Depressive Disorder In Older Adults Research Articles

The Cognitive Profile of Older Adults With Treatment-Resistant Depression: An Analysis of the OPTIMUM Randomized Controlled Trial

ObjectiveMajor depressive disorder in older adults (late-life depression; LLD) is frequently associated with cognitive impairment, and some deficits (e.g., executive function) have been associated with a higher level of treatment resistance. However, the cognitive profile of treatment-resistant LLD (TR-LLD) has not been characterized. We hypothesized that patients with TR-LLD would show deficits in cognitive function, especially executive function, and that executive function deficits would predict poorer response to pharmacotherapy. DesignSecondary analysis of baseline cognitive data from OPTIMUM, a multicenter RCT evaluating pharmacotherapy strategies for TR-LLD. SettingFive outpatient academic medical centers (4 US, 1 Canada). ParticipantsAbout 369 participants aged 60 and older from the OPTIMUM study. MeasurementsBaseline scores on individual tasks and composite scores from the NIH Toolbox-Cognition Battery were transformed into demographically-adjusted T-scores and compared to published norms. Impairments in the set shifting and inhibitory control tasks were investigated as predictors of depressive symptom change following treatment using ANCOVA models. ResultsParticipants had low performance on tasks evaluating inhibitory control, processing speed, verbal/nonverbal memory, and the fluid composite, but normative performance on working memory and set shifting. Participants had high estimated premorbid IQ (superior Performance on oral reading recognition). Age and physical comorbidity negatively associated with processing speed. Impairments in set shifting predicted less improvement in depressive symptoms; impairments in inhibitory control did not. ConclusionsParticipants with TR-LLD presented with broad cognitive deficits relative to healthy norms. Given poorer outcomes following standard pharmacotherapy associated with impaired set shifting, future research needs to identify alternative treatment strategies.

Gender differences in the association between cardiovascular diseases and major depressive disorder among older adults in India.

Despite the global disease burden associated with the co-occurrence of cardiovascular diseases (CVDs) and depression, depression remains underdiagnosed and undertreated in the CVD population, especially among older adults in India. As such, this study examines (1) the association between single and multiple CVDs and major depressive disorder among older Indians; (2) whether this association is mediated by older adults' self-rated health and functional limitations; and (3) whether these associations vary for older men and women. Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study in India. Multivariable logistic regression is used to explore the association between CVDs and major depressive disorder among older men and women. The Karlson-Holm-Breen (KHB) method is used to examine the mediation effects of self-rated health and functional difficulties in the observed associations. Overall, 5.08% of the older adults had multiple CVDs. Older women (9.71%) had a higher prevalence of major depressive disorder compared to men (7.50%). Multiple CVDs were associated with greater odds of major depressive disorder after adjusting the potential covariates (adjusted odds ratio [AOR]: 1.49; 95% confidence interval [CI]: 1.10-2.00). Older men with multiple CVDs had a greater risk of major depressive disorder (AOR: 1.64; 95% CI: 1.05-2.57) relative to women with CVDs (AOR: 1.39; 95% CI: 0.93-2.08). The association between multiple CVDs and depression was mediated by self-rated health (34.03% for men vs. 34.55% for women), ADL difficulty (22.25% vs. 15.42%), and IADL difficulty (22.90% vs. 19.10%). One in five older Indians with multiple CVDs reports major depressive disorder, which is three times more common than the prevalence of depressive disorder in older adults without CVDs. This association is attenuated by self-rated health and functional limitations. Moreover, these associations are more pronounced in older men relative to older women. These findings depart from prior inferences that men with CVDs are less psychologically distressed than their female counterparts. Moreover, the findings underscore the importance of gender-specific approaches to interventions and therapeutics for CVD-related mental health.

Stability of the Subtypes of Major Depressive Disorder in Older Adults and the Influence of Mild Cognitive Impairment on the Stability

ObjectivesTo assess 1) the longitudinal stability of the atypical, melancholic, combined atypical-melancholic and the unspecified subtypes of major depressive disorder (MDD) according to the diagnostic and statistical manual of mental disorders (DSM –IV) specifiers in older adults, and 2) the effect of mild cognitive impairment (MCI) on the stability of these subtypes. DesignProspective cohort study with a 5.1 year-follow-up. SettingPopulation-based cohort from Lausanne, Switzerland. ParticipantsA total of 1,888 participants (mean age: 61.7 years, women: 69.2%) with at least two psychiatric evaluations, one after the age of 65 years. MeasurementsSemistructured diagnostic interview to assess lifetime and 12-month DSM-IV Axis-1 disorders at each investigation and neuro-cognitive tests to identify MCI in participants aged 65 years and over. Associations between lifetime MDD status before and 12-month depression status after the follow-up were assessed using multinomial logistic regression. The effect of MCI on these associations was assessed by testing interactions between MDD subtypes and MCI status. Results1) Associations between depression status before and after the follow-up were observed for atypical (adjusted OR [95% CI] = 7.99 [3.13; 20.44]), combined (5.73 [1.50; 21.90]) and unspecified (2.14 [1.15; 3.98]), but not melancholic MDD (3.36 [0.89; 12.69]). However, there was a certain degree of overlap across the subtypes, particularly between melancholic MDD and the other subtypes. 2) No significant interactions were found between MCI and lifetime MDD subtypes regarding depression status after follow-up. ConclusionThe strong stability of the atypical subtype in particular highlights the need for identifying this subtype in clinical and research settings, given its well-documented links to inflammatory and metabolic markers.

Depressive disorders in older Chinese adults with essential hypertension: A classification tree analysis.

BackgroundAlthough there has been accumulating evidence on the elevated risk of depression in hypertensive patients, data regarding depressive disorders in older adults with hypertension and the interplay between factors associated with depression in this population are very limited. Disentangling the mutual influences between factors may help illuminate the pathways involved in the pathogenesis of the comorbidity of depression in hypertension. This study investigated the prevalence of depressive disorders in older Chinese adults with hypertension and examined major correlates of depressive disorders and the interactions between correlates by using classification tree analysis (CTA).MethodsIn total, 374 older adults with essential hypertension were enrolled from seven urban and six rural primary care centers in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. Family relationship and feelings of loneliness were assessed with standardized questions. A checklist was used to assess the presence of six major medical conditions: diabetes mellitus, heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, chronic gastric ulcer, and arthritis.ResultsThe 1-month prevalence rate of depressive disorders was 25.7%. The CTA model identified four major correlates of depressive disorders: loneliness was the most salient, followed by arthritis, family relationship, and heart disease. There were statistically significant interactions between loneliness and arthritis, loneliness and family relationship, and arthritis and heart disease.ConclusionOver one out of every four older Chinese adults with hypertension suffer from depressive disorders. Collaborative multidisciplinary management services are needed to reduce the burden of depression in hypertensive older adults, which may include social work outreach services to promote family relationship, mental health services to relive loneliness, and primary care services to manage arthritis and heart disease.

Soy product consumption and the risk of major depressive disorder in older adults: Evidence from a cohort study.

BackgroundTo explore the association between soy product consumption and the risk of depression in the community.MethodsIn 2014, a total of 10,901 older people were recruited from Zhejiang province, China, and completed food frequency interviews. Participants were followed up over the next 6 years, and depression was assessed at each visit. Finally, 6,253 participants were included in the present study. Mixed effects models were performed to analyze the association by multivariate adjustments for potential confounders.ResultsOver four-fifths of the eligible participants took soy food at least one day per week. The mixed effects model has shown the adjusted odds ratios (95% CI) of high-frequency consumers (4–7 days per week) were 0.46 (0.39–0.54) for depression with a cut-off score of 5, compared with non-consumers.ConclusionsMore frequent soy product consumption was associated with a lower risk of depression.

Beyond DSM Criteria: Neurobiological and Treatment Implications of Clinically-Identifiable Phenotypes of Late-Life Depression

The diagnosis of Major Depressive Disorder in older adults follows the same DSM5 criteria as is used in younger populations. However, this conceptualization limits us to clinical phenomenology as seen in younger populations. It is informed neither by contributory and comorbid aging processes nor by modern behavioral concepts with a specific underlying neurobiology. Such processes vary across the population of older depressed adults yet can influence short- and long-term clinical outcomes and may have prognostic value. Examples of aging processes include changes in cognitive performance but also extend to motor function, sensory deprivation, and fatigue. Behavioral markers with distinct neurobiological profiles include alterations in reward processes such as the development of apathy, as well as comorbid rumination, anxiety, worry and sleep disturbances.This symposium will discuss how aging processes and deeper assessments of behavioral symptom markers may present in and contribute to negative outcomes for patients with late-life depression (LLD). Dr. Bret Rutherford will discuss the role of motor and gait slowing in older adults. He will discuss how this common finding may influence the development of and presentation of LLD. He will also present a scientific model of how this may reflect underlying dysfunction of dopamine neurotransmitter systems. Dr. Sarah Szymkowicz will discuss work examining profiles of cognitive performance in patients will LLD. She will present data on how different cognitive performance profiles are related to demographic differences, clinical presentation, and how they may be related to acute treatment outcomes. Dr. Lauren Oberlin will then discuss the occurrence of apathy in LLD. She will review the clinical implications of apathy in this population and then present data from a neuroimaging study detailing the discrete functional imaging findings associated with this behavioral marker. Finally, Dr. Warren Taylor will present data from a recently completed pharmacoimaging study that includes clinical deep symptom phenotyping of patients with LLD, including apathy, rumination, and fatigue. He will discuss how different behavioral measures are associated with demographic differences yet also are related to differences in cognitive performance and functional disability. He will also present how these symptoms change during treatment with a selective serotonin reuptake inhibitor and how they may influence the overall antidepressant effect. The session will conclude with an open discussion involving the audience about how to integrate these findings and how they can inform clinical practice.This symposium will highlight the scientific need to do what many clinicians are already doing – conceptualizing LLD beyond traditional depressive symptoms. New approaches that embrace clinical heterogeneity with a broader conceptualization of the presentation of LLD have the potential to provide better prognostic information and identify new targets for pharmacological and non-pharmacological interventions.

Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder in Older Adults: Systematic Review and Meta-analysis

Major depressive disorder (MDD) in older adults is a serious public health concern. Repetitive transcranial magnetic stimulation (rTMS) is a nonpharmacological intervention approved for MDD treatment in adults, but its value in older adults remains unknown. This study aims to systematically review and meta-analyze evidence of rTMS efficacy in MDD treatment among older adults. We systematically reviewed the literature for randomized controlled trials (RCTs) and open-label studies assessing rTMS for the treatment of MDD in patients older than 50 years, published until June 2020. Random-effects meta-analyses using standardized mean differences (SMDs) were conducted to assess change in depression severity score (primary outcome), while odds ratios (ORs) were used to assess secondary categorical outcomes (response and remission). Additionally, univariate meta-regression analyses were performed to identify potential predictors of change in depression severity scores. Fourteen RCTs were included in meta-analyses and 26 studies (10 RCTs and 16 open-label studies) in meta-regression. Active rTMS was significantly superior to sham treatment for reduction of severity (SMD = 0.36; 95% CI = 0.13-0.60), as well as response (OR = 3.26; 95% CI = 2.11-5.04) and remission (OR = 4.63; 95% CI = 2.24-9.55). Studies were of moderate to high quality, with funnel plots and Egger's regression test not suggestive of publication bias. In meta-regressions, higher mean age and number of sessions were significantly associated with greater improvement. Our results support that rTMS is an effective, safe, and well-tolerated treatment for MDD in older adults and that it should be considered in the treatment of this vulnerable population.

Use of the 33-Item Hypomania Checklist (HCL-33) to Distinguish Bipolar Disorder From Major Depressive Disorder in Older Adults.

Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD) in older patients. This study examined the psychometric properties of the 33-item Hypomania Checklist (HCL-33) and its accuracy to differentiate BD from MDD among older adults. A total of 215 depressed older patients were recruited; 107 were diagnosed with BD (71 with BD-type I and 36 with BD-type II) and 108 with MDD. Principal components analysis (PCA) was used to explore the factor structure of the HCL-33. Cronbach's alpha was calculated to test the internal consistency. Intra-class correlation coefficient (ICC) was used to measure test-retest reliability. The receiver operating characteristic (ROC) analysis was used to generate the optimal cut-off value to differentiate between BD and MDD. Two factors were identified in the PCA analysis accounting for 33.9% of the total variance. The Cronbach's alpha value for the HCL-33 was 0.912, with 0.922 for factor I and 0.664 for factor II. The test-retest reliability was excellent (ICC: 0.891). The optimal cut-off of the HCL-33 total score for discriminating between MDD and BD was 14, with a sensitivity of 88.8% and specificity of 82.4%. The HCL-33 had satisfactory reliability and validity and could be used to distinguish BD from MDD in older adults.

Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults: Phase 2 of the PRIDE Study

There is limited information regarding neurocognitive outcomes of right unilateral ultrabrief pulse width electroconvulsive therapy (RUL-UB ECT) combined with pharmacotherapy in older adults with major depressive disorder. We report longitudinal neurocognitive outcomes from Phase 2 of the Prolonging Remission in Depressed Elderly (PRIDE) study. After achieving remission with RUL-UB ECT and venlafaxine, older adults (≥60 years old) were randomized to receive symptom-titrated, algorithm-based longitudinal ECT (STABLE) plus pharmacotherapy (venlafaxine and lithium) or pharmacotherapy-only. A comprehensive neuropsychological battery was administered at baseline and throughout the 6-month treatment period. Statistical significance was defined as a p-value of less than 0.05 (two-sided test). With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to 6-month follow-up. There were no significant differences between the two treatment groups at 6 months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility. To our knowledge, this is the first report of neurocognitive outcomes over a 6-month period of an acute course of RUL-UB ECT followed by one of 2 strategies to prolong remission in older adults with major depression. Neurocognitive outcome did not differ between STABLE plus pharmacotherapy versus pharmacotherapy alone over the 6-month continuation treatment phase. These findings support the safety of RUL-UB ECT in combination with pharmacotherapy in the prolonging of remission in late-life depression.

Neural circuits and behavioral pathways linking hearing loss to affective dysregulation in older adults.

Substantial evidence now links age-related hearing loss to incident major depressive disorder in older adults. However, research examining the neural circuits and behavioral mechanisms by which age-related hearing loss leads to depression is at an early phase. It is known that hearing loss has adverse structural and functional brain consequences, is associated with reduced social engagement and loneliness, and often results in tinnitus, which can independently affect cognitive control and emotion processing circuits. While pathways leading from these sequelae of hearing loss to affective dysregulation and depression are intuitive to hypothesize, few studies have yet been designed to provide conclusive evidence for specific pathophysiological mechanisms. Here we review the neurobiological and behavioral consequences of age-related hearing loss, present a model linking them to increased risk for major depressive disorder and suggest how future studies may facilitate the development of rationally designed therapeutic interventions for older adults with impaired hearing to reduce risk for depression and/or ameliorate depressive symptoms.

More than a Trait: Longitudinal Changes in Psychological Resilience, Mood and Cognition in Late Life Major Depression

<h3>Introduction</h3> Major depressive disorder in older adults or late-life major depression (LLMD) often responds poorly to antidepressants and increases risks of morbidity, mortality, and dementia. Psychological resilience, or the ability to quickly return to a pre-stimulus state after a stressful event, is an understudied construct with potential clinical implications for LLMD. Higher baseline resilience is associated with LLMD remission. While resilience is often treated as a trait, it is better conceptualized as a dynamic pattern of adaptation that can change over time. Little is known regarding possible changes in resilience that accompany LLMD. The impact of resilience on cognitive functioning in LLMD is also unclear. Resilience may prevent cognitive decline by attenuating the negative effects of chronic stress or greater cognitive control may augment an individual's resilience. Our aim within the following study is to observe whether long-term changes in resilience occur in LLMD. Secondly, if changes in resilience are observed to be present, we sought to determine if these changes correlate with changes in cognition and mood over a two year period. <h3>Methods</h3> All subjects (n = 123) were enrolled in NBOLD, an IRB approved, NIMH R01 funded study at UConn Health. All subjects provided informed consent to participate. All subjects met criteria for major depression as established by a geriatric psychiatrist. The Montgomery-Asberg Depression Rating Scale (MADRS) was used to measure depression severity. Each subject completed several self-report measures, including the Brief Resilience Scale (BRS). Participants also underwent neuropsychological evaluations to assess cognition. Assessments were repeated at 12 and 24 months post-enrollment. This was a naturalistic observation study; all participants were offered open-label treatment with sertraline at study onset, but could have been maintained on another antidepressant, or elected not to undergo treatment. Statistical analysis: Demographic differences were compared between individuals above and below the median BRS score. Linear regressions were used to assess the relationship between changes in BRS score, MADRS, and cognitive variables due to the availability of repeated measures. <h3>Results</h3> The median baseline BRS score was 17 (IQR: 13 – 20). Individuals with low resilience (less than median BRS) were more likely to be female (66%, n=40) vs high resilience (28.6% female, n = 18, p <0.001). Low resilience individuals also have a higher baseline MADRS score (mean = 22.1, SD = 5.3) vs high resilience individuals (mean = 17.1, SD = 6.3, p <0.001). Over the two year period, many patient's resilience scores increased (43.5%, n = 54), while other patients' scores didn't change (37%, n = 46) or decreased (19.3%, n = 24). On average, resilience increased by a mean of 1.72 points (SD = 4.4, p = 0.003). BRS increased the most between treatment start (mean = 16.7, SD = 4.72) and 12 months (mean = 18.33, SD = 5.0, p <0.001). With linear regression, increased BRS from baseline to 12 months was associated with lower MADRS score at 24 months (β(SE) = -0.36(0.16), p = 0.03) after adjusting for confounders (including baseline MADRS). BRS score change from baseline to 24 months was not associated with lower MADRS score at 24 months (β(SE) = -0.1(0.15), p = 0.5). For cognition, higher baseline resilience was associated with decreased change in Logical Memory II score at 24 months (β(SE)= -0.27(0.12), p = 0.02). <h3>Conclusions</h3> Resilience is shown to be a dynamic process variable that changes during LLMD treatment. We also demonstrated that shorter term changes in resilience (first 12 months of treatment) are more strongly associated with MADRS score at two years as compared to changes in resilience during the entire treatment period. These "early resilience responders" to treatment may represent a unique subpopulation particularly well-matched to antidepressant therapy. While increases in resilience are a predictor of decreased MADRS at 24 months, we report that higher <i>baseline</i> resilience correlated to decreased cognitive gains on the LMII. This might be due to near-ceiling effects on cognitive tests in high resilient individuals. Future directions include assessing the value of resilience therapy. Prior studies have demonstrated that resilience can be increased with meditation and behavioral therapy. These modalities could guide new therapeutic techniques for individuals with LLMD. <h3>Funding</h3> Funding is provided by the National Institute of Mental Health–funded R01 grant entitled, "Neurobiology and Adverse Outcomes of Neuroticism in Late-life Depression" (MH096725)

Relationship between affective temperament and major depressive disorder in older adults: A case-control study

Background: In clinical practice it is often challenging to determine whether mood disturbances should be considered a state or trait characteristics. This study is important to understand the influence of temperaments in the diagnosis of depression. The objective of the present study was to compare the frequency of three types of affective temperament (dysthymia, hyperthymia and cyclothymia) among older adults with major depression compared to non-psychiatric control patients. Methods: A case-control study comparing 50 patients with major depression aged 65 years or above with a comparison group of 100 non-psychiatric controls. Affective temperaments were assessed using the TEMPS-A questionnaire. The 17-item Hamilton Depression Rating Scale and the Young mania Rating Scale were used for the assessment of symptoms of depression and mania, respectively. Results: In the sample 80% had an affective temperament, most commonly hyperthymia (67.3%). In depressive patients 48% had criteria for hyperthymic temperament against 77% of the controls (OR= 0.3, 95%CI 0.1–0.7). 38.8% of these patients presented cyclothymic temperament, whereas among controls, 12% fulfilled criteria (OR= 2.9, 95%CI 1.1–7.2). Limitations: The sample was relatively small, and their educational level was very low. Conclusion: A cyclothymic temperament may predict major depression unlike hyperthymia. Whether the effectiveness of mood stabilizers in unipolar disorder is moderated by a cyclothymic temperament and should be explored in future randomized controlled trials.

Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials.

Major depressive disorder is a global public health problem among older adults. Many studies show that problem-solving therapy (PST) is a cognitive behavioral approach that can effectively treat late-life depression. To summarize and assess the effects of PST on major depressive disorders in older adults. We searched the PubMed, Web of Science, Cochrane Library, EMBASE, MEDLINE, UpToDate, and PsycINFO databases and three Chinese databases (CNKI, CBM, and Wan Fang Data) to identify articles written in English or Chinese that were published until Feb 1, 2020. Randomized controlled trials were included if they evaluated the impact of PST on major depression disorder (MDD) in older adults. Two authors of this review independently selected the studies, assessed the risk of bias, and extracted the data from all the included studies. We calculated the standard mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We assessed heterogeneity using the I2 statistic. Ten studies with a total of 892 participants met the inclusion criteria. Subgroup analyses and quality ratings were performed. After problem-solving therapy, the depression scores in the intervention group were significantly lower than those in the control group (SMD = -1.06, 95% CI -1.52 to -0.61, p < 0.05; I2 = 88.4%). Compared with waitlist (WL), PST has a significant effect on elderly patients with depression, but we cannot rank the therapeutic effects of all the treatment methods used for MDD. Our meta-analysis and systematic review suggest that problem-solving therapy may be an effective approach to improve major depressive disorders in older adults.

Prevalence and socio-demographic correlates of major depressive disorder in older adults in Hebei province, China

BackgroundMajor depressive disorder (MDD) is common among older adults. The epidemiology of MDD is greatly influenced by sociocultural and economic factors. This study examined the 1-month and lifetime prevalence of MDD and its socio-demographic correlates in older adults living in Hebei province, an agricultural area of China. MethodsMultistage, stratified, random sampling was administered between April and August 2016. The diagnosis of MDD was established with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) Axis I Disorders. ResultsA total of 3911 participants were enrolled. The 1-month and lifetime prevalence of MDD in older adults was 2.0% (95%CI: 1.6–2.4%) and 3.4% (95%CI: 2.8–4.0%), respectively. Multivariable logistic regression analyses revealed that female gender [P < 0.001, adjusted odds ratio (aOR) = 2.6, 95%CI: 1.53–4.53], presence of comorbid major medical conditions (P < 0.001, aOR = 4.8, 95%CI: 2.17–10.39) and family history of psychiatric disorders (P = 0.013, aOR = 3.4, 95%CI: 1.30–8.96) were independently and significantly associated with higher odds of MDD. ConclusionThe prevalence of MDD in older adults in Hebei province, China, was lower than most findings in China and other countries. Nevertheless, continued surveillance of elderly depression in China along with the development of primary, secondary and tertiary preventative interventions for the elderly with MDD is indicated.

A randomized controlled trial of internet-delivered cognitive behaviour therapy to prevent the development of depressive disorders in older adults with multimorbidity

BackgroundMultimorbidity, which commonly impacts older adults is associated with higher rates of depression. We aimed to investigate whether internet delivered cognitive-behaviour therapy (iCBT) could prevent depressive disorders in older adults with multimorbidity who were not currently depressed. Method302 primary care and community participants aged 65 years and over, who had multimorbidity but did not meet criteria for a depressive disorder were randomised to an intervention group who received an eight-week, five session iCBT (n = 150) or to a control group (n = 152) who received treatment as usual. Diagnostic interviews were conducted at baseline, and three and six months after the intervention period, where indicated, and the presence of depressive disorder was the primary outcome. ResultsThe intention to treat, chi-square analyses indicated there were significantly fewer cases of depressive disorder in the treatment group compared to the control group by six-month follow-up (χ²(1,302) = 5.21, p = .02). LimitationsThe main limitations of this RCT are a short follow up period and low proportion of participants who developed depressive disorders. Participants were relatively well educated, with a majority having English as their first language. ConclusionsThese results indicate that depressive disorder was prevented in the first six months following iCBT with three times the number of cases of depressive disorder in the control group compared to the treatment group. Further research is required to determine whether iCBT can be effective for preventing depressive disorder in this population over a longer time period.

Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study

BackgroundIn recent years, there have been increasing calls for integrating late-life mental health services into primary care in China, but data on the epidemiology of depressive disorders in older adults receiving primary care are very limited. This study examined prevalence, correlates and recognition of depressive disorders among Chinese older adults receiving primary care. MethodsA total of 752 older patients (65+ years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. ResultsOne–fifth (20.3%) of the older adults met DSM-IV criteria for depressive disorders during the month prior to the interview: 10.2% had major depression, 4.8% had dysthymia, and 5.3% had minor depressive disorder. The recognition rate of older patients with depressive disorders was 1.3% only. In multiple logistic regression analysis, factors significantly associated with depressive disorders included female gender (OR = 1.61), an education of primary school and below (OR = 1.69), poor financial status (OR = 2.44), poor or fair family relationship (OR = 1.66), loneliness (OR = 1.77), hypertension (OR = 1.91), heart disease (OR = 2.02), chronic gastric ulcer (OR = 6.01), and arthritis (OR = 3.55). LimitationsOlder adults from primary care clinics of economically underdeveloped regions of China were not included. ConclusionsDepressive disorders are prevalent but poorly recognized in Chinese older adults receiving treatment in primary care clinics. In order to improve the emotional well-being and health of older adults, it is time to integrate the management of common mental disorders into primary healthcare in China.

Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence.

This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms “subthreshold depression,” “prevalence,” “treatment” and “older adults” in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.

Identification and treatment of depressive disorders in older adults with cancer.

The increasing number of older adults living with cancer will inevitably include vulnerable subgroups who experience a range of depressive symptoms throughout the care continuum. It is well established that depression can lead to decreased quality of life, poor treatment adherence, increased length of hospital stay and health service utilization, and in severe cases, suicide. Thus, clinicians working in oncology must be able to identify, conceptualize, and treat (or connect to services) the mental health concerns of their older patients. This brief review describes the unique etiologies, features, and treatments for depressive syndromes among older adults in the oncology setting, drawing on the literature and prevailing depression management guidelines from both psycho-oncology and geriatric depression research.

Moderation and Mediation Analysis of the Relationship between Total Protein Concentration and the Risk of Depressive Disorders in Older Adults with Function Dependence in Home Care.

Due to its devastating consequences, late-life depression is an important public health problem. The aim of the study was an analysis of variables which may potentially influence the risk of depression (GDS-SF). Furthermore, the aim was to study possible mediating effects of given variables on the relationship between the total protein concentration and the risk of depression in older adults with chronic diseases, and physical function impairment. The research sample included 132 older adults with chronic conditions and physical function impairments, residing in a long-term care in residential environment. In the studied group of sensory organs, diseases proved to be a significant moderator of the relationship between GDS-SF and total serum protein concentration. A stronger relationship was observed in subjects suffering from diseases of sensory organs (b = −6.42, 95% CI= −11.27; −1.58). The Barthel index and 25(OH)D vitamin were the most significant mediators of the examined relationship. Cohort research is suggested to confirm the hypothesis.

Prevalence of major depressive disorder in older adults in China: A systematic review and meta-analysis

BackgroundThe prevalence of major depressive disorder (MDD) in Chinese older adults in epidemiological surveys have been inconsistent. We thus conducted a systematic review and meta-analysis of the pooled prevalence of MDD in older adults in China. MethodsTwo investigators independently conducted a systematic literature search in English (PubMed, EMBASE, PsycINFO and Cochrane Library) and Chinese (CNKI, Sinomed and Wan Fang) databases. Studies reporting the prevalence of MDD in older adults in China using diagnostic instruments were identified and analyzed using the Comprehensive Meta-Analysis program. ResultsA total of 28 studies with 76,432 subjects were included. The mean age ranged from 62.1 to 74.1 years. The point prevalence of MDD in older adults was 2.7% (95% CI: 2.1%–3.4%), 12-month prevalence was 2.3% (95% CI: 0.6%–8.5%), and lifetime prevalence was 2.8% (95% CI: 1.8%–4.4%). Subgroup analyses revealed significant differences in the prevalence of MDD across regions. ConclusionThe prevalence of MDD in older adults varied across different regions in China. Further epidemiological studies and service planning should take into account such differences.