Effectiveness of treatment programmes for depression among adults with mild/moderate intellectual disability

Background The current study describes the development and evaluation of group treatment programme for people with mild/moderate intellectual disability (ID). Methods A total of 34 participants (16 males, 18 females) completed the treatment programme and 15 participants (six males, nine females) comprised a control group. Results Compared to the control group, the intervention group showed an improvement in levels of depression, positive feelings about the self, and lower levels of automatic negative thoughts after the intervention. These changes were maintained at 3‐month follow‐up. Conclusions These results demonstrate that intervention programmes are effective for the treatment of depression among people with ID.     

Prevalence and factors associated with polypharmacy in Victorian adults with intellectual disability

Although polypharmacy is a medication safety concern leading to increased risk of non-adherence, adverse drug reaction and drug–drug interactions, polypharmacy and associated risk factors has rarely been investigated involving people with ID at a population level. The purpose of this paper is to analyze the prevalence of polypharmacy and to evaluate the role of different factors associated with polypharmacy in a state-wide representative population of adults with ID. In a population-based survey in Victoria, Australia, 897 people with ID 18 years of age or older were selected by simple random sampling. The data were collected from proxy respondents on behalf of people with ID. Polypharmacy was defined as the concomitant use of five or more medications. The data were weighted to reflect the age/sex/geographic distribution of the population. Results revealed that more than 76% of adults with ID had used prescribed medicine and about 21% were exposed to polypharmacy in the last two weeks. In both univariate and multivariate analyses, polypharmacy was significantly associated with older age, unemployment and inability to get help from family and friends if needed. After controlling for age, sex and severity of intellectual disability, polypharmacy was associated with having a blood pressure, blood cholesterol and blood glucose level check. Polypharmacy was also associated with a greater number of visits to general practitioners, fair or poor reported health status and inability to walk unaided. Subjects with epilepsy, diabetes, stroke, osteoporosis and cancer had a higher probability of polypharmacy. None of the disease inducing behaviors was associated with polypharmacy. This study highlights the need that medication should be regularly reviewed overall in ID population and particularly when polypharmacy exists.     

Prevalence and risk factors for depressive disorders in adults with intellectual disability

A sample of 798 persons (>19 years) of all degrees of intellectual disability and from different types of residential facilities was examined in a two-phase prevalence survey with respect to depressive disorders. 4.8% (n = 38) were identified with a DSM-III-R related diagnosis of a current depressive disorder. In comparison with a representative control group (n = 146) those persons with major depression (n = 21) showed a more severe, those with dysthymia (n = 11) a milder degree of intellectual disability. Being female was a risk factor for dysthymic disorder. The group with depressive disorders (n = 38) experienced distinctly reduced social support. Age, epilepsy (yes/no) and etiology (Down syndrome yes/no) did not show any association with the prevalence of depressive disorders. The study does not support the assumption of a specifically high vulnerability of adults with intellectual disability with respect to depressive disorders.     

Neuropsychological characteristics of adults with comorbid ADHD and borderline/mild intellectual disability

This study aimed to characterise the neuropsychological functioning of adults with comorbid attention deficit hyperactivity disorder (ADHD) and intellectual disability. Individuals with ADHD and mild-borderline range intelligence (N=59) and individuals with ADHD and normal intellectual functioning (N=95) were compared on attentional and response inhibition tasks. The comorbid group had significantly lower scores on the majority of measures in comparison with the ADHD alone group. These differences remained significant after co-varying for level of intellectual functioning for variables measuring selective attention and errors of commission during sustained attention. This suggests that individuals with comorbid ADHD and intellectual disability may be vulnerable to a 'double deficit' from both disorders in certain aspects of cognitive functioning.     

The relationship between Axis I psychopathology and quality of life in adults with mild to moderate intellectual disability

Individuals with intellectual disability are at risk for impaired quality of life (QOL) compared to the general population. Little is known, however, about factors that may affect QOL in those with intellectual disability. The current study examined the role that Axis I psychopathology plays in the QOL of 138 adults with moderate to borderline intellectual disability. Scores on the Quality of Life Questionnaire (QOL-Q) were compared between those with a Psychotic Disorder, those with a Mood/Anxiety Disorder, and those with no Axis I diagnosis. Additionally, the effects of number of Axis I diagnoses was explored. Those with no Axis I diagnosis were found to have significantly higher QOL-Q scores than those in either diagnostic group. No significant differences were found between the two diagnostic groups. Additionally, those with no Axis I diagnosis were found to have significantly higher QOL-Q scores than those presenting with two or more Axis I diagnoses. The results and their implications are discussed.     

Onset aging conditions of adults with an intellectual disability associated with primary caregiver depression

Caregivers of adults with an intellectual disability experience depressive symptoms, but the aging factors of the care recipients associated with the depressive symptoms are unknown. The objective of this study was to analyze the onset aging conditions of adults with an intellectual disability that associated with the depression scores of their primary caregivers. A cross-sectional survey was administered to gather information from 455 caregivers of adults with an intellectual disability about their symptoms of depression which assessed by a 9-item Patient Health Questionnaire (PHQ-9). The 12 aging conditions of adults with an intellectual disability include physical and mental health. The results indicate that 78% of adults with an intellectual disability demonstrate aging conditions. Physical conditions associated with aging include hearing decline (66.3%), vision decline (63.6%), incontinence (44%), articulation and bone degeneration (57.9%), teeth loss (80.4), physical strength decline (81.2%), sense of taste and smell decline (52.8%), and accompanied chronic illnesses (74.6%). Mental conditions associated with aging include memory loss (77%), language ability deterioration (74.4%), poor sleep quality (74.2%), and easy onset of depression and sadness (50.3%). Aging conditions of adults with an intellectual disability (p < 0.001) was one factor that significantly affected the presence of depressive symptom among caregivers after controlling demographic characteristics. Particularly, poor sleep quality of adults with an intellectual disability (yes vs. no, OR = 3.807, p = 0.002) was statistically correlated to the occurrence of significant depressive symptoms among their caregivers. This study suggests that the authorities should reorient community services and future policies toward the needs of family caregivers to decrease the burdens associated with caregiving.     

Incidence of and risk factors for falls among adults with an intellectual disability

Background Falls among people with intellectual disability (ID) occur at a younger age than the general population and are a significant cause of injury and hospitalisation. There is very limited research investigating risk factors for falls among people with ID and none with people living outside of formal care arrangements, either independently or with their family. We used a medical chart audit to identify the incidence and risk factors for falls among people with ID living in a variety of settings. Methods We retrospectively identified 114 consecutive patients, aged 18 years and over who attended a clinic for people with developmental disabilities within a 15‐month period. Fall information was measured by carer recall of falls in the past 12 months. Potential risk factors were extracted from medical reports and a patient information questionnaire. Potential predictors were identified using univariate analysis and entered into a multiple logistic regression. Results Of 114 participants, 39 (34%) reported a fall in the previous 12 months. The number of reported falls was similar for formal care and non‐formal care arrangements. The vast majority of fallers (84%) reported sustaining an injury from a fall and many potential risk factors were identified. Multivariate analysis revealed having seizures in the past 5 years, a history of fracture and increasing age were risk factors for falls. Conclusions Falls are a significant health concern for adults with ID of all ages as a result of their incidence and the resulting injuries. Falls appear to be equally an issue for people residing in formal and non‐formal care accommodation. Further research is needed to develop screening tools and interventions for this population.     

Participation in daytime activities among people with mild or moderate intellectual disability

Background Community participation has been defined as performing daytime activities by people while interacting with others. Previous studies on community participation among people with intellectual disability (ID) have mainly focused on the domestic life aspect. This study investigates the variation in community participation in the domains work, social contacts and leisure activities among people with ID in the Netherlands. A number of categories of people with ID were distinguished by: (1) gender; (2) age; (3) type of education; (4) severity of ID; and (5) accommodation type. Methods Data were gathered on 653 people with mild or moderate ID, of whom 513 by oral interviews and 140 by structured questionnaires filled in by representatives of those who could not be interviewed. Pearson chi‐square tests were used to test differences between categories of people with ID in the distributions of the participation variables. Additional logistic regression analyses were conducted to correct for differences between the categories in other variables. Results Most people with mild or moderate ID in the Netherlands have work or other daytime activities, have social contacts and have leisure activities. However, people aged 50 years and over and people with moderate ID participate less in these domains than those under 50 years and people with mild ID. Moreover, people with ID hardly participate in activities with people without ID. Conclusion High participation among people with a mild or moderate ID within the domains of work, social contact and leisure activities does not necessarily indicate a high level of interaction with the community, because the majority hardly interact with people without ID. Furthermore, older people with ID and people with a more severe level of ID seem to be more at risk for social exclusion.     

Environmental, medical, behavioural and disability factors associated with Helicobacter pylori infection in adults with intellectual disability

In institutionalized adults with intellectual disability (ID), Helicobacter pylori infection occurs at approximately twice the rate it appears in the general population, and it may be responsible for the twofold higher rates of peptic ulcer disease and gastric cancer in this population. Medical, behavioural and additional environmental factors, as well as level of ID, may be related to the risk of infection with H. pylori. One hundred and sixty‐eight adults with ID who were currently, had previously been or had never been institutionalized underwent a biopsychosocial evaluation. This included assessment of: level of ID using the Adaptive Behaviour Scale (ABS) Part I; levels of maladaptive behaviour using the ABS Part II; demographic, medical and environmental factors; as well as H. pylori tests using serology and faecal antigen. The overall rates of past or current infection with H. pylori in institutionalized and previously institutionalized participants were about twice that of the overall group of never‐institutionalized participants, i.e. 87% and 79% compared to 44%, respectively (P < 0.001). The rates of H. pylori infection appeared to increase with age in the never‐institutionalized group, but were consistently high across all ages in the other groups. The rate of infection was higher in those institutionalized for more than 5 years (95% versus 76%, P = 0.02), in those with flatmates with excessive oral secretions (65% versus 21%, P < 0.001) or faecal incontinence (67% versus 27%, P < 0.001), and in those with more chronic illness and medications. All mean domain scores of the ABS Part I (Intellectual Disability) were significantly lower (indicating more severe ID) in the group currently infected with H. pylori compared to their non‐infected counterparts. The majority of mean domain scores of the ABS Part II (Behaviour) were also worse, with half of these score differences reaching statistical significance in the currently infected group. The presence of alarm symptoms (e.g. vomiting, weight loss, haematemesis and melena), iron deficiency and body mass index were not significantly different in currently infected subjects. Adults with ID appear to be particularly at risk of infection with H. pylori. Environmental associations with infection include past or current institutionalization, a longer period of institutionalization, living with flatmates with excessive oral secretions and faecal incontinence. Medical associations include chronic disease and more medications, but not alarm symptoms or body mass index. Demographic associations may include increasing age in never‐institutionalized adults, but no age effect in currently or previously institutionalized individuals. Psychosocial associations include more severe ID and maladaptive behaviour with current infection.     

Social comparison and depression: people with mild and moderate intellectual disabilities

There has been limited research on the role of sociocognitive factors in depression with people who have a mild intellectual disability. However, an association has been found between negative social comparison and depressed mood. We extend previous work by including individuals with clinical depression. A between-groups design of 18 depressed versus 18 nondepressed participants was used. Depression measures were administered, along with measures of self-esteem and social comparison. Participants reported the salience of the social comparisons they made. Depressed participants reported significantly more negative social comparisons; the nondepressed group reported that the positive comparisons they made were more salient. These results have implications for cognitive behavior interventions and the possibility of working with people in the context of their interpersonal beliefs.     

Prospective study on risk factors for falling in elderly persons with mild to moderate intellectual disabilities

Elderly persons with intellectual disabilities (ID) are at increased risk for falls and fall-related injuries. Although there has been extensive research on risk factors for falling in the general elderly population, research on this topic in persons with ID is rather sparse. This is the first study to prospective investigate risk factors for falling among elderly persons with mild to moderate ID. Seventy-eight ambulatory persons with mild to moderate ID (mean age 62.8 ± 7.6 years; 44 (56%) men; 34 (44%) mild ID) participated in this study. This longitudinal cohort study involved extensive baseline assessments, followed by a one-year follow-up on fall incidents. Falls occurred in 46% of the participants and the fall rate was 1.00 falls per person per year. The most important risk factors for falling in elderly persons with mild to moderate ID were (mild) severity of ID, (high) physical activity, (good) visuo-motor capacity, (good) attentional focus and (high) hyperactivity-impulsiveness, which together explained 56% of the fall risk. This pattern of risk factors identified suggests a complex interplay of personal and environmental factors in the aetiology of falls in elderly persons with ID. We recommend further research on the development of multifactorial screening procedures and individually tailored interventions to prevent falling in persons with ID.     

Prevalence and risk factors of constipation in adults with intellectual disability in residential care centers in Israel

The normal aging process is not in itself a risk factor for constipation, but age-related morbidities, immobility, neurologic impairment or specific drugs are risk factors for constipation. This study was undertaken to examine the prevalence and risk factors for constipation in a large sample of 2400 persons with intellectual disability (ID) aged 40 years and older living in residential care centers in Israel. Constipation was found in 8% of the total sample with no significant increase in the prevalence of constipation with age. Neurological disease, cerebral palsy, immobility and physical inactivity were risk factors associated with constipation. Mobility and physical activity is recommended in order to lower the prevalence of constipation in this population.     

Cause-specific mortality and death certificate reporting in adults with moderate to profound intellectual disability

Background The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population‐based study to explore cause‐specific mortality in adults with ID compared with the general population. Methods Cause‐specific standardised mortality ratios (SMRs) and exact 95% confidence intervals were calculated by age and sex for adults with moderate to profound ID living in the unitary authorities of Leicester, Leicestershire and Rutland, UK, between 1993 and 2006. Causes of death were also studied to determine how often ID and associated conditions, such as Down syndrome, were mentioned. Results A total of 503 (17% of population) adults with ID died during the 14‐year study period (30 144 person‐years). Relatively high cause‐specific mortality was seen for deaths caused by congenital abnormalities (SMR = 8560), diseases of the nervous system and sense organs (SMR = 1630), mental disorders (other than dementia) (SMR = 1141) and bronchopneumonia (SMR = 647). Excess deaths were also seen for diseases of the genitourinary system or digestive system, cerebrovascular disease, other respiratory infections, dementia (in men only), other circulatory system diseases (in women only) and accidental deaths (in women only). Two‐fifths (n = 204; 41%) of deaths recorded in adults with ID mentioned ID or an associated condition as a contributing cause of death. Conclusions Strategies to reduce inequalities in people with ID need to focus on decreasing mortality from potentially preventable causes, such as respiratory infections, circulatory system diseases and accidental deaths. The lack of mention of ID on death certificates highlights the importance of effective record linkage and ID reporting in health and social care settings to facilitate the government's confidential inquiry into causes of death in this population.     

Mortality in adults with moderate to profound intellectual disability: a population-based study

Background People with intellectual disability (ID) experience a variety of health inequalities compared with the general population including higher mortality rates. This is the first UK population‐based study to measure the extent of excess mortality in people with ID compared with the general population. Method Indirectly standardized all‐cause and disease mortality ratios (SMRs) and exact Poisson confidence intervals were calculated by age and sex for all adults, aged 20 years or over, with moderate to profound ID living in Leicestershire and Rutland, UK, between 1993 and 2005. The general population of Leicestershire and Rutland, which has a population of approximately 700 000 individuals in this age range, was used for comparison. To explore differences within the study population, overall SMRs were also calculated by presence of Down syndrome and last place of residence (city or county). Results Of 2436 adults identified, 409 (17%) died during 23 000 person‐years of follow‐up. Both all‐cause and disease‐specific mortality were around three times higher than the general population but varied considerably with age. The largest differences were observed in people in their twenties, where all‐cause mortality was almost nine times higher in men (SMR = 883; 95% CI = 560–1325) and more than 17 times higher in women (SMR = 1722; 95% CI = 964–2840). At a particular disadvantage were people with Down syndrome and women with ID living in the city. Conclusions The relatively high SMRs observed in young people and in women, particularly those living in inner city areas and with Down syndrome, deserve further investigation for possible explanations, including socio‐economic factors.