Proximity to healthcare clinic and depression risk in South Africa: geospatial evidence from a nationally representative longitudinal study

Proximity to primary healthcare facilities may be a serious barrier to accessing mental health services in resource-limited settings. In this study, we examined whether the distance to the primary healthcare clinic (PHCC) was associated with risk of depression in KwaZulu-Natal Province, South Africa. Depressive symptoms and household coordinates data were accessed from the nationally representative South African National Income Dynamics Study. Distances between households and their nearest PHCCs were calculated and mixed-effects logistic regression models fitted to the data. Participants residing <6 km from a PHCC (aOR?=?0.608, 95% CI 0.42–0.87) or 6–14.9 km (aOR?=?0. 612, 95% CI 0.44–0.86) had a lower depression risk compared to those residing ≥15 km from the nearest PHCC. Distance to the PHCC was independently associated with increased depression risk, even after controlling for key socioeconomic determinants. Minimizing the distance to PHCC through mobile health clinics and technology could improve mental health.     

Vascular nutritional correlates of late-life depression.

OBJECTIVE: The authors sought to examine the association of vascular nutritional factors and depression in an elderly cohort of depression (currently and recently depressed) and comparison (never depressed) subjects. METHOD: Nutrient intake over the past year was assessed in 196 elderly depression and comparison individuals with a Block 1998 food-frequency questionnaire. Nutrient intake, body mass index, and Keys score (a measure of the serum cholesterol-raising capacity of the diet) were determined. Subjects were age 60 and over and were participants in a longitudinal study of major depression. All subjects received psychiatric and medical comorbidity assessments; depression subjects also received psychiatric treatment. RESULTS: Vascular nutritional factors differed between depression and comparison subjects. The depression group had higher intake of saturated fat and cholesterol, higher body mass indices, lower alcohol intake, and higher Keys score than the comparison group. After controlling for age, sex, education, race, and medical comorbidity, associations remained for cholesterol, alcohol, and Keys score. Depression was found to be associated with overall dietary pattern as defined by total kilocalories, saturated fat, cholesterol, body mass index, polyunsaturated fat, sodium, and alcohol. CONCLUSIONS: This study provides evidence that dietary vascular risk factors differ in individuals with current or prior depression when compared with individuals with no history of depression.     

The natural history of late-life depression: a 6-year prospective study in the community

BACKGROUND: Accurate assessment of the natural history of late-life depression requires frequent observation over time. In later life, depressive disorders fulfilling rigorous diagnostic criteria are relatively rare, while subthreshold disorders are common. The primary aim was to study the natural history of late-life depression, systematically comparing those who did with those who did not fulfill rigorous diagnostic criteria. METHODS: Within the Longitudinal Aging Study Amsterdam, a large cohort of depressed elderly persons (n = 277) was identified and followed up for 6 years, using 14 observations. Depression was measured using self-reports (the Center for Epidemiological Studies Depression Scale) and diagnostic interviews (the Diagnostic Interview Schedule). The natural history was assessed for symptom severity (Center for Epidemiological Studies Depression Scale score), symptom duration, clinical course type, and stability of diagnoses. RESULTS: The average symptom severity remained above the 85th percentile of the population average for 6 years. Symptoms were short-lived in only 14%. There were remissions in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32% (percentages do not total 100 because of rounding). Comparing the outcome, there was a clear gradient in which those with subthreshold disorders had the best outcome, followed by those with major depressive disorder, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases, while this group was at high risk of developing DSM affective disorders. CONCLUSIONS: The natural history of late-life depression in the community is poor. DSM affective disorders are relatively rare among elderly persons, but do identify those with the worst prognosis. However, subthreshold depression is serious and chronic in many cases.     

Psychotic late-life depression: a 376-case study.

The aim of the report was to study clinical differences between psychotic late-life depression and psychotic depression in younger patients, to determine if differences were age-related or specific for psychotic late-life depression. Three hundred seventy-six consecutive outpatients, presenting for treatment of unipolar or bipolar depression (with or without psychotic features), were assessed by means of the Structured Clinical Interview for DSM-IV, the Montgomery and Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. Results showed that psychotic late-life (50 years or more) depression, versus psychotic depression in younger patients, was associated with significantly higher age at study entry/onset, longer duration, and lower comorbidity. Psychotic depression versus nonpsychotic late-life depression, in late-life and in younger patients, was associated with significantly greater severity, lower comorbidity, more patients with bipolar I disorder, and fewer patients with unipolar disorder. Findings were related to psychosis or to age, and not to specific features of psychotic late-life depression. These results support a unitary view of psychotic depression.     

Neuropsychological functioning and social anhedonia: three-year follow-up data from a longitudinal community high risk study

Social anhedonia is a promising vulnerability marker for schizophrenia-spectrum pathology. Prior research has demonstrated that individuals with psychometrically-defined social anhedonia show a range of “schizophrenia-like” neurocognitive abnormalities. However, this research is limited in that it is based largely on the study of college students. The present article reports findings from a longitudinal study of social anhedonia recruited from a community sample. As part of this study, a neurocognitive battery was administered at baseline and at three-year follow-up sessions to participants with (n = 78) versus without (n = 77) social anhedonia. Additional measures of global functioning and schizotypal, schizoid and paranoid schizophrenia-spectrum symptoms were also administered. Across groups, subjects showed significant improvement in neurocognitive functioning over time. Compared to controls, at follow-up, individuals with social anhedonia showed significantly poorer attentional vigilance and simple processing speed, but failed to evidence impairments in immediate or delayed verbal memory, immediate or delayed visual memory, visual or verbal working memory, olfaction or executive abilities. At follow-up, within the social anhedonia group, schizoid (and to a lesser extent, schizotypal) symptom severity was associated with a range of neurocognitive impairments. Neurocognitive impairments were generally not associated with paranoid symptoms or global functioning. Baseline neurocognitive performance was not significantly predictive of follow-up symptom severity or functioning. Collectively, these findings suggest that neurocognitive dysfunctions only characterize a subset of individuals with social anhedonia.     

Exposure to pesticide as a risk factor for depression: A population-based longitudinal study in Korea

BackgroundExposure to pesticides is associated with mental disorders, including depression, especially among occupationally exposed populations, such as farmers. The results of experimental studies ascribed the negative effects of pesticides on mental health to their neurotoxic and endocrine-disrupting activities.PurposeThis study aimed to investigate the association between the risk of depression and high- or low-level exposure to pesticides in a rural population.MethodsThis longitudinal study was performed in 2005–2008 (baseline) and 2008–2012 (follow-up) to evaluate the risk of depression among 2151 Korean adults. A standardized questionnaire was used to obtain information on depression upon self-reported exposure to pesticide based on the Center for Epidemiologic Studies Depression Scale. Logistic regression analysis was performed to evaluate the association between pesticide exposure and depression. We adjusted the data for age, cigarette smoking status, current alcohol use, monthly income, educational level, marriage status, and religion.ResultsAmong the individuals who reported depression, the number of participants who used pesticides was significantly higher than that who did not (N = 61 [7.2%] vs. N = 54 [4.2%], P = 0.003). A positive association was noted between >20-year period of pesticide use and depression (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.41–3.88). Individuals who reported depression showed greater odds of being exposed to higher pesticide concentrations (OR, 2.33; 95% CI, 1.40–3.88) and experiencing pesticide poisoning (OR, 5.83; 95% CI, 1.80–18.86) than those who did not.ConclusionExposure to pesticides at a high concentration was found to be associated with depressive symptoms among Korean adults.     

Pharmacologic response to a diagnosis of late-life depression: A population study in Quebec.

OBJECTIVE: To identify predictors of receiving psychoactive medication and receiving recommended first-line pharmacotherapy in individuals with newly diagnosed late-life depression. METHODS: We undertook a retrospective database cohort study of 5258 beneficiaries of the Quebec provincial health insurance plan between 1999 and 2002. Subjects were aged 65 to 84 years and diagnosed with depression by primary care physicians or psychiatrists between October 2000 and March 2001; they had no depression diagnosis in the previous year. We defined receipt of psychoactive medication as having a pharmacy claim in the year following the depression diagnosis. We determined receipt of recommended first-line pharmacotherapy from the first psychoactive medication dispensed following diagnosis and defined it accordingly; we defined first-line pharmacotherapy according to the 2001 Canadian Psychiatric Association guidelines. We used multivariate generalized estimating equations models to identify the determinants of the 2 outcomes. RESULTS: A total of 4421 (84.1%) patients received psychoactive medication following diagnosis; 2623 (59.3%) patients had not received antidepressants in the previous year. Of these, 1310 (49.9%) received recommended first-line pharmacotherapy. Independent predictors of receiving psychoactive medication were female sex, depression not otherwise specified (NOS), increasing comorbidity, and living in rural areas. Independent predictors of receiving recommended first-line pharmacotherapy were male sex, depression NOS, receiving medication in the month following diagnosis, and having the same physician diagnosing and treating the patient. CONCLUSION: Male sex and continuity of care predicted that patients had the recommended medication dispensed.     

Trajectories of depression in adolescents and young adults in Vietnam during rapid urbanisation: evidence from a longitudinal study

Objectives: This paper investigates the trajectories of depression symptoms in adolescents and young adults, and explores factors associated with their depression.

Method: For each respondent, three waves of data were collected in 2006, 2009 and 2013 from adolescents and young adults aged 10 to 24 years. The modified Center for Epidemiological Studies Depression Scale was used to interview participants, while the generalised estimating equation (GEE) model was used to identify whether certain factors were associated with depression.

Results: The mean depression scores in 2006, 2009 and 2013 were 29.76, 30.80 and 30.51 respectively. Compared to boys, girls reported higher initial levels of depressive symptoms. The depression score was found to be highest among adolescents aged 15 to 17 years. Depression among young people was associated with age, gender, marital status, education levels, general health and living location.

Conclusion: Using longitudinal design, this research demonstrated the different trajectories of depression scores between boys and girls over time and provided evidence for interventions improving adolescent mental health in a semi-urban area of Vietnam.     

Citalopram versus nortriptyline in late-life depression: a 12-week randomized single-blind study

OBJECTIVE: The aim of this single-blind study was to examine the efficacy and tolerability of citalopram compared to nortriptyline in moderate to severe major depressive patients aged 60 years or over. Method: In- and out-patients (N=58) with unipolar major depression were randomized to 12-week flexible dose treatment with nortriptyline or citalopram. RESULTS: No significant differences between the number of drop-outs in either group were observed, but the autonomic side-effects were significantly higher for nortriptyline than for citalopram. A significantly higher remission rate to nortriptyline than to citalopram was demonstrated, particularly if severe patients (endogenous or psychotic patients) were assessed. CONCLUSION: The remission rate to a therapeutic plasma level of nortriptyline appears to be higher than the remission rate to a standard dose of citalopram in a group of elderly major depressed patients, especially those with endogenous or psychotic features. On the other hand, citalopram appears to be better tolerated.     

Sex differences in the course of depression: evidence from a longitudinal study of a representative sample of the Belgian population

Outcome studies of major depression indicate high rates of relapse and chronicity, and social role theories imply that chronicity should be greater for women, together suggesting that the well-known sex difference in depression is, at least partially, the result of differences in chronicity. Due to a lack of prospective, longitudinal research, answers to this empirical question are missing. Furthermore, the results of the few available surveys of the general population are inconsistent, showing either higher chronicity for older women or a lack of sex differences in the overall course of depression. Using data from three waves of the Panel Study of Belgian Households (complete data for 3204 women and 2907 men, aged 16 years and older) sex differences in the persistence of depressive behavior are estimated. Depression is measured using a self-report inventory on three occasions separated by intervals of 1 year (1992, 1993, 1994). Results show a significant influence of sex, other sociodemographic characteristics, and depression severity at baseline on depression persistence. Women experience more symptoms for a longer period of time, a difference that can be partially ascribed to sex differences in employment status, education, and marital status. The findings are discussed. Accepted: 30 January 1998     

Incomplete response in late-life depression: getting to remission

Incomplete response in the treatmen tof late-life depression is a large public health challenge: at least 50% of older people fail to respond adequately to first-line antidepressant pharmacotherapy, even under optimal treatment conditions. Treatment-resistant late-life depression (TRLLD) increases risk for early relapse, undermines adherence to treatment for coexisting medical disorders, amplifies disability and cognitive impairment, imposes greater burden on family caregivers, and increases the risk for early mortality, including suicide, Gettinq to and sustaininq remission is the primary goal of treatment yet there is a paucity of empirical data on how best to manage TRLLD. A pilot study by our group on aripiprazole augmentation in 24 incomplete responders to sequential SSRI and SRNI pharmacotherapy found that 50% remitted over 12 weeks with the addition of aripiprazole, and that remission was sustained in all participants during 6 months of continuation treatment In addition to controlled assessment, evidence is needed to support personalized treatment by testing the moderating role of clinical (eg, comorbid anxiety, medical burden, and executive impairment) and genetic (eg, selected polymorphisms in serotonin, norepinephrine, and dopamine genes) variables, while also controlling for variability in drug exposure. Such studies may advance us toward the goal of personalized treatment in late-life depression.     

Low birth-weight and risk for major depression: A community-based longitudinal study

The current study examines the association between low birth weight and risk for major depression from early adolescence to early adulthood. It accounts for eight documented confounders, and depression within families. Data were analyzed from the National Longitudinal Survey of Youth 1979 on mothers and offspring. Major depression was assessed with the Center for Epidemiologic Studies Depression Scale Short-Form (CES-D-SF) among offspring (N=3398) biannually, from 2000 to 2010 (aged 14–25). Competing models were examined with survival analysis and Generalized Estimated Equations (GEE). CES-D-SF based major depression was reported by 33.46% (n=1137) of participants. Among persons with very low birth weight (<1500 g), 47.5% (n=19/40) were classified with CES-D-SF depression (OR=1.81, 95% CI=0.97, 3.39). Similar results were found with survival analysis (HR=1.97, 95% CI=0.97, 4.01). Among multiple offspring families, GEE modeling showed a similar trend. On aggregate (unadjusted OR=2.46, 95% CI=1.07, 5.63; adjusted OR=2.43, 95% CI=0.94, 6.23), and within families of mothers with CES-D-SF depression (unadjusted OR=2.54, 95% CI=0.55, 11.66; adjusted OR=1.79, 95% CI=0.28, 11.42). Compelling evidence is lacking in favor of an association between very low birth weight (<1500 g), and suspected major depression from early adolescence to early adulthood after accounting for documented confounders.     

Incidence and risk factors for depression and anxiety disorders: results from a 34-year longitudinal Swedish cohort study

This study is based on a total cohort (N = 192) of people born in 1902 and 1903 and living in southern Sweden. Subjects were assessed at baseline when 67 years of age and on eight further occasions over 34 years or until death. The participation rate in the nine examinations ranged from 78-100%. Interviews, psychological tests, and medical examinations were used as well as information on medical diagnoses from primary health care records and hospital records. The cumulative probability for the development of clinical depression during the follow-up was 8% and for anxiety 6%. The incidence rate for depression and for anxiety was highest during the period 67-81 years. Persons with poor financial status were more likely to be diagnosed with depression but no significant risk factor for anxiety was found. Only 14% developed depression and anxiety during the follow-up period, females more often than men. The strongest risk factors for the development of depression were perceived economic problems.     

A daily diary study of late-life depression.

OBJECTIVE: The objective of this study was to use data from daily diaries to characterize the day-to-day variability in positive and negative affects, and the relationship between daily events and daily affects in primary care patients with late-life depression. METHOD: Daily diary data were obtained from primary care patients with major depression (N = 25) and other depressive disorders (N = 33); data from a two-week period were compared with those from elderly normal volunteer comparison subjects (N = 70) who participated in other studies. RESULTS: There was significant day-to-day variability in negative affect in patients with major depression and other depressive disorders. Dysphoric days (days with a negative affect ratings that occurred once every two weeks in normal subjects) represented 65.3% (standard deviation [SD]: 37.1) of days in those with major depression and 50.6% (SD: 37.6) in those with other depression versus 7.7% (SD: 16.3) in normal subjects (F = 36.0, p <0.001). The groups did not differ significantly in the number of positive and negative events reported, but the proportion of dysphoric days that occurred in association with negative events was greater in normal subjects than in those with major depression. Mixed-effects analyses demonstrated that patients with major depression had blunted positive affective responses to positive events, consistent with impairments in hedonic processes, and that patients with other depressions exhibited heightened negative affective responses to negative events, greater than those in normal subjects and patients with major depression. CONCLUSIONS: Diary methods demonstrated characteristics of late-life depression that have not been identified with assessment methods that have lower time resolution.     

Vascular risk factors are associated with faster decline of Alzheimer disease: a longitudinal SPECT study

We investigated the effects of cardiovascular risk factors, such as hypertension, diabetes mellitus, and hypercholesterolemia, on longitudinal regional cerebral blood flow (rCBF) changes in Alzheimer’s disease (AD). We followed 68 outpatients with probable AD for an average of 40 months. They were divided into three groups based on no (n = 24), single (n = 27), and multiple (n = 17) vascular risk factors. We assessed longitudinal changes on the Mini-Mental State Examination, Functional Assessment Staging scores, and in rCBF deficits using repeated single photon emission computed tomography (SPECT) using N-isopropyl-p-[¹²³I] iodoamphetamine. During follow-up, the multiple vascular risk factor group showed faster cognitive and functional decline than the no and single vascular risk factor groups. When compared with the initial SPECT, the follow-up SPECT showed a significant rCBF reduction in widespread regions, including the parietotemporal, frontal, and limbic lobes, in the multiple and single vascular risk factor groups, while there was rCBF reduction in small scattered regions of the temporoparietal lobe in the no vascular risk factor group. Multiple vascular risk factors are associated with a greater rate of decline in cognition, function, and rCBF in patients with AD. Our results highlight the contribution of vascular risk factors on the progression of AD.