Anxiety and Depression in Medically Ill Older Adults

Anxiety and depression are extremely common in the elderly with medical problems. They can manifest not only as symptoms of a primary psychiatric illness, but also as physiologic sequelae of medical illnesses and medical treatments. Recognition and treatment of depression and anxiety in the medically ill is especially difficult. If these states go untreated, they result in higher morbidity and mortality, higher health care costs and utilization, and poorer functional status and outcomes. Three of the most common medical illnesses that afflict geriatric patients, cardiovascular disease, pulmonary disease, and rheumatoid arthritis, will be presented to illustrate the difficulty in recognizing depression and anxiety and the impact of treating these symptoms in the medically ill elderly. Multidisciplinary approaches combining optimal medication regimens and psychosocial interventions can be effective for treatment of anxiety and depression in the medically ill elderly.     

Suicide in the Medically Ill

“The undiscover'd country, from whose bourn No traveler returns puzzles the will, And makes us rather bear those ills we have Than fly to others that we know not of?” (Hamlet III, i)     

Conservation Withdrawal vs. Depression in Medically Ill Patients: Rorschach Case Study

The psychological consultant in a general hospital may be asked to evaluate physically ill patients who present ambiguous clinical symptomatology. The differential diagnoses of depression from the normal (conservation-withdrawal) reaction to stress is particularly difficult. A case study is presented illustrating the Rorschach test findings of a patient who appeared depressed upon initial clinical examination, but who illustrates conservation-withdrawal, an adaptive nonpathological stress reaction.     

The Content of Behavior Therapy for Depression Demonstrates Few Associations With Treatment Outcome Among Low-Income, Medically Ill Older Adults

We reported previously the results of a randomized controlled trial of a home-based behavioral treatment for dysthymia or minor depression that emphasized problem solving and activity scheduling among low-income, medically ill older adults. This report focuses on the content of treatment sessions as predictors of depressive symptoms, social activity, and physical activity outcomes among 64 participants who completed 2 or more sessions and evaluations at 6 and 12 months after the baseline evaluation. Worksheets from the treatment sessions were coded for focus on 4 types of problems (functional, social, health/physical, emotional); the number of activities planned was counted. More activity scheduling was associated with increased physical activity at the 12-month evaluation relative to baseline. The limited findings suggest either that the study methodology did not reveal extant associations between treatment variables and outcomes or that the session content variables tested in this study are not the active ingredients of treatment.     

Depression and Mortality in the Elderly

It is well known that depression can be a consequence of medical illness and disability, but a growing literature suggests also that depression can cause biological changes linked to morbidity and mortality. Depression is strongly implicated as a contributor to cardiovascular disease and mortality. Using the cascade-to-death model as a conceptual framework, we explore the complex relations among behavior, affect, motivation, and pathophysiology that might account for the association between depression and premature death. Our model suggests that some individuals become entrapped in a downward spiral in which behavior, medical illness, and depressive affect feed on each other to undermine the biological integrity of the organism. In addition to specifying behavioral and biological mechanisms linking depression to mortality, future research needs to more closely examine phenomenological aspects of depression in order to determine what aspects of depression and related constructs such ashopelessness, vital exhaustion, and motivational depletion account for the link between depression and mortality.     

Selective Responsiveness of Chronically Ill Children to Assessments of Depression

Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies This variation in prevalence rates may be due, in part, to selective reporting of patients based on measure, used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checktist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.     

Religiosity and Church-Based Assistance Among Chronically Ill African-American and White Elderly

ABSTRACT

This study examines religion and church-based assistance among 127 chronically ill African-American and white elderly persons hospitalized for congestive heart failure and discharged to home. Elders reported high levels of religiosity and prayer behavior; they reported low levels of church help received. Controlling for living arrangement, gender, social class and health in probit regression analyses, race was not a significant predictor of subjective religiosity, frequency of prayer, or level of church help received. Findings indicated a significant race-by-health interaction. Subjective religiosity was positively associated with health for whites but no relationship was found between religiosity and health for African-Americans. Further research is called for that replicates study findings on other elders with chronic illness.     

Screening for and Preventing Perinatal Depression

New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons’ implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons’ model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.     

Medically Defining,Screening, and Treating Conduct Disorder: A French Controversy

For several decades, the use of psychotropic medication has either been regarded as a medical issue or an example of the medicalization of social problems. As the publication in 2005 of a knowledge synthesis on conduct disorder in children and adolescents and the reply of the «Pas de zéro de conduite» collaboration (literally: No F for Conduct) was a highly important event in the French mental health scene, it deserves a thorough discussion. In the hope of improving the practices and policies targeting children and their families, it is essential to gain a better understanding of the bones of contention between the proponents and opponents of a medical or rather biosocial model. To achieve this, we first analyze how this model assigns a central role to certain disorders defined and diagnosed based on constellations of symptoms. We then identify five dimensions which seem to hold center stage in the controversy: genetic susceptibility, neurocognitive deficits and temperament, the familial and social environment seen as a reservoir of stressors, large-scale screening for disorders using simple instruments and multi-modal treatments, including psychotropic medication. We take an interest in the French debate as this allows us to stand back from the models prevailing in North America. It also underscores the importance of multidisciplinary thinking and social sciences when elaborating clinical or political mental health guidelines.     

Ethnicity,Social Support,and Depression Among Elderly Chilean People

Recent evidence regarding the relationship between social support and depression in elderly people shows the important role of ethnicity. This research describes the characteristics of social support in a sample of elderly people aged 60 and above living in northern Chile (n = 493), and analyzes the differences in the relationship between social support and depression between an indigenous group (Aymara population, n = 147) and a nonindigenous group (white, Caucasian, mestizo, n = 346). Various dimensions of social support were considered: structural elements, functional social support according to source, and community participation. The results show the existence of significant differences in the characteristics and dimensions of social support depending on sex, ethnicity, and marital status. Further, the central role of the family group is observed for both Aymara and nonindigenous elderly people. The hierarchical regression models obtained result in notable differences in the role of the structural, functional, and community elements of support in explaining depression for the ethnic groups considered.     

Perfectionism and Depression Among Low-Income Chronically Ill African American and White Adolescents and Their Maternal Parent

Most research on perfectionism is based on convenience samples of university students or clinically distressed samples, and therefore relatively less is known about the development and implications of perfectionism for other groups. In this study, we examined perfectionism and depression in low-income African American (n = 39) and White (n = 55) adolescents with chronic illnesses (most with diabetes, asthma, and/or hypertension) and their primary parents. We specifically examined the association between parent and child perfectionism, and the link between perfectionism and depression in both groups. The African American adolescents reported significantly more maladaptive perfectionism than did the White adolescents, and the African American parents reported significantly higher scores on depression than did the White parents. Correlations and regression analyses revealed similarities and differences in perfectionism-depression associations that might be explained in light of cultural differences and the unique physical and emotional challenges faced by youth with chronic illnesses. The word “parent” in this study is used to represent a parent or other adult who was identified as a primary caregiver for the adolescent.     

Depression at 3 Months Poststroke in the Elderly: Predictors and Indicators of Prevalence

The prevalence and determinants of depression in 79 elderly patients were assessed at 3 months poststroke. Predictor variables included gender, age, history of previous stroke, and hemispheric location of stroke. Indicator variables included two measures of physical functioning and seven aspects of cognitive functioning. Results indicated that 56% of patients had impairment in activities of daily living, and 39% reported clinically significant levels of depression. Prevalence of cognitive impairment ranged from 31% on a measure of basic cognitive functioning, through to 89% on a measure of complex attention. The results from a hierarchical multiple regression analysis showed that the combination of predictor and indicator variables explained 53% of the variance in depression scores. The three individual variables of history of previous stroke, physical functioning, and simple attention all made significant unique contributions to the variance in depression scores. The contribution of these findings to the ongoing debate concerning lesion location and poststroke depression is discussed.     

RAAS激活与老年高血压合并抑郁的关系

探讨老年高血压合并抑郁患者肾素-血管紧张素-醛固酮系统( RAAS)的变化及二者之间的关系.入选原发性高血压病患者210例,其中高血压合并抑郁组(80倒)、高血压不合并抑郁组(130例),两组检测血糖、血肌酐、血脂等指标,用放射免疫分析法测定血浆肾素、血管紧张素Ⅱ、醛固酮水平.结果两组在性别、年龄、血糖、血脂等方面无统计学差异,高血压合并抑郁组肾素、血管紧张素及醛固酮水平均显著高于高血压不合并抑郁组.高血压合并抑郁组血浆肾素(r=0.283,P＜0.01)、血管紧张素Ⅱ(r=0.312,P＜0.01)、醛固酮水平(r=0.276,P＜0.01)与HAMD量表总分呈正相关.RAAS系统激活与老年高血压合并抑郁关系密切,这对老年高血压合并抑郁患者的治疗提供了一定的临床价值.     

Comprehensive Intervention for Anxiety and Depression among the Community Elderly with Tuberculosis

Anxiety and depression are common comorbidities in the elderly who have tuberculosis. We conducted a community-based trial to explore the effect of comprehensive interventions on anxiety and depression of the elderly tuberculosis patients. The control group (n?=?122) received health education, and the intervention group (n?=?61) received health education, psychotherapy, home visit, peer support, and psycho-educational workshops. Compared with the control group, the anxiety (β_Group×Time = ?0.79) and depression (β_Group×Time = ?1.13) declined more pronounced in the intervention group. The results suggested that comprehensive interventions could alleviate the anxiety and depression of the elderly tuberculosis patients sustainably and effectively.     

流调中心抑郁量表在老年人群中的因素结构

本研究使用4903名老年人组成的全国样本,系统地检验了流调中心抑郁量表的因素结构。结果表明,Radloff的四因素结构、Guarnaccia等和Yen等的三因素结构对当前样本数据的拟合较好,但信度分析和相关分析显示积极情绪因素降低了总量表信度,并且与其他因素之间不支持共同的高阶因素（抑郁）,基于此,在使用量表合成总分的背景下,4个积极情绪项目不适合包含在CES-D量表中。随后,本研究检验了剔除积极情绪项目后量表各因素结构的拟合情况,发现积极情绪因素对量表因素结构的拟合水平贡献不大。结合拟合指数和Radloff对量表的界定,16项目的三因素结构最适合于我国老年人群,并且,这一因素结构在老年人群中具有跨性别的恒等性。     

Screening for Depression After Stroke: Occupational Therapists' Performance to Protocols

The ability of occupational therapists to enact post-stroke depression screening protocols was considered. The medical notes of 12 patients admitted to an in-patient stroke unit over a 3-month period were consulted to assess timely, appropriate administration, interpretation, and recording of the results of administering the protocols. Post-stroke depression screening by occupational therapists occurred for 83% of patients. Of the screens conducted, all of the patients were administered the correct tool. In 100% of cases screened, the outcome was recorded and in at least 80% clinicians had provided feedback to the patient on the results of the screen.     

Screening for Depression in Cardiovascular Patients in Albania: Findings from the Country Check-Up Program

This is a retrospective study conducted in Vlora from January 2016 to April 2017 and the aim was to report the prevalence of depression in cardiovascular (CVD) patients. Depression assessment was done using the Patient Health Questionnaire (PHQ)-9 (PHQ-9). Data were derived from the patient records and the standard recommended cut-off point of PHQ-9 ≥ 10 was used. In total, data of 300 patients were analyzed. Depressive symptoms (PHQ-9 ≥ 10) were observed at 6% of the participants. Trouble falling asleep or staying asleep or sleeping too much, feeling tired or having little energy and having little interest or pleasure in doing things were the most common symptoms reported. In multivariate analysis, only family status showed statistical significance. Unmarried (mean rank?=?207.22) are more likely to have moderate or severe depression level (OR?3.529; C.I. 95% 1.017–12.238). Future research should focus on the needed actions after depression screening (i.e. referral, treatment etc.).

     

For your Eyes Only: A Q-Methodology on the Ontology of Happiness Among Chronically Ill Filipino Elderly in a Penal Institution

Happiness is a positive phenomenon that is universal in nature and is therefore, pertinent to all human beings. However, the definition of happiness differs from person to person, and varies among cultures, economic status, social connectedness, spiritual upbringing and daily situations. An individual’s contextual perception of happiness can change when subjected to bleak conditions such as incarceration wherein inmates, especially those who are old and are experiencing health impairments are stripped off with their customary source of happiness. Since Filipinos are known to be as “happy people,” this study purports to surface the different facets of what constitute happiness in the context of a penal institution in the Philippine setting. The Q-methodology is the primary design used in the study. It combines the objectivity of quantitative approach with the essence of human experiences as explored in qualitative studies. The participants (P-sample) were twenty elderly inmates suffering from chronic ailments. They were asked to arrange 32 statements (Q-sample), derived from the initial interview, in the Q-sort table based on their degree of agreement, which were then further explicated in the post-sort interviews. The results were then subjected to by-person factor analysis with varimax rotation using the PQ Method version 2.11. Five profiles emerged from the by-person factor analysis, namely: (1) ‘Sense of Affinity’, (2) ‘Sense of Opportunity’, (3) ‘Sense of Indemnity’, (4) ‘Sense of Positivity’ and (5) ‘Sense of Resiliency’. The discussion focused on similarities and differences among profiles regarding the four principal themes (familial, social, internal and spiritual components of happiness) derived from the statements used as the Q-sample. The perception of happiness varies from profile to profile. The differences in views on what constitutes happiness among profiles are more prominent than their said similarities. Most leanings are directed toward the familial and spiritual aspects of happiness however, happiness can also be internally motivated and cognitively construed. While happiness has a direct relationship to an individual’s overall perception of well-being, the nurse, being the primary provider of holistic care, plays a pivotal role in promoting optimum health through awareness, knowledge, and appreciation of vis-a vis an unwavering involvement with the unique and distinct psychological and emotional needs of the elderly inmates characterized by respect, openness, authenticity and inter-subjectivity.     

Social Comparison in Medically High-Risk Pregnant Women1

The present study examined social comparison processes in 147 pregnant women at high risk of incurring an adverse birth outcome such as fetal loss or preterm delivery. These women typically undergo physical and psychological changes which elevate uncertainty and distress. Theoretically derived hypotheses concerning the impact of threat, self-esteem, perceived control, age, and gravidity (previous pregnancy) on social comparison were tested. Women experiencing low pregnancy-related threat and those with higher self-esteem were more likely to compare themselves favorably to other pregnant women. Younger women who had not been pregnant before compared most frequently; comparisons of physical state were more common than comparisons of emotional well-being or interpersonal relationships. Results are contrasted with social comparison processes in other populations facing stressful life events.     

老年人抑郁情绪发展轨迹及社会参与的作用：空巢与非空巢老人的对比研究

应用多样本潜变量增长模型,探究空巢和非空巢老人抑郁情绪发展轨迹的差异以及社会参与对两者抑郁情绪发展轨迹的影响。结果表明：老年人抑郁情绪发展趋势遵循阶段化线性增长轨迹,空巢老人抑郁情绪初始水平及二阶段发展速度均高于非空巢老人;社会参与可以降低老年人抑郁情绪初始水平,对空巢老人而言,社会参与可降低抑郁情绪上升速度。结论：空巢老人是抑郁情绪高发人群,社会参与是降低和缓解老年人抑郁情绪的重要途径。