DOES ONSET OF CHRONIC CONDITIONS MODERATE THE IMPACT OF RELATIONAL LIFE EVENTS ON DEPRESSED MOOD?

Abstract More than 62% of adults aged 65+ have more than one chronic condition; this number increases to more than 82% for those 85+. Older adults simultaneously experience changes in their relationships due to negative relational life events, including illness, injury, or death of a loved one. Stressors occurring in tandem can overload psychological resources and increase risk for poor mental health. Informed by the stress process model, we assessed the influence of relational life events on depressive symptoms over time and evaluated the moderating effects of chronic condition onset. Self-reports of four stressful life events, five chronic conditions, and depressive symptoms as measured by the CES-D came from 2,948 older adults participating in the ORANJ BOWL panel. Using longitudinal multilevel mixed effect modeling, we examined trajectories of depressive symptoms across three waves. While depressive symptoms increased over time, they were greater for people who experienced more relational life events and the onset of more chronic conditions. Participants who reported experiencing all four relational life events but no chronic conditions had an average CES-D score of 5.28 (p<.0001); average CES-D score increased to 12.72 (p<.0001) for those who reported four life events and the onset of four or more new chronic conditions during the study period. In summary, chronic condition onset moderated the relationship between life events and depressive symptoms. Findings highlight the need for practitioner awareness of increased mental health risks for people experiencing stressors in multiple domains of life.

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The Importance of Studying Health Behavior in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3020 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 827-827

Author(s):

Jaime Hughes ◽

Susan Hughes ◽

Mina Raj ◽

Janet Bettger

Keyword(s):

Social Support ◽

Older Adults ◽

Behavior Change ◽

Chronic Conditions ◽

Population Level ◽

Multiple Chronic Conditions ◽

Prior Work ◽

Time Changes ◽

The Impact ◽

Over Time

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

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SEPARATED KIN: RURAL-URBAN MIGRATION AND MENTAL HEALTH TRAJECTORIES OF OLDER ADULTS LEFT BEHIND IN RURAL CHINA

Innovation in Aging ◽

10.1093/geroni/igz038.3223 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S880-S880

Author(s):

Zhiyong Lin

Keyword(s):

Mental Health ◽

Older Adults ◽

Depressive Symptoms ◽

Rural China ◽

Well Being ◽

Migrant Children ◽

Urban Migration ◽

Left Behind ◽

Rate Of Increase ◽

The Impact

Abstract As the processes of urbanization and globalization have intensified across the world, a burgeoning literature has documented the impact of emigration on the health of family members left behind in emigrant communities. Although the association between children’s migration and parental well-being is well documented, few have examined the health implications of children’s migration in the milieu of multiple children and further differentiated between children’s short-term and long-term migration. Therefore, I argue that it is not the geographic locality of a single child but the composition of all children’s location that matters. I further suggest that the impact of children’s migration on parental wellbeing is conditioned on the duration of children’s migration. Using a six waves longitudinal data (2001-2015) collected in rural China, this paper compares mental health (measured as depressive symptoms) trajectories of old adults (aged 60 and older) across different compositions of local and migrant children over a 14-year span. Results from growth curve models show that parents having more migrant children relative to local children experience a more rapid increase in depressive symptoms. In addition, older adults who have their most children migrate away for three or more waves of data have experienced the steepest rate of increase in depressive symptoms. These findings provide new evidence to support the life course processes of mental health disparities among older adults from the perspective of intergenerational proximity.

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Do Depressive Symptoms Shape Blacks’ Perceptions of Stress Over Time?

Innovation in Aging ◽

10.1093/geroni/igaa022 ◽

2020 ◽

Vol 4 (5) ◽

Author(s):

DeAnnah R Byrd ◽

Roland J Thorpe ◽

Keith E Whitfield

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Perceived Stress ◽

Ordinary Least Squares ◽

Community Dwelling ◽

Stressful Events ◽

Age Group ◽

The Impact ◽

Over Time

Abstract Background and Objectives Previous studies have linked stress to multiple negative mental health outcomes, including depression. This established stress–depression association is typically examined in one direction and cross-sectionally. This study examined the bidirectional relationships between depressive symptoms and changes in perceived stress over time in Blacks. Research Design and Methods The present study uses a community-dwelling sample of 450 Black adults, aged 51–96 years old, who participated in the Baltimore Study of Black Aging—Patterns of Cognitive Aging. Perceived stress—measured by the Perceived Stress Scale—and depressive symptoms—measured using the Center for Epidemiologic Studies Depression scale—were both assessed at baseline and follow-up 33 months later. Ordinary least squares regression was used to examine 2 bidirectional longitudinal relationships between (1) stress–depression and (2) depression–stress, and whether these associations are modified by age. Results Initial analyses testing the typical stress–depression relationship showed an effect in the expected direction, that is stress leading to more depressive symptoms over time, adjusting for model covariates, but the effect was not statistically significant (b = 0.014, p = .642). After accounting for baseline perceived stress level, age, sex, education, and chronic health conditions, depressive symptoms were positively associated with follow-up stress (b = 0.210, p < .000). The depression–stress association further varied by age group such that the impact of baseline depression on changes in perceived stress was greatest in Blacks in their 60s versus those in their 50s (b = 0.267, p = .001), controlling for model covariates. Discussion and Implications Contrary to previous work, the results suggest that an individual’s mental health shapes his/her perception of stressful events and this relationship varies by age group. While the typical finding (stress impacting depression) was not significant, the findings reported here highlight the importance of considering the possible bidirectional nature of the relationships between psychosocial measures of stress and mental health in later life among Blacks.

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SOCIAL ACTIVITIES AND DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS IN MEXICO: IMPLICATIONS OF GENDER AND PHYSICAL HEALTH

Innovation in Aging ◽

10.1093/geroni/igz038.787 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S215-S215

Author(s):

Maria Monserud

Keyword(s):

Mental Health ◽

Older Adults ◽

Depressive Symptoms ◽

Physical Health ◽

Later Life ◽

Older Men ◽

Developed Countries ◽

Ordinary Least Squares ◽

Social Activities ◽

The Impact

Abstract Studies in developed countries indicate that social activities can make a difference in mental health in later life. Yet, research on potential benefits of social activities for older adults in developing countries, including Mexico, has been scarce. This study uses the two most recent waves (2012, 2015) of the Mexican Health and Aging Study to investigate the impact of social activities on depressive symptoms among older men (n = 4, 749) and women (n = 6,527), aged 50+, in Mexico. The results of Ordinary Least Squares regressions indicate that it is important to differentiate among specific social activities in later life. Particularly, not only group-based but also solitary social activities were predictive of better mental health. Moreover, the findings demonstrate several gender differences and similarities. Participation in clubs, communication with relatives and friends, physical exercise, and watching television were beneficial for mental health among men, whereas volunteering, playing games, and making crafts were associated with fewer depressive symptoms among women. At the same time, reading as well as doing household chores were related to better mental health among older Mexicans, regardless of gender. Furthermore, this study shows that self-reported health, functional limitations, chronic conditions, and frequent pain might shape the implications of social activities for depressive symptoms among older adults in Mexico. The insights from this study can be helpful for intervention programs that are being developed to promote benefits of group-based and solitary social activities for mental health among older men and women with different levels of physical health.

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Food Insecurity and Mental Health Trajectories During the COVID-19 Pandemic: Longitudinal Evidence

Innovation in Aging ◽

10.1093/geroni/igab046.1578 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 408-409

Author(s):

Dexia Kong ◽

Peiyi Lu ◽

Elissa Kozlov ◽

Mack Shelley

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Longitudinal Data ◽

Health Outcomes ◽

Food Insecurity ◽

Repeated Measures ◽

Mental Health Outcomes ◽

Mixed Effect ◽

Health Trajectories ◽

Over Time

Abstract The extent to which food insecurity impacts changes in mental health outcomes over time in the context of Covid-19 remains unknown. Using longitudinal data from a nationally representative survey, the objectives of the present study were to: (1) assess the prevalence of food insecurity among U.S. adults amid the Covid-19 pandemic; and (2) investigate the relationships between food insecurity statuses and changes in mental health outcomes over time as the pandemic unfolds. Longitudinal data from the Internet-based Understanding Coronavirus in America survey collected bi-weekly between April and December 2020 were used (n=4,068, 15 repeated measures). Adult respondents (aged ≥18) were asked about their food insecurity experiences and stress/anxiety/depressive symptoms. Linear mixed-effect models examined changes in mental health outcomes over time among groups with various food insecurity statuses. Overall prevalence of food insecurity was 8%. Food insecurity was consistently associated with higher levels of stress/anxiety/depressive symptoms (p<0.001). Stress/anxiety/depressive symptoms declined over time among food-secured U.S adults. However, mental health trajectories of respondents with various food insecurity categories, including food insecurity status, persistent food insecurity, and food insecurity of higher severity and longer duration, remained stable or worsened over time. Moreover, the mental health gap between food-secured and food-unsecured participants widened over time. Food insecurity represents a pressing public health problem during the Covid-19 pandemic with substantial mental health implications. Persistent and severe food insecurity may contribute to mental health disparity in the long term. Food insecurity reduction interventions may alleviate the estimated alarming mental health burden as the pandemic unfolds.

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The Effect of Diabetes on the Cognitive Trajectory of Older Adults in Mexico and the United States

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa094 ◽

2020 ◽

Author(s):

Jaqueline C Avila ◽

Silvia Mejia-Arangom ◽

Daniel Jupiter ◽

Brian Downer ◽

Rebeca Wong

Keyword(s):

United States ◽

Older Adults ◽

Linear Models ◽

The United States ◽

Mixed Effect ◽

Cognitive Domains ◽

Aging Study ◽

Nationally Representative ◽

The Impact ◽

Over Time

Abstract Objectives To study the impact of diabetes on the long-term cognitive trajectories of older adults in 2 countries with different socioeconomic and health settings, and to determine whether this relationship differs by cognitive domains. This study uses Mexico and the United States to confirm if patterns hold in both populations, as these countries have similar diabetes prevalence but different socioeconomic conditions and diabetes-related mortality. Methods Two nationally representative cohorts of adults aged 50 years or older are used: the Mexican Health and Aging Study for Mexico and the Health and Retirement Study for the United States, with sample sizes of 18,810 and 26,244 individuals, respectively, followed up for a period of 14 years. The outcome is cognition measured as a total composite score and by domain (memory and nonmemory). Mixed-effect linear models are used to test the effect of diabetes on cognition at 65 years old and over time in each country. Results Diabetes is associated with lower cognition and nonmemory scores at baseline and over time in both countries. In Mexico, diabetes only predicts lower memory scores over time, whereas in the United States it only predicts lower memory scores at baseline. Women have higher total cognition and memory scores than men in both studies. The magnitude of the effect of diabetes on cognition is similar in both countries. Discussion Despite the overall lower cognition in Mexico and different socioeconomic characteristics, the impact of diabetes on cognitive decline and the main risk and protective factors for poor cognition are similar in both countries.

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360 Efficacy of CBT-I and its Components on Health-Related Quality of Life Outcomes in Older Adults

SLEEP ◽

10.1093/sleep/zsab072.359 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A143-A144

Author(s):

Kelly Showen ◽

Kathleen O’Hora ◽

Beatriz Hernandez ◽

Laura Lazzeroni ◽

Jamie Zeitzer ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Older Adults ◽

Health Related Quality ◽

Health Related Qol ◽

Related Quality ◽

Health Related ◽

The Impact ◽

Over Time

Abstract Introduction Insomnia affects 30–48% of older adults and impairs health-related quality of life (HRQoL). Numerous studies report Cognitive Behavioral Therapy (CBT-I) as an effective non-pharmacological treatment for insomnia symptoms, with few examining the impact of CBT-I on mental and physical aspects of HRQoL. While limited research suggests that CBT-I leads to improvements in HRQoL, the impact of the cognitive versus behavioral components of CBT-I on HRQoL is unknown. Methods 128 older adults with insomnia (mean age=69, 66% female, 19% minority) were randomized to receive cognitive therapy (CT), behavior therapy (BT), or CBT-I. The Short Form (36) Health Survey (SF-36) was collected at baseline, post-treatment and six-month follow-up. Split-plot linear mixed models with age and sex as covariates to assess within and between subject changes were used to test intervention, time, and interaction effects on the mental health and physical well-being domains of HRQoL. Significance for all effects was defined as p < 0.05. The effect size (d) was calculated by dividing the difference between means by the root-mean-squared error of the mixed effects model. Results The mental health-related QoL improved over time independent of treatment (Main effect of time: F(2, 202) = 6.51, p < 0.002). The interaction failed to reach significance (Interaction: F(4, 202) = 1.19, p = .31). Simple effects revealed significant improvements among CBT-I participants at six months (p = .02, d = .53) and CT participants at post-treatment (p = .00, d = .79) and six months (p = .03, d = .66), but not among BT participants for either time point (p = .32, d = .24; p = .16, d = .35). Treatment did not improve physical health-related QoL over time (F(2, 202) = 1.01, p = .37) nor was there a significant interaction (F(4, 202) = .46, p = .76). Conclusion These findings suggest that CBT-I, particularly the CT component, may be effective in improving mental health-related QoL outcomes for older adults with insomnia. In contrast, neither CBT-I nor its component treatments were effective in improving physical health-related QoL. Support (if any) NIMHR01MH101468-01; Mental Illness Research, Education, and Clinical Center (MIRECC) at the VAPAHCS

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Do Depressive Symptoms Shape Blacks’ Perceptions of Stress Over Time?

Innovation in Aging ◽

10.1093/geroni/igaa057.1901 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 573-573

Author(s):

DeAnnah Byrd ◽

Roland Thorpe ◽

Keith Whitfield

Keyword(s):

Mental Health ◽

Risk Factors ◽

Depressive Symptoms ◽

Cognitive Aging ◽

Community Dwelling ◽

Future Work ◽

The Impact ◽

Over Time ◽

Time Future

Abstract The established association between stress and depression is typically examined only in one direction and cross-sectionally. Data from the Baltimore Study of Black Aging-Patterns of Cognitive Aging was used to longitudinally examine the bi-directional relationships between (1) stress-depression and (2) depression-stress, and age as a modifier. The sample consisted of 602 community-dwelling Blacks, aged 48-92 years at baseline and 450 at follow-up 33 months later. While the stress-depression relationship was non-significant; the depression-stress was (b= 0.236, p< 0.000) and this association varied by age with the impact of baseline depression on changes in stress greatest among Blacks in their 60’s versus those in their 50’s (b= 0.257, p= 0.002), controlling for model covariates. Findings highlight the importance of depression in shaping Blacks’ perception of stress over time. Future work should continue to identify stress and mental health risk factors that contribute to poor health and health disparities in older Blacks.

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The Effects of a Digital Well-Being Intervention on Patients With Chronic Conditions: Observational Study (Preprint)

10.2196/preprints.16211 ◽

2019 ◽

Author(s):

Acacia C Parks ◽

Allison L Williams ◽

Gina M Kackloudis ◽

Julia L Stafford ◽

Eliane M Boucher ◽

...

Keyword(s):

Chronic Illness ◽

Chronic Conditions ◽

Chronic Condition ◽

Intervention Program ◽

Behavioral Therapy ◽

Past Research ◽

Well Being ◽

Subjective Well Being ◽

The Impact ◽

Over Time

BACKGROUND Chronic conditions account for 75% of health care costs, and the impact of chronic illness is expected to grow over time. Although subjective well-being predicts better health outcomes, people with chronic conditions tend to report lower well-being. Improving well-being might mitigate costs associated with chronic illness; however, existing interventions can be difficult to access and draw from a single theoretical approach. Happify, a digital well-being intervention program drawing from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and nondistressed users. OBJECTIVE This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition. METHODS Data were obtained from Happify users, a publicly available digital well-being program accessible via website or mobile phone app. Users work on tracks addressing a specific issue (eg, conquering negative thoughts) composed of games and activities based on positive psychology, cognitive behavioral therapy, and mindfulness principles. The sample included 821 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 to 179 days) who met other inclusion criteria. As part of a baseline questionnaire, respondents reported demographic information (age and gender) and whether they had any of the prespecified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (450 reported a chronic condition, whereas 371 did not). Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed effects linear regression model was fit for subjective well-being, controlling for demographics and platform usage. RESULTS At baseline, users with a chronic condition had significantly lower subjective well-being (mean 38.34, SD 17.40) than users without a chronic condition (mean 43.65, SD 19.13). However, change trajectories for users with or without a chronic condition were not significantly different; both groups experienced equivalent improvements in well-being. We also found an effect for time from baseline (<italic>b</italic>=0.071; SE=0.010; <italic>P</italic><.01) and number of activities completed (<italic>b</italic>=0.03; SE=0.009; <italic>P</italic><.01), and a 2-way interaction between number of activities completed and time from baseline (<italic>b</italic>=0.0002; SE=0.00006; <italic>P</italic><.01), such that completing more activities and doing so over increasingly longer periods produced improved well-being scores. CONCLUSIONS Data from this study support the conclusion that users with a chronic condition experienced significant improvement over time. Despite reporting lower subjective well-being on the whole, their change trajectory while using Happify was equivalent to those without a chronic condition. Consistent with past research, users who completed more activities over a longer period showed the most improvement. In short, the presence of a chronic condition did not prevent users from showing improved well-being when using Happify.

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The impact of social networks on the relationship between functional impairment and depressive symptoms in older adults

International Psychogeriatrics ◽

10.1017/s1041610215000538 ◽

2015 ◽

Vol 28 (1) ◽

pp. 39-47 ◽

Cited By ~ 14

Author(s):

Kimberly J. Stoeckel ◽

Howard Litwin

Keyword(s):

Mental Health ◽

Older Adults ◽

Social Network ◽

Depressive Symptoms ◽

Functional Impairment ◽

Functional Limitations ◽

Later Life ◽

Meaningful Relationships ◽

The Impact ◽

Network Type

ABSTRACTBackground:To examine the role of meaningful relationship characteristics, defined here as social network type, in relation to the association between functional impairment and depressive symptoms.Methods:The sample included respondents aged 65 years and older (n = 26,401) from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Respondents were classified into one of seven relationship network types (Distal Children (living at a distance), Proximal Family (living nearby), Spouse, Other Family, Friend, Other, and No Network) according to the predominant characteristics of their most meaningful relationships. A two-stage regression analysis was performed in which the number of depressive symptoms was first regressed on the extent of functional impairment and network type, controlling for sociodemographic characteristics, cognition, health, and country. In the second stage, variables representing the interactions between functional impairment and network type were considered.Results:The compositional characteristics of respondents’ relationships in later life, as defined by social network type, were associated with depressive symptoms. In particular, when experiencing functional impairment, those without any meaningful relationships were found to have more depressive symptoms when compared to all other network types. The findings underscore the importance of meaningful relationships for the mental health of older adults experiencing functional impairment as well as the risk of experiencing depression among those who maintain no personal social network.Conclusions:The study shows that differing constellations of meaningful relationships in later life yield different associations with mental health, especially when taking functional limitations into account.

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