Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

Prevalence,stability, 1-year incidence and predictors of depressive symptoms among Norwegian adolescents in the general population as measured by the Short Mood and Feelings Questionnaire

Background In numerous surveys the prevalence of depressive symptoms in adolescents has been examined in single sites and at one time point.

Aims We examined depressive symptoms among adolescents aged 10–19 years in four different large school samples including two cohorts over a 10-year period in different locations in the same health region in central Norway including a total of 5804 adolescents. Two cohorts were retested within a 1-year time period to predict high versus low depressive symptom scores. Changes over a 6-year period in depressive symptom levels were examined in two of the samples of 12–14-year olds.

Methods Depressive symptoms were estimated by the 13-item Short Mood and Feelings Questionnaire (SMFQ). Covariates were student age, sex, school size and location.

Results “Miserable or unhappy”, “Tired”, “Restlessness” and “Poor concentration” were the most commonly reported depressive symptoms. Depressive symptom levels and proportions of high scoring students were consistently higher among girls, in particular in mid and late adolescence. Poisson regression analysis showed that all SMFQ items significantly predicted total scores for the whole sample, while sex (girls having a higher risk) emerged as a consistent 1-year predictor of high depressive symptom levels.

Conclusions The SMFQ constitutes a short, practical and feasible measure. We recommend that this standardized measure should be used in the assessment of depressive symptoms among adolescents in school, primary care and clinical settings but also to evaluate treatment outcome. High scorers should be evaluated in subsequent clinical interviews for the presence of a depressive disorder.     

High depressive symptomatology among older community-dwelling Mexican Americans: The impact of immigration

Objectives: This analysis explores nativity differences in depressive symptoms among very old (75+) community-dwelling Mexican Americans.

Design: Cross-sectional analysis using the fifth wave (2004–2005) of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE).

Participants: The sample consisted of 1699 non-institutionalized Mexican American men and women aged 75 years and above. Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Logistic regression was used to predict high depressive symptoms (CES-D score 16 or higher) and multinomial logistic regression was used to predict sub-threshold, moderate, and high depressive symptoms.

Results: Results showed that elders born in Mexico had higher odds of more depressive symptoms compared to otherwise similar Mexican Americans born in the US. Age of arrival, gender, and other covariates did not modify that risk.

Conclusion: The findings suggest that older Mexican American immigrants are at higher risk of depressive symptomatology compared to persons born in the US, which has significant implications for research, policy, and clinical practice.     

Factors associated with depressive symptoms among older adults living alone: an analysis of sex difference

Objectives: The aim of this study was to explore the prevalence of depressive symptoms and the risk factors that correlated with depressive symptoms among elders living alone.

Methods: A cross-sectional design was implemented. The sample consisted of 117 women and 75 men aged 65 and older who living alone in Tainan, Taiwan. The Chinese version of Center for Epidemiological Studies Depressive Symptoms Scale was adopted to assess depressive symptoms. Logistic regression analyses were employed to determine the risk factors of depressive symptoms in the elderly women and men living alone.

Results: Results of this study showed that the elderly women had a 1.6-fold greater prevalence of depressive symptoms than did men. Women who were aged 85 and above, and less social support, had a significantly higher occurrence rate of depressive symptoms. The risk factors for depressive symptoms in elderly men living alone included educational level, religious beliefs, self-rated health status, number of chronic illnesses, and social support.

Conclusions: Healthcare providers should reflect the sex difference on risk factors of depressive symptoms when planning mental health services for the elderly population.     

Depression and onset of cardiovascular disease in the US middle-aged and older adults

Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults.

Methods: The study sample came from 1992–2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51–61 years old in 1992 with no CVD history. A score of ≥3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan–Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity.

Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27% (hazard ratio [HR] = 1.27, 95% confidence interval = 1.17–1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose–response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant.

Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.     

Prevalence of depressive symptoms and its associated factors in older adults: a cross-sectional study in Kathmandu,Nepal

Objective: Globally, depression is one of the most prevalent and burdensome conditions in older adults. However, there are few population-based studies of depression in older adults in developing countries. In this paper, we examine the prevalence of depressive symptoms and explore possible contributory risk factors in older adults living in Nepal.

Methods: A cross-sectional study was conducted in two semi-urban communities in Kathmandu, Nepal. Depression was assessed using the 15-item Geriatric Depression Scale in 303 participants, aged 60 years and over. Multivariate logistic regression was then used to assess associations between potential risk factors and depression.

Results: More than half of the participants (n = 175, 60.6%) had significant depressive symptomatology, with 27.7% having scores suggesting mild depression. Illiteracy (aOR = 2.01, 95% CI: 1.08–3.75), physical immobility (aOR = 5.62, 95% CI: 1.76–17.99), the presence of physical health problems (aOR = 1.97, 95% CI: 1.03–3.77), not having any time spent with family members (aOR = 3.55, 95% CI: 1.29–9.76) and not being considered in family decision-making (aOR = 4.02, 95% CI: 2.01–8.04) were significantly associated with depression in older adults.

Conclusion: The prevalence of depression was significant in older adults. There are clear associations of depression with demographic, social support and physical well-being factors in this population. Strategies that increase awareness in the community along with the health and social care interventions are needed to address the likely drivers of depression in older adults.     

Body mass index,waist circumference and waist–hip ratio are associated with depressive symptoms in older Chinese women: results from the Rugao Longevity and Ageing Study (RuLAS)

Objective: The objective was to determine whether obesity is associated with depressive symptoms among older Chinese.

Methods: Data from the cross-sectional Rugao Longevity and Ageing Study were used including anthropometric measurements (body mass index (BMI), waist circumference (WC) and waist–hip ratio (WHR)), socio-demographic characteristics, living habits, physical health and cognitive impairment. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS-15). Chi-square tests and multivariate logistic regression analyses were performed to investigate the association between obesity and depressive symptoms.

Results: Among 1732 elderly Chinese aged 70–84 years, the prevalence of depressive symptoms was 6.7% (5.0%–8.5%) in men and 12.5% (10.4%–14.6%) in women. A negative linear trend was found between depressive symptoms and BMI in women (P_{for trend} < 0.05). Women with BMI ≥ 28.0 kg/m² had lower chances (OR = 0.41 (0.20–0.84), p = 0.01) to have elevated depressive symptoms compared with their normal weight counterparts. Furthermore, consistent trends were observed with lower depression prevalence rates in higher WC and WHR categories in women. However, no such associations were apparent in men.

Conclusion: Higher BMI, WC and WHR categories were all associated with a lower risk of depressive symptoms in older women.     

Prevalence of restless legs symptoms according to depressive symptoms and depression type: a cross-sectional study

Background: Restless legs syndrome is a sensorimotor disorder and it is associated with several other diseases especially mental illnesses.

Aims: To analyze the relationship between the symptoms of restless legs syndrome and the severity of depressive symptoms and the prevalence of restless legs symptoms in depression subtypes.

Methods: A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in 706 patients with increased depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory (BDI) and the psychiatric diagnosis was confirmed by means of a diagnostic interview (Mini-International Neuropsychiatric Interview). The subjects with increased depressive symptoms were divided into three groups (subjects with depressive symptoms without a depression diagnosis, melancholic depression and non-melancholic depression).

Results: In the whole study population, the prevalence of restless legs symptoms increased with the severity of depressive symptoms. The prevalence of restless legs symptoms was highest in the melancholic and non-melancholic depressive patients (52 and 46%, respectively) and then in subjects with depressive symptoms without a depression diagnosis (43.4%), but the prevalence was also substantial (24.6%) in subjects without a psychiatric diagnosis.

Conclusions: Restless legs symptoms are very common in primary care among subjects with depression, regardless of the depression type. The prevalence of restless legs symptoms increased with increasing severity of depressive symptoms, regardless of the diagnosis. These findings should be considered in clinical evaluation and treatment of patients visiting their physician due to restless legs or depressive symptoms.     

Association of psychological distress late in life and dementia-related mortality

Objective: It is not fully understood how subjective feelings of psychological distress prognosticate dementia. Our aim was to investigate the association between self-reported psychological distress and risk of dementia-related mortality.

Method: We included 31,043 eligible individuals between the ages of 60 and 80 years, at time of examination, from the CONOR (Cohort of Norway) database. They were followed for a period of 17.4 years (mean 11.5 years). The CONOR Mental Health Index, a seven-item self-report scale was used. A cut-off score equal to or above 2.15 on the scale denoted psychological distress. Cox regression was used to assess the association between psychological distress and risk of dementia-related mortality.

Results: Total number of registered deaths was 11,762 and 1118 (9.5%) were classified as cases of dementia-related mortality. We found that 2501 individuals (8.1%) had psychological distress, of these, 119 (10.6%) had concomitant dementia-related mortality. Individuals with psychological distress had an increased risk of dementia-related mortality HR = 1.52 (95% confidence interval (CI) 1.25–1.85) after adjusting for age, gender and education. The association remained significant although attenuated when implemented in a full adjusted model, including general health status, smoking, obesity, hypertension, diabetes and history of cardiovascular disease; hazard ratio, HR = 1.30 (95% CI 1.06–1.59).

Conclusion: Our results indicate that psychological distress in elderly individuals is associated with increased risk of dementia-related mortality. Individuals at increased risk of dementia may benefit from treatments or interventions that lessen psychological distress, but this needs to be confirmed in future clinical studies.     

Depression and frailty: concurrent risks for adverse health outcomes

Objectives: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury.

Methods: Data come from five waves (2004–2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies – Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury.

Results: Prevalence of frailty increased over the study period (24.1%–32.1%), while the prevalence of depression was relatively constant over time (approximately 13%). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: OR_{Nursing home} = 1.33, 95% CI: 1.09–1.66; OR_Fall = 1.52, 95% CI: 1.12–2.08; Depression: OR_{Nursing home} = 3.63, 95% CI: 1.29–9.97; OR_Fall = 1.16, 95% CI: 1.01–1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression.

Conclusion: Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the frailty index which confer most risk for poor health outcomes.     

Sex-specific associations of depressive symptoms and cardiovascular risk factors in older adults

Objectives: To examine sex-specific associations between depressive symptoms and cardiovascular risk factors in older men and women.

Method: One hundred and thirty-one healthy, community-dwelling older adults [mean age = 66(6.59), 63% male] completed the Beck depression inventory, and engaged in assessment of systolic and diastolic blood pressure, body mass index (BMI), waist circumference (WC), fasting total, low- and high-density lipoprotein cholesterol (TC, LDL-C, and HDL-C), triglycerides, glucose, insulin, and maximal aerobic capacity (Vo2max). Sex-stratified hierarchical regression analyses examined the association between depressive symptoms and each risk factor adjusting for age, education, and BMI (select models).

Results: Significant associations were found between higher levels of depressive symptoms and greater BMI, WC, insulin, LDL-C, and lower Vo2max in women only (p < 0.05). The insulin association was partially mediated by BMI.

Conclusion: In healthy older women, but not men, higher levels of depressive symptoms were associated with greater CVD risk factors. Depressive symptoms may confer biobehavioral risk for cardiovascular and metabolic diseases in older women in part via their association with pertinent biomedical risk factors.     

Neighborhood support network,perceived proximity to community facilities and depressive symptoms among low socioeconomic status Chinese elders

Objectives: Depressive symptoms are common in older people; most previous research on elderly depression focused on individual-level characteristics or neighborhood socioeconomic status. Modifiable neighborhood characteristics of older people dwelling in low-income communities are under-studied. This study aims to identify potentially modifiable social and physical neighborhood characteristics that influence depressive symptoms independent of individual-level characteristics among older Chinese.

Method: Data came from a cross-sectional survey conducted in four low-income public rental housing estates in Hong Kong in 2012. We interviewed a total of 400 elderly residents. The structured questionnaire covered demographics, activities of daily living, recent fall history, neighborhood support networks, and perceived proximity by walk to community facilities. Multiple regression was used to test whether inclusion of neighborhood factors in addition to individual characteristics increases model fit in explaining depressive symptoms in elders with low socioeconomic status.

Results: At individual level, activities of daily living and income significantly predicted depressive symptoms. Receiving support from friends or neighbors is associated with fewer depressive symptoms. However, participants who received organizational support had a 1.17 points of increase on the 15-item Geriatric Depression Scale (GDS-15). At-ease walkable proximity to medical facilities was positively associated with a better GDS score.

Conclusion: Neighborhood support networks and perceived proximity by walk to community facilities contribute significantly to depressive symptoms among low-income elders. Programs and policies that facilitate neighborhood support and commuting or promote facility accessibility may help ameliorate depressive symptoms common among low-income elders.     

The relation between living alone and depressive symptoms in older Korean Americans: do feelings of loneliness mediate?

Objectives: As the opposite end of the continuum from social integration, social isolation may put individuals at a greater risk of poor mental health. Conceptualizing living alone as an objective and structural indicator of social isolation and loneliness as subjective perceptions of social isolation, the present study hypothesized that the relation between living alone and depressive symptoms would be mediated by the feelings of loneliness. Using older Korean Americans as the target population, the mediation model was examined in consideration of the contextual factors such as demographics (age, gender, education, perceived income, and length of stay in the USA), health (chronic conditions and functional disability), and general social integration (size of social network and community social cohesion).

Method: Date were drawn from surveys with 209 older Korean Americans in Central Texas (M_age = 69.6, SD = 7.5). Multivariate regression models of depressive symptoms were entered in the following order: (1) demographics, (2) health, (3) living alone, (4) social network/community social cohesion, and (5) loneliness. The mediation effect of loneliness in the relationship between living alone and depressive symptoms was separately examined using the bootstrapping method.

Results: Loneliness was found to mediate the relation between living alone and depressive symptoms (indirect effect = 1.03, 95% CI = .05–2.08).

Conclusion: The results suggest that subjective perceptions of loneliness may explain the mechanism through which objective social isolation presents risks for depressive symptoms in older Korean Americans.     

Social productivity and depressive symptoms in early old age-results from the GAZEL study

Objectives: We test associations of frequency of performing three types of socially productive activities (voluntary work, informal help and caring for a person) with depressive symptoms in older people. Are depressive symptoms negatively associated with frequency in all three types or rather in those activities that are characterized by a high degree of autonomy and perceived control?

Methods: Data on social activities and frequency of performance were collected in the frame of the annual follow-up of the French GAZEL cohort study in 2005. Depressive symptoms were measured by the CES-D scale. Perceived control was assessed by two items of a quality of life measure (CASP-19). Total of 14477 respondents aged 52–66 years completed a standardized questionnaire. Linear regression models were calculated adjusting for important confounders including self-rated health assessed during the previous year.

Results: In activities characterized by high autonomy (in particular voluntary work) a negative association of frequency with depressive symptoms was observed, whereas the reverse effect was found in the type of activity with low autonomy (care for a person). Perceived control mediated in part the association of frequency of activity with depressive symptoms.

Conclusion: Being often socially productive in early old age may contribute to well-being to the extent that autonomy and perceived control are given.     

High incidence of clinically relevant depressive symptoms in vulnerable persons of 75 years or older living in the community

Objectives: Clinically relevant depressive symptoms are highly prevalent in people who are 75 years of age or older. However, very old people with a vulnerable health status are under-represented in studies focussing on incidence and risk factors, while the risk of developing depressive symptoms is expected to be very high in this group. The incidence rates of clinically relevant depressive symptoms and their predictors were investigated in a vulnerable elderly population.

Methods: In a community-based cohort, 651 vulnerable elderly (75+) people were identified by means of the COOP-WONCA charts (Dartmouth Coop Functional Health Assessment Charts/World Organisation of Family Doctors). To study the incidence of clinically relevant symptoms of depression and their predictors, 266 people with no symptoms (Centre for Epidemiologic Studies Depression Scale, CES-D score <16 at baseline) were selected and measured again at six and 18 months. The incidence of clinically relevant symptoms of depression was defined as a CES-D score ≥16, in combination with at least a five-point change between measurements. Logistic regression analyses were applied to determine risk indicators.

Results: After 18 months, the incidence rate of all clinically relevant symptoms of depression was 48% (95% confidence interval, CI 44.2–51.8). No specific risk factors were identified within this population.

Conclusion: Our estimates of the incidence of depressive symptoms were considerably higher than those previously found in elderly populations living in the community. A vulnerable health status is associated with a high risk of depressive symptoms.     

Regulation of affect in late adulthood: effects of mild depressive symptoms

Background: Recent research has highlighted the important role of emotion dysregulation in the occurrence and maintenance of depressive symptomatology.

Objectives: The purpose of this study was to test the effects of mild depressive symptoms (MDS) on older adults’ ability to regulate emotional experiences.

Method: A total of 70 community dwelling older adults completed self-report measures of affect and were asked to report how often they use specific emotion regulation strategies.

Results: Consistent with previous theories older adults experiencing MDS reported greater difficulties in regulating affect compared to normal controls (NCs).

Conclusion: The present results provide support for previous findings demonstrating that experiencing depressive symptoms affects the ability to regulate emotional responses. Current findings are likely to be informative in terms of understanding emotion dysregulation in older adults at risk of experiencing clinical symptoms of depression.     

Physical activity, social network type, and depressive symptoms in late life: an analysis of data from the National Social Life, Health and Aging Project

Objectives: To clarify whether physical activity among older Americans is associated with depressive symptoms, beyond the effects of social network type, physical health, and sociodemographic characteristics.

Method: The analysis used data from a sub-sample, aged 65–85, from the National Social Life, Health and Aging Project (N?=?1349). Hierarchical regressions examined the respective effects of selected network types and extent of engagement in physical activity on depressive symptoms, controlling for physical health and sociodemographic background.

Results: The findings showed that physical activity was correlated inversely with late life depressive symptoms. However, when interaction terms for the selected social network types and the extent of physical activity were also considered, the main effect of social network on depressive symptoms increased, while that of physical activity was eliminated.

Conclusions: The results show that older American adults embedded in family network types are at risk of limited physical activity. However, interventions aimed to increase their engagement in physical activity might help to reduce depressive symptoms within this group.