Frailty, depression, and anxiety in later life

ABSTRACTBackground: Anxiety and depression are common in older people but are often missed; to improve detection we must focus on those elderly people at risk. Frailty is a geriatric syndrome inferring increased risk of poor outcomes. Our objective was to explore the relationship between frailty and clinically significant anxiety and depression in later life.Methods: This study had a cross-sectional design and involved the assessment of 567 community-dwelling people aged ≥60 years recruited from the Technology Research for Independent Living (TRIL) Clinic, Dublin. Frailty was measured using the Fried biological syndrome model; depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale; and anxiety symptoms measured using the Hospital Anxiety and Depression Scale.Results: Higher depression and anxiety scores were identified in both pre-frail and frail groups compared to robust elders (three-way factorial ANOVA, p ≤0.0001). In a logistic regression model the odds ratio for frailty showed a significantly higher likelihood of clinically meaningful depressive and anxiety symptoms even controlling for age, gender and a history of depression or anxiety requiring pharmacotherapy (OR = 4.3; 95% CI 1.5, 11.9; p = 0.005; OR = 4.36; 95% CI 1.4, 13.8; p = 0.013 respectively).Conclusions: Our findings suggest that even at the earliest stage of pre-frailty, there is an association with increased symptoms of emotional distress; once frailty develops there is a higher likelihood of clinically significant depression and anxiety. Frailty may be relevant in identifying older people at risk of deteriorating mental health.

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Factors associated with symptoms of anxiety and depression in five cohorts of community-based older people: the HALCyon (Healthy Ageing across the Life Course) Programme

Psychological Medicine ◽

10.1017/s0033291711000195 ◽

2011 ◽

Vol 41 (10) ◽

pp. 2057-2073 ◽

Cited By ~ 45

Author(s):

C. R. Gale ◽

A. Aihie Sayer ◽

C. Cooper ◽

E. M. Dennison ◽

J. M. Starr ◽

...

Keyword(s):

Older People ◽

Life Course ◽

Physical Function ◽

Birth Cohort ◽

Depression Scale ◽

Later Life ◽

Healthy Ageing ◽

Anxiety And Depression ◽

Increased Risk ◽

The Life Course

BackgroundSymptoms of anxiety and depression are common in older people, but the relative importance of factors operating in early and later life in influencing risk is unclear, particularly in the case of anxiety.MethodWe used data from five cohorts in the Healthy Ageing across the Life Course (HALCyon) collaborative research programme: the Aberdeen Birth Cohort 1936, the Caerphilly Prospective Study, the Hertfordshire Ageing Study, the Hertfordshire Cohort Study and the Lothian Birth Cohort 1921. We used logistic regression to examine the relationship between factors from early and later life and risk of anxiety or depression, defined as scores of 8 or more on the subscales of the Hospital Anxiety and Depression Scale, and meta-analysis to obtain an overall estimate of the effect of each.ResultsGreater neuroticism, poorer cognitive or physical function, greater disability and taking more medications were associated in cross-sectional analyses with an increased overall likelihood of anxiety or depression. Associations between lower social class, either in childhood or currently, history of heart disease, stroke or diabetes and increased risk of anxiety or depression were attenuated and no longer statistically significant after adjustment for potential confounding or mediating variables. There was no association between birth weight and anxiety or depression in later life.ConclusionsAnxiety and depression in later life are both strongly linked to personality, cognitive and physical function, disability and state of health, measured concurrently. Possible mechanisms that might underlie these associations are discussed.

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Symptoms of mood disorders in family carers of older people with dementia who experience caregiver burden: a network approach

Age and Ageing ◽

10.1093/ageing/afaa008 ◽

2020 ◽

Vol 49 (4) ◽

pp. 628-633

Author(s):

Alex Bacadini França ◽

Adam Lee Gordon ◽

Rajvinder Samra ◽

Evelise Saia Rodolpho Duarte ◽

Alessandro Ferrari Jacinto

Keyword(s):

Network Analysis ◽

Older People ◽

Depression Scale ◽

Anxiety Symptoms ◽

Warning Signs ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Family Carers ◽

People With Dementia

Abstract Background informal carers of people with dementia are at greater risk of anxiety and depressive disorders if they find caregiving to be a burden. The aim of this study was to use a network analysis of cross-sectional data to investigate the relationships between anxiety and depressive symptoms in family carers of older people with dementia who experience burden. Methods sixty family carers exhibiting high levels of burden using the Zarit Burden Interview were included in the study. Participants completed the Hospital Anxiety and Depression Scale. The network analysis identified the depression and anxiety symptom network using features including a topological graph, network centrality metrics and community analysis. The network was estimated through the graphical LASSO technique in combination with a walktrap algorithm to obtain the clusters within the network and the connections between the nodes (symptoms). A directed acyclic graph was generated to model symptom interactions. Results the resulting network architecture shows important bridges between depression and anxiety symptoms. Lack of pleasure and loss of enjoyment were identified as potential gateway symptoms to other anxiety and depression symptoms and represent possible therapeutic targets for psychosocial interventions. Fear and loss of optimism were highly central symptoms, indicating their importance as warning signs of more generalised anxiety and depression. Conclusions this network analysis of depressive and anxiety symptoms in overburdened family carers provides important insights as to what symptoms may be the most important targets for behavioural interventions.

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Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in a sample of Tunisian teenagers

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.438 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S439-S439

Author(s):

L. Ghanmi ◽

S. Elleuch ◽

M. Daoud ◽

K. Zitoun ◽

L. Zouari ◽

...

Keyword(s):

Nicotine Dependence ◽

Tobacco Use ◽

Adolescent Depression ◽

Depression Scale ◽

Anxiety Symptoms ◽

Daily Smoking ◽

Anxiety And Depression ◽

Average Score ◽

Depression And Anxiety ◽

Increased Risk

AimsTo examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in Tunisians teenagers.DesignA cross-sectional study including teenagers (n = 162) from two colleges located in Gabes (south of Tunisia) and used a self-administered anonymous questionnaire. Adolescent depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression scale translated and validated in Tunisia. adolescent tobacco use was defined as: daily use (6 or 7 days per week) and the loss of autonomy over tobacco use was evaluated with the Hooked on Nicotine Checklist (HONC).FindingsThe prevalence of smoking was 61.7%. It was 92% for boys and 8% for girls. In our sample, 30.7% of teenagers used manufactured cigarettes and chicha; 93.8% of daily smokers had already lost control of their smoking. Their average score the HONC was 5.5 (gap deviation 2.4). Of these, 61.3% had a score greater than or equal to 5. Rates of anxiety and depression were respectively 43% and 20%. Nicotine-dependent adolescents were significantly more anxious than non-dependent: 68.3% vs. 48.7% (P = 0.04). We do not note significant differences between depressed teenagers and adolescents without depression, regarding nicotine dependence.ConclusionsSmoking is frequent among teenagers in Gabes. Adolescent smokers with anxiety symptoms are at increased risk for nicotine dependence. These results incite to pursue work that takes account of the specific diagnosis and treatment of tobacco dependence among adolescents, especially when psychiatric comorbidity makes smoking cessation more difficult.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression

International Psychogeriatrics ◽

10.1017/s1041610215000046 ◽

2015 ◽

Vol 27 (5) ◽

pp. 727-737 ◽

Cited By ~ 71

Author(s):

Osvaldo P. Almeida ◽

Andrew H. Ford ◽

Leon Flicker

Keyword(s):

Systematic Review ◽

At Risk ◽

Depressive Symptoms ◽

Vitamin B12 ◽

Depression Scale ◽

Manual Search ◽

Increased Risk ◽

Short Period ◽

Clinically Significant ◽

Folate And Vitamin B12

ABSTRACTBackground:Folate and vitamin B12 insufficiencies have been associated with increased risk of depression. This systematic review aimed to clarify if, compared with placebo, treatment with folate and/or vitamin B12 reduces depression scale scores, increases remission, and prevents the onset of clinically significant symptoms of depression in people at risk.Methods:This systematic review searched the PubMed, PsychInfo, Embase, and Cochrane databases from inception to 6 June 2014, using the following terms and strategy: (vitamin B12 or vitamin B9 or folate or folic acid or cobalamin or cyanocobalamin) and (depression or depressive disorder or depressive symptoms) and (randomized controlled trial or RCT). The electronic search was supplemented by manual search. Two independent reviewers assessed all papers retrieved for eligibility and bias, and extracted crude data. Review Manager 5 was used to manage and analyze the data.Results:Two hundred and sixty-nine manuscripts were identified, of which 52 were RCTs and 11 fulfilled criteria for review. We found that the short-term use of vitamins (days to a few weeks) does not contribute to improve depressive symptoms in adults with major depression treated with antidepressants (5 studies, standardized mean difference = −0.12, 95% confidence interval – 95% CI = −0.45, 0.22), but more prolonged consumption (several weeks to years) may decrease the risk of relapse (1 study, odds ratio (OR) = 0.33, 95% CI = 0.12, 0.94) and the onset of clinically significant symptoms in people at risk (2 studies, risk ratio = 0.65, 95% CI = 0.43, 0.98).Conclusions:The number of available trials remains small and heterogeneity between studies high. The results of these meta-analyses suggest that treatment with folate and vitamin B12 does not decrease the severity of depressive symptoms over a short period of time, but may be helpful in the long-term management of special populations.

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Effect of Anxiety and Depression on Survival of Cancer Patients, a 13 Year Follow-up

Asian Pacific Journal of Cancer Care ◽

10.31557/apjcc.2021.6.1.9-13 ◽

2021 ◽

Vol 6 (1) ◽

pp. 9-13

Author(s):

Suriati Mohamed Saini ◽

Susan Tan Mooi Koon ◽

Mohamad Adam Bujang ◽

Gerard Lim Chin Chye ◽

Shalisah Sharip ◽

...

Keyword(s):

Depressive Symptoms ◽

Cancer Patients ◽

Depression Scale ◽

Cox Proportional Hazards ◽

Anxiety Symptoms ◽

High Rate ◽

Anxiety And Depression ◽

Risk Of Death ◽

Increased Risk

Introduction: Anxiety and depression occur at a high rate in cancer patients. However, debate remains regarding the effect of anxiety and depression on cancer survival. Objective: This study aimed to determine the effect of anxiety and depressive symptoms on the survival of cancer patients. Methods: The subjects consisted of 112 cancer patients who attended the Oncology and Radiotherapy outpatient clinic Hospital Kuala Lumpur, Malaysia, in 1999. Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) questionnaire at inception. Information on patients’ mortality status for extended 13 years follow-up (in 2011) was obtained from the National Registration Department death records. Overall survival for each anxiety and depressive symptoms scores in HADS at 13 years was calculated using Cox proportional hazards regression analysis. Results: Cancer patients experienced more anxiety (83%) compared to depressive symptoms (40.2%). The mean (S.D.) HADS scores for depressive symptoms were 9.9 (2.5), and the anxiety symptoms score was 12.6 (2.1). At 13 years, half of the patients (50.9%) had died. No significant effect of anxiety (p=0.399, 95% C.I.= 6.2-8.4) or depressive symptoms at inception (p=0.749, 95% C.I.= 5.9-8.4) towards cancer patients’ survival was found at 13 years follow-up. Conclusion: The occurrence of anxiety symptoms among cancer patients in this study was 2-folds higher than depressive symptoms. However, no significant increased risk of death was found in cancer patients with anxiety or depressive symptoms at 13 years follow-up. It may imply that as time extended, survival in cancer patients may be related to various interacting elements, and intervening health factors are of importance.

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THE HOSPITAL ANXIETY AND DEPRESSION SCALE: HOMOGENEITY OF THE SUBSCALES

Social Behavior and Personality An International Journal ◽

10.2224/sbp.1993.21.3.197 ◽

1993 ◽

Vol 21 (3) ◽

pp. 197-204 ◽

Cited By ~ 18

Author(s):

Egil Andersson

Keyword(s):

Hospital Care ◽

Depression Scale ◽

Anxiety And Depression ◽

Measuring Instrument ◽

Depression And Anxiety ◽

Factor Analyses ◽

Hospital Anxiety ◽

Factor Solution ◽

Test Items ◽

Clinically Significant

The H.A.D.-scale was originally used as a screening test for assessing the presence of clinically significant degrees of anxiety and depression. It has also been used as a measuring instrument outside hospital care. The main questions in this study are: l) Do the test items fit a sample of non-clinical persons? 2) Are the two subscales of Depression and Anxiety homogeneous? In total 163 persons answered the questionnaire. Two factor analyses are reviewed, a two factor solution and a four factor solution. The two factor solution did not split the items in the way originally intended. A four factor analysis with three interpreted factors gave a better solution. The analysis leads us to recommend great caution when interpreting the H.A.D.-scale, especially when used in a population outside of hospital care.

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Self-reported symptoms of depression and anxiety among informal caregivers of persons with dementia: a cross-sectional comparative study between Sweden and Italy

BMC Health Services Research ◽

10.1186/s12913-020-05964-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Joseba Wulff ◽

Agneta Malmgren Fänge ◽

Connie Lethin ◽

Carlos Chiatti

Keyword(s):

Informal Caregivers ◽

Depression Scale ◽

Well Being ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Cross Sectional ◽

Symptoms Of Depression ◽

People With Dementia

Abstract Background Around 50 million people worldwide are diagnosed with dementia and this number is due to triple by 2050. The majority of persons with dementia receive care and support from their family, friends or neighbours, who are generally known as informal caregivers. These might experience symptoms of depression and anxiety as a consequence of caregiving activities. Due to the different welfare system across European countries, this study aimed to investigate factors associated with self-reported depression and anxiety among informal dementia caregivers both in Sweden and Italy, to ultimately improve their health and well-being. Methods This comparative cross-sectional study used baseline data from the Italian UP-TECH (n = 317) and the Swedish TECH@HOME (n = 89) studies. Main outcome variables were the severity of self-reported anxiety and depression symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). HADS scores were investigated using descriptive and bivariate statistics to compare means and standard deviations. Linear regressions were used to test for associations between potential factors and self-reported symptoms of depression and anxiety. Results Italian informal caregivers reported more severe symptoms of depression and anxiety than Swedish caregivers. In Italy, a higher number of hours of caregiving was associated with anxiety symptoms (β = − 1.205; p = 0.029), being 40–54 years-old with depression symptoms (β = − 1.739; p = 0.003), and being female with symptoms of both depression (β = − 1.793; p < 0.001) and anxiety (β = 1.474; p = 0.005). In Sweden, a higher number of hours of caregiving and being < 39 years-old were associated with depression symptoms (β = 0.286; p < 0.000; β = 3.945; p = 0.014) and a higher number of hours of caregiving, the lack of additional informal caregivers and dementia severity were associated with anxiety symptoms (β = 0.164; p = 0.010; β = − 1.133; p = 0.033; β = − 1.181; p = 0.031). Conclusion Multiple factors are associated with self-reported symptoms of depression and anxiety among informal caregivers in Sweden and Italy. Factors found in this study partly differ between the two countries, suggesting the important role of cultural and social factors affecting the experience of caregiving. A deeper knowledge of these factors may increase the knowledge on potential protective and risk factors, provide information to policymakers and ultimately improve the psychological well-being of informal caregivers to people with dementia across Europe.

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Apathy is associated with incident dementia in community-dwelling older people

Neurology ◽

10.1212/wnl.0000000000004767 ◽

2017 ◽

Vol 90 (1) ◽

pp. e82-e89 ◽

Cited By ~ 12

Author(s):

Jan Willem van Dalen ◽

Lennard L. Van Wanrooij ◽

Eric P. Moll van Charante ◽

Edo Richard ◽

Willem A. van Gool

Keyword(s):

Depressive Symptoms ◽

Older People ◽

Cox Regression ◽

Depression Scale ◽

Community Dwelling ◽

Memory Complaints ◽

Incident Dementia ◽

Increased Risk ◽

Community Dwelling Older People

ObjectiveTo assess whether apathy and depressive symptoms are independently associated with incident dementia during 6-year follow-up in a prospective observational population-based cohort study.MethodsParticipants were community-dwelling older people in the Prevention of Dementia by Intensive Vascular Care trial, aged 70–78 years, without dementia at baseline. Apathy and depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). Dementia during follow-up was established by clinical diagnosis confirmed by an independent outcome adjudication committee. Hazard ratios (HRs) were calculated using Cox regression analyses. Given its potentially strong relation with incipient dementia, the GDS item referring to memory complaints was assessed separately.ResultsDementia occurred in 232/3,427 (6.8%) participants. Apathy symptoms were associated with dementia (HR 1.28, 95% confidence interval [CI] 1.12–1.45; p < 0.001), also after adjustment for age, sex, Mini-Mental State Examination score, disability, and history of stroke or cardiovascular disease (HR 1.21, 95% CI 1.06–1.40; p = 0.007), and in participants without depressive symptoms (HR 1.26, 95% CI 1.06–1.49; p = 0.01). Depressive symptoms were associated with dementia (HR 1.12, 95% CI 1.05–1.19), also without apathy symptoms (HR 1.16, 95% CI 1.03–1.31; p = 0.015), but not after full adjustment or after removing the GDS item on memory complaints.ConclusionsApathy and depressive symptoms are independently associated with incident dementia in community-dwelling older people. Subjective memory complaints may play an important role in the association between depressive symptoms and dementia. Our findings suggest apathy symptoms may be prodromal to dementia and might be used in general practice to identify individuals without cognitive impairment at increased risk of dementia.

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Depression and anxiety in medically unwell older adults: prevalence and short-term course

International Psychogeriatrics ◽

10.1017/s1041610209009399 ◽

2009 ◽

Vol 21 (4) ◽

pp. 754-763 ◽

Cited By ~ 28

Author(s):

Christina Bryant ◽

Henry Jackson ◽

David Ames

Keyword(s):

Older Adults ◽

Depression Scale ◽

Diagnostic System ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Short Term ◽

Time Period ◽

Short Time ◽

Time Of Admission

ABSTRACTBackground: The objective of this study was to examine the prevalence and short-term course of depression and anxiety in a sample of hospitalized, medically unwell older adults, using both a symptom measure and a diagnostic instrument.Methods: One hundred participants were recruited from in-patients in a geriatric hospital in Melbourne, Australia. Anxiety and depression were assessed shortly after admission, and again two months later, using the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Mental Status Schedule/ AGECAT diagnostic system.Results: At Time 1, 60% of the sample exhibited anxiety symptoms at a sub-case level, while 16% had anxiety symptoms at a syndrome case level, whereas 48% of the participants had depression at syndrome level. The HADS and AGECAT were concordant with respect to anxiety for 78% of participants, but agreement was lower for depression; AGECAT identified a further 36 syndrome cases of depression not deemed depressed by the HADS. There was a significant decrease in overall rates of both depression and anxiety symptoms and syndromes from Time 1 to Time 2.Conclusion: This study confirms the findings of previous research with respect to the high prevalence of depression in physically unwell older adults, and extends knowledge about anxiety in this group. Symptoms of anxiety are even more common than symptoms of depression in this group, especially around the time of admission to hospital. Over a relatively short time period, there is a marked reduction in symptoms, but levels of anxiety and depression remain high.

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Determinants of increased frequency of depressive and anxiety symptoms in exercise professionals during the COVID-19 pandemic

Work ◽

10.3233/wor-210648 ◽

2021 ◽

pp. 1-11

Author(s):

Natan Feter ◽

Eduardo L. Caputo ◽

Igor R. Doring ◽

Marcelo C. da Silva ◽

Felipe F. Reichert ◽

...

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Depression Scale ◽

Exercise Program ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Cross Sectional ◽

Social Distancing

BACKGROUND: The coronavirus disease (COVID-19) pandemic has affected workers in different health services including exercise professionals (EP). The urgent need to adapt in-person to online activities might have led to increased frequency of anxiety and depressive symptoms. OBJECTIVE: We aimed to identify the determinants of aggravated depressive and anxiety symptoms in EP in southern Brazil during social distancing from the COVID-19. METHODS: A cross-sectional study was conducted with EP who worked at fitness centers, sports clubs, private schools, or at a public exercise program offered by the municipal council. We used an online-based, self-administered, adapted version of the Hospital Anxiety and Depression scale to compare symptoms of depression and anxiety pre- and during social distancing. RESULTS: Participants (n = 201) had a mean age of 32.7±8.0 years, with more than half being male, white, and having an university degree. We observed that 81%and 71%of respondents reported higher frequency in anxiety and depression symptoms, respectively, during social distancing than in the period before it. Physical education teachers, women, non-white professionals, and those with chronic disease were more likely to worsen anxiety symptoms. Women had higher odds to increased frequency in depressive symptoms. Physical activity and previous experience with internet-based tools for working activities reduced the risk of increased depressive symptoms. CONCLUSIONS: Sex, ethnicity, chronic diseases, educational level, physical activity, and experience with online tools were determinants for increased frequency of depression and anxiety symptoms in EP.

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