A study of self-harm in older people: mental disorder, social factors and motives

Data was collected on seventy-six older people who presented to a specialist self-harm team. Data included: diagnosis, suicide intent, motives for self-harm, social contacts and life events and difficulties. The majority of elderly who harmed themselves had high suicide intent and 69% were depressed. Patients were frequently living alone with an isolated life-style and poor physical health. Depressed self-harm subjects had higher suicide intent scores than non-depressed and to gain relief from an unbearable state of mind was a frequently recorded motive for these patients. Other motives for self-harm appear to be similar between depressed and non-depressed self-harmers. It is important that older people who self-harm receive an appropriate assessment of both risk and need by an experienced mental-health professional skilled at recognising depression in later life. The need for adequate recognition and management of depression in older people in primary care is also highlighted.     

To what extent does age influence the reporting of life events?

A study of life events reporting was carried out among 64 depressed and 74 non-depressed patients. The results show that age as well as depression can affect the number and type of reported life events. The younger age group (less than 45 years) reported more events than the older group, and the depressed patients reported more events than their non-depressed counterparts. The younger group also listed more desirable events than their elders. There was no evidence of an interaction between diagnosis and age.     

Assessing quality of life: mother–child agreement in depressed and non-depressed Hungarian

Purpose  

An important question in child psychiatry is the agreement between parents and children. We studied mother–child concordance about the quality of life of children (QoL). We hypothesized that mothers of depressed children rate lower QoL than children for themselves while mothers of non-depressed children rate better QoL; that inter-informant agreement is higher in the non-depressed sample; and finally that agreement increases with age of the child.     

Autobiographical memory, depression and quality of life in multiple sclerosis

The relationship between autobiographical memory, depression and quality of life (QoL) was investigated in a study of 30 persons with severe neurodisability resulting from multiple sclerosis. Sixty percent (n = 18) of patients were found to have deficits in autobiographical memory (AMI) for incidents in their earlier life; these deficits were associated with significant impairments in personal semantic memory of facts from their past life. Patients with impaired autobiographical memory who had been diagnosed for longer than 21 years reported significantly better QoL (SF-36: Role Physical) than those diagnosed more recently, or those with normal autobiographical memory; patients who had been diagnosed for longer were also significantly less depressed than patients diagnosed more recently. Patients with normal autobiographical memory reported the highest levels of depression (HADS) and the lowest levels of QoL (Role Physical). It is concluded that impairment of autobiographical memory affects perception of QoL; patients with deficits in autobiographical memory had impaired knowledge about their past QoL and may therefore be unable to make valid comparative judgements about the quality of their present life.     

Autobiographical Memory,Depression and Quality of Life in Multiple Sclerosis

The relationship between autobiographical memory, depression and quality of life (QoL) was investigated in a study of 30 persons with severe neurodisability resulting from multiple sclerosis. Sixty percent (n = 18) of patients were found to have deficits in autobiographical memory (AMI) for incidents in their earlier life; these deficits were associated with significant impairments in personal semantic memory of facts from their past life. Patients with impaired autobiographical memory who had been diagnosed for longer than 21 years reported significantly better QoL (SF-36: Role Physical) than those diagnosed more recently, or those with normal autobiographical memory; patients who had been diagnosed for longer were also significantly less depressed than patients diagnosed more recently. Patients with normal autobiographical memory reported the highest levels of depression (HADS) and the lowest levels of QoL (Role Physical). It is concluded that impairment of autobiographical memory affects perception of QoL; patients with deficits in autobiographical memory had impaired knowledge about their past QoL and may therefore be unable to make valid comparative judgements about the quality of their present life.     

Religion,spirituality, social support and quality of life: measurement and predictors CASP-12(v2) amongst older Ethiopians living in Addis Ababa

Objectives: As African populations begin to age developing accurate measures of quality of life (QoL) in later life for use on the continent is becoming imperative. This study evaluates the measurement and predictors of QoL amongst older Ethiopians.

Method: The data come from a multi-stage cluster sample of 214 people aged 55 and over living in Addis Ababa, Ethiopia. QoL was measured using the CASP-12(v2). Confirmatory factor analysis (CFA) was used to test the properties of the scale. The relationships between social support, religiosity/spirituality and socio-demographic factors on QoL were tested with linear regression analyses.

Results: The CASP subscales exhibited good internal reliability and the CFA provides reasonable support for an 11-item 4-factor model (CFI, 0.954; RMSEA 0.075). Multivariate regression analyses suggest that both religiousness/spirituality and social support have positive relationships with QoL.

Conclusion: Older people in Africa can often be socially isolated, marginalised and in extreme poverty. Yet few studies have looked at QoL more generally and there is no accepted gold standard measurement of QoL. Yet such a development would allow researchers to directly compare QoL and the determinants of QoL amongst older Africans and those elsewhere. The results show that a modified 11-item CASP is a meaningful measure of QoL for use with older Ethiopians. Both religiousness/spirituality and social support are positively associated with QoL and might be important buffers against deprivation.     

Suitability of the WHOQOL-BREF and WHOQOL-OLD for Spanish older adults

Background: People are living longer and healthier than at any other time point in history. Therefore, in the last decade, international interest has focussed on the study of quality of life (QoL) in older people. Our aim was to study the psychometric properties of the generic QoL measure WHOQOL-BREF (WHOQOL, World Health Organization Quality of Life) and specific older adult module WHOQOL-OLD in a sample of 286 Spanish elderly.

Methods: Participants were 60 years and older from community centres, primary care centres, family associations and nursing homes. The following information was collected: demographics, self-perception of health, depressive symptoms (Geriatric Depression Scale, GDS-30), functional status (SF-12) and QoL (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using classic psychometric techniques with SPSS v15.0.

Results: We found no ceiling and floor effects, and missing data was low. The internal consistency measured by Cronbach's alpha was 0.90 for the WHOQOL-BREF total scale and 0.80 for the WHOQOL-OLD. A priori expected associations were found between WHOQOL-BREF and WHOQOL-OLD with the SF-12 and the GDS-30, indicating good construct validity. WHOQOL-BREF and WHOQOL-OLD domain scores differentiated between participants with lower and higher level of education, and between groups of older people (healthy vs. unhealthy; non-depressed vs. depressed; non-carers vs. carers and non-residents vs. residents).

Conclusions: The WHOQOL-BREF and WHOQOL-OLD questionnaires demonstrate acceptable psychometric performance in a convenience sample of Spanish older people. They are valuable measures of QoL for use with older people.     

The effect of depression on quality of life of patients with type II diabetes mellitus

Diabetes mellitus (DM) is a frequently encountered metabolic disease with chronic features and involves numerous complications throughout its course, which causes severe restriction and disability in an individual's life. It has been reported that the incidence of depression is higher in diabetic patients and that diabetes is one of the risk factors in the development of depression. It has also been reported that co-morbid psychiatric disorders cause further deterioration in the quality of life in diabetic patients. The aim of this study was to investigate the effects of depression on the quality of life in type II DM patients. Sixty patients (30 females and 30 males) with current major depressive episode diagnosed according to DSM-IV criteria, and 48 type II DM patients (30 females and 18 males) without a major depressive episode (non-depressed group) were included in the study. All patients were evaluated with a semi-structured interview form to assess the clinical features of DM, Hamilton Rating Scale for Anxiety (HRSA), Hamilton Rating Scale for Depression (HRSD), and the Turkish version of The World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF). The HRSD and HRSA scores in the depressed group were 24.87+/-4.83 and 21.07+/-5.44, respectively, whereas those in the non-depressed group were 7.83+/-3.92 and 6.88+/-3.43, respectively. The physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores were found significantly lower in the depressed group than the non-depressed group. There were significant negative correlations between HRSD and HRSA scores and physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. Furthermore, there were significant negative correlations between the HbA1c level and physical health, social relationship, environmental domain, social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. However, there was a significant positive correlation between the level of education and physical health, psychological health, social relationship, environmental social pressure domain, overall quality of life, and WHOQOL-BREF total scores. There were significant negative correlations between social relationship domain score, and age and duration of illness. Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Since treating depression would have a beneficial effect on the quality of life, clinicians should carefully assess for depression associated with type II DM.     

A cross-sectional study on the health related quality of life of depressed Chinese older people in Shanghai

BACKGROUND: With an increasing life expectancy, there is a rapidly growing sector that is aging. Depression is the most prevalent functional mental disorder of older population. It is estimated that about 21% of the older population in Shanghai are suffering from depression. AIM: This study investigated the self-rated health related quality of life of community-dwelling older people diagnosed with depression in Shanghai, and to examine the relationships between this and mental and physical health, functional status and social support. METHODS: A cross-sectional survey was conducted in two community centres with a convenience sample of 71 participants. Measures included subjective perception of health related quality of life, level of depression, cognitive function, number of medical conditions, activities of daily living, functional abilities, and social support. The majority of the participants were female (n=52, 73.23%), and married (n=51, 71.8%). RESULTS: A higher level of depression was related to a poorer health related quality of life. Participants were least satisfied with their physical health. The level of depression, activities of daily living and satisfaction with social support were predictors of health related quality of life ratings. CONCLUSION: The study identified how depression affects the bio-psychosocial status of Chinese older people. Findings are discussed in light of the socio-cultural environment in Shanghai.     

老年期抑郁症病人听觉事件相关电位P300的比较研究

目的 探讨老年期抑郁症病人的认知功能状况。方法 按CCMD-3中心境障碍抑郁发作诊断标准，收集33例60岁以上首次抑郁发作的病人(抑郁组)，32名健康老年人(对照组)。使用HAMD、HAMA和MMSE量表对所有入组者进行评定，并作P300测定。结果 抑郁组MMSE总分低于对照组。抑郁组N2和P3潜伏期比对照组延长；抑郁组的P300潜伏期N2和P3与HAMD的迟缓因子分呈正相关，与MMSE总分呈负相关。结论 老年期抑郁症病人存在认知功能障碍。     

Patterns of brain activity in patients with epilepsy and depression.

Depression is a recognized feature of epilepsy. This study tested the hypothesis that depression arising in patients with epilepsy would be associated with decreased activity in brain regions previously demonstrated to be hypoperfused both in primary depression and in depression secondary to movement disorders. Two groups of patients with temporal lobe epilepsy were studied, one of which also met DSM IV criteria for a major depressive episode. All underwent a SPECT scan using the blood flow marker,(99m)Tc-HMPAO. An automated voxel-based analysis demonstrated no regions of relatively decreased activity in the depressed compared with the non-depressed patients. Sites of relative hyperactivity in the depressed group were concentrated in the left hemisphere, particularly in dorsolateral prefrontal cortex, striatum, thalamus and temporo-parietal regions. Comparison of these data with normal population data revealed that in the depressed epilepsy group regional activities were within the normal range whilst corresponding results from the non-depressed group were below it. Depressed patients with epilepsy have cerebral regions with greater perfusion than non-depressed people with epilepsy, although they are not hyperperfused compared with normals. Our results suggest that depression in people with epilepsy may arise from a mechanism which differs from that underlying the development of depression in patients with movement disorders.     

Do pain,anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature

Introduction

The importance of elucidating the relationships between pain, mood and quality of life (QoL) amongst people with amyotrophic lateral sclerosis/motor neuron disease is evident to clinicians, yet the literature is limited and inconsistent. We explored the relationships between pain, depression, anxiety and QoL to reconcile the previous contrasting findings and inform future research and clinical practice.

Methods

Patient-reported outcomes were obtained as part of the Trajectories of Outcomes in Neurological Conditions study. Mood and QoL scales underwent Rasch analysis. Correlation coefficients examined the strength of association between variables of interest. A bivariate regression model was developed to examine the effects of pain, depression and anxiety on joint psychological and physical QoL domains.

Results

Of 636 people with ALS, 69% reported pain, of these most had mild pain. Seven percent (7%) of participants exceeded published cutoffs for probable depression and 14% had probable anxiety. Pain, depression and anxiety all influence quality of life; depression has a significant effect on both physical and psychological domains of QoL, whereas pain affects physical QoL and anxiety psychological QoL.

Conclusions

These results show the importance of expressing quality of life in a conceptually appropriate way, as failing to take account of the multidimensional nature of QoL can result in important nuances being overlooked. Clinicians must be aware that pain, depression and anxiety all worsen QoL across their ranges, and not just when pain is severe or when anxiety or depression reach case level.

     

Physical and cognitive stimulation in Alzheimer Disease. the GAIA Project: a pilot study

Several data suggest that physical activity and cognitive stimulation have a positive effect on the quality of life (QoL) of people with Alzheimer's disease (AD), slowing the decline due to the disease. A pilot project was undertaken to assess the effect of cognitive stimulation, physical activity, and socialization on patients with AD and their informal caregiver's QoL and mood. Fourteen patients with AD were randomly divided into active treatment group and control group. At the end of treatment, a significant improvement in apathy, anxiety, depression, and QoL in the active treatment group was found. Considering caregivers, those of the active treatment group exhibited a significant improvement in their mood and in their perception of patients' QoL. This study provides evidence that a combined approach based on cognitive stimulation, physical activity, and socialization is a feasible tool to improve mood and QoL in patients with AD and their caregivers.     

Religious denomination as a symptom-formation factor of depression in older Dutch citizens

OBJECTIVES: The type of symptoms in depression is likely to be influenced by cultural environment. As religion represents an important cultural resource for older adults, it is hypothesised that religious denomination represents a symptom-formation factor of depression in the older generation. Focusing on older Dutch citizens, it is expected that depressed Calvinists report: (1) less depressed affect, (2) more vegetative symptoms, and (3) more guilt feelings, than Roman Catholics and non-church members. METHODS AND PROCEDURES: The Center for Epidemiologic Studies Depression Scale (CES-D) was used to distinguish depressed (N=395) and non-depressed (N=2333) older adults, and to assess depressive symptom-profiles. The Diagnostic Interview Schedule (DIS) was used to assess major depressive episodes and criterion-symptoms of depression. RESULTS: Depressed Calvinists, especially males, had higher scores on the vegetative CES-D subscale. The same was found for non-church members with Calvinist parents. Among those who have had a major depressive episode in later life (N=84), support was found for all hypotheses. Feelings of guilt were also more prevalent among Roman Catholics. CONCLUSIONS: Religious denomination modified the type of symptoms in late-life depression. As a Calvinist background was associated with less depressive affect and more inhibition, there is a risk of underdiagnosis of major depression in older Calvinists in The Netherlands.     

The quality of life of older people with epilepsy: findings from a UK community study.

The impact of epilepsy on the quality of life of older people with epilepsy has rarely been investigated. As part of a large prevalence study of epilepsy conducted in one UK Health Region, we investigated the burden of their condition in older compared with younger people. A second analysis compared quality of life in those men and women diagnosed after the age of retirement from the workforce compared with those diagnosed before that age. Data were collected from men and women with epilepsy and from their primary and secondary care physicians. There were few differences between older and younger people with regard to their reported quality of life, though younger people were more likely to report feeling stigmatized by their condition. Older people with epilepsy diagnosed in later life were more anxious and depressed than those diagnosed earlier and their overall perception of quality of life was more likely to be negative. Our data emphasize that older people do not necessarily experience poorer quality of life than younger people, but those first diagnosed in later life do appear to have a quality of life which is more impaired. Consideration should be paid to the important psychosocial consequences of epilepsy in the older person.     

A community-based study of depression in older people in Hefei, China--the GMS-AGECAT prevalence, case validation and socio-economic correlates

OBJECTIVE: Previously published studies of prevalence of depression in older people in China showed much variation in the results, while the pooled prevalence is low. In this study we used a standardised method, the Geriatric Mental State (GMS) to investigate the prevalence of depression in older people in China, validate the GMS-AGECAT depression cases and examine the relationship between depression and socio-economic deprivation. METHODS: 1736 subjects aged > or =65 were recruited from Hefei city, China. They were interviewed at home by a survey team from Anhui Medical Universtiy using the GMS and other interviews. Their mental disorders were diagnosed by the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Chinese psychiatrists re-examined depression cases and their controls. RESULTS: 39 depressed cases were diagnosed by the GMS-AGECAT. Age-standardised prevalence was 2.2% (95% CI 1.5-2.9), which was about five-times lower than that of older people in Liverpool, UK. Agreement on depression diagnoses between the GMS-AGECAT and local Chinese psychiatrists was 83.6%, with a Kappa of 0.67 (p<0.001). Depression was significantly related to socio-economic deprivation. CONCLUSIONS: This community-based study suggested a low prevalence of depression in older people in urban China. Approved training in the use of the GMS-AGECAT in mainland China should make it possible to carry out a large scale epidemiological study on depression in the Chinese elderly population to investigate its geographic variation and risk factors. The dose-response relation between socio-economic deprivation and depression indicates that strategies for tackling inequality in depression in elderly are urgently needed in China.     

脑梗塞后抑郁与心理社会因素的关系探讨

目的　探讨脑梗塞后抑郁与病前生活事件、社会支持以及应对方式的关系。方法　采用Hamilton抑郁量表、生活事件量表、应付方式问卷、社会支持量表等工具评定 30例脑梗塞后伴明显抑郁症状的患者 ,并与 30例不伴明显抑郁症状的脑梗塞及 30名健康人进行对照。结果　负性生活事件刺激量和生活刺激总量 ,抑郁组高于非抑郁组 ,非抑郁组高于健康组 ,差异具有显著性 (P <0 .0 1)。抑郁组寻求帮助因子得分低于健康对照组 (P <0 .0 1) ;抑郁组的退避因子得分高于非抑郁组和健康对照组分 (P <0 .0 1) ;抑郁组的主观支持得分低于健康对照组 (P <0 .0 1)。结论　近期负性生活事件刺激量高、不适当的应对方式和缺乏社会支持是影响脑梗塞后抑郁症状的重要心理社会因素。     

Symptomatic and functional recovery in depression in later life

Objectives

Functional limitations give an indication of the total impact of diseases, such as depression, on individuals health and recovery. This study examines the change in several domains of functioning over 2 years in older persons depressed at baseline (non-remitted group and remitted group after 2 years) and in a non-depressed comparison group.

Methods

Data were used from a cohort study (Netherlands Study of Depression in Older persons [NESDO]) consisting of depressed older persons ≥?60 years (N?=?378) and a non-depressed comparison group (N?=?132) with 2 years of follow-up (attrition rate 24%). Functional limitations (outcome) were assessed with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire every 6 months. Total scores and domain scores were used. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at 2-year follow-up. Severity of depression (predictor) was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals.

Results

Linear mixed models showed that the level of functional limitations differed between the three groups during 2 years of follow-up. The non-remitted group had the highest level of functional limitations during 2 years, followed by the remitted group. Stable low levels of functional limitations were found for the non-depressed group. Remission from depression was accompanied by improvements in functioning, however, compared to the non-depressed comparison group significant functional limitations remained. Higher severity of depression appeared as risk factor for a declining course of functioning, especially the social aspects of functioning.

Methodological considerations

Participants that were more severely depressed and more functionally impaired at baseline had higher attrition rates than the participants that were included in the analytical sample.

Conclusion

This study showed that depression in later life has long-term debilitating effects on functioning, enduring even after remission from depression. This implies that depression treatment in later life should aim broader than just symptomatic recovery, but also include functional recovery.

     

Cognitive distortion in depressed adolescents.

Cognitive theories of the etiology of depression in adulthood have received widespread acceptance. To date there is little evidence of the role of cognitive distortion in the etiology of depression among adolescents. This study was conducted to determine whether or not cognitive distortion differentiates depressed adolescents from non-depressed adolescents. The Dysfunctional Attitude Scale, a measure of cognitive distortion, was administered to three groups of adolescents: clinically depressed; non-depressed with non-psychotic psychiatric disorders; and a non-clinical group of adolescents without psychiatric disorders. A subset of the depressed patients was re-administered the scale after they had clinically recovered from the depressive episode. The depressed adolescents had significantly greater cognitive distortion than the non-depressed adolescents. Remission of the depressive disorder was associated with a significant reduction in cognitive distortion, although the level of cognitive distortion was still significantly higher than normal.     

Altered omega-3 polyunsaturated fatty acid status in depressed post-myocardial infarction patients

OBJECTIVE: Lower levels of long-chain omega-3 polyunsaturated fatty acids (n-3 LCPUFAs) and increased inflammation have been associated with both depressive disorder and myocardial infarction (MI). The present study investigated whether patients who develop depression post-MI, have higher arachidonic acid/eicosapentanoic acid (AA/EPA) ratios than non-depressed post-MI patients and whether depressed post-MI patients have signs of increased inflammation as measured by C-reactive protein (CRP). METHOD: Serum AA/EPA ratio and plasma CRP levels were quantified in 50 post-MI patients, of which 29 were depressed and 21 non-depressed. RESULTS: Compared with the non-depressed group, depressed post-MI patients had significantly higher AA/EPA ratios. No significant difference was observed in CRP levels. CONCLUSION: Depressed post-MI patients had lower levels of n-3 LCPUFAs as measured by mean AA/EPA ratio and no signs of increased inflammation as determined by CRP levels.