Adequacy of Nutrient Intake Among Elderly Persons Receiving Home Care

ABSTRACT

This study examines the adequacy of the dietary intake based on age, sex, and level of nutritional risk among 98 frail elderly persons receiving home care through Community Care Access Centres. The dietary intakes were measured using 24-hour recalls and were compared with the dietary reference intake. The participants' intakes of both macronutrients and micronutrients were found to be inadequate. On average, elderly persons were consuming more than the recommended amount of protein, but the average intakes of many vitamins and minerals were less than optimal based on the average intakes. Paradoxically, more than half of elderly participants were overweight or obese. The results highlight the need for appropriate nutrition, education, and support for elderly persons receiving home care.     

Depressive Symptoms Among Hospitalized Patients in Israel

Depressive symptoms are common among hospitalized patients and can indicate more serious problems. This study examined the level of depressive symptoms among patients in one hospital in Jerusalem, the variables related to depression, and the extent to which social workers provided services to those patients. Over 60% of patients reported high levels of depressive symptoms. Levels were higher among Arabs, those with lower income, small social networks, stronger locus of control (powerful others), weaker internal locus of control, and low emotional support from staff. Social workers were in contact with 44% of patients who had high levels of depressive symptoms.     

Mother-Infant Interaction, Life Events and Prenatal and Postpartum Depressive Symptoms Among Urban Minority Women in Primary Care

Objectives: Prenatal and postpartum depression are significant mental health problems that can have negative effects on mother-infant interactions. We examined the relationships among mother-infant interactions, depressive symptoms, life events, and breastfeeding of low-income urban African American and Hispanic women in primary care settings. Methods: Participants were 89 African American and Hispanic women who were part of a larger mental health intervention study conducted in community health centers. Questionnaire data on depression, as well as negative and positive life events, were collected during pregnancy and at three-months postpartum, while mother-infant interaction observations and breastfeeding practice were only collected at three-months postpartum. Results: The ratings of maternal behavior for ‘depressed’ mothers did not differ from ‘nondepressed’ mothers. Except for gaze aversion behavior, infants' behavior while interacting with their mothers did not differ by maternal depression level. Hierarchical regression analyses revealed that maternal positive life events positively predicted infant interactional summary ratings, while maternal negative life events were inversely associated with maternal interactional summary ratings. Conclusions: To improve services in primary care, perinatal screenings for depression can help identify those women most at risk. When follow-up use of structured diagnostic instruments is not possible or cost-effective, clinician assessment of severity of depression will determine women with clinical levels of depression. Reducing negative life events is beyond the control of women or clinicians but cognitive interventions to help women focus on positive life events can reduce the deleterious effects of depression on mothers and their infants.     

Union Type and Depressive Symptoms Among Mexican Adults

Diversity in union type is increasing around the world as cohabitation and higher order unions become more prevalent in developing and developed countries. This necessitates a more nuanced understanding of how different union types relate to individual well-being across social settings. In this study, the authors analyze nationally-representative data from Mexico in cross-sectional and change models to evaluate differences in depressive symptoms across union type (marital vs. cohabiting and first vs. higher order unions) among Mexican men and women. The findings suggest that cohabiting unions do not provide the same mental health benefits as marital unions (especially for men). Repartnering is also associated with higher depressive symptoms (especially for women), which indicates possible lasting mental health disadvantages of divorce/separation or entrance into lower quality second unions. These results suggest that the changing family context in Mexico, which includes increasing cohabitation and union instability, may have important consequences for individuals' psychological well-being.     

Depressive Symptoms and Neurocognitive Performance Among HIV-Infected Women

The aims of this article were to explore the relationship between depressive symptoms and neuropsychological performance in a sample of HIV-infected women, and to examine the contribution of demographic, HIV-related variables, and depressive symptoms to neurocognitive performance. In this cross-sectional study, a sample of 103 HIV-infected women, recruited from February to December 2010, were assessed for depressive symptoms (with the Beck Depression Inventory) and neurocognitive performance (with the HIV Dementia Scale). Severe depressive symptoms were reported by 31.1% of the women. Findings indicated that severe levels of depressive symptoms were significantly associated with reduced cognitive functioning in HIV-infected women, particularly in domains of attention, psychomotor speed, and construction. Older age and low education level were significantly associated with neurocognitive impairment in univariate analyses. In the multivariate model, only depressive symptoms were significantly related to neurocognitive impairment. Compared to participants with none/minimal depressive symptoms, those with moderate and severe depressive symptoms had odds ratios for neurocognitive impairment of 5.03 (95% CI, 1.33–18.99) and 3.22 (95% CI, 1.15–9.06), respectively. These findings support continued investigation of the presence of neurocognitive impairment, particularly among women, and may help mental health providers with early detection, planning, and implementation of more effective interventions.     

Gender Abuse,Depressive Symptoms,and HIV and Other Sexually Transmitted Infections Among Male-to-Female Transgender Persons: A Three-Year Prospective Study

Objectives. We examined gender abuse and depressive symptoms as risk factors for HIV and other sexually transmitted infections (HIV/STI) among male-to-female transgender persons (MTFs).Methods. We conducted a 3-year prospective study of factors associated with incident HIV, syphilis, hepatitis B, chlamydia, and gonorrhea among 230 MTFs from the New York Metropolitan Area. Statistical techniques included Cox proportional hazards analysis with time varying covariates.Results. Among younger MTFs (aged 19–30 years), gender abuse predicted depressive symptoms (Center for Epidemiologic Studies Depression score ≥ 20), and gender abuse combined with depressive symptoms predicted both high-risk sexual behavior (unprotected receptive anal intercourse) and incident HIV/STI. These associations were independent of socioeconomic status, ethnicity, sexual orientation, hormone therapy, and sexual reassignment surgery.Conclusions. Gender abuse is a fundamental distal risk factor for HIV/STI among younger MTFs. Interventions for younger MTFs are needed to reduce the psychological impact of gender abuse and limit the effects of this abuse on high-risk sexual behavior. Age differences in the impact of gender abuse on HIV/STI suggest the efficacy of peer-based interventions in which older MTFs teach their younger counterparts how to cope with this abuse.Extremely high rates of HIV have been detected among male-to-female transgender persons (MTFs). Community-based studies using nonprobability sampling have observed an HIV prevalence of 22% to 35%, with yearly incidence rates ranging from 3.5% to 7.8%.1–9 Established risk factors for HIV in this population include ethnicity (African Americans and Hispanics compared with Whites) and sexual orientation (those attracted to men only compared with other categories of sexual attraction).1,4The dominant behavioral mode by which MTFs contract HIV and transmit the virus to others, including the general population,10 is unprotected receptive anal intercourse (URAI) with committed, casual, or commercial partners.11 MTFs report frequencies of high-risk sexual behavior (including URAI) with noncommercial and commercial sex partners that are much higher than those for the general population12 and higher than for sexual minorities.13A potentially significant proximal risk factor, which may combine with URAI to cause HIV in this population, is depressed affect. MTFs report levels of depressive symptomatology that are much higher than in the general population,14,15 and some previous studies suggest that depressive symptoms are intertwined with high-risk sexual behavior.16–20A more fundamental distal risk factor, which may cause depressive symptoms and ultimately high-risk sexual behavior and HIV among MTFs, is abuse associated with an atypical presentation of gender. Because they transgress basic gender norms, many MTFs are taunted or beaten by family members, neighbors, coworkers, strangers, or the police,21 and a recent study showed that this abuse is linked to depressive symptomatology.22 For some MTFs, gender abuse may be highly traumatizing and intertwined with depressed affect, which may erode prevention consciousness and the use of condoms to prevent HIV in particular.23–27We present the findings of a community-based prospective study designed to evaluate social, psychological, and behavioral risk factors for incident HIV and other sexually transmitted infections (HIV/STI) among MTFs. We tested 3 interrelated hypotheses, reflecting the literature reviewed here: (1) gender abuse is associated with depressive symptoms as measured by the Center for Epidemiologic Studies Depression scale (CES-D); (2) gender abuse is associated with URAI with committed, casual, and commercial partners, with the effects partially mediated by depressive symptoms; and (3) gender abuse is associated with incident HIV/STI, with the effects partially mediated by depressive symptoms and URAI.Psychological or physical abuse associated with an atypical presentation of gender (gender abuse) is the result of a binary gender system in which all individuals are expected to conform to a single gender role (male or female) consistent with their sexual anatomy at birth.23 Although it is subjectively experienced, this abuse is ultimately the product of social forces beyond the perceptions of individuals28; following the Institute of Medicine’s conceptualization,29 we posited that it was a distal social risk factor for HIV/STI in this population. We conceptualized depressive symptoms as a proximal psychological risk factor for URAI. We included URAI as a behavioral risk factor that directly causes HIV/STI. We hypothesized that gender abuse and depressive symptoms affect HIV/STI via their effects on URAI.We further hypothesized that these associations are modified by age. Some studies suggest that younger MTFs are particularly vulnerable to gender abuse and victimization.30–33 Other studies suggest that older MTFs, after years of coping to this adversity, develop attitudes and skills to better cope with it.29,34 Age differences in vulnerability to gender abuse were demonstrated in a recent retrospective study by our research team: gender abuse was strongly associated with depressive symptomatology during adolescence and early adulthood, but the strength of this association declined markedly during later stages of life.22 Building on this finding, we examined age differences in the effects of gender abuse on depressive symptom longitudinally in this study, with further predictions of age differences in the effects of gender abuse on URAI and HIV/STI.An analysis of HIV among MTFs must also recognize the fact that this is a diverse population with regard to socioeconomic status (SES) and stage of gender transition,29 both of which could confound observed associations between gender abuse and HIV/STI. Because of this potential confounding, we included indicators of SES (education and income) and variation along a spectrum of gender transition (hormone therapy, preoperational transsexual identity, and sexual reassignment surgery) in the analysis.     

Acculturation and Depressive Symptoms Among Pregnant and Postpartum Latinas

Objectives Among childbearing Latinas, higher acculturation has been found to be significantly associated with increased risk for mental health problems (Acevado (Child Abuse Neglect, 24:11–127, 2000)), although these findings have been inconsistent (Beck (Maternal Child Nurs, 31(2), 114–120, 2006)). The aims of this study are to assess and compare the prevalence of elevated depressive symptoms among pregnant and postpartum U.S.- and Mexican-born Latinas, and to describe the relation of elevated depressive symptoms and acculturation indicators. Methods A convenience sample of 439 pregnant and postpartum Latinas attending Public Health Clinics in San Antonio, Texas was screened for depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) Scale. Women with a score of 21 or greater were classified as having elevated depressive symptoms. Sociodemographic data, including birth country and language of interview, were collected as indicators of acculturation. Results 21% of the sample had moderate depressive symptoms; 15% met the threshold for high depressive symptoms. Bivariate analysis showed Latinas who were U.S.-born, single, preferred English or were pregnant were more likely to express elevated levels of depressive symptoms. Being U.S.-born, pregnant and single was significantly associated with moderate levels of depressive symptoms in logistic regression analyses controlling for other variables in the model. Controlling for other variables, being pregnant and single was significantly associated with high levels of depressive symptoms. Conclusions Higher acculturation, pregnancy and single status were positively associated with elevated depressive symptoms. Screening for depression during pregnancy is important for this population group, given Latinas’ high rates of fertility and births to single women, particularly among more acculturated, U.S.-born Latinas.     

Acculturation and Depressive Symptoms Among Dominicans in New York City

Journal of Immigrant and Minority Health - Little is known about the association between acculturation and mental health among Dominican populations in the United States. Data came from a community...     

安徽留守儿童抑郁状况及其影响因素分析

目的了解安徽省留守儿童抑郁症状的性别差异及其与父母打工类型的关系,为改善儿童心理健康提供依据。方法采用无记名面对面的调查方式,以城乡留守儿童为目标人群,共在安徽省城乡调查941人,使用儿童抑郁量表(CDI)评定其抑郁症状,运用多因素Logistic回归分析探讨留守儿童抑郁症状的影响因素。结果留守儿童抑郁症状检出率(15.8%)高于非留守儿童(10.9%),男生抑郁症状检出率高于女生。多因素Logistic回归分析结果表明,父亲外出打工是女生抑郁症状发生的危险因素。结论留守儿童抑郁症状较为普遍,研究留守儿童心理卫生问题时应考虑到性别差异和父、母的角色。     

Depressive Symptoms,Stress and Resources Among Adult Immigrants Living with HIV

Investigation on the mental health of HIV-positive immigrants is severely limited. We examine the independent and combined effects of HIV symptom and coping resources on depressive symptoms among HIV-positive immigrants (n = 259). Ordinary Least Squares regression models were estimated with data from a survey of clinical and social-psychological outcomes in people receiving treatment for HIV infection. We tested for the impact of two HIV-related stressors, one life events stressor and three buffering resources on depressive symptoms, controlling for thirteen demographic, clinical and acculturative factors. HIV-related stressors were found to be positively related to depressive symptom severity. Coping resources, namely self-mastery, mediate the relationships between HIV-related stressors and depressive symptoms. Results from this study provide the first empirical assessment of stress processes for immigrants living with HIV. Although more research is needed to understand mental health among HIV-positive immigrants, the study results suggest that health care providers focus on self-mastery enhancement among HIV-positive immigrants.     

Depressive Symptoms and Sleepiness Among Latino Farmworkers in Eastern North Carolina

ABSTRACT

Depression and sleepiness are both risk factors for occupational accidents and unintentional injury. Relatively little is known about the experiences of these risk factors in the immigrant Latino farmworker population. This analysis uses prospective panel data from a sample of Latino farmworkers in eastern North Carolina that were collected at monthly intervals during the 2008 agricultural season to (1) describe depressive symptoms and daytime sleepiness among immigrant Latino farmworkers across the agricultural season; (2) delineate associations of depressive symptoms with sleepiness across time; and (3) determine whether depressive symptoms precede sleepiness, or if sleepiness precedes depressive symptoms. Results indicated that 45% of farmworkers experienced elevated depressive symptoms across the season, whereas 20% experienced elevated sleepiness. Elevated depressive symptoms were more common among farmworkers living in barracks, and less common among those living in trailers. Sleepiness was more common among women than men. There was no evidence that depressive symptoms contributed to sleepiness, or that sleepiness contributed to depressive symptoms. The pattern of results suggests that a substantial proportion of Latino farmworkers experience levels of depressive symptoms or sleepiness that places them at risk for occupational accident or unintentional injury. The results also suggest that depressive symptoms and sleepiness do not cause each other; rather, the association of depressive symptoms with sleepiness hints at the possibility of a common physiologic mechanism such as circadian disruption.     

Social Media Use and Depressive Symptoms Among United States Adolescents

PurposeDepression is increasingly common among US adolescents; the extent to which social media exposure contributes to this increase remains controversial.MethodsWe used Monitoring the Future data from 8th and 10th grade students (n = 74,472), 2009–2017, to assess the relationship between daily social media use and depressive symptoms. Self-reported depressive symptom score (range: 4–20) was assessed continuously using a log-transformed outcome and at varying cut scores with logistic regression analyses. First, these outcomes were examined overall, comparing adolescents using social media daily to adolescents who were not. We then estimated predicted depressive symptom scores using 26 predictors in order to establish underlying depression risk. We partitioned students into depression risk quintiles to control for confounding due to underlying depression risk and examine heterogeneity in the association between social media use and depressive symptoms. Sensitivity analyses were used to test the robustness of results with different configurations of the predicted score model, and overall associations were examined in two-year groups to identify differences in effects.ResultsFor girls, in adjusted risk-stratified analysis, daily social media use was not associated with high (vs. low) depressive symptoms. For boys, results were inconsistent, suggesting a protective effect of daily social media use at some cut scores. Results were consistent across sensitivity analyses, and any potential harmful effects appear to be limited to 2009–2010, limiting the evidence supporting social media as a current risk factor for depressive symptoms.ConclusionsAmong US adolescents, daily social media use is not a strong or consistent risk factor for depressive symptoms.     

Longitudinal Associations Between Smoking and Depressive Symptoms Among Adolescent Girls

Adolescence is an important period for initiation of smoking and manifestation of depression, which are often comorbid. Researchers have examined associations between depressive symptoms and smoking to elucidate whether those with increased depressive symptoms smoke more to self-medicate, whether those who smoke experience increased subsequent depressive symptoms, or both. Collectively, there have been mixed findings; however, studies have been limited by (1) cross-sectional or short-term longitudinal data or (2) the use of methods that test associations, or only one direction in the associations, rather than a fully-reciprocal model to examine directionality. This study examined the associations between smoking and depressive symptoms in a sample of adolescent girls using latent dual change scores to model (1) the effect of smoking on change in depressive symptoms, and simultaneously (2) the effect of depressive symptoms on change in smoking across ages 11–20. Data were from a cohort-sequential prospective longitudinal study (N?=?262). Girls were enrolled by age cohort (11, 13, 15, and 17 years) and were primarily White (61 %) or African American (31 %). Data were restructured by age. Every 6 months, girls reported depressive symptoms and cigarette use. Results indicated that controlling for sociodemographic characteristics, higher levels of smoking predicted a greater increase in depressive symptoms across adolescence. These findings suggest that a higher level of cigarette smoking does contribute to more depressive symptoms, which has implications for prevention of depression and for intervention and future research.     

Depressive Symptoms and Patterns of Drug Use Among Street Youth

PurposeRates of depression among street youth are poorly characterized, particularly as they pertain to concurrent drug use. We sought to assess associations between drug type and degree of depression in this population.MethodsBetween October 2005 and November 2007, data were collected from a cohort of street-recruited youth aged 14–26 residing in Vancouver, Canada, for the At-Risk Youth Study. Active drug users were classified by predominant substance of use: daily marijuana use, weekly cocaine/crack use, weekly crystal methamphetamine use, or weekly heroin use. Adjusted mean number of depressive symptoms (measured by the Center for Epidemiological Studies Depression [CES-D] scale) was compared among the four groups using multiple linear regression. Logistic regression was also used to assess adjusted odds of CES-D score ≥22.ResultsAmong 447 youth, mean CES-D score was the highest among heroin users (adjusted mean: 22.7; standard deviation [SD]:1.2), followed by crystal methamphetamine users (adjusted mean: 21.8; SD: 1.1), then cocaine and/or crack users (adjusted mean: 19.1; SD: 1.0), and finally, marijuana users (adjusted mean: 18.3; SD: 1.1), resulting in a difference that was significant among groups (p < .001). When compared with daily marijuana users, odds of CES-D score ≥22 were higher among heroin users (adjusted odds ratio [AOR]: 2.64; 95% confidence interval [CI]: 1.39–4.99) and crystal methamphetamine users (AOR: 1.88; 95% CI: 1.04–3.42), but not among cocaine/crack users (AOR: 1.41; 95% CI: .79–2.52).ConclusionTo our knowledge, this is the first report of drug use typologies and depression among street youth. Policymakers might heed the apparent vulnerability of heroin and crystal methamphetamine users to even greater degrees of depression than their peers.     

Psychosocial Factors and Functional Capacity Evaluation Among Persons with Chronic Pain

Psychosocial factors have been found to have a significant impact on functional activity, particularly among persons with chronic pain. While various systems have been developed to assess functional limitations through functional capacity evaluation (FCE), assessment of psychosocial factors that may impact function have been largely ignored. This paper examines the existing literature on psychosocial factors and FCE performance. Given that there are few studies that have directly addressed this issue, the paper also examines psychosocial factors that have been found to influence function in persons with pain. The results of the literature review indicate that few psychosocial factors have been found to be directly associated with FCE and functional measures, although many are related to various measures of disability. The strongest evidence that psychosocial factors are related to functional performance is based on the studies examining the association between functional activity and pain-related fear, self-efficacy, and illness behavior. Psychosocial factors have also been shown to influence measures of sincerity of effort often obtained during FCE. Proposals for modifying FCE assessment are given based on the available data, as well as suggestions for future research.     

Trajectory of Physical Functioning Among Persons Living With HIV in Nursing Homes

Objective(s)

To examine the change in physical functional status among persons living with HIV (PLWH) in nursing homes (NHs) and how change varies with age and dementia.

Postnatal Quality of Life,Depressive Symptoms,and Social Support Among Women in Southern India

Evaluation of postnatal quality of life (QOL) has remained a poorly researched area in India. The present cross-sectional study assessed postnatal QOL, using the Mother Generated Index (MGI) and its associated risk factors, and was conducted during January–March 2013 among 274 mothers, 6–8 weeks postnatally. A semi-structured questionnaire was used to evaluate sociodemographic and obstetric characteristics and social support. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and QOL using the MGI. The vast majority (90.1 percent) of respondents in our study had a primary MGI score <5, those with significantly higher prevalence of physical problems and psychological distress. A total of 39.8 percent of respondents were screened as having other (not major) depressive symptoms and 4.7 percent as having major depressive symptoms. Multiple regression analysis revealed that age (β = 0.033, p = .018) and socioeconomic status (β = 0.156, p < .001) were significantly positively associated with QOL, while increased depressive symptom scores (β = ?0.075, p < .001) were significantly negatively associated with QOL. A wide spectrum of QOL aspects were reported, including physical, emotional, social, and economic concerns by the mothers. Prevention, evaluation, and treatment of postnatal depressive symptoms and impaired QOL are warranted, taking into account the role of various biopsychosocial risk factors and specific concerns raised by the mothers.     

Prevalence of Depressive Symptoms and Depressive Disorder in Primary Care Patients Over 65 Years of Age

The aim of this study was to estimate the prevalence of depressivesymptoms and depressive disorder (ICHPPC-2-defined) in patientsover 65 years of age. A cross-sectional, partly two-phased,study was performed in general practices in The Netherlands.A total of 384 consecutive patients aged 65 and above, 116 menand 265 women were included, both during practice visits andhome visits. Depressive symptoms were recorded with the ZungSelf-rating Depression Scale, the Geriatric Depression Scale,and with physician ratings. Assessments of depressive disorderwere based on an adaptation of interview ratings with the MontgomeryÅsberg Depression Rating Scale. The proportion of patientsconsidered to have depressive symptoms ranged from 11 to 29%of patients, depending on the self-report instrument and thecut-off point. According to interviews a depressive disorderwas estimated to be present in 17%. The high prevalence of depressivesymptoms and depressive disorder suggest a higher index of suspicionof depres sion in elderly general practice patients.