Association between indicators of disability burden and subsequent depression among older persons.

BACKGROUND: Disability is associated with depression in older persons, yet the effect of disability burden on the likelihood of being depressed is uncertain. METHODS: A total of 754 community-living persons, aged ≥70, underwent monthly assessments in four essential activities of daily living and assessments of depression (yes/no) every 18 months for up to 108 months. Within each 18-month person-interval, participants' disability burden was operationalized as none or any, and according to severity (none, mild, or severe) and chronicity (none, nonchronic, or chronic) given the highest level of severity or chronicity experienced during a given 18-month interval, respectively. A variable combining severity and chronicity (none, nonchronic mild, nonchronic severe, chronic-mild, or chronic-severe) was also created. Using generalized estimating equations, we evaluated the association between each indicator of disability burden and subsequent depression. RESULTS: Participants who had any versus no disability during the previous 18 months were 65% more likely to experience subsequent depression (OR = 1.65; 95% confidence interval [CI] 1.34, 2.02). Quantifying severity (mild disability vs. none, OR = 1.43; 95% CI: 1.15, 1.79; severe disability vs. none, OR = 2.07; 95% CI 1.56, 2.74) and chronicity (nonchronic disability vs. none, OR = 1.44; 95% CI 1.13, 1.83; chronic disability vs. none, OR = 1.96; 95% CI 1.50, 2.55) indicated increasingly stronger associations with subsequent depression, with the highest likelihood of subsequent depression (OR = 2.42; 95% CI 1.78, 3.30) observed among participants with chronic-severe disability. CONCLUSIONS: Quantifying the magnitude of disability burden, particularly on the basis of severity and chronicity, provides additional information regarding the likelihood of experiencing subsequent depression among older persons.

Inequality and the association between involuntary job loss and depressive symptoms.

Although socioeconomic status (SES) has been to shown to be associated with susceptibility to involuntary job loss as well as with health, the ways in which individual SES indicators may moderate the job loss-health association remain underexplored. Using data from the Americans' Changing Lives study, we estimate the ways in which the association between job loss and depressive symptoms depends on five aspects of SES: education, income, occupational prestige, wealth, and homeownership. Our findings indicate that higher SES prior to job loss is not uniformly associated with fewer depressive symptoms. Higher education and lower prestige appear to buffer the health impacts of job loss, while financial indicators do not. These results have a number of implications for understanding the multidimensional role that social inequality plays in shaping the health effects of job loss.

Changes in social support within the early recovery period and outcomes after acute myocardial infarction.

OBJECTIVE: To examine changes in social support during early recovery after acute myocardial infarction (AMI) and determine whether these changes influence outcomes within the first year. METHODS: Among 1951 AMI patients enrolled in a 19-center prospective study, we examined changes in social support between baseline (index hospitalization) and 1 month post-AMI to longitudinally assess their association with health status and depressive symptoms within the first year. We further examined whether 1-month support predicted outcomes independent of baseline support. Hierarchical repeated-measures regression evaluated associations, adjusting for site, baseline outcome level, baseline depressive symptoms, sociodemographic characteristics, and clinical factors. RESULTS: During the first month of recovery, 5.6% of patients had persistently low support, 6.4% had worsened support, 8.1% had improved support, and 80.0% had persistently high support. In risk-adjusted analyses, patients with worsened support (vs. persistently high) had greater risk of angina (relative risk=1.46), lower disease-specific quality of life (ß=7.44), lower general mental functioning (ß=4.82), and more depressive symptoms (ß=1.94) (all p≤.01). Conversely, patients with improved support (vs. persistently low) had better outcomes, including higher disease-specific quality of life (ß=6.78), higher general mental functioning (ß=4.09), and fewer depressive symptoms (ß=1.48) (all p≤.002). In separate analyses, low support at 1 month was significantly associated with poorer outcomes, independent of baseline support level (all p≤.002). CONCLUSION: Changes in social support during early AMI recovery were not uncommon and were important for predicting outcomes. Intervening on low support during early recovery may provide a means of improving outcomes.

Caring for grieving family members: results from a national hospice survey.

BACKGROUND: A founding principle of hospice is that the patient and family is the unit of care; however, we lack national information on services to family members. Although Medicare certification requires bereavement services be provided, reimbursement rates are not tied to the level or quality of care; therefore, limited financial incentives exist for hospice to provide more than a minimal benefit. OBJECTIVES: To assess the scope and intensity of services provided to family members by hospice. RESEARCH DESIGN: We fielded a national survey of hospices between September 2008 and November 2009. PARTICIPANTS: A national sample of US hospices with an 84% response rate (N=591). MEASURES: Bereavement services to the family, bereavement services to the community, labor-intensive family services, and comprehensive family services. RESULTS: Most hospices provided bereavement services to the family (78%) and to the community (76%), but only a minority of hospices provided labor-intensive (23%) or comprehensive (27%) services to grieving family members. Larger hospice size was positively and significantly associated with each of the 4 measures of family services. We found no significant difference in provision of bereavement services to the family, labor-intensive services, or comprehensive services by ownership type; however, nonprofit hospices were more likely than for-profit hospices to provide bereavement services to the community. CONCLUSIONS: Our results show substantial diversity in the scope and intensity of services provided to families of patients with terminal illnesses, suggesting a need for clearer guidance on what hospices should provide to exemplify best practices. Consensus within the field on more precise guidelines in this area is essential.

Comparing the use of diagnostic imaging and receipt of carotid endarterectomy in elderly black and white stroke patients.

BACKGROUND: Previous studies show that black patients undergo carotid endarterectomy (CEA) less frequently than white patients. Diagnostic imaging is necessary to determine whether a patient is a candidate for the operation. We determined whether there were differences in the use of diagnostic carotid imaging and the frequency of CEA between elderly black and white ischemic stroke patients. METHODS: Medicare fee-for-service beneficiaries with discharge diagnoses of ischemic stroke (International Classification of Diseases, 9th revision codes 433, 434, and 436) were randomly selected for inclusion in the National Stroke Project 1998-1999, 2000-2001. Receipt of at least one type of carotid imaging study was compared for black and white patients. Binomial logistic regression models were used to evaluate the associations between race and receipt of carotid imaging and CEA with adjustment for demographics, degree of carotid artery stenosis, and other clinical covariates. RESULTS: Among 19,639 stroke patients (1974 black, 17,655 white), 69.6% received at least 1 diagnostic carotid imaging test (blacks 68.4%; whites 69.7%; P = .233). After risk adjustment, blacks were less likely to receive carotid imaging (adjusted odds ratio [OR] 0.87; 95% confidence interval [CI] 0.78-0.97). There was no relationship between race and the receipt of CEA after adjustment for degree of carotid stenosis and other covariates (adjusted OR 1.14; 95% CI 0.66-1.96). CONCLUSIONS: Black ischemic stroke patients were less likely to receive diagnostic carotid imaging than white patients, although the difference was small and only significant after risk adjustment. There was no difference in the proportion having CEA after adjustment for degree of carotid artery stenosis and other clinical factors.

Adherence to risk factor management instructions after acute myocardial infarction: the role of emotional support and depressive symptoms.

BACKGROUND: Emotional support and depression may influence adherence to risk factor management instructions after acute myocardial infarction (AMI), but their role requires further investigation. PURPOSE: To examine the longitudinal association between perceived emotional support and risk factor management adherence and assess depressive symptoms as a moderator of this association. METHODS: Among 2,202 AMI patients, we assessed adherence to risk factor management instructions over the first recovery year. Modified Poisson mixed-effects regression evaluated associations, with adjustment for demographic and clinical factors. RESULTS: Patients with low baseline support had greater risk of poor adherence over the first year than patients with high baseline support (relative risk [RR] = 1.20, 95% confidence interval [CI] = 1.02-1.43). In stratified analyses, low support remained a significant predictor of poor adherence for non-depressed (RR = 1.41, 95% CI = 1.23-1.61) but not depressed (RR = 1.01, 95% CI = 0.78-1.30) patients (p for interaction < 0.001). CONCLUSIONS: Low emotional support is associated with poor risk factor management adherence after AMI. This relationship is moderated by depression, with a significant relationship observed only among non-depressed patients.

Symptoms of anxiety, depression, and posttraumatic stress among survivors of the 2005 Pakistani earthquake.

OBJECTIVES: To assess and compare the prevalence of psychological morbidity among survivors of the 2005 northern Pakistan earthquake from Azad Kashmir and the Northwest Frontier Province (NWFP). METHODS: We conducted a cross-sectional study among randomly sampled survivors (N = 361) of the earthquake living in camps at the time of the interview, approximately 6 months after the earthquake. RESULTS: The prevalence of posttraumatic stress disorder (PTSD) symptoms in the total sample was 51.5% and the prevalence of individuals who received positive scores on the Hopkins Symptom Checklist (HSCL) was 75%. The prevalence rates for anxiety and depression symptoms were 77.3% and 70.9%, respectively. The prevalence in Azad Kashmir was 57.9% for PTSD and 79.8% for positive HSCL, and NWFP had 41.3% PTSD and 67.4% positive HSCL. Study subjects from Azad Kashmir were approximately 2 times as likely to have PTSD or a positive HSCL when compared to subjects from NWFP (odds ratio 1.95, confidence interval 1.27-3.0; P = .0024) and (odds ratio 1.91, confidence interval 1.18-3.1; P = .0085), respectively. CONCLUSIONS: Nearly half of the northern Pakistan earthquake survivors had symptoms of PTSD. Six months after the incident, more than three-fourths exhibited symptoms of an anxiety disorder.

Lifetime discrimination associated with greater likelihood of premenstrual dysphoric disorder.

OBJECTIVES: To evaluate whether the stressor of perceived discrimination was associated with premenstrual dysphoric disorder (PMDD) and premenstrual symptoms among minority women. This study builds on previous research that found perceived discrimination was positively associated with other psychiatric illnesses. METHODS: Participants were 2718 Asian, Latina, and black premenopausal women aged 18-40 years who completed the World Mental Health Composite International Diagnostic Interview for the National Latino and Asian American Survey or the National Survey of American Life. Perceived discrimination was assessed with the Everyday Discrimination Scale. DSM-IV-based diagnostic algorithms generated a provisional lifetime diagnosis of PMDD. RESULTS: Eighty-three percent of the participants reported experiencing discrimination (due to race, gender, age, height or weight, or other reasons) in their lifetimes. The frequency of perceived discrimination was positively associated with PMDD (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10) and premenstrual symptoms (OR 1.04, 95% CI 1.02-1.05), independent of demographic covariates and social desirability. Women reporting gender discrimination (OR 5.18, 95% CI 1.80-14.90), race discrimination (OR 4.14, 95% CI 1.54-11.11), and other forms of discrimination (OR 6.43, 95% CI 2.11-19.65) were significantly more likely than women without experiences of discrimination to have PMDD. Subtle discrimination was more strongly associated with PMDD (OR 1.12, 95% CI 1.01-1.23) than was blatant discrimination (OR 1.04, 95% CI 0.94-1.15). CONCLUSIONS: This study is the first to demonstrate that perceived discrimination is associated with PMDD and premenstrual symptoms. These findings suggest that the prevalence of these conditions may be lessened by reducing discrimination in women's lives.

Exposure to American culture is associated with premenstrual dysphoric disorder among ethnic minority women.

BACKGROUND: Ethnic minorities in America will achieve majority by 2042, and due to their younger age distribution, will represent the largest proportion of women at risk for premenstrual dysphoric disorder (PMDD). Research has not addressed ethnic minority women's vulnerabilities to PMDD. The objective of this study was to examine the relationship between acculturation and PMDD. METHODS: An analysis of acculturation and PMDD among 3856 English-speaking, pre-menopausal Asian, Latina, and Black women from the National Latino and Asian American Survey and the National Survey of American Life was performed. RESULTS: The lifetime prevalence of PMDD was 3.3%. Nativity status, duration of residence, and age at immigration were significantly associated with PMDD. Foreign-born women (OR=0.38; 95% confidence interval (CI)=0.21-0.68) and immigrants arriving to the US after age six (OR=0.33, 95% CI=0.18, 0.62) were less likely to have PMDD, compared to US-born women, and US-born women/immigrants who arrived before age six, respectively. The likelihood of PMDD increased as the duration of residence in the US lengthened. LIMITATIONS: The diagnosis of PMDD was provisional due to retrospective symptom reporting. Statements of causality could not be made because the study was cross-sectional. CONCLUSIONS: A substantial percentage of ethnic minority women suffer from PMDD in their lifetimes. Exposure to American culture appeared to elevate ethnic minority women's likelihood for PMDD. The stressors that are associated with ethnic minority life in America-discrimination, poverty, pressures to assimilate, etc.-may contribute to ethnic minority women's vulnerability to PMDD, and clinicians should be sensitive to the special risks in this population.

The prognostic role of cancer-specific beliefs among prostate cancer survivors.

OBJECTIVE: The objective of this study is to evaluate the association between cancer-specific beliefs and survival among men newly diagnosed with prostate cancer. METHODS: Based on data from a biracial cohort monitored for mortality for up to 15 years, we investigated the association between beliefs and survival among 251 men newly diagnosed with prostate cancer between 1987 and 1990. We examined patients' beliefs related to efficacy of regular checkups for detection, potential negative treatment effects, and perceived curability of cancer. Cox proportional hazards models were adjusted for sociodemographic variables, medical care measures, clinical factors, and lifestyle. RESULTS: In a fully adjusted model, not believing that most cancers can be cured was associated with an increased risk of death from any cause (Hazard Ratio = 1.62; 95% confidence interval = 1.11, 2.38). Beliefs regarding the efficacy of checkups or potential negative treatment effects were not associated with survival. CONCLUSIONS: Prostate cancer patients who reported not believing that most cancers are curable experienced poorer survival after adjusting for a wide array of prognostic factors and potential confounders. Future research to identify underlying behavioral (medical protocol adherence, lifestyle) and physiological (immune and endocrine regulation) mechanisms of this association would translate into improved intervention strategies for cancer survivors.

The prevalence of posttraumatic stress disorder among adult earthquake survivors in Peru.

OBJECTIVES: To estimate the prevalence of posttraumatic stress disorder (PTSD) and to assess the relationships between PTSD and demographic and disaster-related factors. METHODS: Five months after a magnitude 8.0 earthquake struck the city of Pisco, Peru, we conducted a cross-sectional study using demographic questions, the PTSD Checklist, and a translated version of the Harvard Trauma Questionnaire. We used stratified sampling to randomly enroll subjects in Pisco and its annexes. We then used bivariate and multivariate analyses to find correlations between PTSD and demographic and disaster-related factors. RESULTS: We interviewed 298 adult earthquake survivors and detected 75 cases of PTSD (prevalence 25.2%; 95% confidence interval, 20.2%-30.1%). In the bivariate analysis, PTSD was significantly associated with female sex, loss of church, food and water shortages immediately after the earthquake, joblessness, injuries, loss of a relative or friend, lack of clean drinking water or appropriate sleeping conditions 5 months after the earthquake, and low levels of perceived support from family and friends. In the multivariate analysis, only female sex, food and water shortages, loss of church, injuries, and low levels of perceived support from family and friends were independently associated with PTSD. CONCLUSIONS: PTSD affected about a quarter of Pisco's population. Its impact was moderate to severe when compared with other disasters worldwide and in Latin America.

Neighborhood- and individual-level socioeconomic variation in perceptions of racial discrimination.

OBJECTIVE: In approaching the study of racial discrimination and health, the neighborhood- and individual-level antecedents of perceived discrimination need further exploration. We investigated the relationship between neighborhood- and individual-level socioeconomic position (SEP), neighborhood racial composition, and perceived racial discrimination in a cohort of African-American and White women age 40-79 from Connecticut, USA. DESIGN: The logistic regression analysis included 1249 women (39% African-American and 61% White). Neighborhood-level SEP and racial composition were determined using 1990 census tract information. Individual-level SEP indicators included income, education, and occupation. Perceived racial discrimination was measured as lifetime experience in seven situations. RESULTS: For African-American women, living in the most disadvantaged neighborhoods was associated with fewer reports of racial discrimination (odds ratio (OR) 0.44; 95% confidence interval (CI) 0.26, 0.75), with results attenuated after adjustment for individual-level SEP (OR 0.54, CI: 0.29, 1.03), and additional adjustment for neighborhood racial composition (OR 0.70, CI: 0.30, 1.63). African-American women with 12 years of education or less were less likely to report racial discrimination, compared with women with more than 12 years of education (OR 0.57, CI: 0.33, 0.98 (12 years); OR 0.51, CI: 0.26, 0.99 (less than 12 years)) in the fully adjusted model. For White women, neither neighborhood-level SEP nor individual-level SEP was associated with perceived racial discrimination. CONCLUSION: Individual- and neighborhood-level SEP may be important in understanding how racial discrimination is perceived, reported, processed, and how it may influence health. In order to fully assess the role of racism in future studies, inclusion of additional dimensions of discrimination may be warranted.

The role of social support in health status and depressive symptoms after acute myocardial infarction: evidence for a stronger relationship among women.

BACKGROUND: Prior studies have associated low social support (SS) with increased rehospitalization and mortality after acute myocardial infarction. However, relatively little is known about whether similar patterns exist for other outcomes, such as health status and depressive symptoms, and whether these patterns vary by sex. METHODS AND RESULTS: Using data from 2411 English- or Spanish-speaking patients with acute myocardial infarction enrolled in a 19-center prospective study, we examined the association of SS (low, moderate, high) with health status (angina, disease-specific quality of life, general physical and mental functioning) and depressive symptoms over the first year of recovery. Overall and sex-stratified associations were evaluated using mixed-effects Poisson and linear regression, adjusting for site, baseline health status, baseline depressive symptoms, and demographic and clinical factors. Patients with the lowest SS (relative to those with the highest) had increased risk of angina (relative risk, 1.27; 95% confidence interval [CI], 1.10, 1.48); lower disease-specific quality of life (mean difference [beta]=-3.33; 95% CI, -5.25, -1.41), lower mental functioning (beta=-1.72; 95% CI, -2.65, -0.79), and more depressive symptoms (beta=0.94; 95% CI, 0.51, 1.38). A nonsignificant trend toward lower physical functioning (beta=-0.87; 95% CI, -1.95, 0.20) was observed. In sex-stratified analyses, the relationship between SS and outcomes was stronger for women than for men, with a significant SS-by-sex interaction for disease-specific quality of life, physical functioning, and depressive symptoms (all P<0.02). CONCLUSIONS: Lower SS is associated with worse health status and more depressive symptoms over the first year of acute myocardial infarction recovery, particularly for women.

Longitudinal association between self-rated health and timed gait among older persons.

OBJECTIVE: We evaluated the longitudinal association between self-rated health (SRH) and timed gait, an indicator of lower extremity dysfunction, in a community-based sample of older persons. METHODS: Participants (N = 754) were evaluated at 18-month intervals for 72 months. SRH was categorized as Excellent/Very Good/Good and Fair/Poor. Participants were asked to walk a 10-foot course "as fast as it feels safe and comfortable," turn around, and walk back, with timed gait defined as normal (≤10 s) or slow (>10 s). Generalized multinomial logit models, adjusted for demographic features, biomedical and psychosocial factors, and activities of daily living, evaluated the association between SRH and the likelihood of 6 possible transitions (from normal or slow timed gait to normal timed gait, slow timed gait, or death) over time. We also ran a repeated measures linear mixed model with change in timed gait as the outcome. RESULTS: Compared with participants reporting Excellent/Very Good/Good SRH, those reporting Fair/Poor SRH were more likely to transition from normal to slow timed gait or to death. SRH was not associated with transitions from slow timed gait to normal timed gait or to death. In addition, time to complete the gait task increased (i.e., slowed) over time among participants reporting Fair/Poor SRH compared with those reporting Excellent/Very Good/Good SRH. DISCUSSION: Among older persons, SRH is associated with the development of lower extremity dysfunction but not with recovery from lower extremity dysfunction. This relationship may indicate an intermediate step in the pathway from SRH to mortality.

Effects of externally rated job demand and control on depression diagnosis claims in an industrial cohort.

This study examined whether externally rated job demand and control were associated with depression diagnosis claims in a heavy industrial cohort. The retrospective cohort sample consisted of 7,566 hourly workers aged 18-64 years who were actively employed at 11 US plants between January 1, 1996, and December 31, 2003, and free of depression diagnosis claims during an initial 2-year run-in period. Logistic regression analysis was used to model the effect of tertiles of demand and control exposure on depression diagnosis claims. Demand had a significant positive association with depression diagnosis claims in bivariate models and models adjusted for demographic (age, gender, race, education, job grade, tenure) and lifestyle (smoking status, body mass index, cholesterol level) variables (high demand odds ratio = 1.39, 95% confidence interval: 1.04, 1.86). Control was associated with greater risk of depression diagnosis at moderate levels in unadjusted models only (odds ratio = 1.47, 95% confidence interval: 1.12, 1.93), while low control, contrary to expectation, was not associated with depression. The effects of the externally rated demand exposure were lost with adjustment for location. This may reflect differences in measurement or classification of exposure, differences in depression diagnosis by location, or other location-specific factors.

Days of delirium are associated with 1-year mortality in an older intensive care unit population.

RATIONALE: Delirium is a frequent occurrence in older intensive care unit (ICU) patients, but the importance of the duration of delirium in contributing to adverse long-term outcomes is unclear. OBJECTIVES: To examine the association of the number of days of ICU delirium with mortality in an older patient population. METHODS: We performed a prospective cohort study in a 14-bed ICU in an urban acute care hospital. The patient population comprised 304 consecutive admissions 60 years of age and older. MEASUREMENTS AND MAIN RESULTS: The main outcome was 1-year mortality after ICU admission. Patients were assessed daily for delirium with the Confusion Assessment Method for the ICU and a validated chart review method. The median duration of ICU delirium was 3 days (range, 1-46 d). During the follow-up period, 153 (50%) patients died. After adjusting for relevant covariates, including age, severity of illness, comorbid conditions, psychoactive medication use, and baseline cognitive and functional status, the number of days of ICU delirium was significantly associated with time to death within 1 year post-ICU admission (hazard ratio, 1.10; 95% confidence interval, 1.02-1.18). CONCLUSIONS: Number of days of ICU delirium was associated with higher 1-year mortality after adjustment for relevant covariates in an older ICU population. Investigations should be undertaken to reduce the number of days of ICU delirium and to study the impact of this reduction on important health outcomes, including mortality and functional and cognitive status.

Heritability of depressive symptoms: a case study using a multilevel approach.

We present a case study using a multilevel modeling approach to determine whether depressive symptoms are affected by genetic factors. Existing studies examining this question have focused on twins. The present study built on the literature by conducting a preliminary study of the heritability of depressive symptoms within extended families. At the same time, this study assessed the need for adjustment of a heritability measure in a family study using a multigenerational sample. The sample consisted of 230 community-dwelling extended families that included 431 adult offspring, comprising full siblings, half siblings and cousins that participated in the University of Southern California Longitudinal Study of Generations. All participants filled out the Center for Epidemiologic Studies Depression (CES-D) scale. The multilevel analysis allowed us to model the natural hierarchy of the extended family. Results indicate that the proportion of the phenotypic variance for CES-D that occurs due to genetic differences is not significantly larger than zero among these participants [h(2) = 8.6%, 95% confidence interval (CI) = 0-57%, p = 0.71]. Our findings suggest that future studies examining depressive symptoms in this sample can focus on non-genetic explanatory factors without the necessity to control for genetic variation. However, our study may be limited by measurement of prevalent depressive symptoms, which may not generalize to lifetime depressive symptoms.

Cancer-specific beliefs and survival in nonmetastatic colorectal cancer patients.

BACKGROUND: Colorectal cancer (CRC) is the third leading cause of cancer mortality in the United States. Associations between cancer-specific beliefs (beliefs) and survival have been observed among other cancer populations, but similar research in CRC patients is virtually nonexistent, especially in racially diverse populations. The relationship between beliefs and survival was investigated in a cohort of African Americans and non-Hispanic whites with newly diagnosed nonmetastatic CRC, followed for up to 15 years. METHODS: The authors analyzed data from a population-based cohort of 286 individuals (115 African Americans and 171 whites, approximately 52% women) diagnosed with nonmetastatic CRC in Connecticut, 1987 to 1991. Cox proportional hazards models were adjusted for sociodemographic (age, sex, race, education, income, occupational status, marital status) and biomedical (stage at diagnosis, histological grade, treatment) variables. RESULTS: Not believing in the curability of cancer increased the risk of all-cause mortality (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.06-2.39) and CRC-specific mortality (HR, 1.65; 95% CI, 0.90-3.03; P=.10). These multivariate estimates were not altered by additional adjustment for insurance coverage, obesity, smoking, alcohol consumption, or comorbidity. Furthermore, the association between perceived curability and survival did not vary significantly by key sociodemographic or biomedical factors. Other beliefs were not associated with survival. CONCLUSIONS: Among a racially diverse cohort of men and women with CRC, believing in the curability of cancer was independently associated with survival over a 15-year period. Confirmation of the role of cancer-specific beliefs on survival and study of the potential biobehavioral mechanisms is needed. Findings may inform the design of interventions for cancer survivors.

Association of major depression with subtypes of nicotine dependence found among adult daily smokers: a latent class analysis.

Nicotine dependence (ND) and major depression (MD) are highly prevalent disorders that frequently co-occur. Less is known about which aspects of ND are most strongly associated with MD. The present study was designed to determine if subtypes of smokers exist and differ in their risk of MD and lifetime MD symptoms. Latent class analysis was used to identify profiles of DSM-IV ND criteria for 8,842 daily smokers drawn from the larger 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We found evidence for 4 distinct subtypes of smokers mainly characterized by increasing levels of ND severity, by number of criteria endorsed. We found a dose-response relationship between classes by increasing ND severity and odds of past-year MD and lifetime depression criteria. Class 2 was characterized by higher symptom endorsement probabilities (SEPs) for wider range of ND criteria and a higher odds of MD (OR=3.66) compared to class 3, which was characterized by higher SEPs for physiological ND criteria, higher prevalence of ND (class 2, 71.50% vs. class 3, 81.57%), and a lower odds of MD (OR=2.15). A post hoc contrast showed these two distinct classes of respondents with mild to moderate ND significantly differed in their likelihood of MD comorbidity (F=12.25, 1 df, p=0.0008). ND severity mainly characterized the classes, but unique differences may exist between smokers with mild to moderate ND. Individuals with symptom profiles not characterized by physiological dependence endorse wider range of ND criteria and have a higher likelihood of MD.

Religion and the quality of life in the last year of life.

OBJECTIVES: Religious involvement in old age appears to remain quite stable until the very end of life, reflecting patterns established earlier in life. Are there differences in quality of life (QOL) for those who are religiously involved in that last year compared with those who are not? METHODS: We studied 499 elderly persons participating in ongoing annual interviews who died in the 12 months following an interview. We examined public and subjective religious involvement and indicators of health-related and psychosocial QOL, including health status and functional ability, family and friendship networks, depression, and well-being. RESULTS: More deeply religious respondents were more likely to see friends, and they had better self-rated health, fewer depressive feelings, and were observed by the interviewer to find life more exciting compared with the less religious. Respondents receiving strength and comfort from religion reported poorer self-rated health. Those who attended religious services often were most likely to have attended holiday parties, even after adjusting for health status. Significant interactions indicated that the disabled benefited more from both public and subjective religious involvement than the nondisabled. DISCUSSION: Overall, QOL in the last year of life is positively related to religious involvement, particularly its more subjective dimensions.