Behavioral avoidance mediates the relationship between anxiety and depressive symptoms among social anxiety disorder patients

This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult patients with Social Anxiety Disorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might lead to depression in some people. The present study addressed this question by investigating the mediational role of behavioral avoidance in this clinical phenomenon, using self-report data from treatment-seeking socially anxious adults. Mediational analyses were performed on a baseline sample of 190 individuals and on temporal data from a subset of this group. Results revealed behavioral avoidance mediated this relationship, and supported the importance of addressing such avoidance in the therapeutic setting, via exposure and other methods, as a possible means of preventing depressive symptom onset in socially anxious individuals.     

Obesity and depressive symptoms in Chinese elderly

OBJECTIVES: The main objective was to examine the association between obesity and depressive symptoms among Chinese elderly in Hong Kong. METHODS: Cross-sectional data on depressive symptoms and body mass index from 56 167 clients aged 65 or over who enrolled as members of Elderly Health Centres from July 1998 to December 2000 were analysed using multiple logistic regression with adjustment of potential confounders. RESULTS: Among 18 750 men and 37 417 women, the prevalence [95% confidence interval (CI)] of depressive symptoms (based on the Geriatric Depression Scale) was 4.9% (4.6-5.2%) and 7.9% (7.6-8.1%) respectively (p < 0.001). The prevalence of obesity (by World Health Organisation Asian standard: body mass index > or =25.0) in women was significantly higher than that of men (42.1% (41.6-42.7%) vs 36.6% (35.9-37.3%), p < 0.001). Obese men and women were about 20% less likely to suffer from depressive symptoms compared with those with normal weight after adjustment for confounders, with odds ratios (95% CI) of 0.82 (0.69-0.97) and 0.78 (0.71-0.86) respectively. Negative linear trends were observed between depressive symptoms and BMI categories in both sexes, and women showed a greater slope and stronger statistical significance than men. CONCLUSIONS: Both obese elderly men and women in Hong Kong were less likely to suffer from depressive symptoms than those of normal weight. The results support the 'jolly fat' hypothesis previously restricted to men, and extend the hypothesis to female elderly. Chinese traditional culture and positive values towards obesity may be protective against depressive symptoms.     

Assessing social support and depressive symptoms in older Chinese adults: a longitudinal perspective

Objectives: This study examined the relationship between social support and depression in a national longitudinal sample in Taiwan. This study integrates previous literature and develops a predictive model involving seven components of social support – social network size, network composition, frequency of social contact, proximity, types of support received, helping others, and satisfaction with social support.

Method: A total of 4049 elders who were interviewed up to five times over a 14-year period from the ‘Surveys of Health and Living Status of Elderly’ (SHLSE) in Taiwan served as the subjects of this study. Random effects modeling was used to analyze the data.

Results: Greater network size, broader networks, more frequency of contact, living with a married son, receiving instrumental, emotional and financial support, providing financial and short-term instrumental support to others, and higher satisfaction with support were all associated with fewer depressive symptoms. Providing physical care was related to higher levels of depression. Of the social support measures, satisfaction with support emerged as the most powerful predictor of elders’ depression.

Conclusion: This investigation provides evidence that each aspect of social support accounts for a certain portion of the concept and emphasizes the importance of distinguishing different dimensions of social support. Also, the inconsistent findings between the current study and the Chinese literature reminds future investigators that the effect of social support on depression may differ among Chinese elderly in different communities, even through they share the same cultural origin.     

Reciprocal relationship between pain and depression in elderly Chinese primary care patients

BACKGROUND: Pain and depression are common in old age but the reciprocal relationship between pain and depression has not been established in a single study. Moreover, few studies have addressed this issue in a primary care setting. The purposes of this study were to examine the reciprocal relationship between pain and depression and to identify whether social support, functional disability or social functioning mediated the link between pain and depression among Hong Kong Chinese elderly primary care patients. METHOD: Subjects were 318 patients assessed by a trained assessor with MDS-HC at baseline and these subjects were randomly selected from attendants of three randomly selected elderly health centers in Hong Kong. These patients were re-assessed one year after baseline evaluation. RESULTS: Multiple regression analyses revealed that pain at baseline significantly predicted depression at 12-month follow-up assessment when age, gender, martial status, education, and depression at baseline were adjusted for, but depression at baseline was not associated with pain at 12-months after baseline measure while controlling for age, gender, martial status, education, and pain at baseline. However, depression did predict the onset of pain. Moreover, social support, physical disability or social functioning did not mediate the impact of pain on depression. CONCLUSIONS: These data suggest that pain is an important predictor of depression in elderly primary care patients. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.     

Self-reported depressive symptoms among Chinese adolescents

Previous reports on the prevalence and features of depression among adolescents have been inconsistent. The purpose of the current study was to estimate the prevalence of depression among Chinese adolescents with a standardized instrument. A total of 2462 students, aged 13–22, were sampled from the Shandong province of China. The Zung Self-Rating Depression Scale (SDS) was administered to the subjects in their classrooms. It was shown that the mean SDS score was 44.8 (SD 9.9) and it decreased significantly from the age of 18 upward (F = 31.73, df = 9, P < 0.01). No significant difference was found between males and females (t = 0.70, P > 0.05). Taking 55 as a cut-off score, the prevalence rate of depression was 16.9% (95% CI = 15.4–18.4%). Logistic regression showed that increasing age appeared to decrease the risk for depression. Most of the individual items differed between ages, except for weight loss and constipation. Principal components factor analysis revealed that the characteristics of adolescent depression were depressive/anxious mood, psychomotor retardation, loss of self-esteem, somatic symptoms and decreased appetite and libido. Although the study was based on a large sample using an established instrument, the sample was not from a general adolescent population and case ascertainment was not by clinical diagnosis. Accepted: 25 May 1998     

Geographical proximity and depressive symptoms among adult child caregivers: social support as a moderator

Objectives: This study examined whether geographical proximity is a predictor of depressive symptoms, and whether family and friend support can moderate the relationship between geographical proximity and depressive symptoms.

Method: A survey of 557 adult child primary caregivers was conducted in Shanghai, China in 2013. Geographical proximity was measured as a categorical variable: coresidence, short distance (less than 30 minutes’ travel time), and long distance (more than 30 minutes’ travel time). Family and friend support were assessed using the Multidimensional Scale of Perceived Social Support. Depressive symptoms were evaluated using the Center on Epidemiologic Studies Depression Scale. Multiple regression analyses and interaction terms were used to test the moderating roles of family and friend support.

Results: Adult child caregivers who live more than 30 minutes away from care recipients experienced higher depressive symptoms than coresiding caregivers (β = .114, p < .01). Family support (β = ?.408, p < .05) and friend support (β = ?.235, p < .05) were protective factors that lessened depressive symptoms for long-distance adult child caregivers.

Conclusion: This study adds spatial dimension to caregiving literature and extends stress process theory. These findings have important implications for service planning and social support for adult child caregivers.     

Direct and buffering effects of social support on depressive symptoms of the elderly with home help

The purpose of the present study was to examine the prevalence of depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D) and the effect of life stressors or social support on depressive symptoms in 303 elderly people receiving social services at home. We conducted a questionnaire survey six times with a 1-month interval. In the initial wave of questionnaires, 92 (31%) scored 16 points or above on the CES-D, indicative of a risk for depression. Before life stressors, subjects with low-level support showed significantly more severe depressive symptoms than those with high-level support. Subjects with low-level support were significantly more depressive after life stressors than they had been before, whereas those with middle- and high-level support showed no such difference. The former and latter results seem to suggest the direct and buffering effects of social support on depressive symptoms, respectively.     

Gender differences in depressive symptoms among Spanish elderly

The aim of this study is to describe gender differences in depressive symptomatology among an elderly Spanish population and to see whether women are more at risk than men and whether the effects of known risk factors for depression differ between the genders. Data come from the study Envejecer en Leganés (Growing Old in Leganés), where a representative sample of community residing elderly was screened by an at-home interview for high depressive symptomatology using the Center for Epidemiologic Studies Depression Scale (CES-D). Sociodemographic characteristics, health status, Activities of Daily Living and Instrumental Activities of Daily Living, disability, social support, and locus of control were measured as possible correlates of depressive symptoms. Screening was completed in 1116 subjects. The prevalence of high depressive symptomatology varied, being 19.6% for men and 46% for women (OR=3.4; 95% CI=2.6; 4.5). In addition to gender, comorbidity, low emotional support from children, lack of a confidant, few social activities, and a sense of lack of control were independently associated with high levels of depressive symptoms. None of the interactions of gender by the known risk factors of depression was significant. Although the prevalence of depressive symptomatology is higher in women than in men, the known risk factors do not totally explain the difference between genders in this population of Spanish elderly. This difference could be due to the cultural definitions of gender roles that have affected them throughout their lives. Accepted: 22 July 1997     

Social support and pregnancy:II. Its relationship with depressive symptoms among Japanese women

Abstract In a questionnaire survey among 1329 first-trimester pregnant women, both the husband support measures and unwanted pregnancy ('stressor' agent in pregnancy) showed significant effects on an elevated score of the cognitive disturbance subscale of the Zung's self-rating depression scale (SDS), while only unwanted pregnancies showed an effect on an elevated score of the dysphoric mood subscale of the SDS. However, no interaction was observed between the husband support measures and unwanted pregnancy, therefore the effect of the husband's social support on the cognitive disturbance score was not that of a buffer, but rather a main effector. Finally, multiple regression analyses showed that the dysphoric mood score was preceded by unwanted pregnancy, premenstrual irritability, public self-consciousness, and maternal overprotection; while the cognitive disturbance score was preceded by unwanted pregnancy, husband reduced 'given' and 'giving' support, maternal reduced care and overprotection, paternal reduced care, low annual income, low private self-consciousness, and smoking. These findings suggest that the husband's support for a pregnant woman is effective only in reducing cognitive symptoms, and that different symptomatic constellations have different sets of psychosocial correlates.     

Longitudinal support for the relationship between vascular risk factors and late-life depressive symptoms.

OBJECTIVE: The authors examined longitudinal support for the vascular depression hypothesis by assessing the extent to which baseline vascular burden was associated with depressive symptoms 6 and 18 months after discharge from inpatient medical rehabilitation. METHODS: One hundred consecutive geriatric rehabilitation patients were assessed during their rehabilitation stay and subsequently screened for depression 6 and 18 months after discharge. Baseline vascular burden was entered into logistic-regression analyses predicting depression at 6 and 18 months after controlling for baseline levels of depression, general medical burden, limitations in activities of daily living, cognitive impairment, and demographic variables including age, education, gender, and race. RESULTS: Logistic-regression results demonstrated that, after controlling for the covariates described above, baseline vascular burden was associated with increased odds of positive depression screens at 6- and 18-month follow-up assessments. Furthermore, among patients who were not depressed during their rehabilitation stay, vascular burden was predictive of positive depression screens at 6- and 18-month follow-up assessments. CONCLUSIONS: Greater vascular burden was positively associated with depressive symptoms over time. These findings provide further support for the vascular depression hypothesis in late life and highlight the need for careful clinical monitoring of this frail group of elderly patients.     

Genetic contribution to the relationship between social role function and depressive symptoms in Japanese elderly twins: a twin study

Background: Social role function is the capacity to maintain interpersonal relationships and is essential for being independent in the community. Limitations in social role function often coexist with depressive symptoms, suggesting a possible common mechanistic basis. We investigated whether the observed association between these traits is mainly a result of genetic or environmental influences. Methods: In 2008, a questionnaire was sent to 745 male twins aged 65 years and older. Our sample included 397 male twins. The number of monozygotic twins was 302, and dizygotic was 95. Among the twin pairs for whom data were available for both twins, 75 twin pairs (150 individuals) were monozygotic and 28 pairs (56 individuals) were dizygotic. Social role function was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Depressive symptoms were measured by the 15‐item version of the Geriatric Depression Scale. Relative importance of genes and environments for the phenotypes was calculated using structural equation analyses. Results: Our results show that genetic influence was the major contributor to the relationship between social role function and depressive symptoms, and non‐shared environmental influence was important for overall variation in each trait. Conclusions: We concluded that focusing on a non‐shared environment is an essential approach for maintaining social role function and psychological well‐being. It is suggested that treatments specific to depressive symptoms are more effective than indirect intervention targeting social role function.     

Associations between HIV-related stigma,self-esteem,social support,and depressive symptoms in Namibia

ABSTRACT

Objective: The current study sought to investigate the association between HIV-related stigma, self-esteem, social support, and depression of people living with HIV and AIDS (PLWHA) in Namibia.

Method: Purposive sampling was used to recruit a total of 124 men and women living with HIV/AIDS in the Katima Mulilo region of northern Namibia. A cross-sectional survey was used to collect information on demographics, self-esteem, social support, HIV-related stigma, and depression.

Results: Correlation analysis revealed that HIV-related stigma, self-esteem, and social support were all significantly correlated with depression. Further, Ordinary Least Squares (OLS) regression analysis indicated that HIV-related stigma was the largest risk factor and self-esteem was the largest protective factor with respect to depressive symptoms.

Discussion: Findings indicated the necessity of appropriate assessment and intervention for psychosocial distress among PLWHA. Helping professionals should design evidence-based interventions that address individual and societal challenges that impact people living with HIV and AIDS.     

Gender and marital status differences in depressive symptoms among elderly adults: the roles of family support and friend support

Objectives: The objective of this study is to examine the relationship between gender and depressive symptoms as well as between marital status and depressive symptoms in elderly populations, and to examine the roles of friend support and family support in the relationship between gender and depressive symptoms as well as marital status and depressive symptoms.

Method: In a national sample of 1428 elderly adults randomly selected from major Chinese mainland cities, depressive symptoms, friend support, and family support were assessed.

Results: The results revealed a significant relationship between marital status and depressive symptoms; however, the effect of marital status on depressive symptoms was mediated by family support and moderated by friend support. Unlike many previous studies which have found a significant relationship between gender and depressive symptoms, this study failed to reveal any such relationship.

Conclusion: Widowed elderly adults experienced more depressive symptoms than did married. The differences in depressive symptoms between married and widowed elderly people could be explained by the inverse of the level of family support. The subjects’ perception of friend support had different effects on the depressive symptoms of elderly adults with different marital statuses. For finding no relationship between gender and depressive symptoms in this elderly Chinese population, similarities between the sexes in their experience of stressful life events may a possible explanation.     

老年人睡眠时长与抑郁症状的关系

背景 抑郁症严重危害老年人的身心健康,睡眠与抑郁症状的关系已成为研究热点之一,但目前关于睡眠与抑郁症状之间的研究结论存在差异。目的 探讨老年人睡眠时长与抑郁症状之间的关系,为预防老年人出现抑郁症状和延缓已有抑郁症状的老年人病情发展提供参考。方法 采用2018年《中国健康与养老追踪调查》数据库（CHARLS）中8 210名年龄≥60岁老年人的调查结果。按照中文简版流调中心用抑郁量表（CESD-10）评分标准,将老年人分为存在抑郁症状和不存在抑郁症状两组。使用Logistic回归及限制性立方样条模型分析老年人睡眠时长与抑郁症状之间的关联。结果 在8 210名老年人中,检出存在抑郁症状者3 118人（37.98%）,平均每晚睡眠时长为（6.14±2.05）h。睡眠时长与抑郁症状之间存在非线性关联（χ²=412.670,P<0.01,df=4）。在调整了混杂因素后,睡眠时长<6 h、6~6.9 h和≥8 h的老年人出现抑郁症状的风险分别是睡眠时长7~7.9 h老年人的2.971倍（95% CI：2.560~3.449,P<0.01）、1.372倍（95% CI：1.161~1.621,P<0.01）和1.185倍（95% CI：1.009~1.393,P<0.05）。在不同性别及60~69岁组老年人中,未发现睡眠时长≥8 h与抑郁症状检出风险有关（P>0.05）。结论 睡眠时长与抑郁症状存在近似非线性关联,但存在性别和年龄差异。     

The neglected relationship between social interaction anxiety and hedonic deficits: differentiation from depressive symptoms

Depressive symptoms are associated with both the presence of negative subjective experiences and relative absence of positive subjective experiences. A similar affective profile of high negative affect and low positive affect (PA) has been associated with excessive social anxiety (SA). This initial cross-sectional study evaluated the incremental effects of social interaction anxiety on hedonic deficits beyond the effects of depressive and anxiety (i.e., physiological arousal, worry) symptoms. From a sample of 97 college students, a factor analysis on self-report measures of hedonic functioning derived two domains: Positive Subjective Experiences and Curiosity. Social interaction anxiety was uniquely, negatively related to Positive Subjective Experiences and Curiosity after removing variance attributable to various depressive and anxiety symptoms. In contrast, anxious arousal and nonspecific anxiety had near-zero relationships with both domains, and depressive symptoms were negatively related to Positive Subjective Experiences. These data provide some evidence for an association between social interaction anxiety and hedonic deficits that is not attributable to covariance with other internalizing conditions.