老年抑郁症的症状、诊断及测量

对老年抑郁症的症状、诊断和测量的探讨有利于寻找更有效的治疗方法。文章在简要讨论老年抑郁症主要症状以及诊断特点的基础上,重点介绍老年抑郁症的测量工具。文章指出,开展老年抑郁症研究的多学科研究,运用认知神经科学方法深入研究老年抑郁症,制订相对独立的老年抑郁症的分类标准,结合老年抑郁症患者身心特点开发更简便可靠的老年抑郁症量表,将有利于老年抑郁症的进一步研究。     

The treatment of depression in older adults in the primary care setting: an evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults.     

Presentation of Depression and Response to Group Cognitive Therapy with Older Patients

Concerned with response prediction, this research examines the relationships between pre-treatment components of depressive symptomatology and outcome of short-term group cognitive therapy for depression with older adults. Aspects of depressive symptomatology under examination were initial intensity of self-reported depressive symptomatology, profile of melancholic depression, perceived health status, perceived social support, and intensity of negative view of self. Findings indicate that perceived social support is not related to outcome but that a more intense depressive symptomatology, a more negative health evaluation, and a more negative view of self are variables associated with a less favorable outcome. Despite showing a sizable decrease in depressive symptoms over the course of intervention, severely depressed subjects still presented residual depressive symptoms at the conclusion of intervention. There was a tendency for subjects with a melancholic profile to show a poorer response to this intervention.     

老年人自尊、希望和抑郁关系的纵向研究

为考察老年人自尊、希望与抑郁间的关系,本研究对281名老年人进行为期一年的追踪调查。相关分析及纵向中介分析结果表明:(1)自尊和希望与老年人的抑郁显著负相关,老年人自尊和希望显著正相关。(2)自尊正向预测老年人的希望,老年人的希望负向预测抑郁。(3)希望在自尊对老年人抑郁的影响中起中介作用。本研究结果揭示了希望是自尊对老年人抑郁产生效应的重要机制变量。这些结果对于减缓老年人抑郁,促进老年心理健康具有一定的实践价值。     

Psychopathology Following Interpersonal Violence: A Comparison of Risk Factors in Older and Younger Adults

A randomly selected sample of 549 women age 55 years and older and 2,669 women age 18–34 years was interviewed via telephone to determine prevalences of physical and sexual assault, posttraumatic stress disorder (PTSD) symptomatology, and depression. Prevalences of sexual and physical assaults were lower in older compared to younger women. In addition, given a trauma, prevalences and proportionate risk of posttraumatic psychopathology and depression were also lower for older, relative to younger women. Specifically, multivariate analyses revealed that sexual assault predicted only PTSD avoidance in older adults, but all forms of PTSD symptomatology and depression in younger adult women. Similarly, physical assault predicted only PTSD re-experiencing symptoms in older women, but all forms of PTSD symptoms and depression in younger women. Self-reported health status was not associated with any increased risk of psychopathology, and low income predicted increased avoidance and depression only in younger women.     

Depression symptoms: Their association with socio-demographic factors and health among adults in South Africa

The aim of this study was to assess depression symptoms and socio-demographic and health correlates in a recent (2014-2015) national population-based survey of South Africa adults (n = 22 752; females =57.5%; mean age 37.1 years, SD = 17.6). The participants reported on their socio-demographic variables, health statuses, and experience of depression symptoms the previous four weeks. About 13% of the sample scored positive for depression symptoms. In adjusted logistic regression analysis, being female, older age, being long term sick or disabled, having two or more pain disorders, having been diagnosed with diabetes, and having smoked regularly were associated with high risk for depression symptoms. Being a student, having below or average household income, and having exercised three or more times a week was associated with lower risk for depression symptoms.     

Depression in Homebound Older Adults: Problem-Solving Therapy and Personal and Social Resourcefulness

The goal of problem-solving therapy is to teach patients systematic coping skills. For many homebound older adults, coping skills must also include both personal and social (help-seeking) resourcefulness. This study aimed to examine the relationship between perceived resourcefulness and depressive symptoms at postintervention and potential mediating effect of the resourcefulness among 121 low-income homebound older adults who participated in a pilot randomized controlled trial testing feasibility and preliminary efficacy of telehealth-PST. Resourcefulness Scale for Older Adults was used to measure personal and social resourcefulness. Only personal resourcefulness scores were significantly associated with depression outcomes at postintervention, and neither resourcefulness scores were significantly associated with group assignment. Analysis found no mediation effect of resourcefulness. The findings call for further research on potential mediators for the potentially effective depression treatment that could be sustained in the real world for low-income homebound older adults who have limited access to psychotherapy as a treatment modality.     

Age-related changes in word retrieval vary by self-reported anxiety but not depression symptoms

Tip-of-the-tongue states (TOTs) are known to increase in frequency across adulthood, but there is wide variability in older adults’ TOT rates, suggesting that individual difference factors contribute to TOT incidence. We investigated the role of affect by examining the relationship between self-reported anxiety and depression symptoms and the frequency of TOTs during a laboratory task. Participants were young, middle-aged and older adults in a population-based sample of adults aged 18–87. Increased anxiety was associated with fewer TOTs for the middle-aged group but more TOTs for the older adult group. There was no relationship between anxiety and TOTs for younger adults and no relationships between depression symptoms and TOT incidence for any age group. We discuss our results in terms of attentional control theory, which provides an explanation of how age may affect the relationship between anxiety and TOTs.     

Depression in Older Adults

The purpose of this article is to address selected aspects of depression in older adults. Specifically, symptoms, risk factors, diagnosis, and interventions for depression in older adults are reviewed.     

Clinical Predictors of Depression in Patients with Low-Grade Brain Tumors: Consideration of a Neurologic Versus a Psychogenic Model

Few studies have examined quality of life issues in patients with brain tumors, though coping with cancer is stressful and is associated with heightened levels of depression. We used regression to examine the clinical factors that might predict depression in a group of 57 adults with low-grade brain tumors after surgery but prior to radiotherapy and chemotherapy. A neurological model comprised of tumor characteristics and treatment was compared with a psychogenic model comprised of both psychosocial and psychodynamic variables. Demographic variables and level of fatigue were also included. A model consisting primarily of fatigue (also clinically elevated) and secondarily of tumor location and aggressiveness of surgical treatment accounted for 33% of the depression score. In a small group at a later follow-up when patient depression was clinically elevated (4–6 years after baseline), fatigue, female sex, cognitive dysfunction, increased family support, and increased report of physical symptoms were associated with depression. The late out findings remain exploratory because of the small sample size, but they suggest that depression develops over time and results from a combination of neurological and psychosocial problems that ensue initial treatments. Treating these collateral problems may reduce the complications from depression.     

Passive coping response to depressive symptoms among low-income homebound older adults: Does it affect depression severity and treatment outcome?

Due to their homebound state, lack of financial resources, and/or other life demands, a significant proportion of depressed, low-income homebound older adults experience depression. Because of their limited access to psychotherapy, most of these older adults self-manage their depressive symptoms. The purposes of this study were to examine (1) the relationship between homebound older adults' coping responses to depressed mood and the severity of their depressive symptoms at baseline (n = 121), and (2) the moderating effect of passive coping responses on the relationship between participation in problem-solving therapy (PST: in-person or telehealth delivery) and depressive symptoms at 12- and 24-week follow-ups. Controlling for the effects of demographic and disability characteristics, cognitive passive coping was significantly associated with baseline depressive symptoms, while behavioral passive coping was not. The main effect of baseline cognitive passive coping response was also significant in mixed-effects regression analysis, but the interaction between coping pattern and group was not significant. The results point to a possibility that cognitive passive copers may have benefited as much from PST as the rest of the PST participants. Further research needs to examine the moderating effect of coping responses to depressive symptoms on treatment efficacy of PST and other psychosocial interventions for late-life depression.     

社会隔离对老年人认知功能的影响：有调节的链式中介效应

考察中国文化背景下社会隔离对老年人认知功能的影响,并从认知功能心理影响机制的角度探究孤独感和抑郁的链式中介作用。基于中国老年社会追踪调查（CLASS）,对5162名60岁以上老年人的社会隔离、孤独感、抑郁和认知功能进行研究。结果发现：（1）社会隔离显著负向预测老年人的认知功能;（2）社会隔离可以通过抑郁的独立中介作用以及孤独感和抑郁的链式中介作用间接预测老年人的认知功能,但是孤独感的独立中介作用不显著。研究结论对于减少社会隔离对老年人认知功能的消极影响具有积极意义。     

Development and evaluation of the positive psychology intervention for older adults

Although research suggests that positive psychology intervention can enhance subjective well-being and reduce depression, its effectiveness on older adults remains largely unknown. Therefore the present study aimed to develop and evaluate a custom-tailored positive psychology intervention program for older adults. The program offered nine-week group sessions to 74 older people recruited from district community centers and nursing homes in Hong Kong. The intervention program covers eight themes, including optimism, gratitude, savoring, happiness, curiosity, courage, altruism, and meaning of life. The participants consisted mostly of females aged between 63 and 105?years. One-group pre-test/post-test design was adopted to evaluate the effectiveness of the intervention on depression, life satisfaction, gratitude, and happiness. Results revealed that the intervention reduced the number of depressive symptoms and increased the levels of life satisfaction, gratitude, and happiness. Effectiveness of the intervention is discussed in relation to self-awareness, education, self-reinforcement, and sensitivity to age and culture.     

Advancing cognitive behaviour therapy for older adults with comorbid insomnia and depression

Insomnia and depression are two of the most common mental health problems that negatively impact older adults. The burden associated with these highly comorbid conditions requires an innovative approach to treatment. There have been significant advancements in the field of cognitive behaviour therapy for insomnia (CBT-I) over recent years. CBT-I has evolved from targeting homogenous insomnia samples to now showing promising results for comorbid insomnia. CBT-I is not only effective at treating comorbid insomnia, but can also have a positive impact on depression severity. Despite these important clinical developments, limited research has explored whether modifying CBT-I programmes to specifically target comorbid depression could improve outcomes for older populations. This paper reviews recent literature and provides therapeutic recommendations to advance CBT-I for older adults with comorbid insomnia and depression.     

Clinical implications of "subthreshold" depressive symptoms

There is active debate regarding whether diagnosable depression exists on a continuum with subthreshold depressive symptoms or represents a categorically distinct phenomenon. To address this question, multiple indexes of dysfunction (psychosocial difficulties, mental health treatment history, and future incidence of major depression and substance abuse/dependence) were examined as a function of the extent of depressive symptoms in 3 large community samples (adolescent, adult, and older adult; N = 3,003). Increasing levels of depressive symptoms were associated with increasing levels of psychosocial dysfunction and incidence of major depression and substance use disorders. These findings suggest that (a) the clinical significance of depressive symptoms does not depend on crossing the major depressive diagnostic threshold and (b) depression may best be conceptualized as a continuum. Limitations of the present study are discussed.     

Behavioral Activation Treatment for Depression in Older Adults Delivered via Videoconferencing: A Pilot Study

Depression affects up to 25% of older adults. Underdetection and subsequent undertreatment of depression in older adults has been attributed in part to difficulties in older adults being able to access treatment. This uncontrolled pilot study, N = 3, explored the acceptability and efficacy of a brief behavioral activation treatment delivered via videoconferencing to 3 participants, aged 64 to 73 years, diagnosed with major depressive disorder. The results indicate that a 5-session behavioral activation treatment delivered via videoconferencing produced clinically significant and reliable decreases in depression. The results also showed clinically significant and reliable decreases in negative affect and clinically significant and reliable increases in positive affect. Treatment gains were maintained at 1-month follow-up. Videoconferencing can be a valuable and effective tool in increasing accessibility to psychological treatment for older adults.     

Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

鳏与寡对老年人抑郁水平的影响:社会网络的调节作用

为了进一步探讨丧偶与抑郁水平之间的关系,讨论社会网络（包括家庭网络和朋友网络）在其中的作用机制,并比较丧偶与抑郁水平的关系及社会网络作用机制的性别差异,本研究对中国老年社会追踪调查（CLASS）2014年调查中7649名老年人（其中丧偶老人2149名,男性715,女性1434;在婚老人5500名,男性3398,女性2102）的数据进行分析。结果发现,丧偶对老年人抑郁水平有消极影响,但影响作用不存在性别差异;男性丧偶老人的朋友网络显著低于男性在婚老人,而女性老年人中无此差异;相对于在婚老人,家庭网络对男性丧偶老人的抑郁水平的缓解作用更大,而在女性样本未发现家庭网络的缓冲作用。应重视丧偶老年人,特别是男性丧偶老年人,家庭网络的建设与维护,从而缓解丧偶对老年人心理健康的消极影响。     

Psychosocial Treatments for Major Depression and Dysthymia in Older Adults: A Review of the Research Literature

Older adults represent a growing segment of the population with the highest suicide rate and an increasing need of counseling services for major depression and dysthymia. The present study examined the literature with the purpose of identifying research addressing psychosocial treatments of depression in later life. A summary of treatments currently supported by research as being efficacious when treating older individuals experiencing depression or dysthymia is presented. Limitations of the findings are discussed.     

Younger adults report more distress and less well-being: A cross-cultural study of event centrality,depression, post-traumatic stress disorder and life satisfaction

The extent to which highly emotional autobiographical memories become central to one's identity and life story influences mental health. Young adults report higher distress and lower well-being, compared with middle-aged and/or older adults; whether this replicates across cultures is still unclear. First, we provide a review of the literature that examines age-differences in depression, post-traumatic stress disorder (PTSD), and life satisfaction in adulthood across cultures. Second, we report findings from a cross-cultural study that examined event centrality of highly positive and negative autobiographical memories along with symptoms of depression and PTSD, and levels of life satisfaction in approximately 1000 young and middle-aged adults from Mexico, Greenland, China and Denmark. Both age groups provided higher centrality ratings to the positive life event; however, the relative difference between the ratings for the positive and negative event was smaller in the young adults. Young adults reported significantly more distress and less well-being across cultures.