Developmental resources and depression in the elderly

A longitudinal study was carried out with 28 clinically depressed and 28 mentally healthy older adults, matched on age, sex, and years of education. Developmental resources and depression were measured on three occasions using the Developmental Resources of Later Adulthood and the Center for Epidemiological Studies Depression scales. A 2 X (3) repeated measures factorial analysis of variance indicated that the depressed group had significantly lower developmental scores across all three time periods. Results of cross-lagged panel correlation analyses suggested that the direction of the relationship between developmental resources and depressive symptoms differed markedly between the two groups. The mentally healthy group showed a significant causal tendency for developmental resources to influence level of depression; a reverse trend was noted in the depressed group.     

The need to modify health education programs for the mentally retarded and developmentally disabled

The health of individuals who are diagnosed as developmentally disabled or mentally retarded has long been a concern of health professionals. Historically health education has addressed the life style and health issues associated with the norm of the population. While there have been many advances in health education which are admirable, modification of health education programs for the developmentally disabled remains an important consideration. Those areas of health education which might be adapted to the developmentally disabled include mental and emotional health, substance abuse, sexuality and reproduction nutrition, weight control, fitness, and other factors related to disease prevention and overall health and well being. From a review of the literature, it seems that successful modification of health education materials for the developmentally disabled incorporates the use of repetition, involvement of health care providers and family, a focus on managing stress and value clarification as well as the enhancement of self-esteem and self-worth. In general, the health issues of concern for the mentally retarded and the developmentally disabled are not markedly different from that of the general population. It does appear that additional research is necessary for the adaptation of programs which could provide this much needed training for developmentally disabled and mentally retarded individuals.     

随班就读弱智学生学习适应情况的初步分析

目的探讨随班就读弱智学生学习适应性现状 . 方法运用 < 学习适应性测验 > ( AAT) 对上海郊县小学一年级至初二年级的 240例随班就读弱智学生进行了调查 , 其中有效被试为 208例 . 结果随班就读弱智学生学习适应能力总体情况较差 ; 小学三、四年级的适应情况最差 , 之后 , 随年级的增高 , 而有显著改善 ; 听课方法、家庭环境、学习技术以及学习态度等方面的问题在随班就读学生身上反映较为突出 . 结论应对随班就读弱智学生加强学习适应性能力方面的训练 .     

Coping with the sexuality of the disabled: a comparison of the physically disabled and the mentally retarded

Taking as a starting point, papers on sexuality of disabled people and papers on attitudes and representations toward their sexuality, we have demonstrated that the coping of those people is directed by an ideology of rationalisation of sexuality. This ideology is expressed in different ways, with physically disabled and mentally retarded people. This fact makes clear the importance of the handicapped referent over the coping. Procreation is strongly supported for the physically disabled people (paraplegics). Mentally retarded people are strictly forbidden to procreate: this appears especially with the sterilisation of mentally retarded women.     

Depressive symptoms in chiropractic students: a 3-year study

Background:

The intensive training associated with health care education has been suggested to have unintended negative consequences on students’ mental or emotional health that may interfere with the development of qualities deemed essential for proficient health care professionals. This longitudinal study examined the prevalence and severity of depressive symptoms among students at a chiropractic educational institution.

Methods:

Chiropractic students at all levels of training were surveyed at Canadian Memorial Chiropractic College during the academic years of 2000/2001, 2001/2002, and 2002/2003. The measurement tool employed was the Beck Depression Inventory, 2nd edition (BDI-II). Previously established BDI-II cutoff scores were used to assess the severity of reported depression symptoms, and these were compared by sex and year of training.

Results:

The survey was completed by 1303 students (70%) over the 3 years of the study. The prevalence of depressive symptoms was nearly 25%, with 13.7% of respondents indicating a rating of mild depression, 7.1% indicating moderate depressive symptoms, and 2.8% indicating severe symptoms. Significant differences were found between years of training, with 2nd-year students having the highest prevalence of depressive symptoms, and sex, with females having a higher rate of symptoms.

Conclusions:

Chiropractic students surveyed at Canadian Memorial Chiropractic College had high rates of depression similar to those measured in other health care profession students. Chiropractic educational institutions should be aware of this situation and are encouraged to emphasize students’ awareness of their own personal health and well-being and their access to appropriate care, in addition to the same concerns for their future patients.     

Caregiver attributions of success or failure of their mentally retarded dependent

Attitudes and expectations may have an effect on the development and well-being of the mentally retarded. The purpose of this study was to examine caregiver attributions of their developmentally disabled dependent's successes or failures and the congruence of these beliefs with attributional theory. The results indicate that the majority of caregiver explanations adhere to the attributional framework and that the attributions appear related to the dependent's age.     

唐山市城区肢体残疾人抑郁症状及其影响因素的调查分析

应用CES-D量表对唐山市城区428名15～60岁的肢体残疾人进行了调查.结果表明,428名肢体残疾人中可能有抑郁症状者的检出率为29.91%,肯定有抑郁症状者的检出率为21.73%,有严重抑郁症状者的检出率为11.68%.主要症状为:烦恼、苦闷感、自卑感、情绪低沉、乏力、绝望感、睡眠障碍、无愉快感、空虚感和忧愁等.经逐步回归分析发现:影响肢体残疾人产生抑郁症状的主要因素为年龄、职业、人均月收入、自评健康状况、肢残等级、家人是否关心及与朋友的交往情况.     

The impact of cognitive challenges in major depression: the role of the primary care physician

Nearly 1 in 5 Americans will struggle with major depression in their lives; some will have recurring bouts. Recent psychiatric research has given new attention to the prevalence of cognitive deficits in major depression and the impact such deficits have on remission and overall life functioning. When depression is partially treated i.e., leaving residual symptoms, patients have higher rates of relapse and lower functional outcomes. Impaired cognitive functioning is a frequent residual symptom, persisting in about 45% of patients even when emotional symptoms have improved, and results in a disproportionate share of the functional impairment, particularly in the workplace. Patients with depression have disrupted circuitry in brain regions responsible for cognition and it is therefore important to screen depressed patients for cognitive as well as emotional symptoms. Cognitive dysfunction should be evaluated in every mood disordered patient with validated self-report scales such as the Patient Health Questionnaire-9 or the Beck Depression Inventory and objective measures of cognitive function are also very very useful. Two easily administered tests are the Trails B Test and the Digit Symbol Substitution Test. Each take less than two minutes and measure working memory, executive function, and processing speed and can track cognitive improvement in depressed patients. Treatment of cognitive dysfunction in major depression is complicated by the ‘serotonin conundrum’: SSRI’s frequently do not treat to full remission, and can cause cognitive blunting—actually adding to cognitive problems. Based on recent data including results from a recently completed meta-analysis by McIntyre and colleagues, an evidence-based algorithm for treating cognitive symptoms in depression is presented. A hierarchy of antidepressants and augmentation strategies based on the best available evidence is discussed. In conclusion, cognitive symptoms in major depressive disorder have been recognized as a target of therapeutic improvement by the FDA and have become a focus of clinical importance.     

Recalling in a state of natural or experimental depression

In three experiments we attempted to extend the cognitive-effort account of depressive deficits in memory to naturally depressed college students. This account maintains that depression reduces attentional resources, thereby impairing performance on demanding tasks, and has received support through experimental inductions of depressed moods. Nondepressed, naturally depressed, and (in Experiment 2) experimentally depressed college students performed unannounced tests of free recall following learning tasks with two levels of difficulty and (in Experiment 2) two degrees of structure. In Experiments 1 and 2 we measured cognitive effort on those tasks via latencies on a secondary task. Latencies and subsequent recall increased with the structure and difficulty of the learning task for nondepressed and naturally depressed subjects, but these effects were reduced or absent for experimentally depressed subjects. When the secondary task was omitted (Experiment 3), naturally depressed students still recalled without a deficit. We discuss possible differences associated with the two types of depression and implications for the cognitive-effort account.The order of authorship was determined alphabetically. This project was supported by grant R03 MH44044 from the National Institute of Mental Health and by a Trinity University Summer Stipend, each granted to the first author. Portions of the data in Experiment 2 were collected by Scott Schoenherr for his Senior Thesis at Trinity University. We thank Patti Boulanger, Anne-Marie DeWitt, Roger Foster, Tracey Hatcher, Lara Hill, Meg Johnson, and Dottie Masturzo for their assistance in scheduling, scoring, and data collection. We thank Tom Hicks and Pat Kyllonen (especially) for programming efforts. Gil Einstein, Henry Ellis, Rick Ingram, and Colin MacLeod provided helpful comments on an earlier version of the article.     

Stress,perceived support,resourcefulness and depressive symptoms in Taiwanese adolescents

Aims and objective. This study investigated (1) the prevalence of self‐reported depressive symptoms among first‐year students at an Institute of Technology in southern Taiwan; (2) whether perceived support and resourcefulness were associated with these adolescents’ depressive symptoms and (3) the moderating and mediating effects of learned resourcefulness on the relationship between stressors and the adolescents’ depressive symptoms. Background. An individual with adequate social support or resourcefulness may see stressors as less threatening or be more resilient in dealing with stressors compared with depressed individuals. The prevalence of depression in the global population increased rapidly during this past decade and consequently may have had a negative impact on population health outcomes. Among adolescents there has recently been an increased incidence of depression‐related suicide reports. Design. A cross‐sectional, correlational design. Method. Adolescents (n = 913) were recruited to complete the following: the SDI in Chinese, the Inventory of Social Supportive Behaviours Scale – Modified and the Self‐Control Schedule. Data analysis consisted of Pearson correlation and multiple regression analysis. Results. The prevalence of depression among participants was 13·4%. Participants who were younger, expressed lower satisfaction with their grades, perceived their health as worse, described peer relationship problems and exhibited smoking behaviour were more likely to have depressive symptoms. We observed five partially mediating effects of resourcefulness on stressors (age, perceived health, peer relationships, grades satisfaction and smoking behaviour) and depressive symptoms and one moderating effect of resourcefulness on the relationship between peer and depressive symptoms. Conclusions. Learned resourcefulness may play a critical role in decreasing depressive symptoms. Relevance to clinical practice. These findings offer healthcare providers and educators information about the need for possible cognitive–behavioural interventions that could improve adolescents’ relationships with their peers, enhance their satisfaction of grades and moderate or prevent depressive symptoms among this population. Moreover, it might decrease the prevalence of adolescent suicide.     

Coffee consumption is inversely associated with depressive status in Japanese patients with type 2 diabetes

Depression has been reported to be more prevalent among diabetic patients than non-diabetic individuals. Although depression and diabetes are causally and bi-directionally related, the influence of food intake frequency on depressive symptoms in diabetic patients has not been fully evaluated. This cross-sectional study analyzed data obtained from 89 patients with type 2 diabetes who completed self-administered questionnaires regarding food intake frequency, diabetic variables, physical activity and depressive states. The prevalence of a “definite” depressive state was 16.9%. The duration of diabetes, hemoglobin A1c levels, diabetic microvascular complications and physical activity levels were similar between depressed and non-depressed patients. Daily intakes of total lipids, n-6 polyunsaturated fatty acids and lipid energy ratios were significantly lower, and the carbohydrate energy ratio was significantly higher in depressed than in non-depressed patients. Coffee consumption was inversely associated with depressive symptoms, but no significant association was found between tea or green tea consumption and depressive symptoms. The logistic regression analysis showed that coffee consumption was an independent predictor of non-depressed status in diabetic patients. This might be due to biologically active compounds containing in coffee other than caffeine.     

Changes in the age structure of mentally handicapped patients in Sweden between 1973 and 1982

Analyzed for the first time in 1973, the age distribution in the Swedish mentally retarded population was reexamined in 1982. Within a decade considerable changes were found to have taken place, whereas the numbers of disabled persons as well as their share in the total population had remained the same. The share of children and, above all, young people up to age 20 is declining considerably per age group. This could be accounted for by the introduction, in the early 70ies, of prenatal diagnosis and its growing impact, as well as by a considerably higher share of abdominal deliveries. The age-group proportion of mentally retarded in the total population of the 25-34 year olds, on the other hand, is markedly higher today than it had been 10 years ago. This fact is thought to be associated with the introduction of antibiotics in Sweden in 1948. The life expectancy of the other, older mentally retarded persons, too, is higher today than in 1973. This is most obviously explained by the substantial improvements that have occurred since in the living conditions for mentally retarded persons.     

An exploratory study of depression among older African American users of an academic outpatient rehabilitation program

Variation in the presentation of depressive illness among older African Americans may complicate assessment of depression, especially among those with multiple medical comorbidities and functional disabilities. The purpose of this study was to explore the prevalence of depression among older poor African Americans attending an academic outpatient rehabilitation program, using a depression measure with low somatic item content. Correlates of depression in this population also were explored. Health-care records of 150 older African Americans seen over a 2-year period were examined. Depression was assessed on admission using the 30-item Geriatric Depression Scale (GDS). Using a GDS cutoff score for depression of 11 or higher, 30% of the sample (age 75.5 +/- 7.16 years, range 65-95, 75% women) scored positive for depression. Nine percent also reported having suicidal thoughts within the previous week. Consistent with existing literature, depressed patients, as compared to nondepressed patients, were significantly younger, more suicidal, more likely to rate their general health as poor, had higher mean ratings of pain, and more often limited their social activities. Six GDS items were found to have little ability to discriminate between depressed and nondepressed patients: satisfaction with life, getting bored easily, prefer staying at home, find life exciting, getting started on new projects, and full of energy. The authors recommend further testing of the GDS with similar populations of older, poor, medically ill, and functionally disabled older adults.     

Legal contract of workshops for handicapped people--a wish or reality?

In August 1990, the "Werkst?ttenverordnung" (the Workshops for the disabled ordinance) has been in force for ten years. Concluding a lengthy historical development, it describes an utopia seeking to implement the opportunity for personal growth and for economically viable productive activity, even-handedly and concurrently, for all disabled people covered (excepting those with very severe disablement). In everyday practice, such notions are confronted with major obstacles: growing demand; poor transition into other employment, terminal workshop employment instead; problems with performance requirements, with the dependence from customers, and with remuneration issues; insufficient promotional services for learning disabled clients whose labour performance is essential to the workshops; adjustment problems of clients with mental illness within the workshop; counting of alternative service attendants toward the staffing plan; unsolved civil and labour law issues relative to contracts involving mentally retarded persons; protection against dismissal, clients' right to freely choose the workshop, their co-determination and the rights of their relatives; the need for special educational qualification of workshop and group senior staff who have to face up to the expectations and difficulties in the day-to-day running of the workshops.     

关怀性触摸对失能老年人抑郁症状的干预效果

目的探索关怀性触摸对失能老年人抑郁症状的干预效果。方法由接受过培训的36名护生对某养老院36名失能老人(其中22名为重度抑郁患者、14名为轻度抑郁患者)进行连续6个月的关怀性触摸。干预前后,对失能老人和护生分别采用老年抑郁量表(geriatric depression scale,GDS)和护士人文关怀品质量表(护生版)进行测量。结果干预后失能老人的GDS得分低于干预前,护生的人文关怀品质评价量表得分优于干预前,差异均有统计学意义(均P0.05)。结论关怀性触摸不仅有助于改善失能老人的抑郁状况,同时能有效提高护生人文关怀品质。     

Depression and affective meaning for current concerns

Recent inquiries into the etiology and maintenance of depression have had a strong cognitive emphasis. However, relatively less attention has been paid to the connotative significance of depressive experience. In particular, there is much to be learned about the depressed person's emotional response to the incentives in his life. In the present study, moderately to severely depressed and nondepressed college students were asked to provide a list of “current concerns,” which they subsequently ranked in terms of order of importance. Each subject's five most important concerns served as target stimuli for a semantic differential analysis. The results indicated that, relative to nondepressed students, depressed subjects viewed their concerns in a less positive and less active light. The groups did not differ in their ratings of the potency of their concerns, with both groups tending to perceive their concerns as highly potent. A second purpose of the study was to examine whether the groups differed in the number or type of current concerns. Depressed students reported a greater number of concerns. In comparing the groups with respect to the number of concerns mentioned within each of 16 categories, it was found that depressed subjects reported more concerns than nondepressed subjects in the areas of love and sex, employment and money, and mental health.     

Increased health burden associated with comorbid depression in older diabetic Mexican Americans. Results from the Hispanic Established Population for the Epidemiologic Study of the Elderly survey.

OBJECTIVE: To examine the health burden associated with concomitant depressive symptoms and diabetes in older Mexican Americans. RESEARCH DESIGN AND METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used to assess the association between high levels of depressive symptoms, measured with the Center for Epidemiologic Studies of Depression scale, and comorbid chronic health conditions, diabetic complications, functional disability, health service use, and medication use among 636 older diabetic Mexican Americans, in comparison with 2,196 older nondiabetic Mexican Americans. RESULTS: Overall, 31.1% of the older diabetic individuals reported high levels of depressive symptoms. The risks of comorbid myocardial infarction, hypertension, arthritis, and angina were significantly higher in the presence of concomitant depressive symptoms, as were the risks of diabetic complications, functional disability, incontinence, vision impairment, poorer perceived health status, and health service use among both diabetic and nondiabetic individuals. Rates were substantially higher among depressed diabetic individuals, however, in comparison to depressed nondiabetic individuals. Importantly, this increased health burden was evident even when controlling for sociodemographic risk factors, including sex, age, level of education, marital status, immigrant status, and living arrangements. CONCLUSIONS: The presence of concomitant depressive symptoms among older diabetic Mexican Americans is associated with a substantially greater health burden than is seen among diabetic individuals without depression or depressed individuals without diabetes. This association of depression with higher rates of chronic conditions, poorer functioning, and increased health service use is particularly significant in that this study was conducted among community-dwelling adults and was not confounded by the potential association of health care-seeking behavior that might occur in a medically ill sample.     

Content and mode of information processing in major depressive disorder

Although some research has assessed both the content and mode of information processing in subclinical depressive states, studies have yet to address these issues in clinical depression. In particular, research has not examined whether there is evidence of content specificity in the processing of state and trait depressive information, and whether this information is differentially processed in automatic versus effortful processing modes. In this study, depressed inpatients were compared with normals controls on a processing task that allowed for the assessment of both state and trait information processing in automatic or effortful modes. Results indicated better recall overall for control subjects, but when recall within subject conditions was taken into account, depressed patients showed diffuse recall across both state and trait depressive information. The schemas apparent in clinical depression therefore do not appear to be specific to trait depressive information and may function to facilitate the acquisition of any depression-relevant information.This research was supported by grant MH44715 from the National Institute of Mental Health.     

Geriatric depression, medical diagnosis, and functional recovery during acute rehabilitation

OBJECTIVE: To examine and compare the prevalence and functional impact of depressive symptoms for older adult stroke and nonstroke rehabilitation inpatients. DESIGN: Case-control study examining functional outcome using a 2 (stroke, nonstroke) by 2 (depression, no depression) design. SETTING: Urban hospital rehabilitation unit. PARTICIPANTS: A total of 509 rehabilitation inpatients (age, > or = 60 y) were included and grouped by diagnosis of stroke (n=207) and nonstroke (n=302). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Geriatric Depression Scale and FIM instrument. Analysis of covariance procedures examined the impact of depressive symptoms on discharge functional ability controlling for age, sex, admission functional ability, and hospital length of stay. RESULTS: Prevalence of depressive symptoms was similar for stroke (31.8%) and nonstroke (31.5%) and negatively associated with functional ability at discharge for both groups. Overall, the stroke and nonstroke groups did not differ significantly with respect to functional recovery. CONCLUSIONS: Depression, and its impact on acute rehabilitation, is significantly related to functional recovery but does not differ in its frequency or impact for stroke patients. Because depressive symptoms do not appear to discriminate across diagnostic groups, routine screening for depression is recommended for all rehabilitation inpatients.     

Depressed men: an exploratory study of close relationships

Patients suffering from schizophrenia or bipolar affective disorder may progressively worsen and become severely disabled, and may then be classified as suffering from severe and enduring mental illness. Concern about risk to self and others focuses on this patient group, and community psychiatric nurses (CPNs) are under pressure to target patients with this diagnosis. CPNs have been accused of neglecting patients with a severe and enduring diagnosis in favour of other patient groups, but if they restrict services at primary care level this may have serious implications for patients. Patients who have had no previous contact with mental health services may have potentially serious and life threatening conditions. For example, depressed men may not be categorized as severely mentally ill, but the suicide rate amongst this patient group is very high, and they may externalize depression and resort to violence if untreated. Depressed men may lack social support and the means to express psychological distress, and these factors may precipitate or exacerbate depression. Early referral and assessment can prevent crises, deterioration in mental health and suicide. CPNs do not necessarily have to provide ongoing care following assessment, but they do have a significant role to play in primary health care referrals for the non-psychotic mentally ill. CPNs act as a filter for the expertise and resources of multidisciplinary mental health teams. General practitioners will have increasing difficulty accessing the resources of multidisciplinary mental health teams if CPNs are unable to accept primary health care referrals. Primary care interventions are very important for the assessment of depression because they may help men to express psychological distress and assist them to access appropriate services and treatment. The experience of working with depressed men in a primary health care setting revealed that many lack confidants, or do not confide in those close to them. The interview schedule designed by Brown & Harris (1978) to gather data on the relationships of depressed women was used to explore the relationships of depressed men who were attending a Mental Health Day Centre.