Depressive Symptoms In Older Adults Research Articles

Beyond positive psychological processes: does self-rated emotional intelligence still matter in predicting depressive symptoms in older adults?

Beyond positive psychological processes: does self-rated emotional intelligence still matter in predicting depressive symptoms in older adults?

Working hours, social engagement, and depressive symptoms: an extended work-life balance for older adults

BackgroundIn recent years, researchers have been examining the impact of work-life balance (WLB) on mental health, considering it as a potential risk factor. However, it remains unclear whether the traditional understanding of WLB applies to older adults who worked for fewer hours before full retirement and whose children are likely to be independent adults. Therefore, this study aims to propose a modified form of WLB specifically for older adults. Within this context, we hypothesize that an optimum balance between working hours and social engagement protects against depressive symptoms among older adults.MethodWe conducted an analysis using data on 5,751 Korean adults older than 55 years from the Korean Longitudinal Study of Aging 2016. Multivariate logistic regression analysis was used to evaluate the relationships among working hours, social engagement, and depressive symptoms.ResultsOlder adults who worked fewer than 35 h per week were less likely to experience depressive symptoms than were non-working older adults and those working 35 h or more per week. Additionally, older adults with a high level of informal social participation, thus occurring almost every day or two to three times per week, were less likely to experience depressive symptoms than were those with a low level of such participation (once a month or less). Furthermore, depressive symptoms were less frequent among those who worked fewer than 35 h per week and engaged in a high level of informal social participation compared to non-working older individuals and those with a low level of informal social participation.ConclusionsMaintaining an optimal number of working hours and degree of social engagement are necessary to minimize the risk of depressive symptoms in older adults. Based on these findings, we suggest that fulfillment for work and life and their balance are important for older adults and propose work–life fulfillment balance.

Exploring the relationship-oriented spaces of social networks and depressive symptoms among older adults

The Republic of Korea has the highest suicide rate of older population among OECD countries, and depression is the prevailing factor. While it is well-known that the urban physical environment affects mental health, research on the physical characteristics of spaces remains limited. This study aims to explore relationship-oriented space characteristics that can form social networks and reduce depressive symptoms in older adults. After analyzing the differences in social interaction spaces between high-density and low-density areas for older adults in Seoul, we identified social interaction spaces (parks and traditional markets) that are frequently used based on on-site interview results. Two areas were selected for the questionnaire surveys. The main findings revealed that older adults living in areas with diverse spatial planning and close physical relationships between parks and traditional markets, convenient pedestrian environments, and lower population density of older adults had better social networks and lower depressive symptoms. More significantly, the physical characteristics of parks and traditional markets (convenient accessibility, maximized visibility, connectivity, and territoriality) significantly facilitate social interactions. Those engaging in social interactions within these spaces exhibited significantly better social networks and lower depressive symptoms. These findings underscore the importance of considering relationship-oriented space characteristics in spatial and urban planning.

Prevalence of Depressive Symptoms in the Whole Spectrum of Cognitive Aging: Findings from the HELIAD Community Study

AbstractBackgroundDepressive symptoms embody a risk factor for developing age‐related cognitive impairment, while they belong to the most common non‐cognitive symptoms of dementia. The conundrum of the prevalence of depressive symptoms in older adults in the Mediterranean region, but also worldwide is vividly reflected in reported prevalence rates ranging from 7.7% in a study from Malaysia and Australia to 81.1% in India. The present study aimed to shed light on the prevalence of mild, moderate and severe depressive symptoms in the entire spectrum of cognitive aging based on a cohort of randomly selected older adults from municipal rosters of two locations in Attica and central Greece.MethodsBased on a thorough neurological and neuropsychological assessment, the diagnoses of mild cognitive impairment, Alzheimer’s dementia (AD) or dementia caused by other diseases (non‐AD) were established in participants of the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD). The presence of depressive symptoms was tapped with the 15‐item Geriatric Depression Scale (GDS). Scores between 0‐4 point to the absence of depression, while scores between 5‐8, 9‐11, 12‐15 are compatible with mild, moderate and severe depressive symptoms, respectively. Statistical analyses were based on Pearson’s Chi‐squared test and pairwise proportions tests.ResultsThe prevalence of depressive symptoms in the total sample (n = 1937 participants; mean age 73,84 SD: 5,427, females: 1148) was 19.5% (mild 13.1%, moderate 3.8%, severe 2.5%). The prevalence of depressive symptoms in older adults without cognitive impairment was 18%, in patients with MCI 27%, in AD 25% and in non‐AD 23.5%. The differences in the distribution of depressive symptoms of different severity across the four groups reached statistical significance (chi‐squared = 28.957, df = 9, p‐value<0.001). The prevalence of moderate to severe depressive symptoms reached its maximum in AD (11.3%) and its lowest in people without cognitive impairment (5.4%).ConclusionsAlmost one out of five older adults suffered from depressive symptoms, with the prevalence and severity increasing significantly in cases of cognitively impaired individuals. These observations highlight the urgent need for raising awareness regarding the presence of depressive symptoms in older adults and improving primary, secondary and tertiary preventive strategies.

Religious Attendance, Childhood Trauma, and Later Life Depressive Symptoms

AbstractBackgroundOlder adults who experienced childhood trauma are at higher risk of developing depression. Depression is linked with structural changes in the brain and alterations in neurotransmitters and inflammation, placing individuals with depression at 2 times as likely to develop dementia than individuals without depression. A growing body of literature supports religion and spirituality as protective factors for mental health, yet few studies have examined the mediating role of religious attendance on the association between childhood trauma and depressive symptoms in later life. Identifying modifiable protective factors to decrease depression and, potentially, dementia is needed to decrease the growing dementia burden.MethodWe analyzed data from the Health and Retirement Study in 2006‐2012 to examine the mediating role of religious attendance (in 2010) on the association of childhood trauma (in 2008) with later‐life depressive symptoms (in 2012) among older adults in the U.S. (N = 3,240) aged 60 years and older. A mediation analysis was conducted while controlling for covariates: sex, race, education, age, marital status, body mass index (BMI), and cognition.ResultAged 60‐104 years, participants had a mean age of 72.7 (8.45) years, were 57.9% female, and were 82.9% White. A significant association was found for childhood trauma using 4 self‐report items and self‐reported depressive symptoms using the Center for Epidemiological Studies‐Depression scale (CES‐D) (β = 0.2124, 95% CI [0.31, 0.1201], p<.001). There was a partial mediating effect of self‐reported religious attendance (high vs. low) between childhood trauma and depressive symptoms (β = 0.017, 95% CI [0.03, 0.003], p<.05) adjusting for sex, race, education, age, marital status, BMI, and cognition.ConclusionReligious attendance plays a partial mediating role in the relationship between childhood trauma and later‐life depressive symptoms in older adults. Clinical trials are needed to further examine the effect of religious attendance on depressive symptoms in older adults with a history of childhood trauma, with the potential to decrease the risk of dementia.

Types of social support and depressive symptoms in older adults: An IPD meta‐analysis of longitudinal ageing studies

AbstractBackgroundDepression is a known risk factor for dementia, and social support may lower the risk of depression in older adults. There is, however, a lack of longitudinal analyses examining the association between emotional versus instrumental support and depressive symptoms in older adults. We analyzed the association of emotional and instrumental support with depression symptom scores using data from eight international longitudinal cohorts. This is an individual participant data meta‐analysis on harmonized social support and depression data.MethodWe obtained data from eleven COSMIC (Cohort Studies of Memory in an International Consortium) international longitudinal cognitive ageing studies, including data from Australia, Brazil, China, Germany, Greece, India, Indonesia, South Korea, Singapore, Sweden, and the United States. Randomly sampled 27,058 adults in later life (M = 71.7 years), of whom 59.5% were females. Social support was measured using individual items of emotional support (i.e., having a confidante) or instrumental support (i.e., help with daily living activities). Depression was measured using validated scales at baseline and follow‐up (M = 2.02 years). Covariates included age, sex, education, living situation, smoking history, diabetes mellitus, cardiovascular risk, global cognitive function and (where available) history of depression. Depression scores were standardized while other variables were harmonized before analysis.ResultIn the fully adjusted cross‐sectional models, having emotional support (B = ‐0.40, 95%CI: ‐0.60,‐0.21), but not instrument support (B = 0.15, 95%CI: ‐0.29,0.58) was associated with lower depressive symptoms. In the fully adjusted longitudinal models, having emotional support (B = ‐0.36, 95%CI: ‐0.53,‐0.19) but not having instrumental support (B = 0.07, 95%CI: ‐0.33,0.46) was associated with lower depressive symptoms at follow‐up.ConclusionEmotional, but not instrumental support, was associated with lower depressive symptoms cross‐sectionally and at follow‐up in harmonised data from 8 longitudinal ageing studies. Psychosocial interventions targeted at reducing the risk of depression (and therefore dementia) should focus on improving access to emotional support for older adults.

Social anxiety, behavioural activation and depression risk in older men: protection through Men's Shed membership.

Reducing rates of depressive symptoms in older adults is a public health priority. Men's Sheds are a community organisation that may protect against depressive symptoms in older men. It is currently unclear how social anxiety and behavioural activation may relate to depressive symptoms for Men's Shed members. We employed a cross-sectional design to explore whether the relationships between social anxiety, behavioural activation and depressive symptoms were contingent upon Shed social network quality in a sample of 164 Men's Shed members. Conditional effects analysis found social anxiety (B = -0.08, p < 0.01) and behavioural activation's (B = 0.02, p < 0.001) relationships with depression to be contingent on Shed social network quality. Additionally, we found evidence for a conditional effect of social anxiety on the relationship between behavioural activation and depression (B = -0.03, p < 0.01) such that this relationship was stronger for those with higher levels of social anxiety. Our findings suggest that a strong social network within a Men's Shed weakens the association between social anxiety and depression, that the relationship between behavioural activation and depression is stronger in those with poorer Shed social networks, and that the relationship between behavioural activation and depression may be stronger for those with higher levels of social anxiety. We suggest that our findings contribute to increasing quantitative support for the mental health benefits of Men's Shed membership, highlight the potential importance of Shed social network quality and explore how social anxiety may affect the mental health outcomes for members.

P29: Prolonged Intermittent Theta-Burst Stimulation of the Left Dorsolateral Prefrontal Cortex for Older Adults with Treatment-Resistant Depression: Effectiveness and Safety

Objective:Treatment-resistant depression (TRD) is not uncommon in older people. Brain stimulation, such as 4-6 weeks of repetitive transcranial magnetic stimulation (rTMS) or theta burst stimulation (TBS) targeting the left dorsolateral prefrontal cortex, has been evidenced as an essential intervention for adult TRD and also documented in the current international treatment guideline. In 2018, Taiwan Food and Drug Administration cleared the rTMS as a treatment option for TRD and now rTMS is still a treatment at their own expense in Taiwan. Additionally, prolonged intermittent TBS (piTBS) protocol has been proven its similar antidepressant efficacy as standard 4-6 weeks rTMS/iTBS in adult TRD, but in a shorter treatment course of 2 weeks. For older adults with depression, 4-6 weeks of treatment course may burden their caregiver due to their limited ambulation and transportation ability. However, hitherto there was no study to investigate the antidepressant efficacy of left-sided prefrontal piTBS in treating older TRD.Methods:A chart review was performed at a single Taiwan hospital from 2018 to 2020. 17-items Hamilton Depression Rating Scale (HDRS-17) was measured before and after the piTBS intervention. Maudsley Staging Method was used for the depression treatment refractoriness.Results:We identified 23 old adults with TRD (mean [SD] age, 66.0[5.2]; 78% female) who underwent 10-20 sessions of daily piTBS (1800 pulses/session; 10sessions, n=18, 15sessions,n=4, 20session,n=1). On continuous outcomes, mean(SD) HDRS-17 total scores improved from 20.5(6.62) to 11.8(7.7) after receiving piTBS intervention. The mean percent improvement of HDRS-17 was 46.0%±29.4%. Dichotomous outcomes showed response rate of 43.5% and remission rate of 34.8%. No seizures or other serious adverse events were noted, and no premature discontinuation was noted.Conclusion:This study is the largest study demonstrating the piTBS protocol provides a comparable reduction in depression symptoms in older adults with TRD, similar to the effectiveness in adult TRD and the efficacy of standard sequential bilateral rTMS/iTBS in older TRD in the FOUR-D trial. Regarding desirable efficiency and effectiveness, piTBS may be an optimal form of rTMS in treating older adults with TRD. Further large comparative effectiveness trials with standard iTBS or high-frequency rTMS in this population are warranted.

Physical activity, physical frailty and depressive symptoms among Chinese male and female older adults: do different indicators make a difference?

Older adults become more inactive and frailer with aging. Physical status is closely linked to mental health, but it is unclear which physical indicator is more strongly associated with depressive symptoms in older adults. The present study aimed to compare relationships between self-reported physical activity, physical frailty (muscle mass, muscle strength, and gait ability) and depressive symptoms in community male and female older adults. A total of 1,180 adults aged 60 years and older were recruited to participate in this study from a Chinese community receiving annual check-up service from September 2018 to May 2019. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). The Bio-electrical Impedance Analyzer was used to determine the muscle mass. As the indicators of muscle function, grip strength and gait ability were assessed by the dynamometer and Timed Up and Go Test (TUGT), respectively. The 15-item version of Geriatric Depression Scale (GDS-15) was used to examine depressive symptoms. Demographic variables, health status and sleep quality were collected using questionnaire. 11.8% men and 11.9% women reported depressive symptoms. Logistic regression showed that depressive symptoms was associated with low grip strength (OR = 2.42, 95% CI: 1.04-5.63), slow gait ability (OR = 3.60, 95% CI: 1.28-10.13) in older males, and associated with low level of self-reported physical activity (OR = 3.85, 95% CI: 2.00-7.42) in older females. No significant association was found between muscle mass and depressive symptoms. There were gender differences in the relationship between physical activity, physical frailty, and depressive symptoms. Grip strength and gait ability may be a better indicator of frailty for predicting depressive symptoms in older men while physical activity may be useful in predicting depressive symptoms in older women.

Lifestyle behaviors and their association with depression symptoms in older adults during Coronavirus pandemic

Objetivo: Identificar la asociación entre las conductas del estilo de vida y síntomas de depresión en personas adultas mayores entre septiembre de 2021 y marzo de 2022 en Mexicali, Baja California (México). Materiales y métodos: Diseño de tipo transversal. Participaron 103 personas adultas mayores seleccionadas por un muestreo no probabilístico. Se aplicaron instrumentos para evaluar síntomas de depresión, el estado nutricional, actividad física, consumo de tabaco, consumo de alcohol y la presencia de problemas para dormir. Para el análisis de datos se empleó estadística descriptiva e inferencial. Se construyó un modelo con las conductas del estilo de vida. La investigación se desarrolló con base en la reglamentación vigente. Resultados: El 34 % presenta riesgo de desnutrición; 92.2 % tiene baja actividad física; 9.7 % consume tabaco; 15 % consume alcohol; 38.8 % reportó presentar problemas para dormir, y 31.1 % presentó síntomas de depresión. Respecto a las conductas del estilo de vida, se encontró que las personas adultas mayores con riesgo de malnutrición o malnutrición tienen 3.182 (p ? .5) más riesgo de desarrollar síntomas de depresión en comparación con quienes tienen un estado de peso adecuado. Conclusiones: El riesgo de malnutrición o malnutrición, así como el resto de conductas del estilo de vida, son factores modificables que pueden ser intervenidos por los profesionales de la salud a través de intervenciones multicomponentes, en las que se sumen esfuerzos para establecer programas de atención que apoyen a mejorar la salud física y mental de las personas adultas mayores.

The development of depressive symptoms in older adults from a network perspective in the English Longitudinal Study of Ageing

An increased understanding of the interrelations between depressive symptoms among older populations could help improve interventions. However, studies often use sum scores to understand depression in older populations, neglecting important symptom dynamics that can be elucidated in evolving depressive symptom networks. We computed Cross-Lagged Panel Network Models (CLPN) of depression symptoms in 11,391 adults from the English Longitudinal Study of Ageing. Adults aged 50 and above (mean age 65) were followed over 16 years throughout this nine-wave representative population study. Using the eight-item Center for Epidemiological Studies Depression Scale, we computed eight CLPNs covering each consecutive wave. Across waves, networks were consistent with respect to the strength of lagged associations (edge weights) and the degree of interrelationships among symptoms (centrality indices). Everything was an effort and could not get going displayed the strongest reciprocal cross-lagged associations across waves. These two symptoms and loneliness were core symptoms as reflected in strong incoming and outgoing connections. Feeling depressed was strongly predicted by other symptoms only (incoming but not strong outgoing connections were observed) and thus was not related to new symptom onset. Restless sleep had outgoing connections only and thus was a precursor to other depression symptoms. Being happy and enjoying life were the least central symptoms. This research underscores the relevance of somatic symptoms in evolving depression networks among older populations. Findings suggest the central symptoms from the present study (everything was an effort, could not get going, loneliness) may be potential key intervention targets to mitigate depression in older adults.

Relationship of Hoarding and Depression Symptoms in Older Adults

Hoarding disorder (HD) is a debilitating neuropsychiatric condition that affects 2%–6% of the population and increases in incidence with age. Major depressive disorder (MDD) co-occurs with HD in approximately 50% of cases and leads to increased functional impairment and disability. However, only one study to date has examined the rate and trajectory of hoarding symptoms in older individuals with a lifetime history of MDD, including those with current active depression (late-life depression; LLD). We therefore sought to characterize this potentially distinct phenotype. We determined the incidence of HD in two separate cohorts of participants with LLD (n = 73) or lifetime history of MDD (n = 580) and examined the reliability and stability of hoarding symptoms using the Saving Inventory-Revised (SI-R) and Hoarding Rating Scale-Self Report (HRS), as well as the co-variance of hoarding and depression scores over time. HD was present in 12% to 33% of participants with MDD, with higher rates found in those with active depressive symptoms. Hoarding severity was stable across timepoints in both samples (all correlations >0.75), and fewer than 30% of participants in each sample experienced significant changes in severity between any two timepoints. Change in depression symptoms over time did not co-vary with change in hoarding symptoms. These findings indicate that hoarding is a more common comorbidity in LLD than previously suggested, and should be considered in screening and management of LLD. Future studies should further characterize the interaction of these conditions and their impact on outcomes, particularly functional impairment in this vulnerable population.

Association between activities of daily living and depressive symptoms among older adults in China: evidence from the CHARLS.

The limitation of activities of daily living (ADL) affects the mental health of older adults. We distinguished activities of daily living into basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and aimed to explore the relationship between the two limitations and depressive symptoms among Chinese older adults by using nationally representative cross-sectional data. Data from the China Health and Retirement Longitudinal Study (CHARLS, wave 4) were used, and 9,789 older adults aged 60 years and above were screened. The 10-item Center for Epidemiologic Studies Depression (CES-D-10) scale was used to measure the depressive symptoms of older adults, and a 12-item scale for ADL was used to estimate functional limitations. Generalized linear mixed-effect models were employed to examine the relationship between BADL/IADL and depressive symptoms among older adults. The prevalence of high-risk depression among older adults was 43.5%, and the rates of limitation in BADL and IADL were 19.02 and 25.29%, respectively. The prevalence of high-risk depression significantly differed among subgroups of smoking, drinking, chronic diseases, duration of sleep, having social activities or not, and the type of medical insurance. Older adults with limited BADL or IADL were at a higher risk of depression than those without limitations of BADL or IADL; BADL (OR-adjusted = 2.71; 95% CI: 2.40-3.06) and IADL (OR-adjusted = 2.68; 95% CI: 2.41-2.98) had various influences on the risk of depression in older adults. ADL was a related factor in the risk of depression among older adults in China. BADL and IADL had different effects on the risk of depression, suggesting that older adults with physical function limitations might be more likely to suffer from depression.

Association between secondhand smoke exposure across the life course and depressive symptoms among Chinese older adults

BackgroundThere are limited data on the association between secondhand smoke (SHS) exposure across the life course and depressive symptoms among older adults. We aimed to investigate the association of childhood household SHS exposure, adulthood household SHS exposure, lifetime social SHS exposure, and their coexistence with depressive symptoms in older adults. MethodsData were from the 2011–2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. About 4000 participants (aged 60 years or older) were recruited in a randomly selected half of the counties and cities in China. Data on SHS exposure, past-year depressive symptoms, and covariates were collected using a questionnaire. The chi-square test (for categorical variables) and t-test (for continuous variables) were used to assess differences in the participant characteristics across groups of SHS exposures. We estimated the odds ratios (ORs) and 95 % confidence intervals (CIs) of depressive symptom according to different types of SHS exposure. ResultsChildhood household SHS exposure (OR = 1.42, 95%CI = 1.22–1.66), adulthood household SHS exposure (OR = 1.41, 95%CI = 1.21–1.63) and lifetime social SHS exposure (OR = 1.35, 95%CI = 1.14–1.58) were associated with higher odds of depressive symptoms. Additionally, those with a higher SHS exposure score had higher odds of depressive symptoms (1 point: OR = 1.56, 95%CI = 1.22–2.00; 2 points: OR = 1.77, 95%CI = 1.39–2.25; 3 points: OR = 1.83, 95%CI = 1.45–2.31). The results were similar when stratified by lifetime nonsmoking, former smoking, and current smoking. LimitationsRetrospective design may introduce recall bias. ConclusionsSHS exposure was associated with higher odds of depressive symptoms in older adults, with the effect seeming to be addictive.

The association between falls and depressive symptoms among older adults: evidence from the China Health and Retirement Longitudinal Study.

Falls place a heavy burden on older adults and families, and there was little research on the relationship between falls and depressive symptoms among older adults in China. This study is designed to examine the association between falls and depressive symptoms in Chinese older adults. This study was based on 9,539 data sets from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. The 10-item Center for Epidemiologic Studies-Depression Scale (CESD-10) was used to access depressive symptoms in older adults. A logistic regression model was used to calculate multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for falls and depressive symptoms, adjusted for possible confounders. The Classification and regression tree (CART) demonstrates the prediction of the target variable values based on other variables. In this study, 9,539 older people were selected: 60-69 years old accounted for 63.0%, 70-79 years old accounted for 29.7%, and 80 years old and above accounted for 7.3%. Male accounted for 49.7% and female for 50.3%. The rate of falls among older adults was 21.4%, and the rate of depressive symptoms was 33.9%. Adjusted ORs (OR = 1.37, 95% CI: 1.23, 1.53) showed a significant association between falls and depressive symptoms among older adults. Subgroup analysis revealed that this association was statistically significant across male (OR = 1.29, 95% CI: 1.23, 1.53) and female (OR = 1.42, 95% CI: 1.23, 1.64), 60-69 aged (OR = 1.38, 95% CI: 1.19, 1.60) and 70-79 aged (OR =1.42, 95% CI: 1.16, 1.74), rural (OR = 1.42, 95% CI: 1.25, 1.61), <15,000 CNY (OR = 1.35, 95% CI: 1.19, 1.54) and more than 25,000 CNY (OR = 1.42, 95% CI: 1.09, 1.85). Additionally, The CART model showed that the probability (73.0%) of falls was highest among older adults with depressive symptoms who self-rated poor health and female gender. This cross-sectional study demonstrated a significant association between falls and depressive symptoms in Chinese older adults. The findings provide some evidence and support for risk monitoring, screening for depressive symptoms, and early prevention in the high-risk older population.

Gender differences in depressive symptoms among Chinese older adults based on fairlie decomposition analysis

This study aimed to investigate the factors influencing depressive symptoms among Chinese older adults based on gender differences. Data from the eighth wave of Chinese Longitudinal Health Longevity Survey were used. We analyzed the influencing factors of depressive symptoms reported by older adults using the chi-squared test and logistic model. Fairlie decomposition analysis was performed to quantify the contribution level of each influencing factor. We found that 11.71 % of older adults met the CES-D-10 criteria for depressive symptoms. Females (13.89 %) reported a significantly higher level of depressive symptoms than males (9.24 %). Age, residence, sleeping time, exercise, activities of daily living functional disability, instrumental activity of daily living functional disability, and living status influenced depressive symptoms in older adults. Higher education and lower body mass index were only significant in male, whereas middle annual income and exercising were significant only in female. The Fairlie decomposition model explained the reasons for 75.64 % of the gender differences in depressive symptoms, with instrumental activity of daily living functional disability (33.60 %), age (−17.79 %), and education level (17.41 %) being major factors affecting gender differences in depressive symptoms. This is the first nationwide study to examine gender differences in depressive symptoms among older adults. These results provide a basis for relevant Chinese government departments to formulate policies to prevent and control depressive symptoms.

Adverse childhood experiences and age-trajectories of depressive symptoms in older adults from China

Abstract Background Adverse childhood experiences (ACEs) have profound lifelong consequences. Less is known about their impact on outcomes in late life, such as psychological distress in older adults. Moreover, there is a paucity of evidence on associations of ACEs with age-trajectories in depressive symptoms, especially with distinct patterns of trajectories. We investigated associations between ACEs and trajectories of depressive symptoms at mid-to-older ages in a Chinese population sample. Methods We used the longitudinal data from the China Health and Retirement Longitudinal Survey (13846 participants ≥45y). Depressive symptoms were measured by CES-D10 (Centre for Epidemiologic Studies Depression Scale) at four waves (2011-18). A range of ACEs (&amp;lt;17y) were retrospectively reported by participants. Growth Mixture Models were used to identify distinct age-trajectories of depressive symptoms and their associations with ACEs. Results We identified two trajectory groups: (1) persistent high (men 14%; women 19.2%) and (2) low/normal levels of depressive symptoms. Several ACE measures were associated with increased risk of having persistent high levels of depressive symptoms (mid-to-older ages) after adjusting for other ACEs, sex, childhood SES (financial status, parental education, occupation), adult SES (education, financial status, urban/rural residence), health behaviors and limitations in daily activities. For example, adjusted OR was 1.35 (95% CI:1.17,1.55) for physical abuse (28.2%), 1.38(1.19,1.59) for domestic violence (24.3%), 1.48(1.23,1.78) for parental drinking, drug or mental health problems (9.4%), 1.59(1.38,1.84) for those had a bedridden parent (18.7%). Conclusions ACEs have a long lasting effect on trajectories of depressive symptoms in older adults, independent of childhood SES and adult factors, highlighting the need to act early to reduce the long lasting impact on mental health in later life. Key messages • Adverse childhood experiences are associated with persistent high levels of depressive symptoms from mid-to-older ages. • Associations are independent of childhood SES and adult factors.

Exposure to green and blue spaces and depression in older adults: Findings from the EPIPorto cohort

Abstract Background Portugal is amongst the European countries with the largest share of older adults and highest prevalence of depression. Natural environments may play an important role promoting population-level mental health. We investigated the associations between the exposure to green and blue spaces and depression among older adults from Porto (Portugal) and the mediation role of social interactions and physical exercise. Methods This study included data from the fourth wave (2017) of the EPIPorto cohort, which included only participants aged ≥60. The presence of depressive symptoms was measured using the Geriatric Depression Scale (GDS). Using the residential locations, we computed the Normalized Difference Vegetation Index (NDVI), and the shortest distance to the nearest urban green space and blue space. We fitted crude and adjusted negative binomial regression models. Associations were expressed using relative risks (RR) and 95% intervals (95% CI). We used structural equation modelling to assess mediation. Results We included 639 participants, from which 27.2% presented depression (GDS ≥5). In the adjusted models, we found statistically significant associations between having more NDVI within 50 and 100 meters and lower GDS (RR = 0.78 [95%CI 0.65-0.94] and RR = 0.81 [95%CI 0.67-0.97], respectively). Most of the association between NDVI and the GDS was direct, being only slightly mediated by the time spent with family, although both the direct and indirect effects did not reach statistical significance. No significant associations with the remaining variables of exposure were identified. Conclusions We observed a direct association between living in areas with more vegetation and less depressive symptoms in older adults in Porto. Key messages • Our results suggest that the provision of green space may be an effective strategy to promote mental health in late life.

Association of neighborhood recreational facilities and depressive symptoms among Chinese older adults

ObjectivesNeighborhood recreation facilities has been associated with depression that commonly tested with cross-sectional data. This study used longitudinal data to test the effect of neighborhood recreation facilities on the trajectory of depressive symptoms among Chinese older adults.MethodsData was derived from the 2014, 2016 and 2018 China Longitudinal Aging Social Survey (CLASS). Depressive symptoms among older adults were obtained using the CES-D scale. The three-level linear growth model of “time point - individual - community” was conducted to test the association between neighborhood recreation facilities and depressive symptoms.ResultsThis study consisted of 3,804 respondents living in 333 communities. It was found that community fitness facilities had a significant effect on depressive symptoms in older adults (beta=-1.212, P<0.001). A supportive community fitness environment can effectively slow down the rate of increase in depressive symptoms among older adults (beta=-0.415, P<0.01). In subgroup analysis, fitness facilities were the important predictor for people in youngest-old group (beta=-1.247, P<0.01) and outdoor activity space was a protective predictor for oldest-old people’s depressive symptoms (beta=-0.258, P<0.05).ConclusionsThis study demonstrated an association between neighborhood recreation facilities and depressive symptoms in older adults and found the age difference of this effect. Public health department need pay more attention to neighborhood environment construction to promote healthy aging.

Urban-rural differences in key factors of depressive symptoms among Chinese older adults based on random forest model

BackgroundDepression is a major challenge in the global healthy aging process, and exploring the key factors of depression in urban and rural older adults is essential for differentiated and precise interventions. ObjectiveTo explore the urban-rural differences and key influencing factors of depressive symptoms among Chinese older adults. MethodsThe data of 5267 older adults were obtained from the China Health and Retirement Longitudinal Survey (CHARLS2018). Random forest model and logistic regression were used to analyze the key factors influencing depressive symptoms 19 variables. ResultsThe detection rate of depressive symptoms in older adults was 31.0 %, with 22.3 % and 34.8 % in urban and rural areas, respectively. Education, self-rated health, self-rated pain, and self-rated vision were common factors. Physical activity (OR = 0.716 for Moderate PA), social activity (OR = 0.671 for social activity), and self-rated hearing (OR = 0.602 for good) were key factors specific to urban older adults, and alcohol consumption (OR = 0.716 for drinking more than once a month) and marital status (OR = 0.689 for cohabitation) were key factors specific to depressive symptoms in rural older adults (all P < 0.05). LimitationCross-sectional data cannot reflect dynamic processes among variables; The cultural background might affect the cross-cultural validity of the study. ConclusionThe key factors of depressive symptoms among older adults in urban and rural areas differed, which provides priority and references for differential prevention and precise intervention of depressive symptoms to promote the process of healthy aging.