Mediation model of comorbid anxiety disorders in late-life depression.

BACKGROUND: A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD. METHODS: Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects. RESULTS: Being female was associated with comorbid anxiety disorders with an indirect effect (ß = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (ß = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (ß = 0.412, P = < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06. CONCLUSION: Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.

Characteristics of behavioral and psychological symptoms of dementia, severity and levels of distress on caregivers.

OBJECTIVE: To describe the characteristics of the Behavioral and Psychological Symptoms of Dementia (BPSD) and its severity among patients with dementia and their caregivers' stress. MATERIAL AND METHOD: A cross-sectional descriptive study of 158 patients with Alzheimer's disease, mixed vascular dementia and Alzheimer's disease, and unspecified dementia and caregivers in Songkhla Rajanakarindra Psychiatric Hospital were selected by a consecutive sampling. The BPSD and severity of dementia was assessed with the Neuropsychiatric Inventory Questionnaire - Thai version (NPI-Q Thai), the Global Clinical Dementia Rating Scale (CDR), the Mini Mental Status Thai version 2002 (MMSE Thai 2002), and a clinical diagnosis. Consensus of a psychiatrist and a neurologist according to diagnostic criteria of DSMIV-TR was achieved for every patient. RESULTS: Overall, 90.5% had at least one BPSD symptom. Common symptoms were irritability (60.8%), sleep problems (57%), depression (54.5%), anxiety (52%), and agitation/aggression (44.9%). The least common symptom was eating problems (23.5%). The caregivers rated the patient's physical symptoms as more severe than psychological symptoms. The symptom that caused the highest burden to caregivers was agitation/aggression, followed by dis-inhibition, aberrant motor behaviors, and sleep problems. The less burdensome symptoms included irritability, depression, and anxiety. CONCLUSION: BPSD were commonly found among patients with dementia. The top five symptoms were irritability, sleep problems, depression, anxiety, and agitation/aggression. Not only assessment of BPSD, but also feeling and suffering of the caregivers should be assessed by using the NPI-Q. This would help the clinician plan appropriate treatment. Physical symptoms were perceived by caregivers as causing the most anguish and distress, while psychological symptoms were perceived as less severe. Further studies should be done, such as the factors related to burden of caregivers of dementia with BPSD.

Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings.

PURPOSE: The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors. PATIENTS AND METHODS: This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis. RESULTS: Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive-compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated. CONCLUSION: The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.

Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings.

OBJECTIVE: The study investigated the prevalence of depressive and anxiety disorders and suicide risk in geriatric outpatients in tertiary care hospitals. MATERIALS AND METHODS: An observational, cross-sectional study was conducted with 803 participants aged 60 and above attending geriatric outpatient clinics in tertiary care hospitals in Thailand. Participants were assessed using DSM-IV-TR criteria to calculate the prevalence of deressive and anxiety disorders, and their suicide risk. Montreal Cognitive Assessment (MoCA), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support, Core Symptom Index (CSI), 15-item Geriatric Depression Scale (GDS-15), Neuroticism Inventory (NI) and the Revised Experience of Close Relationships Questionnaire (ECR-R) were administered. Quality of life was assessed using the EuroQoL (EQ-5D). RESULTS: The prevalence rate for depressive disorders was 23.7%, anxiety disorders was 6.4%, and current suicide risk was 20.4%. PSS, MSPSS, GDS, CSI, and NI scores were significantly higher in all clinical disorders and a suicide group compared with nonclinical subjects. MoCA and ECR-R did not differentiate between clinical disorder and nonclinical samples. Comparing all four outcomes, the EQ-5D differed most in the mixed depressive-anxiety disorder and nonclinical groups (t = 12.20, p < .001). CONCLUSION: The present findings revealed a high prevalence of depression, anxiety and suicidality among elderly patients attending tertiary care hospitals. Perceived stress, perceived social support, and neuroticism scores were significantly higher in this group. Role of sociodemographic, clinical and psychosocial variables as risk factors for these clinical disorders should be further examined.

The effectiveness of a cognitive training program in people with mild cognitive impairment: A study in urban community.

OBJECTIVE: To assess the effectiveness of a cognitive training program on global cognition among people with mild cognitive impairment. METHODS: In this experimental study, using purposive sampling, 60 participants age 50 years and over who complained of subjective memory impairment were screened in their communities by public health volunteers with the Abbreviated Mental Test. Those with dementia were excluded as well as those with depression, which were screened out by the Thai Geriatric Depression Scale (TGDS-15). Mild cognitive impairment was diagnosed and confirmed by the Montreal Cognitive Assessment (MoCA) and joint agreement between a psychiatrist and a neurologist. The participants were alternately assigned to receive a cognitive training program (intervention group) while the other half received their normal usual therapy (control group). The program involved training of 4 aspects of cognition through 6 sessions; 2 sessions per month for 3 months. The MoCA and TGDS-15 scales were given at baseline and again at week 13, and at months 6 and 9. Independent t-tests were used to compare changes in global cognition among the two groups. RESULTS: MoCA scores at 9 months were significantly higher than at baseline in both groups. However, the mean difference in intervention group was significantly higher than control group. TGDS-15 scores at 6 months was significantly lower than at baseline among the intervention group but not the control group. CONCLUSION: This cognitive training program helped to improve global cognition and reduce depressive symptoms.

DUPLICATE: The effectiveness of a cognitive training program in people with mild cognitive impairment: A study in urban community.

OBJECTIVE: To assess the effectiveness of a cognitive training program on global cognition among people with mild cognitive impairment. METHODS: In this experimental study, using purposive sampling, 60 participants age 50 years and over who complained of subjective memory impairment were screened in their communities by public health volunteers with the Abbreviated Mental Test. Those with dementia were excluded as well as those with depression, which were screened out by the Thai Geriatric Depression Scale (TGDS-15). Mild cognitive impairment was diagnosed and confirmed by the Montreal Cognitive Assessment (MoCA) and joint agreement between a psychiatrist and a neurologist. The participants were alternately assigned to receive a cognitive training program (intervention group) while the other half received their normal usual therapy (control group). The program involved training of 4 aspects of cognition through 6 sessions; 2 sessions per month for 3 months. The MoCA and TGDS-15 scales were given at baseline and again at week 13, and at months 6 and 9. Independent t-tests were used to compare changes in global cognition among the two groups. RESULTS: MoCA scores at 9 months were significantly higher than at baseline in both groups. However, the mean difference in intervention group was significantly higher than control group. TGDS-15 scores at 6 months was significantly lower than at baseline among the intervention group but not the control group. CONCLUSION: This cognitive training program helped to improve global cognition and reduce depressive symptoms.

Development of a burden scale for caregivers of dementia patients.

OBJECTIVE: To develop a scale to measure the burden of care for caregivers of patients with dementia and explore its factor structure. METHODS: The initial draft of the Thai dementia patients' caregiver burden (Thai-DCAB) scale was developed based on literature review, in-depth interviews and expert opinions. The drafted scale was administered to 203 caregivers of dementia patients treated at two large public hospitals in southern Thailand. An exploratory factor analysis using maximum likelihood extraction with varimax rotation was conducted. The reliability of the scale was assessed using Cronbach's alpha. RESULTS: The Thai-DCAB scale consisted of 18 questions. Three factors were obtained, covering psychological, physical and financial burdens of the caregivers in taking care of dementia patients. These three factors accounted for 67% of the variance. The Cronbach's alpha coefficient was 0.95. CONCLUSION: The Thai-DCAB scale has high internal consistency and captures key theoretical constructs of the perceived burden among caregivers of patients with chronic and deteriorating dementia and in accordance with the social and cultural contexts and the way of life of the Thai people.