Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: Rationale,design, methodology,prevalence and attributes

Background

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.

Objectives

To determine the prevalence and attributes of frailty in institutionalized Spanish older adults.

Design

Cross-sectional analysis of basal data of a concurrent cohort study.

Setting

Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.

Participants

331 institutionalized adults older than 65 years.

Measurements

Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ² tests, t-Student and logistic regression.

Results

Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p < 0.001), and frail participants were older (85.1 vs. 82.3; p < 0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2–6.2), Barthel index (OR 2.2 95%CI 1.2–4.4), depression risk (OR 2.2 95%CI 1.0–4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6–0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8–4.5) and emergency visits (OR 1.5 95%CI 0.7–3.2) in the previous 6 months.

Conclusion

In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.     

Probing for depression and finding diabetes: a mixed-methods analysis of depression interviews with adults treated for type 2 diabetes

Background

Depression has increased prevalence and consistently predicts poor health outcomes among patients with diabetes. The impact of stressors related to diabetes and its treatment on depression assessment is infrequently considered.

Methods

We used mixed methods to evaluate depressive symptoms in adults with type 2 diabetes. We categorized responses related to diabetes and its treatment during interviews (n=70) using the Montgomery–Åsberg Depression Rating Scale (MADRS) and administered questionnaires to measure diabetes-related distress and depressive symptoms.

Results

Participants (M age=56, SD=7; 67% female; 64% Black; 21% Latino) had mild depression on average (MADRS M=10, SD=9). Half of those with symptoms spontaneously mentioned diabetes context; 61% said diabetes contributed to their symptoms when questioned directly. Qualitative themes included: overlapping symptoms of diabetes and depression; burden of diabetes treatment; emotional impact of diabetes; and the bidirectional influence of depression and diabetes. Diabetes was mentioned more often at higher levels of depression severity (r=.38, p=.001). Higher HbA1c was associated with mentioning diabetes as a context for depressive symptoms (r=.32, p=.007). Insulin-users mentioned diabetes more often than those on oral medications only (p=.005).

Limitations

MADRS is not a traditional qualitative interview so themes may not provide an exhaustive view of the role of diabetes context in depression assessment.

Conclusions and clinical implications

The burden of type 2 diabetes and its treatment often provide an explanatory context for depressive symptoms assessed by structured clinical interviews, the gold standard of depression assessment. Diabetes context may influence accuracy of assessment and should inform intervention planning for those needing treatment.     

Course sequences in bipolar disorder: Depressions preceding or following manias or hypomanias

Background

Inferior response to lithium treatment has been reported in bipolar disorder (BD) patients with mania or hypomania following episodes of major depression (DMI) versus preceding depression (MDI), with intervening euthymic periods. However, additional characteristics of BD course-patterns require further assessment.

Methods

We reviewed computerized clinical records and life-charts of 855 DSM-IV-TR BD-I or -II patients assessed and followed at mood-disorder centers in Cagliari or Rome to characterize their predominant course-sequences.

Results

Morbidity over an average of 9.5 cycles in 18 years was characterized for sequencing of illness-episodes and euthymic intervals. Prevalent sequences included: major depression–hypomania (15.0%), mania–major depression (14.6%), major depression–mania (11.6%), and rapid-cycling (9.6%). Among subjects grouped by course-sequences (based on mania, mixed-states, or hypomania and major or minor depression), depression-before-[hypo]mania (DMI) cases were more likely to be women, diagnosed BD-II, have first-episodes of depressive or anxiety disorder, spend more time ill in depression, and benefit less with long-term mood-stabilizing treatments than with the opposite pattern (MDI). MDI patients were more likely to have substance-abuse and receive long-term mood-stabilizer treatments. Meta-analysis of 5 previous reports plus present findings found inferior treatment-response in DMI vs. MDI cases at a pooled risk-difference of 29% [CI: 18–40%] (p<0.0001).

Limitations

Some data were retrospective and subject to recall bias, and treatment was clinical (non-randomized).

Conclusions

The DMI course was strongly associated with first-episode depression or anxiety, excess depressive morbidity, and inferior treatment response, especially for depression.     

DSM-5 mixed specifier for manic episodes: Evaluating the effect of depressive features on severity and treatment outcome using asenapine clinical trial data

Background

To describe the frequency of mixed specifier as proposed in DSM-5 in bipolar I patients with manic episodes, and to evaluate the effect of mixed specifier on symptom severity and treatment outcome.

Methods

This post-hoc analysis used proxies for DSM-5 mixed features specifier by using MADRS or PANSS items.

Results

Of the 960 patients analysed, 34%, 18% and 4.3% of patients, respectively, had ≥3 depressive features with mild (score ≥1 for MADRS items and ≥2 for PANSS item), moderate (score ≥2 MADRS, ≥3 PANSS) and severe (score ≥3 MADRS, ≥4 PANSS) symptoms. In patients with ≥3 depressive features and independent of treatment: MADRS remission (score ≤12) rate decreased with increasing severity (61–43%) and YMRS remission (score ≤12) was similar for mild and moderate patients (36–37%), but higher for severe (54%). In asenapine-treated patients, the MADRS remission rate was stable regardless of baseline depressive symptom severity (range 64–67%), whereas remission decreased with increasing severity with olanzapine (63–38%) and placebo (49–25%). Reduction in YMRS was significantly greater for asenapine compared with placebo at day 2 across the 3 severity cut-offs and continued to decrease throughout the treatment period. The difference between olanzapine and placebo was statistically significant in mild and moderate patients.

Limitations

Results are from post-hoc analyses.

Conclusions

These analyses support the validity of proposed DSM-5 criteria. They confirm that depressive features are frequent in bipolar patients with manic episodes. With increasing baseline severity of depressive features, treatment outcome was poorer with olanzapine and placebo, but remained stable with asenapine.     

A prospective study of the bi-directional association between vision loss and depression in the elderly

Background

Increasing visual impairment (VI) with age has been associated with mental health problems but the question of temporal direction and reverse causality has not been addressed previously. Our objective was to prospectively examine the bi-directional association of VI and visual function (VF) loss with depressive symptoms in the elderly.

Methods

The cohort comprised 4216 participants (40.2% men) aged 65 and over with 10 years of follow-up. Near VI was defined using measured usual-corrected binocular acuity while distance VF was self-declared. Participants having a major depressive episode or a Center for Epidemiologic Studies Depression Scale score ≥16 were classified as having depressive symptomatology. Longitudinal analyses used mixed logistic models for repeated evaluations.

Results

After adjustment for demographic factors, participants with moderate to severe near VI at baseline had increased odds of developing depressive symptomatology (Odds Ratio [OR]=1.60; 95% Confidence Interval [CI]=1.08–2.38), but after multiple adjustments the association fell below the significance level. A 2-year decrease in distance VF was associated with increased odds of depressive symptomatology during follow-up after multiple adjustments (OR=3.03; 95% CI=1.75–5.23). Baseline depressive symptomatology was not associated with incident near VI but was associated with VF loss after multivariate adjustment (OR=1.62; 95% CI=1.15–2.28).

Limitations

The causes of VI have not been recorded.

Conclusions

The relation of vision loss to onset of depressive symptomatology differs according to near VI or distance VF and declines across time. A reverse strong association was found between baseline depression and incident loss of distance VF suggesting a downward spiral of events.     

Transcranial direct current stimulation (tDCS) for depression: Analysis of response using a three-factor structure of the Montgomery–Åsberg depression rating scale

Background

There is growing evidence that transcranial direct current stimulation (tDCS) may be an effective treatment for depression. However, no study to date has profiled the antidepressant effects of tDCS using items or factors on depression symptom severity rating scales. This could potentially provide information about the mechanisms by which tDCS achieves its antidepressant effects and also identify clinical predictors of response.

Methods

The present study analysed scores on the Montgomery–Åsberg depression rating scale (MADRS) from a randomised, sham-controlled trial of tDCS (Loo et al., 2012. British Journal of Psychiatry. 200, 52–59) using a three-factor model of MADRS items (Suzuki et al., 2005. Depression and Anxiety. 21, 95–97) encompassing dysphoria, retardation and vegetative symptoms.

Results

Participants in the active tDCS treatment group showed significant improvement in dysphoria while participants in the sham treatment group did not. While both groups showed improvement in retardation symptoms, improvement was significantly greater in the active tDCS group. Both groups also showed improvement in vegetative symptoms but there were no between-group differences.

Limitations

Further studies with larger sample sizes are warranted to investigate the generalisability of results and whether the MADRS factor structure may change as a result of the specific treatment used.

Conclusions

tDCS appears to be particularly effective in treating dysphoria and retardation, but not vegetative symptoms of depression. This may have implications for selection of types of depression most likely to respond to this treatment.     

Empathy in adults with clinical or subclinical depressive symptoms

Background

Depression is associated with problems in social functioning. Impaired empathic abilities might underlie this association. Empathy is a multidimensional construct and involves both affective and cognitive processes. We reviewed the literature to find out to what extent depression may be associated with abnormal levels of affective and cognitive empathy. We also explored potential gender differences in these associations.

Methods

We used PsycInfo and Medline to conduct a systematic review of all studies on empathy and depression conducted in individuals with a primary diagnosis of major depressive disorder (MDD; patient samples) or in individuals with primarily subclinical depressive symptoms (analog samples).

Results

Thirty-seven studies met the inclusion criteria. The results indicated that depression was related to one type of affective empathy. Specifically, depression was related to high levels of empathic stress but not to abnormal empathic concern. Further, depression was related to limited cognitive empathy, as indicated by poor perspective taking, theory of mind, and empathic accuracy.

Limitations

Few studies have considered the variable gender in their design and analyses. Between and within study variation in demographic and clinical variables limits the interpretation of results. Self-report measures of empathy are subjective and vulnerable to bias. Poor performance on the more objective laboratory tasks might partially be explained by the broader cognitive deficits commonly observed in depression. Lastly, because all studies used a cross-sectional design, causality is difficult to establish.

Conclusions

Empathic abilities may be impaired in depression. The relation between empathy, depression, and gender is unclear. Future studies could use implicit and more ecologically valid measures of empathy. Insight into impaired empathy in depression may not only help explain poor social functioning in MDD but also benefit clinician–patient interactions.     

Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa

Background

Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions.

Objectives

Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people.

Methods

In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE).

Results

Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0–36.2%) than HIV-infected (14.8%, 95% CI 9.9–19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7–30.6%) than in HIV-affected (15.1%, 95% CI 10.3–19.8%) participants. Being female (aOR 3.04, 95% CI 1.73–5.36), receiving a government grant (aOR 0.34, 95% CI 0.15–0.75), urban residency (aOR 1.86, 95% CI 1.16–2.96) and adult care-giving (aOR 2.37, 95% CI 1.37–4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2–3 times more likely to report poor health perceptions.

Limitations

Study limitations include the cross-sectional design, limited sample size and possible selection biases.

Conclusions

Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.     

Neural mechanisms of cognitive reappraisal in remitted major depressive disorder

Background

Down-regulation of negative emotions by cognitive strategies relies on prefrontal cortical modulation of limbic brain regions, and impaired frontolimbic functioning during cognitive reappraisal has been observed in affective disorders. However, no study to date has examined cognitive reappraisal in unmedicated euthymic individuals with a history of major depressive disorder relative to symptom-matched controls. Given that a history of depression is a critical risk factor for future depressive episodes, investigating the neural mechanisms of emotion regulation in remitted major depressive disorder (rMDD) may yield novel insights into depression risk.

Method

We assessed 37 individuals (18 rMDD, 19 controls) with functional magnetic resonance imaging (fMRI) during a task requiring cognitive reappraisal of sad images.

Results

Both groups demonstrated decreased self-reported negative affect after cognitive reappraisal and no group differences in the effects of cognitive reappraisal on mood were evident. Functional MRI results indicated greater paracingulate gyrus (rostral anterior cingulate cortex, Brodmann area 32) activation and decreased right midfrontal gyrus (Brodmann area 6) activation during the reappraisal of sad images.

Limitations

Trial-by-trial ratings of pre-regulation affect were not collected, limiting the interpretation of post-regulation negative affect scores.

Conclusions

Results suggest that activation of rostral anterior cingulate cortex, a region linked to the prediction of antidepressant treatment response, and of the right midfrontal gyrus, a region involved in cognitive control in the context of cognitive reappraisal, may represent endophenotypic markers of future depression risk. Future prospective studies will be needed to validate the predictive utility of these neural markers.     

Elevated homocysteine is associated with poorer self-perceived physical health in older men: The Health in Men Study

Objectives

To determine the relationship between high total homocysteine (tHcy) and self-perceived physical health, by investigating the associations between tHcy, the methylenetetrahydrofolate reductase (MTHFR) 677T polymorphism and physical health-related quality of life (HRQOL).

Study design

We conducted a cross-sectional study using a cohort of 4248 community-dwelling men aged 70–88 years.

Main outcome measures

In addition to clinical determinants of physical health, tHcy was measured by immunoassay, the MTHFR 677T polymorphism was detected by a polymerase chain reaction (PCR)-based method, and physical HRQOL were assessed with the SF-36 Health Survey.

Results

In multiple regression analyses, the odds of being in the lowest quartile of the physical component summary (PCS) scores (i.e. <35) was 1.47 (95% CI 1.21–1.78) for men with high tHcy (≥15 μmol/l), after adjusting for age, smoking, history of hazardous alcohol use, polypharmacy, prevalent falls and weighted Charlson co-morbidity index. When history of hypertension, heart disease, stroke, arthritis and osteoporosis were included in place of the Charlson's index, the result was unchanged (OR 1.45, 95% CI 1.20–1.75). Men with the MTHFR TT homozygosity had significantly higher tHcy concentration than those with the CC genotype (mean difference of 1.38 μmol/l, 95% CI 0.77–1.99). However, there was no apparent association between the MTHFR polymorphism and PCS.

Conclusion

Elevated tHcy is associated with poorer self-perceived physical health in community-dwelling older men. The results of this study support further longitudinal investigations to assess this relationship prospectively.     

Breast cancer screening programmes: Challenging the coexistence with opportunistic mammography

Objective

This study investigated predictive factors of women's participation in organized mammography screening (OrgMS) and/or opportunistic mammography screening (OppMS) when the two screening modes coexist.

Methods

Questionnaires were sent to 6,000 women aged 51–74 years old invited to attend an OrgMS session between 2010 and 2011 in France. Data collected concerned the women's healthcare behaviour and their socioeconomic characteristics. Women without a personal or family history of breast cancer that could explain their participation in OppMS were retained in the generalized logits analysis.

Results

The data of 1,202 women were analysed. Of these, 555 (46.2%) had attended OrgMS only, 105 (8.7%) OppMS only and 542 (45.1%) had performed both OrgMS and OppMS. Multivariable analyses showed that women who had regular gynaecological check-ups were more likely to perform OppMS only or both OrgMS and OppMS, OR 95% CI were 2.1 [1.1–3.9], 1.9 [1.4–2.6], respectively. Being employed also increased participation in OppMS only [OR: 2.1 (1.2–3.7)] or both OrgMS and OppMS [OR: 1.5 (1.1–2.05)].

Conclusion and practice implications

In countries where OrgMS and OppMS coexist, strategies involving gynaecologists, referring doctors or company doctors and the organization of healthcare services to promote adequate screening round may help to reduce the overuse of mammography.     

An exploratory randomized controlled trial of body psychotherapy for patients with chronic depression

Background

Chronic major depressive disorder and dysthymia are associated with a high burden and substantial care costs. New and more effective treatments are required. This is the first randomized controlled trial designed to evaluate the effectiveness of Body Psychotherapy (BPT) in patients with chronic depression.

Methods

Patients with chronic depressive syndromes (more than 2 years symptomatic) and a total score of ≥20 on the Hamilton Rating Scale for Depression (HAMD) were randomly allocated to either immediate BPT or a waiting group which received BPT 12 weeks later. BPT was manualized, delivered in small groups in 20 sessions over a 10 weeks period, and provided in addition to treatment as usual. In an intention to treat analysis, primary outcome were depressive symptoms at the end of treatment adjusted for baseline symptom levels. Secondary outcomes were self-esteem and subjective quality of life.

Results

Thirty-one patients were included and twenty-one received the intervention. At the end of treatment patients in the immediate BPT group had significantly lower depressive symptom scores than the waiting group (mean difference 8.7, 95% confidence interval 1.0–16.7). Secondary outcomes did not show statistically significant differences. When the scores of the waiting group before and after BPT (as offered after the waiting period) were also considered in the analysis, the differences with the initial waiting group remained significant.

Conclusions

The results suggest that BPT may be an effective treatment option for patients with chronic depression. Difficulty recruiting and subsequent attrition was one of the limitations, but the findings merit further trials with larger samples and process studies to identify the precise therapeutic mechanisms.     

Associations between depression severity and purinergic receptor P2RX7 gene polymorphisms

Background

Major depressive disorder (MDD) and bipolar disorder (BPD) have significant genetic predisposition. The P2RX7 gene (coding for P2X7 purinergic receptor) has been suggested as a susceptibility gene for both MDD and BPD. In the current study the genetic effects of rs2230912 (Gln460Arg) and rs1653625 (located in the 3′ untranslated region of the P2RX7 gene) were explored in mood disorders.

Methods

Genotype frequencies were established in 315 patients (195 with MDD and 120 with BPD diagnosis) and in 373 controls. Depression severity was assessed by the clinician-rated Montgomery–Åsberg Depression Rating Scale (MADRS) and by the self-report Hospital Anxiety and Depression Scale (HADS).

Results

In the case-control analysis we did not find any significant differences between genotype frequencies of either BPD or MDD cases and controls. However, BPD patients carrying at least one rs2230912 G-allele scored higher on both MADRS and HADS-depression scale (nominal p-value was 0.028 and 0.003, respectively). The rs1653625 AA genotype was also associated with higher depression scores in the BPD group (nominal p-value of MADRS: 0.019, HADS-depression: 0.017). After correction for multiple testing, the association between rs2230912 and HADS-depression score remained significant in the BPD group (p<0.006); this genetic effect explained 9% of the variance (partial η²=0.09). In the MDD group we did not find any significant genetic effect.

Limitations

The relatively small number of BPD patients warrants for a replication study.

Conclusions

Our genetic association study supports the association between P2RX7 gene and severity of depressive symptoms in BPD patients.     

A randomized trial of pictorial versus prose-based medication information pamphlets

Objective

The goal of this study was to compare prose and pictorial-based information pamphlets about the medication methotrexate in the domains of free recall, cued recall, comprehension and utility.

Methods

A single blind, randomized trial of picture versus prose-based information pamphlets including 100 participants aged 18–65 years of age, who had not completed high school, could read English, and had no prior knowledge about methotrexate. Superiority of pamphlet type was assessed using immediate free recall, cued recall and comprehension.

Results

There were no differences between picture and prose pamphlets in free recall, cued recall, and comprehension either immediately or after a 1-week interval. Immediate free recall of important information was 17–26%; free recall fell even lower to 7–16% after 1 week. The pictorial pamphlet was preferred over the prose-based pamphlet.

Conclusion

This study found no benefit in free recall, cued recall, or comprehension through the addition of pictograms to a simple prose-based medication pamphlet.

Practice implications

In order for them to be effective in clinical practice, even simple medication information pamphlets that have been assessed for patients’ ability to comprehend them cannot be used as the sole means for conveying important medication-related information to patients.     

The association between the disruption of motor imagery and the number of depressive episodes of major depression

Background

Mental rotation performance may be used as an index of mental slowing or bradyphrenia, and may reflect, in particular, speed of motor preparation. Previous studies suggest depressive patients present the correlates of impaired behavioural performance for mental rotation and psychomotor disturbance. The aim of this study is to compare the mental rotation abilities of patients with a first episode of depression, recurrent depression and healthy control subjects with regard to hand tasks.

Methods

We tested 32 first episode of depression, 38 recurrent depression and 36 healthy control subjects by evaluating the performance of depressed patients with regard to the hand mental rotation tasks.

Results

First, the first episode and recurrent depression subjects were significantly slower and made more errors than controls in mentally rotating hands. Second, the first depressive episode but not the recurrent depression displayed the same pattern of response times to stimuli at various orientations relative to control subjects in the hand task. Third, in particular, recurrent depression subjects were significantly slower and made more errors during the mental transformation of hands than first depressive episode relative to control subjects and the differences were significantly larger in female than male subjects in the mental rotation hand task.

Limitations

Patients were on antidepressant medication.

Conclusions

These results suggest that the impaired behavioural performance for mental representation processing are related to the number of previous episodes. Moreover, the recurrent major depressive episodes may contribute to the reinforcement of cognitive impairments and further the development or maintenance of mental representation dysfunctions, especially in female patients. A deficit on mental rotation in the depressive patients may be potential biomarkers for recurrence chronically.     

Exposure to light at night and risk of depression in the elderly

Background

Recent advances in understanding the fundamental links between chronobiology and depressive disorders have enabled exploring novel risk factors for depression in the field of biological rhythms. Increased exposure to light at night (LAN) is common in modern life, and LAN exposure is associated with circadian misalignment. However, whether LAN exposure in home settings is associated with depression remains unclear.

Methods

We measured the intensities of nighttime bedroom light and ambulatory daytime light along with overnight urinary melatonin excretion (UME) in 516 elderly individuals (mean age, 72.8). Depressive symptoms were assessed using the Geriatric Depression Scale.

Results

The median nighttime light intensity was 0.8 lx (interquartile range, 0.2–3.3). The depressed group (n=101) revealed significantly higher prevalence of LAN exposure (average intensity, ≥5 lx) compared with that of the nondepressed group (n=415) using a multivariate logistic regression model adjusted for daytime light exposure, insomnia, hypertension, sleep duration, and physical activity [adjusted odds ratio (OR): 1.89; 95% confidence interval (CI), 1.10–3.25; P=0.02]. Consistently, another parameter of LAN exposure (duration of intensity ≥10 lx, ≥30 min) was significantly more prevalent in the depressed than in the nondepressed group (adjusted OR: 1.71; 95% CI, 1.01–2.89; P=0.046). In contrast, UME was not significantly associated with depressive symptoms.

Limitation

Cross-sectional analysis.

Conclusion

These results suggested that LAN exposure in home settings is significantly associated with depressive symptoms in the general elderly population. The risk of depression may be reduced by keeping nighttime bedroom dark.     

Perception or reality of body weight: Which matters to the depressive symptoms

Background

Failure to control for the confounding effects from body perceptions may contribute to the inconsistency of literature on the relationship between body weight and depression. The aim was to determine if perception mediates the associations between measured weight and depression.

Methods

We analyzed the data of 13,548 adults age 18 or older, collected in the National Health and Nutrition Examination Survey, 2005–2008. Depression status was ascertained using the Patient Health Questionnaire; and the BMI was calculated from measured height and weight.

Results

Among women, adjusting for perception weakened the relationship between measured weight and depression. The odds ratios (OR) of depression for being obese and overweight were 2.26 [95% confidence interval (1.50–3.40)] and 1.92 (1.29–2.85) before being adjusted for perception and 1.72 (1.01–2.92) and 1.62 (1.01–2.60) when perception was adjusted for. Independent from measured weight, women who perceived themselves as underweight [OR=2.95(1.47–5.14)] or overweight [1.73 (1.14–2.61)] had an increased odds of depression compared with women who perceived themselves as about the right weight. Among men, measured weight, neither overweight nor underweight, was associated with depression, perceiving oneself as underweight [OR=2.80 (1.42–5.54)] was associated with depression.

Limitation

The inherent limitation of the study's cross-sectional design prevented the authors from investigating causality.

Conclusion

Perception may be more important than measured weight in the relationship with depression. Independent from measured weight either perceived under or overweight among women, or underweight among men, appear to be significantly associated with depression.     

Cognitive coping and goal adjustment in people with Peripheral Arterial Disease: Relationships with depressive symptoms

Objective

The aim was to study relationships between cognitive coping strategies, goal adjustment processes (goal disengagement and re-engagement) and symptoms of depression in people with Peripheral Arterial Disease (PAD).

Methods

The sample consisted of 88 patients with PAD. Strategies of cognitive coping, goal disengagement, goal re-engagement, and depression were measured by written questionnaires. The main statistical methods were Pearson correlations and Multiple Regression Analyses.

Results

The results showed that a ruminative and catastrophizing way of coping in response to the disabilities was related to more depressive symptoms in this group. In contrast, coping by seeking and re-engaging in alternative, meaningful goals was related to less depressive symptoms.

Conclusion

These findings suggest that improvements in cognitive and goal-related coping strategies might reduce the level or risk of depressive symptomatology. This confirms the need for specific intervention programs that bring about effective changes in the coping strategies of people suffering from PAD.

Practice implications

As both cognitive and goal-related coping are generally assumed to be mechanisms that are subject to potential influence and change, the results of this study provide important targets for such an intervention.     

Quality of life and physical activity associated to lower prevalence of depression in community-dwelling elderly subjects from Sao Paulo

Background

Studies investigating major depression and associated factors in older people from developing countries are scarce.

Methods

Cross-sectional study of a community-based sample of 1563 elderly subjects aged 60 years or older from Sao Paulo, Brazil. The frequency of major depression (MD) and the relationship with sociodemographic factors, cognitive and functional impairment (CFI), clinically significant depressive symptoms (CSDS) and clinical diseases were analyzed. A brief instrument for screening of depressive symptoms in elderly people, the Mini Mental State Examination, the Fuld Object Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, the Bayer Activities of Daily Living Scale, the Cambridge Mental Disorders of the Elderly Examination, and a sociodemographic and clinical questionnaire were applied to the subjects.

Results

Major depression was diagnosed in 60 patients (3.8%). A higher odds ratio of MD was associated with female gender, being widowed, previous depressive episode, hypertension, use of psychotropic medication, (CFI), and alcohol use. A lower odds ratio of depression diagnosis was associated with physical activity and going to cinema.

Limitations

The cross-sectional design of the study; our sample was restricted only to community residents, excluding persons in hospitals or nursing homes.

Conclusion

Our study shows significant association between depression and potentially modifiable factors, reinforcing the benefit of probable preventive measures, to incentive healthy lifestyle, leisure activities and the practice of physical exercise, as well as the diagnosis and treatment of CSDS, especially in primary care.     

Depressive symptoms and menopausal burden in the midlife

Objective

The goal of this study was to assess whether menopausal symptoms were more common and/or more severe among women with depressive symptoms.

Methods

A cross-sectional survey of 1358 women, ages 45–70, at two large integrated health plans (Seattle; Boston) was performed. Information on demographics, medical and reproductive history, medication use, menopausal experience and depressive symptoms (PHQ-8) were collected. Women taking HT were excluded. Logistic regression models adjusted for age and body mass index tested the associations between menopausal symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) and presence of moderate/severe depressive symptoms.

Results

770 women were included; 98 (12.7%) had moderate/severe depressive symptoms and 672 (87.3%) had no/mild depressive symptoms. Women with moderate/severe depressive symptoms were almost twice as likely to report recent vasomotor symptoms (hot flashes and or night sweats) vs. women with no/mild depressive symptoms (adjusted odds ratio (aOR) 1.67, 95%CI 1.04–2.68), and to report them as severe (aOR 1.63, 95%CI 0.95–2.83). A higher symptom burden was observed despite the fact that 20% of women with moderate/severe depressive symptoms (vs. 4.6% no/mild depressive symptoms) were using an SSRI or SNRI, medications known to improve vasomotor symptoms. The percentage of women with menopausal symptoms, and the percentage with severe vasomotor symptoms were linearly associated with the depressive symptom score.

Conclusions

Depressive symptoms “amplified” the menopausal experience, or alternatively, severe vasomotor symptoms worsened depressive symptoms.