The association between past and current physical activity and depressive symptoms in young adults: a 10-year prospective study

PurposeThe objectives of this study were to assess (1) the longitudinal associations of past moderate-to-vigorous physical activity (MVPA) and involvement in team sports during secondary school with depressive symptoms in early adulthood, and (2) the cross-sectional associations of current MVPA and involvement in team sports with depressive symptoms during young adulthood.MethodsData were drawn from the Nicotine Dependence in Teens study, which is an ongoing prospective cohort study of 1293 adolescents aged 12–13 years at baseline (52% female). Data analyses involved latent growth curve modeling and multiple hierarchical linear regression models.ResultsCurrent MVPA (β = ?0.12), but not past MVPA, participation was significantly negatively related to depressive symptoms during young adulthood (P < .05). Both current and past involvement in team sports were significantly negatively related to depressive symptoms (β ≥ ?0.09; P < .05); however, these associations were no longer significant (P = .08) when covariates were controlled for.ConclusionsFindings provide insight about the unique associations between the timing and type of physical activity and depressive symptoms, suggesting that physical activity within team sport contexts should be encouraged so that young adults may experience less depressive symptoms.     

Life events,perceived stress and depressive symptoms in a physical activity intervention with young adult women

ObjectiveExamine interactive effects of life events, perceived stress and depressive symptoms during a randomized controlled aerobics intervention among women (aged 18–30) in the urban U.S. Midwest, 2006–2009.MethodParticipants [n = 372 at baseline and n = 303 at follow-up] completed perceived stress, depressive symptoms and life events scales at baseline and 5–6 month follow-up. Life events were correlated with perceived stress and depressive symptoms scales using Pearson correlation. Multivariate linear regression tested the relationship between the 20 most common life events with perceived stress and depressive symptoms. Regression models explored relationships between life events, perceived stress and depressive symptoms and the intervention effect.ResultsHigher levels of perceived stress and depressive symptoms correlated with more life events. At baseline, for every additional life event, depressive symptoms were higher; follow-up showed marginal significance with depressive symptoms, but a strong positive association with perceived stress. In the stratified model, for every life event at follow up, the perceived stress scale increased by 0.68 in the exercise group, but not in the controls. For every life event at follow-up, depressive symptoms were higher in controls, but not in the exercise group.ConclusionPerceived stress and depressive symptoms co-occurred with life events at baseline and follow-up for participants. At follow up, perceived stress increased significantly among exercisers; depressive symptoms were significantly higher among controls. Findings suggest that new participation in structured physical activity entails a change in daily life that may buffer against depressive symptoms in relation to life events but not perceived stress.     

Physical activity characteristics and depressive symptoms in older Latino adults

BackgroundPhysical activity (PA) has been consistently associated with fewer depressive symptoms in observational and intervention studies. Emphasis on leisure-time PA, reliance on self report measures of PA, and lack of inclusion of racial/ethnic minority populations have contributed to uncertainty regarding the minimal and optimal dose (minutes/day), intensity (i.e., light, moderate, or vigorous), bout duration (i.e., incidental vs. 10-min bouts), and domain (i.e., leisure-time, occupational, and household) of PA for reducing and preventing depressive symptoms across diverse populations.PurposeTo investigate the relationship between PA characteristics (i.e., dose, intensity, bout duration, and domain) and depressive symptoms in older Latinos using both objective and subjective measures of PA.MethodsOlder Latinos (n = 174) completed questionnaires and wore accelerometers for seven days. Accelerometer output provided daily minutes of sedentary, light, and moderate-vigorous PA (MVPA) overall and in 10-min bouts. The Community Healthy Activity Model Program for Seniors (CHAMPS) questionnaire provided daily minutes of leisure-time PA, household PA, and sedentary activities. Hierarchical linear regression analysis was used to predict Center for Epidemiological Studies Depression Scale (CES-D) score.ResultsAfter controlling for established correlates of depressive symptoms (i.e., demographics, acculturation, and health characteristics), MVPA in ≥10-min bouts independently predicted fewer depressive symptoms (β = ?.231, ΔR2 = .052, p ≤ .01) and household PA greater depressive symptoms (β = .263, ΔR2 = .056, p ≤ .001).ConclusionsResults suggest that PA intensity, bout duration, and domain influence the strength and direction of the relationship between PA and depressive symptoms in older Latino adults.     

The role of physical activity enjoyment on the acute mood experience of exercise among smokers with elevated depressive symptoms

ProblemDepressive symptoms are consistently shown to be related to poor smoking cessation outcomes. Aerobic exercise is a potential treatment augmentation that, given its antidepressant and mood enhancing effect, may bolster cessation outcomes for smokers with elevated depressive symptoms. Lower enjoyment of physical activity may inhibit the acute mood enhancing effects of aerobic exercise. The current study investigated the associations between depressive symptoms, physical activity enjoyment and the acute mood experience from exercise among low-active smokers with elevated depressive symptoms.MethodDaily smokers with elevated depressive symptoms (N = 159; M_age = 45.1, SD = 10.79; 69.8% female) were recruited for a randomized controlled exercise-based smoking cessation trial. Participants self-reported levels of depressive symptoms, physical activity enjoyment, and rated their mood experience (assessed as “mood” and “anxiety”) before and after a standardized aerobic exercise test.ResultsHierarchical regression analysis revealed that depressive symptom severity accounted for significant unique variance in physical activity enjoyment (R² = 0.041, t = −2.61, p = 0.010), beyond the non-significant effects of gender and level of tobacco dependence. Additionally, physical activity enjoyment was a significant mediator of the association between depressive symptom severity and acute mood experience (“mood” and “anxiety”) following the exercise test.ConclusionsPhysical activity enjoyment may explain, at least in part, how depressive symptom severity is linked to the acute mood experience following a bout of activity. Interventions that target increasing physical activity enjoyment may ultimately assist in enhancing the mood experience from exercise, and therefore improve smoking cessation likelihood, especially for smokers with elevated depressive symptoms.     

A pilot study to assess the feasibility and acceptability of a community based physical activity intervention (involving internet,telephone, and pedometer support), integrated with medication and mood management for depressed patients

ObjectiveTo assess the feasibility and acceptability of a multi-component intervention to treat depression in primary care.MethodsA single group prospective design was used to examine the feasibility and acceptability of a 12-week intervention combining antidepressant medication, brief behavioral counseling and physical activity (PA) promotion, and also associated changes in depression and various self-reported measures. A sample of adults with mild-to-moderate major depression and willingness to take antidepressant medication were recruited through local primary care clinics. A Research Nurse Practitioner (RNP) prescribed the selective serotonin reuptake inhibitor, escitalopram (10–20 mg), and provided brief weekly counseling. In addition participants received a pedometer, printed materials, and weekly emails addressing behavioral skills to increase their physical activity. Participants' depressive symptoms, quality of life and PA attitudes were surveyed at baseline, 6 and 12 weeks. At week 12 they also reported their satisfaction with the study components.ResultsOf the 36 participants recruited, 64% of participants completed measures at week 12, 30% completed all 12 counseling sessions and 60% responded to half the emails. By week 12, participants reduced their depressive symptom scores (by 4.7; p < .001), improved their quality of life scores (by 9.7; p < .001) and increased their daily step counts (by 2449.2; p < .03). Of the 23 who responded, over 70% thought the pedometer, calls and print materials helped improve their mood. Those who completed more counseling were more likely to reduce their depressive symptoms at week 12 (r = −.46; p < .05).ConclusionThis pilot study demonstrated the feasibility and acceptability of a multi-component intervention to reduce depressive symptoms in a sample of mild-to-moderately depressed adults.     

An examination of the reciprocal associations between physical activity and anxiety,depressive symptoms,and sleep quality during the first 9 weeks of the COVID-19 pandemic in Belgium

During the initial outbreak of the global COVID-19 pandemic, many countries imposed a total lockdown (containment at home). Although it was still allowed in Belgium to be physically active or exercise with people from your household in the vicinity of your home, engaging in sports or physical activity in a group or club context was no longer permitted. To examine whether a lack of physical activity was potentially threatening to the mental well-being of citizens and vice versa, the present study examined concurrent and reciprocal relationships between physical activity and anxiety, depressive symptoms, and sleep quality during the COVID-19 lockdown in a 9-week longitudinal design. In a sample of 983 Belgian adults (75.1% female; M_age = 43.78, range = 18–82 years), we explored these relationships at both the between- and within-person levels through random intercept cross-lagged panel models. The findings indicate that more physical activity was associated with lower symptoms of anxiety and depression and better sleep quality, a finding observed both at the between-person (across weeks; β_anxiety = −0.25, β_depression = −0.30, β_{sleep quality} = 0.24, p < .001) and within-person level (within weeks; β_anxiety = −0.10, β_depression = −0.14, β_{sleep quality} = 0.11, p < .05). Moreover, at the within-person level, an increase in feelings of anxiety and depression at one moment predicted lower levels of physical activity one week later (β_anxiety = −0.04, β_depression = −0.06, p < .05). Since poor mental health poses a threat to the maintenance of physical activity, the current findings suggest that it is critical to invest in the mental health of individuals during distressing times.     

Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination

PurposePrevious studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumption.MethodsInterviews were conducted with 5,147 children and their caregivers from three sites at child ages 11, 13, and 16. At each time point, youth reported on their frequency of consuming soft drinks, aggressive behavior, and depressive symptoms. An autoregressive cross-lagged path model tested reciprocal relationships between soft drink consumption, aggressive behavior, and depressive symptoms over time.ResultsMore frequent consumption of soft drinks was associated with more aggressive behavior at each time point and depressive symptoms at ages 11 and 13 (r = .04 to .18, p ≤ .002). After adjusting for covariates and stability of each behavior over time, soft drink consumption at ages 11 and 13 predicted more aggressive behavior at the next time point (β = .08 and .06, p < .001). Aggressive behavior at age 13 also predicted more soft drink consumption at age 16 (β = .06, p = .002). Soft drink consumption at age 13 predicted fewer depressive symptoms (β = ?.04, p = .007), but depressive symptoms did not predict soft drink consumption.ConclusionsMore frequent consumption of soft drinks may contribute to aggressive behavior in adolescents over time; there is some support for reciprocal relationships. There is no evidence for soft drink consumption contributing to adolescents' depression. Future research should examine longitudinal effects over shorter intervals.     

Technology acceptance and trust: Overlooked considerations in young people's use of digital mental health interventions

ObjectivesDigital mental health interventions (DMHIs) have potential to provide support at scale for young people, yet uptake is low. The present study investigated whether attitudes towards technology solutions in relation to perceived usefulness, perceived ease of use, and trust of DMHIs influenced young people's intentions to use DMHIs.MethodsYoung people aged 17–25 (N = 248) were recruited online via advertising (e.g., Facebook, Twitter) to a survey assessing attitudes of technology acceptance and intentions to use DMHIs, previous use of DMHIs, demographics, and mental health need.ResultsParticipants reported relatively neutral attitudes towards DMHIs. Outcomes from linear regression indicated that greater perceived usefulness (β = .24) and trust of DMHIs (β = .28) have significant small to moderate positive associations with higher intentions to use DMHIs. Perceived ease of use (β = .07) was not associated with intentions to use DMHIs. Gender, age, previous use of DMHIs, and mental health need did not moderate unique associations between intentions to use DMHIs and perceived usefulness, perceived ease of use, and trust of DMHIs.ConclusionsModerate levels of technology acceptance for mental health, particularly in domains of perceived usefulness and trust of DMHIs, may represent a barrier to DMHI adoption among young people. Developers and service providers are recommended to provide information about the usefulness, effectiveness, and trustworthiness of DMHIs to improve uptake among young people.     

Correlates of Physical Activity Engagement among Pregnant Women with Overweight and Obesity

BackgroundExcess weight during pregnancy increases risk for adverse obstetrical outcomes. Physical activity (PA) may buffer these effects, although it is unclear what factors are associated with PA in women who begin pregnancy with overweight/obesity. The present study sought to characterize the demographic and psychological correlates of PA among women with prepregnancy overweight/obesity.MethodsPregnant women (N = 249; mean age, 28.48 ± 5.48 years; mean body mass index, 34.13 ± 7.07 kg/m²) at 12–20 weeks of gestation (mean, 15.68 ± 2.44 weeks of gestation) completed ratings of perceived stress and depressive symptoms and were interviewed using the pregnancy version of the Eating Disorders Examination. The Paffenbarger Physical Activity Survey was administered via interview to estimate energy expenditure. Continuous outcomes were evaluated via linear regression, while logistic regression was conducted to assess likelihood of meeting PA guidelines.ResultsMean weekly duration of moderate to vigorous PA was 109.50 ± 248.17 minutes, with 21% of women meeting federal PA guidelines of 150 minutes or more. Higher perceived stress (β = –0.217; p = .02) and eating psychopathology (β = –0.213; p < .01) were associated with lower total energy expenditure. Black women reported lower expenditure specifically from walking compared with White women (β = –0.180; p = .03). Depressive symptoms were not associated with PA. No estimate of PA predicted body mass index.ConclusionsPregnant women with overweight/obesity engage in modest amounts of PA early in pregnancy, although few meet PA guidelines. Greater perceived stress and eating psychopathology were associated with lower PA engagement. These factors should be monitored by obstetrics providers to identify women who may particularly benefit from counseling about PA during pregnancy.     

An exploratory study of fitness practitioner intentions toward exercise programming for individuals with multiple sclerosis

BackgroundIncreasing community practice that facilitates physical activity for people with multiple sclerosis (MS) is critical to improve health outcomes and enhance quality of life in this population.ObjectiveThe purpose of this exploratory study was to employ the Theory of Planned Behavior (TPB) in order to examine beliefs, attitudes and intentions of fitness practitioners (FPs) toward working with adults with MS in community-based fitness facilities. The study also aimed to assess the relative contribution of FP attributes on the best predictor of favorable intentions to work with individuals with MS.MethodPractitioners (N = 580) completed the Fitness Practitioner Survey via a web-based platform.ResultsThe FPs' intention to work with a club member with MS was best predicted by attitudes (R = .81, R² = .65, F_6,373 = 114.46, p < .001) and favorable attitude was best predicted by perceived competence (R = .52; R² = .27, F_9,338 = 14.18, p < .001).ConclusionPractitioners believed that, by working with a person with MS, both staff and other club members would benefit and that including an individual with MS into their practice was worth the effort. As well, the individual with MS would benefit by experiencing success, increasing functional independence, and having greater social interaction. Fitness practitioners who had more education, held various professional certifications associated with physical activity and fitness, and had prior positive quality experiences working with diverse populations reported higher perceived competence.     

But that's who I Am: The inability to enact physical activity identity is associated with depression and anxiety symptoms

There is strong evidence to suggest that physical activity reduces depression and anxiety symptoms, and recently there have been calls to consider the role of psychological determinants of physical activity behaviour as part of this effect. We investigated whether a person's physical activity identity moderated the impact of physical activity on depression and anxiety symptoms. Participants aged 19–33 years (N = 97; M = 21.8; 50.5% female, 44.3% Caucasian) self-reported their physical activity identity then wore activity monitors for six days. On the seventh day, participants self-reported their depression symptoms and anxiety symptoms. Multiple linear regression models were conducted to determine whether physical activity identity moderated the link of physical activity with prospective depression and anxiety symptoms. For people who had physical activity identity scores greater than 1.51 SD more than M, physical activity and depression symptoms were negatively associated. For people with a physical activity identity score greater than 0.52 SD more than M, physical activity and anxiety symptoms were negatively associated. For those with a strong physical activity identity, not being physically active was associated with more prospective depressive and anxiety symptoms although the effect sizes were small. It may be that there are negative mental health impacts of not being physical active for those with strong physical activity identities. Physical activity interventions targeting mental health outcomes may need to be tailored for a person's identity and provide support when people do not engage with the physical activity behaviour that they value as part of their identity standards.     

Family history and perceived risk of diabetes,cardiovascular disease,cancer, and depression

BackgroundFamily history is a useful and inexpensive tool to assess risks of multifactorial diseases. Family history enables individualized disease prevention, but its effects on perceived risks of various diseases need to be understood in more detail. We examined how family history relates to perceived risk of diabetes mellitus, cardiovascular disease (CVD), cancer, and depression, and whether these associations are independent of or moderated by sociodemographic factors, health behavior/weight status (smoking, alcohol consumption, physical activity, BMI [kg/m²]), or depressive symptoms.MethodsParticipants were Finnish 25–74-year-olds (N = 6258) from a population-based FINRISK 2007 study. Perceived absolute lifetime risks (Brewer et al., 2004; Becker, 1974; Weinstein and Nicolich, 1993; Guttmacher et al., 2004; Yoon et al., 2002) and first-degree family history of CVD, diabetes, cancer and depression, and health behaviors were self-reported. Weight and height were measured in a health examination.ResultsFamily history was most prevalent for cancer (36.7%), least for depression (19.6%). Perceived risk mean was highest for CVD (2.8), lowest for depression (2.0). Association between family history and perceived risk was strongest for diabetes (β = 0.34, P < 0.001), weakest for depression (β = 0.19, P < 0.001). Adjusting for sociodemographics, health behavior, and depressive symptoms did not change these associations. The association between family history and perceived risk tended to be stronger among younger than among older adults, but similar regardless of health behaviors or depressive symptoms.DiscussionAssociation between family history and perceived risk varies across diseases. People's current understandings on heritability need to be acknowledged in risk communication practices. Future research should seek to identify effective strategies to combine familial and genetic risk communication in disease prevention.     

Unravelling the relation between physical activity,self-esteem and depressive symptoms among early and late adolescents: A mediation analysis

PurposeDepression is a serious public health issue among adolescents; however, few studies have examined the role of protective factors, such as engagement in physical activity, on depressive symptoms. Preliminary evidence using community samples of mainly adolescent girls suggests that self-esteem may influence the benefits of physical activity on depressive symptoms. Thus, the objective of this study was to test the hypothesis that the inverse relation between physical activity and depressive symptoms would be mediated by self-esteem in both early and late adolescent boys and girls.MethodsSecondary data analysis was conducted using self-reported measures of physical activity, self-esteem, depressive symptoms, and socio-demographic information completed by a sample of girls (n = 2109) and boys (n = 2095) during early (M_age = 14.7) and late (M_age = 16.2) adolescence selected from the National Longitudinal Study of Adolescent Health. Using the method suggested by Baron and Kenny (1986), mediation was tested separately for boys and girls during early and late adolescence.ResultsDuring early adolescence, self-esteem fully mediated the association between physical activity and depressive symptoms for adolescent boys only. Full mediation was obtained for both boys and girls during late adolescence.ConclusionsIn early and late adolescent boys, and only late adolescent girls, associations between physical activity and depressive symptoms were no longer significant once self-esteem was statistically controlled for. The study has important implications for depression prevention initiatives including the inclusion of physical activity components that are effectively structured to reliably enhance self-esteem, especially among early adolescents.     

Effectiveness of Powerful Tools for Caregivers on Caregiver Burden and on Care Recipient Behavioral and Psychological Symptoms of Dementia: A Randomized Controlled Trial

ObjectiveThe aim of this study was to evaluate the effectiveness of a psychoeducational intervention, Powerful Tools for Caregivers (PTC), for family caregivers of individuals with dementia.DesignA pragmatic, 2-arm randomized controlled trial compared the PTC intervention, as delivered in practice, to usual care. Participants randomized to usual care functioned as a control group and then received the PTC intervention.InterventionPTC is a 6-week manualized program that includes weekly 2-hour classes in a group setting facilitated by 2 trained and certified leaders. The educational program helps caregivers to enhance self-care practices and manage emotional distress.Setting and participantsTwo stakeholder organizations delivered the intervention in community settings. Participants were family caregivers of individuals with dementia recruited from the community in Florida.MethodsPrimary outcomes were caregiver burden and behavioral and psychological symptoms of dementia of the care recipient. Secondary outcomes included caregiver depressive symptoms, self-efficacy, self-rated health, and life satisfaction. Measures were collected at baseline (n = 60 participants), postintervention (n = 55), and at 6-week follow-up (n = 44).ResultsIntent-to-treat analyses found PTC reduced caregiver burden (d = −0.48) and depressive symptoms (d = −0.53), and increased self-confidence (d = 0.68), but found no significant benefit for behavioral and psychological symptoms of dementia in care recipients. PTC was rated highly by participants and program attrition was low, with 94% of caregivers completing at least 4 of the 6 classes.Conclusions and implicationsAlthough no significant effects were found for behavioral and psychological symptoms of dementia, this trial supports the effectiveness of PTC to improve caregiver outcomes as delivered in the community.     

Reciprocal associations between physical activity,physical self-concept,somatic symptoms,and depression from adolescence to young adulthood: Disaggregating within- and between-person effects

The mechanisms by which physical activity may influence depressive symptoms, and vice versa, during adolescence are not well understood. The present study examined the longitudinal, reciprocal within-person associations between physical activity and depressive symptoms among a community-based sample of adolescents who were followed into young adulthood, while also estimating between-person effects and exploring physical self-concept and somatic symptoms as potential mediators. Data were from the Victoria Healthy Youth Survey (V-HYS), which followed adolescents (W1; N = 662; ages 12–18) biannually for ten years into young adulthood (W6; n = 478; ages 22–29). Random-intercept cross-lagged panel models were specified to understand the within- and between-person associations between physical activity and depressive symptoms, as well as potential mediation by physical self-concept and somatic symptoms. Results showed anticipated between-person associations between physical activity, physical self-concept, somatic symptoms, and depressive symptoms. Although within-person increases in depressive symptoms predicted decreases in physical activity two years later, within-person deviations in physical activity did not significantly predict subsequent changes in depressive symptoms. Within-person cross-lagged associations between physical self-concept and depressive symptoms, as well as somatic symptoms and depressive symptoms, were significant and bidirectional in nature. Results are consistent with past research demonstrating the potential long-term and enduring health risks of depressive symptoms. Future research that uses a shorter timeframe between assessments (e.g., days or weeks) may further clarify the link between physical activity and depression, including potential mechanisms that explain why this association unfolds.     

Exploring the Impact of Racism on Black Youth: A Multidimensional Examination of Discriminatory Experiences Across Place and Time

PurposeCommunity violence disproportionally impacts Black youth. Experiences of racism and discrimination may create additional challenges for youth recovering from violence exposure. This study used ecological momentary assessment to elucidate how perceptions of racism and social support influence health and safety outcomes among Black youth following violence exposure.MethodsTwenty-five Black youth (14–19 years old, 60% female) who had witnessed violence within the past three months completed a baseline survey that assessed discrimination experiences, social support, post-traumatic stress symptoms (PTS), and perceived safety. Youth completed ecological momentary assessments three times daily for two weeks about the place they were in, people they were with, their current emotional state, and in-the-moment racism perceptions. Multilevel models estimated the relationship between overall and time-varying perceptions of racism and social support, PTS symptoms, and perceived safety.ResultsOverall, 76% of youth reported at least one discrimination experience at baseline. Prior discrimination was associated with higher PTS (B = 1.86, p = .001) and depressive symptoms (B = 0.13, p = .013) at baseline. Youth who reported higher overall perceptions of racism in-the-moment reported higher PTS (B = 0.50, p = .002) and lower perceived safety (B = ?0.53, p = .001). In-the-moment perceptions of racism were associated with lower perceived safety in that place (B = ?0.09, p < .01). Emotional and instrumental support were associated with lower PTS and higher perceived safety (p < .05).DiscussionExperiences of racism and being in discriminatory places impacted youth’s depressive symptoms, PTS symptoms, and perceived safety. Interventions attuned to in-the-moment experiences of racism, and that leverage social support, are needed to support Black youth exposed to violence and discrimination.     

A curriculum on care for people with disabilities: Effects on medical student self-reported attitudes and comfort level

BackgroundEarly, frequent encounters with people with disabilities may improve medical students' knowledge, attitudes and skills regarding their care. We developed and implemented a longitudinal four-year curriculum addressing caring for people with disabilities.Objectives/hypothesisTo test differences in mean scores between intervention and control groups on individual post-survey items regarding attitudes toward people with disabilities, and to conduct exploratory procedures to examine individual factors that may account for group differences.MethodsStudents at two U.S. medical schools, one with the new curriculum, and one with no specific disabilities curriculum, were surveyed in Year 1 of medical school, prior to curriculum introduction, and again at the end of Year 3, using a validated 30-item instrument measuring medical students' self-reported attitudes and comfort toward people with disabilities. We compared mean item ratings between the two groups using χ² and ANOVA. Principal components analysis was then used to construct linear composite variables that were then regressed on potential predictors of attitudes and comfort level.ResultsThe intervention led to significant or near-significant improvement in several factors. However, male students in the intervention group, particularly those who encountered people with disabilities in a clinical context, had a tendency to more frequently agree with negative statements (β = .628, p = .005).ConclusionsExposure of medical students to a longitudinal curriculum for caring for people with disabilities led to significant improvement in several factors related to comfort and attitudes. The gender-related reinforcement of some negative attitudes merits further investigation and caution when implementing the curriculum in the future.     

A Cluster Randomized Controlled Trial Testing the Impact of Function and Behavior Focused Care for Nursing Home Residents With Dementia

ObjectiveThe purpose of this study was to test the effectiveness of the Function and Behavior Focused Care for the Cognitively Impaired (FBFC-CI) intervention on function, physical activity, and behavioral symptoms among nursing home residents with dementia, and to explore the adoption of the intervention at the facility level.DesignThis study was a clustered, randomized controlled trial with a repeated measures design that was implemented in 12 nursing homes randomized to either treatment (FBFC-CI) or educational control [Function and Behavior Focused Care Education (FBFC-ED)].Setting and ParticipantsTwelve nursing homes (6 treatment and 6 control) and 336 residents (173 treatment and 163 control) with moderate to severe cognitive impairment.MeasuresOutcomes included functional ability (Barthel Index), physical activity (actigraphy and survey), behavioral symptoms (Resistiveness to Care Scale, Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia), and psychotropic medication use.ResultsThe participants were 82.6 (SD = 10.1) years of age, mostly female, and were moderate to severely cognitively impaired (Mini-Mental State Exam of 7.8, SD = 5.1). There was a significantly greater increase in time spent in total activity (P = .004), moderate activity (P = .012), light activity (P = .002), and a decrease in resistiveness to care (P = .004) in the treatment versus control group at 4 months. There was no change in mood, agitation, and the use of psychotropic medications. There was some evidence of adoption of the intervention at treatment sites.Conclusions and ImplicationsThis study provides some support for the use of the FBFC-CI Intervention to increase time spent in physical activity and decrease resistive behaviors during care commonly noted among nursing home residents with moderate to severe cognitive impairment.     

Temporal Relationship Between Depressive Symptoms and Cognition in Mid and Late Life: A Longitudinal Cohort Study

ObjectivesTo examine the bidirectional temporal relationship between depressive symptoms and cognition in relation to risk, reaction, and prodrome.DesignCross-lag analysis of longitudinal data collected online at baseline and 12-month follow-up.Setting and ParticipantsA United Kingdom population cohort of 11,855 participants aged 50 years and over.MeasuresPatient Health Questionnaire-9 (depressive symptoms), cognitive measures: Paired Associate Learning, Verbal Reasoning, Spatial Working Memory, and Digit Span.ResultsDepressive symptoms predicted a decline in paired associates learning [β = −.020, P = .013, (95% confidence interval [CI], ‒.036, −.004)] and verbal reasoning [β = −.014, P = .016, (95% CI ‒.025, −.003)] but not vice versa. Depressive symptoms predicted [β = −.043, P < .001, (95% CI ‒.060, −.026); β = −.029, P < .001, (95% CI ‒.043, −.015)] and were predicted by [β = −.030, P = < .001, (95% CI ‒.047, −.014); β = −.025, P = .003, (95% CI ‒.041, −.009)], a decline in spatial working memory and verbal digit span, respectively.Conclusions and ImplicationsDepressive symptoms may be either a risk factor or prodrome for cognitive decline. In addition, a decline in attention predicts depressive symptoms. Clinical implications and implications for further research are discussed.