Late-life Depressive Symptoms Research Articles

The shattered "Iron Rice Bowl": effects of Chinese state-owned enterprise reformon depressive symptoms in later life.

The SOE reform was the first time that economic insecurity was introduced since 1949 in China, with hundreds of million employees affected by the laid off. This study took the State-Owned Enterprises (SOE) reform in China as a natural experiment to explore the impact of economic insecurity on depressive symptoms in later life. Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS), 2014 and 2015. CHARLS is a nationally representative survey covering 28 provinces in China. CHARLS used the probabilities proportional to size (PPS) sampling method and involved 450 villages/resident committees, 150 counties/districts and 12,400 households. A total of 5113 urban dwellers born earlier than 1971 (aged 25years old and above at the start of the SOE reform, 1995) were involved. Using the province-level economic loss from the layoffs, we examined the impact of economic insecurity exposure on the score of depressive symptoms using a difference-in-differences model (DID). Individuals with economic insecurity exposure had a significantly increased risk of higher depressive symptoms scores, in which a 1 percentage point increase in expected economic loss would increase the CESD-10 score by 0.10. For an individual at the median distribution (CESD-10 = 5), this implies a shift to the 58th percentile (CESD-10 = 6). Given that the average intensity of expected economic loss is 10.22% and the mean CESD-10 is 6.92, exposure to the SOE reform led to an average increase in the CESD-10 score by 1.02 and by at least 14.74%. The heterogeneity analyses showed that the role of SOE reform in depressive symptoms scores was robust in both female and male groups and groups with different educational attainment. Economic insecurity exposure increased the depressive symptoms score later in life in the context of China. Programs, such as adequate unemployment insurance benefits, can protect individuals against the risk of financial loss, thereby reducing their negative impact on depressive symptoms. Providing mental symptoms surveillance and psychological counseling to those experienced at a time of great uncertainty is important for preventing depression in times of economic insecurity.

Driving Cessation and Late-Life Depressive Symptoms: Findings from the National Health and Aging Trends Study

Driving Cessation and Late-Life Depressive Symptoms: Findings from the National Health and Aging Trends Study

Polygenic Risk Scores Predict Late-life Depressive Symptoms in Older Whites, but Not in Older African Americans: Stratified Analyses by Sex at Birth

Polygenic Risk Scores Predict Late-life Depressive Symptoms in Older Whites, but Not in Older African Americans: Stratified Analyses by Sex at Birth

Depression and Anxiety in Old Age during the COVID-19 Pandemic: A Comparative Study of Individuals at Cardiovascular Risk and the General Population.

Our study aims to examine the associations of sociodemographic factors, social support, resilience, and perceptions of the COVID-19 pandemic with late-life depression and anxiety symptoms in a cardiovascular risk group and a matched sample from the German general population during the beginning of the pandemic and draw a comparison regarding psychosocial characteristics. Data of n = 1236 participants (aged 64-81 years) were analyzed, with n = 618 participants showing a cardiovascular risk profile, and n = 618 participants from the general population. The cardiovascular risk sample had slightly higher levels of depressive symptoms and felt more threatened by the virus due to pre-existing conditions. In the cardiovascular risk group, social support was associated with less depressive and anxiety symptoms. In the general population, high social support was associated with less depressive symptoms. Experiencing high levels of worries due to COVID-19 was associated with more anxiety in the general population. Resilience was associated with less depressive and anxiety symptoms in both groups. Compared to the general population, the cardiovascular risk group showed slightly higher levels of depressive symptomatology even at the beginning of the pandemic and may be supported by addressing perceived social support and resilience in prevention programs targeting mental health.

Later-life depressive symptoms during the Covid-19 pandemic: Investigations of individual, cumulative, and synergistic effects of social isolation

Objectives This study examines associations between social isolation and depressive symptoms among Hong Kong Chinese adults aged 65 and older by investigating the distinct effects of individual indicators, cumulative index, and typologies of social isolation during the Covid-19 pandemic. Methods We used a sample of 260 older adults from a cross-sectional, city-wide online survey targeting 1,109 aged 45+ adults through purposive sampling. Seven indicators of social isolation (not married; living alone; not engaging in social/organizational activities; no social contact with friends or families; lack of family and friends networks; loneliness) using Cornwell & Waite’s framework were selected to construct three unique types of social isolation measures. We used latent class analysis (LCA) and regression models to examine the effects of varied typologies of social isolation on depressive symptoms. Results Individual model of social isolation showed that lack of social contact and feeling lonely were significant predictors of depressive symptoms. A strong linear-trend gradient effect of cumulative social isolation on depressive symptoms was also observed. The LCA model identified four typologies of social isolation (socially isolated; living alone but socially engaged; married but lacking social ties, and not socially isolated); those in the ‘socially isolated’ and ‘married but lacking social ties’ groups had the most depressive symptoms. Conclusion Three operationalizations of social isolation demonstrated different utilities and implications in assessing the impacts of social isolation on depressive symptoms. Social contacts and loneliness, rather than living status or other characteristics of isolation, were the factors most strongly associated with depressive symptoms. Support programs should target lonely older adults who lack social engagement opportunities, as they are at increased risk of depression.

Network analysis of late-life depressive symptoms in patients with mild degree cognitive disorder

Network analysis of late-life depressive symptoms in patients with mild degree cognitive disorder

Adverse Childhood Experiences, Inflammation, and Depressive Symptoms in Late Life: A Population-Based Study.

This study investigated the association and dose-response relationship between adverse childhood experiences (ACEs) and depressive symptoms in late life and explored the mediating roles of inflammatory markers in the ACEs-depressive symptom association among Chinese older adults. This study was conducted using 2014 life history survey data and 2015 follow-up data from the China Health and Retirement Longitudinal Study. Data on ACEs and depression, inflammatory markers of high-sensitivity C-reactive protein (CRP), and white blood cell were collected. The association between ACEs and depressive symptoms was examined using logistic regression, and the mediation effects of inflammatory markers were evaluated. A total of 6,518 individuals over 60 years were included in the analysis. Compared to no ACE exposure, the adjusted odd ratios ranged from 1.377 (95% confidence interval [CI], 1.133-1.673) when participants had been exposed to 2 ACEs to 1.809 (95% CI, 1.451-2.256) when participants were exposed to 4 or more ACEs. A significant dose-response relationship between cumulative ACE scores and depression was observed. Six of the 12 ACE exposures were related to increased odds of depressive symptoms. CRP appeared to partially mediate the ACE-depressive symptom association, and the proportion of the effect of ACEs on depression was 1.17% (P = 0.008). A dose-response association exists between ACEs and the prevalence of depressive symptoms among older Chinese adults. CRP partially mediated the ACE-depressive symptom association in late life. Emphasizing interventions targeting individuals with ACE exposure may minimize the burden of late-life depression in China.

10-Year trajectories of depressive symptoms and subsequent brain health in middle-aged adults

Depressive symptoms differ in severity and stability over time. Trajectories depicting these changes, particularly those with high late-life depressive symptoms, have been associated with poor brain health at old age. To better understand these associations across the lifespan, we examined depressive symptoms trajectories in relation to brain health in middle age. We included 1676 participants from the ORACLE Study, all were expecting a child at baseline (mean age 32.8, 66.6% women). Depressive symptoms were assessed at baseline, 3 years and 10 years after baseline. Brain health (global brain volume, subcortical structures volume, white matter lesions, cerebral microbleeds, cortical thickness, cortical surface area) was assessed 15 years after baseline. Using k-means clustering, four depressive symptoms trajectories were identified: low, low increasing, decreasing, and high increasing symptoms. The high increasing trajectory was associated with smaller brain volume compared to low symptoms, not surviving multiple testing correction. The low increasing trajectory was associated with more cortical thickness in a small region encompassing the right lateral occipital cortex compared to low symptoms. These findings show that longitudinal depressive symptoms trajectories are only minimally associated with brain health in middle age, suggesting that associations may only emerge later in life.

Transcranial direct current stimulation effects in late life depression: A meta-analysis of individual participant data

• tDCS showed a modest but non-null effect in improving depressive symptoms in late life depression • Acceptability was high for tDCS treatment in late life depression • tDCS is a potential new treatment for late life depression • Large scale, randomised controlled trials of tDCS treatment in late life depression are required Late life depression (LLD) refers to major depressive disorder (MDD) in adults over 65 years. LLD is associated with high morbidity and poor treatment outcomes. Transcranial direct current stimulation (tDCS) is a novel treatment for MDD. Efficacy in LLD though is unclear. Our aim was to investigate tDCS efficacy by pooling randomised controlled trials (RCT) in an individual participant data meta-analysis. Databases were searched for sham controlled RCTs of tDCS in MDD and bipolar depression. Individual participant data (IPD) were requested. Primary outcome was change in depressive symptoms. Bayesian multilevel modelling meta-analysis was conducted with individual participants nested within studies. 6 RCTs were eligible, consisting of 43 participants (22 women), mean age 69.2 years. Active anodal tDCS over left dorsolateral prefrontal cortex (n=19) was associated with an improvement in depressive severity, effect size 0.14 (95% credible interval [-0.44;0.15]) as compared to sham tDCS, which was not statistically significant. There was an 82% probability that tDCS treatment has a modest but non-null effect in improving depressive symptoms. Acceptability was high with no significant differences in discontinuation rates between active and sham groups. The total sample size was small, limiting power. In LLD, tDCS demonstrates a modest but non-null effect in improving depressive symptoms. Acceptability was high as measured by discontinuation rates. tDCS is a potential novel treatment option in LLD, though large scale RCTs in LLD are required to investigate this important clinical application.

Association of childhood threat and deprivation with depressive symptoms and the moderating role of current economic status among middle-aged and older adults in China.

To investigate the independent impact of threat-related and deprivation-related adverse childhood experiences (ACEs) on depressive symptoms among middle-aged and older adults, and to evaluate the moderating role of current economic status in these associations. This cross-sectional study included 11,048 participants aged ≥ 45years from the China Health and Retirement Longitudinal Study. We captured five threat-related ACEs and five deprivation-related ACEs by questionnaires. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Current economic status was reflected by annual per capita household consumption expenditure. We performed logistic regression analyses to evaluate the independent association of childhood threat and deprivation with depressive symptoms, and conducted stratified analyses and tests for interaction to explore the moderation effect of current economic status in such associations. Compared with the nonexposed group, the experience of both childhood threat and deprivation were independently associated with greater risks of depressive symptoms later in life (odds ratio [OR] 1.75, 95% CI 1.49-2.05 for ≥ 2 threat-related ACEs; OR 2.02, 95% CI 1.67-2.43 for ≥ 2 deprivation-related ACEs). High current economic status significantly ameliorated the impact of childhood deprivation, but not threat, on depressive symptoms (P value for interaction 0.038). Both threat-related and deprivation-related ACEs were associated with the risk of depressive symptoms among middle-aged and older adults, while current economic status was a significant moderator in such risks only for childhood deprivation. The findings implied that prioritising targeted interventions for individuals with ACEs, especially for childhood deprivation victims who were economically disadvantaged in adulthood, may help mitigate depressive symptoms in later life.

Device-based physical activity and late-life depressive symptoms: An analysis of influential factors using share data

BackgroundRegular physical activity is effective for preventing and managing depression; however, only a few studies have assessed physical activity using device-based measures. We aimed to examine the association between device-based total physical activity and late-life depressive symptoms and explore which factors may explain this relationship. MethodsData from 10 European countries who participated in wave 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were analyzed. Triaxial accelerometers (Axivity AX3; Axivity, Newcastle UK) were used to assess total physical activity. Depressive symptoms were assessed through the EURO-D scale. Possion regression models and mediation analysis were performed. ResultsThe final sample included 785 older adults (70 participants had missing data in one or more variables and were excluded from the analysis) [mean (SD): age 68.6 (8.8) years; 59.2 % female]. After adjusting for several confounders, a 10 % increase in the mean acceleration was associated with lower depressive symptoms (B = −0.0228; 95%CI = −0.0395, −0.0061). This association was partly explained by limitations in activities of daily living and quality of life. LimitationsCross-sectional design, convenience sample, bi-directionality, lack of cutoff points for classification of the Axivity AX3 placed in the thigh, into intensities. ConclusionsHigher device-based total physical activity was linked with lower depressive symptoms in older European adults. Future studies employing device-based measures that allow to better capture important physical activity dimensions (i.e., intensity) will better inform about dose-response relationships.

The welfare cost of late-life depression

We quantify the welfare cost of depression among older Americans by estimating a panel VAR model of mental and physical health, labor supply, and consumption using data from the Health and Retirement Study. We use the estimated model and age sixty joint distribution of outcomes to simulate life-cycle paths with and without prevalence of depressive symptoms after age sixty. We estimate that the prevalence of late-life depressive symptoms costs an average of between 0.85 and 2.1 years in quality-adjusted life expectancy per person. Moreover, depression may result in an average loss of labor supply of up to 1.1 months and lifetime consumption of up to $16,000. Combining into a single compensating variation welfare metric, we estimate a bound on the average welfare cost of depression of 8–15% of annual consumption after age sixty. On aggregate, this amounts to roughly $180–360 billion annually. We also project that while the average welfare cost of late-life depression is declining slightly over birth cohorts, the welfare burden is becoming significantly more unequal.

The association between adverse childhood experiences and depression symptoms in older adults in China: An analysis of the China health and retirement study

We used data from the China Health and Retirement Longitudinal Study (CHARLS) to examine the impact of adverse childhood experiences (ACEs) on depression symptoms in Chinese adults aged 60 years or over. A dearth of studies has examined this issue in the Chinese context, which is different from Western contexts owing to China’s post-revolutionary experiences (e.g., famine, Cultural Revolution). CHARLS contained historical information about 14 ACEs, current information about depression symptoms, and a series of individual-level covariates (e.g., age, sex), and community-level covariates, such as population density and aggregate income. In an analysis sample of 1218 participants, three of the 14 ACEs (bullied, felt alone, relationship with mother) were positively associated with depression symptoms (p < 0.05). Our findings closely resembled results from studies undertaken in Western samples. Educational and mental health interventions during childhood might reduce the impact of late-life depression symptoms in Chinese adults.

The moderating effect of cognitive function on the association between social support and depressive symptoms among community-dwelling older adults: Cross-sectional and longitudinal analyses

BackgroundThe moderating effect of cognitive function on the association between social support and late-life depressive symptoms has not been thoroughly investigated. Identifying cognitive function as a possible moderator of this association might help plan community-based interventions for late-life depressive symptoms. MethodsParticipants were community-dwelling older adults who visited a community-based mental health center. The ENRICHD Social Support Instrument and the Montgomery-Asberg Depression Rating Scale were used to evaluate social support and depressive symptoms, respectively. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Data from 1088 and 506 participants were included in the cross-sectional and longitudinal analyses, respectively. Multiple linear regression analysis was performed to assess the effects of social support on depressive symptoms and the possible moderating effect of cognition. ResultsAfter adjusting for possible confounders, greater social support at baseline was associated with fewer depressive symptoms in both cross-sectional (estimate = −0.25 standard error [SE] = 0.03, P < 0.001) and longitudinal analyses (estimate = −0.11, SE = 0.05, P = 0.014). Moreover, the association between social support and depressive symptoms was significantly moderated by cognitive function (P for interaction < 0.001 for cross-sectional analysis, and P for interaction = 0.011 for longitudinal analysis). LimitationsThe tool for assessing social support was self-reported. There may have been a selection bias in the study sample. ConclusionsGreater social support was associated with fewer late-life depressive symptoms in both analyses. However, social support may have less benefits for alleviating depressive symptoms in older adults with cognitive decline.

Aging With Incarceration Histories: An Intersectional Examination of Incarceration and Health Outcomes Among OlderAdults.

Experiences with incarceration are linked to poor mental and physical health across the life course. The purpose of this research is to examine whether incarceration histories are associated with worse physical and mental health among older adults. We apply an intersectionality framework and consider how the intersection of sexism and racism leads to unequal health outcomes following incarceration among women and people of color. We employ 2 measures of health (i.e., number of depressive symptoms and physical limitations) to broadly capture mental and physical health. Using data from Waves 11 and 12 of the Health and Retirement Study, we estimated a series of general linear models to analyze differences in health by incarceration history, gender/sex, and race/ethnicity. Findings suggest that experiences with incarceration are associated with a greater number of physical limitations and more depressive symptoms among older men and women, net of sociodemographic characteristics, early-life conditions, and lifetime stressful events. Formerly incarcerated women, particularly women of color, had more physical limitations and depressive symptoms relative to other groups. These findings suggest that incarceration histories have far-reaching health implications. Older women of color with incarceration histories experience markedly high levels of physical limitations and depressive symptoms in later life.

Early-life interparental relationship quality and late-life depressive symptoms: A mediation analysis

BackgroundA growing body of literature has demonstrated that poor relationships between parents are associated with offspring's elevated depressive symptoms among children and adolescents. However, researchers have paid scant attention to whether marital discord during offspring's childhood casts a long shadow on their late-life depressive symptoms. This study examines the association between early exposure to a poor interparental relationship and offspring's late-life depressive symptoms among Chinese and identifies underlying mechanisms. MethodsWe employed path models to analyze data from the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample consisted of 4107 respondents aged 60 and older in 2015. Depressive symptoms were assessed with a 10-item Center for Epidemiologic Studies Depression Scale (CES-D). ResultsIndividuals who had experienced poor interparental relationships in childhood showed higher levels of and faster increases in depressive symptoms in late adulthood. The mediators were offspring's experiences of physical abuse by their parents in childhood and their poor relationships with spouses and children in adulthood. LimitationsLimitations include recall bias on childhood conditions, absence of personality traits, and limited measures of parenting practices. ConclusionsEarly-life interparental relationships exert a long-term effect on offspring's mental health. Individuals who suffered from poor interparental relationships during childhood might be at relatively high risk of developing depressive symptoms in late adulthood. Possible measures to relieve these depressive symptoms include protecting offspring from physical abuse in childhood and improving their relationships with their spouses and children later in life.

Educational Attainment Inequalities in Depressive Symptoms in More Than 100 000 Individuals in Europe

IntroductionIncreasing educational attainment (EA) could decrease the occurrence of depression. We investigated the relationship between EA and depressive symptoms in older individuals across four European regions.Objectives1) examine association between EA and depressive symptoms 2) determine, if there is an upper limit to this association 3) explore regional and demographic differences within this relationship across EuropeMethodsWe studied 108 315 Europeans (54 % women, median age 63 years old) in Europe assessing EA and depressive symptoms. Logistic regression estimated the association between EA and depressive symptoms, adjusting for sociodemographic and health-related factors; testing for sex/age/region and education interactions.ResultsHigher EA was associated with lower odds of depressive symptoms, independent of sociodemographic and health-related factors. A threshold of the lowest odds of depressive symptoms was detected at the first stage of tertiary education (OR 0.60; 95% CI 0.55-0.65; p&lt;0.001; relative to no education). Central and Eastern Europe showed the strongest association (OR for high vs. low education 0.37; 95% CI 0.33-0.40; p&lt;0.001) and Scandinavia the weakest (OR for high vs. low education 0.69; 95% CI 0.60-0.80; p&lt;0.001). The association was strongest amongst younger individuals. There was a sex and education interaction only within Central and Eastern Europe.ConclusionsLevel of EA is reflected in later-life depressive symptoms, suggesting that supporting individuals in achieving EA, and considering those with lower EA at increased risk for depression, could lead to decreased burden of depression across the life-course. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women.DisclosureNo significant relationships.

An investigation of depression and inflammation as potential mediators linking adverse childhood experiences with cognitive decline in adulthood: results from a prospective cohort study

IntroductionAdverse childhood experiences (ACEs) have been associated with numerous health consequences in adulthood including cognitive decline. However, the underlying mechanisms implicated remain unclear.ObjectivesIn this study, depressive symptoms and systemic inflammation were investigated as potential independent mediators of the association between ACEs and cognitive decline.MethodsParticipants were adults aged 50+ from the English Longitudinal Study of Ageing (N = 3,029; 54.8% female). Measures included self-reported ACEs at wave 3 (2006-2007), C-reactive protein (CRP) and depressive symptoms at wave 4 (2008-2009), and cognitive function at waves 3 and 7 (2014-2015). Mediation analyses examined the direct associations between ACEs and cognitive function at wave 7 and the indirect associations via depressive symptoms and CRP at wave 4 and were conducted using ordinary least squares regression models with the SPSS PROCESS macro. In Step 1, models were adjusted for sociodemographic factors and baseline cognitive function. Models in Step 2 were additionally adjusted for obesity and health behaviours (n = 1,874).ResultsCumulative ACEs exposure was shown to positively predict later-life depressive symptoms, which in turn predicted cognitive decline. ACEs were also shown to positively predict systemic inflammation as measured by CRP. However, CRP did not mediate the association between ACEs and cognitive decline.ConclusionsThese findings suggest that ACEs are related to cognitive decline partly via depressive symptoms and corroborate prior research linking ACEs with adult systemic inflammation. Efforts towards screening for, preventing, and mitigating the effects of ACEs may therefore represent an important avenue for improving health outcomes in later life.DisclosureNo significant relationships.

Gender differences and determinants of late-life depression in China: A cross-sectional study based on CHARLS

BackgroundLiterature related to within-gender differences in depression among older individuals in China is sparse, and often limited to specific provinces. MethodsWe analyzed data on 8104 participants from the fourth waves of the China Health and Retirement Longitudinal Study (CHARLS). Using logistic regressions, we identified the correlates of depressive symptoms among older individuals, both in the aggregate and along gender lines. Additionally, we examined the interaction between other covariates and gender. ResultsThe prevalence of late-life depression symptoms among females was 45.79%, which was higher than among males (31.13%, P < 0.01). Living in a rural area, earned income, education level, tobacco use and number of chronic diseases were correlated with depression in both genders (P < 0.05), with no interaction (Pint > 0.050). Social activities were correlated with depression in males but not in females (Pint = 0.373), inverse in their 70s (Pint = 0.020) group. The correlation between daily sleep duration and depression is stronger in females than in males (Pint ≤ 0.020). Female who drunk <1 per month decreased their prevalence of depression, but it increased in males (Pint = 0.001). Taking part in LTPA and being a religious believer were correlated with depression in females (P < 0.05), but not in males (P(LTPA)int = 0.009; P(religious believers)int = 0.033). LimitationsSince only analyzed one wave of data, we could not conclude that there was causation. ConclusionsGeriatric depression is a serious mental health issue in China. There is, an urgent need for prevention and intervention activities for older individuals, and these needs diverge along gender lines.

Trajectories of depressive symptoms in older adults and associated health outcomes.

With the progressive aging of the world's population, prolongation of a healthy lifespan in old age has become a medical research priority. The presence of depressive symptoms in later life is associated with poor health prognosis and increased mortality1,2. Here we explore distinct trajectories of depressive symptoms in later life and their association with several health-related outcomes in 19,110 older individuals followed for a median of 4.7 years. Using a latent class, mixed-modeling approach we identified four distinct trajectories of depressive symptoms with scoring patterns of consistently low, moderate, emerging and persistently high. Compared to those with minimal depressive symptoms, membership of any other class was associated with specific patterns of baseline sociodemographic and medical factors. Membership of any group with depressive symptoms was associated with a higher likelihood of health events, including physical disability, cancer and major bleeding episodes. Membership of the persistently depressed class was associated with increased mortality, while a diagnosis of dementia was generally limited to the class with initially low and progressively rising symptoms. The course of depressive symptoms in older individuals can vary widely and depend on several factors. The presence of depressive symptoms, including those that do not meet criteria for major depression, can flag a poor prognosis and risk for specific health conditions. Systematic assessment of depressive symptoms may facilitate early identification of at-risk populations.