Depressive Symptoms Among Older Adults in Mexico City

BACKGROUND  Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries. OBJECTIVE  To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider. DESIGN  Cross-sectional, multistage community survey. PARTICIPANTS  A total of 7,449 persons aged 60 years and older. MEASUREMENTS  Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire. MAIN RESULTS  The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = −20.2, 95% CI = −21.3, −19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2). CONCLUSIONS  According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.     

Coping Styles for Anxiety and Depressive Symptoms in Community-Dwelling Older Adults

The aim of the present study was to examine whether specific coping styles are associated with self-reported anxiety in a sample of older adults. A total of 210 community-dwelling older adults completed self-report measures of anxiety and depression and the Coping Orientations to Problems Experienced scale. Results indicated that a tendency to utilize dysfunctional coping strategies predicted anxiety symptomatology in late life, with older adults who reported high levels of anxiety more likely to report using dysfunctional coping. After controlling for depressive symptoms, use of venting and self-blame made an independent contribution in predicting anxiety symptoms. Overall, 65% of the variance in anxiety symptoms was explained by education, depressive affect, and use of self-blame and venting as coping strategies. Our findings indicate that specific coping styles such as venting and self-blame are associated with experiencing high levels of anxiety symptoms in late life. These results suggest that targeting specific dysfunctional copying styles may be useful for prevention strategies and interventions treating anxiety in late life.     

Depressive Symptoms and Cognitive Decline in Community‐Dwelling Older Adults

OBJECTIVES: To examine the temporal association between depressive symptoms and cognitive functioning and estimate the effect measure modification of the apolipoprotein E (APOE) ?4 allele on this relationship. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Population‐based sample of 598 cognitively intact older adults aged 60 and older, with re‐assessments after 3 (N=479) and 6 years (N=412). MEASUREMENTS: Depressive symptoms (Symptom Checklist) and neurocognitive functioning (memory, Visual Verbal Learning Test; attention, Stroop Color–Word Test; processing speed, Letter Digit Substitution Test; general cognition, Mini‐Mental State Examination). Longitudinal associations were assessed using linear mixed models. The risk for cognitive impairment, no dementia (CIND) was examined using logistic regression. RESULTS: Adjusting for age, sex, education, and baseline cognition, the rate of change in memory z‐scores was 0.00, ?0.11, ?0.20, and ?0.37 for those in the lowest (reference group), second, third, and highest depressive symptom quartiles at baseline, respectively (P<.001 for highest vs lowest quartile). The odds ratios for developing CIND with amnestic features were 1.00, 0.87, 0.69, and 2.98 for the four severity groups (P=.05 for highest vs lowest quartile). Associations were strongest for those with persistent depressive symptoms, defined as high depressive symptoms at baseline and at least one follow‐up visit. Results were similar for processing speed and global cognitive function but were not as strong for attention. No APOE interaction was observed. CONCLUSION: Depression and APOE act independently to increase the risk for cognitive decline and may provide targets for prevention and early treatment.     

Depressive Symptoms Among Urban Hispanic Older Adults in Miami: Prevalence and Sociodemographic Correlates

This study documents a 35% prevalence of clinically relevant depressive symptoms in a population-based sample of mostly Cuban older adults residing in a low-income, urban Miami neighborhood. This rate is comparable to, or higher than, prevalence rates reported by most other population-based samples of U.S. older adults. Logistic regression analyses indicate that perceived financial strain was the only sociodemographic factor associated with greater odds of clinically relevant symptoms when other sociodemographic factors were statistically controlled. Gender, age, and marital status were not related to elevated depressive symptoms. A case study illustrates the impact of financial strain on older adults' mental health. Findings highlight the need for mental health screening and case management services among these older adults, particularly those who experience financial strain.     

Depressive Symptoms Among Urban Hispanic Older Adults in Miami: Prevalence and Sociodemographic Correlates

This study documents a 35%?prevalence of clinically relevant depressive symptoms in a population-based sample of mostly Cuban older adults residing in a low-income, urban Miami neighborhood. This rate is comparable to, or higher than, prevalence rates reported by most other population-based samples of U.S. older adults. Logistic regression analyses indicate that perceived financial strain was the only sociodemographic factor associated with greater odds of clinically relevant symptoms when other sociodemographic factors were statistically controlled. Gender, age, and marital status were not related to elevated depressive symptoms. A case study illustrates the impact of financial strain on older adults' mental health. Findings highlight the need for mental health screening and case management services among these older adults, particularly those who experience financial strain.     

Depressive Symptoms,Self-Reported Physical Functioning,and Identity in Community-Dwelling Older Adults

In this study, we examined the relationship between self-reported physical functioning and depressive symptoms by testing the mediation of identity processes in linking this relationship. Sixty-eight older adults (mean age = 74.4) participated in this cross-sectional study. Participants completed measures of physical functioning (Physical Symptoms Checklist), depressive symptoms (CESD-20) and identity processes (IES-G). The relationship between physical functioning and depressive symptoms was partially mediated by sensitivity of older adults to feedback from experiences, the process known as identity accommodation (Whitbourne et al. 2002). Not only are physical changes relevant to negative psychological outcomes in later adulthood, but it is the interpretation of these changes that seems to have particular relevance for aging individuals. Though preliminary based on cross-sectional data, the findings suggest that examining individual differences in sensitivity to aging stereotypes may help identify factors related to depressive symptoms in later adulthood. Future research is needed to disentangle these interrelated concepts.     

Cultural Equivalence in Depressive Symptoms in Older White, Black, and Mexican-American Adults

OBJECTIVES: To examine cultural equivalence in responses to depressive symptom items of three racial or ethnic elderly groups.
DESIGN: Cross-sectional analyses of two national data sets.
SETTING: The New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the five-state Hispanic EPESE (H-EPESE).
PARTICIPANTS: Whites (n=1,876) and blacks (n=464) were drawn from the New Haven EPESE and Mexican Americans (n=2,623) were drawn from the H-EPESE.
MEASUREMENT: The original 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D).
RESULTS: From differential item functioning analyses, a lack of measurement equivalence was found for 16 depressive symptom items. Mexican Americans were predisposed to endorse 12 depressive symptoms. Blacks were more likely than whites to endorse two interpersonal items (unfriendly and disliked). Mexican Americans were more likely than whites to respond to four positive affect items (good, hopeful, happy, and enjoyed) and more likely than blacks to endorse three positive items (good, happy, and enjoyed).
CONCLUSION: Results suggested response bias to depressive symptom items in racially and ethnically diverse older adults. Mexican Americans were more likely than whites to endorse the large number of depressive symptom items. Blacks were much more likely to respond in patterns similar to those of the whites. Findings from this study provide a foundation for developing culturally appropriate depression measures in health disparities research.     

Physical Activity and Depressive Symptoms Interact to Predict Executive Functioning Among Community-Dwelling Older Adults

Background/Study Context: Physical activity is beneficial for the executive functioning (EF) of older adults, but may be particularly protective of EF when they are cognitively vulnerable, such as during depressive episodes. Intervention studies support more potent effects of physical activity on EF among clinically depressed older adults, although these results may have limited generalizability to the daily mood and physical activity of healthy, community-dwelling older adults.

Methods: The current study aimed to test whether physical activity among older adults was more protective of EF during periods of cognitive vulnerability due to mildly elevated depressive symptoms. Longitudinal data from 150 generally healthy, community-dwelling older adults were collected semiannually and analyzed with multilevel modeling.

Results: Physical activity was more protective of EF within individuals during periods of relatively elevated depressive symptoms.

Conclusions: The power of physical activity to protect EF during periods of cognitive vulnerability may extend to community-dwelling older adults with nonclinical levels of depressive symptoms.     

The Role of Psychosocial and Cultural Factors as Correlates of Depressive Symptoms in Chinese-American Older Adults

Building upon the literature showing the negative impact of physical health constraints on depressive symptoms, this study examined the role of health and psychosocial and cultural factors as correlates of depressive symptoms in community-dwelling Chinese-American older adults. Data were drawn from surveys with 108 older Chinese Americans living in the Tampa and Orlando areas of Florida (M age = 70.6 years, SD?=?7.70). Results from hierarchical regression analysis suggest the importance of chronic health conditions and functional status as correlates of depressive symptoms. In addition, high levels of sense of mastery and acculturation were also found to be significant. Findings highlight the importance of psychosocial and cultural factors and suggest that such factors need to be considered in efforts to promote the mental health of ethnic minority older adults. Limitations and clinical implications of the findings are discussed.     

Health Perception and Depressive Symptoms Among Older Korean Americans

Given the increasing recognition of racial/ethnic health disparities, the present study focused on older Korean Americans. Using data from 230 older Korean Americans in Florida (M age = 69.8, SD = 7.05), we assessed (a) how background variables (demographic information and acculturation), health constraints (chronic conditions and functional disability), and psychosocial factors (sense of mastery and filial satisfaction) were associated with health perception and depressive symptoms; and (b) whether health perception mediated the connections between health constraints and depressive symptoms. We observed positive perceptions of health and emotional states among individuals with higher levels of acculturation, fewer chronic conditions, less disability, and a greater sense of mastery. We also found that persons who were more satisfied with their relationships with adult children and who had more positive health perception were less depressed. Additionally, the findings supported a mediation model of health perception in the linkages between physical and mental health. Findings and implications are discussed here in a cultural context.     

Low Blood Pressure and Depressive Symptoms among Chinese Older Subjects: A Population-based Study

Background

The relationships between blood pressure and depression are unclear. There are inconsistent reports of an association between low blood pressure and depressive symptoms.

Methods

In a population-based sample of 2611 Chinese older adults aged 55 years and above, including participants with treated (n = 1088), untreated (n = 545), or no hypertension (n = 978), depressive symptoms were determined by the 15-item Geriatric Depression Scale (≥5), and current systolic blood pressure and diastolic blood pressure measurements were used to classify participants into high, normal, and low blood pressure groups. Estimates of association were adjusted for confounding by use of antihypertensive and depressogenic drugs and other covariables in hierarchical regression analyses.

Results

Systolic blood pressure and diastolic blood pressure were negatively associated with Geriatric Depression Scale scores, independent of other variables. Low systolic blood pressure (odds ratio [OR] 1.54; 95% confidence interval [CI], 1.07-2.22), low diastolic blood pressure (OR 1.67; 95% CI, 0.98-2.85), and low systolic blood pressure or diastolic blood pressure (or both) (OR 1.55; 95% CI, 1.10-2.19) were independently associated with depressive symptoms. The associations with depressive symptoms were particularly observed for low systolic blood pressure (OR 2.13; 95% CI, 1.13-4.03) among treated hypertensive participants, and low diastolic blood pressure (OR 2.42; 95% CI, 1.26-4.68) among untreated or nonhypertensive participants.

Conclusion

Low blood pressure was independently associated with depressive symptoms in both older subjects who were treated for hypertension and those who were not.