Hair glucocorticoids in adults with intellectual disabilities and depressive symptoms pre- and post-bright light therapy: First explorations.

BACKGROUND: Depressive symptoms and stress are common in adults with intellectual disabilities. Our aim was to explore long-term biological stress levels, assessed by hair cortisol (HairF) and cortisone (HairE) concentrations, in adults with intellectual disabilities and depressive symptoms and to investigate the effects of bright light therapy (BLT) on hair glucocorticoids. METHOD: Scalp hair samples (n = 14) were retrospectively examined at baseline and post-BLT (10.000 and 300 lux). Liquid chromatography-tandem mass spectrometry was used to measure hair glucocorticoids. RESULTS: A significant correlation was found between baseline HairF and depression scores (r = .605, p = .028). Post-intervention HairE levels were significantly increased ([95% CI: 11.2-17.4 pg/mg], p = .003), in particular after dim light (300 lux) ([95% CI: 10.0-18.3 pg/mg], p = .020). CONCLUSIONS: This study showed that retrospectively examining biological levels of stress in adults with intellectual disabilities seems a potentially promising and objective method to gain insight in the stress level of adults with intellectual disabilities.

The effect of bright light therapy on depressive symptoms in adults with intellectual disabilities: Results of a multicentre randomized controlled trial.

BACKGROUND: Although a large number of adults with intellectual disabilities have depressive symptoms, non-pharmacological treatments are scarce. The present authors investigated whether bright light therapy (BLT) is effective in decreasing depressive symptoms compared to care as usual. METHODS: This multicentre randomized controlled trial consisted of three study groups (10,000 lux BLT, dim light BLT and a no-BLT group). Participants received BLT for 30 min in the morning (14 consecutive days), additional to their regular care. Primary outcome was as follows: depressive symptoms measured with the ADAMS Depressive Mood subscale 1 week after the end of BLT (same time period in the no-BLT group). RESULTS: Forty-one participants were included in our trial. In both BLT groups, a significant decrease in depressive symptoms was seen. No significant differences were found between 10,000 lux BLT and no-BLT (p = .199) and no significant differences between dim light BLT and no-BLT (p = .451). A minimum amount of side effects and no adverse events were reported. CONCLUSIONS: In both BLT interventions, a decrease in depressive symptoms was seen. With 10,000 lux BLT, depressive symptoms decreased even below the clinical cut-off point, which makes BLT a promising intervention for clinical practice.

Reliability and validity of the Dutch Anxiety, Depression And Mood Scale in adults aged <50 years with intellectual disabilities.

BACKGROUND: Reliable and valid screening instruments for depression and anxiety are needed for adults with intellectual disabilities. METHODS: Internal consistency (n = 198), inter-rater reliability (n = 41), test-retest reliability (n = 37) and criterion validity (n = 43) were studied in adults aged between 18 and 49 years. Internal consistency was also studied in a sample with epilepsy (n = 98). RESULTS: Internal consistencies of the Dutch ADAMS total scale and subscales were satisfactory to good (α = 0.76-0.92), as well as in the subgroup with epilepsy (α = 0.74-0.88). Inter-rater reliability and test-retest reliability were fair to excellent for the total scale (ICC's: 0.57-0.84) and subscales (ICC's: 0.43-0.86). The criterion validity of the Dutch ADAMS Depressive Mood subscale was good with a sensitivity of 88% (95% CI: 53%-98%) and a specificity of 80% (95% CI: 64%-90%). CONCLUSIONS: Our study shows that the Dutch ADAMS is a reliable and valid instrument for adults aged between 18 and 49 years with intellectual disabilities (and comorbid epilepsy).

Comparison of anxiety as reported by older people with intellectual disabilities and by older people with normal intelligence.

OBJECTIVES: Older people with intellectual disabilities (ID) may experience more and different symptoms of anxiety than older people with normal intelligence. STUDY QUESTIONS: (1) Is the reported severity of anxiety in this group similar to that in the general older population; (2) Are specific anxiety symptoms reported as frequently by both groups? DESIGN: Cross-sectional. SETTING: Formal Dutch intellectual disability services and Dutch population-based study. PARTICIPANTS: One hundred fifty-four participants of the Healthy Ageing and Intellectual Disability study with mild or moderate ID (IQ <70), aged 55-85 years, and 2,917 participants of the Longitudinal Aging Study Amsterdam with normal intelligence, aged 55-85 years. MEASUREMENTS: The general anxiety subscale of the Hospital Anxiety and Depression Scale. RESULTS: Mean (standard deviation) Hospital Anxiety and Depression Scale total score of subjects with ID was significantly higher than that of subjects with normal intelligence (3.53 [3.03]) versus 2.53 [3.30]; p <0.01), whereas the percentage of scores above cutoff in both groups was similar. Four of 7 items were more often reported as present by subjects with ID: "tense or wound up feelings," "frightened feelings," "worrying thoughts," and "sudden feelings of panic." CONCLUSIONS: Older people with ID report more symptoms of anxiety than older people with normal intelligence. Tense feelings and worrying especially need more attention, because more than one-half of all older people with ID reported such symptoms.

Factors associated with depression and anxiety in older adults with intellectual disabilities: results of the healthy ageing and intellectual disabilities study.

OBJECTIVE: The objective of this article is to study which factors are associated with depression and anxiety in older adults with intellectual disabilities (ID). METHODS: Depressive and anxiety symptoms were studied in 990 participants with borderline to profound ID, aged ≥ 50 years, using self-report and informant-report screening questionnaires. In 290 participants, major depression and anxiety disorders were assessed with a standardised psychiatric interview. Associations with personal, medical and psychosocial factors, which were collected through questionnaires and participants' medical and psychological records, were studied using multiple logistic regression analysis. RESULTS: Increased depressive symptoms were positively associated with increased anxiety symptoms, number of life events during the past year and chronic diseases (heart failure, stroke, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus and malignity in the previous 5 years) and negatively with instrumental activities of daily living (IADL) abilities. Major depression was positively associated with chronic diseases and negatively with IADL abilities. Increased anxiety symptoms were positively associated with borderline or mild ID and increased depressive symptoms and negatively associated with Down syndrome, epilepsy and social contacts. Anxiety disorders showed no significant associations. CONCLUSIONS: To develop effective prevention and treatment policies, factors associated with depression and anxiety in older adults with ID should be further examined in longitudinal research.

Multimorbidity and Polypharmacy Are Independently Associated With Mortality in Older People With Intellectual Disabilities: A 5-Year Follow-Up From the HA-ID Study.

We studied the association between multimorbidity, polypharmacy, and mortality in 1,050 older adults (50+) with intellectual disability (ID). Multimorbidity (presence of ≥ 4 chronic health conditions) and polypharmacy (presence ≥ 5 chronic medication prescriptions) were collected at baseline. Multimorbidity included a wide range of disorders, including hearing impairment, thyroid dysfunction, autism, and cancer. Mortality data were collected during a 5-year follow-up period. Cox proportional hazards models were used to determine the independent association between multimorbidity and polypharmacy with survival. Models were adjusted for age, sex, level of ID, and the presence of Down syndrome. We observed that people classified as having multimorbidity or polypharmacy at baseline were 2.60 (95% CI = 1.86-3.66) and 2.32 (95% CI = 1.70-3.16) times more likely to decease during the follow-up period, respectively, independent of age, sex, level of ID, and the presence of Down syndrome. Although slightly attenuated, we found similar hazard ratios if the model for multimorbidity was adjusted for polypharmacy and vice versa. We showed for the first time that multimorbidity and polypharmacy are strong predictors for mortality in people with ID. Awareness and screening of these conditions is important to start existing treatments as soon as possible. Future research is required to develop interventions for older people with ID, aiming to reduce the incidence of polypharmacy and multimorbidity.

A multicenter randomized controlled trial for bright light therapy in adults with intellectual disabilities and depression: Study protocol and obstacle management.

Due to the limited cognitive and communicative abilities of adults with intellectual disabilities (ID), current treatment options for depression are often limited to lifestyle changes and pharmacological treatment. Bright light therapy (BLT) is an effective intervention for both seasonal and non-seasonal depression in the general population. BLT is an inexpensive, easy to carry out intervention with minimal side effects. However, knowledge on its anti-depressant effect in adults with ID is lacking. Obstacles in realizing a controlled intervention study in this particular study population may have contributed to this lack. To study the effect of BLT on depression in this population, it is necessary to successfully execute a multicenter randomized controlled trial (RCT). Therefore, the study protocol and the management of anticipated obstacles regarding this trial are presented.

Multimorbidity in older adults with intellectual disabilities.

Multimorbidity may be related to the supposed early aging of people with intellectual disabilities (ID). This group may suffer more often from multimorbidity, because of ID-related physical health conditions, unhealthy lifestyle and metabolic effects of antipsychotic drug use. Multimorbidity has been defined as two or more chronic conditions. Data on chronic conditions have been collected through physical assessment, questionnaires, and medical files. Prevalence, associated factors and clusters of multimorbidity have been studied in 1047 older adults (≥ 50 years) with ID. Multimorbidity was prevalent in 79.8% and associated with age and severe/profound ID. Four or more conditions were prevalent in 46.8% and associated with age, severe/profound ID and Down syndrome. Factor analyses did not reveal a model for disease-clusters with good fit. Multimorbidity is highly prevalent in older adults with ID. Multimorbidity should receive more attention in research and clinical practice for targeted pro-active prevention and treatment.

A systematic review on the effect of exercise interventions on challenging behavior for people with intellectual disabilities.

BACKGROUND: Challenging behavior, such as aggressive or self-injurious behavior, is a major concern for the health and well-being of people with intellectual disabilities (ID) and for their relatives, friends, and caregivers. The most common contemporary treatments have drawbacks, such as the adverse side effects of antipsychotics. Exercise interventions could be a good alternative, but little is known about its beneficial effects on challenging behavior in people with ID yet. METHOD: A systematic review of the literature was done and methodological quality of the selected studies has been judged on four points. With one-way Analysis of Variance (ANOVA), the effect of exercise interventions on challenging behavior was studied. The effect of low versus high intensity exercise interventions was studied with independent samples T-test using mean improvement scores. RESULTS: Twenty studies studying the effects of exercise interventions on challenging behavior in people with ID have been found. A quantitative evaluation of the results showed a significant decrease in challenging behavior after participating in an exercise intervention (M=30.9%, 95% CI: 25.0, 36.8). Furthermore, no significant difference was found between high (M=32.2%) and low (M=22.9%) intensity exercise interventions. CONCLUSIONS: The found decrease in challenging behavior shows that exercise seems to be recommendable as an effective treatment for people with challenging behavior and ID. However, most studies were of low methodological quality and more research is needed to optimize recommendations about the exact intensity, duration, frequency, and mode (group or individual) of exercise interventions for this group of people.

Prevalence of depression and anxiety in older users of formal Dutch intellectual disability services.

BACKGROUND: Little is known about the prevalence of depression and anxiety among older people with intellectual disabilities (ID). Therefore, the aim of this study was to study the prevalence of depression and anxiety in this population. METHOD: This study is a cross-sectional epidemiologic multicentre study which was part of the "Healthy Ageing and Intellectual Disabilities" study. The study population consisted of 990 participants aged ≥50 years with borderline to profound ID which were screened with self-report and informant-report instruments; 290 of them were assessed with a standardized diagnostic interview. RESULTS: Depressive symptoms were prevalent in 16.8% (95% CI: 14.4-19.1) and significantly associated with higher age. Anxiety symptoms were prevalent in 16.3% (95% CI: 14.0-18.6) and significantly associated with female gender and borderline to mild ID. Major depressive disorder was prevalent in 7.6% (95% CI: 5.2-11.0), anxiety disorders in 4.4% (95% CI: 2.6-7.0) and both in 0.7% (95% CI: 0.2-1.6). There was no relationship with gender, age or level of ID. LIMITATIONS: For most participants, informant-report instruments have been used instead of self-report to overcome communication difficulties or inabilities. Also, a standardized psychiatric diagnostic interview has been used instead of psychiatric diagnoses made by an experienced psychiatrist. CONCLUSION: Prevalence of major depressive disorder is higher and of anxiety disorders lower than in the Dutch general older community-dwelling population.

Life events and their associations with depression and anxiety in older people with intellectual disabilities: results of the HA-ID study.

BACKGROUND: People with intellectual disabilities (ID) may be exposed to more life events due to different living circumstances and limited coping abilities. The frequency of life events may increase with age due to age-related decline, loss of significant others and forced relocations. We studied the occurrence of life events in adults with mild to profound ID aged ≥ 50 years and their association with depression and anxiety. METHODS: Occurrence and burden of life events were assessed with a checklist of 28 items, completed by professional caregivers. Depression and anxiety were assessed with self-report and informant-report screening instruments (n=988) and with a psychiatric interview (n=286). Associations with depression and anxiety were studied for life events in general and for specific life events. RESULTS: 97% of the participants had been exposed to multiple life events during the preceding year and 72% had been exposed to one or more negative life events. The frequency was significantly higher in participants aged 65 years or over, in participants with mild or moderate ID and in participants with depression or anxiety. Minor physical illness and problems with a fellow resident were significantly associated with depression and anxiety, decline or loss of mobility and loss of leisure-time activities with depression and change at work or from work with anxiety. LIMITATIONS: This study was cross-sectional and therefore lacks reliable information about causality. CONCLUSIONS: Given the high prevalence of life events and their association with depression and anxiety, life events should be better monitored and, if possible, prevented.

Feasibility, reliability and validity of the Dutch translation of the Anxiety, Depression And Mood Scale in older adults with intellectual disabilities.

BACKGROUND: The informant-based Anxiety, Depression And Mood Scale was translated into Dutch and its feasibility, reliability and validity in older adults (aged ≥ 50 years) with intellectual disabilities (ID) was studied. METHOD: Test-retest (n = 93) and interrater reliability (n = 83), and convergent (n = 202 and n = 787), discriminant (n = 288) and criterion validity (n = 288) were studied. Convergent and criterion validity were studied for the Depressed mood and General anxiety subscales. Subgroups based on level of ID and autism have been made to study the criterion validity. Psychiatric diagnoses based on the PAS-ADD Interview were used as gold standard. RESULTS: All subscales had good internal consistency (α ≥ 0.80), excellent test-retest reliability (ICC ≥ 0.75) and good interrater reliability (ICC ≥ 0.74), except for the Social avoidance subscale (ICC = 0.57). The Depressed mood subscale showed low correlation (r = 0.44) with the self-report Inventory of Depressive Symptomatology, high correlation with the informant-report Signalizing Depression List for people with ID (r = 0.71) and no correlation with the PAS-ADD's sleep disorders subscale (r = 0.15). Its sensitivity ranged from 73 to 80%, and its specificity from 71 to 79%. The General anxiety subscale showed low correlation with the self-report scales: Glasgow Anxiety Scale (r= 0.37) and Hospital Anxiety and Depression Scale (r = 0.41), and no correlation with the sleep disorder subscale (r = 0.02). Its sensitivity ranged from 67 to 100%, and its specificity from 48 to 81%. CONCLUSIONS: The Dutch translation of the ADAMS is reliable and sufficiently valid to screen for anxiety and depression in older people with ID.

Frailty and disability in older adults with intellectual disabilities: results from the healthy ageing and intellectual disability study.

OBJECTIVES: To obtain first insight into prevalence and correlates of frailty in older people with intellectual disability (ID). DESIGN: Population-based cross-sectional study in persons using formal ID services. SETTING: Three Dutch care provider services. PARTICIPANTS: Eight hundred forty-eight individuals with borderline to profound ID aged 50 and older participating in the Healthy Ageing and Intellectual Disability (HA-ID) Study. MEASUREMENTS: All participants underwent an extensive health examination. Frailty was diagnosed according to Cardiovascular Health Study criteria. Associations between frailty and participant characteristics were investigated using multivariate logistic regression analysis. RESULTS: Prevalence of frailty was 11% at age 50 to 64 and 18% at age 65 and older. Age, Down syndrome, dementia, motor disability, and severe ID were significantly associated with frailty, but only motor disability had a unique association with frailty. In a regression model with these variables, 25% of the variance of frailty was explained. CONCLUSION: At age 50 to 64, prevalence of frailty is as high as in the general population aged 65 and older (7-9%), with a further increase after the age of 65. Motor disability only partially explains frailty. Future studies should address health outcomes, causes, and prevention of frailty in this population.

Instruments assessing anxiety in adults with intellectual disabilities: a systematic review.

BACKGROUND: In the last decades several instruments measuring anxiety in adults with intellectual disabilities have been developed. AIM: To give an overview of the characteristics and psychometric properties of self-report and informant-report instruments measuring anxiety in this group. METHOD: Systematic review of the literature. RESULTS: Seventeen studies studying 14 different instruments were found. Methodological quality as measured with the Quality Assessment of Diagnostic Accuracy Studies checklist was insufficient for four studies, sufficient for seven, and good for six. For self-report, the Glasgow Anxiety Scale for people with a learning disability appears most promising, with good internal consistency (a = 0.96), high test-retest reliability (r = 0.95), sensitivity (100%) and specificity (100%). For informant-report, the general anxiety subscale of the Anxiety, Depression and Mood Scale may be promising, with good internal consistency (a = 0.83 and a = 0.84) and excellent test-retest reliability (ICC = 0.78 and ICC = 0.92), but poor interrater reliability (ICC = 0.39). CONCLUSIONS: Two instruments appear promising. However, these instruments have only been studied once or twice, whereas the methodological quality of these studies was varying.

Study healthy ageing and intellectual disabilities: recruitment and design.

Problems encountered in epidemiologic health research in older adults with intellectual disabilities (ID) are how to recruit a large-scale sample of participants and how to measure a range of health variables in such a group. This cross-sectional study into healthy ageing started with founding a consort of three large care providers with a total client population of 2322 clients of 50 years and over, and two academic institutes. This consort made formal agreements about a research infrastructure and research themes: (1) physical activity and fitness, (2) nutrition and nutritional state, and (3) mood and anxiety. Subsequently, preparation was started by carefully reviewing and selecting instruments to measure a wide set of health variables to answer the research questions. Specific demands of these instruments were that they could be executed efficiently and accurately on-site in a large sample of participants and that the burden of these measurements for participants as well as their caregivers was as minimal as possible. Then, preparation was continued by designing and executing a thorough communication plan for clients, legal representatives and staff of the care providers, preceding the informed consent procedure. In this plan, which had a top-down structure, specific attention was given to personally informing and motivating of key stakeholders: the professional care givers. This preparation led to a recruitment of 1050 participants (45.2%) and to high participation rates in key parts of the assessment. A detailed description is provided about the recruitment and organization and the selected instruments.

Characteristics of instruments screening for depression in adults with intellectual disabilities: systematic review.

The aim of this study was to obtain information on feasibility, reliability and validity of available instruments screening for depression applied in people with intellectual disabilities (ID). Therefore, literature was systematically reviewed. For self-report, the Glasgow Depression scale for people with a Learning Disability appears most promising (internal consistency α=0.90, test-retest reliability r=0.97, sensitivity 96% and specificity 90%). For informant-report three instruments seem promising: the Assessment of Dual Diagnosis (internal consistency α=0.77 and α=0.91, test-retest reliability r=0.94, interrater reliability r=0.98), the Reiss Screen for Maladaptive Behaviour (internal consistency α=0.58-0.83, interrater reliability r=0.61-0.84, sensitivity 80%, specificity 83%), and the Children's Depression Inventory (internal consistency α=0.86, sensitivity 83%, specificity 93%). None of these three instruments have been studied satisfactorily in this group, yet. More research on psychometric properties, especially sensitivity and specificity in the ID population, is needed.