scholarly journals Bridging late-life depression and chronic somatic diseases: a network analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Federico Triolo ◽  
Martino Belvederi Murri ◽  
Amaia Calderón-Larrañaga ◽  
Davide Liborio Vetrano ◽  
Linnea Sjöberg ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Disease Burden ◽  
Late Life ◽  
National Study ◽  
Late Life Depression ◽  
Suicidal Thoughts ◽  
Disease Clusters ◽  
Cognitive Difficulties ◽  
Somatic Disease ◽  
Somatic Diseases

AbstractThe clinical presentation of late-life depression is highly heterogeneous and likely influenced by the co-presence of somatic diseases. Using a network approach, this study aims to explore how depressive symptoms are interconnected with each other, as well as with different measures of somatic disease burden in older adults. We examined cross-sectional data on 2860 individuals aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, Stockholm. The severity of sixteen depressive symptoms was clinically assessed with the Comprehensive Psychopathological Rating Scale. We combined data from individual clinical assessment and health-registers to construct eight system-specific disease clusters (cardiovascular, neurological, gastrointestinal, metabolic, musculoskeletal, respiratory, sensory, and unclassified), along with a measure of overall somatic burden. The interconnection among depressive symptoms, and with disease clusters was explored through networks based on Spearman partial correlations. Bridge centrality index and network loadings were employed to identify depressive symptoms directly connecting disease clusters and depression. Sadness, pessimism, anxiety, and suicidal thoughts were the most interconnected symptoms of the depression network, while somatic symptoms of depression were less interconnected. In the network integrating depressive symptoms with disease clusters, suicidal thoughts, reduced appetite, and cognitive difficulties constituted the most consistent bridge connections. The same bridge symptoms emerged when considering an overall measure of somatic disease burden. Suicidal thoughts, reduced appetite, and cognitive difficulties may play a key role in the interconnection between late-life depression and somatic diseases. If confirmed in longitudinal studies, these bridging symptoms could constitute potential targets in the prevention of late-life depression.

scholarly journals Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

2021 ◽  
Vol 30 ◽  
Author(s):  
Shiyu Lu ◽  
Tianyin Liu ◽  
Gloria H. Y. Wong ◽  
Dara K. Y. Leung ◽  
Lesley C. Y. Sze ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Symptom Severity ◽  
Social Care ◽  
Late Life ◽  
Community Dwelling ◽  
Service Utilisation ◽  
Late Life Depression ◽  
Social Care Service ◽  
Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

scholarly journals Cognitive Functioning and Late-Life Depression

2014 ◽  
Vol 20 (5) ◽  
pp. 461-467 ◽  
Author(s):  
Aaron M. Koenig ◽  
Rishi K. Bhalla ◽  
Meryl A. Butters
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Cognitive Functioning ◽  
Neuropsychological Assessment ◽  
Cognitive Deficits ◽  
Late Life ◽  
Cognitive Outcomes ◽  
Review Of The Literature ◽  
Late Life Depression ◽  
The Relationship

AbstractThis brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient’s symptoms. (JINS, 2014, 20, 1–7)

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.

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 Use of Passive Sensing in Psychotherapy Studies in Late Life: A Pilot Example, Opportunities and Challenges

2021 ◽  
Vol 12 ◽  
Author(s):  
Jihui Lee ◽  
Nili Solomonov ◽  
Samprit Banerjee ◽  
George S. Alexopoulos ◽  
Jo Anne Sirey
Keyword(s):  
Depressive Symptoms ◽  
Behavioral Activation ◽  
Elder Abuse ◽  
Late Life ◽  
Activity Level ◽  
Activity Levels ◽  
Late Life Depression ◽  
Sensing Data ◽  
Passive Sensing ◽  
Over Time

Late-life depression is heterogenous and patients vary in disease course over time. Most psychotherapy studies measure activity levels and symptoms solely using self-report scales, administered periodically. These scales may not capture granular changes during treatment. We introduce the potential utility of passive sensing data collected with smartphone to assess fluctuations in daily functioning in real time during psychotherapy for late life depression in elder abuse victims. To our knowledge, this is the first investigation of passive sensing among depressed elder abuse victims. We present data from three victims who received a 9-week intervention as part of a pilot randomized controlled trial and showed a significant decrease in depressive symptoms (50% reduction). Using a smartphone, we tracked participants' daily number of smartphone unlocks, time spent at home, time spent in conversation, and step count over treatment. Independent assessment of depressive symptoms and behavioral activation were collected at intake, Weeks 6 and 9. Data revealed patient-level fluctuations in activity level over treatment, corresponding with self-reported behavioral activation. We demonstrate how passive sensing data could expand our understanding of heterogenous presentations of late-life depression among elder abuse. We illustrate how trajectories of change in activity levels as measured with passive sensing and subjective measures can be tracked concurrently over time. We outline challenges and potential solutions for application of passive sensing data collection in future studies with larger samples using novel advanced statistical modeling, such as artificial intelligence algorithms.

scholarly journals Longitudinal Association Between Cognition and Depression in Patients With Late-Life Depression: A Cross-Lagged Design Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhangying Wu ◽  
Xiaomei Zhong ◽  
Qi Peng ◽  
Ben Chen ◽  
Min Zhang ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Structural Equation ◽  
Late Life ◽  
Equation Model ◽  
Depression Symptoms ◽  
Information Processing Speed ◽  
Late Life Depression ◽  
Cross Sectional ◽  
Two Factors ◽  
Longitudinal Association

Objectives: Although previous studies have extensively confirmed the cross-sectional relationship between cognitive impairment and depression in depressed elderly patients, the findings of their longitudinal associations are still mixed. The purpose of this study was to explore the two-way causal relationship between depression symptoms and cognition in patients with late-life depression (LLD).Methods: A total of 90 patients with LLD were assessed across two time points (baseline and 1-year follow up) on measures of 3 aspects of cognition and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects.Results: Depressive symptoms predicted a decline in executive function (β = 0.864, p = 0.049) but not vice versa. Moreover, depressive symptoms were predicted by a decline in scores of working memory test (β = −0.406, p = 0.023), respectively. None of the relationships between the two factors was bidirectional.Conclusion: These results provide robust evidence that the relationship between cognition and depressive symptoms is unidirectional. Depressive symptoms may be a risk factor for cognitive decline. The decrease of information processing speed predicts depressive symptoms.

Depression and associated organic diseases: are there any specific depressive symptoms? Results from the dialogue-2 survey

2004 ◽  
Vol 19 (7) ◽  
pp. 446-449 ◽  
Author(s):  
J.D. Guelfi ◽  
C. Rousseau ◽  
S. Lancrenon
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Symptoms ◽  
Organic Disease ◽  
Depressed Patients ◽  
Somatic Disease ◽  
Significant Difference ◽  
Somatic Diseases

AbstractThe objective of the survey was to compare depressive symptoms in depression with and without a concomitant organic disease. The results based on the HAD and CES-D scales showed that, compared to those with an isolated depression, the patients with an associated chronic organic disease have a higher score on two items on the HAD. Three variables on the CES-D scale also helped to differentiate the two groups of depressed patients. No significant difference was found between the two groups in terms of anxiety or cognitive symptoms, fatigue or feelings of disability. Our results do not indicate any symptom that is specific to a combination of depression and somatic diseases. Guilt and hostility showed a lower level in depression associated with a concomitant somatic disease than in isolated depression.

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