Treatment of Late-Life Depression Alleviates Caregiver Burden

OBJECTIVES: To describe the burden experienced by family caregivers of older adults with depression and to examine the positive effects on caregivers of treating late-life depression.
DESIGN: Two-phase treatment study for major depressive disorder (MDD) that included 6 weeks of open treatment with antidepressant medication for all older patients followed by 16 weeks of randomized treatment for patients who were partial responders, comparing a combination of medication and interpersonal psychotherapy with medication alone.
SETTING: Primary care and university late-life mental health research clinic.
PARTICIPANTS: Adults aged 60 and older participating in a randomized trial for treatment of MDD who enrolled in a family caregiver study and their caregiver (N=244 dyads).
MEASUREMENTS: Improvement in patient symptoms during open treatment (lower scores on the Hamilton Rating Scale for Depression (HRSD)) and remission of depression during randomized treatment (3 consecutive weekly HRSD scores of ≤7) were examined as predictors of lower general caregiver burden and burden specific to patient depression.
RESULTS: Caregivers reported a moderate to high level of general caregiver burden on average. Change in patient depression during open treatment was associated with significantly decreased depression-specific burden (β=−0.22, P =.001) and a trend toward lower general burden (β=−0.08, P =.08). Caregivers of patients who remitted showed significantly decreased depression-specific burden ( F (1,76)=4.27, P =.04).
CONCLUSION: Treatment of late-life depression has benefits that extend to the family members on whom patients depend. Caregiver education and support may strengthen these effects.     

Pain-related anxiety in relation to anxiety and depression among persons living with HIV/AIDS

Persons living with HIV/AIDS (PLHA) experience clinically significant pain as a result of HIV and such pain is often related to increased levels of anxiety/depression. Pain-related anxiety has been identified as a mechanism in the onset and progression of pain experience and associated affective distress. However, there has not been empirical study of pain-related anxiety in relation to affective processes among PLHA. To address this gap, hierarchical multiple regressions were conducted using SPSS v.21 to examine pain-related anxiety (as measured using the Pain Anxiety Symptoms Scale) in relation to anxiety and depressive symptoms (as measured using the Mood and Anxiety Symptoms Questionnaire) among 93 PLHA (10.8% female; Mean age?=?49.63, SD?=?8.89). Pain-related anxiety was significantly related to anxious arousal symptoms (β?=?.43) and anhedonic depressive symptoms (β?=?.25); effects were evident beyond the variance accounted for by CD4 count, race, sex, income level, and current level of bodily pain. The present results suggest that pain-related anxiety may play a role in the experience of anxiety and depressive symptoms among PLHA.     

Patient Anxiety and Depression Moderate the Effects of Increased Self-management Knowledge on Physical Activity: A Secondary Analysis of a Randomised Controlled Trial on Health-Mentoring in COPD

Objective. Anxiety and depression are common comorbidities in people with chronic obstructive pulmonary disease (COPD). While these comorbidities could potentially lead to a higher motivation to learn about self-management, they could also inhibit patients from translating this knowledge into appropriate self-management behaviours. This paper explores the moderating effects of anxiety and depression on a health-mentoring intervention, focusing on mechanisms of change (mediation). Methods. 182 COPD patients participated in an RCT, with anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS), self-management knowledge by the Partners in Health Scale, and spontaneous physical activity using accelerometers, all measured at baseline, 6 and 12 months. The moderated mediation model tested the intervention's effect on physical activity, mediated via changes in self-management knowledge, at different levels of anxiety and depression. Results. Knowledge mediated the effect of the intervention on changes in physical activity only for participants reporting low levels of anxiety or depression. Both acted as moderators: Increased knowledge led to more physical activity among participants reporting low anxiety or depression and to less activity among highly anxious or depressed participants. Conclusion. Although health-mentoring interventions can be an effective tool to increase knowledge and physical activity among COPD patients, it is essential to take anxiety and depression into account, as increased knowledge may have detrimental effects in highly anxious or depressed participants. This suggests that patients with elevated anxiety or depression may need to be treated appropriately before engaging in chronic disease self-management interventions.     

Mental health of nurses involved with COVID-19 patients in Japan,intention to resign,and influencing factors

The purpose of this study was to investigate the association between mental health (posttraumatic stress disorder, depression, anxiety disorder, and burnout) and intention to resign, and influencing factors regarding nurses involved with COVID-19 patients in A Prefecture as subjects.The design is a cross-sectional questionnaire-based study.Methods are conducted between August 4 and October 26, 2020. Basic attributes (gender, age, years of experience, etc.) were examined. Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, Impact of Event Scale-Revised, Maslach Burnout Inventory, “intent to resign,” were used to collect data from nurses working at hospitals treating patients with COVID-19 in Japan.As a result, between 20% and 30% of nurses involved with patients with COVID-19 are in a state of high mental distress. Regarding the associations between psychiatric symptoms and intention to resign, “I want to quit being a nurse” was affected by “cynicism” and “professional efficacy”; “I want to change hospitals/wards” was affected by “cynicism”; and “subthreshold depression,” “anxiety disorder,” and “burnout” affected “I want to continue working as a nurse.” The increase in the number of patients with COVID-19 was a factor affecting mental health and intention to resign. When the number of patients increased, anxiety disorders and intention to resign also increased. Damage from harmful rumors increased the severity of every psychiatric symptom. To prepare for a pandemic such as COVID-19, it is necessary in normal times to construct psychological support systems and community systems to prevent damage from harmful rumors.     

Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards

Objective:To establish the frequency of criteria-based depression and anxiety in newly admitted medical inpatients and to determine the natural history of depressive and anxiety symptoms during hospitalization. Design:Prospective structured assessment of criteria-based depression and anxiety diagnoses within 24 hours of hospitalization with routine follow-up depression and anxiety questionnaires until discharge. Setting:A tertiary care university hospital and an affiliated Veterans Administration hospital. Patients:One hundred twenty-eight adult patients admitted to internal medicine inpatient units between May 1990 and August 1990. Main results:On admission, 43 of the 128 patients inducted met the DSM-III criteria for major depression, while an additional six met the criteria for adjustment disorder with depressed mood. Only six patients met the criteria for panic disorder, generalized anxiety disorder, or adjustment disorder with anxious mood at the time of admission to the study. Patients with high symptom scores on the anxiety and depression scales showed significant decreases in these scores without specific psychiatric intervention. Those who remained in the hospital 20 days or longer showed initial improvement and subsequently returned to baseline symptom levels of depression and anxiety. In approximately 9% of patients, symptoms of depression persisted or worsened. Conclusions:Major depression occurs more commonly than anxiety disorder in newly admitted medical inpatients but both resolve spontaneously in the majority during the course of hospitalization without specific psychiatric intervention unless the hospitalization is prolonged. One in ten will continue to show symptoms of depression. Supported by a Veterans Administration Health Services Research and Development Field Program Grant.     

Depression and anxiety before and after percutaneous coronary intervention and their relationship to age

Background and Objective Percutaneous coronary intervention (PCI) is becoming a common practice in the treatment of patients with coronary heart disease (CHD) of all age. Depression is considered to be a risk factor for the development of CHD and deteriorates the outcome after cardiac rehabilitation efforts. The aim of our study was to evaluate the presence of clinically relevant anxiety and depression in patients before and after PCI. Additionally we evaluated their relationship to age because of the increasing number of elderly patients undergoing PCI. Methods One hundred and twelve consecutive patients in three Sanatoria for Retired Cadres in Beijing who underwent PCI were asked to fill in the Hospital Anxiety and Depression Scale (HADS) to measure depression and anxiety scores two days before and ten days after PCI. Differences between these pre- and post-surgical scores were then calculated as means for changes, and the amount of elevated scores was appraised. In order to investigate the relationship between age and anxiety and depression, respectively, Spearman correlations between age and the difference scores were calculated. In addition, ANOVA procedures with the factor “age group” and McNemar tests were calculated. Results 25.8% of the patients were clinically depressed before and 17.5% after PCI; 34.0% of the patients were clinically anxious before and 24.7% after PCI. This overall change is not significant. We found a significant negative correlation between age and the difference between the two time points for anxiety (Spearman rho = -.218, P = 0.03), but not for depression (Spearman rho = -.128, P = 0.21). ANOVA and McNemar tests revealed that anxiety scores and the number of patients high in anxiety declined statistically meaningful only in the youngest patient group. Such a relationship could not be found for depression. Conclusions Our data show a relationship between age and anxiety. Younger patients are more anxious before PCI than older ones and show a decline in symptoms while elderly patients show hardly any change.     

Comparison of efficacy and safety of complementary and alternative therapies for coronary heart disease complicated with anxiety or depression disorder: A protocol for Bayesian network meta-analysis

Background:With the acceleration of the pace of life, the phenomenon of anxiety and depression in patients with coronary heart disease (CHD) is more and more common, and “psycho-cardiology” arises spontaneously. At present, the drug treatments of psycho-cardiology are difficult to achieve satisfactory results, and the side effects are obvious. Complementary and replacement therapies of CHD complicated with anxiety or depression disorder play an increasingly positive role, but there is a lack of comparison among different complementary and alternative therapies. In this study, Bayesian network meta-analysis (NMA) analysis method will be used for the first time to synthesize all the evidences of direct and indirect comparison among a variety of interventions, and rank their effectiveness and safety.Methods:Two independent researchers will search from the beginning to January 2021 mainly including randomized controlled trials (RCTs) and closely related ongoing RCTs of complementary and alternative therapies for CHD complicated with anxiety or depression disorder. And then identify, select and extract the data. The primary outcome measures are frequency of acute attack angina, severity of angina pectoris; the changed score in the validated scales, which can assess severity of anxiety or depression. Secondary outcomes include total efficacy rate, electrocardiogram improvement, traditional Chinese medicine symptoms score, changes of dosage of nitroglycerin and adverse effects. Using softwares WinBUGS 1.4.3 and STATA 16.0 for pairwise meta-analysis and NMA to comprehensively evaluate various interventions. The quality of evidences will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation.Results:This NMA will comprehensively compare and rank the efficacy and safety of a series of complementary and alternative therapies in the treatment of CHD complicated with anxiety or depression disorder.Conclusion:Supplementary and replacement therapies play an essential role in improving CHD complicated with anxiety or depression disorder. We expect that the NMA will provide reliable evidences of evidence-based medicine for treatment of CHD complicated with anxiety or depression disorder.Protocol registration number:INPLASY202120046.Ethical approval:This review does not require ethical approval.     

A review of etiologies of depression in COPD

There is significant evidence supporting an increased prevalence of depression in patients with COPD, but that depression is not a homogenous entity because there are multiple contributing etiologies for the depressive symptoms. Additionally the relationship between COPD and depression is neither exclusively linear, nor unidirectional. “Early onset” depression is defined as depression that develops prior to the diagnosis of COPD, often during an individual’s youth. This is often reflective of a genetic vulnerability to depression which increases adolescents’ risk for developing addiction to nicotine, setting up a life-long exposure to tobacco – the single greatest risk factor for the development of COPD. When COPD does develop it brings with it attendant losses, particularly in level of independent function and self image that contribute to a “reactive” depression that is not distinct from the losses experienced by those suffering with other chronic illnesses. Lastly there is increasing evidence through magnetic resonance imaging (MRI) and biochemical markers that systemic, physiologic changes associated with COPD have direct effects on the brain’s vasculature that have also been associated with depression in the elderly, termed “late onset” depression. The conclusion is that the presence of depression in a COPD patient does not reflect a single pathologic pathway. Rather the two disorders each contribute to the morbidity of the other. This review discusses the evidence supporting each of these contributors and suggests that an understanding of these varying elements can direct healthcare interventions.     

History of major depressive disorder and diabetes outcomes in diet- and tablet-treated post-menopausal women: a case control study.

AIMS: Little is known about the long-term associations between remitted major depressive disorder (MDD) and clinical diabetes outcomes. This study investigated associations between a remote history of fully remitted MDD and (i) glycaemic control, (ii) diabetes symptoms, and (iii) physical and emotional functioning in post-menopausal women with Type 2 diabetes (T2DM). METHODS: Forty-four post-menopausal women with diet- or tablet-treated T2DM participated. Twenty-three had never experienced depression and 21 had a history of MDD. All participants had been free of MDD and antidepressant treatment for > or = 1 year. RESULTS: Compared with their never-depressed counterparts, women with a history of MDD had significantly higher HbA(1c) (7.0 vs. 6.5%), more diabetes symptoms, and worse emotional functioning, after controlling for confounding variables. Differences in HbA(1c) and diabetes symptoms were not accounted for by the higher current subclinical depressive symptoms observed in the previously depressed group. Differences in emotional functioning were accounted for by current subclinical depressive symptoms. CONCLUSIONS: Most health-care providers overlook fully remitted depression. However, previously depressed patients, who outnumber currently depressed patients, may still have poorer glycaemic control than never-depressed patients.     

Effects of exercise training on older patients with major depression.

BACKGROUND: Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated. OBJECTIVE: To assess the effectiveness of an aerobic exercise program compared with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial. METHODS: One hundred fifty-six men and women with MDD (age, > or = 50 years) were assigned randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride), or combined exercise and medication. Subjects underwent comprehensive evaluations of depression, including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. Secondary outcome measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions. RESULTS: After 16 weeks of treatment, the groups did not differ statistically on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depression yielded an essentially identical result. Growth curve models revealed that all groups exhibited statistically and clinically significant reductions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combination therapy, those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms. CONCLUSIONS: An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.     

Conceptual models of psychological distress among low-income patients in an inner-city primary care clinic

Although depression and anxiety syndromes are common in primary care, many depressed and anxious patients fail to receive effective treatment. Little attention has been given to the role of illness beliefs in shaping these patients' treatment preferences and decisions. Using semistructured interviews, this study examined conceptual models of depressive symptoms among patients in an inner-city clinic. A theoretical taxonomy of patients' conceptual models of distress was developed: each category was associated with a unique pattern of treatment preferences. We conclude that patients' models of distress may play an important role in treatment-seeking decisions, and deserve further investigation.     

Subsyndromal (“Mixed”) anxiety-depression in primary care

Objective: To determine in primary care settings the prevalence, clinical characteristics, and functional status of patients who have anxious and depressive symptoms who did not meet diagnostic criteria for major mood and anxiety diagnoses. Design: Patients were screened with the General Health Questionnaire and interviewed if they exceeded the cutoff score of 5. Also, one patient whose score was below the cutoff was interviewed for every two patients whose scores were above the cutoff. Setting: Five primary care sites in the United States, France, and Australia. Patient: Two hundred sixty-seven patients presenting to their primary care physicians for general medical care and follow-up. Methods: Structured diagnostic interviews were conducted and ratings of anxiety, depression, and functional impairment were obtained by trained interviewers. Results: After adjustments for sampling, 5% of the patients had symptoms of anxiety, depression, and functional impairment, without meeting formal criteria for a major DSM-III-R mood or anxiety disorder. This was comparable to the prevalence of diagnosable DSM-III-R mood disorders but only one-fourth the prevalence of diagnosable anxiety disorders. These patients who had subsyndromal symptoms had rates of lifetime psychiatric disorders and prior psychiatric treatment comparable to those of patients meeting criteria for major mood and anxiety disorders. Conclusion: The comparable rates of symptomatic distress, functional impairment, and prior psychiatric illness and treatment suggest that patients with subsyndromal anxiety and depressive symptoms warrant clinical recognition and possibly specific treatment. Supported in part by a grant from the American Psychiatric Association.     

Can We Clinically Recognize a Vascular Depression?: The Role of Personality in an Expanded Threshold Model

The vascular depression (VD) hypothesis postulates that cerebrovascular disease may “predispose, precipitate, or perpetuate” a depressive syndrome in elderly patients. Clinical presentation of VD has been shown to differ to major depression in quantitative disability; however, as little research has been made toward qualitative phenomenological differences in the personality aspects of the symptom profile, clinical diagnosis remains a challenge.We attempted to identify differences in clinical presentation between depression patients (n = 50) with (n = 25) and without (n = 25) vascular disease using questionnaires to assess depression, affect regulation, object relations, aggressiveness, alexithymia, personality functioning, personality traits, and counter transference.We were able to show that patients with vascular dysfunction and depression exhibit significantly higher aggressive and auto-aggressive tendencies due to a lower tolerance threshold. These data indicate that VD is a separate clinical entity and secondly that the role of personality itself may be a component of the disease process. We propose an expanded threshold disease model incorporating personality functioning and mood changes. Such findings might also aid the development of a screening program, by serving as differential criteria, ameliorating the diagnostic procedure.     

Late-life depression: rationalizing pharmacological treatment options

BACKGROUND: Depressive symptoms in late life are a major concern as they increase disability and aggravate existing medical conditions. Depression is underrecognised and undertreated in the elderly, be it due to somatic symptoms, comorbid physical illness or anxiety, or because it is accepted as a normal feature of ageing. There is little doubt that effective and well-tolerated antidepressant therapy is required. OBJECTIVE: This paper reviews the antidepressant treatment options for late-life depression (selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, mixed noradrenergic and serotonergic agents), in terms of their efficacy, safety and pharmacokinetics in elderly patients. RESULTS: In addition to proven efficacy, selection of an antidepressant agent for late-life depression must be based on an understanding of safety and pharmacokinetic issues associated with each agent. Comorbid conditions and lifestyle characteristics of the elderly that are different to those encountered in the younger adult population should also be considered. CONCLUSIONS: To date, published clinical evidence in the elderly suggests that the first-choice agents for treating late-life depression are the SSRIs.     

Is there really a ‘J‐shaped’ curve in the association between alcohol consumption and symptoms of depression and anxiety? Findings from the Mater‐University Study of Pregnancy and its outcomes*

AIMS: To determine the nature of the association between alcohol consumption and symptoms of anxiety and depression in women. DESIGN: Prospective cohort study of women (n = 4527) who received antenatal care at a major public hospital (Mater Misericordiae Hospital) in South Brisbane between 1981 and 1984 and who have follow-up data on alcohol use, depressive and anxiety symptoms over a 14-year period. FINDINGS: At the 5-year follow-up there was a 'J-shaped' association between alcohol consumption and both symptoms of depression and of anxiety. However, at the baseline assessment and the 14-year follow-up alcohol consumption was linearly and positively associated with depressive symptoms with increasing prevalence of symptoms with greater consumption. At the 5-year follow-up the prevalence of depressive and anxiety symptoms among those who were abstainers at both baseline and 5-year follow-up was similar to that among those who had been previous drinkers and then become abstainers (P = 0.67). Similarly, the prevalence of these symptoms was the same at the 14-year follow-up comparing those who had been abstainers at baseline, 5-year and 14-year follow-up to those who had previously consumed alcohol but were then abstainers. CONCLUSIONS: The nature of the association between alcohol consumption and symptoms of depression and anxiety may vary across their life course in women. Previous drinkers who become abstainers do not appear to be at any higher risk of symptoms of depression or anxiety compared to those who always abstained, suggesting that increased symptoms in abstainers at age 30 is not due to 'sick quitters'. The association of high alcohol consumption with symptoms of depression and anxiety may be confounded by low income and smoking.     

Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study

AimsWe examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type.MethodsCross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10.ResultsIn both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone.ConclusionsComorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.     

Effects on mood of a bogus weight gain

This study investigated the extent to which just one weighing session influenced mood using an experimental, independent measures design. Female undergraduates (N = 97) were divided into two groups who each weighed themselves and completed anxiety and depression inventories. Two sets of weighing scales were used, one of which was altered to show 7 lb (3.18 kg) above true weight. Participants who weighed themselves on the altered scales showed significantly higher levels of anxiety and depression than those using accurate scales. Merely thinking weight had been gained was sufficient to demonstrate an increased level of both anxiety and depression. Considering the extent to which one's weight varies naturally, weighing in as higher than a personal norm is likely to be a common experience if weighing takes place frequently. Some women may be unwittingly inducing anxious and depressed moods by what they assume to be a harmless activity. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Mood disorders. Effective management of major depressive disorder in the geriatric patient

Major depressive disorder (MDD), commonly called depression, is characterized by a collection of psychologic, somatic, physical, behavioral, and cognitive symptoms that interfere with or prevent the execution of normal daily responsibilities and activities (e.g., work, exercise, hobbies, intellectual pursuits). Older persons with MDD are likely to present with weight loss and suicidal ideation or a preoccupation with death. Also common is irritability, anxiety, a change in functional ability, or some combination of these. Pharmacotherapy is an effective intervention for management of MDD symptoms. It can be used in combination with psychotherapy, or as monotherapy in patients who do not respond to psychotherapy and other nondrug interventions.