for elders in nursing home settings has been a critical issue, as the aging population grows rapidly and institutional care becomes a necessity for some elders. The purpose of this quasi-experimental study was to describe the effect of participation in reminiscence group therapy on older nursing home residents' depression, self-esteem, and life satisfaction. Purposive sampling was used to recruit participants who met the study criteria. Residents of one ward were assigned to the reminiscence therapy group intervention, while residents of the other ward served as controls. Nine weekly one-hour sessions were designed to elicit reminiscence as group therapy for 12 elders in the experimental group. Another 12 elders were recruited for a control group matched to experimental subjects on relevant criteria. Depression, self-esteem, and life satisfaction were measured one week before and after the therapy. The Statistical Package for the Social Sciences (SPSS, Version 10.0) was used to analyze data. Results indicated that group reminiscence therapy significantly improved self-esteem, although effects on depression and life satisfaction were not significant. Reminiscence groups could enhance elders' social interaction with one another in nursing home settings and become support groups for participants. The model we created here can serve as a reference for future application in institutional care.
Heider, Dirk; Schomerus, Georg; Matschinger, Herbert; Wittmund, Bettina; Wilms, H Ulrich; Brieger, Peter; Angermeyer, Matthias C
A new group intervention program has been assessed, rating its ability to increase the quality of life in partners of patients suffering under depression. Over a period of six months 66 subjects participated in an intervention group for a total of twelve sessions. The control group consisted of 50 persons, and quality of life was assessed with the WHOQOL-BREF. The five WHOLQOL domains were used as independent variables in random-effects regression models measuring the time effect. Although the quality of life of the subjects was below that of the general population at the beginning of the intervention, the study resulted in no significant improvement in quality of life. In contrast, satisfaction of participants with the intervention was high.
Wakawa, Ibrahim Abdu; Said, Jidda Mohammed; Abba, Wakil Musa; Shehu, Saleh; Rabbebe, Isa Bukar; Beida, Omeiza
Background: Globally, depression compromises the quality of life (QOL) of people suffering from it. We assessed the impact of comorbid depression on the health-related quality of life (HRQOL) of adults on highly active antiretroviral therapy (HAART) in northeastern Nigeria in this study. Materials and Methods: Three hundred and three adults on HAART were recruited for this study from the ART clinic of the University of Maiduguri Teaching Hospital in northeastern Nigeria. The depressive disorder module of the Composite international diagnostic interview (CIDI version 3.0) and the WHO quality of life instrument (WHOQOL-BREF) were used for the evaluation of depression and quality of life respectively. Results: The prevalence of depression in this study was 19.8%. The depressed respondents rated their HRQOL poorer than their nondepressed counterparts on the physical, psychological, social relationships and environmental domains as well as the global outcome, as shown by these statistically significant findings (T = 9.739, P = <0.001), (T = 8.972, P = <0.001), (T = 6.533, P = <0.001), (T = 8.913, P = <0.001), and (T = 10.018, P = <0.001), respectively. Female gender, CD4 counts <200/mm3 and diagnosis of depression were significant predictors poor QOL. Conclusion: Depression has a negative impact on the QOL of the respondents. We therefore recommend incorporation of the routine screening of this important psychiatric comorbidity into the care of this vulnerable group in order to optimize patient care. PMID:25336775
Chachamovich, Eduardo; Fleck, Marcelo; Laidlaw, Ken; Power, Mick
Purpose: The impact of major depression on quality of life (QOL) and aging experiences in older adults has been reported. Studies have demonstrated that the clinical diagnosis of major depression is the strongest predictor for QOL. We postulate that some findings are biased because of the use of inadequate instruments. Although subsyndromal…
Magidson, Jessica F.; Seitz-Brown, C. J.; Safren, Steven A.; Daughters, Stacey B.
Antiretroviral therapy to treat HIV/AIDS has substantially improved clinical outcomes among patients living with HIV/AIDS, but only in the presence of very consistent adherence. One of the most prevalent and impactful individual-level predictors of poor adherence is depressive symptoms, even at subthreshold levels. Evidence-based cognitive behavioral interventions exist to address improvements in depressive symptoms and adherence in this population, yet these techniques have largely been designed and tested as individual treatments for delivery in mental health settings. This presents a significant challenge when transporting these techniques to medical settings where other formats for delivery may be more appropriate (i.e., groups, less frequent visits) and few hands-on resources exist to guide this process. As such, primary aims of this study were to adapt and implement evidence-based cognitive behavioral techniques for depression (behavioral activation; BA) and HIV medication adherence (Life-Steps) that have potential for dissemination in an outpatient community health center. The intervention incorporated feedback from health center staff and utilized a modular, group format that did not rely on sequential session attendance. Feasibility was examined over 8 weeks (n = 13). Preliminary effects on depression, health-related quality of life, and medication adherence were examined and exit interviews were conducted with a subset of participants (n = 4) to inform future modifications. Treatment descriptions and recommendations for effective clinical implementation based on patient and clinician feedback are provided along with case material of two individual patients and an example group session. Current efforts are an important next step for disseminating evidence-based techniques for depression and HIV medication adherence to community health center or AIDS service organization settings. PMID:25419102
Bohn, Annette; Berntsen, Dorthe
The authors investigated the relationship between the acquisition of cultural life scripts and the degree of coherence in children's and adolescents' life stories. Three groups of Danish school children aged 9 to 15 years participated. In 3 sessions, they wrote down a recently experienced single autobiographical event, their life story, and their…
Park, Subin; Hatim Sulaiman, Ahmad; Srisurapanont, Manit; Chang, Sung-man; Liu, Chia-Yih; Bautista, Dianne; Ge, Lan; Choon Chua, Hong; Pyo Hong, Jin
We investigated the associations between negative life events, social support, depressive and hostile symptoms, and suicide risk according to gender in multinational Asian patients with major depressive disorder (MDD). A total of 547 outpatients with MDD (352 women and 195 men, mean age of 39.58±13.21 years) were recruited in China, South Korea, Malaysia, Singapore, Thailand, and Taiwan. All patients were assessed with the Mini-International Neuropsychiatric Interview, the Montgomery-Asberg Depression Rating Scale, the Symptoms Checklist 90-Revised, the Multidimensional Scale of Perceived Social Support, and the List of Threatening Experiences. Negative life events, social support, depressive symptoms, and hostility were all significantly associated with suicidality in female MDD patients. However, only depressive symptoms and hostility were significantly associated with suicidality in male patients. Depression severity and hostility only partially mediated the association of negative life events and poor social support with suicidality in female patients. In contrast, hostility fully mediated the association of negative life events and poor social support with suicidality in male patients. Our results highlight the need of in-depth assessment of suicide risk for depressed female patients who report a number of negative life events and poor social supports, even if they do not show severe psychopathology.
Thorp, Steven R.; Ayers, Catherine R.; Nuevo, Roberto; Stoddard, Jill A.; Sorrell, John T.; Wetherell, Julie Loebach
Objective To evaluate the efficacy of different types of behavioral treatments for geriatric anxiety [cognitive-behavioral therapy (CBT) alone, CBT with relaxation training (RT), and RT alone]. Method We compared effect sizes from 19 trials. Analyses were based on uncontrolled outcomes (comparing post-treatment and pre-treatment scores) and effects relative to control conditions on both anxiety and depressive symptoms. Results Treatments for older adults with anxiety symptoms were, on average, more effective than active control conditions. Effect sizes were comparable to those reported elsewhere for CBT for anxiety in the general population or for pharmacotherapy in anxious older adults. CBT (alone or augmented with RT) does not appear to add anything beyond RT alone, although a direct comparison is challenging given differences in control conditions. Effects on depressive symptoms were smaller, with no differences among treatment types. Conclusion Results suggest that behavioral treatments are effective for older adults with anxiety disorders and symptoms. Results must be interpreted with caution given the limitations of the literature, including differing sample characteristics and control conditions across studies. PMID:19155744
Gonda, X; Eszlari, N; Kovacs, D; Anderson, I M; Deakin, J F W; Juhasz, G; Bagdy, G
Several studies indicate that 5-HTTLPR mediates the effect of childhood adversity in the development of depression, while results are contradictory for recent negative life events. For childhood adversity the interaction with genotype is strongest for sexual abuse, but not for other types of childhood maltreatment; however, possible interactions with specific recent life events have not been investigated separately. The aim of our study was to investigate the effect of four distinct types of recent life events in the development of depressive symptoms in a large community sample. Interaction between different types of recent life events measured by the List of Threatening Experiences and the 5-HTTLPR genotype on current depression measured by the depression subscale and additional items of the Brief Symptom Inventory was investigated in 2588 subjects in Manchester and Budapest. Only a nominal interaction was found between life events overall and 5-HTTLPR on depression, which failed to survive correction for multiple testing. However, subcategorising life events into four categories showed a robust interaction between financial difficulties and the 5-HTTLPR genotype, and a weaker interaction in the case of illness/injury. No interaction effect for the other two life event categories was present. We investigated a general non-representative sample in a cross-sectional approach. Depressive symptoms and life event evaluations were self-reported. The 5-HTTLPR polymorphism showed a differential interaction pattern with different types of recent life events, with the strongest interaction effects of financial difficulties on depressive symptoms. This specificity of interaction with only particular types of life events may help to explain previous contradictory findings. PMID:27138797
Gonda, X; Eszlari, N; Kovacs, D; Anderson, I M; Deakin, J F W; Juhasz, G; Bagdy, G
Several studies indicate that 5-HTTLPR mediates the effect of childhood adversity in the development of depression, while results are contradictory for recent negative life events. For childhood adversity the interaction with genotype is strongest for sexual abuse, but not for other types of childhood maltreatment; however, possible interactions with specific recent life events have not been investigated separately. The aim of our study was to investigate the effect of four distinct types of recent life events in the development of depressive symptoms in a large community sample. Interaction between different types of recent life events measured by the List of Threatening Experiences and the 5-HTTLPR genotype on current depression measured by the depression subscale and additional items of the Brief Symptom Inventory was investigated in 2588 subjects in Manchester and Budapest. Only a nominal interaction was found between life events overall and 5-HTTLPR on depression, which failed to survive correction for multiple testing. However, subcategorising life events into four categories showed a robust interaction between financial difficulties and the 5-HTTLPR genotype, and a weaker interaction in the case of illness/injury. No interaction effect for the other two life event categories was present. We investigated a general non-representative sample in a cross-sectional approach. Depressive symptoms and life event evaluations were self-reported. The 5-HTTLPR polymorphism showed a differential interaction pattern with different types of recent life events, with the strongest interaction effects of financial difficulties on depressive symptoms. This specificity of interaction with only particular types of life events may help to explain previous contradictory findings.
Ishida, Yasushi; Honda, Misato; Ozono, Shuichi; Okamura, Jun; Asami, Keiko; Maeda, Naoko; Sakamoto, Naoko; Inada, Hiroko; Iwai, Tsuyako; Kamibeppu, Kiyoko; Kakee, Naoko; Horibe, Keizo
To examine the late effects and health-related quality of life among childhood cancer survivors (CCS) after stem cell transplantation (SCT), we performed a cross-sectional survey using self-rating questionnaires. The subjects were divided into 3 groups: SCT-treated CCS, CCS treated without SCT, and the general population who matched for age, gender, residential area, and work status with the CCS. We analyzed the questionnaires of 185 CCS and 1,000 control participants. The median ages of CCS at diagnosis and survey were 8 and 22 years, respectively. The mean final heights of male and female participants were significantly lower for SCT-treated CCS than for CCS treated without SCT and the controls. Among the SCT-treated CCS, >40% were underweight (BMI < 18.5). Late effects were observed in 78% of SCT-treated CCS versus 45% of CCS treated without SCT. Multivariate analysis revealed that >15 years' duration after therapy completion (OR 2.95; p = 0.014), solid tumors (4.31; p = 0.040), radiotherapy (2.82; p = 0.009), recurrence (4.22; p = 0.017), and SCT (3.39; p = 0.014) were significant risk factors for late effects. Subjective symptoms were significantly frequent in SCT-treated CCS. Physical dysfunction, psychological stress, and social adaptation problems were observed in >70% of SCT-treated CCS.
Martin, Ramon F; Desai, Sukumar P
Horace Wells was a Hartford, Connecticut, dentist whose practice flourished because of his clinical skills. He had an imaginative mind that propelled him to the forefront in several aspects of dentistry. Unfortunately, he suffered a recurrent "illness" that began in the winter and resolved in the spring. These symptoms were compatible with both major depressive disorder and seasonal affective disorder as a qualifier. Wells' introduction of nitrous oxide as an anesthetic was also associated with self-inhalation. This led to periods of hypomania, followed by depression. With the progression to ether, then chloroform, there was an episode of mania in January 1848, followed by depression and suicide.
The second half of the 19th century marked the rise of obstetrics as a legitimate physician-dominated medical specialty. In this period of transition, distanced from traditional cultures of social childbirth but not yet embracing hospital deliveries, many middle-class North American women turned to prescriptive literature to fill a crucial gap. In the medical advice they directed at young wives and expectant mothers, physicians consistently emphasized the middle-class woman's heightened sensitivity to the pain of giving birth, relying on arguments that resonated with the class, gender, and racial tensions of the late-Victorian period while consistently reaffirming physicians' expanding authority.
Smid, Geert E.; Lensvelt-Mulders, Gerty J. L. M.; Knipscheer, Jeroen W.; Gersons, Berthold P. R.; Kleber, Rolf J.
Following resettlement in Western countries, unaccompanied refugee minors (URM) are at risk of developing posttraumatic stress disorder (PTSD). It is unclear to what extent PTSD in this group may become manifest at later stages following resettlement and which factors are associated with late onset. We examined data from URM collected 1 (T1) and 2…
Butcher, Howard K; McGonigal-Kenney, Meghan
The misconception that aging and depression are inevitably entwined is not only common but also dangerous. It can lead to a variety of adverse events, which might have been avoided had the depression been recognized and treated. However, recognizing depression in older adults can be difficult as it may present differently in this population than it does in younger adults. Furthermore, while treatment options are similar, adjustments may need to be made to deal with the physiological changes inherent to age. The authors address the recognition and treatment of depression in older adults. They also propose a diagnosis of dispiritedness, "a feeling of being in low spirits" that they have found to be common among older adults and suggest appropriate nursing interventions.
The purpose of this study is to examine the relationship between contact with the dead and death anxiety. The data come from an ongoing nationwide survey of older adults. A conceptual model is developed that contains the following theoretical linkages: (1) making contact with the dead instills a deeper appreciation of the connection that exists among all people; (2) this fundamental sense of connectedness with others fosters a deeper sense of religious meaning in life; and (3) individuals with a deeper sense of religious meaning in life are less likely to experience feelings of death anxiety than people who have not been able to find meaning in life through religion. The findings from this study provide support for each of these relationships. The theoretical implications of these hypotheses are discussed.
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Park, Crystal L; Kaiser, Anica Pless; Spiro, Avron; King, Daniel W; King, Lynda A
Our earlier study of U.S. prisoners of war in Vietnam (King et al., 2011) examined personal and military demographics and aspects of the stressful experience of wartime impriso