Physical illness and symptoms of depression among elderly outpatients.

Elderly outpatients were assessed to clarify relations between symptoms of depression and physical illness, disability, pain, and selected psychosocial variables. Three types of assessments were made: (1) medical evaluations by physicians, (2) self-reported symptoms of depression and physical health, and (3) demographic and psychosocial data relating to participants' life circumstances. Both objective (physician-rated illness symptoms) and subjective (self-reported health, activity restriction, and use of pain medications) indicators of health accounted for independent variance in symptoms of depression. After controlling for these factors, additional variance was explained by health-related concerns (e.g., health care expenses, service needs), social support, and "other worries" (e.g., feeling useless, becoming a burden to others). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of depressive symptoms among rural elderly: Examining the need for mental health services.

Reexamined the prevalence of depressive symptoms among 1,724 rural, noninstitutionalized older adults (aged 59–99 yrs) and documented the need for mental health services as they relate to depression and potential barriers to receiving needed services. A telephone survey was conducted in North Dakota, with a random sample drawn from each of 8 human service districts. Instruments included the Geriatric Depression Scale and the CAGE. Results indicate that the prevalence of depression was relatively low. Controlling for potential alcohol abuse, cognitive impairment, and medical problems, the study found that 5% of older adults reported current depressive symptomatology. When using a cutoff score that is likely to correspond to a diagnosis of major depression, the study found a prevalence rate of 1.6%. Of those reporting significant levels of depression, only 27.6% were currently being treated for an emotional problem. The survey data suggested that cost, transportation, and concern about stigma are not major barriers to receiving needed mental health services. Rather, lack of awareness of available services and a lack of routine contact with mental health service providers are important factors that limit service utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease

Stellate ganglion block (SGB) is considered to increase blood flow to the governing area, but recent studies have shown the decrease of common carotid arterial blood flow in the unblocked side following SGB. We investigated the influence of SGB on bilateral cerebral blood flow and oxygenation using a regional oxygen saturation (rSO2) monitor, TOS-96 (TOSTEC, Japan). The changes of blood volume (hemoglobin index: Hb I) and rSO2 were measured in twenty adult patients who underwent SGB at the transverse process of the C 6 vertebra. Prior to the investigation, two sensors were calibrated and placed on either side of each patient's forehead in order to see the difference. There were significant increases in rSO2 and Hb I in the blocked side and decreases in rSO2 and Hb I in the contralateral side. These results suggest that blood flow in the blocked side following SGB increases with decreased blood flow in the unblocked side. Patients with cerebral vascular disease undergoing SGB might be at risk of a decrease in cerebral blood flow in the unblocked area.     

Convergent validity of the CORE measures with measures of depression for clients in cognitive therapy for depression.

Clients (N = 77) undergoing cognitive therapy for depression were assessed before treatment with the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), which encompasses domains of subjective well-being, problems, functioning, and risk of harming self or others, along with the Beck Depression Inventory-II (BDI-II), the Hamilton Rating Scale for Depression (HRSD), the Beck Hopelessness Scale (BHS), and a measure of avoidant (Cluster C) personality problems (Inventory of Interpersonal Problems-Avoidant [IIP-Av]). The CORE-OM and the BDI-II were strongly correlated with each other and showed coherent and similar patterns of correlations with the HRSD, the BHS, and the IIP-Av. Sixty-one of the clients were repeatedly assessed during treatment with alternating versions of the CORE Short Form and with the BDI-II. Results strongly supported the convergent validity of the CORE measures with the BDI-II in across-clients comparisons of means scores and rates of improvement and in across-sessions comparisons within clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and correlates of major depressive episode among the elderly in a community in Japan

A random sample of 205 persons from a community of about 45,500 residents, aged 65 years or older, in a city in Japan, was surveyed using an interview schedule including a structured psychiatric interview to analyze prevalence of major depressive episode (DSM-III-R). A total of 157 (77%) participated in the study. Results were as follows: 1) The Prevalence of major depressive episode during the past 6 months was 2.1% for males and 3.7% for females among the 155 respondents who completed the psychiatric interview. 2) Significantly higher prevalence during the past 6 months was observed in those who were physically inactive in the past year than in those physically active (p < 0.05). 3) Levels of satisfaction with available social support were significantly lower in those who experienced major depressive episode during the past six months than in those who experienced no depressive episode (p < 0.05). 4) Levels of life satisfaction (PGC scale score) and cognitive functioning were significantly lower in those experienced major depressive episode during the past six months than in those who experienced no depressive episode (p < 0.05).     

Gender and reporting differences in measures of depression.

135 female and 75 male undergraduates (aged 18–30 yrs) responded to the Beck Depression Inventory and to 9 items assessing depression from the Hopkins Symptom Checklist. The hypothesis was explored that males particularly would endorse test items in a less "depressed" direction when presented explicitly as constituting a test of depression, but would endorse more depressive content when items were presented in a context not portrayed as measuring depression. Some support was obtained for the view that males may approach and respond differently to depression inventories compared to females. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of episodes of ST-segment depression among mild-to-moderate hypertensive patients in northern Italy: the Cardioscreening Study

OBJECTIVES: To assess the prevalence of episodes of ST-segment depression in a population of consecutive patients with mild-to-moderate essential hypertension who are free of clinical signs of coronary artery disease. METHODS: The study involved 28 Italian centers that enrolled 414 hypertensive patients (aged 50-70 years; diastolic blood pressure > or = 95-115 mmHg or systolic blood pressure > or = 150-220 mmHg, or both, 10 days after withdrawal of medications). Silent myocardial ischemia was assessed by means of exercise stress testing and 48 h Holter monitoring. An ischemic episode was defined as a horizontal or downward sloping ST-segment depression > or = 100 microV, occurring 80 ms after the J point, and lasting for at least 1 min. RESULTS: Of the 414 patients enrolled, 411 completed the exercise stress test. During the test significant ST-segment depression occurred for 25 patients (6.1%) and all episodes but one were asymptomatic and not associated with arrhythmias. Of the 396 patients for whom we analyzed a 48 h Holter recording, 43 (10.9%) had at least one episode of ST-segment depression and seven of these had also had one during the exercise stress test The median number of episodes per patient was five (range 1-19), median duration was 9 min (range 1-20 min), and the mean amplitude of the ST-segment depression was 190 +/- 180 microV. None of these episodes was associated with symptoms and all of them occurred under resting condition. Patients with (n = 61) and without (n = 335) ST-segment depression during Holter monitoring or exercise stress testing had similar ages (59 +/- 6 versus 58 +/- 6 years) and did not differ for tobacco smoking, plasma lipid levels, blood pressure values and prevalence of echocardiographic left ventricular hypertrophy (57% of patients had left ventricular mass indexes > or = 134 g/m2 for men and > or = 110 g/m2 for women in both groups). Women had a higher prevalence of ST-segment depression than did men during Holter monitoring [32 of 183 (17.5%) versus 11 of 213 (5.2%)], whereas the prevalences of ischemia during the exercise stress test were similar. Female sex was the only significant factor associated with the occurrence of silent myocardial ischemia [odds ratio 2.56 (95% confidence interval 1.40-4.71)]. CONCLUSIONS: Our results show that 15% of patients with mild-to-moderate hypertension, who are free of clinical signs of coronary artery disease, experience episodes of ST-segment depression during Holter monitoring or exercise stress testing. Most of these episodes are asymptomatic and are not associated with the severity of hypertension, the presence of left ventricular hypertrophy, and other risk factors for coronary artery disease. Episodes of ST-segment depression are more common for women than they are for men, particularly during Holter monitoring. The early detection of silent myocardial ischemia by Holter monitoring or by the exercise stress test might be useful for the identification of hypertensive patients who should be investigated further and administered a more specific treatment.     

Religious activity and depression among community-dwelling elderly persons with cancer: the moderating effect of race

OBJECTIVES: Research has been oriented toward elucidating the links between religion and mental health. The purpose of this article is to further our knowledge in this area by examining the effect of religious activity on depressive symptomatology among community-dwelling elderly persons with cancer. We also test whether these effects differ between Blacks and Whites. METHODS: We use two waves of data collected from a community-dwelling sample of elderly persons living in North Carolina. Depressive symptomatology is measured using four subscales from the CES-D 20 scale: somatic-retarded activity, depressed affect, positive affect, and interpersonal relations. Measures of religious activity include service attendance, religious devotion, and watching or listening to religious programs. RESULTS: The findings indicate that among Blacks with cancer, religious activity is related to lower levels of depressive symptomatology; no such relationship is found for respondent with other illnesses or no illness. Further, the effects of religious activity are stronger among Blacks than Whites. DISCUSSION: The analyses lend support to the hypothesis that religious activity is a strong predictor of depression in elderly adults with cancer. This finding, however, is not as strong as we had anticipated.     

Detecting depression in elderly medical inpatients.

Prevalence rates for depression indicate that elderly medical patients are a population at high risk. Studies of middle-aged adults show that detection of depression in medical patients by primary health care providers is poor and that screening instruments can improve detection, although little is known about geriatric patients. The present study used Research Diagnostic Criteria to assess the base rate of detection by nonpsychiatric physicians in a random sample of 150 elderly medical inpatients. In addition, the psychometric properties of three slightly different self-report screening instruments were evaluated. Results indicated that detection by house staff was extremely low (8.7%). All three instruments were much more sensitive, were equally specific, and yielded greater predictive power than the procedures used by hospital staff. All three instruments were especially sensitive to major depression. Of the scales, the Beck Depression Inventory (BDI), the BDI Psychological subscale, and the Geriatric Depression Scale had the best reliability and validity and were the most efficient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms of depression among community-dwelling elderly African-American and white older adults

BACKGROUND: Few studies have explored the variance in individual symptoms by race in older adults. METHODS: Data were analysed from the Duke site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), a community sample of persons 65 years-of-age and older, 54% of whom were African-Americans. Of the 3401 subjects with adequate data on depressive symptomatology, confirmatory factor analysis and LISREL were first used to confirm the presence of the factor structure previously reported for the CES-D. Next, bivariate analysis was performed to determine the prevalence of individual symptoms by race. Finally, LISREL analysis was performed to control for potential confounding variables. RESULTS: When bivariate comparisons of specific symptoms by race were explored, African-Americans were more likely to report less hope about the future, poor appetite, difficulty concentrating, requiring more effort for usual activities, less talking, feeling people were unfriendly, feeling disliked by others and being more 'bothered' than usual. When LISREL analyses were applied to these data (controlling for education, income, cognitive impairment, chronic health problems and disability and other factors) racial differences in somatic complaints and life satisfaction disappeared, yet differences in interpersonal relations persisted. CONCLUSIONS: This study confirms earlier findings of minimal overall differences in symptom frequency between African-American and non-African-American community-dwelling older adults in controlled studies.     

Cancer occurrence in the elderly: agreement between three major data sources

OBJECTIVE: To identify the individual, dyad, and family variables that influence young women's perceptions of risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). DESIGN: Cross-sectional telephone survey using forced-choice questioning. Data were analyzed using first-order correlations and logistic regression. SETTING: Participants were recruited from a mid-Atlantic study of young adults and from volunteers at a mid-Atlantic university and surrounding community. PARTICIPANTS: A convenience sample of 93 sexually active, unmarried, heterosexual women, ages 17-26 years. The majority of the study sample was white. MAIN OUTCOME MEASURE: Respondents were asked to estimate their own level of risk for STDs, including HIV, using the responses no, low, moderate, and high risk. Responses were later recoded into no risk versus some risk. RESULTS: Communication with parents about sexual risk decreased the odds that women would see themselves as being at no risk. Consistent condom use, relationship satisfaction, and perceiving the partner as no risk increased the odds that women would believe they were at no risk. CONCLUSIONS: Nurses can incorporate these and other study findings into the design of sexual risk reduction programs. Programs that enhance parent-teen communication about sexual risks and assist young women to examine their perceptions of their partners may be more effective than programs that provide information only.     

Prevalence and correlates of postpartum depression in first-time mothers.

Examined the prevalence and correlates of postpartum depression in a large (N?=?1,033) sample of married, primiparous, middle class mothers of full-term, healthy infants; 9.3% met modified Research Diagnostic Criteria for depression. However, 39% of the nondepressed women also reported at least 1 somatic symptom. Depressed women whose symptoms were current obtained elevated scores on the Center for Epidemiological Studies–Depression scale, as did some women who did not meet depression criteria. Depressed women differed from nondepressed women on several socioeconomic status indicators and the occurrence of obstetric complications, even in this low-risk sample. These data have implications for the assessment of depression in postpartum women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A possible association between paternal longevity and major depression among elderly men

Platinum-based chemotherapy is the standard treatment for advanced ovarian cancer, with response rates of 40-60%. In patients who fail platinum treatment, paclitaxel has resulted in response rates of 10-48%. Docetaxel has partial non-cross-resistance with and is twice as potent in vitro as paclitaxel in inhibiting microtubule disaggregation. The combination of docetaxel and cyclophosphamide is synergistic in pre-clinical studies and clinically active in breast cancer. We present the case of a patient with platinum and paclitaxel refractory ovarian cancer who achieved a remission with docetaxel and cyclophosphamide.     

Cognitive assessment of depression: Reliability and validity of three measures.

456 undergraduates completed the Beck Depression Inventory, an automatic thoughts questionnaire (ATQ), the Dysfunctional Attitude Scale (DAS), and an interpretation inventory (II). Comparison of the ATQ, DAS, and II in terms of their internal reliability and concurrent validity showed that the ATQ was a more satisfactory instrument for measuring depression. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Area and volume conservation among the elderly: Assessment and training.

Conducted 2 studies to examine whether the elderly maintain the competence to adequately solve problems of logical thinking. In the 1st study the performance of 60 noninstitutionalized middle-class elderly females was assessed on area and volume conservation tasks. On overall performance only 33.3% of the Ss were classified as conservers. In the 2nd study a training paradigm was used to determine whether simple verbal feedback activated the strategies required for adequate performance on conservation tasks. 22 Ss who failed at least 2 conservation tasks in the assessment study were administered a 20-trial training procedure. Half of these Ss received simple verbal feedback following each response, while half received no feedback. Results on an immediate posttest indicated that the feedback group performed significantly better than the control group on the near transfer posttest task and on the majority of far transfer tasks. The results are discussed in terms of a distinction between competence and performance. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readability of self-report measures of depression and anxiety.

As the demand for accountability in service provision settings increases, the need for valid methods for assessing clinical outcomes is of particular importance. Self-report measures of functioning are particularly useful in the assessment of psychological functioning, but a vital factor in their validity and transportability is the reading level needed to comprehend them. We evaluated the reading grade levels required to comprehend the instructions and items from 105 evidence-based self-report measures of depression and anxiety. Results indicated substantial variability in readability among measures, with anxiety measures generally requiring a higher reading level relative to depression measures. In some cases, reading levels required for measure instructions were particularly high, and most measures were written at or above the mean reading grade level in the United States. This analysis provides information that may aid in selecting appropriate symptom measures in clinical and research settings. Future directions, including the development of measures for individuals with low levels of literacy, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum.

Examined the prevalence of depression in a heterogeneous sample of 360 pregnant women. Subjects were assessed with respect to both depressive symptomatology and diagnostic status during pregnancy and after delivery. At both assessments, approximately 25% of the sample reported elevated levels of depressive symptomatology. In contrast, 10% of the women met diagnostic criteria for depression during pregnancy, and 6.8% were depressed postpartum. However, only half of the cases of postpartum depression were new onset (3.4%); the remaining women receiving a diagnosis in the postpartum had also been depressed during pregnancy. Finally, depression during pregnancy was related to different sociodemographic variables than was postpartum depression, suggesting that depression at these two times may be associated with different psychological or etiological factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of depression among elderly institution residents: affective and somatic correlates of physical frailty

BACKGROUND: Confounding of depression with somatic illness and anxiety, a problem in any age group, may be especially troublesome in frail older persons. This paper examined this problem in a factor analytic study of the structure of depressive symptomatology, identifying affective and somatic symptom clusters and relating those clusters to health and functional variables cross-sectionally and prospectively over a 1-year interval. METHODS: The factor structure of a DSM-IV symptom checklist was examined among 1,245 elderly long-term care residents. Regression analyses examined the association of resulting factors with cognition, functional disability, self- and physician-rated health, and pain at baseline and a year later. One-year mortality was also examined. RESULTS: Factor analysis revealed three unique symptom clusters: depressed mood, somatic symptoms, and psychic anxiety. Depressed mood and somatic symptoms were associated cross-sectionally with all functional health variables, but psychic anxiety was associated only with pain. Longitudinally, depressed mood was the only independent predictor of decline in cognition, functional ability, physician-rated health, and mortality; the last effect, however, did not withstand control for baseline health and functioning. Somatic symptoms at baseline predicted decrement in self-rated health a year later. Effects varied as a function of cognitive status. CONCLUSIONS: These data suggest that concerns about the confounding role of somatic symptoms in the association of depression with physical health are unfounded. Although somatic symptoms of depression and anxiety were associated with health and functional status cross-sectionally, depressed mood was by far the stronger predictor of health declines over time.     

Suicide and depression among college students.

We surveyed 962 college students from three institutions in regard to their experiences with depression and suicide. Results indicate that incidents of depression and suicide are prevalent on college campuses and that there are a number of specific causes of depression, suicidal ideation, and suicidal behavior. Suicide attempters are compared with nonattempters, institutions are compared, and institutional implications for colleges and universities are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)