The effect of diet quality and body mass index on depression in older adults: a growth curve analysis.

BACKGROUND: Nutrition not only plays an important role in one's physical health, but also mental health. The causal association between nutrition and mental health remains unclear. While a healthy dietary pattern may protect one against mental illness, it is also possible that poor mental health could lead to unhealthy eating habits or choices. Furthermore, emerging studies suggest that a higher body mass index (BMI) is associated with a lower risk of depressive symptoms in older adults, contrasting the effect observed in other populations. With an ageing population, this study aimed to investigate the long-term impact of a healthy dietary pattern, BMI, and other covariates on depressive symptoms in older adults. METHODS: We conducted a cohort study between 2014 and 2017, with each follow-up assessment being one year apart. A total of 2081 participants above 65 years old (M = 79.65, SD = 7.94) completed the baseline assessment in 2014, which included basic demographics, self-reported eating habits, depressive symptoms, and the measurement of height and weight. Distance to supermarkets and fast food was calculated based on participants' residential addresses. Two growth models were performed to assess the trajectory of change in depressive symptoms over time. RESULTS: Older adults experienced a significant decrease in depressive symptoms over time (intercept = 2.68, p < .001; slope = -0.25, p < .001). At baseline, a higher diet quality (B = -0.95, p < .001), higher BMI (B = -0.09, p < .001), younger age (B = 0.40, p = .001), being a male (B = 0.76, p < .001), and having fewer chronic diseases (B = 0.39, p < .001) were associated with lower levels of depressive symptoms. Over time, a higher diet quality (B = 0.14, p = .05), higher BMI (B = 0.02, p = .04), and fewer chronic diseases (B = -0.08, p < .001) predicted lower levels of depressive symptoms over time. CONCLUSIONS: A higher diet quality and higher BMI may serve as protective factors for depressive symptoms in older adults. Potential implications are being discussed.

Objective and perceived service accessibility and mental health in older adults.

OBJECTIVES: Service accessibility plays a pivotal role in older adults' mental health. However, accessibility measures used in previous studies are either objective or perceived. This study aimed to integrate both objective and perceived measures of service accessibility to explore the relationship between environmental cognition on service accessibility and mental health in older adults and the pathways. METHODS: We used both questionnaire data collected from 2,317 older adults in Hong Kong and geographical data to explore the direct and indirect effect of environmental cognition (i.e. positive, negative, and matching evaluation) relating to service accessibility on mental health and two pathways (i.e. physical activity and sense of belonging) based on a structural equation model. RESULTS: Physical activity mediated the positive relationship between non-negative perceptions toward access to convenience stores, leisure facilities, clinics, community centers, places of worship and mental health. Sense of community can significantly mediate the positive relationships between non-negative perceptions toward all 10 types of services and mental health. CONCLUSION: This study provides an empirical contribution to environmental cognition theory and person-environment fit theory; its findings have implications for urban planning policy.

The findings from this study provide significant evidence that environmental cognition distortion, especially negative perception, can be significantly associated with lower mental health through physical activity and a sense of community. This suggests that policies focused on changing environmental cognitions could be a promising public health strategy. Environmental cognition theory suggests that improving awareness of setting could help improve the precision of cognitive mapping of environmental reality. This can be very important where it is difficult to change the objective environment due to the deep-rooted and long-standing urban structure.

Neighborhood built environments and cognition in later life.

Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults' cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population.Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition.Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80.Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.

Dimensionality and risk factors of the personal stigma of depression in adults aged 50 years and older at risk of depression.

Objectives: Knowledge about the mechanism of the personal stigma of depression may inform strategies to reduce stigma and promote help-seeking. We examined the dimensionality and risk factors of the personal stigma of depression in older adults at risk of depression.Methods: Seven-hundred and one Hong Kong adults aged 50 years and older at risk of depression completed the personal stigma subscale of the depression Stigma Scale (DSS-personal) at two-time points. We used exploratory factor analysis (EFA) to explore the factor structure of DSS personal and confirmatory factor analysis to examine the model fit of the EFA-informed factor structure and structures proposed in previous studies. Regression analyses examined the relationships between risk factors and personal stigma dimensions.Results: Factor analyses identified a 3-factor structure of DSS-personal resembling the social-cognitive model consistent over time and included stereotype, prejudice, and discrimination (CFI = 0.95, TLI = 0.92, RMSEA = 0.05). Regression analyses indicated all stigma dimensions were associated with older age, less education, and no personal history of depression (B = -0.44 to 0.06); discrimination was also associated with more depressive symptoms (B = 0.10 to 0.12).Conclusion: Findings illustrated the potential theoretical underpinning of DSS-personal. Stigma reduction interventions could target and tailor to older adults with risk factors to enhance effectiveness and promote help-seeking.

Depression risk among community-dwelling older people is associated with perceived COVID-19 infection risk: effects of news report latency and focusing on number of infected cases.

Awareness of COVID-19 infection risk and oscillation patterns ('waves') may affect older people's mental health. Empirical data from populations experiencing multiple waves of community outbreaks can inform guidance for maintaining mental health. This study aims to investigate the effects of COVID-19 infection risk and oscillations on depression among community-dwelling older people in Hong Kong.A rolling cross-sectional telephone survey method was used. Screening for depression risk was conducted among 8,163 older people (age ≥ 60) using the Patient Health Questionnaire-2 (PHQ-2) from February to August 2020. The relationships between PHQ-2, COVID-19 infection risk proxies - change in newly infected cases and effective reproductive number (Rt), and oscillations - stage of a 'wave' reported in the media, were analysed using correlation and regression.8.4% of survey respondents screened positive for depression risk. Being female (ß = .08), having a pre-existing mental health issue (ß = .21), change in newly infected cases (ß = .05), and screening during the latency period before the media called out new waves (ß = .03), contributed to higher depression risk (R2 = .06, all p <.01).While depression risk does not appear alarming in this sample, our results highlight that older people are sensitive to reporting of infection, particularly among those with existing mental health needs. Future public health communication should balance awareness of infection risks with mental health protection.

The intersectionality of life course socioeconomic status, race, and cognitive decline: An 18-year follow-up.

OBJECTIVES: Studies have documented the impact of childhood socioeconomic status (SES) on cognition. However, research that simultaneously considers SES in varied life stages, the multidimensional mechanisms, and racial differences is relatively understudied. This study examines the intersectionality across age, SES, and race and its impact on cognitive trajectories. METHODS: Using 8376 respondents aged 65+ from the 1998-2016 Health and Retirement Study, we used latent growth curve modeling to examine the effects of four life course models (latency, pathway, accumulation, and mobility) on 18-year trajectories of mental status and episodic memory. We further tested for differences in the links between SES and cognitive trajectories between black and white respondents. RESULTS: Cognitive function declines with age and is interrelated with SES and race. Adulthood has a stronger effect on cognitive performance than childhood. However, linked positive childhood and adulthood SES contributes to positive cognition. Accumulated SES disadvantages were associated with lower cognition. Older adults with downward mobility and low SES throughout their lifespans had the lowest cognition scores. Life course models operated differently on trajectories of cognitive decline, yet the effects were particularly evident among older black respondents. Overall, those with socioeconomic advantages tended to have a slower decline in cognition, while a faster decline occurred for those with accrued disadvantages. CONCLUSIONS: Cognitive performance is a complex, longitudinal process intertwined with socioeconomic conditions and population heterogeneity shaped by life course contexts. Policies that facilitate healthy cognitive performance and address SES inequality could equalize health opportunities and address racial cognitive disparities later in life.

Consuming Information Related to COVID-19 on Social Media Among Older Adults and Its Association With Anxiety, Social Trust in Information, and COVID-Safe Behaviors: Cross-sectional Telephone Survey.

BACKGROUND: COVID-19-related information on social media is overabundant and sometimes questionable, resulting in an "infodemic" during the pandemic. While previous studies suggest social media usage increases the risk of developing anxiety symptoms, how induced anxiety affects attitudes and behaviors is less discussed, let alone during a global pandemic. Little is known about the relationship between older adults using social media during a pandemic and their anxiety, their attitudes toward social trust in information, and behaviors to avoid contracting COVID-19. OBJECTIVE: The goal of this study was to investigate the associations between using social media for COVID-19-related information and anxiety symptoms as well as the mediation effect of anxiety symptoms on social trust in information and COVID-safe behaviors among older adults. METHODS: A cross-sectional telephone survey was conducted in Hong Kong between May and August 2020. A rapid warm-call protocol was developed to train social workers and volunteers from participant nongovernmental organizations to conduct the telephone surveys. Questions related to COVID-safe behaviors, social trust in information, social media use, anxiety and depressive symptoms, and sociodemographic information were asked. The number of confirmed COVID-19 cases at the community level was used to account for the risk of contracting COVID-19. Ordinary least squares regressions examined the associations between social media use and anxiety symptoms, and how they were associated with social trust in information and COVID-safe behaviors. Structural equation modeling further mapped out these relationships to identify the mediation effects of anxiety symptoms. RESULTS: This study collected information regarding 3421 adults aged 60 years and older. Use of social media for COVID-19-related information was associated with more anxiety symptoms and lower social trust in information but had no significant relationship with COVID-safe behaviors. Anxiety symptoms predicted lower social trust in information and higher COVID-safe behaviors. Lower social trust in information was predicted by using social media for COVID-19 information, mediated by anxiety symptoms, while no mediation effect was found for COVID-safe behaviors. CONCLUSIONS: Older adults who rely on social media for COVID-19-related information exhibited more anxiety symptoms, while showing mixed effects on attitudes and behaviors. Social trust in information may be challenged by unverified and contradictory information online. The negligible impact on COVID-safe behaviors suggested that social media may have caused more confusion than consolidating a consistent effort against the pandemic. Media literacy education is recommended to promote critical evaluation of COVID-19-related information and responsible sharing among older adults.

Longitudinal impacts of grandparent caregiving on cognitive, mental, and physical health in China.

OBJECTIVES: Although studies have documented the effects of grandparenting, little is known about grandparents' long-term health outcomes in terms of optimal engagement with grandchildren, and whether age, gender, or location make a difference. This study explores the longitudinal impacts of grandparenting on health, with considerations for subgroup differences. METHODS: Using three waves of China Health and Retirement Longitudinal Study, we used propensity score analysis combined with multilevel analysis to examine the longitudinal effect of grandparenting (no, low-, moderate-, and high-intensity) on health (self-rated health, mobility limitations, depressive symptoms, and cognition) among 4,925 grandparents with at least one grandchild, and how impact varies by age, gender, and urban/rural areas. RESULTS: A nonlinear relationship between grandparenting and health was observed. Compared to those not providing care, grandparents who provided care at a low-to-moderate level were more likely to have fewer mobility limitations and depressive symptoms and better cognition. High intensity had no positive impacts on health. The effects of grandparenting on health operated differently across subgroups. Older grandparents showed better physical, mental, and cognitive health compared to their younger counterparts. Both genders had fewer mobility limitations if they provided care at a low-to-moderate level, although females reported better self-rated health. Rural grandparents reported better physical health; whereas urban grandparents reported better cognition. CONCLUSION: Grandparenting could improve health in later life; however, there are complex interactions at play. Policies aimed at supporting grandparenting should consider optimal hours of care relevant to age, gender, and urban/rural contexts.

Associations between Volunteering and Mental Health during COVID-19 among Chinese Older Adults.

Evidence about the association between volunteering and the mental health of older adults during COVID-19 remains underexplored. This study investigated (1) patterns of volunteering among older adults in Hong Kong during COVID-19; (2) associations between volunteering and mental health of older adults during COVID-19; and (3) associations between key psychological resources (e.g., self-efficacy and self-esteem) and volunteering among older adults during COVID-19. This study applied a cross-sectional design with data collected from 128 older adults in June 2020, who were trained as volunteers in a volunteer program that began before COVID-19. The study found that older adults continued to actively contribute to their communities by engaging in volunteering during COVID-19. The specific type of volunteering activities was linked to few depressive and anxiety symptoms. Older adults with increased self-esteem prior to COVID-19 were more likely to participate in volunteering activities related to COVID-19. Our study suggested that encouraging older adults to volunteer during the pandemic is a key pathway to maintain mental health. Social workers are encouraged to engage older adults in volunteerism regularly to offset the risk of depression and anxiety symptoms in times of crisis.

Cognitive changes associated with mentally active lifestyle and structured cognitive programs: a 2-year longitudinal study.

Objectives: Mentally stimulating leisure activities and cognitive interventions are associated with delayed cognitive decline, although evidence has not been unequivocal, possibly due to differential contribution of the two types of activities. This study aimed to examine the respective contributions of mentally active lifestyle and structured cognitive programs on cognitive changes in older adults.Methods: This was a 2-year prospective cohort study of 1,793 healthy older adults. We recorded mentally active lifestyle and participation in cognitive program. Cognitive function was assessed using the Montreal Cognitive Assessment. Physical frailty was also screened for the potential effect on cognition.Results: Compared to the mentally inactive group, the mentally active group had better baseline cognitive functioning (standardized mean difference of 0.08, t = -3.8; p < 0.001), but both groups showed a mild cognitive decline over time (both p < 0.05). The mentally active group were less physical frail, more physical independent, and less depressed. Participation in structured cognitive programs was associated with cognition improvement, in older persons who had a mentally active or inactive lifestyle (standardized mean differences of 0.22 and 0.27, respectively; both p < 0.01), but these gains significantly diminished at year 2 in the latter group. Lower baseline cognitive function and higher level of physical frailty predicted greater cognitive gains from structured cognitive programs.Conclusion: Both a mentally active lifestyle and structured cognitive programs contributed to better cognition. Structured cognitive programs appeared to add on to the benefits of a mentally active lifestyle, and predicted cognitive changes regardless of lifestyle.

Validating a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for dementia caregivers.

OBJECTIVES: The present study aimed to develop and validate a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for Hong Kong Chinese dementia caregivers. METHODS: The 12-item Zarit Burden Interview (ZBI) was translated into spoken Cantonese and back-translated by two bilingual research assistants and face validated by a panel of experts. Five hundred Chinese dementia caregivers showing signs of stress reported their burden using the translated ZBI and rated their depressive symptoms, overall health, and care recipients' physical functioning and behavioral problems. The factor structure of the translated scale was identified using principal component analysis and confirmatory factor analysis; internal consistency and item-total correlations were assessed; and concurrent validity was tested by correlating the ZBI with depressive symptoms, self-rated health, and care recipients' physical functioning and behavioral problems. RESULTS: The principal component analysis resulted in 11 items loading on a three-factor model comprised role strain, self-criticism, and negative emotion, which accounted for 59% of the variance. The confirmatory factor analysis supported the three-factor model (CZBI-Short) that explained 61% of the total variance. Cronbach's alpha (0.84) and item-total correlations (rho = 0.39-0.71) indicated CZBI-Short had good reliability. CZBI-Short showed correlations with depressive symptoms (r = 0.50), self-rated health (r = -0.26) and care recipients' physical functioning (r = 0.18-0.26) and disruptive behaviors (r = 0.36). CONCLUSIONS: The 12-item CZBI-Short is a concise, reliable, and valid instrument to assess burden in Chinese dementia caregivers in clinical and social care settings.

Self-administered acupressure for symptom management among Chinese family caregivers with caregiver stress: a randomized, wait-list controlled trial.

BACKGROUND: Caregiving can be stressful, potentially creating physical and psychological strain. Substantial evidence has shown that family caregivers suffer from significant health problems arising from the demands of caregiving. Although there are programs supporting caregivers, there is little evidence regarding their effectiveness. Acupressure is an ancient Chinese healing method designed to restore the flow of Qi (vital energy) by applying external pressure to acupoints. A randomized, wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress (primary objective) and stress-related symptoms of fatigue, insomnia, depression, and health-related quality of life (secondary objectives) in Chinese caregivers of older family members. METHODS: Two hundred Chinese participants, aged ≥ 21 years, who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong. Subjects will be randomized to receive either an immediate treatment condition (self-administered acupressure intervention) or a wait-list control condition. The self-administered acupressure intervention will include (i) an individual learning and practice session twice a week for 2 weeks, (ii) a home follow-up visit once a week for 2 weeks, and (iii) 15-min self-practice twice a day for 6 weeks. The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention. We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress, fatigue, insomnia, depression, and higher health-related quality of life after completion of the intervention than participants in the wait-list control group. DISCUSSION: This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue, insomnia, depression, and health-related quality of life in Chinese family caregivers. The findings will inform the design of interventions to relieve negative health effects of caregiving. Furthermore, the results can raise community awareness and serve as a basis for policymaking, planning, and allocation of resources regarding empowerment of family caregivers for self-care. TRIAL REGISTRATION: Current Controlled Trials NCT02526446 . Registered August 10, 2015.

Comparison of networks of loneliness, depressive symptoms, and anxiety symptoms in at-risk community-dwelling older adults before and during COVID-19.

Network analysis provides an innovative approach to examining symptom-to-symptom interactions in mental health, and adverse external conditions may change the network structures. This study compared the networks of common risk factors and mental health problems (loneliness, depressive symptoms, and anxiety symptoms) in community-dwelling older people before and during COVID-19. Older adults (aged ≥ 60) at risk for depression were recruited through non-governmental organizations. Loneliness, depressive symptoms and anxiety symptoms were measured using the three-item Loneliness Scale (UCLA-3), nine-item Patient Health Questionnaire (PHQ-9), and seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Data from 2549 (before) and 3506 (during COVID-19) respondents were included using propensity score matching. Being restless (GAD-7-item5) was most central, indicated by Expected Influence, in both pre and during COVID-19 networks despite low severity (mean score). The network during COVID-19 had higher global strength and edge variability than the pre-pandemic network, suggesting easier symptom spread and potentially more complex symptom presentation. In addition, feeling isolated from others (UCLA-3-item3) had stronger connections with feeling worthless/guilty (PHQ-9-item6) and anticipatory anxiety (GAD-7-item7) during COVID-19 than before. These findings may enhance our knowledge of the symptom structure of common mental health problems and the impacts of the pandemic. Targeting central symptoms may offer novel preventive strategies for older people.

Nonpharmacological Interventions for Chronic Pain in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Nonpharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different nonpharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis. RESEARCH DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions. RESULTS: Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences -0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity. DISCUSSION AND IMPLICATIONS: Nonpharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults.

A core competency framework for mental health peer supporters of older adults in a Chinese community: cross-culturally informed Delphi study.

AIMS AND METHOD: Non-Western literature on the core competencies of mental health peer supporters remains limited. Therefore, we used a three-round Delphi study with peer supporters, service users (i.e. someone using peer support services) and mental health professionals to develop a core competency framework for peer supporters in the Chinese context. RESULTS: The final framework included 35 core competencies, the conceptual origins of which were local (14.3%), Western (20%) and both local and Western (65.7%). They were grouped into five categories in ascending peer supporter role specificity: (1) self-care and self-development, (2) general work ethics, (3) work with others, (4) work with service users and (5) peer support knowledge. CLINICAL IMPLICATIONS: A culturally valid mental health peer support competency framework can minimise role confusion and refine training and practice guidelines. In a Chinese context, peer supporters were valued as generic support companions, whereas functions highlighted in the West, such as role modelling, were perceived as less critical.

Hybrid-delivered community psychoeducation for people aged 50 and older: A mixed-method evaluation and lesson learned.

Introduction: Hybrid training mode comprising in-person and teleconferencing sessions is effective and sustainable, yet no standardized principles guide its development for older people. This study aimed to develop a set of principles for hybrid-mode psychoeducation for older people from the experiences of middle-aged and older people in two folds: (1) examining the effects of hybrid-mode community psychoeducation and (2) identifying features that could enhance participants' experience. Methods: We delivered 12-hour Older Person Mental Health First Aid and 3-hour late-life depression training to adults aged 50 and older in in-person and hybrid modes. Hybrid group participants received technology-related support, including in-advance training and on-site support. All participants completed assessments on depression literacy, depression stigma, meaning in life, social support, depressive symptoms, and anxiety pre-and post-intervention and evaluated the program in open-ended questions. Results: A total of 471 in-person and 346 hybrid group participants completed the psychoeducation and post-assessment (80.4 % female, mean age = 64.73 years, SD = 7.29). Linear mixed models revealed improvements in depression literacy, depression stigma, meaning in life, social support, and anxiety (B = -1.43 to 0.13, all p < .001), with no significant difference between in-person and hybrid groups. Thematic analysis of open-ended questions identified three themes: (1) informational content with case studies, (2) hardcopy course handouts, and (3) interactive learning environment. Discussion/conclusion: Hybrid-mode and in-person psychoeducation had comparable benefits on middle-aged and older people. The TORCH principles, an acronym for Technology provision, On-site technical support, Rehearsal, Connection with group members, and Hardcopy notes, was derived from practice wisdom and qualitative findings to support older people in online learning.

Supporting Older Adults' Mental Health Against Suspected Mental Health Problems: The Moderating Role of an Age-Friendly Neighborhood.

This study examined how compensatory and enabling domains of an Age-Friendly City (AFC) moderate the relationship between suspected mental health problems and depressive and anxiety symptoms among older adults. Four thousand six hundred and twenty-five Hong Kong Chinese aged ≥60 years completed a telephone survey between April and July 2022, including PHQ-2 and GAD-2. AFC indices sourced from prior territory-wide study. Linear mixed models showed that enabling AFC domains, namely, social participation, respect and social inclusion, and civic participation and employment, alleviated the effects of suspected mental health problems on respondents' depressive and anxiety symptoms (b = -0.40 to -0.56). Three-way interaction models revealed that the protective effects of all compensatory and enabling AFCC domains (b = -1.23 to -6.18), except civic participation and employment, were stronger in old-old (70-79 years) and oldest-old (≥80 years) than young-old (60-69 years). AFCC-based interventions should focus on compensatory and enabling domains to support older adults' mental health.

Projecting the 10-year costs of care and mortality burden of depression until 2032: a Markov modelling study developed from real-world data.

Background: Based on real-world data, we developed a 10-year prediction model to estimate the burden among patients with depression from the public healthcare system payer's perspective to inform early resource planning in Hong Kong. Methods: We developed a Markov cohort model with yearly cycles specifically capturing the pathway of treatment-resistant depression (TRD) and comorbidity development along the disease course. Projected from 2023 to 2032, primary outcomes included costs of all-cause and psychiatric care, and secondary outcomes were all-cause deaths, years of life lived, and quality-adjusted life-years. Using the territory-wide electronic medical records, we identified 25,190 patients aged ≥10 years with newly diagnosed depression from 2014 to 2016 with follow-up until 2020 to observe the real-world time-to-event pattern, based on which costs and time-varying transition inputs were derived using negative binomial modelling and parametric survival analysis. We applied the model as both closed cohort, which studied a fixed cohort of incident patients in 2023, and open cohort, which introduced incident patients by year from 2014 to 2032. Utilities and annual new patients were from published sources. Findings: With 9217 new patients in 2023, our closed cohort model projected the 10-year cumulative costs of all-cause and psychiatric care to reach US$309.0 million and US$58.3 million, respectively, with 899 deaths (case fatality rate: 9.8%) by 2032. In our open cohort model, 55,849-57,896 active prevalent cases would cost more than US$322.3 million and US$60.7 million, respectively, with more than 943 deaths annually from 2023 to 2032. Fewer than 20% of cases would live with TRD or comorbidities but contribute 31-54% of the costs. The greatest collective burden would occur in women aged above 40, but men aged above 65 and below 25 with medical history would have the highest costs per patient-year. The key cost drivers were relevant to the early disease stages. Interpretation: A limited proportion of patients would develop TRD and comorbidities but contribute to a high proportion of costs, which necessitates appropriate attention and resource allocation. Our projection also demonstrates the application of real-world data to model long-term costs and mortality, which aid policymakers anticipate foreseeable burden and undertake budget planning to prepare for the care need in alternative scenarios. Funding: Research Impact Fund from the University Grants Committee, Research Grants Council with matching fund from the Hong Kong Association of Pharmaceutical Industry (R7007-22).

Threats to personhood from within the family? A study of family caregivers of people with dementia in the Chinese context.

BACKGROUND AND OBJECTIVES: Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers' reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs. RESEARCH DESIGN AND METHODS: We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews. RESULTS: Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers' views, infantilization, treachery, and exclusion and imposition. DISCUSSION AND IMPLICATIONS: These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.

"Participation Is Fun and Empowering": A Participatory Approach to Co-Design a Cultural Art Program for Older Chinese at Risk of Depression in Hong Kong.

Background and Objectives: Internalized ageism and stigma of mental illness may disempower older people and impede help-seeking among those at risk of depression. Arts are deemed enjoyable, stigma-free, and conducive to mental health, and a participatory approach can engage and empower potential service users. This study aimed to co-design a cultural art program and test its feasibility in empowering older Chinese people in Hong Kong and preventing depression. Research Design and Methods: Adopting a participatory approach and guided by the Knowledge-to-Action framework, we co-designed a 9-session group art program using Chinese calligraphy as the channel for gaining emotional awareness and facilitating expression. The iterative participatory co-design process engaged 10 older people, 3 researchers, 3 art therapists, and 2 social workers through multiple workshops and interviews. We tested the program's acceptability and feasibility in 15 community-dwelling older people at risk of depression (mean age = 71.6). Mixed methods were used, including pre- and postintervention questionnaires, observation, and focus groups. Results: Qualitative findings suggest the feasibility of the program, and quantitative findings indicated its effects in increasing empowerment (t(14) = 2.82, p < .05), but not in other mental health-related measurements. Participants reflected that active participation and learning new art skills were fun and empowering, arts enabled them to gain insight into and express deeper feelings, and groups with peers made them feel relatable and accepted. Discussion and Implications: Culturally appropriate participatory arts groups can effectively promote empowerment in older people, and future research should balance eliciting meaningful personal experiences and measurable changes.