Is 70 the new 60? A longitudinal analysis of cohort trends inintrinsic capacity in England and China.

To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study on Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). We applied multilevel growth curve models to examine change over time and cohort trends. We found that more recent cohorts entered older ages with higher levels of capacity, and their subsequent age-related declines were somewhat compressed compared to earlier cohorts. These improvements in capacity were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old ELSA participant born in 1950 had higher capacity than a 62-year-old born just 10 years earlier. Trends were similar for men and women, and findings were generally consistent across English and Chinese cohorts.

A quantitative approach to the intersectional study of mental health inequalities during the COVID-19 pandemic in UK young adults.

PURPOSE: Mental health inequalities across social identities/positions during the COVID-19 pandemic have been mostly reported independently from each other or in a limited way (e.g., at the intersection between age and sex or gender). We aim to provide an inclusive socio-demographic mapping of different mental health measures in the population using quantitative methods that are consistent with an intersectional perspective. METHODS: Data included 8,588 participants from two British cohorts (born in 1990 and 2000-2002, respectively), collected in February/March 2021 (during the third UK nationwide lockdown). Measures of anxiety and depressive symptomatology, loneliness, and life satisfaction were analysed using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) models. RESULTS: We found evidence of large mental health inequalities across intersectional strata. Large proportions of those inequalities were accounted for by the additive effects of the variables used to define the intersections, with some of the largest gaps associated with sexual orientation (with sexual minority groups showing substantially worse outcomes). Additional inequalities were found by cohort/generation, birth sex, racial/ethnic groups, and socioeconomic position. Intersectional effects were observed mostly in intersections defined by combinations of privileged and marginalised social identities/positions (e.g., lower-than-expected life satisfaction in South Asian men in their thirties from a sexual minority and a disadvantaged childhood social class). CONCLUSION: We found substantial inequalities largely cutting across intersectional strata defined by multiple co-constituting social identities/positions. The large gaps found by sexual orientation extend the existing evidence that sexual minority groups were disproportionately affected by the pandemic. Study implications and limitations are discussed.

Differences in the impact of the COVID-19 pandemic in the long-term trajectories of life satisfaction by sex in the UK: a prospective cohort study.

BACKGROUND: The COVID-19 pandemic has disproportionately affected women's mental health, with most evidence focused on mental ill-health outcomes. Previous research suggests that differences in time-use might explain this disparity, as women generally spent more time doing psychologically taxing activities than men. We investigated (1) sex differences in the impact of the pandemic in the long-term trajectories of life satisfaction and (2) whether time-use differences partly explained that differential impact. METHODS: In this prospective cohort study, we used the 1970 British Cohort Study, a birth cohort representing people born in Great Britain in 1970. Since 1970, information has been collected for all cohort members every 4-10 years (ten sweeps). Additional data were collected at three timepoints during the pandemic (May 2020, September-October 2020, February-March 2021) as part of the COVID-19 Survey. Response rates within the target population ranged between 23·6% (May, 2020) and 32·5% (March, 2021) in the COVID-19 Survey. We used non-response weights to restore sample representativeness to the target population (cohort members alive and residing in the UK during the pandemic). Life satisfaction was prospectively assessed at ages 26 (1996), 30, 34, 42, 46, 50, 50·5, and 51 years (2021) using a single question with responses ranging from 0 (lowest life satisfaction) to 10 (highest life satisfaction). We used multiple-group piecewise latent growth curve models grouped by sex assigned at birth. Additional models were adjusted for self-reported number of hours spent working, volunteering, home-schooling children, taking care of children and other people, and doing housework during the pandemic. Participants provided verbal informed consent. Ethics approval was not sought as non-sensitive, open-access data with minimal risk of identification was used. FINDINGS: We analysed data from 6766 adults (3799 [56·2%] women and 2967 [43·8%] men). Compared with men, women had consistently higher levels of life satisfaction before the pandemic (Δintercept,unadjusted = 0·213, 95% CI 0·087 to 0·340, p=0·0009), and experienced a more accelerated decline with its onset (Δquad2,unadjusted = -0·018, -0·026 to -0·011; p<0·0001), even after accounting for time use (Δquad2,adjusted = -0·016, -0·031 to -0·001; p=0·0348). Results were robust to adjustment for concurrent financial and occupational situation (Δquad2,adjustedfull = -0·019, -0·035 to -0·004; p=0·0158). INTERPRETATION: Our study shows sex inequalities in the impact of the pandemic on the long-term life satisfaction trajectories of adults in their 50s. Self-reported time-use differences did not account for these inequalities. One of the limitations is that we relied on self-reported time-use and were not able to include factors like the so-called mental load (being responsible for organising or monitoring activities, regardless of being involved in their execution), which might partly explain these results. FUNDING: Economic and Social Research Council (ESRC) Centre for Society and Mental Health at King's College London.

The performance of long vs. short questionnaire-based measures of depression, anxiety, and psychological distress among UK adults: A comparison of the patient health questionnaires, generalized anxiety disorder scales, malaise inventory, and Kessler scales.

It is often important to minimise the time participants in social science studies spend on completing questionnaire-based measures, reducing response burden, and increasing data quality. Here, we investigated the performance of the short versions of some widely used depression, anxiety, and psychological distress scales and compared them to the performance of longer versions of these scales (PHQ-2 vs PHQ-9, GAD-2 vs GAD-7, Malaise-3 vs Malaise-9, K6 vs K10). Across a sample of UK adults (N = 987, ages 18-86), we tested the existing factor structure and accuracy of the scales through confirmatory factor analyses and exploration of the total information functions, observing adequate model fit indices across the measures. Measurement invariance was tested across birth sex and age groups to explore whether any differences in measurement properties or measurement bias may exist, finding support for the invariance of most measures. We conducted bivariate correlations across the measures as a way of obtaining evidence of the equivalence in the rank-ordering of short vs long scales. The results followed a similar pattern across the young adult subsample (N = 375, ages 18-39) as in the overall sample. Overall, these results indicate that the short forms of the tested scales may perform similarly to the full versions. Where brevity is important, researchers may opt to use the shorter versions of the scales based on these data.

Parent-adolescent informant discrepancy on the Strengths and Difficulties Questionnaire in the UK Millennium Cohort Study.

BACKGROUND: Developmental researchers often use a multi-informant approach to measure adolescent behaviour and adjustment, but informant discrepancies are common. In general population samples, it is often found that parents report more positive and less negative outcomes than adolescents themselves. This study aimed to investigate factors associated with informant discrepancy, including adolescent sex, and parental level of psychological distress and education. METHODS: Informant discrepancy on the Strengths and Difficulties Questionnaire was investigated using a Latent Difference Score (LDS) approach, which estimates the true difference between parent and adolescent reports in a structural equation model. The sample were parent-adolescent dyads from the seventh wave of the UK Millennium Cohort Study (N = 6947, 49.3% female, aged 17 years). RESULTS: Parents reported lower levels of difficulties (emotion symptoms, peer problems, conduct problems), and higher levels of pro-social behaviour than adolescents themselves. Conditional effects were found, as discrepancy was greater amongst parent-daughter dyads for emotion and peer problems, and greater amongst parent-son dyads for conduct problems and pro-social behaviour. Parent-adolescent discrepancy was also greater generally if parents had a lower level of psychological distress or a higher level of education. CONCLUSIONS: In a large general population sample from the UK, it was found that adolescents tended to report more negative and less positive outcomes than parents reported about them. Conditional effects were found at the parent and adolescent level suggesting that specific informant biases are likely to impact the measurement of adolescent behaviour and adjustment across reporters.

Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review.

BACKGROUND: STIs in older adults (adults aged 50 years and older) are on the rise due to variable levels of sex literacy and misperceived susceptibility to infections, among other factors. We systematically reviewed evidence on the effect of non-pharmacological interventions for the primary prevention of sexually transmitted infections (STIs) and high-risk sexual behaviour in older adults. METHODS: We searched EMBASE, MEDLINE, PSYCINFO, Global Health and the Cochrane Library from inception until March 9th, 2022. We included RCTs, cluster-randomised trials, quasi-RCTs, interrupted time series (ITS) and controlled and uncontrolled before-and-after studies of non-pharmacological primary prevention interventions (e.g. educational and behaviour change interventions) in older adults, reporting either qualitative or quantitative findings. At least two review authors independently assessed the eligibility of articles and extracted data on main characteristics, risk of bias and study findings. Narrative synthesis was performed. RESULTS: Ten studies (two RCTs, seven quasi-experiment studies and one qualitative study) were found to be eligible for this review. These interventions were mainly information, education and communication activities (IECs) aimed at fostering participants' knowledge on STIs and safer sex, mostly focused on HIV. Most studies used self-reported outcomes measuring knowledge and behaviour change related to HIV, STIs and safer sex. Studies generally reported an increase in STI/HIV knowledge. However, risk of bias was high or critical across all studies. CONCLUSIONS: Literature on non-pharmacological interventions for older adults is sparse, particularly outside the US and for STIs other than HIV. There is evidence that IECs may improve short-term knowledge about STIs however, it is not clear this translates into long-term improvement or behaviour change as all studies included in this review had follow-up times of 3 months or less. More robust and higher-quality studies are needed in order to confirm the effectiveness of non-pharmacological primary prevention interventions for reducing STIs in the older adult population.

Long-term psychological distress trajectories and the COVID-19 pandemic in three British birth cohorts: A multi-cohort study.

BACKGROUND: Growing evidence suggests that population mental health outcomes have worsened since the pandemic started. The extent that these changes have altered common age-related trends in psychological distress, where distress typically rises until midlife and then falls after midlife in both sexes, is unknown. We aimed to analyse whether long-term pre-pandemic psychological distress trajectories were disrupted during the pandemic, and whether these changes have been different across cohorts and by sex. METHODS AND FINDINGS: We used data from three nationally representative birth cohorts comprising all people born in Great Britain in a single week of 1946 (National Survey of Health and Development, NSHD), 1958 (National Child Development Study, NCDS), or 1970 (British Cohort Study, BCS70). The follow-up data used spanned 39 years in NSHD (1982 to 2021), 40 years in NCDS (1981 to 2001), and 25 years in BCS70 (1996 to 2021). We used psychological distress factor scores, as measured by validated self-reported questionnaires (NSHD: Present State Examination, Psychiatric Symptoms Frequency, and 28- and 12-item versions of General Health Questionnaire; NCDS and BCS70: Malaise Inventory; all: 2-item versions of Generalized Anxiety Disorder scale and Patient Health Questionnaire). We used a multilevel growth curve modelling approach to model the trajectories of distress across cohorts and sexes and obtained estimates of the differences between the distress levels observed during the pandemic and those observed at the most recent pre-pandemic assessment and at the peak in the cohort-specific pre-pandemic distress trajectory, located at midlife. We further analysed whether pre-existing cohort and sex inequalities had changed with the pandemic onset using a difference-in-differences (DiD) approach. The analytic sample included 16,389 participants. By September/October 2020, distress levels had reached or exceeded the levels of the peak in the pre-pandemic life-course trajectories, with larger increases in younger cohorts (standardised mean differences [SMD] and 95% confidence intervals of SMDNSHD,pre-peak = -0.02 [-0.07, 0.04], SMDNCDS,pre-peak = 0.05 [0.02, 0.07], and SMDBCS70,pre-peak = 0.09 [0.07, 0.12] for the 1946, 1958, and 1970 birth cohorts, respectively). Increases in distress were larger among women than men, widening pre-existing sex inequalities (DiD and 95% confidence intervals of DiDNSHD,sex,pre-peak = 0.17 [0.06, 0.28], DiDNCDS,sex,pre-peak = 0.11 [0.07, 0.16], and DiDBCS70,sex,pre-peak = 0.11 [0.05, 0.16] when comparing sex inequalities in the pre-pandemic peak in midlife to those observed by September/October 2020). As expected in cohort designs, our study suffered from high proportions of attrition with respect to the original samples. Although we used non-response weights to restore sample representativeness to the target populations (those born in the United Kingdom in 1946, 1958, and 1970, alive and residing in the UK), results may not be generalisable to other sections within the UK population (e.g., migrants and ethnic minority groups) and countries different than the UK. CONCLUSIONS: Pre-existing long-term psychological distress trajectories of adults born between 1946 and 1970 were disrupted during the COVID-19 pandemic, particularly among women, who reached the highest levels ever recorded in up to 40 years of follow-up data. This may impact future trends of morbidity, disability, and mortality due to common mental health problems.

Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth.

This study aimed to investigate the relationship between sociodemographic characteristics, depressive symptomatology, mobile phone ownership, and different uses of WhatsApp among older adults enrolled in primary care clinics in Guarulhos, São Paulo State, Brazil. This is a secondary data analysis, using data collected in the screening of participants to be included in the PROACTIVE cluster randomized trial. Individuals aged ≥ 60 years, registered in primary care clinics in Guarulhos, were assessed for sociodemographic characteristics, depressive symptoms according to the PHQ-9, mobile phone ownership, and use of WhatsApp. We performed multiple logistic regression models to investigate characteristics of the potential users of digital interventions. Of 3,356 older adults screened for depression, 45.7% said they use WhatsApp to receive/send messages. In the subsample that presented depressive symptomatology (n = 1,020), 41.9% stated using WhatsApp. Younger older adults and those with better socioeconomic status used more WhatsApp and were more likely to own a mobile phone. Participants with higher levels of symptoms of depression were less likely to use WhatsApp. Gender, age, schooling level, income, and depressive symptomatology are variables associated with the possession of a cell phone and with the use of WhatsApp by the older adults of the sample. These findings can help to implement digital health programs better suited to disadvantaged populations in Brazil and other low- and middle-income countries through mental telehealth interventions using WhatsApp and mobile health services to the older people.

Understanding the effects of a complex psychological intervention on symptoms of depression in Goa, India: findings from a causal mediation analysis.

BACKGROUND: Understanding how and under what circumstances a highly effective psychological intervention, improved symptoms of depression is important to maximise its clinical effectiveness. AIMS: To address this complexity, we estimate the indirect effects of potentially important mediators to improve symptoms of depression (measured with the Patient Health Questionnaire (PHQ-9)) in the Healthy Activity Program trial. METHOD: Interventional in(direct) effects were used to decompose the total effect of the intervention on PHQ-9 scores into the direct and indirect effects. The following indirect effects were considered: characteristics of sessions, represented by the number of sessions and homework completed; behavioural activation, according to an adapted version of the Behavioural Activation for Depression Scale - Short Form; and extra sessions offered to participants who did not respond to the intervention. RESULTS: Of the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.1, bias-corrected 95% CI -3.2 to -1.5), 34% was mediated through improved levels of behavioural activation (mean difference: -0.7, bias-corrected 95% CI -1.2 to -0.4). There was no evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment. CONCLUSIONS: Findings from our robust mediation analyses confirmed the importance of targeting behavioural activation. Contrary to published literature, our findings suggest that neither the number of sessions nor proportion of homework completed improved outcomes. Moreover, in this context, alternative treatments other than extra sessions should be considered for patients who do not respond to the intervention.

Generational, sex, and socioeconomic inequalities in mental and social wellbeing during the COVID-19 pandemic: prospective longitudinal observational study of five UK cohorts.

BACKGROUND: Research suggests that there have been inequalities in the impact of the coronavirus disease 2019 (COVID-19) pandemic and related non-pharmaceutical interventions on population mental health. We explored generational, sex, and socioeconomic inequalities during the first year of the pandemic using nationally representative cohorts from the UK. METHODS: We analysed data from 26772 participants from five longitudinal cohorts representing generations born between 1946 and 2000, collected in May 2020, September-October 2020, and February-March 2021 across all five cohorts. We used a multilevel growth curve modelling approach to investigate generational, sex, and socioeconomic differences in levels of anxiety and depressive symptomatology, loneliness, and life satisfaction (LS) over time. RESULTS: Younger generations had worse levels of mental and social wellbeing throughout the first year of the pandemic. Whereas these generational inequalities narrowed between the first and last observation periods for LS [-0.33 (95% CI -0.51 to -0.15)], they became larger for anxiety [0.22 (0.10, 0.33)]. Generational inequalities in depression and loneliness did not change between the first and last observation periods, but initial depression levels of the youngest cohort were worse than expected if the generational inequalities had not accelerated. Women and those experiencing financial difficulties had worse initial mental and social wellbeing levels than men and those financially living comfortably, respectively, and these gaps did not substantially differ between the first and last observation periods. CONCLUSIONS: By March 2021, mental and social wellbeing inequalities persisted in the UK adult population. Pre-existing generational inequalities may have been exacerbated with the pandemic onset. Policies aimed at protecting vulnerable groups are needed.

Midlife Health in Britain and the US: A comparison of Two Nationally Representative Cohorts.

Background: Older adults in the United States (US) have worse health and wider socioeconomic inequalities in health compared to Britain. Less is known about how health in the two countries compares in midlife, a time of emerging health decline, including inequalities in health. Methods: We compare measures of smoking status, alcohol consumption, obesity, self-rated health, cholesterol, blood pressure, and glycated haemoglobin using population-weighted modified Poisson regression in the 1970 British Cohort Study (BCS70) in Britain (N= 9,665) and the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the US (N=12,297), when cohort members were aged 34-46 and 33-43, respectively. We test whether associations vary by early- and mid-life socioeconomic position. Findings: US adults had higher levels of obesity, high blood pressure and high cholesterol. Prevalence of poor self-rated health, heavy drinking, and smoking was worse in Britain. We found smaller socioeconomic inequalities in midlife health in Britain compared to the US. For some outcomes (e.g., smoking), the most socioeconomically advantaged group in the US was healthier than the equivalent group in Britain. For other outcomes (hypertension and cholesterol), the most advantaged US group fared equal to or worse than the most disadvantaged groups in Britain. Interpretation: US adults have worse cardiometabolic health than British counterparts, even in early midlife. The smaller socioeconomic inequalities and better overall health in Britain may reflect differences in access to health care, welfare systems, or other environmental risk factors. Funding: ESRC, UKRI, MRC, NIH, European Research Council, Leverhulme Trust.

A task-shared, collaborative care psychosocial intervention for improving depressive symptomatology among older adults in a socioeconomically deprived area of Brazil (PROACTIVE): a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial.

BACKGROUND: There is an urgent need to reduce the burden of depression among older adults in low-income and middle-income countries (LMICs). We aimed to evaluate the efficacy of a task-shared, collaborative care psychosocial intervention for improving recovery from depression in older adults in Brazil. METHODS: PROACTIVE was a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial conducted in Guarulhos, Brazil. Primary care clinics (clusters) were stratified by educational level and randomly allocated (1:1) to either enhanced usual care alone (control group) or to enhanced usual care plus the psychosocial intervention (intervention group), which involved a 17-week psychosocial programme based on psychoeducation and behavioural activation approaches. Individuals approached for the initial screening assessment were selected randomly from a list of individuals provided by the Health Secretariat of Guarulhos. Face-to-face baseline assessments were conducted among adults aged 60 years or older registered with one of the primary care clinics and identified with clinically significant depressive symptomatology (9-item Patient Health Questionnaire [PHQ-9] score ≥10). Community health workers delivered the programme through home sessions, supported by a dedicated tablet application. Masking of clinic staff and community health workers who delivered the intervention was not feasible; however, research assistants conducting recruitment and follow-up assessments were masked to trial allocation. The primary outcome was recovery from depression (PHQ-9 score <10) at 8-month follow-up. All primary analyses were performed by intention to treat with imputed data. Adaptations to the protocol were made due to the COVID-19 pandemic; recruitment and intervention home sessions were stopped, and follow-up assessments were conducted by telephone. This trial is registered with the ISRCTN registry, ISRCTN57805470. FINDINGS: We identified 24 primary care clinics in Guarulhos that were willing to participate, of which 20 were randomly allocated to either the control group (ten [50%] clusters) or to the intervention group (ten [50%] clusters). The four remaining eligible clusters were kept as reserves. Between May 23, 2019, and Feb 21, 2020, 8146 individuals were assessed for eligibility, of whom 715 (8·8%) participants were recruited: 355 (49·7%) in the control group and 360 (50·3%) in the intervention group. 284 (80·0%) participants in the control group and 253 (70·3%) in the intervention group completed follow-up at 8 months. At 8-month follow-up, 158 (62·5%) participants in the intervention group showed recovery from depression (PHQ-9 score <10) compared with 125 (44·0%) in the control group (adjusted odds ratio 2·16 [95% CI 1·47-3·18]; p<0·0001). These findings were maintained in the complete case analysis. No adverse events related to the intervention were observed. INTERPRETATION: Although the COVID-19 pandemic altered delivery of the intervention, the low-intensity psychosocial intervention delivered mainly by non-mental health professionals was highly efficacious in improving recovery from depression in older adults in Brazil. Our results support a low-resource intervention that could be useful to reduce the treatment gap for depression among older people in other LMICs. FUNDING: São Paulo Research Foundation and Joint Global Health Trials (UK Department for International Development, Medical Research Council, and the Wellcome Trust).

Not in education, employment and training: pathways from toddler difficult temperament.

BACKGROUND: Youths disengaged from the education system and labour force (i.e. 'Not in Education, Employment, or Training' or 'NEET') are often at reduced capacity to flourish and thrive as adults. Developmental precursors to NEET status may extend back to temperamental features, though this - and possible mediators of such associations such as attention deficit hyperactivity (ADHD) symptoms and antisocial behaviours (ASB) - have yet to be directly tested. This study investigates if i) difficult temperament in toddlerhood associates with NEET status in adulthood and ii) different subdomains of ADHD (i.e. hyperactivity-impulsivity vs. inattention) in late childhood and ASB in adolescence partially explain this pathway. METHODS: Participants were 6,240 mother-child dyads (60.7% female) from the Avon Longitudinal Study of Parents and Children. Mothers reported on their child's (a) difficult temperament (i.e. mood, intensity and adaptability) at age 2 and (b) ADHD symptoms at ages 8 and 10. Participants reported their own ASB at age 14 and NEET status in adulthood (ages 18, 20, 22 and 23). RESULTS: First, higher levels of difficult temperament in toddlerhood directly associated with an increased probability of being NEET in adulthood. Second, this effect was carried through hyperactivity-impulsivity, but not inattention, in late childhood, and ASB in adolescence; this demonstrates differential contribution to the pathway between the ADHD dimensions, with symptoms of hyperactivity-impulsivity playing a prominent role. CONCLUSIONS: Early difficult temperament is a vulnerability factor for NEET status in adulthood. Our findings suggest that one developmental pathway for this vulnerability manifests through increased hyperactivity-impulsivity in childhood and ASB in adolescence. Of note, difficult temperament, as measured here, reflects difficulties in emotional and behavioural self-control (e.g. low adaptability and high intensity negative emotional expressions). Our results, therefore, suggest a prominent developmental role for lack of self-control from toddlerhood onwards in increasing risk for NEET.

A Validation Study of the EQ-5D-5L and ICEpop Capability Measure for Older People Among Older Individuals With Depressive Symptoms in Brazil.

OBJECTIVES: This study aimed to assess the known-groups validity of the EQ-5D-5L and the ICEpop Capability Measure for Older People (ICECAP-O), 2 outcome measures used in economic evaluation, among older adults with depressive symptoms in socioeconomically deprived areas of Brazil. We also explored the role of education and income on responses to these measures. METHODS: This cross-sectional study used baseline data from PROACTIVE, a cluster randomized controlled trial to evaluate a psychosocial intervention for late-life depression among older adults. Participants aged ≥60 years with a 9-item Patient Health Questionnaire score ≥10 were recruited from 20 primary healthcare clinics. Ordered logistic regression models assessed the association between depressive symptoms severity, income, and education and dimension-level responses on the EQ-5D-5L and ICECAP-O. Multivariable regression models investigated the ability of EQ-5D-5L and ICECAP-O scores to discriminate between depressive symptoms severity levels and other characteristics, including education level and household income. RESULTS: A total of 715 participants were included in the study. Depressive symptoms severity was associated with all EQ-5D-5L and ICECAP-O dimensions, except the ICECAP-O enjoyment attribute. In contrast, household income was only associated with the ICECAP-O security attribute. Higher severity of depressive symptoms (9-item Patient Health Questionnaire scores) was also strongly associated with lower (ie, worse) scores on both measures in all models. Education level and household income showed no association with either EQ-5D-5L or ICECAP-O scores. CONCLUSIONS: To best of our knowledge, this is the first study that investigated the validity of these 2 measures among older adults in Brazil. Both EQ-5D-5L and ICECAP-O showed evidence of validity in differentiating depressive symptom severity.

Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil.

Depressive and subthreshold depressive symptomatology are common but often neglected in older adults. OBJECTIVE: This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil. METHODS: This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire-9 (PHQ-9). Depressive status was classified according to the total PHQ-9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ-9 score 0-4, or 5-9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ-9 score 5-9 and at least one core depressive symptom); and depressive symptomatology (PHQ-9 score ≥ 10). Sociodemographic information and self-reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model. RESULTS: Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension. CONCLUSIONS: Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non-mental health specialists can be a first step for improving this alarming and neglected situation among older adults.

Psychometric properties of the PHQ-9 measure of depression among Brazilian older adults.

Objectives: To obtain evidence on the psychometric properties of the Patient Health Questionnaire - 9 (PHQ-9, one of the most extensively used tools for assessing depression) in the Brazilian older population.Method: Data on 3,356 Brazilian adults aged 60+ years living in Guarulhos, São Paulo state were used. The factor structure of the questionnaire was analysed using a factor analysis approach. The questionnaire's measurement equivalence was tested across gender, age, personal income, and education level groups. The scores were compared across groups based on the highest level of equivalence achieved. The questionnaire's internal consistency was analysed considering its factor structure.Results: A one-factor solution was identified as the most adequate factor structure, with the factor explaining 57.6% of the items' variance. The correlation of the resulting latent score with the overall raw sum score in the PHQ-9 was r = 0.96. Measurement equivalence regarding thresholds and loadings was achieved for all tested groups. On average, women, older, less educated, and poorer people had higher latent scores on the depression factor. The measure showed a good internal consistency with Revelle's omega total ωt=0.92.Conclusion: The results suggest that, among Brazilian older adults living in Guarulhos, São Paulo state, the PHQ-9 measures depressive symptomatology equivalently across different sociodemographic subgroups. Moreover, it can be scored using the raw sum of the item scores to adequately reflect different levels of depressive symptomatology.

Late-life disability trajectories in Yoruba Nigerians and the Spanish population: a state space model in continuous time.

OBJECTIVES: We compared the trajectory of activities of daily living (ADL) in a nationally representative sample of older Nigerians with their Spanish peers and identified factors to explain country-specific growth models. METHODS: Data from two household multistage probability samples were used, comprising older adults from Spain (n = 2,011) and Nigeria (n = 1,704). All participants underwent assessment for ADL. Risk factors including sex, household income, urbanicity, years of education, depression, alcohol consumption and smoking were assessed using validated methods. State-space model in continuous time (SSM-CT) methods were used for trajectory comparison. RESULTS: Compared with Nigerians (µADL80=0.44, SE = 0.015, p < 0.001), Spanish older adults had higher disability scores (µADL80=1.23, SE = 0.021, p < 0.001). In SSM-CT models, the rate of increase in disability was faster in Nigerians (Nigeria: ß = 0.061, p<.01; Spain: ß = 0.028, p < 0.010). An increasing course of disability in the Spanish sample was predicted by female sex, lower education and depression diagnosis. CONCLUSION: The rate of increase in disability was faster in older Nigerians living in an economically disadvantaged context.

The age-invariant role of resilience resources in emotional symptomatology.

Objectives 1) To study the relationship between resilience resources (both social and individual) and emotional symptomatology (depression and anxiety symptoms), taking into account the potential indirect effects through perceived stress; 2) to investigate whether this network of relationships varies in different age groups. METHOD: A sample of 718 Brazilians completed self-reports on perceived stress, depressive and anxious symptomatology, social support and individual resilience. The sample comprised two age groups: a sample of adults aged 60 or older (n = 361; 38.78% men; Mage = 67.32 years, SDage = 5.76, range = 60-86), and a sample of younger adults (n = 357; 29.41% men; Mage = 41.37 years, SDage = 7.23, range = 18-59). Multigroup multiple indicator, multiple cause (MIMIC) modelling was used to test for the direct and indirect effects of resilience resources on emotional symptom development, considering the age groups. RESULTS: The relationship between individual resilience resources and depressive or anxiety symptomatology was found to take place exclusively through stressfulness appraisal. On the other hand, social resilience resources showed a direct and indirect effect on emotional symptoms. This pattern of relationships was found to be invariant across age groups. CONCLUSION: Our findings suggest that both individual and social resilience resources are negatively related to both depressive and anxiety symptoms in adults regardless of age, thus opening the way to future research analysing how interventions may build resilience resources to minimise the influence of stressful and traumatic events across the lifespan.

Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth / Uso do WhatsApp por idosos depressivos em áreas socioeconomicamente carentes de Guarulhos, São Paulo, Brasil: desafios e possibilidades para a telessaúde / Uso de WhatsApp por ancianos deprimidos en áreas desfavorecidas socioeconómicamente en Guarulhos, São Paulo, Brasil: retos y posibilidades de la telesalud

This study aimed to investigate the relationship between sociodemographic characteristics, depressive symptomatology, mobile phone ownership, and different uses of WhatsApp among older adults enrolled in primary care clinics in Guarulhos, São Paulo State, Brazil. This is a secondary data analysis, using data collected in the screening of participants to be included in the PROACTIVE cluster randomized trial. Individuals aged ≥ 60 years, registered in primary care clinics in Guarulhos, were assessed for sociodemographic characteristics, depressive symptoms according to the PHQ-9, mobile phone ownership, and use of WhatsApp. We performed multiple logistic regression models to investigate characteristics of the potential users of digital interventions. Of 3,356 older adults screened for depression, 45.7% said they use WhatsApp to receive/send messages. In the subsample that presented depressive symptomatology (n = 1,020), 41.9% stated using WhatsApp. Younger older adults and those with better socioeconomic status used more WhatsApp and were more likely to own a mobile phone. Participants with higher levels of symptoms of depression were less likely to use WhatsApp. Gender, age, schooling level, income, and depressive symptomatology are variables associated with the possession of a cell phone and with the use of WhatsApp by the older adults of the sample. These findings can help to implement digital health programs better suited to disadvantaged populations in Brazil and other low- and middle-income countries through mental telehealth interventions using WhatsApp and mobile health services to the older people.

Este estudo teve como objetivo investigar a relação entre características sociodemográficas, sintomatologia depressiva, posse de telefone celular e diferentes usos do WhatsApp entre idosos cadastrados em unidades básicas de saúde de Guarulhos, São Paulo, Brasil. Trata-se de uma análise de dados secundários com informações coletadas na triagem dos participantes a serem incluídos neste estudo randomizado em cluster PROATIVO. Indivíduos com 60 anos ou mais, cadastrados em unidades básicas de saúde de Guarulhos, foram avaliados quanto a características sociodemográficas, sintomas depressivos, de acordo com o PHQ-9, posse de telefone celular e uso do WhatsApp. Foram utilizados modelos de regressão logística múltipla para investigar as características dos potenciais usuários de intervenções digitais. Dos 3.356 idosos depressivos, 45,7% usavam o WhatsApp para receber/enviar mensagens. Na subamostra que apresentou sintomatologia depressiva (n = 1.020), 41,9% disseram usar o WhatsApp. Adultos mais jovens e com melhor status socioeconômico usavam mais o WhatsApp e eram mais propensos a possuir um telefone celular. Participantes com níveis mais altos de sintomas de depressão eram menos propensos a utilizar o WhatsApp. Sexo, idade, escolaridade, renda e sintomatologia depressiva são variáveis associadas à posse de telefone celular e ao uso do WhatsApp pelos idosos da população estudada. Esses achados podem ajudar a implementar programas de saúde digital mais adequados para populações desfavorecidas no Brasil e em outros países de baixa e média renda, principalmente intervenções de telessaúde mental que utilizem o WhatsApp e serviços móveis de saúde para idosos.

Este estudio tuvo como objetivo determinar la relación entre las características sociodemográficas, los síntomas depresivos, la tenencia de teléfono celular y los diferentes usos de WhatsApp entre los ancianos inscritos en unidades básicas de salud en Guarulhos, São Paulo, Brasil. Este es un análisis de datos secundarios, que recopiló la información del triaje de los participantes a ser incluidos en este estudio aleatorio en un clúster PROACTIVO. Se evaluaron las características sociodemográficas, los síntomas depresivos según el PHQ-9, la tenencia de celular y el uso de WhatsApp de los participantes de 60 años o más, registrados en unidades básicas de salud de Guarulhos. Se utilizaron los modelos de regresión logística múltiple para identificar las características de los potenciales usuarios de las intervenciones digitales. De los 3.356 ancianos deprimidos, el 45,7% utilizaba WhatsApp para recibir/enviar mensajes. En la submuestra que presentó síntomas depresivos (n = 1.020), el 41,9% dijo usar WhatsApp. Los adultos más jóvenes con mejor nivel socioeconómico usaban más WhatsApp y tenían más probabilidades de tener un teléfono celular. Los participantes con niveles más altos de síntomas de depresión tenían menos probabilidades de usar WhatsApp. El sexo, la edad, la educación, la renta y los síntomas depresivos fueron las variables asociadas a la tenencia de celular y al uso de WhatsApp por parte de los ancianos de la población estudiada. Estos hallazgos pueden ayudar a implementar programas de salud digital que sean más adecuados para las poblaciones desfavorecidas en Brasil y en otros países de bajos y medianos ingresos, en particular las intervenciones de telesalud mental que utilizan WhatsApp y servicios de salud móviles para ancianos.

Measuring functional ability in healthy ageing: a nationwide cross-sectional survey in the Philippine older population.

OBJECTIVES: To analyse the empirical support of the functional ability concept in the healthy ageing framework developed by the WHO in a sample of the Philippine older population. According to this framework, environmental factors may enhance or hinder functional ability, which is the person's ability to do what they value, broadly represented by subjective well-being. Moreover, this network of relationships may be moderated by personal characteristics such as gender. DESIGN: Cross-sectional observational study. SETTING: Philippines, general population. PARTICIPANTS: Respondents of the 2016 National Disability Prevalence Survey/Model Functioning Survey aged 50+ (N=2825). PRIMARY AND SECONDARY OUTCOME MEASURES: Latent (unobserved) measures of functional ability, environmental factors (physical environmental factors and social network and support) and subjective well-being (positive affect, negative affect and evaluative well-being) were obtained from different items from the survey questionnaire using a SEM framework. RESULTS: We found that the relationship between environmental factors and the three components of subjective well-being considered in this study was partially explained by differences in functional ability. The portion of those effects accounted for by functional ability was comparatively larger for the physical than for the social environmental factors. We found no evidences of gender differences in this network of relationships. CONCLUSIONS: These findings suggest the relevance of functional ability at explaining the relationship between environmental factors and subjective well-being in older adults. Future studies may replicate these findings longitudinally and including other relevant measures as the person's objective level of intrinsic capacity.