Self-perception of depressive symptoms, self-reported medical diagnosis, and associated factors: findings from the Brazilian Longitudinal Study of Aging, 2019-2021

To estimate the prevalence of self-reported physician-diagnosed depression and to assess its association with self-perceived depressive symptoms, sociodemographic variables, physical activity, alcohol consumption, and smoking among Brazilian older adults. This study employed a cross-sectional design using data from the Brazilian Longitudinal Study of Aging. The outcome was the self-reported physician-diagnosed depression. Independent variables included sociodemographic factors, physical activity, alcohol consumption, and smoking. The association between the outcome and self-perception of depressive symptoms was evaluated. Data from 6,872 older adults were included. The prevalence of self-reported physician-diagnosed depression was 12.2% (95% confidence interval - 95%CI 11.4; 13.0). Self-perceived depressive symptoms were reported by 15.6% (95%CI 14.7; 16.5). Self-reported physician-diagnosed depression was higher among females (prevalence ratio - PR 2.23; 95%CI 1.80; 2.89), individuals with up to eight years of schooling (PR 1.32; 95% CI 1.10; 1.61), and those who did not engage in physical activity (PR 1.32; 95% CI 1.10; 1.57). The prevalence of self-reported physician-diagnosed depression among Brazilian older adults was 12.2%, independently associated with female sex, lower schooling, and physical inactivity. However, the prevalence of self-perceived depressive symptoms was even higher and was also associated with self-reported physician-diagnosed depression. Self-report may be a valuable tool, reinforcing the need for a hybrid approach that combines it with objective methods when addressing depression among older people.

Socioeconomic inequality in health in older adults in Brazil.

The aim is to identify the prevalence and main factors associated with self-reported poor sleep quality in Brazilian adults aged 50 and older. A cross-sectional study with participants from the Brazilian Longitudinal Study of Aging (2019-2021). A total of 9,849 participants aged 50 and older with complete information for the variables of interest were included. Self-reported sleep quality was the outcome variable. Independent variables included sociodemographic, behavioral, and health-related indicators. Poisson regression was performed to estimate prevalence ratios (PR) and their respective 95% confidence intervals (CI95%). The prevalence of poor sleep quality was 15.6%. Significant associations were observed between the outcome and male gender (PR = 0.70; CI95%: 0.61-0.81), self-rated good health (PR = 0.49; CI95%: 0.40-0.60), and residence in the southern region (PR = 0.68; CI95%: 0.49-0.94), the number of chronic diseases (PR = 2.52; CI95%: 1.97-3.24, for those with two or more), and self-rated poor memory (PR = 1.30; CI95%: 1.12-1.51). Poor sleep quality in Brazilian older adults was associated with various factors, including female gender, negative perception of health and memory, excessive alcohol consumption, and the presence of multiple chronic conditions.

This study aimed at estimating the prevalence of stroke in older adults in Brazil, and at identifying the sociodemographic, health-related, health service-related, and environmental factors associated with independence in daily activities. Across-sectional, population-based study (Brazilian Longitudinal Study of Aging 2015-2016) was conducted. 536 individuals (≥ 50 years), from 9,412 participants, have had stroke and were included. Prevalence of stroke was 5.3% among individuals aged 50 years and over, increasing up to 8.0% among individuals aged 75 years and over, showing a dissimilar pattern between sex. Independence was associated with walking speed (Prevalence Ratio (PR) 2.72, 95%CI: 1.96 to 3.77), physical activity (PR 1.24; 95%CI: 1.04 to 1.47) and use of walking devices (PR 0.63; 95%CI: 0.41 to 0.96). A significant interaction was found between walking speed plus home adaptations and performance of daily living activities (PR 3.42; 95%CI: 1.04 to 11.29). The probability of independence was 40% among slow walkers (< 0.4 m/s), increasing up to 70% among fast walkers (> 0.8 m/s), and to 90% among those who also have home adaptations. Faster walking speed combined with home adaptations was the main factor associated with long-term independence after stroke.

The impact of education level and socioeconomic status on the association between depressive symptoms and memory in an older population in Latin America: An exploratory analysis from the Brazilian Longitudinal Study of Aging (ELSI-BRAZIL)

Although prior research has noted the benefits of Internet use on physical and mental health among older adults in developed countries, its impact within less developed countries, particularly in Latin America concerning rural-urban disparities, is poorly understood. This study investigated the health disparities between rural and urban older adults in Brazil and examined how Internet use moderated these disparities. Data from the second wave of the Brazilian Longitudinal Study of Aging with 9,751 adults aged 50 and above were analyzed. The outcome variables include the number of chronic conditions, limitations in basic and instrumental activities of daily living (ADL &amp; IADL), depressive symptoms and cognitive functioning. Using a series of weight-adjusted multivariate linear regression analyses, we found that compared to the older adults who lived in rural areas, urban residents tended to have more chronic conditions, IADL disabilities, higher depressive symptoms, but better cognitive functioning. A significant interaction between Internet use and rural-urban residency was identified for chronic conditions (β=0.72, 95% CI= 0.55-0.94), cognitive functioning (β=0.85, 95% CI=0.73-0.99), and depressive symptoms (β=1.40, 95% CI=1.04-1.89), indicating that Internet use mitigated the rural-urban disparity in chronic conditions and cognitive functioning, while it increased the disparity in depressive symptoms. The study’s findings underscore the potential of Internet use as a means to reduce health disparities among older adults in Brazil. Future interventions could include targeted digital inclusion strategies tailored to address the socioeconomic challenges in rural areas to leverage the benefits of the Internet.

To describe the socioeconomic, behavioral, clinical, and health-related characteristics of Brazilian older adults with Alzheimer's disease (AD). Baseline data from the Brazilian Longitudinal Study of Aging were analyzed. This nationwide survey interviewed 9,412 adults aged at least 50 years. Self-reported medical diagnosis of AD and exposure variables (sociodemographic, clinical, behavioral, and health-related) were assessed by face-to-face questionnaire-based interview. Multivariate analyses accounted for possible confounding factors, and values were reported in prevalence ratio (PR) and 95% confidence interval (95%CI). Participants with AD have important demographic differences compared with older non-AD participants such as low education level and retirement. Clinically, these patients reported more medical appointments, falls, and higher frequency and duration of hospitalizations compared with non-AD participants. These characteristics may be related to worse physical and mental health observed in this population. Indeed, two out of five older adults with AD in Brazil reported always feeling lonely, while two out of three said they felt depressed or sad much of the time. Adjusted analyses showed that patients with AD were 95% (95%CI 1.08 - 3.50) more likely to be hospitalized in a year compared with non-AD older adults. People with AD in Brazil were more likely to be diagnosed with diabetes (PR = 1.83 [95%CI 1.08 - 3.12]), depression (PR = 3.07% [95%CI 1.63 - 5.79]), Parkinson's disease (PR = 17.63 [95%CI 6.99 - 44.51]), and stroke (PR = 3.55 [95%CI 1.90 - 6.67]) compared with non-AD participants. Older adults with AD in Brazil reported impaired physical and mental health compared with the non-AD population.

This study examined isolated and combined associations of physical activity (PA) and sitting time (ST) with body mass index (BMI) among older Brazilian adults. We have analyzed baseline data of 8,177 participants aged 50 years and older from the Brazilian Longitudinal Study of Aging. Respondents were categorized into sufficient PA/low ST, sufficient PA/high ST, insufficient PA/low ST, or insufficient PA/high ST using the Short Version of International Physical Activity Questionnaire. Multinomial logistic regression analysis examined the associations of being underweight (BMI, <18kg/m2), overweight (BMI, 25-29.9kg/m2), and obese (BMI, ≥30kg/m2) with PA and ST categories. High ST (≥165min/day) was associated with overweight (odds ratio, 1.26; 95% confidence interval [1.11, 1.44]) and obesity (odds ratio, 1.43; 95% confidence interval [1.21, 1.70]). However, no association was observed between PA and BMI. Participants in the insufficient and sufficient PA/high ST categories were more likely to be obese after adjusting for sociodemographic and health condition. Our findings call for public health initiatives that consider reducing ST in older adults.

Introduction: Functional disabilities are more prevalent in older adults with multimorbidity and depression. However, few studies have investigated the combination of multimorbidity and depression with functional disability. This study aims to verify whether symptoms of depression and multimorbidity combined increase the prevalence of functional disability in Brazilian older adults. Material and methods: This is a cross-sectional study conducted with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline examination in 2015-2016 in adults aged 50years and older. The variables included were basic (BADL) and instrumental activities of daily living (IADL), depressive symptoms, multimorbidity (≥2 chronic diseases), sociodemographic variables, and lifestyle. Logistic regression was performed to estimate crude and adjusted odds ratios. Results: A total of 7,842 participants over 50years of age were included. Of these, 53.5% were women and 50.5% were between 50 and 59years old, 33.5% reported ≥4 depressive symptoms, 51.4% had multimorbidity, 13.5% reported difficulty in performing at least one BADL, and 45.1% reported difficulty in performing the IADL. In the adjusted analysis, the prevalence of difficulty on BADL was 6.52 (95% CI: 5.14; 8.27) and on IADL was 2.34 (95% CI: 2.15; 2.55), higher for those with depression and multimorbidity combined when compared with those without these conditions. Conclusion: The combination of symptoms of depression and multimorbidity may increase functional impairments in the BADL and IADL of Brazilian older adults, impairing self-efficacy, independence, and autonomy. Early detection of these factors benefits the person, their family, and the healthcare system for health promotion and disease prevention.

With the dramatic growth of the Chinese economy, the number of children/adolescents with being overweight/having obesity is increasing, which has a certain impact on their psychology, such as depression and anxiety symptoms. Our purpose was to conduct a meta-analysis to assess the prevalence and odds ratios of depression and anxiety symptoms among overweight/obese children/adolescents and non-overweight/obese children/adolescents in China. As of July 2018, the three most comprehensive computerized academic databases in China have been systematically screened, namely China national knowledge infrastructure (CNKI) databases, Wanfang databases and Vip databases. The same operations are performed in PubMed and Web of Science (SCIE) databases without language restrictions. Case-control studies on prevalence of depression and anxiety symptoms in overweight/obese children/adolescents in China were analyzed. Study selection and evaluation were performed independently by three authors. Unweighted prevalence, pooled random-effects estimates of odds ratio (OR), and 95% confidence intervals (CI) were all calculated. A total of 11 eligible studies involving 17,894 subjects were included. The prevalence of depression and anxiety symptoms in overweight/obese children/adolescents was significantly higher than that in non-overweight/non-obese children/adolescents (depression: 21.73% vs. 17.96%, OR = 1.46, 95% CI: 1.14, 1.87, p = 0.003; anxiety: 39.80% vs. 13.99%, OR = 1.47, 95% CI: 1.21, 1.79, p < 0.001). Subgroup analyses conducted according to scale types showed that scale types have certain significance to evaluate the relationship between depression symptoms and overweight/obesity. The OR of depression symptoms between overweight/obese children/adolescents and non-overweight/non-obese children/adolescents was greatest on the Middle School Student Mental Health Scale (MSSMHS) was 2.06 (95% CI: 1.41, 3.02, I2 = 0.00%), Center for Epidemiologic Studies Depression Scale (CES-D) was 1.03 (95% CI: 0.84, 1.25, I2 = 0.00%), and Children’s Depression Inventory (CDI) was 1.21 (95% CI: 1.02, 1.42, I2 = 0.00%). We concluded that the prevalence of depression and anxiety symptoms in overweight/obese children/adolescents in China is higher than that in the non-overweight/obese children/adolescents. The results of the study indicate that the prevalence of depression and anxiety symptoms among overweight/obese children/adolescents in Chinese medical institutions should receive more attention. Physical exercise and psychological interventions should be strengthened to prevent psychological problems. However, because of some clear limitations (no clinical interview and few studies), these results should be interpreted with caution.

Little is known about sleeping pills consumption among older adults in low- and middle-income countries. This study investigated the prevalence and factors associated with sleeping pills use among Brazilians aged 50 and over. A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9412). Univariate and bivariate analyses were used to describe the sample. Robust Poisson regression was employed to estimate prevalence ratios and predict probabilities. Prevalence of sleeping pills use among older Brazilians was estimated at 16.8%, with considerable disparities related to gender (22.3% among women and 10.3% among men), race/skin colour (19.7% among whites and 11.9% among blacks) and geographic region (ranging from 5.9% in the North to 20.5% in the South). The multivariate analysis showed associations between sleeping pills consumption and sociodemographic factors (age, gender, race/skin colour, geographic region and income), health status/behaviour characteristics (poor self-rated health status, number of chronic conditions and alcohol consumption) and variables related to healthcare utilisation (number of visits, usual source of care, care coordination, doctor's awareness of all medication, difficulty in managing own medication and number of medicines). Our work found that sleeping pills consumption is disproportionately prevalent among women, is associated with worse health status and increases with more medical office visits and use of additional medicines. Moreover, the large inexplicable variations in care deserve special attention from policy-makers and clinicians.

There is little nationally representative information about factors associated with longevity among older Brazilians. Baseline survey data from the Brazilian longitudinal Study of Aging (ELSI-Brazil) were linked to vital statistics systems. Mortality rates and life expectancy estimates were calculated and compared to official sources. Cox Proportional Hazards models and Population Attributable Fractions (PAFs) identified significant predictors of mortality. Results: Calculated mortality rates and life expectancy estimates were similar to official statistics for most ages with higher risk of death among older ages, as expected. High School completion, being partnered, and female sex were negatively associated with mortality, while being underweight, previous diagnosis of a chronic condition, having any functional limitations, poor self-rated health, low grip strength, and smoking were all associated with higher mortality risk. Discussion: The ELSI-Brazil study has potential to identify factors associated with longevity and to inform programs and policies designed to enhance healthy aging among older adults in Brazil.

Close kin availability and mortality among older adults in Brazil.

To investigate whether having a higher number of depressive symptoms is associated with negative self-rated health (SRH) even in the absence of illness. This is a secondary analysis of baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, using a national sample of 9,412 people aged 50 or over. SRH was dichotomized into poor or very poor and very good or excellent, good, or average. Depressive symptoms were assessed through the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8). Sociodemographic variables, information about unhealthy behaviors, and the number of chronic conditions were also analyzed. Having depressive symptoms was strongly associated with poor or very poor SRH both in the unadjusted and adjusted analyses. The magnitude of the association was reduced when the number of chronic illnesses was included in the multivariate analysis, along with the other sociodemographic variables and unhealthy behaviors (OR 1.35, 95%CI 1.31-1.39). Having depressive symptoms may contribute towards having a poorer perception of health, even in the absence of health conditions. SRH is a multidimensional construct that can accurately reflect a person's state of general mental health.

This study aimed to describe the prevalence of depressive symptoms and associated factors among older adults. A cross-sectional population-based study using data from the 2019 Brazilian National Health Survey was carried out. The prevalence of depressive symptoms was determined using the 9-item Patient Health Questionnaire (PHQ-9), and associations were tested according to sociodemographic, health and behavioral variables. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson's regression. The overall prevalence of depressive symptoms was 10.7% (95%CI: 9.9; 11.5). Higher PHQ-9 scores were associated with female gender (PR = 2.11, 95%CI: 1.82; 2.44), lack of participation in religious activities (PR = 1.20, 95%CI: 1.07; 1.35), nonsmoking status (PR = 1.55, 95%CI: 1.32; 1.83), poor or very poor self-perceived health (PR = 7.55, 95%CI: 5.82; 9.80), and multimorbidity (PR = 2.26, 95%CI: 1.85; 2.75). Higher education (PR = 0.55, 95%CI: 0.42; 0.73), income (PR = 0.68, 95%CI: 0.54; 0.85), and physical activity (PR = 0.72, 95%CI: 0.57; 0.90) were found to be negatively associated with the outcome. The most prevalent depressive symptoms were: sleeping problems (24.8%, 95%CI: 23.8; 25.8), not feeling rested or willing/feeling without energy (14.5%, 95%CI: 13.7; 15.4), and being depressed/down/without perspective (10.5%, 95%CI: 9.7; 11.2). These findings highlight the importance of prioritizing the identification and treatment of depressive symptoms in older Brazilian populations, particularly given that one in ten older Brazilians experience depressive symptoms.