Healthy but unhappy? Cross-national comparative analysis of depressive symptoms in Japanese vs. Korean elders

BackgroundJapan and South Korea, two neighbouring countries in East Asia, enjoy the highest life expectancies in the world, yet suffer paradoxically from high suicide rates.AimWe sought to conduct a cross-national comparative analysis of depressive symptoms among older adults in Japan vs. Korea, focusing particularly on poverty and physical health status.MethodsWe used nationally representative samples aged 65 and over from the Comprehensive Survey of Living Conditions in Japan and the Korean Community Health Survey in South Korea. Multivariate logistic regression models were conducted to examine if equivalized household income, poor self-rated health, disability and comorbidity (number of diseases) were associated with depressive symptoms, adjusting for age, education, marital status, alcohol use, smoking and living alone.ResultsOlder Japanese adults with poor self-rated health and disability were more likely to report depressive symptoms, but income level was not significantly associated with mental distress. By contrast, among older Korean people, depressive symptoms were strongly patterned by household income level, as well as poor self-rated health, disability, and comorbidity.ConclusionPoor physical health status was correlated with depressive symptoms among both Japanese and Korean seniors. However, income level was associated with depressive symptoms among only Korean elders, but not Japanese. Thus, the current generation of older Japanese adults appears to enjoy (relative) financial security, longevity, and mental wellbeing. By contrast, older Koreans experience high levels of mental distress, especially if they are financially insecure.     

Retirement transitions, gender, and psychological well-being: a life-course, ecological model

This longitudinal study investigated the relationship between retirement transitions and subsequent psychological well-being using data on 458 married men and women (aged 50-72 years) who were either still in their primary career jobs, retired, or had just made the transition to retirement over the preceding 2 years. The findings show that the relationship between retirement and psychological well-being must be viewed in a temporal, life course context. Specifically, making the transition to retirement within the last 2 years is associated with higher levels of morale for men, whereas being "continuously" retired is related to greater depressive symptoms among men. The results suggest the importance of examining various resources and contexts surrounding retirement transitions (gender, prior level of psychological well-being, spouses' circumstance, and changes in personal control, marital quality, subjective health, and income adequacy) to understand the dynamics of the retirement transition and its relationship with psychological well-being.     

Factors Associated With Depressive Symptoms Among Elders in Senior Residences: The Importance of Feeling Valued by Others

This study investigated (a) whether feeling valued and important is a significant predictor of depressive symptoms in elders residing in senior residences and (b) whether feeling valued and important is a more important predictor of depressive symptoms than self-rated health in this population. The sample consisted of older adults (N?=?47) from four senior residences in New York City. The Geriatric Depression Scale was used to assess depressive symptoms and a multiple regression analysis was employed for the analysis. Self-rated health, education level, and feeling valued and important were significant predictors of depressive symptoms. Further, the unique contribution of feeling valued and important accounted for an equal amount of the variance in depressive symptoms as compared to the well established predictor of self-rated health. Therefore, given the importance of feeling valued and important, interventions that provide the opportunity for elders in senior residences to provide meaningful contributions to family and society should be considered.     

Association between multiple geriatric syndromes and life satisfaction in community-dwelling older adults: A nationwide study in Taiwan

ObjectiveAlthough previous studies have investigated the association between a single geriatric syndrome and life satisfaction in the older adults, the accumulated effects of multiple geriatric syndromes on life satisfaction remain unclear.MethodsWe conducted a nationwide study by using data from the Taiwan Longitudinal Study on Aging database. A total of 2415 older adults were enrolled. Life satisfaction was evaluated according to the Life Satisfaction Index, and the geriatric syndromes included a depressive disorder, cognitive impairment, functional impairment, urine incontinence, pain, a fall, and polypharmacy. Other characteristics were age, sex, marital status, education level, self-rated health, and chronic diseases.ResultsUnivariate analysis revealed that the older adults, who were illiterate, did not live with a partner, yet other issues such as stroke, malignancy, osteoarthritis, poor self-rated health, a depressive disorder, functional impairment, urine incontinence, or pain were associated with lower life satisfaction. In the multivariate regression model, the older adults who were male, illiterate, lived without a partner, had poor self-rated health, or had a depressive disorder were more likely to have lower life satisfaction. In addition, life satisfaction was unaffected in the older adults with only 1 geriatric syndrome, but among those with ≥2 geriatric syndromes, an increased number of geriatric syndromes were associated with lower life satisfaction.ConclusionIn addition to socio-demographic factors, cumulative effects of multiple geriatric syndromes might affect life satisfaction in the older adults. Further study of interventions for reducing geriatric syndromes to maintain life satisfaction is required.     

Associations Between Prognostic Awareness,Acceptance of Illness,and Psychological and Spiritual Well-being Among Patients With Heart Failure

BackgroundThis study aimed to (1) investigate the association of prognostic awareness with psychological (distress level and emotional well-being) and spiritual well-being among patients with heart failure, and (2) assess the main and moderating effects of illness acceptance on the relationship between prognostic awareness and psychological and spiritual well-being.Methods and ResultsThis study used baseline data of a Singapore cohort of patients with heart failure (N = 245) who had New York Heart Association class 3 or 4 symptoms. Patients reported their awareness of prognosis and extent of illness acceptance. Multivariable linear regressions were used to investigate the associations. Prognostic awareness was not significantly associated with psychological and spiritual well-being. Illness acceptance was associated with lower levels of distress (β [SE] = –0.9 [0.2], P < .001), higher emotional well-being (β [SE] = 2.2 [0.4], P < .001), and higher spiritual well-being (β [SE] = 5.4 [0.7], P < .001). Illness acceptance did not moderate the associations of prognostic awareness with psychological and spiritual well-being.ConclusionsThis study suggests that illness acceptance could be a key factor in improving patient well-being. Illness acceptance should be regularly assessed and interventions to enhance illness acceptance should be considered for those with poor acceptance.     

The role of education on the association between disability and depressive symptoms among community-dwelling older adults: Evidence from Frailty in Brazilian Older People (Fibra) study

ObjectivesTo explore whether higher socioeconomic status attenuates the effects of depressive symptoms on disability among older adults.MethodsWe conducted a cross-sectional study based on 596 older adults, aged 65 and over, from a large city (Belo Horizonte) in Brazil. Disability was defined as limitation in activities such as Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Covariates were age, comorbidities, Body Mass Index (BMI) and grip strength. Statistical analyses were based on Ordinal Logistic Regression and calculated separately for men and women.ResultsElderly women with disability and higher education levels have similar prevalence of depressive symptoms compared to those without disability (17.9% and 16.1%, respectively), but lower compared to those disabled with lower education (37.2%). A positive gradient trend was observed for depressive symptoms across disability categories among women (OR = 2.61; 95% CI 1.52, 4.48). However, these patterns were not observed among men.ConclusionA higher level of education attenuates odds of depressive symptoms in elderly women with disability but does not eliminate it. Therefore, screening for depressive symptoms in low-educated elderly women is important in order to identify them and start early prevention care for target risk population and decrease the disability expenses for health services.     

The uniqueness of subjective ageing: convergent and discriminant validity

Although a large body of research has demonstrated the predictive power of subjective ageing for several decisive developmental outcomes, there remains some controversy about whether subjective ageing truly represents a unique construct. Thus, information about the convergent and discriminant validity of different approaches to measuring subjective ageing is still critically needed. Using data from the 2014 wave of the German Ageing Survey, we examined how three established subjective ageing measures (subjective age, global attitude toward own ageing, multidimensional ageing-related cognitions) were inter-related as well as distinct from general dispositions (optimism, self-efficacy) and well-being (negative affect, depressive symptoms, self-rated health). Using correlational and multivariate regression analysis, we found that the three subjective ageing measures were significantly inter-related (r = |.09| to |.30|), and that each measure was distinct from general dispositions and well-being. The overlap with dispositional and well-being measures was lowest for subjective age and highest for global attitudes towards own ageing. The correlation between global attitudes towards own ageing and optimism was particularly striking. Despite the high convergent validity of the different dimensions of ageing cognitions, we nevertheless observed stronger associations between specific dimensions of ageing cognitions with negative affect and self-rated health. We conclude that researchers should be aware of the multidimensional nature of subjective ageing. Furthermore, subjective age appears to be a highly aggregated construct and future work is needed to clarify its correlates and reference points.Electronic supplementary materialThe online version of this article (10.1007/s10433-019-00529-7) contains supplementary material, which is available to authorized users.     

Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus

Background and aimsEmotional problems including anxiety, depression and fear of hypoglycemia (FOH) are common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the prevalence of depressive and anxiety symptoms among patients with T1DM and their relation to glycemic control, diabetes complications and to FOH.MethodsThis study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose and HbA1c. A subsample of 75 patients was screened for diabetes complications.ResultsThe prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and 20% respectively. Female sex was related to depressive symptoms but not to anxiety symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score were independently correlated with both anxiety symptoms and depressive symptoms. Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score, HFS-W score and HFS-II total score.ConclusionsFOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the factors contributing to the increased prevalence of anxiety and depressive symptoms among those individuals. Addressing and managing the different psychological aspects of diabetes should be integrated within the routine diabetes care services for people with T1DM.     

Physical health,subjective health,and psychological distress in older adults: Reciprocal relationships concurrently and over time

This study addresses the reciprocal associations between physical health (objectively assessed and self-rated) and psychological distress among older adults. Psychological distress (both depressive symptoms and anxiety level) made a significant independent contribution to the prediction of concurrent and future negative perception of one’s health, over and above objective health. As anxious and depressive components of psychological distress intensify, a negative outlook on life includes an increased negative view of one’s health among older adults. Conversely, negative subjective health independently predicted both depressive symptoms and anxiety level, concurrently and over time, over and above objective health. It thus appears that negative health appraisal heralds psychological distress, manifested as depressive symptoms and also anxiety among older adults. Taken together these findings draw the picture of a vicious circle of negative health appraisal leading to depression and anxiety, these in turn leading to further negative perception of health. His research and teaching activities are in the domain of psychogerontology, especially clinical geropsychology. His research interests include the treatment of depression, and reminiscence and autobiographical memory. Sabine Sèvre-Rousseau, Psy.D., defended her thesis in developmental psychology at the University of Paris V, Sorbonne. She was the coordinator of the mental health division of the Quebec Research Network on Aging during this study. She is also teaching psychology and statistical sciences at the Universities of Montreal and Sherbrooke. His research and teaching activities are in the domain of clinical geropsychology. In terms of research, he has a special interest for the etiology, assessment, and treatment of agitation and depression. Michel Préville, Ph.D., is associate professor at the Université de Sherbrooke, and Researcher at the Research Center on Aging, Scherbrooke Geriatric University Institute. He is director of the Mental Health Division of the Quebec Research Network on Aging.     

Do subjective cognitive complaints correlate with cognitive impairment in systemic lupus erythematosus? A Danish outpatient study

This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsychological test-battery, a 20-item self-administered Perceived Deficits Questionnaire (PDQ) and a self-rated depression scale (Major Depression Inventory). Twenty-two patients (38.5%) were classified as cognitively impaired, mostly with deficits in executive functions and attention. Among cognitively impaired patients only 18.2% had significantly higher PDQ scores than the normal range. PDQ scores were highly correlated to depressive symptoms (r = 0.67, p < 0.001). Only two neuropsychological tests were significantly correlated with subjective cognitive complaints. When these variables and self-rated depression score were entered into a regression model both depression score and Symbol Digit Modalities Test performances were significantly associated with the PDQ score. In conclusion, cognitive impairments were common in this group of (mild) SLE outpatients, but the level of significant subjective cognitive complaints was low even among patients with cognitive impairment. Affective status may influence subjective experience of cognitive functions even more than cognitive functioning itself, and absence of subjective cognitive complaints did not exclude the presence of cognitive impairments.     

Do HIV-Positive Women Receive Depression Treatment that Meets Best Practice Guidelines?

This study addressed whether psychopharmacologic and psychotherapeutic treatment of depressed HIV+ women met standards defined in the best practice literature, and tested hypothesized predictors of standard-concordant care. 1,352 HIV-positive women in the multi-center Women’s Interagency HIV Study were queried about depressive symptoms and mental health service utilization using standards published by the American Psychiatric Association and the Agency for Healthcare Research and Quality to define adequate depression treatment. We identified those who: (1) reported clinically significant depressive symptoms (CSDS) using Centers for Epidemiological Studies-Depression Scale scores of ≥16; or (2) had lifetime diagnoses of major depressive disorder (MDD) assessed by World Mental Health Composite International Diagnostic Interviews plus concurrent elevated depressive symptoms in the past 12 months. Adequate treatment prevalence was 46.2 % (n = 84) for MDD and 37.9 % (n = 211) for CSDS. Multivariable logistic regression analysis found that adequate treatment was more likely among women who saw the same primary care provider consistently, who had poorer self-rated role functioning, who paid out-of-pocket for healthcare, and who were not African American or Hispanic/Latina. This suggests that adequate depression treatment may be increased by promoting healthcare provider continuity, outreaching individuals with lower levels of reported role impairment, and addressing the specific needs and concerns of African American and Hispanic/Latina women.     

Associations of perceived poor societal treatment among the oldest-old

BackgroundPrevious studies of perceived ageism among older people have focused on younger age groups with the respondents’ mean age far below 80.ObjectiveTo explore the perceptions of poor societal treatment of older people among home-dwelling people aged 75–100+ and how their perceptions are associated with demographic characteristics, health, functioning, and wellbeing.MethodsIn the Helsinki Aging Study, a random sample of 2,917 home-dwelling people aged 75–104 received a postal questionnaire inquiring about their health, wellbeing and experiences. The response rate was 74%. We asked: ‘How in your opinion are older people treated in Finland?’ (well/moderately/poorly) and categorized the respondents according to their responses. A multivariable forward stepwise ordered logistic regression model was used to determine the independent associations of the variables on the ordinal level of perceptions of treatment.ResultsOf the participants, 1,653 responded to the index item. Of these, only 13% thought that older people are treated well in society, and 66% and 21% were of the opinion that older people are treated moderately or poorly in society, respectively. Perceived poor societal treatment was more common among women, the younger respondents, and those with lower incomes, as well as family caregivers and those with lower self-rated health and lower psychological wellbeing. Those who were able to walk outside unassisted and those with a regular hobby perceived poor societal treatment more often.ConclusionsSeveral demographic factors, self-rated health, psychological wellbeing and better functioning were associated with perceptions of poor treatment among the oldest-old.     

Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with Alzheimer’s disease

ObjectivesThis study aimed to investigate factors associated with frailty in patients with mild to moderate Alzheimer’s disease (AD).MethodsOne hundred fifty-seven outpatients aged 65 years or older with mild to moderate AD were enrolled from January 2018 to December 2018. Cognitive status, depressive mood, activities of daily livings (ADLs), body mass index, handgrip strength (HGS), usual gait speed (UGS), and serum levels of 25-hydroxyvitamin D, hemoglobin (Hb), albumin, and creatinine were assessed. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: fatigue, resistance, ambulation, illness, and unintentional weight loss.ResultsThe prevalence of frailty was 15.9%. Those classified as being frail were significantly older, had worse cognitive function, worse ADLs, slower UGS, and lower level of Hb compared to those classified as being pre-frail and those robust, respectively. The pre-frail group was significantly older, had worse ADLs, and slower UGS compared to the robust group. Both the frail and pre-frail groups had more depressive symptoms and weaker HGS than the robust group. Multiple logistic regression analysis showed that cognitive function, UGS, level of Hb, and depressive symptoms were associated with frailty, and that only depressive symptoms were associated with pre-frailty.ConclusionsDepressive symptoms were a common risk factor for pre-frailty and frailty in patients with AD. Hb levels and UGS were associated with being frail. Preventing frailty in patients with AD should be approached from both physiological and psychological aspects.     

Exploring health literacy needs in Chronic obstructive pulmonary disease (COPD): Associations between demographic,clinical variables,psychological well-being and health literacy

BackgroundThe World Health Organization (WHO) points to health literacy as an important factor in prevention and control of non-communicable diseases (NCDs), including COPD.ObjectiveTo investigate associations between selected demographic and clinical variables, psychological well-being and health literacy.MethodsHealth literacy was measured using the nine domain Health Literacy Questionnaire (HLQ) and one domain from the eHealth Literacy Questionnaire (eHLQ). Using data from a cross-sectional sample of 158 people with COPD, recruited from a hospital-based patient list period (2014-2016), multiple regression analyses were performed.ResultsThe strongest associated variables with health literacy were psychological well-being, measured by the WHO-5 well-being index and education, indicating that higher psychological well-being and educational level are associated with higher levels of health literacy.ConclusionThe present study highlights the importance of specifically looking to psychological factors in determining potentially health literacy needs among people with COPD.     

Physical activity and subjective age across adulthood in four samples

The present study examined the prospective association between physical activity and subjective age across adulthood and factors that mediate this association. Participants were adults aged from 20 to 90 years (N > 10,000) drawn from the Wisconsin Longitudinal Study graduates and siblings samples, the Health and Retirement Study and the Midlife in the United States Survey. In the four samples, physical activity was assessed at baseline and subjective age was measured 8 to 20 years later. Personality, self-rated health, disease burden, depressive symptoms, and cognition were assessed as potential mediators. In the four samples, higher physical activity at baseline was associated with a younger subjective age at follow-up. Logistic regression revealed that physical activity was related to a 30–50% higher likelihood of feeling younger 8 to 20 years later. Significant indirect effects were found through openness to experience and self-rated health in the four samples. This study provides new evidence on the link between a health-related behavior and subjective age. Physically active individuals may sustain health and an open psychological disposition that is associated with feeling younger.     

Depressive Symptoms Affect the Relationship of N-Terminal Pro B-Type Natriuretic Peptide to Cardiac Event-Free Survival in Patients With Heart Failure

BackgroundBoth N-terminal pro B-type natriuretic peptide (NT-pro BNP) and depressive symptoms independently predict cardiac events in heart failure (HF) patients. However, the relationship among NT-pro BNP, depressive symptoms, and cardiac event is unknown.Methods and ResultsBlood was drawn to measure NT-pro BNP and depressive symptoms were measured by the Patient Health Questionnaire 9 (PHQ-9) among 210 patients with HF. Data about cardiac event-free survival were collected for the average follow-up period of 397 days. Cox proportional hazards regression with survival curves were used to determine the relationship of NT-pro BNP and depressive symptoms to cardiac event-free survival. Higher NT-pro-BNP confers greater risk of cardiac events among those with depressive symptoms than those without depressive symptoms (P for the interaction = .029). Patients with NT-pro BNP >581 pg/mL and total PHQ-9 score ≥10 had a 5.5 times higher risk for cardiac events compared with patients with NT-pro BNP ≤581 pg/mL and total PHQ-9 score < 10 (P = .001).ConclusionsThe prognostic association of NT-pro BNP with cardiac event-free survival in patients with HF differed by the presence of depressive symptoms. Monitoring and treatment of depressive symptoms may be important for improving cardiac event-free survival in patients with HF.     

Health-related quality of life in older age and a risk of being a victim of domestic violence

Violence against older people remains a taboo topic in Poland, and is still an under-recognized phenomenon. The aim of this study was to examine the risk of different types of domestic violence in older people in relation to their health-related quality of life as measured by chronic conditions, functional limitations, psychological well-being, depressive symptoms and feelings of social isolation. A cross-sectional study using a standardized questionnaire in a simple random sample of 518 older citizens of Krakow was carried out. A multidimensional logistic regression of data showed that such factors as poor assessment of psychological health, number of chronic conditions, suffering from emotional and social loneliness and lack of social support in everyday life significantly increased the risk of being a victim of domestic violence in older citizens of Krakow.     

The difference between self-perceived and chronological age in the elderly may correlate with general health,personality and the practice of good health behavior: A cross-sectional study

Background and objectiveFor the elderly, maintaining a young self-perceived age has a positive impact on physical and mental health. The purpose of this study was to investigate the impact of the discrepancy between self-perceived age and chronological age in regards to physical activity, instrumental activities of daily living, functional capacity, personality, general self-efficacy, depressive symptoms, and disease burden.MethodsParticipants were 3094 older adults from 2015 baseline data of the Keeping Active across Generations Uniting the Youth and the Aged study. The questionnaire was mailed to 8004 elderly people aged 65 years or older. Of the 3871 people who returned the questionnaire (collection rate, 48.3%), 3094 subjects were analyzed in this study (female, 52%). The questionnaire included aspects of physical activity, instrumental activity of daily living, functional capacity, personality traits, general self-efficacy, depressive symptoms, history of falls, fear of falling, communication with young people, medical history, and self-perceived age, as well as basic characteristics such as age, sex, living alone or not, and educational history.ResultsRegression analysis showed that the presence of high self-rated health, personality traits of extraversion and openness to experience, higher general self-efficacy, and the presence of fear of falling were positively associated with a younger self-perceived age.ConclusionsThe results identified personality and psychological factors related to of self-perceived age in community-dwelling elderly people. Therefore, changes in personality traits and subjective health accompanying aging affect the self-perceived age, which may also affect the extension of healthy life expectancy.     

Sex-discrete role of depressive symptomatology on 10-year first and recurrent cardiovascular disease incidence: results from ATTICA and GREECS prospective studies

ObjectiveThe sex-specific effect of depressive symptomatology on 10-year first and recurrent cardiovascular disease (CVD) events was evaluated.MethodsThe Greek samples from ATTICA (2002-2012, n = 845 free-of-CVD subjects) and GREECS (2004-2014, n = 2,172 subjects with acute coronary syndrome (ACS)) prospective epidemiological studies with baseline psychological assessments were used for the first and the recurrent event, respectively. Depressive symptomatology was assessed at baseline, through Zung Self-Rating Depression Scale in the ATTICA study, and through the Center for Epidemiological Studies-Depression scale in the GREECS study.ResultsACS as well as free-of-CVD women scored significantly higher for depressive symptomatology. Men scored higher than women against first (19.7% vs. 11.7%) and subsequent CVD events (38.8% vs. 32.9%). In participants with depressive symptoms man-to-woman first and recurrent CVD event rate ratio was below 1, confirming that depressive women were more likely to have a CVD event than depressive men. Multiadjusted analysis revealed that depressive symptomatology had an independent aggravating effect on the first (hazard ratio (HR) = 2.72, 95% confidence interval (95% CI) 1.50, 9.12) and recurrent (HR = 1.31, 95% CI 1.01, 1.69) CVD events only in women. Mediation analysis in women revealed that 35% (23%, 44%) of excess first-CVD-event risk of depressive symptoms was attributed to conventional risk factors. The respective number for recurrent CVD events was 46% (23%, 53%); different patterns of ranking regarding the mediating effect corresponding to each adjustment factor were observed.ConclusionsThe present work augments prior evidence that psychological stressors possess important drivers of CVD onset and progression mainly in women, while it gives rise to research toward unidentified paths behind this claim.