Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

2012 ◽  
Vol 42 (12) ◽  
pp. 2619-2629 ◽  
Author(s):  
E. Scafato ◽  
L. Galluzzo ◽  
S. Ghirini ◽  
C. Gandin ◽  
A. Rossi ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Late Life ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Late Life Depression ◽  
Longitudinal Changes ◽  
The Impact

BackgroundDepression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.MethodAs part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.ResultsSeverity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.ConclusionsConsistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

scholarly journals Late-life depression and mortality: influence of gender and antidepressant use

2008 ◽  
Vol 192 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Joanne Ryan ◽  
Isabelle Carriere ◽  
Karen Ritchie ◽  
Robert Stewart ◽  
Gwladys Toulemonde ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Depression Scale ◽  
Severe Depression ◽  
Epidemiological Studies ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Late Life Depression ◽  
Cox Proportional Hazards Models ◽  
Antidepressant Use

BackgroundDepression may increase the risk of mortality among certain subgroups of older people, but the part played by antidepressants in this association has not been thoroughly explored.AimsTo identify the characteristics of older populations who are most at risk of dying, as a function of depressive symptoms, gender and antidepressant use.MethodAdjusted Cox proportional hazards models were used to determine the association between depression and/or antidepressant use and 4-year survival of 7363 community-dwelling elderly people. Major depressive disorder was evaluated using a standardised psychiatric examination based on DSM-IV criteria and depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale.ResultsDepressed men using antidepressants had the greatest risk of dying, with increasing depression severity corresponding to a higher hazard risk. Among women, only severe depression in the absence of treatment was significantly associated with mortality.ConclusionsThe association between depression and mortality is gender-dependent and varies according to symptom load and antidepressant use.

Educational level influenced the gold standard diagnosis of late-life depression in the GreatAGE study

2017 ◽  
Vol 41 (S1) ◽  
pp. S173-S173
Author(s):  
M. Lozupone ◽  
F. Veneziani ◽  
L. Lofano ◽  
I. Galizia ◽  
E. Stella ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Functioning ◽  
Educational Level ◽  
Depressive Disorders ◽  
Depression Scale ◽  
Late Life ◽  
Population Based ◽  
Cognitive Variables ◽  
Late Life Depression ◽  
Axis I

IntroductionThe validity of the 30-item Geriatric Depression Scale (GDS-30) in detecting late-life depression (LLD) requires a certain level of cognitive functioning. Further research is needed in population-based setting on other socio-demographic and cognitive variables that could potentially influence the accuracy of clinician rated depression.ObjectiveTo compare the diagnostic accuracy of two instruments used to assess depressive disorders [(GDS-30) and the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] among three groups with different levels of cognitive functioning (normal, Mild Cognitive Impairment – MCI, Subjective Memory Complain – SMC) in a random sampling of the general population 65+ years.MethodsThe sample, collected in a population-based study (GreatAGE Study) among the older residents of Castellana Grotte, South-East Italy, included 844 subjects (54.50% males). A standardized neuropsychological battery was used to assess MCI, SMC and depressive symptoms (GDS-30). Depressive syndromes were diagnosed through the SCID IV-TR. Socio-demographic and cognitive variables were taken into account in influencing SCID performance.ResultsAccording to the SCID, the rate of depressive disorders was 12.56%. At the optimal cut-off score (≥ 4), GDS-30 had 65.1% sensitivity and 68.4% specificity in diagnosing depressive symptoms. Using a more conservative cut-off (≥ 10), the GDS-30 specificity reached 91.1% while sensitivity dropped to 37,7%. The three cognitive subgroups did not differ in the rate of depression diagnosis. Educational level is the only variable associated to the SCID diagnostic performance (P = 0.015).ConclusionsAt the optimal cut-off, GDS-30 identified lower levels of screening accuracy for subjects with normal cognition rather than for SMC (AUC 0.792 vs. 0.692); educational attainment possibly may modulate diagnostic clinician performance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 1034
Author(s):  
Vincenza Gianfredi ◽  
Annemarie Koster ◽  
Anna Odone ◽  
Andrea Amerio ◽  
Carlo Signorelli ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Dietary Patterns ◽  
Proportional Hazards ◽  
A Priori ◽  
Preventive Measure ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Healthy Diet ◽  
Patient Health

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

scholarly journals Bidirectional Association Between Knee Osteoarthritis and Depressive Symptoms: A Nationwide Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 220-220
Author(s):  
Han Lu ◽  
Shaomei Shang ◽  
Limin Wang ◽  
Hongbo Chen
Keyword(s):  
Cohort Study ◽  
Depressive Symptoms ◽  
Knee Osteoarthritis ◽  
Proportional Hazards ◽  
Depression Scale ◽  
Cox Proportional Hazards ◽  
Depression Symptoms ◽  
Physical And Mental Health ◽  
Bidirectional Association ◽  
Bidirectional Relationship

Abstract Both knee osteoarthritis (KOA) and depressive symptoms are common health issues affecting the quality of life of old adults. Although it is presumed that KOA has a bidirectional relationship with the depressive symptoms, no cohort study has proven it. This is the first study to determine the strength of association for the bidirectional relationship between KOA and depressive symptoms. Data were gathered from the nationally survey of China Health and Retirement Longitudinal Study in 2011-2015. The presence of depressive symptoms was defined by the 10-item Center for Epidemiologic Studies Depression Scale score of 10 or higher. The adjusted Cox proportional hazards regression model was conducted to estimate hazards ratios (HRs). Controlled covariates include gender, age, education, marital status, residence, number of chronic diseases, and disability. The analysis of KOA predicting the depressive symptoms onset consisted of 4,377 participants free from depressive symptoms at baseline. During 4 years follow-up, diagnosed KOA participants were more likely to have depressive symptoms than their peers without KOA (HR = 1.50, 95% CI: 1.23-1.83). The parallel analysis of depressive symptoms predicting KOA onset included 6,848 participants without KOA at baseline, those with depressive symptoms had a higher relative risk of developing KOA (HR = 1.64, 95% CI: 1.41-1.92). Our results provide compelling evidence that the KOA-depressive symptoms association is bidirectional, highlighting the importance of evaluating the relationship between physical and mental health among older people. Particularly, taking this association into consideration in the risk assessment and primary prevention of KOA and depression symptoms.

A neuropsychological group rehabilitation program with institutionalized elderly

2016 ◽  
Vol 33 (S1) ◽  
pp. s235-s235
Author(s):  
L. Lemos ◽  
H. Espírito-Santo ◽  
S. Simões ◽  
F. Silva ◽  
J. Galhardo ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Depressive Symptomatology ◽  
Randomized Study ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Rehabilitation Program ◽  
Post Intervention ◽  
Institutionalized Elderly ◽  
Group Rehabilitation ◽  
The Impact

IntroductionElderly institutionalization involves an emotional adaptation and the research shows that the risk of depression increases.ObjectivesEvaluate the impact of a neuropsychological group rehabilitation program (NGRP) on depressive symptomatology of institutionalized elderly.AimsNGRP influences the decrease of depressive symptoms.MethodsElderly were assessed pre- and post-intervention with the Geriatric Depression Scale (GDS) and divided into a Rehabilitated Group (RG), a Waiting List Group (WLG), and a Neutral Task Group (NTG).ResultsIn this randomized study, before rehabilitation, 60 elderly people (RG; 80.31 ± 8.98 years of age; 74.2% women) had a mean GDS score of 13.33 (SD = 9.21). Five elderly included in the NTG (80.13 ± 10.84 years; 75.0% women) had a mean GDS score of 10.60 (SD = 4.72). Finally, 29 elderly in the WLG (81.32 ± 6.68 years; 69.0% women) had a mean GDS score of 14.93 (SD = 6.02). The groups were not different in GDS baseline scores (F = 0.74; P = 0.478). ANCOVA has shown significant differences (P < 0.05) in GDS scores between the three groups after 10 weeks. Sidak adjustment for multiple comparisons revealed that elderly in the WLG got worse scores in GDS, comparing with elderly in RG (P < 0.01), and with elderly in NTG (P < 0.05).ConclusionsElderly that are not involved in a task get worse in depressive symptomatology. Being involved in a structured group task means lower depressive symptoms and being in a NGRP means even greater results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Physical activity and depressive symptoms in community-dwelling elders from southern Brazil

2011 ◽  
Vol 33 (2) ◽  
pp. 165-170 ◽  
Author(s):  
César L. Reichert ◽  
César L. Diogo ◽  
José L. Vieira ◽  
Roberta R. Dalacorte
Keyword(s):  
Physical Activity ◽  
Depressive Symptoms ◽  
Linear Trend ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Population Based ◽  
Community Dwelling ◽  
Active Group ◽  
Lower Prevalence ◽  
Cross Sectional

OBJECTIVE: To determine the existence of a relationship between physical activity and depressive symptoms in community-dwelling elders. METHOD: This is a cross-sectional, population-based study, which included 379 community-dwelling elders from Novo Hamburgo, state of RS, Brazil. The level of physical activity was estimated using the International Physical Activity Questionnaire and depressive symptoms were diagnosed according to the Yesavage Geriatric Depression Scale. The association between the level of physical activity and depressive symptoms was analyzed by logistic regression. RESULTS: A tendency towards a lower prevalence of depressive symptoms was observed in individuals with higher levels of physical activity, both in the sample as a whole as well as among men, but not among women (p for linear trend 0.04, 0.03 and 0.36, respectively). The odds ratio of the presence of depressive symptoms in the very active group, as compared against that of the insufficiently active group was 0.32 (95% CI: 0.12-0.86) for men and 0.76 (95% CI: 0.39-1.46) for women. CONCLUSION: In this population of aged individuals, more intense physical activity is related to a lower prevalence of depressive symptoms. As shown by gender stratification, physical activity is inversely related to depressive symptoms in men, albeit not in women.

Abstract MP60: Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Parveen K Garg ◽  
Wesley T O'Neal ◽  
Ana V Diez Roux ◽  
Alvaro Alonso ◽  
Elsayed Soliman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Cox Proportional Hazards ◽  
Fee For Service ◽  
Score Distribution ◽  
Ethnic Study ◽  
Increased Risk

Background: Depression has been suggested as a potential risk factor for atrial fibrillation (AF) through effects on the autonomic nervous system and hypothalamus-pituitary-adrenal axis. Current literature examining the prospective relationship between depression and AF is inconsistent and limited to studies performed in predominantly white populations. We determined the relationship of both depressive symptoms and anti-depressant use with incident AF in a multi-ethnic cohort. Methods: The Multi-Ethnic Study of Atherosclerosis is a prospective study of 6,814 individuals without clinical cardiovascular disease. Depressive symptoms were assessed at baseline by the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and use of anti-depressant medications. Five CES-D groups were created based on the score distribution in approximate quartiles, and the top quartile split in 2 such that the top group represented persons with a score ≥16, a value commonly used to identify clinically relevant symptoms. Incident AF was identified from study ECGs verified for AF, ICD-9 hospital discharge diagnoses consistent with AF, and, for participants enrolled in fee-for-service Medicare, inpatient and outpatient AF claims data. Results: 6,644 participants (mean age=62; 53% women; 38% white; 28% black; 22% Hispanic; 12% Chinese-American) were included and followed for a median of 13 years. In separate adjusted Cox proportional hazards analyses, a CES-D≥16 (referent=CES-D<2) and anti-depressant use were each associated with higher incidence of AF (Table). Associations did not differ by race or gender (interaction p-values of 0.18 and 0.17 respectively). Similar results were obtained using time-updated measures of depression. Conclusions: Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.

Culturally adapted and lay-delivered cognitive behaviour therapy for older adults with depressive symptoms in rural China: a pilot trial

2020 ◽  
pp. 1-5
Author(s):  
Jiaqi Yuan ◽  
Yi Yin ◽  
Xinfeng Tang ◽  
Tan Tang ◽  
Qinshu Lian ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Health Workers ◽  
Pilot Trial ◽  
Depression Scale ◽  
Late Life ◽  
Late Life Depression ◽  
Mixed Effect ◽  
Culturally Adapted ◽  
Cognitive Behaviour

Abstract Background: Late-life depression issues in developing countries are challenging because of understaffing in mental health. Cognitive behavioural therapy (CBT) is effective for treating depression. Aim: This pilot trial examined the adherence and effectiveness of an eight-session adapted CBT delivered by trained lay health workers for older adults with depressive symptoms living in rural areas of China, compared with the usual care. Method: Fifty with screen-positive depression were randomly assigned to the CBT arm or the care as usual (CAU) arm. The primary outcomes were the session completion of older adults and changes in depressive symptoms, assessed using the Geriatric Depression Scale (GDS). Results: The majority (19/24) of participants in the CBT arm completed all sessions. Mixed-effect linear regression showed that the CBT reduced more GDS scores over time compared with CAU. Conclusion: Lay-delivered culturally adapted CBT is potentially effective for screen-positive late-life depression.

scholarly journals The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study

2018 ◽  
Vol 14 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Maria Carlsson ◽  
Tom Wilsgaard ◽  
Stein Harald Johnsen ◽  
Liv-Hege Johnsen ◽  
Maja-Lisa Løchen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Intracerebral Hemorrhage ◽  
Proportional Hazards ◽  
Temporal Trends ◽  
Population Based ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Intracerebral Hemorrhages ◽  
The Impact

Background Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. Aims To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study. Methods We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. Results We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. Conclusions We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.

scholarly journals Impact of Age, Comorbidity, and Polypharmacy on Treatment and Survival for Aggressive Non-Hodgkin Lymphoma

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Laura Tapley ◽  
Pamela Skrabek ◽  
Pascal Lambert ◽  
Jenniebie Bravo ◽  
Kathleen Decker ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Proportional Hazards ◽  
Hematologic Malignancy ◽  
Age Groups ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Advisory Committees ◽  
Substantial Impact ◽  
Curative Therapy ◽  
The Impact

Introduction: Non-Hodgkin's lymphoma (NHL) is the most prevalent hematologic malignancy, with most people diagnosed aged over 65 years (Alexander et. al. Int.J.Cancer 2007). Older populations have more comorbid health conditions, frailty, polypharmacy, and health resource use (Ogle et. al. Cancer 2000). The complex interplay of these factors may influence the prescription of curative therapy and prognosis. In trials evaluating NHL therapies, elderly patients are underrepresented, particularly those with frailty or comorbidity, resulting in knowledge gaps. We report a retrospective, population-based cohort study of aggressive NHL patients and examine the impact of age and its interaction with comorbidity and polypharmacy on treatment patterns and survival. Methods: Using the Manitoba Cancer Registry we identified patients aged over 18 years with NHL diagnosed from 2004-2015. We limited the cohort to aggressive NHL types using morphology codes. Data on demographics, stage, NHL type, comorbidities, polypharmacy, and chemotherapy were obtained from population-based provincial databases. Comorbidity was measured using Johns Hopkins ACG System software, which factored in all measured hospital-based and outpatient medical services utilized and collapsed them into one of six Resource Utilization Band (RUB) categories, from no use to very high user. Overall survival (OS) was calculated using Kaplan-Meier curves. Cox proportional hazards regression models were constructed to determine the interaction of age with a variety of factors. Multi-variable logistic regression was also used to examine the receipt of chemotherapy and the interaction with age. Results: In our cohort of 1,073 patients with aggressive NHL, 704 were treated with systemic chemotherapy. Treatment rates decreased with increasing age and medication count, while stage and comorbidity had little impact (Table 1). Median OS decreased with age among treated patients and was very short without chemotherapy (Table 1). Multivariate analyses found that individuals with increasing age, stage III, unknown stage, histology other than DLBCL, and higher medication counts were less likely to receive chemotherapy. For the receipt of chemotherapy, no age interactions were found. In addition, in patients who received chemotherapy, increased age and stage were associated with poorer survival, while more recent year of diagnosis improved survival. No age interactions with a substantial impact on survival were found. Conclusions: OS in aggressive NHL diminishes with increasing age, but is longer in those receiving chemotherapy across all age groups. Comorbidity and medication count influenced the receipt of chemotherapy and OS. Higher medication count was only independently associated with less likelihood of receiving chemotherapy, while comorbidity was not independent of other factors for either receipt of chemotherapy or OS. Disclosures Dawe: AstraZeneca Canada: Research Funding; AstraZeneca Canada: Membership on an entity's Board of Directors or advisory committees; Boehringer-Ingelheim: Honoraria; Merck Canada: Membership on an entity's Board of Directors or advisory committees.

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