scholarly journals Associations Between Comorbidity and Depressive Symptoms During COVID-19: Variation by Social Isolation?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 39-39
Author(s):  
Jianjia Cheng ◽  
Lindsay Kobayashi
Keyword(s):  
Depressive Symptoms ◽  
Social Isolation ◽  
Chronic Conditions ◽  
Mixed Effects ◽  
Living Alone ◽  
Mixed Effects Models ◽  
Middle Aged ◽  
Association Data ◽  
Comorbidity Status

Abstract Adults with comorbidities are at high COVID-19 risk and may experience elevated depressive symptoms during the pandemic. We aimed to investigate the associations between comorbidity at pandemic onset and subsequent depressive symptoms and whether social isolation modified this association. Data were from monthly online questionnaires in the COVID-19 Coping Study of US adults aged ≥55 from April/May-September/October 2020 (n=4,383). Depressive symptoms were measured by the 8-item CES-D, and social isolation as “high” vs. “low” based on contact with family, friends, social organizations, and living alone. In multivariable mixed-effects models, comorbidity (≥2 vs. <2 chronic conditions) was associated with greater depressive symptoms at baseline (β=0.50; 95% CI: 0.36-0.64), this association varied negligibly by social isolation. Differences in depressive symptoms by comorbidity status at pandemic onset were consistent over the six-month follow-up. This study indicates that middle-aged and older US adults with comorbidities experienced persistently elevated depressive symptoms during the COVID-19 pandemic.

scholarly journals Change in Loneliness Experienced by Older Men and Women Living Alone and With Others at the Onset of the COVID-19 Pandemic

2021 ◽  
pp. 016402752110266
Author(s):  
Maureen Wilson-Genderson ◽  
Allison R. Heid ◽  
Francine Cartwright ◽  
Amy L. Collins ◽  
Rachel Pruchno
Keyword(s):  
Older People ◽  
Social Isolation ◽  
Living Arrangements ◽  
Living Arrangement ◽  
Mixed Effects ◽  
Living Alone ◽  
Mixed Effects Models ◽  
Perceived Support ◽  
Socially Isolated ◽  
Older Men And Women

Building on theory suggesting that loneliness is distinct from living arrangements, social isolation, and perceived social support, we examined change in loneliness for older people at the onset of the COVID-19 pandemic. Analyzing 14-years of data with multilevel mixed-effects models, we found higher levels of loneliness among people living alone, people more socially isolated, and people with less perceived support. Gender affected changes in loneliness, controlling for social isolation, perceived support, living arrangements, age, education, income, health, and marital status. Women, whether living alone or with others, experienced increases in loneliness; women living alone reported the greatest increase in loneliness. Men living alone reported high levels of loneliness prior to the pandemic, but only a slight increase over time. These analyses, which demonstrate that loneliness changed at the onset of the pandemic as a function of gender and living arrangement identify older people most likely to benefit from intervention.

scholarly journals Design and analysis of a 2-year parallel follow-up of repeated ivermectin mass drug administrations for control of malaria: Small sample considerations for cluster-randomized trials with count data

2021 ◽  
pp. 174077452110285
Author(s):  
Conner L Jackson ◽  
Kathryn Colborn ◽  
Dexiang Gao ◽  
Sangeeta Rao ◽  
Hannah C Slater ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Mixed Effects ◽  
Small Sample ◽  
Mixed Effects Models ◽  
Type I ◽  
Cluster Randomized ◽  
Cluster Level ◽  
Generalized Estimating

Background: Cluster-randomized trials allow for the evaluation of a community-level or group-/cluster-level intervention. For studies that require a cluster-randomized trial design to evaluate cluster-level interventions aimed at controlling vector-borne diseases, it may be difficult to assess a large number of clusters while performing the additional work needed to monitor participants, vectors, and environmental factors associated with the disease. One such example of a cluster-randomized trial with few clusters was the “efficacy and risk of harms of repeated ivermectin mass drug administrations for control of malaria” trial. Although previous work has provided recommendations for analyzing trials like repeated ivermectin mass drug administrations for control of malaria, additional evaluation of the multiple approaches for analysis is needed for study designs with count outcomes. Methods: Using a simulation study, we applied three analysis frameworks to three cluster-randomized trial designs (single-year, 2-year parallel, and 2-year crossover) in the context of a 2-year parallel follow-up of repeated ivermectin mass drug administrations for control of malaria. Mixed-effects models, generalized estimating equations, and cluster-level analyses were evaluated. Additional 2-year parallel designs with different numbers of clusters and different cluster correlations were also explored. Results: Mixed-effects models with a small sample correction and unweighted cluster-level summaries yielded both high power and control of the Type I error rate. Generalized estimating equation approaches that utilized small sample corrections controlled the Type I error rate but did not confer greater power when compared to a mixed model approach with small sample correction. The crossover design generally yielded higher power relative to the parallel equivalent. Differences in power between analysis methods became less pronounced as the number of clusters increased. The strength of within-cluster correlation impacted the relative differences in power. Conclusion: Regardless of study design, cluster-level analyses as well as individual-level analyses like mixed-effects models or generalized estimating equations with small sample size corrections can both provide reliable results in small cluster settings. For 2-year parallel follow-up of repeated ivermectin mass drug administrations for control of malaria, we recommend a mixed-effects model with a pseudo-likelihood approximation method and Kenward–Roger correction. Similarly designed studies with small sample sizes and count outcomes should consider adjustments for small sample sizes when using a mixed-effects model or generalized estimating equation for analysis. Although the 2-year parallel follow-up of repeated ivermectin mass drug administrations for control of malaria is already underway as a parallel trial, applying the simulation parameters to a crossover design yielded improved power, suggesting that crossover designs may be valuable in settings where the number of available clusters is limited. Finally, the sensitivity of the analysis approach to the strength of within-cluster correlation should be carefully considered when selecting the primary analysis for a cluster-randomized trial.

scholarly journals The Association Between Depressive Symptoms and Cognitive Functioning in Older Hispanic/Latino Adults Enrolled in an Exercise Intervention: Results From the “¡Caminemos!” Study

2017 ◽  
Vol 30 (6) ◽  
pp. 843-862 ◽  
Author(s):  
Rosalba Hernandez ◽  
Elaine Cheung ◽  
Minli Liao ◽  
Seth W. Boughton ◽  
Lisett G. Tito ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Cognitive Functioning ◽  
Chronic Conditions ◽  
Exercise Intervention ◽  
Longitudinal Analyses ◽  
Symptoms Of Depression ◽  
Intervention Method

Objective: We examined the association between depressive symptoms and cognitive functioning in older Hispanics/Latinos enrolled in an exercise intervention. Method: We analyzed baseline, 1-year, and 2-year in-person interview data collected from Hispanics/Latinos aged ≥60 years participating in an exercise intervention across 27 senior centers ( N = 572). Results: Mean age was 73.13 years; 77% female. At baseline, older adults screening positive for depression were 1.58 times more likely to experience cognitive impairment ( p = .04); controlling for demographics and comorbid chronic conditions. Compared to peers with little to no depressive symptoms, lower cognitive functioning scores were evident at each follow-up assessment point where elevated depressive symptoms were present, but baseline depression was not associated with cognitive function in longitudinal analyses. Discussion: In older Hispanics/Latinos enrolled in an exercise intervention, though baseline depression did not predict cognitive function over time, elevated symptoms of depression were associated with greater cognitive impairment at every point in this study.

scholarly journals Combined Effects of Ethnicity and Education on Burden of Depressive Symptoms over 24 Years in Middle-Aged and Older Adults in the United States

2020 ◽  
Vol 10 (4) ◽  
pp. 209
Author(s):  
Shervin Assari
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Ethnic Minorities ◽  
White Americans ◽  
Middle Aged ◽  
Highly Educated ◽  
Education Levels ◽  
Nationally Representative ◽  
Hispanic White

Ethnicity and educational attainment are among the major social determinants of depression in the general population. While high education credentials protect individuals against depressive symptoms, this protection may be weaker for ethnic minority groups such as Hispanic Whites compared to the majority group (non-Hispanic Whites). Built on marginalization-related diminished returns (MDRs), the current study used 24-year follow-up data from a nationally representative sample of middle-aged and older adults to explore ethnic variation in the protective effect of education levels against the burden of depressive symptoms over time. Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992–ongoing), a nationally representative longitudinal study. HRS followed 8314 middle-aged and older adults (50+ years old) for up to 24 years. From this number, 763 (9.2%) were Hispanic White, and 7551 (90.8%) were non-Hispanic White Americans. Education level was the independent variable. We had two outcomes. Firstly, using cluster analysis, individuals were categorized to low- and high-risk groups (regarding the burden of depressive symptoms over 24 years); secondly, average depressive symptoms were observed over the 24 years of follow up. Age and gender were the covariates. Ethnicity was the moderator. Linear and logistic regression were used for analysis. Logistic regression showed that, overall, high educational credentials reduced the odds of chronic depressive symptoms over the 24 years of follow-up. Linear regression also showed that higher years of education were associated with lower average depressive symptoms over time. Both models showed statistically significant interactions between ethnicity and graduation, indicating a smaller protective effect of high education against depressive symptoms over the 24 years of follow-up time among Hispanic with respect to non-Hispanic White people. In line with the MDRs, highly educated Hispanic White Americans remain at high risk for depressive symptoms, a risk that is unexpected given their education. The burden of depressive symptoms, however, is lowest for highly educated non-Hispanic White Americans. Policies that exclusively focus on equalizing educational gaps across ethnic groups may fail to eliminate the ethnic gap in the burden of chronic depressive symptoms, given the diminished marginal health return of education for ethnic minorities. Public policies must equalize not only education but also educational quality across ethnic groups. This aim would require addressing structural and environmental barriers that are disproportionately more common in the lives of ethnic minorities across education levels. Future research should test how contextual factors, residential segregation, school segregation, labor market practices, childhood poverty, and education quality in urban schools reduce the health return of educational attainment for highly educated ethnic minorities such as Hispanics.

scholarly journals Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples

2019 ◽  
Author(s):  
Courtney A Polenick ◽  
Kira S Birditt ◽  
Angela Turkelson ◽  
Benjamin C Bugajski ◽  
Helen C Kales
Keyword(s):  
Depressive Symptoms ◽  
Marital Quality ◽  
Chronic Conditions ◽  
Later Life ◽  
Well Being ◽  
Middle Aged ◽  
Older Couples ◽  
Individual Level ◽  
The Individual ◽  
Over Time

Abstract Objectives Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms. Methods The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006–2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner’s baseline report of negative marital quality and number of chronic conditions in each wave. Results Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions. Discussion Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood.

scholarly journals Physical Isolation and Mental Health Among Older U.S. Adults in the COVID-19 Coping Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 39-39
Author(s):  
Carly Joseph ◽  
Brendan O'Shea ◽  
Jessica Finlay ◽  
Lindsay Kobayashi
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mixed Effects Models ◽  
Middle Aged ◽  
Linear Mixed Effects ◽  
Us States ◽  
Physical Isolation ◽  
The Impact ◽  
Do So

Abstract The ongoing COVID-19 pandemic has set an urgent need to understand the impact of physical isolation on mental health. We aimed to investigate the relationships between physical isolation during the period when many US states had shelter-in-place orders (April-May 2020) and subsequent longitudinal trajectories of mental health in middle-aged and older adults (aged 55+, N=3,978) over a six-month follow-up (April to October 2020). We used population and attrition-weighted multivariable linear mixed-effects models. At baseline, 7 days/week of physical isolation (vs. 0 days/week) was associated with elevated depressive symptoms (β=0.82; 95% CI: 0.04-1.60), and all of 1-3, 4-6, and 7 days/week of physical isolation (vs. 0 days/week) were associated with elevated anxiety symptoms and loneliness. Physical isolation was not associated with changes in mental health symptoms over time. These findings highlight the need to prioritize opportunities for in-person connection for middle-aged and older adults when safe to do so.

scholarly journals Chronic Pain And Depressive Symptoms In Chinese Middle-Aged And Older Adults:A Follow Up Study

2021 ◽  
Author(s):  
Jialin Liu ◽  
Zixuan Chen ◽  
Yuke Yu ◽  
Qin Wang ◽  
Xiuxiu Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Depressive Symptoms ◽  
Health Status ◽  
Elderly People ◽  
Elderly Care ◽  
Univariate Analysis ◽  
Depression Scale ◽  
Middle Aged

Abstract Objective: This study aimed to analyze the effects of chronic pain on the occurrence of depressive symptoms in Chinese middle-aged and older adults, and to provide a scientific basis for reducing the incidence of depressive symptoms, improving the quality of life in middle-aged and older adults, and reducing the disease burden in the aging population.Methods: a prospective study was conducted to select adults aged 45 years or older from the longitudinal study of China Health and elderly care follow-up survey (Charls) (2015 and 2018). Pain was assessed according to the patient's self exposure, and depression was assessed using the Chinese version of the center for epidemiological research Depression Scale (CES-D). Univariate analysis and binary logistic regression model were used for analysis. Results: The 3-year cumulative incidence of depression in chronic pain patients was 52.4% and the annual incidence was 17.5% in the middle-aged and elderly Chinese population. Univariate analysis showed statistically significant differences in the incidence of depressive symptoms between the different genders, age, residence, education level, marriage, self perceived health status, nocturnal sleep time, number of social activities in the past month, smoking, alcohol consumption, impaired ADL and Medicare insurance coverage. This study, after controlling for demographic characteristics, health status and health behaviors, Different pain conditions remained statistically significant for depression in middle-aged and older adults. Compared with middle-aged and older adults without pain, both Unisomatic pain (OR = 1.388) and Multiple somatic pain (OR= 1.869) increased the risk of depression in the middle-aged and older populations. Conclusion: chronic pain is associated with the risk of depressive symptoms in middle-aged and elderly people, and the incidence of depression in middle-aged and elderly people in China is not optimistic.

Impact of obesity and physical inactivity on the long-term change in grip strength among middle-aged and older European adults

2019 ◽  
Vol 73 (7) ◽  
pp. 619-624 ◽  
Author(s):  
Tianyu Wang ◽  
Wenjing Feng ◽  
Suyun Li ◽  
Qihua Tan ◽  
Dongfeng Zhang ◽  
...  
Keyword(s):  
Grip Strength ◽  
Chronic Conditions ◽  
Physical Inactivity ◽  
Middle Aged ◽  
Physically Active ◽  
Term Change ◽  
All Cause Mortality ◽  
Gender Specific

BackgroundGrip strength is a well-established predictor of various chronic conditions and all-cause mortality. Body weight and physical activity (PA) are considered potential determinants of muscle strength. This study aimed to investigate gender-specific associations of baseline obesity and physical inactivity with long-term changes in grip strength among middle-aged and older European adults.MethodsData from the Survey of Health, Ageing and Retirement in Europe 2004–2015 which was conducted in 12 countries were analysed. Grip strength was repeatedly measured at five follow-up visits with average 2-year intervals. Obesity and physical inactivity at baseline were primary exposures. Generalised estimated equations stratified by gender were fitted.ResultsThis study included 8616 males and 10 088 females with a median follow-up of 9.42 years. Significant interactions between obesity and time with grip strength were identified in both males (χ2interaction=16.65, p = 0.002) and females (χ2interaction=10.80, p = 0.029). No significant interaction between physical inactivity and time with grip strength was identified in males (χ2interaction=9.42, p = 0.051) or females (χ2interaction=5.62, p = 0.230). Those who were less physically active at baseline had weaker grip strength from the beginning at baseline (β = −2.753, p < 0.001 for males and β = −1.529, p < 0.001 for females) to Visit 6 (β = −2.794, p < 0.001 for males and β = −1.550, p < 0.001 for females). Further combined analysis suggested a trend that exposure to both obesity and physical inactivity was related to the fastest decline rate of grip strength.ConclusionsThis study provides the additional evidence that PA and obesity prevention earlier in life play an important role in maintaining grip strength during ageing.

scholarly journals DISCORDANT CHRONIC CONDITIONS AND DEPRESSIVE SYMPTOMS AMONG MIDDLE-AGED AND OLDER COUPLES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S58-S58
Author(s):  
Courtney A Polenick ◽  
Kira S Birditt ◽  
Angela Turkelson ◽  
Benjamin Bugajski ◽  
Helen C Kales
Keyword(s):  
Depressive Symptoms ◽  
Marital Quality ◽  
Chronic Conditions ◽  
Later Life ◽  
Well Being ◽  
Minority Status ◽  
Middle Aged ◽  
Older Couples ◽  
Individual Level ◽  
Retirement Study

Abstract Discordant chronic conditions (i.e., those with competing management requirements) have adverse consequences for well-being, yet little is known about their implications among couples. We evaluated how depressive symptoms are linked to discordant conditions within individuals and between spouses across an 8-year period. The U.S. sample included 1,116 middle-aged and older couples from five waves (2006 – 2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models controlled for age, minority status, education, depressive symptoms in the previous wave, and each partner’s report of baseline marital quality and number of chronic conditions in each wave. Wives and husbands with their own discordant conditions reported higher depressive symptoms, and this association intensified over time. Over and above this link, husbands had higher depressive symptoms when there were discordant conditions between spouses. Both individual-level and couple-level discordant chronic conditions appear to have enduring implications for depressive symptoms in middle and later life.

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